1. 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

2. 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.

3. 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