Does prior short-segment surgery for adult scoliosis impact perioperative complication rates and clinical outcome among patients undergoing scoliosis correction?

Clinical article

Manish K. Kasliwal M.D., M.Ch.1, Justin S. Smith M.D., Ph.D.1, Christopher I. Shaffrey M.D.1, Leah Y. Carreon M.D., M.Sc.2, Steven D. Glassman M.D.2, Frank Schwab M.D.3, Virginie Lafage Ph.D.3, Kai-Ming G. Fu M.D., Ph.D.4, and Keith H. Bridwell M.D.5
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  • 1 Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;
  • | 2 Norton Leatherman Spine Center, Louisville, Kentucky;
  • | 3 Hospital for Joint Diseases, NYU Langone Medical Center, New York;
  • | 4 Department of Neurosurgery, Weill Cornell Medical College, New York, New York; and
  • | 5 Spinal Deformity Service, Washington University in St. Louis, Missouri
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Object

In many adults with scoliosis, symptoms can be principally referable to focal pathology and can be addressed with short-segment procedures, such as decompression with or without fusion. A number of patients subsequently require more extensive scoliosis correction. However, there is a paucity of data on the impact of prior short-segment surgeries on the outcome of subsequent major scoliosis correction, which could be useful in preoperative counseling and surgical decision making. The authors' objective was to assess whether prior focal decompression or short-segment fusion of a limited portion of a larger spinal deformity impacts surgical parameters and clinical outcomes in patients who subsequently require more extensive scoliosis correction surgery.

Methods

The authors conducted a retrospective cohort analysis with propensity scoring, based on a prospective multicenter deformity database. Study inclusion criteria included a patient age ≥ 21 years, a primary diagnosis of untreated adult idiopathic or degenerative scoliosis with a Cobb angle ≥ 20°, and available clinical outcome measures at a minimum of 2 years after scoliosis surgery. Patients with prior short-segment surgery (< 5 levels) were propensity matched to patients with no prior surgery based on patient age, Oswestry Disability Index (ODI), Cobb angle, and sagittal vertical axis.

Results

Thirty matched pairs were identified. Among those patients who had undergone previous spine surgery, 30% received instrumentation, 40% underwent arthrodesis, and the mean number of operated levels was 2.4 ± 0.9 (mean ± SD). As compared with patients with no history of spine surgery, those who did have a history of prior spine surgery trended toward greater blood loss and an increased number of instrumented levels and did not differ significantly in terms of complication rates, duration of surgery, or clinical outcome based on the ODI, Scoliosis Research Society-22r, or 12-Item Short Form Health Survey Physical Component Score (p > 0.05).

Conclusions

Patients with adult scoliosis and a history of short-segment spine surgery who later undergo more extensive scoliosis correction do not appear to have significantly different complication rates or clinical improvements as compared with patients who have not had prior short-segment surgical procedures. These findings should serve as a basis for future prospective study.

Abbreviations used in this paper:

EBL = estimated blood loss; ODI = Oswestry Disability Index; SF-12 = 12-Item Short Form Health Survey; SRS = Scoliosis Research Society; SVA = sagittal vertical axis.

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Contributor Notes

Address correspondence to: Justin S. Smith, M.D., Ph.D., Department of Neurosurgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, Virginia 22908. email: jss7f@virginia.edu.

Please include this information when citing this paper: published online June 8, 2012; DOI: 10.3171/2012.4.SPINE12130.

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