The safety and efficacy of one-stage posterior surgery in the treatment of presumed adolescent idiopathic scoliosis associated with intraspinal abnormalities a minimum 3-year follow-up comparative study.

Abstract

Adolescent idiopathic scoliosis (AIS) is a common type of idiopathic scoliosis. Previous studies reported that the incidence of intraspinal abnormalities among the presumed idiopathic scoliosis was 13-43%. Intraspinal abnormalities were also considered increasing the risks of progressing of scoliosis and neurological complications following scoliosis corrective surgery. The surgical strategy of presumed adolescent idiopathic scoliosis (PAIS) associated with intraspinal abnormalities remains controversial. The purpose of this study was to investigate whether one-stage posterior surgery safe and effective for the PAIS patients associated with intraspinal abnormalities. One hundred and thirteen consecutive patients who underwent one-stage posterior correction surgery were included. Thirty PAIS patients with intraspinal abnormalities without preoperative neurological symptoms were matched with eighty-three AIS patients for sex, age, blood loss, operating time, number of levels and location of instrumentation and curve magnitude. Radiographic and clinical parameters of the patients were evaluated before surgery, within 1 week after surgery, and more than 3 years at the last follow-up for complications and changes in main curve correction, global coronal balance, thoracic kyphosis, sagittal vertical axis, and ODI scores. On average, the duration of follow-up was 51.5months in the PAIS group compared to 52.5months in the AIS group. The preoperative mean major coronal curve was 79.6° (ranged 56.2°-106.7°) and improved to 22.4° (ranged 6.4°-58.1°) at the last follow-up for a 71.9% of correction in the AIS group. The preoperative mean major coronal curve was 80.4° (ranged 63.4°-108.1°) and improved to 23.2° (ranged 4.8°-66.2°) at the last follow-up for a 71.1% of correction in PAIS group. The preoperative ODI score was 32.4 (10-42) in the PAIS group and improved to 11.4 (4-22) at last follow-up, 33.4 (12-42) in the AIS group and improved to 11.5 (5-22) at last follow-up. The global coronal balance, TK and SVA were all significantly improved after surgery and maintained to the last follow-up in the two groups. The neurological complications were observed in 3.3% of PAIS patients and 3.6% of AIS patients. No statistical difference in the parameters between the two groups was observed at the last follow-up. One-stage posterior corrective surgery is safe and effective in PAIS patients associated with intraspinal abnormalities without preoperative neurological symptoms. Surgical guidelines of AIS are appropriate for the treatment of PAIS patients associated with intraspinal abnormalities.