Adolescent Idiopathic Scoliosis – Surgical Outcomes
Abstract
Adolescent idiopathic scoliosis is an entity commonly and successfully treated via non-surgical (bracing) and surgical means. For the patients who do go on to operative intervention, a variety of surgical techniques exist. Along with the advantages of ever-evolving technology and research often also arise the possibilities of associated morbidity and mortality. The overall goals, however, remain constant: achieving good correction while preserving motion levels in the safest manner possible. Historically, surgical outcomes were based primarily on the degree of surgical correction obtained. Recently, more emphasis is being placed not only on surgical correction, but also on the social and psychological implications of this entity on patients and families afflicted with this condition.Adolescent idiopathic scoliosis, surgical correction and outcomes, complications, pseudoarthrosis, infection, health-related quality of life
Adolescent idiopathic scoliosis (AIS) surgery has evolved over the last 100 years to encompass today a variety of surgical techniques and approaches that have had a profound impact on the efficacy of correction achieved. With newer instrumentation and technology there is now even more emphasis on preserving fusion levels while at the same time reducing associated morbidity. The treatment goals, however, remain constant: obtain good correction, prevent curve progression, achieve a solid fusion and improve cosmetic appearance.
Natural History/Classification
AIS, as the name implies, remains a diagnosis of exclusion (after having ruled out other causes, i.e. congenital, neuromuscular). Commonly defined as a persistent lateral spine curvature of 10 degrees or more, AIS is commonly associated with rotation of the spine in different planes, hence truly making it a complex 3D entity.
Idiopathic scoliosis can be divided into three broad categories based on age at initial curve presentation: infantile (birth to two years), juvenile (three to 10 years) and adolescent (11–17 years), of which adolescent is the most common. Although the exact aetiology of AIS remains unknown, studies have found the risk of curve progression to be greater in females than males, even though both are equally affected.
Traditionally AIS has been addressed via one of three treatment modalities: observation, bracing and surgery. Curves falling in the 0–20 degree range generally warrant initial observation. Curves between 20 and 45 degrees are usually treated with bracing. Surgery is reserved for curves greater than 50 degrees, or curves that demonstrate progression despite bracing.
Diagnosis, Signs and Symptoms, and Measurements
AIS is most commonly diagnosed in school screenings, initial visits with a primary care physician or by a family member. Usually initially painless, the first notation is one of a fullness or back prominence (rib hump). Other signs and symptoms include shoulder asymmetry, waistline asymmetry (which may present as limb-length inequality) and trunk shift (chest to pelvis alignment).
A scoliometer is used to measure the angle of trunk rotation at the apex of the prominence. Radiographs are obtained with the patient standing and these radiographs consist of anteroposterior (AP), lateral and side bending (to help determine rigidity). Cobb angle is used to measure the curve in the coronal plane, with the largest measurement representing the major curve.
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