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European Spine Journal

, Volume 22, Supplement 6, pp 795–802 | Cite as

Do benefits overcome the risks related to surgery for adult scoliosis? A detailed analysis of a consecutive case series

  • Giovanni Barbanti BròdanoEmail author
  • Silvia Terzi
  • Alessandro Gasbarrini
  • Stefano Bandiera
  • Christiano Simoes
  • Stefano Boriani
Original Article

Abstract

Purpose

The surgical approach to adult spine deformities is complex and presents a high incidence of complications.

Methods

We report here a prospective consecutive case series analysis of 20 patients submitted to posterior correction and instrumented fusion for adult degenerative scoliosis. Clinical outcomes were assessed by self-reported measures. Pre-operative and post-operative complications were analysed during a mean 30-month follow-up period.

Results

Eleven patients (55 %) presented pre-operative or post-operative complications. Fifteen different complications occurred, six in the early pre-operative period and nine during follow-up period: ten of these complications occurred in patients who underwent a previous surgery for spine disease.

Conclusions

The clinical improvement at the final follow-up resulted as statistically significant only for the group of patients exposed to posterior fusion without interbody fusion. The observations reported here have to be considered for a shared decision-making in the management of adult scoliosis.

Keywords

Adult degenerative scoliosis Posterior instrumented arthrodesis Posterior lumbar interbody fusion (PLIF) Transforaminal lumbar interbody fusion (TLIF) Pre-operative and post-operative complications 

Notes

Acknowledgments

The authors would like to thank Dr. Cristiana Griffoni for her helpful contribution in manuscript editing and Carlo Piovani for his helpful collaboration in patients’ images storage and editing.

Conflict of interest

None.

References

  1. 1.
    Aebi M (2005) The adult scoliosis. Eur Spine J 14:925–948PubMedCrossRefGoogle Scholar
  2. 2.
    Smith JS, Shaffrey CI, Berven S et al (2009) Operative versus non operative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-years follow up. Spine 34:1693–1698PubMedCrossRefGoogle Scholar
  3. 3.
    Smith JS, Shaffrey CI, Berven S et al (2009) Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery 65:86–93PubMedCrossRefGoogle Scholar
  4. 4.
    Bridwell KH, Berven S, Edwards C II et al (2007) The problems and limitations of applying evidence-based medicine to primary surgical treatment of adult spinal deformity. Spine 32:S135–S139PubMedCrossRefGoogle Scholar
  5. 5.
    Cho KJ, Suk SI, Park SR, Kim JH, Kim SS, Choi WK, Lee KY, Lee SR (2007) Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine (Phila Pa 1976) 32:2232–2237CrossRefGoogle Scholar
  6. 6.
    Zimmerman RM, Mohamed AS, Skolasky RL, Robinson MD, Kebaish KM (2010) Functional outcomes and complications after primary spinal surgery for scoliosis in adults aged forty years or older. Spine 35:1861–1866PubMedCrossRefGoogle Scholar
  7. 7.
    Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL, Horton WC, Ondra SL, Sansur CA, Bridwell KH (2011) The spinal deformity study group. Risk-benefit assessment of surgery for adult scoliosis. Spine 36:817–824PubMedCrossRefGoogle Scholar
  8. 8.
    Yadla S, Maltenfort MG, Ratliff JK, Harrop JS (2010) Adult scoliosis surgery outcomes: a systematic review. Neurosurg Focus 28:E3PubMedCrossRefGoogle Scholar
  9. 9.
    Bridwell KH, Lewis SJ, Edwards C, Lenke LG, Iffrig TM, Berra A et al (2003) Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine (Phila Pa 1976) 28:2093–2101CrossRefGoogle Scholar
  10. 10.
    Shapiro GS, Taira G, Boachie-Adjei O (2003) Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis: a study of long-term clinical radiographic outcomes. Spine (Phila Pa 1976) 28:358–363Google Scholar
  11. 11.
    Buchowski JM, Bridwell KH, Lenke LG, Kuhns CA, Lehman RA Jr, Kim YJ et al (2007) Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine (Phila Pa 1976) 32:2245–2252CrossRefGoogle Scholar
  12. 12.
    Kim YJ, Bridwell KH, Lenke LG, Cheh G, Baldus C (2007) Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976) 32:2189–2197CrossRefGoogle Scholar
  13. 13.
    Mermer MJ, Boachie-Adjei O, Rawlins BA, Peskin M, Bhatnagar R (2006) Comprehensive analysis of cantilever, translational, and modular correction techniques in adults with scoliosis treated with surgery to the sacropelvis. J Spinal Disord Tech 19:513–522PubMedCrossRefGoogle Scholar
  14. 14.
    Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D (2012) Complication and risk factors of primary adult scoliosis surgery. Spine 37:693–700PubMedCrossRefGoogle Scholar
  15. 15.
    Glassman SD, Schwab F, Bridwell KH, Shaffrey C, Horton W, Hu S (2009) Do 1-year outcomes predict 2-year outcomes for adult deformity surgery? Spine J 9:317–322PubMedCrossRefGoogle Scholar
  16. 16.
    Sansur CA, Smith JS, Coe JD, Glassman SD, Berven SH, Polly DW Jr, Perra JH, Boachie-Adjei O, Shaffrey CI (2011) Scoliosis Research Society—Morbidity and mortality of adult scoliosis surgery. Spine (Phila Pa 1976) 36:E593–E597CrossRefGoogle Scholar
  17. 17.
    Wu CH, Wong CB, Chen LH, Niu CC, Tsai TT, Chen WJ (2008) Instrumented posterior lumbar interbody fusion for patients with degenerative lumbar scoliosis. J Spinal Disord Tech 21:310–315PubMedCrossRefGoogle Scholar
  18. 18.
    Crandall DG, Revella J (2009) Transforaminal lumbar interbody fusion versus anterior lumbar interbody fusion as an adjunct to posterior instrumented correction of degenerative lumbar scoliosis: three year clinical and radiographic outcomes. Spine (Phila Pa 1976) 34:2126–2133CrossRefGoogle Scholar
  19. 19.
    Li F, Chen Q, Chen W, Xu K, Wu Q (2011) Posterior-only approach with selective segmental TLIF for degenerative lumbar scoliosis. J Spinal Disord Tech 24:308–312PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Giovanni Barbanti Bròdano
    • 1
    Email author
  • Silvia Terzi
    • 1
  • Alessandro Gasbarrini
    • 1
  • Stefano Bandiera
    • 1
  • Christiano Simoes
    • 2
  • Stefano Boriani
    • 1
  1. 1.Department of Oncologic and Degenerative Spine SurgeryRizzoli Orthopaedic InstituteBolognaItaly
  2. 2.Spine Surgery Unit, Department of Orthopedics and TraumatologyHospital Felício RochoBelo HorizonteBrazil

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