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

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Abstract

Study design

Prospective registry.

Summary of background data

The evolution of spinal instrumentation has provided better outcomes 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)-22 scores 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.

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Acknowledgements

This study was supported in part by grants to the Setting Scoliosis Straight Foundation from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive and Zimmer Biomet in support of Harms Study Group research. Harms Study Group Investigators Aaron Buckland, MD: New York University; Amer Samdani, MD: Shriners Hospitals for Children—Philadelphia; Amit Jain, MD: Johns Hopkins Hospital; Baron Lonner, MD: Mount Sinai Hospital; Benjamin Roye, MD: Columbia University; Burt Yaszay, MD: Rady Children’s Hospital; Chris Reilly, MD: BC Children’s Hospital; Daniel Hedequist, MD: Boston Children’s Hospital; Daniel Sucato, MD: Texas Scottish Rite Hospital; David Clements, MD: Cooper Bone & Joint Institute New Jersey; Firoz Miyanji, MD: BC Children’s Hospital; Harry Shufflebarger, MD: Nicklaus Children’s Hospital; Jack Flynn, MD: Children’s Hospital of Philadelphia; Jahangir Asghar, MD: Cantor Spine Institute; Jean Marc Mac Thiong, MD: CHU Sainte-Justine; Joshua Pahys, MD: Shriners Hospitals for Children—Philadelphia; Juergen Harms, MD: Klinikum Karlsbad-Langensteinbach, Karlsbad; Keith Bachmann, MD: University of Virginia; Larry Lenke, MD: Columbia University; Mark Abel, MD: University of Virginia; Michael Glotzbecker, MD: Boston Children’s Hospital; Michael Kelly, MD: Washington University; Michael Vitale, MD: Columbia University; Michelle Marks, PT, MA: Setting Scoliosis Straight Foundation; Munish Gupta, MD: Washington University; Nicholas Fletcher, MD: Emory University; Patrick Cahill, MD: Children’s Hospital of Philadelphia; Paul Sponseller, MD: Johns Hopkins Hospital; Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children; Peter Newton, MD: Rady Children’s Hospital; Peter Sturm, MD: Cincinnati Children’s Hospital; Randal Betz, MD: Institute for Spine & Scoliosiscba; Ron Lehman, MD: Columbia University; Stefan Parent, MD: CHU Sainte-Justine; Stephen George, MD: Nicklaus Children’s Hospital; Steven Hwang, MD: Shriners Hospitals for Children—Philadelphia; Suken Shah, MD: Nemours/Alfred I. duPont Hospital for Children; Tom Errico, MD: Nicklaus Children’s Hospital; Vidyadhar Upasani, MD: Rady Children’s Hospital.

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Authors and Affiliations

  1. Orthopedics and Scoliosis Division, Rady Children’s Hospital, 3020 Children’s Way, MC 5062, San Diego, CA, 92123, USA

    Peter O. Newton, Tracey P. Bastrom, Carrie E. Bartley & Burt Yaszay

  2. Department of Orthopedic Surgery, University of California, San Diego, CA, USA

    Peter O. Newton & Burt Yaszay

  3. Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan

    Masayuki Ohashi

  4. Setting Scoliosis Straight Foundation, San Diego, CA, USA

    Michelle C. Marks

  5. Institute for Spine and Scoliosis, Lawrenceville, NJ, USA

    Randal Betz

  6. Department of Orthopedics, Columbia University, New York, NY, USA

    Lawrence G. Lenke

  7. Cooper Bone & Joint Institute, Camden, NJ, USA

    David Clements

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  1. Peter O. Newton
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Contributions

PON, MO, TPB, CEB, BY, MCM, RB, LGL and DC: conception or design of the work; or acquisition, analysis, or interpretation of data for the work; drafting or critically revising the work; final approval of the version to be published

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Correspondence to Peter O. Newton.

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Newton, P.O., Ohashi, M., Bastrom, T.P. et al. Prospective 10-year follow-up assessment of spinal fusions for thoracic AIS: radiographic and clinical outcomes. Spine Deform 8, 57–66 (2020). https://doi.org/10.1007/s43390-019-00015-1

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