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  • New Research of Interest

    Spine (Phila Pa 1976). 2010 Sep 15;35(20):1872-5.
    Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy.


    Transfeldt EE, Topp R, Mehbod AA, Winter RB.

    Twin Cities Spine Center, Minneapolis, MN, USA.
    Abstract

    STUDY DESIGN: A retrospective clinical cohort study at a single spine center of patients with degenerative scoliosis and radiculopathy severe enough to require surgery.

    OBJECTIVE: To evaluate the functional outcomes of 3 surgeries for degenerative scoliosis with radiculopathy; decompression alone, decompression and limited fusion, and decompression and full curve fusion.

    SUMMARY OF BACKGROUND DATA: Although these 3 surgical treatments have all been described for this problem, there exists little information as to what outcomes to expect.

    METHODS: The study cohort consisted of 85 patients who met the inclusion criteria of degenerative scoliosis and radiculopathy, who had undergone 1 of the above 3 surgeries, who had not had any previous lumbar spine surgery, who had a minimum follow-up of at least 2 years, and who had filled out preoperative and postoperative functional evaluation forms including SF-36, Oswestry Disability Index, Roland Morris Scores, and a satisfaction questionnaire. Logistic regression analysis was conducted to predict the likelihood of success as related to decompression alone of rotatory olisthetic segments, extent of fusion, and postoperative sagittal balance. Patient demographics including curve magnitude, operative blood loss, length of hospital stay, complications, and need for revision surgeries were analyzed. The patients having decompression alone had the highest mean age (76.4 years) compared to decompression and limited fusion (70.4), and decompression and full curve fusion (62.5).

    RESULTS: Cobb scoliosis angles remained unchanged in the 2 groups not having full curve fusion, while the full curve fusion group changed from a mean 39° before surgery to 19° at follow-up. The complication rate was highest (56%) in the full fusion group, was 40% in the limited fusion group, and 10% in the decompression alone group. The overall SF-36 analysis showed significant improvement in bodily pain, social function, role emotional, mental health, and mental composite domains. Oswestry Disability Indexes improved significantly in the decompression alone and limited fusion groups, but not in the full fusion group. In contrast, the satisfaction questionnaire showed the highest success to be in the full-curve fusion group and the lowest in the decompression-only group.Regression analysis revealed that sacrum to curve apex fusions and positive postoperative sagittal imbalance were associated with poor outcomes.

    CONCLUSION: Both good and poor results were seen with each of the 3 procedures.

    PMID: 20802398 [PubMed - in process]


    Spine (Phila Pa 1976). 2010 Sep 15;35(20):1861-6.
    Functional outcomes and complications after primary spinal surgery for scoliosis in adults aged forty years or older: a prospective study with minimum two-year follow-up.


    Zimmerman RM, Mohamed AS, Skolasky RL, Robinson MD, Kebaish KM.

    Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
    Abstract

    STUDY DESIGN: A prospective study.

    OBJECTIVE: Our purpose was to evaluate prospectively the complications, clinical outcomes, and self-reported quality of life in a relatively homogenous group of adults aged ≥ 40 years undergoing primary surgical treatment for scoliosis.

    SUMMARY OF BACKGROUND DATA: Relatively few reports have examined surgical outcomes in adult patients with scoliosis, especially adults aged ≥ 40 years, whose outcomes may differ because of more rigid curves and more frequent and severe comorbidities. Although most studies have shown patient benefits despite high complication rates after such surgery, most were retrospective and conducted before the introduction of third-generation instrumentation techniques.

    METHODS: We prospectively studied a consecutive series of 35 patients of age ≥ 40 years (average age, 56.3 years) undergoing primary surgery for scoliosis by one surgeon. Most of our patients (86%) had at least one comorbidity. We collected complete radiographic measurements and Oswestry Disability Index, Short Form 36, and Scoliosis Research Society 22 questionnaires before surgery and at each follow-up, and recorded the number and type of complications. Outcomes were assessed in the context of complications, degree of correction, and procedure characteristics to detect significant (P < 0.05) correlations.

    RESULTS: The overall complications rate was 49%; 26% of the patients had a major complication and 31% had a minor one. There were no deaths. Coronal curve correction was 30.8° (61%) on average. There were statistically significant postoperative improvements in Oswestry Disability Index, Short Form 36, and Scoliosis Research Society 22 scores. Patients whose fusions ended at L4 or L5 showed greater improvements in some of the Short Form 36 component scores than patients whose fusions involved the sacrum (P = 0.041). There were no significant differences in outcomes related to presence of complications or operative staging.

    CONCLUSION: Adults ≥ 40 years with symptomatic scoliosis benefit from surgical treatment, despite the high complication rate.

    PMID: 20802387 [PubMed - in process]
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  • #2
    As a sidebar...

    Dr. Ensor Transfeldt was learning/mentoring under Dr Bradford when Dr Bradford did my surgery. Dr Transfeldt was really cool.

    Just sayin...

    Carry on.

    Brad
    Surgeries July 26th & August 3rd 1983 (12 years old)
    Still have 57 degree curve
    2 Harrington rods
    Luque method used
    Dr David Bradford
    Twin Cities Scoliosis Center
    Preop xray (with brace on)
    Postop xray

    Comment


    • #3
      Hi Linda - Hope you are well.
      Thanks for posting this research. If you don't mind I am going to take the second portion, regarding the adult scoliosis surgery, and post on my blog.
      Always interesting stuff.
      Take care,
      Shari
      Shari - 55 years old
      Pre-Surgery 62 degree thorasic curve with shifting.
      Post op 13 degree curve.
      Successful surgery 4/15/10, T3-L2 fused.
      2nd surgery to reopen incision 10" to diagnose infection, 5/18/10
      Beaumont Hospital, Royal Oak, MI - the late Dr. Harry Herkowitz
      www.scoliosisthejourney.com

      Comment


      • #4
        Linda,

        Sounds like no advantages to either of the procedures, correct?

        rich

        Comment


        • #5
          Linda-in the second study of >40, what is the time frame to determine complications? During and immediately following surgery or a longer period of time? I didn't see that mentioned in the study but thought you might know.
          Age 56
          Wore a Milwaukee Brace for 3 years in hs
          Fused L4-S1 for high grade spondylolisthesis Jan '09 in Indy
          Thoracic 68
          Surgery Aug 31, 2010 T3 to L1
          Dr Bridwell St Louis
          http://www.scoliosis.org/forum/attac...1&d=1289881696

          Comment


          • #6
            Originally posted by LisaB View Post
            Linda-in the second study of >40, what is the time frame to determine complications? During and immediately following surgery or a longer period of time? I didn't see that mentioned in the study but thought you might know.
            A minimum of 2 years.
            Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
            ---------------------------------------------------------------------------------------------------------------------------------------------------
            Surgery 2/10/93 A/P fusion T4-L3
            Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

            Comment


            • #7
              Originally posted by rich1752 View Post
              Linda,

              Sounds like no advantages to either of the procedures, correct?

              rich
              Hi Rich...

              Which study are you referring to?

              --Linda
              Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
              ---------------------------------------------------------------------------------------------------------------------------------------------------
              Surgery 2/10/93 A/P fusion T4-L3
              Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

              Comment


              • #8
                Originally posted by ShariMSU View Post
                Hi Linda - Hope you are well.
                Thanks for posting this research. If you don't mind I am going to take the second portion, regarding the adult scoliosis surgery, and post on my blog.
                Always interesting stuff.
                Take care,
                Shari
                It's always a good thing to disseminate any information that might help someone make an informed choice.
                Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                ---------------------------------------------------------------------------------------------------------------------------------------------------
                Surgery 2/10/93 A/P fusion T4-L3
                Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                Comment


                • #9
                  Originally posted by LindaRacine View Post
                  [B]Patients whose fusions ended at L4 or L5 showed greater improvements in some of the Short Form 36 component scores than patients whose fusions involved the sacrum (P = 0.041). PMID: 20802387 [PubMed - in process]
                  This is interesting. I thought most of the studies recently were saying the opposite--that fusing to the sacrum was better than stopping at L5. Do you know, Linda?

                  Evelyn
                  age 48
                  80* thoracolumbar; 40* thoracic
                  Reduced to ~16* thoracolumbar; ~0* thoracic
                  Surgery 3/14/12 with Dr. Lenke in St. Louis, T4 to S1 with pelvic fixation
                  Broken rods 12/1/19; scheduled for revision fusion L1-L3-4 with Dr. Lenke 2/4/2020
                  Not "confused" anymore, but don't know how to change my username.

                  Comment


                  • #10
                    Originally posted by Confusedmom View Post
                    This is interesting. I thought most of the studies recently were saying the opposite--that fusing to the sacrum was better than stopping at L5. Do you know, Linda?

                    Evelyn
                    Hi Evelyn...

                    The SF36 is measuring patient satisfaction. And, since these are relatively short-term follow-up results, it doesn't surprise me to find that the people whose fusions stopped short of the sacrum are happier than those whose fusions went to the sacrum. We'd have to know what happens in another 5-10 years to know if the same results would be found.

                    Here's a quote from the full text:
                    The only difference was that patients whose fusions ended at L4–L5 showed greater SF-36 mental health component score improvements than those whose fusions included the sacrum (4.18 vs. 1.32 points; P = 0.041). This small difference (of likely no clinical significance) does not outweigh the need to fuse to the sacrum if necessary to achieve stability or balance. Fusion to the sacrum is often determined by the curve type, sagittal and coronal balance, bone quality, and presence of degenerative changes at the lumbosacral junction. When fusion to the sacrum is indicated, the patient should be counseled about reasonable expectations and potential limitations.

                    Note that the author talks about it being a slight difference.

                    --Linda
                    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                    ---------------------------------------------------------------------------------------------------------------------------------------------------
                    Surgery 2/10/93 A/P fusion T4-L3
                    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                    Comment


                    • #11
                      All good points, thanks Linda!

                      Evelyn
                      age 48
                      80* thoracolumbar; 40* thoracic
                      Reduced to ~16* thoracolumbar; ~0* thoracic
                      Surgery 3/14/12 with Dr. Lenke in St. Louis, T4 to S1 with pelvic fixation
                      Broken rods 12/1/19; scheduled for revision fusion L1-L3-4 with Dr. Lenke 2/4/2020
                      Not "confused" anymore, but don't know how to change my username.

                      Comment

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