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1- vs. 2-year follow-up after posterior spinal fusion for AIS: what additional information is gained?

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Abstract

Purpose

Traditionally, 2-year follow-up data have been the established standard for reporting clinical outcomes following spinal deformity surgery. However, previous studies indicate that 2-year follow-up does not represent long-term outcomes. Currently, there is no clear data that demonstrate a difference in outcomes between the 1 and 2 years postoperative time-periods following posterior spinal fusions (PSF) for adolescent idiopathic scoliosis (AIS).

Methods

A multi-center, prospective database was queried for AIS patients treated with PSF. Clinical outcome scores, assessed by SRS-22, coronal and sagittal radiographic parameters were assessed at time periods: 6 months, 1 year, and 2 years post operatively. Complications and reoperation rates were also assessed. Statistical analysis compared outcomes variables across time-points to assess for significant differences.

Results

694 patients (82.6% female, mean age at surgery 14.9 ± 2.13 years) were identified. Between post-operative year 1 and 2, significant difference in SRS-22 domain scores were present for function domain (4.5 vs. 4.6; p < 0.001), mental health domain (4.3 vs. 4.2; p < 0.001), and total domain score (4.4 vs. 4.4; p = 0.03) but were below the minimal clinically important difference threshold. New complication development was significantly higher within the first year following surgery than the 1–2 year follow-up period (p < 0.001) with greater complication severity within the 0–1 year follow-up period (P = 0.03).

Conclusion

There are no clinically important changes in SRS-22 domain scores between 1 and 2 years following PSF for AIS, with higher complications in the first year following PSF. Two-year follow-up data provide little added clinical information while under-estimating the cumulative complication and reoperation rates at long-term follow-up.

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Acknowledgements

Harms Study Group Investigators: Aaron Buckland, MD: New York University. Amer Samdani, MD; Joshua Pahys, MD; and Steven Hwang, MD: Shriners Hospitals for Children—Philadelphia. Amit Jain, MD; and Paul Sponseller, MD: Johns Hopkins Hospital. Baron Lonner, MD: Mount Sinai Hospital. Benjamin Roye, MD; Larry Lenke, MD; Michael Vitale, MD; and Ron Lehman, MD: Columbia University. Burt Yaszay, MD; Peter Newton, MD; and Vidyadhar Upasani, MD: Rady Children's Hospital. Chris Reilly, MD; and Firoz Miyanji, MD: BC Children's Hospital. Daniel Hedequist, MD; and Michael Glotzbecker, MD: Boston Children's Hospital. Daniel Sucato, MD: Texas Scottish Rite Hospital. David Clements, MD: Cooper Bone & Joint Institute New Jersey. Harry Shufflebarger, MD; Stephen George, MD; and Tom Errico, MD: Nicklaus Children's Hospital. Jack Flynn, MD; and Patrick Cahill, MD: Children's Hospital of Philadelphia. Jahangir Asghar, MD: Cantor Spine Institute. Jean Marc Mac-Thiong, MD; and Stefan Parent, MD: CHU Sainte-Justine. Juergen Harms, MD: ETHIANUM Klinik, Heidelberg, Germany. Keith Bachmann, MD; and Mark Abel, MD: University of Virginia. Michael Kelly, MD; and Munish Gupta, MD: Washington University. Michelle Marks, PT, MA: Setting Scoliosis Straight Foundation. Nicholas Fletcher, MD: Emory University. Peter Gabos, MD; and Suken Shah, MD: Nemours/Alfred I. duPont Hospital for Children. Peter Sturm, MD: Cincinnati Children's Hospital. Randal Betz, MD: Institute for Spine & Scoliosis.

Funding

No funding was received for this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA

    K. Aaron Shaw

  2. Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA

    Keith Orland

  3. Department of Pediatric Orthopaedic Surgery, Rady Children’s Hospital, San Diego, CA, USA

    Tracey P. Bastrom & Peter O. Newton

  4. Department of Pediatric Orthopaedic Surgery, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA

    Nicholas D. Fletcher

Authors
  1. K. Aaron Shaw
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  2. Keith Orland
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  3. Tracey P. Bastrom
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  4. Peter O. Newton
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  5. Nicholas D. Fletcher
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Consortia

Harms Study Group

  • Aaron Buckland
  • , Amer Samdani
  • , Joshua Pahys
  • , Steven Hwang
  • , Amit Jain
  • , Paul Sponseller
  • , Baron Lonner
  • , Benjamin Roye
  • , Larry Lenke
  • , Michael Vitale
  • , Ron Lehman
  • , Burt Yaszay
  • , Peter Newton
  • , Vidyadhar Upasani
  • , Chris Reilly
  • , Firoz Miyanji
  • , Daniel Hedequist
  • , Michael Glotzbecker
  • , Daniel Sucato
  • , David Clements
  • , Harry Shufflebarger
  • , Stephen George
  • , Tom Errico
  • , Jack Flynn
  • , Patrick Cahill
  • , Jean Marc Mac-Thiong
  • , Stefan Parent
  • , Juergen Harms
  • , Keith Bachmann
  • , Mark Abel
  • , Michael Kelly
  • , Munish Gupta
  • , Michelle Marks
  • , Nicholas Fletcher
  • , Peter Gabos
  • , Suken Shah
  • , Peter Sturm
  •  & Randal Betz

Contributions

KAS: study design, data analysis, data interpretation, manuscript drafting, manuscript approval, accountable. KO: study design, data analysis, manuscript approval, accountable. TPB: study design, data analysis, manuscript editing, manuscript approval, accountable. PON: study design, data interpretation, manuscript editing, manuscript approval, accountable. NDF: study design, data analysis, manuscript editing, manuscript approval, accountable.

Corresponding author

Correspondence to Nicholas D. Fletcher.

Ethics declarations

Conflict of interest

Dr. Shaw is a committee member for NASS and AAOS; Dr. Orland reports nothing to disclose; Ms. Bastrom reports nothing to disclose; Dr. Newton is a consultant for Depuy, Globus Medical, Mirus, Pacira, Stryker, receives IP royalties from Depuy and Stryker, is a paid speaker for Medtronic, receives publishing royalties from Thieme, receives research support from Depuy, EOS Imaging, Medtronic, Nuvasive, Stryker, and Zimmer Biomet, is a committee member for Harms Study Group, International Pediatric Orthopedic Think Tank, Setting Scoliosis Straight Foundation; Dr. Fletcher is a consultant for Medtronic, a paid speaker for Zimmer, Nuvasive, Orthopediatrics, and Medtronic, is a board member for SRS and POSNA and serves on the editorial board for JPOSNA. All authors read and approved the final manuscript.

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Shaw, K.A., Orland, K., Bastrom, T.P. et al. 1- vs. 2-year follow-up after posterior spinal fusion for AIS: what additional information is gained?. Spine Deform 10, 1359–1366 (2022). https://doi.org/10.1007/s43390-022-00555-z

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  • DOI: https://doi.org/10.1007/s43390-022-00555-z

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