Abstract
Précis: A recently developed Classification of adult scoliosis was utilised to study surgical treatment in 339 patients. At 12 month follow up after surgery for thoracolumbar/lumbar scoliosis greatest improvement in outcome scores were noted in the following patients: lost lumbar lordosis, treatment with osteotomies, fusion to the sacrum for marked sagittal imbalance. Complication rates were greatest for: fusion to the sacrum, sagittal imbalance greater than 4cm.
Introduction: A recently proposed radiographic Classification of adult scoliosis offers a useful system with high clinical impact and reliability. Continued work is required to apply this system in the development of treatment guidelines. The purpose of this study was to anal surgical treatment outcomes, and complications, by Classification subtype at 12 months post-operative follow up.
Material and Method: This study included 339 patients: Type IV (thoracolumbar major) and Type V (lumbar major) adult scoliosis (Spinal Deformity Study Group). All patients had complete full-length spine radiographs and outcomes questionnaires (SRS, ODI and SF-12). An analysis of classification subtypes (modifiers) included outcome scores by surgical treatment. The latter included approach (anterior, posterior, both), use of osteotomies, and extension to the sacrum (or not).
Results: Lordosis modifier was strongly correlated with baseline disability and post-operative improvement. Type C (loss of lordosis) patients had the lowest baseline outcome but also greatest improvement with surgery (p< 0.05). Subluxation modifier had impact on preoperative but not on postoperative outcomes measures. Marked sagittal balance had the worst outcomes of all groups if fusion fell short of the sacrum. Patients with osteotomies saw greater improvement than those without (p< 0.05). Anterior, posterior or combined procedures showed no significant difference in outcomes. Peri- and post-operative complications did not vary by lordosis modifier, subluxation modifier but were elevated for fusion to the sacrum (p< 0.05).
Conclusion: At 12 month follow up for surgical treatment of adult thoracolumbar/lumbar scoliosis greatest improvement in outcome scores were noted in the following patients: lost lumbar lordosis, treatment with osteotomies, fusion to the sacrum for marked sagittal imbalance. Complication rates were greatest for: fusion to the sacrum, sagittal imbalance greater than 4cm. Further longitudinal follow up will permit validation of optimal treatment by Classification type of adult spinal deformity and refine patient and surgeon expectations of operative care.
Correspondence should be addressed to Jeremy C T Fairbank at The Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX7 7LD, UK
