A Comparison Between the Perioperative Outcomes of Female Adolescent Idiopathic Scoliosis (AIS) Versus Adult Idiopathic Scoliosis (AdIS) Following Posterior Spinal Fusion: A Propensity Score Matching Analysis Involving 425 Patients

Abstract

Study Design: Retrospective propensity score matching (PSM) study. Objective: To investigate the perioperative outcomes comparing adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) patients following posterior spinal fusion (PSF). Methods: 425 female AIS and AdIS patients who were operated (between January 2015 to March 2020) using a dual attending surgeon strategy were stratified into G1 (AIS aged 10-16 years old) and G2 (AdIS > 20 years old). PSM analysis with one-to-one, nearest neighbor matching technique with match tolerance of 0.001 was used to matched 357 AIS patients to 68 AdIS patients. Operation duration, intraoperative blood loss (IBL), blood loss percentage, hemoglobin drift, blood salvaged, postoperative wound length, allogenic blood transfusion requirement, postoperative hospital stay, postoperative Cobb, correction rate and postoperative complications were documented and reported. Results: Following PSM, G1 and G2 each had 50 patients with comparable and balanced covariates. As anticipated, G2 patients were heavier, taller and had higher body mass index compared to G1 patients ( P < 0.05). We could not find any significant differences in the perioperative outcome comparing this 2 groups. AIS and AdIS patients had similar operation duration (125.9 ± 27.2 min vs 127.3 ± 37.8 min), IBL (749.8 ± 315.7 ml vs 723.8 ± 342.1 ml) and length of hospital stay (3.3 ± 0.4 days vs 3.5 ± 0.8 days) ( P > 0.05). Hemoglobin drift and amount of blood salvaged were comparable ( P > 0.05). G2 had stiffer curves. There was a trend toward a lower correction rate in G2 in the immediate postoperative period, however it did not reach statistical significance (61.8 ± 11.2% vs. 66.3 ± 11.6%, P = 0.051). No patients required blood transfusion and none had any postoperative complications. Conclusion: Adolescent and adult female scoliosis patients had comparable perioperative outcome following PSF surgery that was carried out using a dual attending surgeon strategy.

MRI T2WI High Signal Is a Risk Factor for Perioperative Complications in Patients with Cervical Spondylosis with Spinal Cord Compression: A Propensity Matching Score Analysis

“…The use of PSM (propensity score matching) analysis in our clinical study allowed for a good correction of selectivity bias, which was confirmed in many previous studies [18][19][20][21]. SPSS used version 22.0 (SPSS, Inc., Chicago, IL, USA), and P value < 0.05 was considered statistically significant.…”

Hi-PoAD technique for Adolescent Idiopathic Scoliosis in Adult: Personal case series

“…The triplanar correction rate of the technique proved to be really efficient with excellent correction rates in terms of coronal and sagittal correction (70.1% correction of the main curve, 57.9% increase in TK and 32% increase in LL). Indeed, the obtained 70.1% of coronal correction is superior to the higher percentage of correction observed in the literature [2,5,13,20]. Only Zhu et al [21] reported similar correction rates (up to 71%) but in younger patients (22.2 years old) with flexible curves (curve flexibility of 48%).…”

“…Hi-PoAD technique, although technically demanding, resulted in average operative time and blood loss equal or inferior to the principal case series dealing with AdIS [2,5,13,20,21]. It also proved to be efficient in respect surgical planning, with no need to extent the fusion area due to screw pull-out at the most cephalad and caudal levels, meaning that the procedure is really effective in dissipating corrective forces avoiding intra-operative mechanical complications.…”

“…Another issue is represented by the corrective manoeuvre. The majority of the studies reporting outcomes after AdIS focuses on osteotomies, without extensive description of the applied manoeuvre [2,5,13,20,21]. A combined manoeuvre, mixing column translation over differently moulded rods simultaneously applied, DVR and selective compression and distraction at periapical levels are fundamental in author's opinion to obtain satisfactory results.…”

“…Adult Idiopathic Scoliosis (AdIS) is as an Adolescent Idiopathic Scoliosis (AIS) of the thoracic and/or lumbar spine which progresses in adult life (Aebi type 2), usually combined with secondary degeneration and/or imbalance [1]. Despite adult life is defined as starting at the end of the growing period, the strategies of surgical correction of AdIS can be effectively inspired from those adopted in AIS in the second and third decade of life [2]. The main features of Aebi type 2 AdIS usually occur from the fourth decade of life with worsening of the main curve (in terms of angular value, as well as stiffness) and structural changes of compensatory curves [3].…”