Results of surgical treatment of painful adult scoliosis

Abstract

Study design: In a consecutive clinical series, using before and after treatment measures, outcome was evaluated in adults with pain and scoliosis who underwent spinal fusion.

Objective: This outcome study tested the hypothesis that adult scoliosis patients with chief complaints of pain can have good results, reflected in decreased pain and increased activity postoperatively, when surgical intervention is based not only on analysis of structural deformity, but also on comprehensive evaluation of pain-producing pathology.

Methods: Twenty-eight adults with idiopathic scoliosis and 25 adults with degenerative scoliosis treated with spinal fusion were followed prospectively for 2 to 7 years. All patients had chief complaints of pain and underwent comprehensive evaluations of pain-producing pathology, as well as evaluations of structural deformity. Before initial evaluations, patients completed questionnaires including pain rating, activity level specifically related to standing, sitting, and walking tolerances, ability to work, and period of disability. At a minimum of 24 months postop, patients completed confidential questionnaires seeking report of pain, activity, and work status. These data were compared to responses obtained before surgery. Pseudoarthroses were assessed by superimposed flexion/extension films.

Results: The pseudoarthrosis rate was 17.5%, all occurring in patients fused to the sacrum in single posterior procedures. Pain relief was associated with solid fusion (P = .02). Reported pain reduction was 80% among patients with idiopathic scoliosis and 70% among patients with degenerative scoliosis. Improved sitting and walking tolerances were seen in patients with idiopathic scoliosis, and improved standing and walking were seen in patients with degenerative scoliosis.