2008 – Increasing Pain and Disability, Rather Than Deformity, Determine Treatment Modality for Older Patients with Adult Scoliosis

AUTHORS: Boachie-Adjei, Oheneba¹; Bess, Shay²; Cunningham, Matthew E.¹; Burton, Doug³; Shaffrey, Christopher⁴; Shelokov, Alexis P.⁵; Hostin, Richard A.⁵; Schwab, Frank⁶; Wood, Kirkham⁷; Gupta, Munish C.⁸; Akbarnia, Behrooz A.²

INSTITUTIONS:

1. Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
2. San Diego Center for Spinal Disorders, San Diego, CA, USA.
3. University of Kansas Medical Center, Kansas City, KS, USA.
4. Neurosurgery, University of Virginia, Charlottesville, VA, USA.
5. Baylor Scoliosis Center, Plano, TX, USA.
6. Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
7. Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
8. Orthopaedic Surgery, University of California – Davis, Sacramento, CA, USA.

Introduction: Little information exists on factors determining adult scoliosis (AS) treatment. Existing reports have not age stratified features leading to operative (OP) or nonoperative (NON) treatment. The goals of this study were to identify age related clinical and radiographic features correlating with AS treatment.

Methods: Multi-center, retrospective review of 282 AS patients treated OP (n=150; avg. age 52 yrs) or NON (n=132; avg. age 54.6 yrs). Inclusion criteria: age >18 yrs, scoliosis >20 deg. Patients divided into treatment type (OP or NON) and stratified into 3 age groups (GP1=<50 yrs, GP2=50-65 yrs, GP3=>65 yrs). Radiographic (XR) evaluation included coronal, sagittal and spinopelvic measures. Health related quality of life measures (HRQL): SRS-22, Oswestry Disability Index (ODI), visual analog pain scale (VAS).

Results: Age non-stratified, OP vs. NON showed no demographic differences. Average thoracic curve size was the only age non-stratified XR difference (OP=51.2, NON=45 dg; p<0.05). Age non-stratified VAS and SRS scores were worse in OP vs. NON (VAS=6.9 vs. 5.6, p<0.001; SRS=2.9 vs. 3.1, p<0.05). All age stratified subgroups had similar patient numbers and mean age. Age stratified XR differences within treatment type: OP= GP1 had larger avg. thoracic curve than GP3 (54 vs. 34 dg, p<0.05), and GP2 had larger avg. thoracolumbar curve than GP3 (58 vs. 46 dg, p<0.05). Conversely, NON= GP2 had larger avg. thoracic curve than GP1 (53 vs. 43 dg, p<0.05). Both OP and NON demonstrated progressive sagittal imbalance with aging (p<0.05). Age stratified XR differences by treatment type: GP1= OP thoracic curves were larger than NON (53 vs. 43 dg, p<0.05). GP2= OP demonstrated hypokyphosis and hypolordosis compared to NON. GP3= No XR differences OP vs. NON. Comparing HRQL values: GP1= no differences OP vs. NON. GP2 and GP3= all OP HRQL were worse than NON, except SRS score (Table 1). GP3 OP demonstrated worst VAS and ODI of all groups. All NON groups had similar HRQL.

Conclusion: Operative treatment for older patients is driven by disability and poor HRQL scores while deformity dictates treatment for younger patients. Radiographic parameters have little treatment influence for older patients.

Please login first in order to download this document.