Functional and Radiographic Outcomes after Surgery for Adult Scoliosis Using Third Generation Instrumentation Techniques

Raed M. Ali, MD,
Oheneba Boachic–Adjei, MD,
Bernard A. Rawlins. MD
* (c– DePuy–AcroMed)

PURPOSE:
To assess patient outcomes after surgery for adult scoliosis using traditional radiographic parameters along with a self perceived outcomes questionnaire.

METHODS:
Records and radiographs were retrospectively reviewed for all patients undergoing corrective surgery for adult idiopathic scoliosis between Dec. 30, 1994 and Dec 30, 1997. Inclusion criteria were: age>20, primary surgery, fusion above the sacrum, availability of medical records along with pre–op, post–op, and 2 year follow–up radiographs. Additionally, a self–perceived–outcomes questionnaire was administered to these patients at minimum 2 year follow–up.

RESULTS:
Patients were all female (28/28). The indications for surgery were pain + progression in 54% (15/28), pain in 29% (8/28), progression in 14% (4/28), and radiculopathy in 4% (1/28). Curve types were lumbar in 14% (4/28), thoracic in 32% (9/28), thoracolumbar in 14% (4/28), and double major in 39% (11/28). The average pre–op major curve measurement was 65° (38–98), with an avg. bending to 42° (11–85) or corr. of 38%. The avg. post–op major curve measurement was 24° (5–59) or a corr. of 64%. The average f/u curve measurement was 27° (3–60), for a corr. of 6l%. The avg. pre–op, post–op, and f/u thoracic kyphosis/lumbar lordosis were: 40° (19–75)/48° (16–74), 38° (20–74)/49° (22–74), and 41° (24–66)/46° (21–70) respectively. 71% of cases were ant. + post. And 29% were post. only. There was 1/28 intra–operative complication, a dural tear, which was repaired without sequelae. There were 4 post–op complications in 3 patients: a superficial wound infection requiring I&D + IV antibiotics, a dislodged femoral ring interbody graft requiring replacement, and 2 cases of junctional degeneration requiring extension to the sacrum. The average number of hospital days was 11 (4–28). The self–perceived outcome questionnaires were available for 83% (23/28) of patients. Definite or probable relief of symptoms were reported in 74% (17/23). Definite or probable improved ability to perform ADLs were reported in 70% (16/23), improved ability to sleep was reported in 61% (14/23), ability to return to their usual job was reported in 57% (13/23) and the return to exercise and recreational activities was reported in 74% (17/23). Satisfaction with the results of surgery was reported in 87% (20/23) and 78% (18/23) stated they would definitely have the surgery again in retrospect, while 17% (4/23) stated they would probably have the surgery again.

CONCLUSION:
Surgery for adult idiopathic scoliosis using third generation instrumentation techniques provide significant clinical improvement, scoliosis correction, sagittal alignment, and patient satisfaction with an acceptable complication rate.

* If noted, the author indicates something of value received. The codes are identified as: a research or institutional support, b–miscellaneous funding, c–royalties, d–stock options, e–consultant.