Adolescent Idiopathic Scoliosis: Are There Advantages of Surgical Correction During Adolescence?

International Society for the Advancement of Spine Surgery (ISASS17) Meeting Highlight

Clinical outcomes of patients with adolescent idiopathic scoliosis (AIS) who have undergone surgery during adolescence—defined as <18 years of age—is well researched.  It is generally believed that clinical outcomes differ when correction surgery is instead performed when the patients are young adults (>18 years).
Various file folders, one labeled "Results"Clinical outcomes of patients with adolescent idiopathic scoliosis who have undergone surgery during adolescence is well researched. As noted by Isador H. Lieberman, MD, FRCSC, MBA, at the 17th Annual Conference of International Society for the Advancement of Spine Surgery (ISASS), until now, no studies have directly compared the outcomes. Dr. Lieberman presented results of a retrospective study that compared the surgical outcome of idiopathic scoliosis patients who underwent corrective surgery as young adults (>18 years) with those who had surgery during adolescence. Dr. Lieberman is Director of the Scoliosis and Spine Tumor Center at the Texas Back Institute, in Plano, Texas, where he treats both adolescents and adults with scoliosis.

The study collected and reviewed data from 27 consecutive young adults (ages 19-30 years) and 29 adolescents (11-18 years) with idiopathic scoliosis who underwent corrective surgery between 2010 and 2014 by one of two spine surgeons. Patients who had had previous correction surgery were excluded. The study examined perioperative complications (up to 90 days’ postoperative) and postoperative complications (including additional surgery). Radiographic measurements were obtained preoperatively as well as at the latest follow-up.

Study Results
Patients in the adolescent group ranged in age from 12 to 18 (mean of 15 years), and from 19 to 29 years (mean of 23) in the young adult group. There were no statistically significant differences between the two groups with regard to gender (substantially more females than males), mean body mass index (23.6 in young adults and 22.4 among adolescents), and mean follow-up (23 months for young adults, 20 months for adolescents). Preoperatively, young adult patients reported greater back pain (visual analogue score (VAS) = 5.7) and leg pain (VAS = 1.2) than did adolescents (VAS = 4.5 and 0.8, respectively), but neither represented a significant difference. Similarly, the difference in average preoperative main coronal curve degree did not significantly differ between young adults (53-degrees) and adolescents (57.1-degrees).

Dr. Lieberman reported there were no significant differences between the young adult group and adolescents regarding length of surgery (344 minutes versus 377, respectively) or length of time in the hospital (5.8 days vs 4.9 days, respectively).  However, compared with adolescents, he noted that young adults had significantly more levels fused (10.6 versus 8.9) and greater intra-operative blood loss (872 ml vs 564 ml; both P=0.02). None of the adolescent patients and 2 of the young adult patients had complications, including one wound infection and one wound seroma.

Follow-Up
Patients in both groups had significant correction of their main coronal curve at a mean of 21 months’ follow-up (21.3-degrees vs 53.0-degrees in young adult patients, P<0.001; 18.5-degrees vs 57.1-degrees in adolescent patients, P<0.001). Adolescent patients had significantly greater percentage correction than did young adult patients (68% versus 61%, respectively; P=0.03). No adolescents (0%) and 3 young adult patients (11%; P=0.07) required additional surgeries—one for wound infection, one for wound seroma, and one for hardware prominence.

Conclusions
The study showed that young adult patients who underwent idiopathic scoliosis surgery tend to have more levels fused, a relatively longer hospital stay and relatively higher perioperative complication rate, and lower percentage correction of their main coronal curve when compared with adolescent patients. In addition, young adult patients had a relatively higher rate of additional surgery than the younger, adolescent patients.

Discussing the results of this study, Dr. Lieberman noted that “it appears to be advantageous to address surgical correction of scoliosis in adolescence versus young adulthood—young adults require more levels and achieve less correction. While this is intuitive, this research study was able to confirm our beliefs. Surgery at either age group has the same risks, but provides different outcomes.”

Updated on: 02/08/18
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