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Functional Outcomes and Complications After Primary Spinal Surgery for Scoliosis in Adults Aged Forty Years or Older: A Prospective Study With Minimum Two-Year Follow-up

Zimmerman, Ryan M. MD; Mohamed, Ahmed S. MBBCh; Skolasky, Richard L. ScD; Robinson, Malaya D. BSN; Kebaish, Khaled M. MD

doi: 10.1097/BRS.0b013e3181e57827
Health Services Research

Study Design. A prospective study.

Objective. Our purpose was to evaluate prospectively the complications, clinical outcomes, and self-reported quality of life in a relatively homogenous group of adults aged ≥40 years undergoing primary surgical treatment for scoliosis.

Summary of Background Data. Relatively few reports have examined surgical outcomes in adult patients with scoliosis, especially adults aged ≥40 years, whose outcomes may differ because of more rigid curves and more frequent and severe comorbidities. Although most studies have shown patient benefits despite high complication rates after such surgery, most were retrospective and conducted before the introduction of third-generation instrumentation techniques.

Methods. We prospectively studied a consecutive series of 35 patients of age ≥40 years (average age, 56.3 years) undergoing primary surgery for scoliosis by one surgeon. Most of our patients (86%) had at least one comorbidity. We collected complete radiographic measurements and Oswestry Disability Index, Short Form 36, and Scoliosis Research Society 22 questionnaires before surgery and at each follow-up, and recorded the number and type of complications. Outcomes were assessed in the context of complications, degree of correction, and procedure characteristics to detect significant (P < 0.05) correlations.

Results. The overall complications rate was 49%; 26% of the patients had a major complication and 31% had a minor one. There were no deaths. Coronal curve correction was 30.8° (61%) on average. There were statistically significant postoperative improvements in Oswestry Disability Index, Short Form 36, and Scoliosis Research Society 22 scores. Patients whose fusions ended at L4 or L5 showed greater improvements in some of the Short Form 36 component scores than patients whose fusions involved the sacrum (P = 0.041). There were no significant differences in outcomes related to presence of complications or operative staging.

Conclusion. Adults ≥40 years with symptomatic scoliosis benefit from surgical treatment, despite the high complication rate.

Relatively little research has explored the outcomes of adults undergoing surgery for scoliosis. We prospectively evaluated a consecutive group of 35 adults aged ≥40 years undergoing primary spinal reconstruction for scoliosis. The overall complication rate was 49% and questionnaires showed patient improvements, which were independent of complications.

From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.

Ryan M. Zimmerman is currently at Harvard Combined Orthopaedic Residency Program, MA General Hospital, Boston, MA.

Acknowledgment date: November 29, 2008. First revision date: November 20, 2009. Second revision date: March 26, 2010. Acceptance date: March 31, 2010.

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

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Khaled M. Kebaish, MD, c/o Elaine P. Henze, BJ, ELS, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, A665, Baltimore, MD 21224; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.