212. Operative treatment of adult spinal deformity patients with severe scoliosis: retrospective review of a prospectively collected multicenter series with minimum 2-year follow up

Abstract

BACKGROUND CONTEXT Prior studies have demonstrated potential benefits of adult spinal deformity (ASD) surgery, but less outcomes data exist for operative ASD patients with severe scoliotic curves (thoracic [TH] curve ≥75°, thoracolumbar [TL] curve ≥50°, or lumbar [LL] curve ≥50°). Also, the surgical complication profile is less clear for this subset of patients with severe scoliotic deformity and warrants focused investigation. PURPOSE The objective of the current study was to assess treatment outcomes and complication rates associated with ASD surgery in patients with severe scoliosis. STUDY DESIGN/SETTING Retrospective review of a prospectively collected multicenter consecutive case registry PATIENT SAMPLE Enrollment required: age ≥18 yrs, scoliosis ≥20°, sagittal vertical axis (SVA) ≥5cm, pelvic tilt ≥25°, and/or thoracic kyphosis ≥60°. OUTCOME MEASURES Standard coronal and sagittal spinopelvic deformity measurements and health-related quality of life (HRQL) outcomes, which included Oswestry Disability Index (ODI), Short Form-36 (SF-36) scores, and Scoliosis Research Society-22 (SRS-22) scores. METHODS Using a prospective multicenter database, we identified surgically treated ASD patients with severe scoliosis (TH Cobb ≥75° or TL/LL Cobb ≥50°) and minimum 2-yr follow-up. Demographic data, surgical characteristics, radiographic alignment measurements, HRQL outcomes and associated complications were analyzed. RESULTS Of 178 patients, 146 (82%, mean age 54 yrs, 92% women, 88 TL, 50 LL, 8 TH) had minimum 2-yr follow-up (mean=3.1 yrs). Almost 30% had prior spine fusion, 6% were active or past smokers, 16% had osteoporosis and 77% had at least 1 comorbidity. Surgical details included: posterior-only (58%) or anterior-posterior approach (42%), SPO (65%), 3CO (14%), TLIF (23%), ALIF (37%), sacropelvic fixation (76%), upper thoracic UIV (64%) and mean posterior fusion length of 13.2 levels. Postoperative coronal alignment improved significantly for all patients (global coronal alignment 3.8 to 2.8 cm, p CONCLUSIONS Surgery for severe adult scoliosis is associated with significant improvement in radiographic alignment and HRQL measures. Although associated complication rates are high, these appear to be comparable to reports of less severe scoliosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.