Preoperative and Perioperative Factors Effect on Adolescent Idiopathic Scoliosis Surgical Outcomes
- 1 September 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Spine
- Vol. 35 (20), 1867-1871
- https://doi.org/10.1097/brs.0b013e3181efa6f5
Abstract
Prospective multicenter database. To identify factors associated with outcomes from adolescent idiopathic scoliosis (AIS) surgery outcomes and especially poor results. Because AIS is rarely symptomatic during adolescence, excellent surgical results are expected. However, some patients have poor outcomes. This study seeks to identify factors correlating with results and especially those making poor outcomes more likely. Demographic, surgical, and radiographic parameters were compared to 2-year postoperative Scoliosis Research Society (SRS) scores in 477 AIS surgical patients using stepwise linear regression to identify factors predictive of 2-year domain and total scores. Poor postoperative score patients (>2 SD below mean) were compared using t tests to those with better results. The SRS instrument exhibited a strong ceiling effect. Two-year scores showed more improvement with greater curve correction (self-image, pain, and total), and were worse with larger body mass index (pain, mental, total), larger preoperative trunk shift (mental and total), larger preoperative Cobb (self-image), and preoperative symptoms (function). Poor results were more common in those with Lenke 3 curve pattern (pain), less preoperative coronal imbalance, trunk shift and rib prominence (function), preoperative bracing (self-image), and anterior procedures (mental). Poor results also had slightly less average curve correction (50% vs. 60%) and larger curve residuals (31° vs. 23°). Complications, postoperative curve magnitude, and instrumentation type did not significantly contribute to postoperative scores, and no identifiable factors contributed to satisfaction. Curve correction improves patient's self-image whereas pain and poor function before surgery carry over after surgery. Patients with less spinal appearance issues (higher body mass index, Lenke 3 curves) are less happy with their results. Except in surgical patient selection, many of these factors are beyond physician control.Keywords
This publication has 26 references indexed in Scilit:
- Score Distribution of the Scoliosis Quality of Life Index Questionnaire in Different Subgroups of Patients With Adolescent Idiopathic ScoliosisSpine, 2007
- The Reliability and Concurrent Validity of the Scoliosis Research Society-22r Patient Questionnaire Compared With the Child Health Questionnaire-CF87 Patient Questionnaire for Adolescent Spinal DeformitySpine, 2007
- Refinement of the SRS-22 Health-Related Quality of Life Questionnaire Function DomainSpine, 2006
- Outcome in adolescent idiopathic scoliosis after brace treatment and surgery assessed by means of the Scoliosis Research Society Instrument 24European Spine Journal, 2005
- Discrimination Validity of the Scoliosis Research Society-22 Patient QuestionnaireSpine, 2003
- A Multicenter Study of the Outcomes of the Surgical Treatment Of Adolescent Idiopathic Scoliosis Using the Scoliosis Research Society (SRS) Outcome InstrumentSpine, 2002
- Prospective Radiographic and Clinical Outcomes and Complications of Single Solid Rod Instrumented Anterior Spinal Fusion in Adolescent Idiopathic ScoliosisSpine, 2001
- Further Development and Validation of the Scoliosis Research Society (SRS) Outcomes InstrumentSpine, 2000
- Patients’ Perceptions of Overall Function, Pain, and Appearance After Primary Posterior Instrumentation and Fusion for Idiopathic ScoliosisSpine, 1999
- Results of the Scoliosis Research Society Instrument for Evaluation of Surgical Outcome in Adolescent Idiopathic ScoliosisSpine, 1999