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Are Surgical Results in Larger Curves Inferior to Those in Smaller Curves?: Paper #4

Sanders, James O. MD; Lenke, Lawrence G. MD; Emans, John B. MD; Johnston, Charles E. MD; Richards, Stephens B. MD; Sucato, Daniel J. MD, MS; Diab, Mohammad MD; Erickson, Mark A. MD; Polly, David W. MD

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Summary: Surgery in large curves (>70°) results in more frequent allogenic blood transfusion, osteotomy, complications, longer surgical time, lower pulmonary function, larger residual curvature, and fusion into the lower lumbar spine than surgery in smaller curves (<60°). Because the surgery is more complex and difficult for larger curves, early detection and referral for scoliosis remains important for optimum surgical results.

Introduction: If surgical results in larger curves are inferior to those in smaller curves, then earlier detection and referral should improve outcomes. The purpose of this study is to evaluate surgical results comparing larger to smaller curves.

Methods: From a prospectively collected database of adolescent idiopathic scoliosis surgery, patients with curves <60° (smaller curves) preoperatively were compared to those >70° (larger curves) both for perioperative issues and 2 year postoperative results. Chi‐Square or Fisher's Exact Tests were used for categorical comparisons, and unpaired t‐tests or Wilcoxon Ranked Sums for continuous variables.

Results: 1729 patients had main curves <60° and 414 had curves >70° preoperatively. Larger curves were more common in non‐Caucasians than Caucasians (p<0.0001) and in males than females (p=0.0253).

Patients with larger curves more frequently underwent osteotomies (p<0.0001), were more likely to receive perioperative allogenic blood (p<0.0001), have longer operative times (347min vs. 272 min, p<0.0001), and experience complications (p=0.0022) than patients with smaller curves. Compared to patients with smaller curves, pulmonary function was significantly lower both preoperatively and postoperatively (p<0.001) for those with larger curves. They also had larger residual curves postoperatively (p< 0.0001). For each Lenke curve type, there was a shift for larger curves to have instrumentation lower into the lumbar spine, which was statistically significant for types 1, 2, 3, and 6.

On the other hand, those with larger curves had greater curve magnitude percent correction and improvement in SRS and SAQ scores than those with smaller curves

Conclusion: Surgery for larger curves, which is more common in minority populations, is more likely to result in blood transfusion, lower pulmonary function, complications, and fusion into the lower lumbar spine than surgery in smaller curves.

Significance: Because surgery for larger curves is more difficult with potential long‐term effects than surgery in smaller curves, early detection and referral for scoliosis appears important for surgical results regardless of whether or not non‐operative treatment is effective.

© 2010 Lippincott Williams & Wilkins, Inc.

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