Operative Treatment of Severe Scoliosis in Symptomatic Adults: Multicenter Assessment of Outcomes and Complications With Minimum 2-Year Follow-up

Abstract

Few reports focus on adults with severe scoliosis. To report surgical outcomes and complications for adults with severe scoliosis. A multicenter, retrospective review was performed on operatively treated adults with severe scoliosis (minimum coronal Cobb: thoracic [TH] ≥ 75°, thoracolumbar [TL] ≥ 50°, lumbar [L] ≥ 50°). Of 178 consecutive patients, 146 (82%; TH=8, TL=88, L=50) achieved minimum 2-yr follow-up (mean age=53.9±13.2 yr, 92% women). Operative details included posterior-only (58%), 3-column osteotomy (14%), iliac fixation (72%), and mean posterior fusion=13.2±3.7levels. Global coronal alignment (3.8 to 2.8 cm, P=.001) and maximum coronal Cobb improved significantly (P≤.020): TH (84º to 57º; correction=32%), TL (67º to 35º; correction=48%), L (61º to 29º; correction=53%). Sagittal alignment improved significantly (P<.001), most notably for L: C7-sagittal vertical axis 6.7 to 2.5 cm, pelvic incidence-lumbar lordosis mismatch 18º to 3º. Health-related quality-of-life (HRQL) improved significantly (P<.001), most notably for L: Oswestry Disability Index (44.4±20.5to 26.1±18.3), Short Form-36 Physical Component Summary (30.2±10.8to 39.9±9.8), and Scoliosis Research Society-22r Total (2.9±0.7 to 3.8±0.7). Minimal clinically important difference and substantial clinical benefit thresholds were achieved in 36% to 75% and 29% to 51%, respectively. Ninety-four (64%) patients had≥1 complication (total=191, 92 minor/99 major, most common=rod fracture [13.0%]). Fifty-seven reoperations were performed in 37 (25.3%) patients, with most common indications deep wound infection (11) and rod fracture (10). Although results demonstrated high rates of complications, operative treatment of adults with severe scoliosis was associated with significant improvements in mean HRQL outcome measures for the study cohort at minimum 2-yr follow-up.