Summary: Analysis of 250 patients (126 primary and 124 revision) who had multilevel fusion surgery for adult scoliosis demonstrated lower rate of complications in primary (32.5%; major 24.6%) than revision (44.4%; major 29.0%) surgical patients. Primary patients reported higher preop and final clinical outcome measures than revision patients, although this difference between 2 cohorts disappeared in older patients. Revision patients seemed to have benefited from surgery just as much as primary patients.
Introduction: We compared clinical outcome and perioperative complications (Glassman, Spine 2007) in adult patients who underwent primary (P) vs revision (R) scoliosis surgery.
Methods: Clinical and radiographic assessment of 250 consecutive adult patients (mean age 51.4 years) who underwent primary vs revision surgery (>6 levels) for idiopathic or de novo scoliosis between 2002 and 2007 by 2 surgeons at 1 institution with a minimum 2‐year f/u (mean 3.6 years) were performed. SRS scores and ODI were used.
Results: There were 126 patients in P group and 124 in R group. Mean age (P=51.2 vs R=51.6 yrs, p=0.79), f/u (P=3.6 vs R=3.6 yrs), comorbidities (p=0.43), and smoking status (p=0.98) were similar between 2 groups. BMI (P=25.5 vs R=27.4 kg/m2, p=0.01), number of final fusion levels (P=10.5 vs R 12.1 levels, p=0.00), fusion to sacrum (P=61.0% vs R=87.1%), osteotomy (P=14.3% vs R=54.9%, p=0.00), length of surgery (P=6.5 vs R=8.2 hrs, p=0.00), and EBL (P=1072.1 vs R=1401.3 ml, p=0.05) were statistically different. Primary patients had lower perioperative (P=17.5% vs R=23.4%; Major P=7.9% vs R=8.1%, Minor P=11.1% vs R=16.1%) and overall (P=32.5% vs R=44.4%; Major P=24.6% vs R=29.0%, Minor P=15.1% vs R=21.9%) complications. Primary patients reported higher preop and final clinical outcome measures in all SRS domains and ODI compared to revision patients. Patients over 60 yrs of age, however, reported similar SRS and ODI scores between 2 groups. The extent of surgical benefit patients received, i.e., final score minus preop score, was similar in all categories between 2 groups.
Conclusion: Adult patients undergoing primary scoliosis surgery had lower perioperative (P=17.5% vs R=23.4%) and overall (P=32.5% vs R=44.4%) complications compared to revision patients. Primary patients reported higher preop and final clinical outcome measures than revision patients, although this difference between 2 groups disappeared in older patients. The benefit of surgery as reflected in the difference between final f/u and preop scores was similar between 2 groups.