191. Operative treatment for thoracic adult Scheuermann kyphosis: preoperative disability and surgical outcomes

Abstract

BACKGROUND CONTEXT While there is a substantial amount of information regarding treatment for adolescent Scheuermann kyphosis, little data exists on surgical outcomes for thoracic adult Scheuermann kyphosis (TASK). Comparison of surgical outcomes for TASK to outcomes for adult scoliosis patients may assist patient counseling and formulation of treatment strategies. PURPOSE Evaluate preoperative disability and surgical outcomes for TASK compared to adult scoliosis. STUDY DESIGN/SETTING Retrospective analysis of a prospective multicenter adult spine deformity (ASD) database. PATIENT SAMPLE TASK and adult scoliosis patients with no history of prior spine surgery, enrolled into a multicenter database and subsequently surgically treated. OUTCOME MEASURES Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form Health Survey-36 (SF-36), numeric rating scale (NRS) back and leg pain, Oswestry Disability Index (ODI), neck disability index (NDI). METHODS ASD patients age >18 years enrolled into a prospective multicenter ASD database were evaluated for (1) TASK (as defined by Sorensen's criteria) and (2) no history of spine surgery prior to database enrollment. Following database enrollment, TASK patients were treated surgically, pre- and postoperative demographic, radiographic, patientreported outcome measures, and surgical complications were evaluated and compared to surgically treated adult scoliosis (AS) patients (as defined by Scoliosis Research Society ASD classification) matched according to age, upper instrumented vertebra (UIV), lower instrumented vertebra (LIV) and total levels fused, with minimum 2-year follow-up. RESULTS Twenty of 27 TASK patients eligible for study were evaluated [mean follow-up 2.9 year (2-5 years), age 43.2 years (18.5-78.9), preoperative thoracic kyphosis 74.3° (61.2-107.5°), lumbar lordosis 71.7° (28.2-88.9°). Mean TASK postoperative thoracic kyphosis was 50.6° (41.2-61.4), postoperative lumbar lordosis 62.6 (44.1-89), levels fused 13.8 (11-18)], median UIV= T2, LIV= L3. TASK complication rate was 50% including PJK 5% (n=1), DJK 5% (n=1), and implant failure 10% (n=2). Comparing TASK to matched AS patients, TASK had similar preoperative back pain (6.9 vs 6.4), ODI (37.6 vs 32.7), SRS-22r total (2.8 vs 3.0), SRS-22r self image (2.2 vs 2.6), SF36-PCS (34.6 vs 38.1), and NDI (21.3 vs 24.5), respectively (p>0.05). Postoperative patient reported outcomes were similar for TASK and AS including back pain (4.4 vs 4.2), ODI (24.1 vs 23.8), SRS-22r total (3.6 vs 3.8), SRS-22r self image (3.8 vs 3.8), SF36-PCS (48.7 vs 50.9), and NDI (23.2 vs 23.0), respectively (p>0.05). Postoperative complications were similar for TASK and matched AS including, PJK, DJK, infection, implant failure and revision spine surgery (p CONCLUSIONS Evaluation of surgically treated TASK patients matched to adult scoliosis according to age, UIV and LIV demonstrates TASK has a negative impact on pain, disability, and self image analogous to adult scoliosis. Surgical treatment for TASK demonstrates excellent improvements in pain and self-image, with similar associated postoperative complication rates at minimum two-year follow-up as adult scoliosis. Treating physicians should be cognizant of the negative impact TASK can have on quality of life and responsiveness to surgical treatment. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.