Adult Scoliosis: Surgical Outcomes

Abstract

Background: Adult scoliosis is a common spine deformity. It is very debilitating to daily activities of the patients. Surgical management requires a clear assessment of the functional impact of scoliosis, the failure of conservative treatments and precise analysis of radiological investigations (full spine views, dynamic X-rays and MRI). The back pain was the main complaint as it was the main presentation. The aim of the work is to assess the outcomes of surgical procedures in patients with adult scoliosis.
 Methods: This prospective study was conducted on 30 patients with adult scoliosis with cobb angel more than 10 degrees. Surgical techniques (anterior and posterior approaches, decompression, osteotomies, fusion, and instrumentation) done and tailored to each patient. Decompression alone found usually not enough, fusion needed almost in all cases.
 Results: Patient disability using Oswestry disability index assessed before and after intervention. Also a good, accepted change achieved as 15 patients restore about 75% of their abilities ,7 patients restore more than 50% of their usual ability,3 patients restore about 25% of their usual ability. Cobb’s angel before intervention was 6 cases < 60 degrees,14 cases between 50 and 60 degrees and 10 cases between 40 and 50 degrees became 14 cases between 10 and 0 degrees, and 10 cases between 10 and 20 degrees. Surgical treatment of adult scoliosis is associated with a better quality of life for patients when good selection of the patient and maneuvers done. Visual analogue scale before and postoperative, and three and six months later detect ,a good result achieved, As VAS before intervention was ; 20 patients from 9 to 10,9 patients from 6 to 8, one patient from 3 to 5. VAS post-operative after sex months became only four patients from 6 to 8, twenty four patients from 3 to 5and only two patients from 0 to 2.
 Conclusions: Surgical management of adult scoliosis become more applicable, Spine managed as one unit, Correction of coronal and sagittal malalignment done together, Do not neglect one of them. Using both free hand , c arm and even navigator when needed help in good outcomes and complications avoidance, management strategy differ according many factors, The technique requires proper selection of cases before surgery and meticulous attention during surgery to identify the correct starting point, screw orientation and screw length selection. Surgical outcomes of adult scoliosis clinical, radiological and neurological outcome were satisfied without major complications.