ADULT IDIOPATHIC SCOLIOSIS OPERATIVE TREATMENT

Abstract

Purpose: The presentation of our experience in the operative treatment of adult idiopathic scoliosis (AIS) with different posterior instrumentation systems.

Materials and methods: 195 patients with AIS, who underwent posterior instrumentation between January 1989 and December 2002 were included. Patients with degenerative scoliosis were not included in this study. 151 patients were female (77%) and 44 male (23%), with a mean age of 29 years (range, 18–68). The distribution of the lesions according to type was: 48 Th (25%), 67 Th/L (34%), 28 ThL (14%), 50 L (26%) and 2 Th/Th (1,0%). The mean preoperative Cobb angle was 52° (range, 32°–90°). The main indication for surgical treatment in older patients was unremitting pain after 15 months of conservative treatment. Preoperatively, 57% of the patients complained about pain (75% axial back pain, 25% radicular pain) and 43% about deterioration of deformity. Correction of the deformity in pre-operative lateral bending films was 43%. The systems for posterior instrumentation used were: Harrington:15, Hartshill: 26, Isola:38, Colorado:1, TSRH:35, CD-Horizon:21, Synergy:26, Moss-Miami:30, Spine evolution:1, Isobar-Isolock:2.

Results: postoperative correction of the Cobb angle was 48% and subjective improvement of pain was reported by 71,2% of symptomatic patients. Postoperative complications occurred in14 patients (7%): 4 had deep wound infection, 2 had transient worsening of radicular symptoms, 1 had postoperative icterus, 1 had transient postoperative thoracic pain, 3 had implant failure that was symptomatic in 2 of them and were revised, 2 had CSF leak and 1 had postoperative back pain and had the implants removed after fusion had been achieved.

Conclusion: The operative treatment of adult idiopathic scoliosis with posterior instrumentation is a safe method that provides a great amount of correction of deformity and diminishes pain in symptomatic patients.