Operative Treatment of Severe Scoliosis in Symptomatic Adults: Multicenter Assessment of Outcomes and Complications With Minimum 2-Year Follow-up. Issue 6 (18th October 2021)

• Record Type: Journal Article
• Authors: Buell, Thomas J; Smith, Justin S; Shaffrey, Christopher I; Kim, Han Jo; Klineberg, Eric O; Lafage, Virginie; Lafage, Renaud; Protopsaltis, Themistocles S; Passias, Peter G; Mundis, Gregory M; Eastlack, Robert K; Deviren, Vedat; Kelly, Michael P; Daniels, Alan H; Gum, Jeff L; Soroceanu, Alex; Hamilton, D Kojo; Gupta, Munish C; Burton, Douglas C; Hostin, Richard A; Kebaish, Khaled M; Hart, Robert A; Schwab, Frank J; Bess, Shay; Ames, Christopher P
• Is Part Of: Neurosurgery. Volume 89:Issue 6(2021)
• Page Start: 1012
• Page End: 1026
• Publication Date: 2021-10-18
• Subjects: Adult spinal deformity -- Complications -- Coronal imbalance/malalignment -- Health-related quality of life -- Outcomes -- Sagittal imbalance/malalignment -- Scoliosis -- Spine surgery; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyab352
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Few reports focus on adults with severe scoliosis. OBJECTIVE: To report surgical outcomes and complications for adults with severe scoliosis. METHODS: A multicenter, retrospective review was performed on operatively treated adults with severe scoliosis (minimum coronal Cobb: thoracic [TH] ≥ 75°, thoracolumbar [TL] ≥ 50°, lumbar [L] ≥ 50°). RESULTS: Of 178 consecutive patients, 146 (82%; TH = 8, TL = 88, L = 50) achieved minimum 2-yr follow-up (mean age = 53.9 ± 13.2 yr, 92% women). Operative details included posterior-only (58%), 3-column osteotomy (14%), iliac fixation (72%), and mean posterior fusion = 13.2 ± 3.7 levels. Global coronal alignment (3.8 to 2.8 cm, P = .001) and maximum coronal Cobb improved significantly ( P ≤.020): TH (84º to 57º; correction = 32%), TL (67º to 35º; correction = 48%), L (61º to 29º; correction = 53%). Sagittal alignment improved significantly ( P < .001), most notably for L: C7-sagittal vertical axis 6.7 to 2.5 cm, pelvic incidence-lumbar lordosis mismatch 18º to 3º. Health-related quality-of-life (HRQL) improved significantly ( P < .001), most notably for L: Oswestry Disability Index (44.4 ± 20.5 to 26.1 ± 18.3), Short Form-36 Physical Component Summary (30.2 ± 10.8 to 39.9 ± 9.8), and Scoliosis Research Society-22r Total (2.9 ± 0.7 to 3.8 ± 0.7). Minimal clinically important difference and substantial clinical benefit thresholds were achieved in 36% to 75% and 29% to 51%, respectively. Ninety-four (64%) patients had ≥1 complication (total = 191, 92 minor/99 major, most common = rod fracture [13.0%]). Fifty-seven reoperations were performed in 37 (25.3%) patients, with most common indications deep wound infection (11) and rod fracture (10). CONCLUSION: Although results demonstrated high rates of complications, operative treatment of adults with severe scoliosis was associated with significant improvements in mean HRQL outcome measures for the study cohort at minimum 2-yr follow-up. Graphical Abstract: