A. F. Mannion, M. Loibl, J. Bago, A. Vila-Casademunt, S. Richner-Wunderlin, T. F. Fekete, D. Haschtmann, D. Jeszenszky, F. Pellisé, A. Alanay, I. Obeid, F. S. Pérez-Grueso, F. S. Kleinstück

June 2020, Volume 29, Issue 6, pp 1340 - 1352 Original Article Read Full Article 10.1007/s00586-020-06365-z

First Online: 18 March 2020

What level of symptoms are patients with adult spinal deformity prepared to live with? A cross-sectional analysis of the 12-month follow-up data from 1043 patients


Previous studies suggest that a meaningful and easily understood measure of treatment outcome may be the proportion of patients who are in a “patient acceptable symptom state” (PASS). We sought to quantify the score equivalent to PASS for different outcome instruments, in patients with adult spinal deformity (ASD).


We analysed the following 12-month questionnaire data from the European Spine Study Group (ESSG): Oswestry Disability Index (ODI; 0–100); Numeric Rating Scales (NRS; 0–10) for back/leg pain; Scoliosis Research Society (SRS) questionnaire; and an item “if you had to spend the rest of your life with the symptoms you have now, how would you feel about it?” (5-point scale, dichotomised with top 2 responses “somewhat satisfied/very satisfied” being considered PASS+, everything else PASS−). Receiver operating characteristics (ROC) analyses indicated the cut-off scores equivalent to PASS+.


Out of 1043 patients (599 operative, 444 non-operative; 51 ± 19 years; 84% women), 42% reported being PASS+ at 12 months’ follow-up. The ROC areas under the curve were 0.71–0.84 (highest for SRS subscore), suggesting the questionnaire scores discriminated well between PASS+ and PASS−. The scores corresponding to PASS+ were > 3.5 for the SRS subscore (> 3.3–3.8 for SRS subdomains); ≤ 18 for ODI; and ≤ 3 for NRS pain. There were slight differences in cut-offs for subgroups of age, treatment type, aetiology, baseline symptoms, and sex.


Most interventions for ASD improve patients’ complaints but do not totally eliminate them. Reporting the percentage achieving a score equivalent to an “acceptable state” may represent a more stringent and discerning target for denoting treatment success in ASD.

Graphic abstract

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