Prospective 10-year follow-up assessment of spinal fusions for thoracic AIS: radiographic and clinical outcomes

Study design: Prospective registry. Summary of background data: The evolution of spinal instrumentation has provided betteroutcomes in adolescent idiopathic scoliosis (AIS); however, there is a paucity of reliable prospective information on 10-year post-operative outcomes of modern surgical techniques. Methods: A prospective multicenter registry of patients who had surgical correction of AIS was reviewed. Patients with major thoracic scoliosis (Lenke types 1–4) operated on between 1997 and 2007, with 10-year post-operative follow-up data were included. Radiographic and clinical outcomes including Scoliosis Research Society (SRS)-22scores and revision surgeries were evaluated. Results: One hundred and seventy-four patients (mean 25.0 years of age at most recent evaluation) were included. Pedicle screw constructs were used in 102 patients (58%), hook or hybrid constructs in 22 (13%), and anterior screw-rod constructs in 50 (29%). The mean pre-operative thoracic Cobb angle was corrected from 53° to 18° initially. At 10-year follow-up, the mean thoracic curve was 22° (mean 57% correction), with 29 patients (16.7%) having loss of correction (LOC) ≥ 10°. There were a total of 14 revision surgeries performed in 13 patients (7.5%). SRS-22 pain (p = 0.035), self-image (p < 0.001), and total scores (p < 0.001) significantly improved at 2-year follow-up. The mean pain score at 10-year follow-up was similar to pre-operative scores and lower (more pain) than previously published mean scores of normal adults aged 20–40 years (p < 0.05). Conclusions: Spinal fusion patients report SRS-22 quality of life 10 years after scoliosis surgery that is minimally reduced compared to healthy peers and substantially better than an un-operated cohort of comparably aged scoliosis patients. Adolescents with thoracic idiopathic scoliosis should expect little if any change in their health-related quality of life compared to before surgery, high satisfaction, and a 7.5% chance of revision surgery 10 years after their index spinal fusion. Level of evidence: Therapeutic II.