Long-term outcome of posterior spinal fusion for the correction of adolescent idiopathic scoliosis

Abstract

BackgroundAdolescent idiopathic scoliosis (AIS) is the most common form of idiopathic scoliosis, and surgery is considered as one of the therapeutic options. However, it is associated with a variety of irreversible complications, in spite of the benefits it provides. Here, we evaluated the long-term outcome of posterior spinal fusion (PSF) of AIS to shed more light on the consequences of this surgery.MethodsIn a cross-sectional study, a total of 42 AIS patients who underwent PSF surgery were radiographically and clinically inspected for the potential post-operative complications. Radiographic assessments included the device failure, union status, and vertebral tilt below the site of fusion. Clinical outcomes were evaluated using the Oswestry disability index (ODI) and visual analogue scale (VAS).ResultsThe mean age of the surgery was 14.4 ± 5.1 years. The mean follow-up of the patients was 5.6 ± 3.2 years. Complete union was observed in all patients, and no device failure was noticed. Pre- and post-operative vertebral tilt below the site of fusion were 11.12° ± 7.92° and 6.21° ± 5.73°, respectively (p < 0.001). The mean post-operative ODI was 16.7 ± 9.8. The mean post-operative VAS was 2.1 ± 0.7. ODI value was positively correlated with follow-up periods (p = 0.04, r = 0.471). New degenerative disc disease (DDD) was observed in 6 out of 37 (16%) patients.ConclusionIn spite of the efficacy and safety of PSF surgery of AIS, it might result in irreversible complications such as DDD. Moreover, the amount of post-operative disability might increase over the time and should be discussed with the patients.

Current concepts in the diagnosis and management of adolescent idiopathic scoliosis

“…Although there are no reported differences in blood loss, length of hospital stay and patient reported outcomes between both approaches, the posterior approach may save on the negative impacts of the anterior approach on pulmonary function. Studies also showed that the posterior-only approach has the same correction as a combined anterior/posterior spinal fusion, without the need for entering the thorax and thus negatively impacting pulmonary function [57][58][59][60][61][62][63][64][65][66][67][68][69][70][71].…”

Back pain in adolescent idiopathic scoliosis: A comprehensive review

“…A cross-sectional study evaluated clinical outcomes via the Oswestry Disability Index (ODI) and VAS score in AIS patients who underwent posterior spinal fusion (PSF) surgery and followed for a mean 5.6 years. 92 DD was observed in 16% of patients, but it was not associated with preoperative or postoperative vertebral tilt, VAS and ODI scores. Other residual deformities and their relationship to pain have been explored by various studies.…”

Pain After Spine Fusion for Adolescent Idiopathic Scoliosis

“…12 Although the percentage of patients who develop ASD following PSF varies among studies, one study that specifically addressed adolescents found that 16% of patients who had normal discs on initial preoperative imaging developed ASD. 13 Most cases of ASD develop within the first 3-5 years following initial PSF. 13 Studies have shown that anywhere from 2.6-27.4% of adult patients who have been treated with lumbar PSF undergo additional surgery for ASD that did not respond to conservative treatment.…”

“…13 Most cases of ASD develop within the first 3-5 years following initial PSF. 13 Studies have shown that anywhere from 2.6-27.4% of adult patients who have been treated with lumbar PSF undergo additional surgery for ASD that did not respond to conservative treatment. 12 This number is likely lower in the short term among AIS patients who tend to be younger and, therefore, have less degeneration; however, in the long term, it may prove higher as the fusion constructs are longer and the patients have more years of life ahead of them to develop degeneration.…”