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Background: National survey data exploring the patient experience with lipedema are lacking. Methods: We conducted national surveys from 2016 to 2022 of women with lipedema as well as female controls. Surveys collected information on symptomatology, pain, and therapies. We performed logistic regression comparing symptoms among those with lipedema versus controls adjusting for age and BMI. Results: A total of 707 women with lipedema and 216 controls completed the surveys. Those with lipedema had a mean age of 48.6 years and mean BMI of 40.9 kg/m2. Lipedema symptom onset occurred frequently at puberty (48.0%) or pregnancy (41.2%). Compared to controls, women with lipedema were more likely to report leg swelling in heat (odds ratio [OR], 66.82; 95% CI, 33.04–135.12; p < 0.0001), easy bruising (OR, 26.23; 95% CI, 15.58–44.17; p < 0.0001), altered gait (OR, 15.54; 95% CI, 7.58–31.96; p < 0.0001), flu-like symptoms (OR, 12.99; 95% CI, 4.27–39.49; p < 0.0001), joint hypermobility (OR, 12.88; 95% CI, 6.68–24.81; p < 0.0001), cool skin (OR, 12.21; 95% CI, 5.20–28.69; p < 0.0001), varicose veins (OR, 11.29; 95% CI, 6.71–18.99; p < 0.0001), and fatigue (OR, 9.59; 95% CI, 6.10–15.09; p < 0.0001). Additionally, 70.3% had upper arm involvement, 21.2% reported foot swelling, and 16.6% reported foot pain. Most (52.2%) reported no symptom improvement with diet or exercise. Common therapies used included compression therapy (45.0%), gastric bypass (15.7%), and lower-extremity liposuction (14.0%). Conclusion: In a large, national, symptom survey, women with lipedema reported excess pain, swelling, and fat in the legs along with numerous symptoms beyond those classically described. Symptom responses to common therapies remain understudied. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Deep vein thrombosis (DVT) is a potentially fatal condition that occurs in 100 persons per 100 000 population, and accounts for 60 000 deaths per year in the United States, making its evaluation and diagnosis essential. Diagnosing DVT can be challenging due to symptom variations between patients. There are no previous reports of DVT patients presenting with foot drop in the literature. Therefore, the purpose of this case report is to present an unusual presentation of DVT in a middle-aged man with no clearly identifiable risk factors for DVT. Case Report: A 54-year-old otherwise symptom-free male smoker (for 30 years) presented to the Emergency Department complaining of pain in the left leg, which then escalated to weakness and decreased sensation in the left foot. However, he was able to walk with limping. Upon his presentation to the Emergency Department, he stated that his left leg felt quite weak. The neurological examination did not show any remarkable results, except for unilateral limb weakness. After that, a point-of-care ultrasound was carried out, which showed the possibility of non-compressible veins; then, a D-dimer test was conducted. When it tested positive, an official ultrasound was done, which showed thrombi in the left external iliac and common and superficial femoral veins. Conclusions: This study reported a unique presentation of foot drop due to DVT in a middle-aged man, with the absence of known risk factors. Utilizing point-of-care ultrasound is a valuable tool in the evaluation of acute unilateral lower limb weakness. [ABSTRACT FROM AUTHOR]

Background: Lumbar disc herniations (LDH) are among the most common spinal conditions. Despite increased appreciation for the importance of social determinants of health, the role that these factors play in patients with lumbar disc herniations is poorly defined.Purpose: To elucidate the association between insurance status and baseline patient reported outcome measures (PROMs) in the setting of lumbar disc herniations.Study Design/setting: Retrospective cohort study PATIENT SAMPLE: Baseline patient-reported outcome measures (PROMS) were reviewed from 924 adult patients presenting for treatment of lumbar disc herniation within our institutional healthcare system (2015-2020).Outcome Measures: The Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, PROMIS Global-Physical, and visual analogue scale (VAS) for back and leg pain were assessed.Methods: PROMIS scores at presentation were defined at the primary outcome and insurance status as the primary predictor. Differences in clinical and sociodemographic characteristics between our cohorts, stratified by insurance status, were evaluated using Wilcoxon rank-sum or chi-squared testing. We used multivariable negative binomial regression modeling to adjust for potential confounders including age, gender, race, language, ethnicity, comorbidity index, and median geospatial household income.Results: We included 924 patients, with mean age of 58.4 +/- 15.2 years and 52.6% male prevalence. Patients insured through Medicaid were more likely to be Black, Hispanic, and non-English speaking patients compared with the commercially insured. The Charlson Comorbidity index was significantly higher in the Medicare group. Following adjusted analysis, patients with Medicaid insurance had significantly worse PF10a (IRR, 0.90, 95% CI 0.85-0.96), as well as PROMIS Global-Physical score (IRR 0.88, 95% CI 0.82-0.94), and VAS low back pain (IRR 1.20, 95% CI 1.04-1.40) when compared to the commercially insured.Conclusions: We encountered worse physical function, mental, and pain-related patient-reported outcomes for those with Medicaid insurance in a population of patients presenting for evaluation of lumbar disc herniation. These findings, including worse depression, anxiety, and higher axial back pain scores, merit further investigation into potential health system asymmetries, and should be accounted for by treating providers. [ABSTRACT FROM AUTHOR]

Background Context: Despite the growing senior population within the United States, there is a lack of consensus regarding the safety and efficacy of performing lumbar spinal fusion for this population.Purpose: To evaluate the clinical and radiographic outcomes in different age cohorts following lumbar spinal fusion.Study Design: Retrospective cohort analysis.Patient Sample: Analysis of 1,184 patients who underwent posterolateral lumbar fusion from 2011 to 2018. Surgery was indicated after failure of conservative treatment to address radiculopathy and/or neurogenic claudication. Patients were excluded if they were under 18 years of age at the time of surgery, had a lumbar fracture, tumor, or infection, or had fusions involving the thoracic spine, high-grade spondylolisthesis, or concomitant deformity. Of the 1,184 patients, 850 patients were included. Patients were divided into three roughly equal groups for analysis: young (18-54 years), middle-aged (55-69 years), and senior (≥70 years).Outcome Measures: Visual Analog Scale Back/Leg pain, and Oswestry Disability Index (ODI) were collected, and achievement of minimal clinically important difference was evaluated. Lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and PI-LL difference were measured on radiographs. Rates of postoperative complications were analyzed.Methods: Several radiographic parameters were measured using plain radiographs obtained at preoperative, immediately postoperative (standing radiographs performed on postoperative day 1), and most recent follow-up visits. Preoperative and final patient-reported outcomes, along with demographic information, were obtained all patients. Binary outcome variables were compared between groups with multivariate logistic regression, and continuous outcome variables were compared using multivariate linear regression, with age 18 to 54 years used as the reference. Multivariate regressions were used to compare outcomes between cohorts while controlling baseline characteristics.Results: A total of 850 patients were included; 330 young (38.80%), 317 middle-aged (37.30%), and 203 senior (23.90%). Seniors had higher postoperative length of stay compared to younger patients (p<.001). Younger patients had worse final ODI scores compared to middle-aged patients (p=.002). Seniors had higher rates of proximal ASD (p=.002) compared to young patients. There was no difference in achievement of minimal clinically important differences (MCID) between all three groups.Conclusions: Senior patients have significant improvement in patient-reported clinical outcomes, despite having greater comorbidities, and longer length of stay. However, given a general lack of achievement of MCID across all cohorts, these findings suggest the need for a critical re-evaluation of the role of lumbar spinal fusion in the management of patients with refractory radiculopathic and/or neurogenic claudication symptoms. [ABSTRACT FROM AUTHOR]

Background: Spinal cord stimulation has been an established treatment for chronic back and leg pain for more than 50 years; however, outcomes are variable and unpredictable, and objective evidence of the mechanism of action is needed. A novel spinal cord stimulation system provides the first in vivo, real-time, continuous objective measure of spinal cord activation in response to therapy via recorded evoked compound action potentials (ECAPs) in patients during daily use. These ECAPs are also used to optimise programming and deliver closed-loop spinal cord stimulation by adjusting the stimulation current to maintain activation within patients' therapeutic window. We aimed to examine pain relief and the extent of spinal cord activation with ECAP-controlled closed-loop versus fixed-output, open-loop spinal cord stimulation for the treatment of chronic back and leg pain.Methods: This multicentre, double-blind, parallel-arm, randomised controlled trial was done at 13 specialist clinics, academic centres, and hospitals in the USA. Patients with chronic, intractable pain of the back and legs (Visual Analog Scale [VAS] pain score ≥60 mm; Oswestry Disability Index [ODI] score 41-80) who were refractory to conservative therapy, on stable pain medications, had no previous experience with spinal cord stimulation, and were appropriate candidates for a spinal cord stimulation trial were screened. Eligible patients were randomly assigned (1:1) to receive ECAP-controlled closed-loop spinal cord stimulation (investigational group) or fixed-output, open-loop spinal cord stimulation (control group). The randomisation sequence was computer generated with permuted blocks of size 4 and 6 and stratified by site. Patients, investigators, and site staff were masked to the treatment assignment. The primary outcome was the proportion of patients with a reduction of 50% or more in overall back and leg pain with no increase in pain medications. Non-inferiority (δ=10%) followed by superiority were tested in the intention-to-treat population at 3 months (primary analysis) and 12 months (additional prespecified analysis) after the permanent implant. This study is registered with ClinicalTrials.gov, NCT02924129, and is ongoing.Findings: Between Feb 21, 2017, and Feb 20, 2018, 134 patients were enrolled and randomly assigned (67 to each treatment group). The intention-to-treat analysis comprised 125 patients at 3 months (62 in the closed-loop group and 63 in the open-loop group) and 118 patients at 12 months (59 in the closed-loop group and 59 in the open-loop group). The primary outcome was achieved in a greater proportion of patients in the closed-loop group than in the open-loop group at 3 months (51 [82·3%] of 62 patients vs 38 [60·3%] of 63 patients; difference 21·9%, 95% CI 6·6-37·3; p=0·0052) and at 12 months (49 [83·1%] of 59 patients vs 36 [61·0%] of 59 patients; difference 22·0%, 6·3-37·7; p=0·0060). We observed no differences in safety profiles between the two groups. The most frequently reported study-related adverse events in both groups were lead migration (nine [7%] patients), implantable pulse generator pocket pain (five [4%]), and muscle spasm or cramp (three [2%]).Interpretation: ECAP-controlled closed-loop stimulation provided significantly greater and more clinically meaningful pain relief up to 12 months than open-loop spinal cord stimulation. Greater spinal cord activation seen in the closed-loop group suggests a mechanistic explanation for the superior results, which aligns with the putative mechanism of action for spinal cord stimulation and warrants further investigation.Funding: Saluda Medical. [ABSTRACT FROM AUTHOR]

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer diagnosed in the United States. The disease causes a decrease in hematopoiesis, so children often present with symptoms related to anemia, thrombocytopenia, and leukopenia. Symptoms for this malignancy may have significant overlap with other conditions such as osteomyelitis. Case Report: A 2-year-oldmalewith no significantmedical history presented with lower extremity pain and fever. Initial investigations, including imaging and complete blood count, led physicians to diagnose bilateral osteomyelitis. The patient was prescribed a course of antibiotics; however, his symptoms returned. Eventually, a bone marrow aspiration showed CD99 membrane-positive small round blue cell tumors. The patient was diagnosed with ALL. He was successfully treated with chemotherapy and is now in remission. Conclusion: This case demonstrates the importance of a broad differential diagnosis for a child presenting with leg pain and fever. [ABSTRACT FROM AUTHOR]

Purpose: Lumbar disc surgery is a common procedure in the USA. It is frequently performed with good or excellent results in most patients. This article reviews common causes of persistent radiculopathy after surgical intervention.Methods: We performed an extensive review of the literature as well as applying our own experience.Results: Common causes of persistent leg pain following operative intervention include re-herniation, epidural fibrosis, biochemical/physiologic changes in the nerve root, and psychosocial issues.Conclusions: Patients with persistent leg pain after surgical treatment of lumbar disc herniation can pose a challenging clinical problem. Summary of these topics and available treatment options are reviewed. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective review of results from a prospectively collected Canadian cohort in comparison to published literature.Objectives: (1) To investigate whether patients in a universal health care system have different outcomes than those in a multitier health care system in surgical management of degenerative spondylolisthesis (DS). (2) To identify independent factors predictive of outcome in surgical DS patients.Summary Of Background Data: Canada has a national health insurance program with unique properties. It is a single-payer system, coverage is universal, and access to specialist care requires referral by the primary care physician. The United States on the other hand is a multitier public/private payer system with more rapid access for insured patients to specialist care.Methods: Surgical DS patients treated between 2013 and 2016 in Canada were identified through the Canadian Spine Outcome Research Network (CSORN) database, a national registry that prospectively enrolls consecutive patients with spinal pathology from 16 tertiary care academic hospitals. This population was compared with the surgical DS arm of patients treated in the Spine Patients Outcome Research Trial (SPORT) study. We compared baseline demographics, spine-related, and health-related quality of life (HRQOL) outcomes at 3 months and 1 year. Multivariate analysis was used to identify factors predictive of outcome in surgical DS patients.Results: The CSORN cohort of 213 patients was compared with the SPORT cohort of 248 patients. Patients in the CSORN cohort were younger (mean age 60.1 vs. 65.2; p<.001), comprised fewer females (60.1% vs. 67.7%; p=.09), and had a higher proportion of smokers (23.3% vs. 8.9%; p<.001). The SPORT cohort had more patients receiving compensation (14.6% vs. 7.7%; p<.001). The CSORN cohort consisted of patients with slightly greater baseline disability (Oswestry disability index scores: 47.7 vs. 44.0; p=.008) and had more patients with symptom duration of greater than 6 months (93.7% vs. 62.1%; p<.001). The CSORN cohort showed greater satisfaction with surgical results at 3 months (91.1% vs. 66.1% somewhat or very satisfied; p<.01) and 1 year (88.2% vs. 71.0%, p<.01). Improvements in back and leg pain were similar comparing the two cohorts. On multivariate analysis, duration of symptoms, treatment group (CSORN vs. SPORT) or insurance type (public/Medicare/Medicaid vs. Private/Employer) predicted higher level of postoperative satisfaction. Baseline depression was also associated with worse Oswestry disability index at 1-year postoperative follow-up in both cohorts.Conclusions: Surgical DS patients treated in Canada (CSORN cohort) reported higher levels of satisfaction than those treated in the United States (SPORT cohort) despite similar to slightly worse baseline HRQOL measures. Symptom duration and insurance type appeared to impact satisfaction levels. Improvements in other patient-reported health-related quality of life measures were similar between the cohorts. [ABSTRACT FROM AUTHOR]

Background: Chronic wounds affect around 2.4 – 4.5 million patients in the United States. The burden of wound management is growing rapidly. Objective: Management of chronic wounds with integrated conventional medicine and Ayurveda treatment. Clinical Features: A 52-year-old female patient, presented with non-healing chronic wound on the right leg with pain persisting for 5 years. Initial measurement of the wound was 48 cm length × 13 cm width × 0.4 cm depth. Intervention and Outcomes: Wound depth was measured during different stages of healing along with photographic images. Patient was given Ciprofloxacin 500mg twice daily for 10 days, compression leg wraps and diuretics along with washing of the wound with Triphala decoction daily and application of wound dressing with Turmeric powder, neem bark powder and Medihoney daily were done. Marma therapy was performed once a week. Patient was also suggested kapha pacifying diet and lifestyle. Results: The wound was completely healed with normal skin coloration by the sixth week. Conclusions: This case study discusses the use of integration of ayurvedic herbs with conventional medicine for the management of wound healing. Interventional studies should be conducted to better understand the effectiveness of this integrative approach for the treatment of chronic wounds. [ABSTRACT FROM AUTHOR]

Canada has a government-fundeduniversal health care system and access to specialist care requires a referral by general practitioners. In contrast, the United States utilizes a blended public and private payer system where insured patients can directly access specialists. The purpose of this study is to investigate whether clinical outcomes differ between those surgically treated for lumbar disc herniation in Canada as compared to the United States. A retrospective analysis of the surgical lumbar disc herniation patients enrolled in the Canadian Spine Outcome Research Network (CSORN) prospective multicenter registry and the Spine Patients Outcome Research Trial (SPORT) study. Consecutive surgical lumbar disc herniation patients enrolled in the CSORN registry and the SPORT trial. Baseline demographics, and spine-related patient-reported outcomes (PROs), including disatisfaction, were compared at three months and one year postoperatively. A retrospective analysis of surgical lumbar disc herniation patients enrolled in the CSORN registry and the SPORT trial. The CSORN cohort consisted of 703 patients and the SPORT cohort included 573 patients. The rate of females in each cohort was similar (47.2% vs 46.4%, p=0.78); however, patients in the CSORN cohort were older (46.2 ±13.2 vs 41.6 ±10.9, p<0.001), had a higher rate of smoking (32.0% vs 22.8%, p<0.001), and were more likely to be employed (66.9% vs 61.3%, p=0.034). The CSORN cohort had a slightly lower Owestry Disability score at baseline (50.5±15.1 vs 55.7±19.6, p<0.01) but had a higher proportion of patients with a symptom duration greater than six months (44.5% vs 21.1%, p<0.0001). The CSORN cohort demonstrated significantly greater rates of satisfaction after surgery at three months (74.8% vs 65.3%, p=0.003) and one year (81.4% vs 68.7%, p<0.001). Improvements in back and leg pain followed similar trajectories between the two cohorts. Patients undergoing surgical treatment for lumbar disc herniation in Canada (CSORN cohort) reported higher rates of satisfaction at three months and one year postoperatively compared to the United States cohort (SPORT) despite having longer durations of symptoms prior to surgery. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Opioid addiction is the number one health care issue in the United States with spinal ailments the leading medical condition associated with opioid addiction. Patients with chronic pain syndrome and opioid addiction going for spine surgery are at high risk for several poor outcomes, including life-long use of opioids. Current evidence-based methods to optimize patients prior to spine surgery have been: (1) transition from opioids to nonopioid medications, (2) cardiovascular exercise program, (3) smoking cessation, (4) alcohol cessation, and (5) psychotherapy to treat mood and maladaptive pain behavior. The authors hypothesized that an initiation of an interdisciplinary "prehab" protocol utilizing all five aforementioned modalities prior to spine surgery in patients with chronic pain syndrome and opioid addiction would optimize postoperative outcomes, including decreased pain and opioid consumption. Prospective and retrospective review of patients with and without an interdisciplinary "prehab" program prior to spine surgery. Eighty-nine patients with prehab and 85 patients without prehab prior to spine surgery. Opioid usage, visual analog scale (VAS) for axial pain and radiculopathy, EQ-5D, QALY, PHQ-9, pain castrophizing scale (PCS), and chronic pain acceptance questionnaire (CPAQ). A review from 2013 to 2017 at a single institution was performed on patients undergoing spine surgery. Inclusion criteria were patients undergoing spine surgery who had preoperative chronic pain syndrome and opioid addiction. Two cohorts were investigated which included patients going for spine surgery with and without a multidisciplinary "prehab" protocol. The protocol was the initiation of a multidisciplinary task team to preoperatively optimize patients with opioid addiction and chronic pain syndrome going for spine surgery. Collaboration was between the spine surgery division, pain management, pharmacy, psychiatry, psychology, primary care, physical therapy, and nutritionist. Patients in the "prehab" cohort underwent a preoperative optimization checklist: patients were transitioned off of opioids with utilization of nonopioid medications; patients who were smokers were enrolled in an smoking cessation program; patients who had alcohol dependence had a behavioral medicine consult with psychology; patients who were obese (BMI >35) were enrolled in a multidisciplinary weight loss program through monitored cardiovascular exercising and nutritionist consultation; and all patients had a consultation with behavioral medicine for their chronic pain syndrome to forge healthy relationships with their pain. Demographics and case breakdown (surgery type performed) were similar between cohorts. A significantly greater amount of patients receiving prehab were opioid-free following spine surgery compared to patients without prehab (8% vs 72%, respectively, p<0.0001). Furthermore, pain relief was greater in those receiving prehab. Improvement in axial pain (VAS neck/back pain) and radiculopathy (VAS arm/leg pain) were both two-fold greater in patients with prehab compared to those without prehab (p<0.001, p<0.001, respectively). Patients receiving prehab also had significant improvements in quality of life, depression, and pain acceptance compared to those without prehab (p<0.001, p<0.001, p<0.0001). A multidisciplinary "prehab" program for patients with opioid addiction and chronic pain syndrome going for spine surgery is efficacious at reducing opioid addiction and pain, improving quality of life and depression, and forging a healthier relationship with pain. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Chronic exertional compartment syndrome (CECS) is a debilitating condition that is not uncommon in athletes and military service members. The only curative treatment for this condition, surgical fascial release, was first described in 1956. In the ensuing 62 years, this has remained the standard therapy despite symptom recurrence in 45% of military service members who underwent surgery. In 2013, a case series introduced intracompartmental injections of botulinum toxin A as a non-surgical treatment option for CECS, which proved effective in 15 out of 16 patients. In this case report, we present the case of a U.S. military service member treated with BoNT-A for bilateral lower leg CECS. This patient remains pain free at 11 months after initial treatment. This case, coupled with previously published cases series, demonstrates the potential of this novel treatment as a long-term, non-surgical alternative for CECS in the U.S. military population., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2018.)

Purpose: Prolonged standing at work has been shown to be associated with a number of potentially serious health outcomes, such as lower back and leg pain, cardiovascular problems, fatigue, discomfort, and pregnancy-related health outcomes. Recent studies have been conducted examining the relationship between these health outcomes and the amount of time spent standing while on the job. The purpose of this article was to provide a review of the health risks and interventions for workers and employers that are involved in occupations requiring prolonged standing. A brief review of recommendations by governmental and professional organizations for hours of prolonged standing is also included., Findings: Based on our review of the literature, there seems to be ample evidence showing that prolonged standing at work leads to adverse health outcomes. Review of the literature also supports the conclusion that certain interventions are effective in reducing the hazards associated with prolonged standing. Suggested interventions include the use of floor mats, sit-stand workstations/chairs, shoes, shoe inserts and hosiery or stockings. Studies could be improved by using more precise definitions of prolonged standing (e.g., duration, movement restrictions, and type of work), better measurement of the health outcomes, and more rigorous study protocols., Conclusion and Clinical Relevance: Use of interventions and following suggested guidelines on hours of standing from governmental and professional organizations should reduce the health risks from prolonged standing., (© 2014 Association of Rehabilitation Nurses.)

OBJECT Back and leg pain are the primary outcomes of adult spinal deformity (ASD) and predict patients' seeking of surgical management. The authors sought to characterize changes in back and leg pain after operative or nonoperative management of ASD. Outcomes were assessed according to pain severity, type of surgical procedure, Scoliosis Research Society (SRS)-Schwab spine deformity class, and patient satisfaction. METHODS This study retrospectively reviewed data in a prospective multicenter database of ASD patients. Inclusion criteria were the following: age > 18 years and presence of spinal deformity as defined by a scoliosis Cobb angle ≥ 20°, sagittal vertical axis length ≥ 5 cm, pelvic tilt angle ≥ 25°, or thoracic kyphosis angle ≥ 60°. Patients were grouped into nonoperated and operated subcohorts and by the type of surgical procedure, spine SRS-Schwab deformity class, preoperative pain severity, and patient satisfaction. Numerical rating scale (NRS) scores of back and leg pain, Oswestry Disability Index (ODI) scores, physical component summary (PCS) scores of the 36-Item Short Form Health Survey, minimum clinically important differences (MCIDs), and substantial clinical benefits (SCBs) were assessed. RESULTS Patients in whom ASD had been operatively managed were 6 times more likely to have an improvement in back pain and 3 times more likely to have an improvement in leg pain than patients in whom ASD had been nonoperatively managed. Patients whose ASD had been managed nonoperatively were more likely to have their back or leg pain remain the same or worsen. The incidence of postoperative leg pain was 37.0% at 6 weeks postoperatively and 33.3% at the 2-year follow-up (FU). At the 2-year FU, among patients with any preoperative back or leg pain, 24.3% and 37.8% were free of back and leg pain, respectively, and among patients with severe (NRS scores of 7-10) preoperative back or leg pain, 21.0% and 32.8% were free of back and leg pain, respectively. Decompression resulted in more patients having an improvement in leg pain and their pain scores reaching MCID. Although osteotomies improved back pain, they were associated with a higher incidence of leg pain. Patients whose spine had an SRS-Schwab coronal curve Type N deformity (sagittal malalignment only) were least likely to report improvements in back pain. Patients with a Type L deformity were most likely to report improved back or leg pain and to have reductions in pain severity scores reaching MCID and SCB. Patients with a Type D deformity were least likely to report improved leg pain and were more likely to experience a worsening of leg pain. Preoperative pain severity affected pain improvement over 2 years because patients who had higher preoperative pain severity experienced larger improvements, and their changes in pain severity were more likely to reach MCID/SCB than for those reporting lower preoperative pain. Reductions in back pain contributed to improvements in ODI and PCS scores and to patient satisfaction more than reductions in leg pain did. CONCLUSIONS The authors' results provide a valuable reference for counseling patients preoperatively about what improvements or worsening in back or leg pain they may experience after surgical intervention for ASD.