Surgery for the Adolescent Idiopathic Scoliosis Patients After Skeletal Maturity: Early Versus Late Surgery.

dc.contributor.author

Lonner, Baron S

dc.contributor.author

Ren, Yuan

dc.contributor.author

Bess, Shay

dc.contributor.author

Kelly, Michael

dc.contributor.author

Kim, Han Jo

dc.contributor.author

Yaszay, Burt

dc.contributor.author

Lafage, Virginie

dc.contributor.author

Marks, Michelle

dc.contributor.author

Miyanji, Firoz

dc.contributor.author

Shaffrey, Christopher I

dc.contributor.author

Newton, Peter O

dc.date.accessioned

2023-06-20T15:30:57Z

dc.date.available

2023-06-20T15:30:57Z

dc.date.issued

2019-01

dc.date.updated

2023-06-20T15:30:57Z

dc.description.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.
dc.identifier

S2212-134X(18)30089-3

dc.identifier.issn

2212-134X

dc.identifier.issn

2212-1358

dc.identifier.uri

https://hdl.handle.net/10161/28228

dc.language

eng

dc.publisher

Springer Science and Business Media LLC

dc.relation.ispartof

Spine deformity

dc.relation.isversionof

10.1016/j.jspd.2018.05.012

dc.subject

Lumbar Vertebrae

dc.subject

Thoracic Vertebrae

dc.subject

Humans

dc.subject

Scoliosis

dc.subject

Disease Progression

dc.subject

Postoperative Complications

dc.subject

Treatment Outcome

dc.subject

Length of Stay

dc.subject

Spinal Fusion

dc.subject

Retrospective Studies

dc.subject

Age Factors

dc.subject

Time Factors

dc.subject

Quality of Life

dc.subject

Adolescent

dc.subject

Adult

dc.subject

Female

dc.subject

Male

dc.subject

Operative Time

dc.title

Surgery for the Adolescent Idiopathic Scoliosis Patients After Skeletal Maturity: Early Versus Late Surgery.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

84

pubs.end-page

92

pubs.issue

1

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

7

Files

Original bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
Surgery for the Adolescent Idiopathic Scoliosis Patients After Skeletal Maturity Early Versus Late Surgery..pdf
Size:
1.76 MB
Format:
Adobe Portable Document Format