• Alice Baroncini, Daniel Larrieu, Anouar Bourghli, Javier Pizones, Ferran Pellisé, Frank S Kleinstueck, Ahmet Alanay, Louis Boissiere, and Ibrahim Obeid.
• IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy. Alice.baroncini@gmail.com.
• Eur Spine J. 2025 Jan 11.

PurposeThe choice of the best management for Adult Spine Deformity (ASD) is challenging. Health-related quality of life (HRQoL), comorbidities, symptoms and spine geometry, along with surgical risk and potential residual disability play a role, and a definite algorithm for patient management is lacking. Machine learning allows to analyse complex settings more efficiently than other available statistical tools. Aim of this study was to develop a machine-learning algorithm that, based on baseline data, would be able to predict whether an ASD patient would undergo surgery or not.MethodsRetrospective evaluation of prospectively collected data. Demographic data, HRQoL and radiographic parameters were collected. Two clustering methods were performed to differentiate groups of patients with similar characteristics. Three models were then used to identify the most relevant variables for management prediction.ResultsData from 1319 patients were available. Three clusters were identified: older subjects with sagittal imbalance and high PI, younger patients with greater coronal deformity and no sagittal imbalance, older patients with moderate sagittal imbalance and lower PI. The group of younger patients showed the highest error rate for the prediction (37%), which was lower for the other two groups (20-27%). For all groups, quality of life parameters such as the ODI and the SRS 22 and the Cobb angle of the major curve were the strongest predictors of surgical indication, albeit with different odds ratios in each group.ConclusionThree clusters could be identified along with the variables that, in each, are most likely to drive the choice of management.© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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