gms | German Medical Science

Objectives: Adult scoliosis is a challenging condition particularly in female patients above the age of 60 years. In the future the incidence will steadily increase in line with expected population demographic changes. If surgery is indicated, one, two or three stage procedure may be required based on curve type, severity and patient frailty. At present there is uncertainty about the ideal amount of postural correction and the relationship of functional outcome.

The aim of this study was to analyse the correlation between surgical adult scoliosis correction and functional outcome.

Methods: A retrospective study was conducted using the prospective collected data from the Australian Spine Registry. All patients above the age of 18 years were included. Patients were asked to complete the Oswestry Disability Index (ODI), EQ-5D-3L before surgery and then after 6, 12 and 24 months. In addition, demographics, comorbidities and complications were noted. All pre- and post-operative EOS scans were analysed measuring the pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, hip occipital angle, sagittal vertical axis, upper and lower cobb angles, coronal list, and number of fusion levels. The number of surgical stages were recorded. A Pearson correlation test was performed to analyse the correlation between postoperative PROMs and change in radiographic measurements.

Results and conclusion: A total of 60 patients at a mean age of 54.4±16.0 years met the inclusion criteria between 2018 and 2021. The lumbar primary curve had a preoperative Cobb angle of 45.8±18.9° on average and a thoracic Cobb angle of 30.6±17.4°. The coronal list was 24.7±21.0mm and the sagittal vertical axis -52.3±76.4mm. After surgery, the lower cobb angle improved -26.2±18.4° to 21.2±14.3 and the upper cobb angle by -11.9±15.7° to 19.3±12.9°. After surgery, the coronal list was 21.4±18.3mm (a change of -3.1±22.7mm) and the sagittal vertical axis was -13.6±45.4mm (a change of 36.4±65.3mm). Lumbar lordosis was improved by 12.9±20.4° to 44.0±12.2° and thoracic kyphosis by 12.8±13.8 to 52.9±16.2°. No significant changes in, pelvic tilt or sacral slope were noted.

Before surgery, the ODI was 36.7±18.2 and this improved to 24.3±18.0 after 6 months, 22.4±16.2 after 12 months (p=0.182), and 19.9±15.5 after 24 months (p=0.012). For the EQ-5D-3L this was 62.0±17.8 preoperative, 74.5±16.6 after 6 months, 75.5±16.6 after 12 months and 77.5±13.3 (p=0.024) after 24 months (p=0.050). No significant correlation was observed between the patient related outcome measures and radiographic measurements.

Satisfaction of degenerative scoliosis patients does not require a full anatomical reduction. Even if a remaining scoliosis was present patients were still highly satisfied. Therefore, the current concepts recommending anatomical reduction needs to be correlated with PROMs results.. The functional outcome should be prioritized in the upcoming studies.