Long-term Outcomes of Anterior Spinal Fusion With Instrumentation for Thoracolumbar and Lumbar Curves in Adolescent Idiopathic Scoliosis

Abstract

A retrospective review of the long-term clinical and radiographic outcomes of anterior spinal fusion with instrumentation for thoracolumbar and lumbar curves in adolescent idiopathic scoliosis (AIS). To evaluate a group of patients based on Scoliosis Research Society (SRS)-30 and Oswestry data as well as radiographic and magnetic resonance imaging (MRI) and report the results of long-term follow-up of this surgical treatment for this particular curve pattern in AIS. Anterior spinal fusion with instrumentation has been used for many years in the treatment of thoracolumbar and lumbar curves in AIS. However, the long-term radiographic and functional outcomes of this procedure are not well known. During 1984 to 1995, 31 patients with the diagnosis of AIS underwent anterior spinal instrumentation and fusion for thoracolumbar or lumbar scoliosis at our institution. A retrospective review of this patient group was performed to evaluate patient satisfaction, functional outcome, curve progression, implant failure, and disc degeneration. Radiographs and lumbar MRIs were obtained along with SRS-30 Questionnaire and Oswestry Disability Index data. Eighteen patients were available for review. Average follow-up for this study was 16.97 years. Based on SRS-30 and the Oswestry Disability Index data, most patients had good function scores and acceptable pain levels. Radiographs demonstrated no progression of the thoracolumbar or thoracic curves. Implant failure was identified in 2 patients. Radiographic changes of early degenerative disc disease were identified in most patients but had no correlation with SRS or Oswestry data. These degenerative changes were evident on both radiographs and MRI. The anterior approach in the treatment of thoracolumbar and lumbar curves in AIS offers good long-term functional outcomes for patients. Despite expected degenerative changes, patients scored well on the SRS and Oswestry tests, and were able to pursue careers and family activities.