Abstract
Aim: To test the null hypothesis that older instrumentations with their complications do not produce a clinical improvement.
Introduction: Surgical treatment of adult scoliosis is difficult with a high incidence of complications. The presenting complaints and expectations from the surgery are different to those in adolescent scoliosis.
Methods and results: Inclusion: All cases of adult idiopathic scoliosis presenting at or after the age of 20 and requiring surgical treatment. Exclusions: Revisions. Average age of follow-up is 6 years (range 2 to 14 years) with 107 patients. For analysis three groups were decided on the basis of the age. A number of different instrumentation systems were used with time. Treatment varied according to senior author’s planning for the individual patient, ranging from posterior instrumentation, anterior release and posterior instrumentation, and combined anterior and posterior instrumentation.
Group I: Age 20–30 years, consisted of 64 patients. Average pre-operative primary curve was 56° with post-operative correction 50%. Deformity was the most common presenting complaint. Seventy-one per cent felt an overall improvement, the rest noticed no benefit.Twenty-two per cent would prefer not to have the surgery. Complications included four pseudoarthrosis, nine required further surgery, and one late infection.
Group II: Age 31–40 years, 20 patients with an average primary curve of 63°, and a correction of 56%. Fifteen per cent had significant pain at presentation. Seventy per cent felt an overall benefit although all noticed a cosmetic improvement. Complications: two pseudarthrosis, three subsequent surgical procedures.
Group III: Age > 41 years, 23 patients, an average primary curve of 72° with a correction of 39%. Eleven out of 23 had significant pain on presentation. Complications: four pseudoarthrosis, metal pull out in one. Further surgery was performed in nine. All felt some benefit from the treatment and despite the high proportion of complications, would have the surgery again.
Conclusions: There is a clinical benefit from surgical treatment of adult idiopathic scoliosis. There is a higher number of complications in the older age group.
Abstracts prepared by Mr J. Dorgan. Correspondence should be addressed to him at the Royal Liverpool Children’s Hospital, Alder Hey, Eaton Road, Liverpool L12 2AP, UK
President’s Lecture: Natural history and management of Congenital Kyphosis and Kyphoscoliosis M.J. McMaster, Edinburgh, Scotland, UK
Greg Houghton Lecture: Idiopathic Scoliosis – Alternatives to traditional surgery R.R. Betz, Philadelphia, USA
Instructional Lecture:New thoughts on the treatment of paralytic scoliosis R.R. Betz, Philadelphia, USA
Keynote Lectures: Idiopathic Scoliosis – How to manage the patient R.A. Dickson, Leeds, UK
Concave or convex approach for Kyphoscoliosis J. Dubousset, Paris, France Surgery or bracing for moderate AIS. How long term follow-up studies change your perspective A. Nachemson, Göteborg, Sweden
