Clinical, radiological and HRQoL outcomes after selective thoracic fusion with minimum 15-year follow-up

Introduction The purpose of the study was to provide a 15-year natural history evaluation of the radiographic appearance of uninstrumented compensatory lumbar curves in patients who had undergone selective thoracic fusion (STF) for scoliosis, measure any changes in health-related quality of life scores (HRQoL) and compare them with controls matched for age, gender and body-mass index (BMI). Methods STF group included 43 female adolescent idiopathic scoliosis (AIS) patients who underwent STF with mean age 33(27-42) years and a mean follow-up of 18.7 (15-28) years, mean BMI 22(18-29). Preop, early postop and follow-up radiographs were reviewed for behavior of lumbar curves. Control group included a random selection of healthy volunteers with no history of back pain and with mean age 33(27-41), and mean BMI 22(17-33). HRQoL scores were compared between two groups in latest f/up. Radiographs including low dose biplanar imaging with EOS were used to measure disc heights and assess for radiographic evidence of degenerative changes. Various parameters were statistically compared. Results Posterior fusion was performed in all 43, with all pedicle screws used in 41 and all-hook constructs in 2. Main thoracic curve correction was improved from pre-op to early-post-op and maintained at latest f/up (55.6 degrees-16.1 degrees-16.9 degrees). Spontaneous lumbar curve correction (SLCC) was also maintained beyond 15 years (39.9 degrees-16.6 degrees-17.1 degrees). Two patients developed coronal decompensation following surgery, but improved with time and were well compensated at final follow-up. Mean HRQoL scores, self-image and mental health scores were higher in STF group than control group (p < 0.05). SRS-22r pain and function, Oswestry Disability Index and Numeric Rating Scale, marital status, number of children were similar between the groups(p > 0.05). All disc heights except L5-S1 were significantly lower in STF group (p < 0.05). There was no significant difference between the groups for degenerative changes in the latest radiographs. Conclusion In this group of patients, the uninstrumented lumbar curve spontaneously corrected and the correction was maintained after 18 years following surgery using STF. Mild degenerative changes were seen radiographically and HRQoL scores suggest that the psychological-functional well-being are quite good in the long term in AIS patients who have undergone STF when compared with an age-gender-BMI-matched population.