Summary: Young adult scoliosis patients treated surgically with the worst outcomes are older, have more baseline pain and narcotic use, have greater body mass index, and have a higher prevalence of depression/anxiety and smoking, compared to those with the best outcomes. Except for modest associations with follow‐up sagittal balance and Cobb angle, no other radiographic or surgical parameters distinguished between patients with the best and worst outcomes.
Introduction: It remains unclear why some adults with scoliosis markedly improve with surgery, while others fail to improve. Our objective was to assess for factors that differ between patients aged 18‐45 yrs with the best and worst outcomes following surgery for scoliosis.
Methods: This is a secondary analysis of a prospective multicenter deformity database. Inclusion criteria included: age 18‐45, Cobb angle >20°, no prior instrumentation and availability of outcomes measures (ODI or SRS‐22) at minimum of two years following surgery. Patients were sorted based on each outcome measure at follow‐up, and the best and worst ˜15% were selected for comparison.
Results: For ODI, best (ODI=0) and worst (ODI>30) groups consisted of 19 (22%) and 15 (17%) patients, respectively. For SRS‐ 22, best (SRS‐22>4.5) and worst (SRS‐22<3.1) groups consisted of 15 (17%) and 13 (15%) patients, respectively. Factors that were statistically significantly different between the best and worst groups are summarized in Table 1. This included higher pre‐operative pain levels, narcotic use, greater body mass index, higher proportions of depression/anxiety and smoking. There was a trend towards differences in follow‐up sagittal balance and Cobb angles between the groups. There was no statistically significant difference in pre‐operative Cobb angle, pre‐operative coronal or sagittal balance, comorbidities, occurrence of minor or major complications, operative time, estimated blood loss, and need for revision surgery between the two groups. Conclusion: Compared with those having the best outcomes, younger adult scoliosis patients treated surgically with the worst outcomes are older, have more pain and narcotic use at baseline, have greater BMI, and have higher proportions of depression/anxiety and smoking. Except for modest associations with follow‐up SB and Cobb angle, the factors that distinguished between the patients with the best and worst outcomes were not radiographic or surgical parameters.