Lonner Baron S, Ren Yuan, Bess Shay, Kelly Michael, Kim Han Jo, Yaszay Burt, Lafage Virginie, Marks Michelle, Miyanji Firoz, Shaffrey Christopher I, Newton Peter O
Mount Sinai Hospital, 1468 Madison Ave, New York, NY 10029, USA.
Mount Sinai Hospital, 1468 Madison Ave, New York, NY 10029, USA.
Spine Deform. 2019 Jan;7(1):84-92. doi: 10.1016/j.jspd.2018.05.012.
Informed decision making for operative treatment of the skeletally mature adolescent idiopathic scoliosis (AIS) patient meeting surgical indications requires a discussion of differences in operative morbidity in adult scoliosis versus AIS. This study evaluated differences in operative data and outcomes between AIS and adult scoliosis patients based on an estimated natural history of curve progression.
Twenty-eight adult scoliosis patients (43.7 ± 15.8 years; 93% F) were 1:2 matched with 56 (Risser 4/5) AIS patients (15.7 ± 2.1 years) based on gender and curve type as vetted by 5 surgeons' consensus in committee. Curve progression of 0.3°/year for the first 10 years following skeletal maturity and a 0.5°/year thereafter was assumed to estimate curve progression from AIS to adulthood for the adult counterpart. Operative data, complications, and quality of life (Scoliosis Research Society [SRS-22r] questionnaire) measures were evaluated, with a minimum 2-year follow-up.
Postoperative major Cobb and percentage correction were similar between adult versus AIS, whereas operative time, percentage estimated blood loss (EBL; % total blood volume), length of hospital stay (LOS), and total spine levels fused were greater for adult patients (p < .05). No difference was found in EBL, operative time, or LOS when normalized by levels fused. Ten (36%) adult scoliosis patients were fused to the pelvis compared with none in AIS (p < .0001). Major complication rate was higher for adult versus AIS (25% vs. 5.4%; p < .05). Preoperative SRS-22r scores were worse for adult patients; however, they demonstrated greater improvement in SRS-22r than the AIS cohort at final follow-up. A higher percentage of adult patients reached the MCID in self-image domain than the AIS patients (92.3% vs. 61.8%; p = .0040).
Treatment of the adult scoliosis patient who has undergone an estimated natural history of progression is characterized by greater levels fused, operative time, and higher complication rates than the AIS counterpart. Longer-term follow-up of AIS is needed to define the benefits of early intervention of relatively asymptomatic adolescent patients versus late treatment of symptomatic disease in the adult.
对于符合手术指征的骨骼成熟的青少年特发性脊柱侧凸（AIS）患者，进行手术治疗的明智决策需要讨论成人脊柱侧凸与AIS手术发病率的差异。本研究基于曲线进展的估计自然史，评估了AIS患者与成人脊柱侧凸患者在手术数据和结果方面的差异。
28例成人脊柱侧凸患者（43.7±15.8岁；93%为女性）与56例（Risser 4/5）AIS患者（15.7±2.1岁）按1:2进行匹配，匹配依据为性别和曲线类型，由5位外科医生在委员会中达成共识确定。假设骨骼成熟后的前10年曲线进展为0.3°/年，此后为0.5°/年，以估计AIS患者到成年时对应成人患者的曲线进展情况。评估手术数据、并发症和生活质量（脊柱侧凸研究学会[SRS - 22r]问卷）指标，随访时间至少为2年。
成人患者与AIS患者术后主要Cobb角和矫正百分比相似，而成人患者的手术时间、估计失血量百分比（EBL；占总血容量的百分比）、住院时间（LOS）和融合的脊柱节段总数更多（p < 0.05）按融合节段进行标准化后，EBL、手术时间或LOS未发现差异。10例（36%）成人脊柱侧凸患者融合至骨盆，而AIS患者中无此情况（p < 0.0001）。成人患者的主要并发症发生率高于AIS患者（25%对5.4%；p < 0.05）。成人患者术前SRS - 22r评分较差；然而，在末次随访时，他们在SRS - 22r方面的改善比AIS队列更大。在自我形象领域，达到最小临床重要差异（MCID）的成人患者百分比高于AIS患者（92.3%对61.8%；p = 0.0040）。
对于经历了估计自然进展史的成人脊柱侧凸患者的治疗，其特点是融合节段更多、手术时间更长且并发症发生率高于AIS患者。需要对AIS进行更长时间的随访，以确定相对无症状的青少年患者早期干预与成人有症状疾病的晚期治疗的益处。
