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  • Surgery for Idiopathic Scoliosis in Adolescents versus Young Adults: A Matched Cohort Analysis

    Final Number:
    367

    Authors:
    Ian G. Dorward MD; Lawrence Lenke MD; Keith Bridwell MD; Kathleen McCoy MD; Terrence F. Holekamp MD, PhD; Brian J Neuman MD; Kevin O'Neill BA; Wilson Zachary Ray MD; Brenda A. Sides MA; Linda A. Koester BS

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: It is unknown if outcomes differ between adolescents and young adults with idiopathic scoliosis (IS) when extent of surgery (i.e. instrumented levels) is similar. We compared adolescents versus young adults matched for instrumented/fused levels.

    Methods: Two groups of 59 patients with IS [adolescents 10-18 (“AIS”) vs young adults 19-39 (“YAIS”)] were matched from a prospectively-enrolled database 1:1 on the basis of gender (76% females in each group) and instrumented levels (mean 10.9 levels in each). Only posterior-only, pedicle screw constructs ending at/above L5 were included. Operative data, radiographs, complications, and SRS-30 scores were compared at preop, 2-yr postop, and final f/u (3.67 yrs AIS, 3.61 yrs YAIS).

    Results: OR time (mean 274min AIS vs 280min YAIS, P=.92) and EBL (534mL AIS vs 605mL YAIS, P=.63) did not differ. AIS had greater reduction than YAIS in Cobb angles for MT curves (56° to 18° AIS vs 50° to 29° YAIS, P=.002), TL/L curves (38° to 10° for AIS vs 38° to 22° for YAIS, P=.04), and coronal balance (20mm to 7mm for AIS vs 14mm to 17mm for YAIS, P=.0002) at final f/u. Complications occurred in over twice as many YAIS [11 (19%)] as AIS [5 (8%)], though this was not significant (P=.11). YAIS began with worse SRS scores in all domains except mental health, but there were no differences in postop change (Subscores: AIS—3.98 improved to 4.44 postop; YAIS—3.64 improved to 4.15 postop; P=.0002 preop and P=.69 for difference between groups in final postop change)( Figure 1).

    Conclusions: AIS gained more correction of MT and TL/L curves and coronal balance than YAIS. SRS scores for YAIS were lower preop but not different in postop improvement. YAIS had more complications, though this was not statistically significant. These results are important for discussion when AIS pts consider delaying surgery until their young adult life.

    Patient Care: Patients with adolescent idiopathic scoliosis (AIS) frequently present to a clinician with deformities that are severe enough for operative therapy to be a valid option but not an imperative. At this point, these patients may opt for conservative management, with the understanding that if their curves progress or lead to pain or advanced degeneration in adulthood, they may need to have surgery in the future. To date, we have lacked valid data to counsel these patients on the relative risks of delaying surgery, in terms of the differential complication rates or radiographic success rates for these procedures in young adults versus adolescents. The data from this study help surgeons to counsel their patients that surgery for idiopathic scoliosis in young adults may carry a somewhat greater complication rate and will likely not be as effective for radiographic correction, but will probably yield a similar degree of success in terms of self-reported outcomes.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Note that both adolescents and young adults experience significant improvements in SRS-30 scores following surgery for idiopathic scoliosis, but that there is no difference between groups; 2) Recognize that young adults in our series did experience over twice as many complications as adolescents, though the difference was not statistically significant; 3) Note that young adults experienced inferior radiographic corrections of their curves compared with adolescents following surgery for idiopathic scoliosis.

    References: Enercan M, Acaroglu E, Alanay A, Pellise F, Ozturk C, Kochai A, Kahraman S, Sanli T, Hamzaoglu A. Comparison of Outcomes of Surgery Performed in the Second Decade vs. the Third and Fourth Decades for Idiopathic Scoliosis. Paper #26, Scoliosis Research Society 47th Annual Meeting, Chicago, IL, Sept. 6, 2012.

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