title: Adult Degenerative Scoliosis Surgical Outcomes: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  There is increasing awareness of adult degenerative or de novo scoliosis, and its surgical treatment when indicated can be challenging and resource intense. Surgical randomized controlled trials are rare, and observational studies pose limitations because of the heterogeneity of surgical practices, techniques, and patient populations. Pooled analysis of current literature may identify effective treatment strategies and guide future efforts at prospective clinical research. This study aimed to synthesize existing data on the outcomes of surgical intervention for adult degenerative scoliosis.
  
  
  METHODS
  PubMed, Medline, Cochrane, and Web of Science databases were searched using key words and were limited to the English language. Spine surgeons reviewed abstracts and evaluated whether they contained surgically treated cohorts of adults (more than 18 years of age) with degenerative scoliosis. Full-text articles were reviewed in detail and data were abstracted. All meta-analyses were conducted using random effects models and heterogeneity was estimated with I2. Random-effects meta-regression models were used to investigate the association of treatment effects with baseline levels of each outcome.
  
  
  RESULTS
  Of 482 articles, 24 (n = 805) met inclusion criteria Available outcomes included Cobb angle correction, coronal and sagittal balance, visual analog scale for pain (VAS), and Oswestry Disability Index. Despite significant heterogeneity among studies, random-effects meta-analysis showed significant improvements in Cobb angle (-11.1°; 95% confidence interval [CI], -13.86° to -8.40°), coronal balance (7.674 mm; 95% CI, -10.5 to -4.9), VAS (-3.24; 95% CI, -4.5 to -1.98), and Oswestry Disability Index (-27.18%; 95% CI, -34.22 to -20.15) postoperative treatment (p < .001). Meta-regression models showed that preoperative values for Cobb angle, coronal balance, and VAS were significantly associated with surgical treatment effect (p < .05). Changes in sagittal balance did not reach statistical significance although only 6 articles were included.
  
  
  CONCLUSIONS
  Exhaustive literature review yielded 24 studies reporting preoperative and postoperative data regarding the surgical treatment of adult degenerative scoliosis. No randomized clinical trials (RCTs) were identified. Despite heterogeneity, a limited meta-analysis showed significant improvement in Cobb angle, coronal balance, and VAS after surgical treatment of adult degenerative scoliosis.
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave. S R200, Minneapolis, MN 55454, USA. Electronic address: ledon001@umn.edu.
authors.forename: Charles G T
authors.initials: CG
authors.lastname: Ledonio
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave. S R200, Minneapolis, MN 55454, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Polly
authors.affiliation: Norton Leatherman Spine Center, 210 East Gray Street, Suite 900 Louisville, KY 40202, USA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Crawford
authors.affiliation: University of Minnesota, Cardiovascular Division, 420 Delaware Street, SEMMC 508, Minneapolis, MN 55455, USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Duval
authors.affiliation: University of Virginia, Spine Center, Fontaine Research Park 415 Ray C. Hunt Dr., Charlottesville, VA 22903, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Buchowski
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave. S R200, Minneapolis, MN 55454, USA.
authors.forename: Sharon C
authors.initials: SC
authors.lastname: Yson
authors.affiliation: Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
authors.forename: A Noelle
authors.initials: AN
authors.lastname: Larson
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave. S R200, Minneapolis, MN 55454, USA.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Sembrano
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave. S R200, Minneapolis, MN 55454, USA.
authors.forename: Edward R G
authors.initials: ER
authors.lastname: Santos
keywords: Adult degenerative scoliosis; De novo scoliosis; Meta-analysis; Surgical outcome; Systematic review