LaBarge Matthew E, Chanbour Hani, Waddell William H, Vickery Justin, Jonzzon Soren, Roth Steven G, Croft Andrew J, Abtahi Amir M, Louer Craig R, Martus Jeffrey E, Mencio Gregory A, Zuckerman Scott L, Stephens Byron F
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21St Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA.
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Spine Deform. 2023 Nov;11(6):1443-1451. doi: 10.1007/s43390-023-00708-8. Epub 2023 Jul 11.
The natural history of adolescent idiopathic scoliosis (AIS) has been well documented, but the impact of age at the time of surgical correction is relatively understudied. In this study, we matched patients undergoing surgical correction of adult idiopathic scoliosis (AdIS) with a cohort of AIS patients to compare: (1) coronal and sagittal radiographic correction, (2) operative variables, and (3) postoperative complications.
A single-institution scoliosis registry was queried for patients undergoing idiopathic scoliosis surgery from 2000-2017.
patients with idiopathic scoliosis, no previous spine surgery, and 2-year follow-up. AdIS patients were matched 1:2 with AIS patients based on Lenke classification and curve characteristics. Independent sample t-test and Chi-square test was used to analyze the data.
31 adults underwent surgical correction of idiopathic scoliosis and were matched with 62 adolescents. Mean age of adults was 26.2 ± 11.05, mean BMI was 25.6 ± 6.0, and 22 (71.0%) were female. Mean age of adolescents was 14.2 ± 1.8, mean BMI was 22.7 ± 5.7, and 41(66.7%) were female. AdIS had significantly less postoperative major Cobb correction (63.9% vs 71.3%, p = 0.006) and final major Cobb correction (60.6% vs 67.9%, p = 0.025). AdIS also had significantly greater postoperative T1PA (11.8 vs 5.8, p = 0.002). AdIS had longer operative times (p = 0.003), higher amounts of pRBCs transfused (p = 0.005), longer LOS (p = 0.016), more ICU requirement (p = 0.013), higher overall complications (p < 0.001), higher rate of pseudarthrosis (p = 0.026), and more neurologic complications (p = 0.013).
Adult patients undergoing surgical correction of idiopathic scoliosis had significantly worse postoperative coronal and sagittal alignment when compared with adolescent patients. Adult patients also had higher rates of complications, longer operative times, and longer hospital stays.
III.
青少年特发性脊柱侧凸（AIS）的自然病史已有充分记录，但手术矫正时年龄的影响相对研究较少。在本研究中，我们将接受成人特发性脊柱侧凸（AdIS）手术矫正的患者与一组AIS患者进行匹配，以比较：（1）冠状面和矢状面影像学矫正情况；（2）手术变量；（3）术后并发症。
查询单一机构的脊柱侧凸登记处，获取2000年至2017年接受特发性脊柱侧凸手术的患者信息。
特发性脊柱侧凸患者，既往无脊柱手术史，且有2年随访资料。根据Lenke分类和曲线特征，将AdIS患者与AIS患者按1:2进行匹配。采用独立样本t检验和卡方检验分析数据。
31例成人接受了特发性脊柱侧凸的手术矫正，并与62例青少年进行了匹配。成人的平均年龄为26.2±11.05岁，平均体重指数为25.6±6.0，女性22例（71.0%）。青少年的平均年龄为14.2±1.8岁，平均体重指数为22.7±5.7，女性41例（66.7%）。AdIS术后主要Cobb角矫正（63.9%对71.3%，p = 0.006）和最终主要Cobb角矫正（60.6%对67.9%，p = 0.025）明显较少。AdIS术后T1PA也明显更大（11.8对5.8，p = 0.002）。AdIS的手术时间更长（p = 0.003），输注的浓缩红细胞量更多（p = 0.005），住院时间更长（p = 0.016），需要入住重症监护病房的情况更多（p = 0.013），总体并发症更多（p < 0.001），假关节发生率更高（p = 0.026），神经并发症更多（p = 0.013）。
与青少年患者相比，接受特发性脊柱侧凸手术矫正的成年患者术后冠状面和矢状面排列明显更差。成年患者的并发症发生率更高，手术时间更长，住院时间也更长。
III级。
