Surgical treatment of young adults with idiopathic scoliosis

Corey T. WalkerDepartment of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California;

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Nitin AgarwalDepartment of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and

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Robert K. EastlackDivision of Orthopedics, Scripps Clinic, San Diego, California

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Gregory M. Mundis Jr.Division of Orthopedics, Scripps Clinic, San Diego, California

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Nima AlanDepartment of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and

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Tina IannaconeDivision of Orthopedics, Scripps Clinic, San Diego, California

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Behrooz A. AkbarniaDivision of Orthopedics, Scripps Clinic, San Diego, California

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David O. OkonkwoDepartment of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and

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OBJECTIVE

In this study, the authors report on their experience with the surgical treatment of young adults with idiopathic scoliosis (YAdISs) who did not have surgical treatment in adolescence but did require intervention after skeletal maturity.

METHODS

The medical records of YAdISs between 18 and 40 years of age who had been surgically treated at two institutions between 2009 and 2018 were retrospectively evaluated. Pre- and postoperative clinical and radiographic information was gathered and compared at 2 years after treatment.

RESULTS

Twenty-eight patients (9 male, 19 female) with a median age of 25 years (range 18–40 years) met the study inclusion criteria. Five patients (18%) had postoperative complications, including 2 deep venous thromboses, 1 ileus, and 2 reoperations, one for implant failure and the other for pseudarthrosis. The mean maximum coronal curve angle improved from 43° ± 12° to 17° ± 8° (p < 0.001), but there were no significant differences in sagittal vertical axis, lumbar lordosis, pelvic tilt, or thoracic kyphosis (p > 0.05). There was no relationship between the amount of correction obtained and patient age (p = 0.46). Significant improvements in the Oswestry Disability Index (31 vs 24, p = 0.02), visual analog scale score for both back pain (6.0 vs 4.0, p = 0.01) and leg pain (2.6 vs 1.1, p = 0.02), and self-image score (Δ1.1, p < 0.001) were seen.

CONCLUSIONS

YAdISs can present with pain, deformity progression, and/or appearance dissatisfaction because of their scoliosis despite successful nonoperative management during adolescence. Once the scoliosis becomes symptomatic, surgical correction can result in significant clinical and radiographic improvements at the 2-year follow-up with a relatively low complication rate compared to that for other types of adult spinal deformity.

ABBREVIATIONS

AIS = adolescent idiopathic scoliosis; ASD = adult spinal deformity; HRQOL = health-related quality of life; MCID = minimal clinically important difference; ODI = Oswestry Disability Index; SRS = Scoliosis Research Society; VAS = visual analog scale; YAdIS = young adult with idiopathic scoliosis.
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Illustration from Beck et al. (pp 147–152). © Department of Neurosurgery, Freiburg Medical Center; published with permission.

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