Scoliosis surgery in adulthood: what challenges for what outcome?

Abstract

Adolescent idiopathic scoliosis that has progressed over time, de novo scoliosis, and degenerative scoliosis represent different types of adult spinal deformity (ASD). Functional impairment and muscular fatigue are due to sagittal and coronal imbalance of the trunk. Surgical treatment can provide a significant improvement of three-dimensional (3D) thoracolumbar alignment, function, and health-related quality of life (QoL). A patient-specific benefit-risk assessment, including clinical expectations, comorbidities, and the spinal deformity itself, has to be done preoperatively since the risk for mechanical complications is relatively high. Minimal invasive techniques combine posterior percutaneous instrumentation and lateral interbody fusion cages which enables vertebral realignment and indirect foraminal stenosis decompression. This strategy seems appropriate in mild and moderate ASD with a limited number of degenerated segments in the lumbar spine and remaining curve flexibility. Severe ASD needs to be addressed by open surgery, which combines posterior instrumentation, interbody fusion, and osteotomies in stiff deformities. Longer posterior instrumentation of the thoracolumbar spine, the sacrum, and the pelvis carries a risk for mechanical complications such as non-union and proximal junctional kyphosis (PJK). Modern surgical techniques including circumferential lumbosacral fusion and double rods might lower the risk for non-union. Accurate sagittal alignment planning, setting the lumbar sagittal apex according to pelvic incidence, and segmental lordosis distribution, are mandatory for minimizing the risk of PJK.

Which Is More Predictive Value for Mechanical Complications: Fixed Thoracolumbar Alignment (T1 Pelvic Angle) Versus Dynamic Global Balance Parameter (Odontoid-Hip Axis Angle)

“…38 Otherwise, some studies reported although the rigid SPF has decreased the risk for distal screw loosening, cyclic loading during daily activities might lead to fatigue of the posterior instrumentation, which can result in mechanical long-term complications such as nonunion and eventually increase the risk of iliac screw loosening, development of PJK, PJF, and pseudarthrosis or pedicle screw loosening at L5-S1 level. 10,39,40 In our study, statistical significance was not observed, but there was a force to SPF was related with development of mechanical complication especially PJK/PJF. Also, many articles reported that older age, osteoporosis, and obesity are important risk factors of mechanical complication, PJK, and PJF.…”

Robot-assisted orthopedic surgery in the treatment of adult degenerative scoliosis: a preliminary clinical report

“…However, adverse factors such as osteoporosis, spinal stenosis, severe degeneration of facet joints, pedicle rotation, and sclerosis have greatly increased the difficulty of screw placement. Besides, incidence of postoperative complications such as internal fixation failure, non-union, and proximal junction kyphosis (PJK) are still relatively high [ 6 ]. Therefore, in order to reduce the unfavorable factors such as the loosening of the trajectory, deformity surgery requires extremely high surgical skills from doctors, who should strive for a successful screw placement at the first attempt.…”

Posterior-only correction surgery for idiopathic scoliosis Lenke type 5c: differences of strategies and outcomes between adult patients and adolescent patients

“…In addition, back pain was more often seen in adult patients than in adolescent patients, which could be a reason for pursuing corrective surgery [5]. Several studies have compared surgical outcomes between AIS and adult idiopathic scoliosis (AdIS) [6][7][8]. However, most of the studies focused on patients with major thoracic curves (Lenke 1 or 2 types), and there was no study concerning patients with thoracolumbar or lumbar curves (Lenke 5 or 6 types).…”