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Clinical and Radiographic Factors that Distinguish Between the Best and Worst Outcomes of Scoliosis Surgery for Adults 46‐85 Years Old: Paper #45

Smith, Justin S. MD, PhD; Shaffrey, Christopher I. MD; Glassman, Steven D. MD; Carreon, Leah Y. MD, MSc; Schwab, Frank J. MD; Lafage, Virginie C. PhD; Berven, Sigurd H. MD; Bridwell, Keith H. MD

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Spine Journal Meeting Abstracts: 2010 - Volume - Issue - p 78
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Summary: Older adult scoliosis patients treated surgically with the worst outcomes have higher pre‐operative pain, narcotic use, body mass index, and prevalence of depression' anxiety than those having the best outcomes. At follow‐up they have poorer coronal and sagittal balance. 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 differences between older adult patients 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 46‐85, Cobb angle >20°, no prior instrumentation and outcomes (ODI or SRS‐22) at a minimum of 2 years following surgery. The best and worst ˜15% for each outcome measure at follow‐up were selected for comparison.

Results: For ODI, best (ODI<5) and worst (ODI>40) groups consisted of 28 (15%) and 32 (17%) patients, respectively. For SRS‐22, best (SRS‐22>4.5) and worst (SRS‐22<3) groups consisted of 32 (17%) and 30 (16%) patients, respectively. Factors that were statistically significantly different between the best and worst groups are summarized Table 1. These included higher pre‐operative levels of back pain, greater body mass index, and greater proportions of patients on narcotics and reporting depression and anxiety in the worst group compared to the best group. On follow‐up the worst group had statistically greater coronal and sagittal imbalance than the best group. There were no statistically significant differences between the two groups in terms of age, comorbidities, idiopathic vs de novo scoliosis, pre‐operative or follow‐up Cobb angle, pre‐operative sagittal or coronal balance, occurrence of minor or major complications, operative time, estimated blood loss, and need for revision surgery.

Conclusion: Older adult scoliosis patients treated surgically with the worst outcomes have higher pre‐operative pain, narcotic use, body mass index, and prevalence of depression/anxiety than those having the best outcomes. At follow‐up they have poorer coronal and sagittal balance. No other radiographic or surgical parameters distinguished between patients with the best and worst outcomes.

© 2010 Lippincott Williams & Wilkins, Inc.