Clinical Spine Fellow University at Buffalo Neurosurgery Buffalo, NY, US
Introduction: Surgical indications and management of Adult Idiopathic Scoliosis (AdIS) are not well defined. There is little utility in adolescent thresholds for surgical intervention in the adult population. Surgical management has become more frequent but is associated with high rates of complications.
Methods: A systematic MEDLINE/PubMed database search was performed between January 1, 2000, to December 30, 2019, based on PRISMA guidelines. Studies were screened and selected based on predefined inclusion and exclusion criteria. Only patients who underwent surgical intervention were included. Study characteristics, patient description, longitudinal radiographic, and patient outcomes assessment data were extracted. The quality of the study was assessed utilizing the NIH study quality assessment tool. Meta-analysis was conducted to assess radiographic change with surgical intervention. Univariate meta-regression analysis was conducted to identify predictors of the effects. Subgroup analysis dichotomized by age was conducted on coronal and sagittal changes.
Results: Patients who undergo surgery were in their second or fourth decade of life. The mean preoperative MC (57.8º) had an average correction of 58.1 ± 15.9% and was maintained through follow-up. The mean preoperative thoracic kyphosis (remained within the normal limits through follow-up. The mean LL (45.9º), PT (17.2 º), and SVA (15.1 ±16.8 mm) were all within normal limits. Meta-regression analysis revealed that ΔMC was influenced by SVA, ΔSVA was influenced by TK, and ΔTK was influenced by flexibility and preoperative MC.
Conclusion : The overall correction of the coronal plane was maintained at follow-up with an intimate correlation with the sagittal plane. The behavior of TK had the least degree of variability among studies. Further studies are necessary to identify the source of this ΔTK.
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