Very long-term clinical and radiographic outcomes after posterior spinal fusion with pedicular screws for thoracic adolescent idiopathic scoliosis.

PURPOSE: To report radiographic and functional outcomes, with an average follow-up of 20 years, of adolescents treated surgically for thoracic idiopathic scoliosis by hybrid construct using only pedicular screws for the distal fixation.

METHODS

We retrospectively reviewed 109 patients. Radiographic data were evaluated on fullspine radiographs (Cobb angle, pelvic incidence, sacral slope, pelvic tilt, thoracic kyphosis, lumbar lordosis). Clinical data were evaluated with ODI, SF-12, SRS-30 and Analog Pain Scale. Disc height and listhesis below the arthrodesis were measured.

RESULTS

We analyzed 90 women and 19 men with a mean age of 16.9 y.o. at surgery. Radiographic data were assessed for 46 patients after 17.4 years. Mean preoperative Cobb angle was 58°, mean correction 40.1% with 5.3° of loss at final FU. Lumbar lordosis and thoracic kyphosis increased significantly at last FU. Degenerative changes below the arthrodesis were reported in 5 cases. Clinical data were assessed for 42 patients after 19.9 years: SRS-30 3.8; ODI 12.3%; SF-12 PCS 48.6 and MCS 46. Low back pain was reported in 69% of cases with low intensity (3.1). The lowest instrumented vertebrae did not influence significantly the functional outcome.

CONCLUSIONS

The correction of thoracic AIS with lumbar or thoracolumbar pedicle screw instrumentation provides good radiological and clinical outcomes at very long term. The reduction in the coronal plane is stable; the HRQoL is quite as good as the general population. The degenerative evolution below remain relatively rare, therefore global sagittal balance is not modified.