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Surgery for the Adolescent Idiopathic Scoliosis Patients After Skeletal Maturity: Early Versus Late Surgery

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Abstract

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.

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Author information

Authors and Affiliations

  1. Mount Sinai Hospital, 1468 Madison Ave, New York, NY, 10029, USA

    Baron S. Lonner MD & Yuan Ren PhD

  2. Denver International Spine Clinic, 1601 E 19th Ave #6250, Denver, CO, 80218, USA

    Shay Bess MD

  3. Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA

    Michael Kelly MD

  4. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Han Jo Kim MD & Virginie Lafage PhD

  5. Rady Children’s Hospital San Diego, 3020 Children’s Way, San Diego, CA, 92123, USA

    Burt Yaszay MD, Michelle Marks PT, MA & Peter O. Newton MD

  6. British Columbia Children’s Hospital, 4480 Oak St, Vancouver, BC, V6H 3N1, Canada

    Firoz Miyanji MD

  7. University of Virginia Medical Center, 1215 Lee Street, Charlottesville, VA, 22903, USA

    Christopher I. Shaffrey MD

Authors
  1. Baron S. Lonner MD
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  2. Yuan Ren PhD
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  3. Shay Bess MD
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  4. Michael Kelly MD
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  5. Han Jo Kim MD
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  6. Burt Yaszay MD
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  7. Virginie Lafage PhD
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  8. Michelle Marks PT, MA
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  9. Firoz Miyanji MD
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  10. Christopher I. Shaffrey MD
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  11. Peter O. Newton MD
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Corresponding author

Correspondence to Baron S. Lonner MD.

Additional 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 ent “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).

Funding: Research grant funding was received by Setting Scoliosis Straight Foundation to support Harms Study Group’s research.

No Funding support was received for any aspect of the submitted work by the International Spine Study Group. Grants from DePuy were received by the International Spine Study Group for data collection.

IRB Approval: Institutional review board approval was obtained for this study from all participating sites.

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Lonner, B.S., Ren, Y., Bess, S. et al. Surgery for the Adolescent Idiopathic Scoliosis Patients After Skeletal Maturity: Early Versus Late Surgery. Spine Deform 7, 84–92 (2019). https://doi.org/10.1016/j.jspd.2018.05.012

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  • DOI: https://doi.org/10.1016/j.jspd.2018.05.012

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