Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA.
Spine (Phila Pa 1976). 2011 May 1;36(10):817-24. doi: 10.1097/BRS.0b013e3181e21783.
Retrospective review of a prospective, multicenter database.
The purpose of this study was to assess whether elderly patients undergoing scoliosis surgery had an incidence of complications and improvement in outcome measures comparable with younger patients.
Complications increase with age for adults undergoing scoliosis surgery, but whether this impacts the outcomes of older patients is largely unknown.
This is a retrospective review of a prospective, multicenter spinal deformity database. Patients complete the Oswestry Disability Index (ODI), SF-12, Scoliosis Research Society-22 (SRS-22), and numerical rating scale (NRS; 0-10) for back and leg pain. Inclusion criteria included age 25 to 85 years, scoliosis (Cobb ≥ 30°), plan for scoliosis surgery, and 2-year follow-up.
Two hundred six of 453 patients (45%) completed 2-year follow-up, which is distributed among age groups as follows: 25 to 44 (n = 47), 45 to 64 (n = 121), and 65 to 85 (n = 38) years. The percentages of patients with 2-year follow-up by age group were as follows: 25 to 44 (45%), 45 to 64 (48%), and 65 to 85 (40%) years. These groups had perioperative complication rates of 17%, 42%, and 71%, respectively (P < 0.001). At baseline, elderly patients (65-85 years) had greater disability (ODI, P = 0.001), worse health status (SF-12 physical component score (PCS), P < 0.001), and more severe back and leg pain (NRS, P = 0.04 and P = 0.01, respectively) than younger patients. Mean SRS-22 did not differ significantly at baseline. Within each age group, at 2-year follow-up there were significant improvements in ODI (P ≤ 0.004), SRS-22 (P ≤ 0.001), back pain (P < 0.001), and leg pain (P ≤ 0.04). SF-12 PCS did not improve significantly for patients aged 25 to 44 years but did among those aged 45 to 64 (P < 0.001) and 65 to 85 years (P = 0.001). Improvement in ODI and leg pain NRS were significantly greater among elderly patients (P = 0.003, P = 0.02, respectively), and there were trends for greater improvements in SF-12 PCS (P = 0.07), SRS-22 (P = 0.048), and back pain NRS (P = 0.06) among elderly patients, when compared with younger patients.
Collectively, these data demonstrate the potential benefits of surgical treatment for adult scoliosis and suggest that the elderly, despite facing the greatest risk of complications, may stand to gain a disproportionately greater improvement in disability and pain with surgery.
前瞻性、多中心数据库的回顾性研究。
本研究旨在评估接受脊柱侧凸手术的老年患者的并发症发生率和结局测量指标的改善情况是否与年轻患者相当。
成年人接受脊柱侧凸手术时，并发症随年龄增长而增加，但这是否会影响老年患者的结局尚不清楚。
这是一项对前瞻性、多中心脊柱畸形数据库的回顾性研究。患者完成 Oswestry 残疾指数（ODI）、SF-12、脊柱侧凸研究协会 22 项（SRS-22）和数字评分量表（NRS；0-10）的背部和腿部疼痛评分。纳入标准包括年龄 25 至 85 岁、脊柱侧凸（Cobb 角≥30°）、计划接受脊柱侧凸手术和 2 年随访。
453 名患者中有 206 名（45%）完成了 2 年随访，其年龄分布如下：25 至 44 岁（n=47）、45 至 64 岁（n=121）和 65 至 85 岁（n=38）。各年龄组的 2 年随访率如下：25 至 44 岁（45%）、45 至 64 岁（48%）和 65 至 85 岁（40%）。这些组的围手术期并发症发生率分别为 17%、42%和 71%（P<0.001）。在基线时，老年患者（65-85 岁）的残疾程度（ODI，P=0.001）、健康状况（SF-12 生理评分（PCS），P<0.001）和背部及腿部疼痛（NRS，P=0.04 和 P=0.01）均较年轻患者更为严重。基线时 SRS-22 评分无显著差异。在每个年龄组中，在 2 年随访时，ODI（P≤0.004）、SRS-22（P≤0.001）、背部疼痛（P<0.001）和腿部疼痛（P≤0.04）均有显著改善。25 至 44 岁患者的 SF-12 PCS 无显著改善，但 45 至 64 岁（P<0.001）和 65 至 85 岁（P=0.001）患者的 SF-12 PCS 有显著改善。老年患者的 ODI 和腿部疼痛 NRS 改善程度显著大于年轻患者（P=0.003，P=0.02），并且老年患者的 SF-12 PCS（P=0.07）、SRS-22（P=0.048）和背部疼痛 NRS（P=0.06）的改善程度也有更大的趋势。
综上所述，这些数据表明脊柱侧凸手术治疗成人脊柱侧凸的潜在益处，并提示尽管老年患者面临最大的并发症风险，但他们可能会因手术而获得不成比例的更大的残疾和疼痛改善。
