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Risk-Benefit Assessment of Surgery for Adult Scoliosis: An Analysis Based on Patient Age

Smith, Justin S. MD, PhD*,†; Shaffrey, Christopher I. MD*,†; Glassman, Steven D. MD; Berven, Sigurd H. MD§; Schwab, Frank J. MD; Hamill, Christopher L. MD; Horton, William C. MD**; Ondra, Stephen L. MD††; Sansur, Charles A. MD‡‡; Bridwell, Keith H. MD§§; the Spinal Deformity Study Group

doi: 10.1097/BRS.0b013e3181e21783
Deformity
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Study Design. Retrospective review of a prospective, multicenter database.

Objective. The purpose of this study was to assess whether elderly patients undergoing scoliosis surgery had an incidence of complications and improvement in outcome measures comparable with younger patients.

Summary of Background Data. Complications increase with age for adults undergoing scoliosis surgery, but whether this impacts the outcomes of older patients is largely unknown.

Methods. This is a retrospective review of a prospective, multicenter spinal deformity database. Patients complete the Oswestry Disability Index (ODI), SF-12, Scoliosis Research Society-22 (SRS-22), and numerical rating scale (NRS; 0–10) for back and leg pain. Inclusion criteria included age 25 to 85 years, scoliosis (Cobb ≥ 30°), plan for scoliosis surgery, and 2-year follow-up.

Results. Two hundred six of 453 patients (45%) completed 2-year follow-up, which is distributed among age groups as follows: 25 to 44 (n = 47), 45 to 64 (n = 121), and 65 to 85 (n = 38) years. The percentages of patients with 2-year follow-up by age group were as follows: 25 to 44 (45%), 45 to 64 (48%), and 65 to 85 (40%) years. These groups had perioperative complication rates of 17%, 42%, and 71%, respectively (P < 0.001). At baseline, elderly patients (65–85 years) had greater disability (ODI, P = 0.001), worse health status (SF-12 physical component score (PCS), P < 0.001), and more severe back and leg pain (NRS, P = 0.04 and P = 0.01, respectively) than younger patients. Mean SRS-22 did not differ significantly at baseline. Within each age group, at 2-year follow-up there were significant improvements in ODI (P ≤ 0.004), SRS-22 (P ≤ 0.001), back pain (P < 0.001), and leg pain (P ≤ 0.04). SF-12 PCS did not improve significantly for patients aged 25 to 44 years but did among those aged 45 to 64 (P < 0.001) and 65 to 85 years (P = 0.001). Improvement in ODI and leg pain NRS were significantly greater among elderly patients (P = 0.003, P = 0.02, respectively), and there were trends for greater improvements in SF-12 PCS (P = 0.07), SRS-22 (P = 0.048), and back pain NRS (P = 0.06) among elderly patients, when compared with younger patients.

Conclusion. Collectively, these data demonstrate the potential benefits of surgical treatment for adult scoliosis and suggest that the elderly, despite facing the greatest risk of complications, may stand to gain a disproportionately greater improvement in disability and pain with surgery.

Elderly patients with scoliosis electing for surgical treatment have significantly greater disability and worse health status compared with younger patients. Collectively, these data demonstrate the potential benefits of surgical treatment for adult scoliosis and suggest that the elderly, despite facing the greatest risk of complications, may stand to gain a disproportionately greater improvement in disability and pain with surgery.

*Neurosurgery

Orthopedic Surgery, University of Virginia, Charlottesville, VA

Norton Leatherman Spine Center, Louisville, KY

§Spinal Disorders Service, University of California, San Francisco, CA

NYU Hospital for Joint Diseases, New York City

State University of New York, Buffalo, NY

**Emory Orthopedics and Spine Center, Atlanta, GA

††Department of Neurosurgery, Northwestern University, Chicago, IL

‡‡Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD

§§Spinal Deformity Service, WA University, St Louis, MO

Address correspondence and reprint requests to Justin S. Smith, MD, PhD, Departments of Neurosurgery and Orthopedic Surgery, University of Virginia, PO Box 800212, Charlottesville, VA 22908; E-mail: jss7f@virginia.edu

Acknowledgement date: October 5, 2009; Revision date: February 6, 2010; Acceptance date: March 18, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Corporate/Industry funds were received in support of this work. One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, and decision-making position.

Supported by an educational grant from Medtronic (to the Spinal Deformity Study Group).

IRB: Approval obtained from all contributing institutions.

This manuscript was presented in part at the 2009 Scoliosis Research Society Annual Meeting and received the Russell A. Hibbs Clinical Award for the best presentation at the 2009 annual meeting.

© 2011 Lippincott Williams & Wilkins, Inc.