LAUSR

STUDY DESIGN Prospective Longitudinal Cohort. OBJECTIVES To determine if Functional Treadmill Testing (FTT) demonstrates differences between patients treated operatively and non-operatively for Adult Symptomatic Lumbar Scoliosis (ASLS). SUMMARY OF BACKGROUND DATA ASLS has become increasingly prevalent as the population ages. ASLS can be accompanied by neurogenic claudication, leading to difficulty walking. FTT may provide a functional tool to evaluate patients with ASLS. METHODS One hundred and eighty-seven patients who underwent Non-operative (n = 88) or Operative treatment (n = 99) of ASLS with complete baseline and two-year post-treatment FTTs and concurrent patient reported outcomes were identified. FTT parameters included maximum speed, time to onset of symptoms, distance ambulated, time ambulated, and back and leg pain severity before and after testing. RESULTS At baseline, patients treated operatively reported worse post-FTT back pain (4.39 vs 3.45, p = 0.032) than those treated non-operatively, despite similar ODI, SRS22 Pain and Activity domain scores. Mean Time ambulated (+2.15 vs -1.20 p = 0.001), pre-FTT back pain (+0.19 vs -1.60, p < 0.000) and leg pain (+0.25 vs -0.54, p = 0.024) improved in the Operative group but deteriorated in the Non-operative group. On the two-year follow-up FTT, both groups showed improvement in post-FTT back pain (-0.53 vs -2.64, p < 0.000) and leg pain (-0.13 vs -1.54, p = 0.001) severity but the improvement was statistically significantly greater in the Operative compared to the Non-operative group. CONCLUSION FTT results at baseline were worse in patients treated operatively than those treated non-operatively. FTT may be a useful adjunct to assess treatment outcomes in patients with ASLS and may help surgeons counsel patients regarding expectations two years after operative or nonoperative treatment for ASLS.. At two year follow-up, time ambulated deteriorated in patients treated non-operatively but improved in patients treated operatively. Although both groups showed improvement in post-FTT back and leg pain at two years, the improvement was greater in the operative compared to the Non-operative group. LEVEL OF EVIDENCE 2.