TY - JOUR
T1 - Operative Treatment of Severe Scoliosis in Symptomatic Adults
T2 - Multicenter Assessment of Outcomes and Complications With Minimum 2-Year Follow-up
AU - Buell, Thomas J.
AU - Smith, Justin S.
AU - Shaffrey, Christopher I.
AU - Kim, Han Jo
AU - Klineberg, Eric O.
AU - Lafage, Virginie
AU - Lafage, Renaud
AU - Protopsaltis, Themistocles S.
AU - Passias, Peter G.
AU - Mundis, Gregory M.
AU - Eastlack, Robert K.
AU - Deviren, Vedat
AU - Kelly, Michael
AU - Daniels, Alan H.
AU - Gum, Jeff L.
AU - Soroceanu, Alex
AU - Hamilton, D. Kojo
AU - Gupta, Munish C.
AU - Burton, Douglas C.
AU - Hostin, Richard A.
AU - Kebaish, Khaled M.
AU - Hart, Robert A.
AU - Schwab, Frank J.
AU - Bess, Shay
AU - Ames, Christopher P.
N1 - Publisher Copyright:
© Congress of Neurological Surgeons 2021.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - 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 (84ºto 57º; correction = 32%), TL (67ºto 35º; correction = 48%), L (61ºto 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 18ºto 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.
AB - 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 (84ºto 57º; correction = 32%), TL (67ºto 35º; correction = 48%), L (61ºto 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 18ºto 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.
KW - Adult spinal deformity
KW - Complications
KW - Coronal imbalance/malalignment
KW - Health-related quality of life
KW - Outcomes
KW - Sagittal imbalance/malalignment
KW - Scoliosis
KW - Spine surgery
UR - http://www.scopus.com/inward/record.url?scp=85121990892&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyab352
DO - 10.1093/neuros/nyab352
M3 - Article
C2 - 34662889
AN - SCOPUS:85121990892
SN - 0148-396X
VL - 89
SP - 1012
EP - 1026
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -