Outcomes of Surgical Treatment for Patients With Mild Scoliosis and Age-Appropriate Sagittal Alignment With Minimum 2-Year Follow-up

Abstract

Objective: The goal of this study was to determine if patients with mild scoliosis and age-appropriate sagittal alignment have favorable outcomes following surgical correction.

Methods: Retrospective review of a prospective, multicenter adult spinal deformity database. Inclusion criteria: operative patients age ≥18 years, and preoperative pelvic tilt, mismatch between pelvic incidence and lumbar lordosis (PI-LL), and C7 sagittal vertical axis all within established age-adjusted thresholds with minimum 2-year follow-up. Health-related quality of life (HRQoL) scores: Oswestry Disability Index (ODI), 36-item Short Form health survey (SF-36), Scoliosis Research Society-22R (SRS22R), back/leg pain Numerical Rating Scale and minimum clinically important difference (MCID)/substantial clinical benefit (SCB). Two-year and preoperative HRQoL radiographic data were compared. Patients with mild scoliosis (Mild Scoli, Max coronal Cobb 10°-30°) were compared to those with larger curves (Scoli).

Results: One hundred fifty-one patients included from 667 operative patients (82.8% women; average age, 56.4 ± 16.2 years). Forty-two patients (27.8%) included in Mild Scoli group. Mild Scoli group had significantly worse baseline leg pain, ODI, and physical composite scores (p < 0.02). Mean 2-year maximum coronal Cobb angle was significantly improved compared to baseline (p < 0.001). All 2-year HRQoL measures were significantly improved compared to (p < 0.001) except mental composite score, SRS activity and SRS mental for the Mild Scoli group (p > 0.05). From the mild Scoli group, 36%-74% met either MCID or SCB for the HRQoL measures. Sixty-four point three percent had minimum 1 complication, 28.6% had a major complication, 35.7% had reoperation.

Conclusion: Mild scoliosis patients with age-appropriate sagittal alignment benefit from surgical correction, decompression, and stabilization at 2 years postoperative despite having a high complication rate.

Keywords: Adult spinal deformity; Complications; Mild scoliosis; Outcomes; Sagittal alignment.

Fig. 1.

The percentage of patients that reached minimal clinically important difference (MCID) and significant clinical benefit (SCB) from baseline to 2 years postoperative for the Scoli and Mild Scoli groups. Scoli, patients with larger curves (greater than 30°); Mild Scoli, patients with mild scoliosis (10°–30°); ODI, Oswestry Disability Index; PCS, physical composite score of the medical Short Form 36 (SF-36); MCS, mental composite score of the SF-36; SRS, Scoliosis Research Society-22 questionnaire; NRS, Numerical Rating Scale. *p<0.05, statistically significant differences.

Fig. 2.

Case example. Preoperative anteroposterior (A) and lateral (B) radiographs demonstrating the coronal and sagittal spinal alignment parameters. The vertical line in the left image represents the coronal C7-plumb line (3.2 cm) and the Max coronal Cobb angle was 28.3°. SVA, sagittal vertical axis (2.9 cm); PI, pelvic incidence; LL, lumbar lordosis (PI–LL=4.0°); PT, pelvic tilt (22.6°).

Fig. 3.

Case example. Two-year postoperative anteroposterior (A) and lateral (B) radiographs demonstrating the coronal and sagittal spinal alignment parameters. The vertical line in the left image represents the coronal C7-plumb line (1.4 cm) and the corrected Max coronal Cobb angle was 7.3°. SVA, sagittal vertical axis (3.0 cm); PI, pelvic incidence; LL, lumbar lordosis (PI–LL=-5.8°); PT, pelvic tilt (24.4°).