title: 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.
abstract: METHODS
  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.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  Adults ≥ 40 years with symptomatic scoliosis benefit from surgical treatment, despite the high complication rate.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Zimmerman
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Mohamed
authors.forename: Richard L
authors.initials: RL
authors.lastname: Skolasky
authors.forename: Malaya D
authors.initials: MD
authors.lastname: Robinson
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Kebaish
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D012600:Scoliosis / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome