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Risk‐Benefit Assessment of Surgery for Adult Scoliosis: An Analysis Based on Patient Age: Paper #20

Smith, Justin S. MD, PhD; Shaffrey, Christopher I. MD; Glassman, Steven D. MD; Berven, Sigurd MD; Hamill, Christopher L. MD; Horton, William C. MD; Ondra, Stephen L. MD; Schwab, Frank J. MD; Sansur, Charles A. MD; Bridwell, Keith H. MD

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Spine Journal Meeting Abstracts: September 2009 - Volume 10 - Issue - p 66–67
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Introduction: Complications increase with age for adults undergoing scoliosis surgery. We assessed whether elderly patients undergoing scoliosis surgery have improvement in outcome measures that is at least comparable to younger patients, despite increased risk of complications.

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Methods: This is a retrospective review of a prospective multicentered spinal deformity database (Level III). Patients complete the Oswestry Disability Index (ODI), SF‐12 and SRS‐22. Inclusion criteria included: age 25–85, scoliosis (Cobb angle ≥30 degrees), plan for scoliosis surgery and 2‐year follow‐up.

Results: Over a 5‐year period, 206 of 453 patients (45%) completed 2‐year follow‐up, distributed among age groups as follows: 25–44 (n=47), 45–64 (n=121), and 65–85 (n=38). Perioperative complication rates were greater among older patients, with minor complication rates of 11%, 27% and 42% (P=0.004) and major complication rates of 6%, 15% and 29% (P=0.02) among patients aged 25–44, 45–64 and 65–85 years, respectively. At baseline older patients had greater disability (ODI, P=0.001) and worse health status (SF12‐PCS, P<0.001). 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) and SRS‐22 (P≤0.001). SF‐12PCS did not improve significantly for patients 25–44 years old but did among those 45–64 (P<0.001) and 65–85 years old (P=0.001). Improvement in ODI was significantly greater among older patients (mean change, 25–44: ‐7; 45–64: ‐13; 65–85: ‐19, P=0.003), and there were trends for greater improvement in SF‐12PCS (P=0.08) and SRS‐22 (P=0.047) among older patients.

Conclusion: Elderly patients with scoliosis electing for surgical treatment have significantly greater disability and worse health status compared with younger patients. Despite increased complications, elderly patients undergoing scoliosis surgery had improvements in disability and health status that are at least comparable to younger patients.

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** RUSSELL A. HIBBS AWARD NOMINEE FOR BEST CLINICAL PRESENTATION

© 2009 Lippincott Williams & Wilkins, Inc.