My name is Thomas Buell, and I'd like to thank the scientific subcommittee of the AANS for the opportunity to give my virtual talk entitled, Multi-Center Prospective Assessment of Outcomes and Complications Associated with Adult Severe Scoliosis Surgery in 146 Patients with Minimum Two-Year Follow-Up. I'd also like to acknowledge my co-authors and the ISSG. Here are our disclosures. Adult spinal deformity is highly prevalent. Some studies suggesting it can affect up to 68% of the elderly. Current predictions suggest an unprecedented expansion of the elderly population in the coming years. Therefore, it's important for healthcare workers and surgeons alike to be aware of adult spinal deformity, its various subtypes and forms, as well as its various treatments. This is a heterogeneous disease with varying clinical impact depending on the specific subtype and severity of deformity. Several important studies come to mind, which quantified the health impact of adult spinal deformity and various subtypes of it and compared it to the general population, as well as other important chronic diseases. Some of these studies suggested lower baseline functional scores in comparison to the general population, as well as other disease-specific groups, such as back pain, hypertension, arthritis, chronic lung disease, diabetes, and congestive heart failure. More recently, Bessing colleagues used self-reported SF36 scores to demonstrate the heterogeneity of adult spinal deformity and its various types and its impact on health-related quality of life assessment. Notably, Bessing colleagues demonstrated patients with combined lumbar scoliosis and severe sagittal deformity reported lower HRQL than patients with limited use of arms and legs. Given the significant impact of adult spinal deformity on self-reported health assessments, such as pain and disability, several studies have focused on its treatment, as well as potential improvements and associated complications. Current evidence, including the as-treated analysis of a recent controlled trial, suggests that operative treatment can provide significant improvement despite associated complications. Knowing that there are various subtypes and severity of deformity, some authors have demonstrated positive results even in the subset of severe scoliosis. In this multicenter study, we aim to investigate the subset of deformity characterized by severe scoliosis. We report treatment outcomes and associated complication rates after adult spinal deformity surgery. We performed a retrospective analysis of a prospective multicenter ISSG database of consecutive surgical adult spinal deformity patients. For the study, severe scoliosis was defined as a thoracic cob angle greater than 75 degrees or thoracolumbar, a lumbar cob angle greater than 50 degrees. Operatively treated patients with minimum two-year follow-up were assessed. Of 178 potentially eligible patients, 146 had minimum two-year follow-up and were included. Their mean age was 54 years, 92% were women, almost 30% had prior fusion, 6% were active or past smokers, 16% had diagnosis of osteoporosis, and 77% had at least one comorbidity. According to study inclusion criteria for severe scoliosis, 6% had thoracic scoliosis, 60% had thoracolumbar scoliosis, and 34% had severe lumbar scoliosis. Summary of surgical data is illustrated on this slide. I'd like to point out a few findings. 58% had a posterior-only approach surgery, 14% had a three-column osteotomy, 76% had sacropelvic fixation, the mean number of fused levels was approximately 13 levels, and almost two-thirds had an upper thoracic, uppermost instrumented vertebral level. The mean estimated surgical blood loss was nearly two liters. The vast majority of assessed radiographic alignment parameters were significantly improved after minimum two-year follow-up. A breakdown of the coronal plane and sagittal plane results are on the next two slides. In the coronal plane, global alignment improved significantly from 3.8 to 2.8 centimeters. For the thoracic subcohort, major curve improved from 83 to 55 degrees. For the thoracolumbar subcohort, major curve improved from 67 to 33 degrees, and for the lumbar subcohort, the major curve improved from 61 to 27 degrees. These results are similar to the coronal plane correction results reported by recent single-center studies. Overall, sagittal alignment improved significantly. This was most notable for the spherolumbar scoliosis subset, with SVA corrected from 6.7 to 2.5 centimeters, and the pelvic incidence lumbar lordosis mismatch corrected from 18 to 3 degrees. Patient-reported outcome measures were significantly improved, and these met the thresholds for minimum clinically important differences. There were 191 associated complications, most commonly dural tear, pleural effusion, rod fracture, radiculopathy, and proximal junctional kyphosis. There were 34 reoperations, and approximately 18% of the patients were diagnosed with a junctional kyphosis. There were 34 reoperations, and approximately 18% of patients. The most common indications for reoperation were rod fracture, pseudoarthrosis, deep wound infection, and neurological deficit. In conclusion, the study was a retrospective analysis of prospective multicenter ISSG data of consecutive adult spinal deformity surgical cases with minimum two-year follow-up. We demonstrated surgery for severe adult scoliosis was associated with significant radiographic alignment improvement, as well as benefits in self-reported HRQL measures. This is on par with recent single-center studies. Although there were high associated complication rates, these appear to be comparable to reports of less severe scoliosis. Thank you for listening to this virtual talk.

adult severe scoliosis surgery

prevalence of adult spinal deformity

lower functional scores

retrospective analysis

high complication rates