Anterior arthrodesis with instrumentation for thoracolumbar scoliosis - Comparison of efficacy in adults and adolescents

Study Design. A retrospective review was performed of adult and adolescent patients who underwent anterior spinal fusion for thoracolumbar idiopathic scoliosis; radiographic and clinical outcomes were compared. Objective. The objective of this study was to compare the efficacy of anterior instrumentation to treat thoracolumbar scoliosis in adults and adolescents by evaluating radiographic and clinical outcomes. Summary of Background Data. Anterior spinal arthrodesis is an effective treatment for idiopathic scoliosis. Deformity characteristics and clinical outcomes of adults versus adolescents have not been compared. Methods. A retrospective review of patients undergoing anterior fusion for thoracolumbar scoliosis was performed. Clinical outcomes were assessed using SRS- 22. Preoperative and postoperative long films were evaluated independently. Flexibility, curve correction, and clinical outcomes were compared between adult and adolescents. Results. Fifteen adults and 15 adolescents who underwent anterior spinal fusion and instrumentation were evaluated. Mean follow- up was 47 and 46 months, respectively. Flexibility of the major curve in adults ( 63%) was less than in adolescents ( 79%) ( P < 0.05). Mean pre-operative, major curve Cobb angles were 51 degrees and 49 degrees for adults and adolescents, respectively. Mean postoperative Cobb angles improved less for adults (17 degrees) than for adolescents (10 degrees) ( P < 0.05). The SRS- 22 questionnaire revealed no statistical difference between populations. Conclusion. Anterior spinal fusion is an option for both adults and adolescents with flexible, moderate thoracolumbar/ lumbar curves. Flexibility significantly decreased with increased age and curve magnitude. This significantly affected curve correction. Adult patients may develop early degeneration at primary curve and compensatory curves. Careful patient selection is critical with this technique.