TY - JOUR
T1 - Surgery for the Adolescent Idiopathic Scoliosis Patients After Skeletal Maturity
T2 - Early Versus Late Surgery
AU - Lonner, Baron S.
AU - Ren, Yuan
AU - Bess, Shay
AU - Kelly, Michael
AU - Kim, Han Jo
AU - Yaszay, Burt
AU - Lafage, Virginie
AU - Marks, Michelle
AU - Miyanji, Firoz
AU - Shaffrey, Christopher I.
AU - Newton, Peter O.
N1 - Funding Information:
Author disclosures: BSL (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from Setting Scoliosis Straight Foundation, personal fees from DePuy Synthes Spine, personal fees from K2M, Paradigm Spine, Spine Search, and Ethicon; nonfinancial support from Spine Deformity Journal; grants from AO Spine, John and Marcella Fox Fund Grant, and the Orthopaedic Research and Education Foundation [OREF], outside the submitted work), YR (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), SB (grants from Setting Scoliosis Straight Foundation, grants from International Spine Study Group Foundation, during the conduct of the study; grants from DePuy Synthes spine, grants from k2 medical, grants from NuVasive, grants from Innovasis, grants from Stryker spine, grants from Medtronic, outside the submitted work; in addition, SB has a patent NuVasive pending, a patent Innovasis pending, and a patent k2 medical with royalties paid), MK (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from Cervical Spine Research Society [CSRS], OREF, Cerapedics, AOSpine, Barnes Jewish Foundation, Fox Family Foundation, and Patient-Centered Outcomes Research Institute, outside the submitted work), HJK (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from K2M, Zimmer-Biomet, grants from International Spine Study Group [ISSGF], grants and personal fees from AO Spine, outside the submitted work; in addition, HJK has a patent null pending), BY (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and personal fees from K2M and DePuy Synthes Spine; personal fees from NuVasive, Medtronic, Orthopediatrics, Stryker, and Globus; grants from Setting Scoliosis Straight Foundation, outside the submitted work; in addition, BY has a patent with K2M with royalties paid), VL (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from DePuy Spine, NuVasive, K2M, Stryker; personal fees from NuVasive, DePuy Spine, Medicrea, MSD, and K2M; other from Nemaris INC, outside the submitted work), MM (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from Setting Scoliosis Straight, outside the submitted work), FM (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; other from DePuy Synthes Canada, outside the submitted work), CIS (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from ISSG, personal fees from Medtronic, NuVasive, Zimmer-Biomet, K2M, and Stryker; grants from National Institutes of Health [NIH], AOSpine North America [AO], and Department of Defense, outside the submitted work; in addition, CIS has a patent Medtronic with royalties paid, a patent NuVasive with royalties paid, and a patent Zimmer-Biomet with royalties paid), PON (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation; other from Rady Children's Specialists; grants and personal fees from DePuy Synthes Spine; personal fees from Law firm of Carroll, Kelly, Trotter, Franzen & McKenna; personal fees from Law firm of Smith, Haughey, Rice & Roegge; grants from NIH and OREF; grants and other from Scoliosis Research Society [SRS]; grants from EOS Imaging; personal fees from Thieme Publishing; other from NuVasive; personal fees from Ethicon Endosurgery; other from Electrocore; personal fees from Cubist; other from International Orthopedic Think Tank and from Orthopediatrics Institutional Support; personal fees from K2M, outside the submitted work; in addition, PON has a patent “Anchoring Systems and Methods for Correcting Spinal Deformities” [8540754] with royalties paid to DePuy Synthes Spine; a patent “Low Profile Spinal Tethering Systems” [8123749] issued to DePuy Spine, Inc.; a patent “Screw Placement Guide” [7981117] issued to DePuy Spine, Inc.; and a patent “Compressor for Use in Minimally Invasive Surgery” [7189244] issued to DePuy Spine, Inc).
Publisher Copyright:
© 2018 Scoliosis Research Society
PY - 2019/1
Y1 - 2019/1
N2 - 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.
AB - 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.
KW - Adolescent idiopathic scoliosis (AIS)
KW - Adult spinal deformity
KW - Matched comparison
KW - Natural history
KW - Operative outcome
UR - http://www.scopus.com/inward/record.url?scp=85057258521&partnerID=8YFLogxK
U2 - 10.1016/j.jspd.2018.05.012
DO - 10.1016/j.jspd.2018.05.012
M3 - Article
C2 - 30587326
AN - SCOPUS:85057258521
SN - 2212-134X
VL - 7
SP - 84
EP - 92
JO - Spine Deformity
JF - Spine Deformity
IS - 1
ER -