The Problems and Limitations of Applying Evidence-Based Medicine to Primary Surgical Treatment of Adult Spinal Deformity

In Brief Study Design. Assessment of peer-reviewed literature and personal experience with publications and grant organization. Objective. This is an analysis of the current status of evidence-based medicine for primary adult spinal deformity to answer the question of whether surgical treatment benefits patients. Summary of Background Data. A limited number of evidence-based studies have been performed for primary adult scoliosis and spinal deformity surgery. None of these studies is ideal. Methods. This is an assessment of current literature and study group methodology in an attempt to provide an evidence-based medicine approach for the study of primary presentation adult scoliosis and related spinal deformity. Results. Many reasonable studies exist; however, there are no current definitive studies that answer the question posed above. There are many obstacles, both financial and organizational, to producing an “ideal” study. Most smaller studies suggest that surgical treatment of primary adult scoliosis benefits the patient. However, there is no multicenter prospective randomized study to answer this question. Conclusion. A multicenter funded study is needed to answer appropriate questions. Limited literature exists regarding primary surgical treatment of adult scoliosis and related spinal deformities. However, few studies are prospective and none is randomized. Objective radiographic assessment and validated HRQOLs, such as SRS-22, Oswestry, and SF-36, are needed to validate the usefulness of surgical treatment in this group of patients; 100% data entry and patient follow-up are problematic.