Christopher P. Ames, Justin S. Smith, Ferran Pellisé, Michael Kelly, Jeffrey L. Gum, Ahmet Alanay, Emre Acaroğlu, Francisco Javier Sánchez Pérez-Grueso, Frank S. Kleinstück, Ibrahim Obeid, Alba Vila-Casademunt, Christopher I. Shaffrey Jr., Douglas C. Burton, Virginie Lafage, Frank J. Schwab, Christopher I. Shaffrey Sr., Shay Bess, Miquel Serra-Burriel

August 2019, Volume 28, Issue 9, pp 1998 - 2011 Original Article Read Full Article 10.1007/s00586-019-06079-x

First Online: 19 July 2019

Development of predictive models for all individual questions of SRS-22R after adult spinal deformity surgery: a step toward individualized medicine


Health-related quality of life (HRQL) instruments are essential in value-driven health care, but patients often have more specific, personal priorities when seeking surgical care. The Scoliosis Research Society-22R (SRS-22R), an HRQL instrument for spinal deformity, provides summary scores spanning several health domains, but these may be difficult for patients to utilize in planning their specific care goals. Our objective was to create preoperative predictive models for responses to individual SRS-22R questions at 1 and 2 years after adult spinal deformity (ASD) surgery to facilitate precision surgical care.


Two prospective observational cohorts were queried for ASD patients with SRS-22R data at baseline and 1 and 2 years after surgery. In total, 150 covariates were used in training machine learning models, including demographics, surgical data and perioperative complications. Validation was accomplished via an 80%/20% data split for training and testing, respectively. Goodness of fit was measured using area under receiver operating characteristic (AUROC) curves.


In total, 561 patients met inclusion criteria. The AUROC ranged from 56.5 to 86.9%, reflecting successful fits for most questions. SRS-22R questions regarding pain, disability and social and labor function were the most accurately predicted. Models were less sensitive to questions regarding general satisfaction, depression/anxiety and appearance.


To the best of our knowledge, this is the first study to explicitly model the prediction of individual answers to the SRS-22R questionnaire at 1 and 2 years after deformity surgery. The ability to predict individual question responses may prove useful in preoperative counseling in the age of individualized medicine.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]

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