European Spine Journal

, Volume 28, Issue 1, pp 127–137 | Cite as

Factors associated with having an indication for surgery in adult spinal deformity: an international european multicentre study

  • S. Richner-WunderlinEmail author
  • A. F. Mannion
  • A. Vila-Casademunt
  • F. Pellise
  • M. Serra-Burriel
  • B. Seifert
  • E. Aghayev
  • E. Acaroglu
  • A. Alanay
  • F. J. S. Pérez-Grueso
  • I. Obeid
  • F. Kleinstück
  • European Spine Study Group (ESSG)
Original Article



The aim of this study was to evaluate factors that distinguish between patients with adult spinal deformity (ASD) with and without an indication for surgery, irrespective of their final treatment.


Baseline variables (demographics, medical history, outcome measures, coronal, sagittal and neurologic parameters) were evaluated in a multicentre, prospective cohort of patients with ASD. Multivariable analyses were carried out for idiopathic and degenerative patients separately with the dependent variable being “indication for surgery” and baseline parameters as independent variables.


In total, 342 patients with degenerative ASD and 624 patients with idiopathic ASD were included in the multivariable models. In patients with degenerative ASD, the parameters associated with having an indication for surgery were greater self-rated disability on the Oswestry Disability Index [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02–1.07] and a lower thoracic kyphosis (OR 0.97 95% CI 0.95–0.99), whereas in patients with idiopathic ASD, it was lower (worse) SRS self-image scores (OR 0.45 95% CI 0.32–0.64), a higher value for the major Cobb angle (OR 1.03 95% CI 1.01–1.05), lower age (OR 0.96 95% CI 0.95–0.98), prior decompression (OR 3.76 95% CI 1.00–14.08), prior infiltration (OR 2.23 95% CI 1.12–4.43), and the presence of rotatory subluxation (OR 1.98 95% CI 1.11–3.54) and sagittal subluxation (OR 4.38 95% CI 1.61–11.95).


Specific sets of variables were found to be associated with an indication for surgery in patients with ASD. These should be investigated in relation to patient outcomes for their potential to guide the future development of decision aids in the treatment of ASD.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Adult spinal deformity Indication for surgery Decision-making Multivariable analyses Prognostic factors 



The European Spine Study Group is sponsored by a Johnson and Johnson DePuy-Synthes Spine research grant.

Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.

Supplementary material

586_2018_5754_MOESM1_ESM.pptx (151 kb)
Supplementary material 1 (PPTX 150 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • S. Richner-Wunderlin
    • 1
    Email author
  • A. F. Mannion
    • 1
  • A. Vila-Casademunt
    • 2
  • F. Pellise
    • 2
  • M. Serra-Burriel
    • 2
  • B. Seifert
    • 3
  • E. Aghayev
    • 1
  • E. Acaroglu
    • 4
  • A. Alanay
    • 5
  • F. J. S. Pérez-Grueso
    • 6
  • I. Obeid
    • 7
  • F. Kleinstück
    • 1
  • European Spine Study Group (ESSG)
  1. 1.Schulthess KlinikZurichSwitzerland
  2. 2.Vall d’Hebron Institute of ResearchBarcelonaSpain
  3. 3.Department of Biostatistics and Epidemiology, Biostatistics and Prevention InstituteUniversity of ZurichZurichSwitzerland
  4. 4.Ankara Spine CenterAnkaraTurkey
  5. 5.Acibadem UniversityIstanbulTurkey
  6. 6.Hospital Universitario La PazMadridSpain
  7. 7.Pellegrin University HospitalBordeauxFrance

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