• Eur Spine J · Jul 2019

    Adult spinal deformity surgical decision-making score : Part 1: development and validation of a scoring system to guide the selection of treatment modalities for patients below 40 years with adult spinal deformity.

    • Takashi Fujishiro, Louis Boissière, Derek Thomas Cawley, Daniel Larrieu, Olivier Gille, Jean-Marc Vital, Ferran Pellisé, Pérez-Grueso Francisco Javier Sanchez FJS Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain., Frank Kleinstück, Emre Acaroglu, Ahmet Alanay, Ibrahim Obeid, and European Spine Study Group, ESSG.
    • Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki-shi, Osaka, 569-8686, Japan. ort167@osaka-med.ac.jp.
    • Eur Spine J. 2019 Jul 1; 28 (7): 1652-1660.

    PurposeWe aimed to develop and internally validate a simple scoring system: the adult spinal deformity (ASD) surgical decision-making (ASD-SDM) score, which is specific to the decision-making process for ASD patients aged below 40 years.MethodsA multicentre prospective ASD database was retrospectively reviewed. The scoring system was developed using data from a derivation cohort and was internally validated in a validation cohort. The accuracy of the ASD-SDM score was assessed using the area under the receiver operating characteristic curve (AUC).ResultsA total of 316 patients were randomly divided into derivation (253 patients, 80%) and validation (63 patients, 20%) cohorts. A 10-point scoring system was created from four variables: self-image score in the Scoliosis Research Society-22 score, coronal Cobb angle, pelvic incidence minus lumbar lordosis mismatch, and relative spinopelvic alignment, and the surgical indication was graded into low (score 0-4), moderate (score 5-7), and high (score 8-10) surgical indication groups. In the validation cohort, the AUC for selecting surgical management according to the ASD-SDM score was 0.789 (SE 0.057, P < 0.001, 95% CI 0.655-0.880). The percentage of patients treated surgically were 21.1%, 55.0%, and 80.0% in the low, moderate, and high surgical indication groups, respectively.ConclusionsThe ASD-SDM score, to the best of our knowledge, is the first algorithm to guide the decision-making process for the ASD population and could be one of the indices for aiding the selection of treatment for ASD. These slides can be retrieved under Electronic Supplementary Material.

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