Supplemental PowerPoint Slides Patient Factors That Influence Decision Making: Randomization versus Observational Nonoperative versus Observational Operative Treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) Brian J. Neuman, MDa; Christine Baldus, RN, MHSb; Lukas P. Zebala, MD b; Michael P. Kelly, MDb; Christopher Shaffrey, MDc; Charles Edwards, II, MDd; Tyler Koski, MDe; Frank Schwab, MDf; Steven Glassman, MDh; Stefan Parent, MDi; Stephen Lewis, MDj; Lawrence G. Lenke MDb; Jacob M. Buchowski, MDb; Justin S. Smith MD, PhDc; Charles H. Crawford, III, MDh; Han Jo Kim, MDg; Virginia Lafage, PhDf; Jon Lurie, MDk; Leah Carreon, MDh; Keith H. Bridwell, MDb a: Johns Hopkins University ,b: Washington University in St. Louis, c: University of Virginia, d: Mercy Medical Center, e: Northwestern University, f: NYU Langone Medical Center, g: Hospital for Special Surgery, h: Norton Leatherman Spine Center, i: Sainte-Justine University Hospital, j: UHN Orthopaedics-Toronto Western Hospital, k: Dartmouth College Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized commercial reproduction of this slide is prohibited

An NIH-funded prospective, randomized controlled and observational trial for primary symptomatic adult lumbar scoliosis patients was analyzed to identify variables influencing patient’s participation in three potential arms: Randomization (RAND), Observational Surgical (OBS-S) or Observational Non Surgical (OBS-NS). Age Group Cohort   Total Chi Square p value RAND OBS-S OBS-NS All Patients High School, GED or Less Count 19 27 44 20 0.057 Percent 28 24 38 30.5 College degree 48 86 71 205 72 76 62 69.5 67 113 115 295 40-59 years 12 15 39 0.074 43 29 16 49 37 102 57 80 61 52 141 60-80 years 7 51 0.010 18 46 33 32 34 103 82 54 63 154 There were no differences in the educational level attained among study participation groups (p=0.061). Subanalysis of older patients (60-80 years), found 54% of OBS-NS had college degrees compared to 80% of RAND and 71% of OBS-S.

Significantly Different Cohorts Conclusions: Patients who elect to be part of a randomization cohort have similar clinical characteristics to patients deciding to be part of an observational surgical cohort. However, patients in the randomized cohort had worse SRS Function and Self-Image domain scores and ODI scores than patients who decided to be treated nonsurgically. In addition, patients deciding to be treated nonsurgically have statistically better baseline PRO scores (SRS Pain, Function, Self-Image domains; back pain NRS; and ODI), less post-ambulation back and leg pain and smaller lumbar and fractional coronal curves than patients deciding to undergo surgery. Radiographic sagittal parameters were non-influential in this patient population. Dependent Variable Significantly Different Cohorts Post Hoc Sig. Duration of Back Symptoms (months) OBS-S Rand .023 Duration of Leg Symptoms (months) .041   Back Pain NRS Past 4 weeks OBS-NS .007 SRS Pain Domain .018 SRS Function Domain .019 SRS Self Image Domain .002 SRS Subscore ODI .029 Post Treadmill Back Pain NRS Post Treadmill Leg Pain NRS .037 Lumbar Cobb <0.001 RAND .034 .016 .006