Adult Scoliosis in Patients Over Sixty-Five Years of Age: Outcomes of Operative Versus Nonoperative Treatment at a Minimum Two-Year Follow-up

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2009-09, Vol.34 (20), p.2165-2170
• Main Authors: GANG LI, PASSIAS, Peter, KOZANEK, Michal, FU, Eric, SHAOBAI WANG, QUN XIA, GUOAN LI, RAND, Frank E, WOOD, Kirkham B
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Case-Control Studies; Cerebrospinal fluid. Meninges. Spinal cord; Disability Evaluation; Female; Health Status; Humans; Male; Medical sciences; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Nervous system (semeiology, syndromes); Neurology; Patient Satisfaction; Physical Therapy Modalities; Quality of Life; Radiography; Retrospective Studies; Scoliosis - diagnostic imaging; Scoliosis - physiopathology; Scoliosis - therapy; Self-Examination; Spinal Fusion - methods; Treatment Outcome
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e3181b3ff0c

Retrospective case-control study. The purpose of this study was to compare the self-reported outcomes between operatively and nonoperatively treated patients over the age of 65 with adult scoliosis, using 4 distinct self-assessment questionnaires (SRS-22, SF-12, EQ5D, and Oswestry disability index [ODI]) and standard radiographic measurement parameters. The current spine literature contains no studies that directly compare the self-reported and radiographic outcomes of operatively and nonoperatively treated patients over the age of 65 years with adult scoliosis. We retrospectively analyzed the self-reported outcomes of 83 adult scoliosis in patients over the age of 65 years. A total of 34 patients were treated operatively, whereas 49 patients were managed nonoperatively. For each of these patients, standard radiographic measurements were recorded both before and after treatment, and each patient received 4 questionnaires (SRS-22, SF-12, EQ5D, and ODI) that were completed with a minimum of 2-year follow-up from the time the treatment was initiated. The outcomes of both groups were then statistically compared. As compared to the nonoperative group, the operative group reported significantly better self-assessment scores for the EQ5D index, EQ5D Visual Analogue Score, and SRS-22 questionnaires. However, no statistically significant difference between the groups was detected for the ODI, SF-12 Mental Health Component Summary, and SF-12 PCS. Furthermore, the operative group also had a significant improvement in radiographic measurements. Adult scoliosis patients over the age of 65 years treated operatively had significantly less pain, a better health-related quality of life, self image, mental health, and were more satisfied with their treatment than patients treated conservatively. However, we found no statistically significant differences in their degree of disability as measured by the ODI as well as physical and mental health by the SF-12 instrument. Preoperative radiographic deformity was not determined to be a significant factor for predicting whether an operative or nonoperative treatment course was chosen.