title: Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age.
abstract: METHODS
  Retrospective review of a prospective, multicenter database.
  
  
  OBJECTIVE
  The purpose of this study was to assess whether elderly patients undergoing scoliosis surgery had an incidence of complications and improvement in outcome measures comparable with younger patients.
  
  
  BACKGROUND
  Complications increase with age for adults undergoing scoliosis surgery, but whether this impacts the outcomes of older patients is largely unknown.
  
  
  METHODS
  This is a retrospective review of a prospective, multicenter spinal deformity database. Patients complete the Oswestry Disability Index (ODI), SF-12, Scoliosis Research Society-22 (SRS-22), and numerical rating scale (NRS; 0-10) for back and leg pain. Inclusion criteria included age 25 to 85 years, scoliosis (Cobb ≥ 30°), plan for scoliosis surgery, and 2-year follow-up.
  
  
  RESULTS
  Two hundred six of 453 patients (45%) completed 2-year follow-up, which is distributed among age groups as follows: 25 to 44 (n = 47), 45 to 64 (n = 121), and 65 to 85 (n = 38) years. The percentages of patients with 2-year follow-up by age group were as follows: 25 to 44 (45%), 45 to 64 (48%), and 65 to 85 (40%) years. These groups had perioperative complication rates of 17%, 42%, and 71%, respectively (P < 0.001). At baseline, elderly patients (65-85 years) had greater disability (ODI, P = 0.001), worse health status (SF-12 physical component score (PCS), P < 0.001), and more severe back and leg pain (NRS, P = 0.04 and P = 0.01, respectively) than younger patients. Mean SRS-22 did not differ significantly at baseline. Within each age group, at 2-year follow-up there were significant improvements in ODI (P ≤ 0.004), SRS-22 (P ≤ 0.001), back pain (P < 0.001), and leg pain (P ≤ 0.04). SF-12 PCS did not improve significantly for patients aged 25 to 44 years but did among those aged 45 to 64 (P < 0.001) and 65 to 85 years (P = 0.001). Improvement in ODI and leg pain NRS were significantly greater among elderly patients (P = 0.003, P = 0.02, respectively), and there were trends for greater improvements in SF-12 PCS (P = 0.07), SRS-22 (P = 0.048), and back pain NRS (P = 0.06) among elderly patients, when compared with younger patients.
  
  
  CONCLUSIONS
  Collectively, these data demonstrate the potential benefits of surgical treatment for adult scoliosis and suggest that the elderly, despite facing the greatest risk of complications, may stand to gain a disproportionately greater improvement in disability and pain with surgery.
authors.affiliation: Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA. jss7f@virginia.edu
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Steven D
authors.initials: SD
authors.lastname: Glassman
authors.forename: Sigurd H
authors.initials: SH
authors.lastname: Berven
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Schwab
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Hamill
authors.forename: William C
authors.initials: WC
authors.lastname: Horton
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Ondra
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sansur
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D019299:Decompression, Surgical / Q000009:adverse effects*; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects*; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012600:Scoliosis / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome