ADOLESCENTS UNDERGOING SURGERY FOR ADOLESCENT IDIOPATHIC SCOLIOSIS: DOES SURGERY AND SURGICAL TECHNIQUE AFFECT PATIENT OUTCOMES?

Abstract

Patient outcomes using the Scoliosis Research Society (SRS) questionnaire after thoracoscopic and posterior surgical techniques for thoracic idiopathic scoliosis were compared after > 2 years post-op. Additional comparisons were made with non-operated scoliosis and normal patients. Our objective was to determine if scoliosis surgery and surgical technique used to treat a cohort of patients with the same type of scoliosis deformity affects patient outcome. The SRS-24 questionnaire was prospectively administered to 4 groups of patients:

1. 42 patients with thoracic idiopathic scoliosis who underwent thoracoscopic instrumented fusion surgery (thoracoscopic group);

2. 42 patients with thoracic scoliosis who underwent posterior instrumented fusion surgery (posterior group);

3. 97 patients with thoracic scoliosis who did not have surgery (scoliosis control group);

4. 72 patients who did not have scoliosis (normal group).

The 2 surgical groups were comparable with regards to age at surgery, pre-op Cobbo and follow-up. SRS-24 domian scores were computed for all 4 groups and were compared on SPSSv13 software. Our results show the thoracoscopic group having a significantly smaller mean post-op Cobbo (17° vs 25.1°, respectively; p< .001), which was achieved using less fusion segments (7 vs 9.3 segments, respectively; p< .001). The mean Cobbo of the scoliosis control group was significantly larger than the post-op Cobbo of the thoracoscopic group (p< .001), and was comparable to the post-op Cobbo of the posterior group. Comparing the 2 surgical groups, the thoracoscopic group showed trends towards better scores in 4 of the SRS-24 domains compared to the posterior group, but this only reached statistical significance for the satisfaction domain (p< .05). When comparing the 4 groups, Pain scores of both surgical groups were similar to those who did not have surgery, and were worse than normal patients (p< .0001); Self-image scores after surgery were higher than those who did not have surgery(p< .05) and were comparable to normal patients; Function and Activity scores of the thoracoscopic group was significantly inferior to the scoliosis control group (p< .05). Our study demonstrates that > 2 years after surgery, both thoracoscopic & posterior surgery resulted in pain scores that were similar to patients with scoliosis that did not have surgery, and were worse than the normal group. However, both surgical techniques resulted in self-image scores that are comparable to normal individuals despite a difference in post-op Cobbo. When comparing the two surgical techniques, the SRS-24 showed no difference between the 2 surgical techniques, except for patient satisfaction which was better in the thoracoscopic group.