Is there a difference in outcome between patients under and over age 60 who have long fusions to the sacrum for the primary treatment of adult scoliosis?
2009
SUMMARY
We studied 63 patients who underwent fusion to the sacrum at a single institution for the primary treatment of adult scoliosis. We compared the clinical and radiographic outcomes between young patients (Y; <60-yrs old) and older patients (O; >60-yrs old). We found that both groups witnessed a significant improvement in SRS/ODI with surgery. The O cohort, despite more complications, sustained a greater incremental improvement following surgery than the Y group in terms of pain, self-image, overall subscore, and ODI (P<0.05).
INTRODUCTION
The purpose was to determine if there was a difference in outcome following fusion to the sacrum for the primary treatment of adult scoliosis in patients younger (Y) or older (O) than age 60.
METHODS
Consecutive patients who underwent primary surgery for adult scoliosis from 2002-2006 were studied. Y and O cohorts were matched by diagnosis, BMI, co-morbidities, extent of deformity, and f/u. All patients were fused to the sacrum (>6 levels) through a posterior approach. Min f/u for all patients was 2-yrs. SRS scores and ODI were used.
RESULTS
63 pts (Y=38, O=25), mean f/u 3.0±1.1-yrs. Diagnoses: idiopathic (n=45; 71.4%) and de novo (n=18; 28.6%). Mean ages: Y=51.8±6.6-yrs; O=65.8±4.6-yrs. The groups had similar fusion levels (Y=10.8 vs O=11.6), mg of rhBMP-2/level (Y=6.4 vs O=8.3), mL of EBL (Y=1019 vs O=1174), and surgery time in hrs (Y=7.3 vs O=7.4). Complications were higher in the O group, both perioperatively (Y=13.2% vs O=36.0%, P=0.061) and overall (Y=34.2% vs O=52.0%, P=0.196). Preop SRS function was worse in the O group (Y=3.2 vs O=2.8, P=0.032) and there were trends towards lower self-image, pain, subscore (4 domains minus satisfaction), and ODI (0.0515) was also significantly higher in the older patients: (Y=44.7% vs O=72.0%, P=0.041).
CONCLUSION
Despite a higher rate of complications, patients over age 60 appear to sustain a greater benefit from long fusion to the sacrum for the primary treatment of adult scoliosis. This might be in part attributable to a more debilitated functional status in older patients prior to surgery based on the SRS outcomes instrument and the ODI.
SIGNIFICANCE
This study strongly supports the benefit associated with surgical treatment of adult scoliosis in patients with an aging spine (i.e., greater than 60-yrs old)
Table 1. Between Group Comparisons of Change in Clinical Outcome Measures |
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|
|
Function |
Self-Image |
Mental Health |
Pain |
Subscore |
ODI** |
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|
Y |
O |
Y |
O |
Y |
O |
Y |
O |
Y |
O |
Y |
O |
|
|
Pre-op |
3.20 |
2.75 |
2.61 |
2.29 |
3.62 |
3.75 |
2.95 |
2.59 |
3.10 |
2.85 |
33.8 |
41.3 |
|
Final |
3.66 |
3.53 |
3.80 |
4.03 |
4.06 |
4.43 |
3.98 |
4.16 |
3.87 |
4.04 |
18.2 |
17.6 |
|
Change |
0.46 |
0.77 |
1.19 |
1.74 |
0.44 |
0.69 |
1.03 |
1.57 |
0.77 |
1.19 |
15.6 |
23.7 |
|
P-value |
0.10583 |
0.02044 |
0.13644 |
0.00435 |
0.00495 |
0.03505 |
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|
**ODI = Oswestry Disability Index. Y=Young Group (age <60 years); O=Older Group (age>60 years). |
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