Adult degenerative scoliosis: comparison of patient-rated outcome after three different surgical treatments

Few studies have examined the effectiveness of surgical treatment for adult degenerative scoliosis (ADS) using validated patient-orientated outcome instruments. This study reports patient outcomes in a large, consecutive series of patients being treated for ADS by simple decompression (D), short fusion (SF), or long fusion (LF). Our local spine surgery database (part of the Eurospine Spine Tango Registry) was used to acquire the data from patients with ADS undergoing D, SF or LF. Preoperatively and at 12 and 24 months follow-up (FU), patients completed the multidimensional Core Outcome Measures Index (COMI; 0-10); at FU, satisfaction and global outcome were rated on a five-point Likert scale and dichotomised as "good" and "poor", and patient-rated complications were recorded. 173 patients took part (81 D, 53 SF, 39 LF). Compared with the two fusion groups, the D group was significantly older, had more comorbidity, and had more leg pain than back pain (each p < 0.05). There were significant differences among the groups for operation duration, blood loss and general complications (each p < 0.05), in each case with the LF group showing the greatest values and the D group the lowest values. However, patient-rated complications were not significantly different between the groups (p > 0.89). Further surgery within the 2-year follow-up was required in 7 % of the D group, 15 % in SF and 28 % in LF. All groups benefited significantly from surgery with no significant differences (p > 0.05) between them: improvement in COMI after 24 months was 2.9 +/- 2.8 points for D, 3.1 +/- 3.3 points for SF and 3.2 +/- 3.1 points for LF; a "good global outcome" was recorded for 69, 74 and 76 % patients, respectively. Despite the complexity of the disease, patient-orientated outcomes after surgery for ADS were similar to those previously reported using the same outcome instruments in patients with lumbar stenosis and degenerative spondylolisthesis. The use of D, SF and LF for ADS yielded similarly good results from the patient's perspective. This most likely reflects careful and appropriate patient selection. Further analyses are warranted to identify baseline variables predicting the 26-31 % cases in each group with a poor outcome.