Adult scoliosis surgery outcomes: a systematic review

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Appreciation of the optimal management of skeletally mature patients with spinal deformities requires understanding of the natural history of the disease relative to expected outcomes of surgical intervention. Appropriate outcome measures are necessary to define the surgical treatment. Unfortunately, the literature lacks prospective randomized data. The majority of published series report outcomes of a particular surgical approach, procedure, or surgeon. The purpose of the current study was to systematically review the present spine deformity literature and assess the available data on clinical and radiographic outcome measurements.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A systematic review of MEDLINE and PubMed databases was performed to identify articles published from 1950 to the present using the following key words: “adult scoliosis surgery,” “adult spine deformity surgery,” “outcomes,” and “complications.” Exclusion criteria included follow-up shorter than 2 years and mean patient age younger than 18 years. Data on major curve (coronal scoliosis or lumbar lordosis Cobb angle as reported), major curve correction, Oswestry Disability Index (ODI) scores, Scoliosis Research Society (SRS) instrument scores, complications, and pseudarthroses were recorded.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Forty-nine articles were obtained and included in this review; 3299 patient data points were analyzed. The mean age was 47.7 years, and the mean follow-up period was 3.6 years. The average major curve correction was 26.6° (for 2188 patients); for 2129 patients, it was possible to calculate average curve reduction as a percentage (40.7%). The mean total ODI was 41.2 (for 1289 patients), and the mean postoperative reduction in ODI was 15.7 (for 911 patients). The mean SRS-30 equivalent score was 97.1 (for 1700 patients) with a mean postoperative decrease of 23.1 (for 999 patients). There were 897 reported complications for 2175 patients (41.2%) and 319 pseudarthroses for 2469 patients (12.9%).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Surgery for adult scoliosis is associated with improvement in radiographic and clinical outcomes at a minimum 2-year follow-up. Perioperative morbidity includes an approximately 13% risk of pseudarthrosis and a greater than 40% incidence of perioperative adverse events. Incidence of perioperative complications is substantial and must be considered when deciding optimal disease management. Although the quality of published studies in this area has improved, particularly in the last few years, the current review highlights the lack of routine use of standardized outcomes measures and assessment in the adult scoliosis literature.</jats:p></jats:sec>

Comparison of two minimally invasive surgery strategies to treat adult spinal deformity

“…9,25 In our study, the cMIS group suffered fewer major and minor complications, which may reflect the less invasive nature of the techniques used. However, it should be noted that preoperatively the HYB group had a mean of 1.6 more comorbidities than the cMIS group, which certainly could impact the complication rate.…”

“…In comparison, an average 26.6° (range 9.1°-53.1°) of curve correction was reported in a systematic review of open scoliosis surgery. 25 Although the HYB and cMIS groups did not achieve the reported average in the systematic review, the degree of improvement was within the range of reported curve corrections for open surgery. Regarding spinopelvic parameters, the HYB approach resulted in a significant improvement in the LL-PI mismatch; however, there was not a significant change with the cMIS approach.…”

Do benefits overcome the risks related to surgery for adult scoliosis? A detailed analysis of a consecutive case series

“…However, there is a paucity of current peer-reviewed literature addressing the premise that adult spinal deformity patients benefit from surgical treatment [2][3][4]. Yadla et al [8] in a recent systematic review analysed 49 articles reporting data in 3,299 patients, and found only four articles reporting on all specified outcome measures (change in ODI scores before and after surgery, change in SRS scores, curve reduction, complications, and pseudoarthrosis) [9][10][11][12]. The articles analysed reported a huge number of complications, with a pooled incidence of 41.2 % [8].…”

“…Yadla et al [8] in a recent systematic review analysed 49 articles reporting data in 3,299 patients, and found only four articles reporting on all specified outcome measures (change in ODI scores before and after surgery, change in SRS scores, curve reduction, complications, and pseudoarthrosis) [9][10][11][12]. The articles analysed reported a huge number of complications, with a pooled incidence of 41.2 % [8]. Mermer et al [13] reported an overall complication rate of 69 %, with a propensity to sustain more complications for patients undergoing revision surgery with respect to patient undergoing primary surgery [13].…”

Outcome instruments to assess scoliosis surgery

“…In this population, in which pain and disability are two predominating aspects, some researchers [66] suggest using the Oswestry Disability Index and numeral rating scales on back and leg pain in addition to the SRS-22.…”