School of Medicine, Vanderbilt University, Nashville, TN, USA.
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Eur Spine J. 2024 Apr;33(4):1637-1643. doi: 10.1007/s00586-024-08177-x. Epub 2024 Mar 4.
While the natural history of adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) is well documented in the literature, the impact of age on postoperative outcomes remains an active area of research. We performed a systematic review and meta-analysis to compare patients undergoing surgery for AIS and AdIS with respect to: (1) postoperative Cobb correction, (2) perioperative variables, and (3) postoperative complications.
A systematic literature search was performed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.
studies published between 2002 and 2022, retrospective, and comparing AIS vs. AdIS patients undergoing deformity surgery. The primary outcome was postoperative Cobb correction. Secondary outcomes included estimated blood loss (EBL), operative time, total instrumented levels, length of stay (LOS), and postoperative complications. Random-effects models were performed according to the method of DerSimonian and Laird.
Of 190 identified articles, 14 fit the inclusion criteria. A total of 1788 patients were included, 1275(71.3%) with AIS, and 513(28.7%) with AdIS. There was a significant age difference between AIS and AdIS (15.3 vs. 36.7 years, mean difference (MD) = 21.3 years, 95%CI = 14.3-28.4,p < 0.001). Mean postoperative Cobb percentage correction was reported in 5 articles and was significantly higher in AIS (68.4%) vs. AdIS (61.4%) (MD = -7.2, 95%CI = -11.6,-2.7,p = 0.001). EBL was not significantly different between AIS and AdIS (695.6 mL vs 817.7 mL,p = 0.204). Furthermore, no difference was found in operative time (MD = 37.9 min,95%CI = -10.7;86.6,p = 0.127), total instrumented level (MD = 0.88,95%CI = -0.7,2.4,p = 0.273), and LOS (MD = 0.5, 95%CI = -0.2;1.2, p = 0.188). Four articles reported postoperative complications in AIS vs AdIS, with no difference in neurological deficit, instrumentation-related complications, and medical complications.
AIS patients had better radiographic correction compared to AdIS. Though no difference was found in perioperative outcomes and complications, these findings emphasize the importance of counseling patients regarding the optimal timing of surgical correction.
尽管青少年特发性脊柱侧凸（AIS）和成人特发性脊柱侧凸（AdIS）的自然史在文献中已有详细记载，但年龄对术后结果的影响仍是一个活跃的研究领域。我们进行了系统评价和荟萃分析，以比较接受 AIS 和 AdIS 手术治疗的患者在以下方面的情况：（1）术后 Cobb 矫正；（2）围手术期变量；和（3）术后并发症。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了系统的文献检索。
2002 年至 2022 年期间发表的回顾性研究，比较 AIS 与 AdIS 患者接受畸形手术的研究。主要结局是术后 Cobb 矫正。次要结局包括估计失血量（EBL）、手术时间、总器械水平、住院时间（LOS）和术后并发症。根据 DerSimonian 和 Laird 的方法进行随机效应模型分析。
在 190 篇已识别的文章中，有 14 篇符合纳入标准。共有 1788 名患者入选，其中 1275 名（71.3%）为 AIS 患者，513 名（28.7%）为 AdIS 患者。AIS 和 AdIS 之间存在显著的年龄差异（15.3 岁 vs. 36.7 岁，平均差异（MD）= 21.3 岁，95%CI = 14.3-28.4，p<0.001）。5 篇文章报告了术后 Cobb 百分比矫正的平均值，AIS （68.4%）明显高于 AdIS （61.4%）（MD=-7.2，95%CI=-11.6，-2.7，p=0.001）。AIS 和 AdIS 之间的 EBL 无显著差异（695.6 mL 比 817.7 mL，p=0.204）。此外，手术时间（MD=37.9 分钟，95%CI=-10.7；86.6，p=0.127）、总器械水平（MD=0.88，95%CI=-0.7，2.4，p=0.273）和 LOS（MD=0.5，95%CI=-0.2；1.2，p=0.188）无差异。有 4 篇文章报道了 AIS 与 AdIS 术后并发症，在神经功能缺损、器械相关并发症和医疗并发症方面无差异。
与 AdIS 相比，AIS 患者的影像学矫正效果更好。尽管在围手术期结果和并发症方面没有差异，但这些发现强调了向患者咨询手术矫正的最佳时机的重要性。
