Clinical Spine Fellow University at Buffalo Neurosurgery Buffalo, NY, US
Introduction: Prior studies emphasize the importance of age-adjusted radiographic thresholds for surgical planning. There is a need to better understand the radiographic and clinical outcomes following surgical intervention for adult idiopathic scoliosis (AdIS). The primary goal of our study was to evaluate the long-term clinical and radiographic outcomes of surgically treated AdIS including the evaluation of age-adjusted correction. Additionally, we reported the demographics of patients and evaluated indications for surgery.
Methods: A systematic MEDLINE/PubMed database search was performed based on PRISMA guidelines. Study characteristics, patient description, longitudinal radiographic, and patient outcomes assessment data were extracted. Age-adjusted thresholds were compared to actual radiographic results. Meta-analysis assessed radiographic change and longitudinal clinical outcomes. Subgroup analysis dichotomized by age was conducted on significant radiographic changes.
Results: Twenty-six studies with 1,438 patients were included, with a mean follow-up time of 4.5 years. The mean Cobb angle was 31.5º and was maintained at follow-up (p <.0001). AdIS patients had low-normal baseline thoracic kyphosis (TK), with no malalignment on pelvic tilt (PT), pelvic incident (PI), sagittal vertical axis (SVA), and lumbar lordosis (LL). There was a 51.1% improvement in pain intensity, but no change in SRS (p = .09; I2 = 0) or ODI (p = .2; I2 = 98.2) at follow-up. There was a high level of congruency of sagittal balance (74.2%), moderate for PT (57.8%), and low for PI-LL (19.7%).
Conclusion : AdIS patients present with seemingly normal preoperative alignment. Surgical intervention improves pain severity and maintains functional disability, but greater knowledge regarding functional and HRQoL outcomes is necessary. Modest coronal corrections were achieved and maintained at follow-up. With age-adjusted thresholds, there was a high level of congruency of sagittal balance, moderate for PT, and low for PI-LL. Further studies evaluating age-adjusted spinal pelvic parameters and clinical outcomes are necessary.