Risk-Benefit Assessment of Surgery for Adult Scoliosis An Analysis Based on Patient Age

被引:270
|
作者
Smith, Justin S. [1 ,2 ]
Shaffrey, Christopher I. [1 ,2 ]
Glassman, Steven D. [3 ]
Berven, Sigurd H. [4 ]
Schwab, Frank J. [5 ]
Hamill, Christopher L. [6 ]
Horton, William C. [7 ]
Ondra, Stephen L. [8 ]
Sansur, Charles A. [9 ]
Bridwell, Keith H. [10 ]
机构
[1] Univ Virginia, Dept Neurosurg, Charlottesville, VA 22908 USA
[2] Univ Virginia, Dept Orthoped Surg, Charlottesville, VA 22908 USA
[3] Norton Leatherman Spine Ctr, Louisville, KY USA
[4] Univ Calif San Francisco, Spinal Disorders Serv, San Francisco, CA 94143 USA
[5] NYU, Hosp Joint Dis, New York, NY USA
[6] SUNY Buffalo, Buffalo, NY 14260 USA
[7] Emory Orthoped & Spine Ctr, Atlanta, GA USA
[8] Northwestern Univ, Dept Neurosurg, Chicago, IL 60611 USA
[9] Univ Maryland, Med Ctr, Dept Neurosurg, Baltimore, MD 21201 USA
[10] WA Univ, Spinal Deform Serv, St Louis, MO USA
关键词
adult scoliosis; complications; outcomes; surgery; disability; age; elderly; DEGENERATIVE LUMBAR SCOLIOSIS; SPINAL DEFORMITY SURGERY; LOW-BACK-PAIN; NONOPERATIVE TREATMENT; PERIOPERATIVE COMPLICATIONS; OPERATIVE TREATMENT; SURGICAL-TREATMENT; SRS-22; INSTRUMENT; FOLLOW-UP; POPULATION;
D O I
10.1097/BRS.0b013e3181e21783
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. Retrospective review of a prospective, multicenter database. Objective. 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. Summary of Background Data. Complications increase with age for adults undergoing scoliosis surgery, but whether this impacts the outcomes of older patients is largely unknown. Methods. 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 degrees), plan for scoliosis surgery, and 2-year follow-up. Results. 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. Conclusion. 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.
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页码:817 / 824
页数:8
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