Baron S Lonner1, Yuan Ren2, Shay Bess3, Michael Kelly4, Han Jo Kim5, Burt Yaszay6, Virginie Lafage5, Michelle Marks6, Firoz Miyanji7, Christopher I Shaffrey8, Peter O Newton6. 1. Mount Sinai Hospital, 1468 Madison Ave, New York, NY 10029, USA. Electronic address: blonner@nyc.rr.com. 2. Mount Sinai Hospital, 1468 Madison Ave, New York, NY 10029, USA. 3. Denver International Spine Clinic, 1601 E 19th Ave #6250, Denver, CO 80218, USA. 4. Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA. 5. Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. 6. Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA. 7. British Columbia Children's Hospital, 4480 Oak St, Vancouver, BC V6H 3N1, Canada. 8. University of Virginia Medical Center, 1215 Lee Street, Charlottesville, VA 22903, USA.
Abstract
INTRODUCTION: Informed decision making for operative treatment of the skeletally mature adolescent idiopathic scoliosis (AIS) patient meeting surgical indications requires a discussion of differences in operative morbidity in adult scoliosis versus AIS. This study evaluated differences in operative data and outcomes between AIS and adult scoliosis patients based on an estimated natural history of curve progression. METHODS: Twenty-eight adult scoliosis patients (43.7 ± 15.8 years; 93% F) were 1:2 matched with 56 (Risser 4/5) AIS patients (15.7 ± 2.1 years) based on gender and curve type as vetted by 5 surgeons' consensus in committee. Curve progression of 0.3°/year for the first 10 years following skeletal maturity and a 0.5°/year thereafter was assumed to estimate curve progression from AIS to adulthood for the adult counterpart. Operative data, complications, and quality of life (Scoliosis Research Society [SRS-22r] questionnaire) measures were evaluated, with a minimum 2-year follow-up. RESULTS: Postoperative major Cobb and percentage correction were similar between adult versus AIS, whereas operative time, percentage estimated blood loss (EBL; % total blood volume), length of hospital stay (LOS), and total spine levels fused were greater for adult patients (p < .05). No difference was found in EBL, operative time, or LOS when normalized by levels fused. Ten (36%) adult scoliosis patients were fused to the pelvis compared with none in AIS (p < .0001). Major complication rate was higher for adult versus AIS (25% vs. 5.4%; p < .05). Preoperative SRS-22r scores were worse for adult patients; however, they demonstrated greater improvement in SRS-22r than the AIS cohort at final follow-up. A higher percentage of adult patients reached the MCID in self-image domain than the AIS patients (92.3% vs. 61.8%; p = .0040). CONCLUSION: Treatment of the adult scoliosis patient who has undergone an estimated natural history of progression is characterized by greater levels fused, operative time, and higher complication rates than the AIS counterpart. Longer-term follow-up of AIS is needed to define the benefits of early intervention of relatively asymptomatic adolescent patients versus late treatment of symptomatic disease in the adult.
INTRODUCTION: Informed decision making for operative treatment of the skeletally mature adolescent idiopathic scoliosis (AIS) patient meeting surgical indications requires a discussion of differences in operative morbidity in adult scoliosis versus AIS. This study evaluated differences in operative data and outcomes between AIS and adult scoliosispatients based on an estimated natural history of curve progression. METHODS: Twenty-eight adult scoliosispatients (43.7 ± 15.8 years; 93% F) were 1:2 matched with 56 (Risser 4/5) AISpatients (15.7 ± 2.1 years) based on gender and curve type as vetted by 5 surgeons' consensus in committee. Curve progression of 0.3°/year for the first 10 years following skeletal maturity and a 0.5°/year thereafter was assumed to estimate curve progression from AIS to adulthood for the adult counterpart. Operative data, complications, and quality of life (Scoliosis Research Society [SRS-22r] questionnaire) measures were evaluated, with a minimum 2-year follow-up. RESULTS: Postoperative major Cobb and percentage correction were similar between adult versus AIS, whereas operative time, percentage estimated blood loss (EBL; % total blood volume), length of hospital stay (LOS), and total spine levels fused were greater for adult patients (p < .05). No difference was found in EBL, operative time, or LOS when normalized by levels fused. Ten (36%) adult scoliosispatients were fused to the pelvis compared with none in AIS (p < .0001). Major complication rate was higher for adult versus AIS (25% vs. 5.4%; p < .05). Preoperative SRS-22r scores were worse for adult patients; however, they demonstrated greater improvement in SRS-22r than the AIS cohort at final follow-up. A higher percentage of adult patients reached the MCID in self-image domain than the AISpatients (92.3% vs. 61.8%; p = .0040). CONCLUSION: Treatment of the adult scoliosispatient who has undergone an estimated natural history of progression is characterized by greater levels fused, operative time, and higher complication rates than the AIS counterpart. Longer-term follow-up of AIS is needed to define the benefits of early intervention of relatively asymptomatic adolescent patients versus late treatment of symptomatic disease in the adult.