Skip to main content
SpringerLink
Log in

Adult versus adolescent idiopathic scoliosis surgery: a meta-analysis of clinical and radiographic outcomes

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Introduction

While the natural history of adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) is well documented in the literature, the impact of age on postoperative outcomes remains an active area of research. We performed a systematic review and meta-analysis to compare patients undergoing surgery for AIS and AdIS with respect to: (1) postoperative Cobb correction, (2) perioperative variables, and (3) postoperative complications.

Methods

A systematic literature search was performed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Inclusion criteria: studies published between 2002 and 2022, retrospective, and comparing AIS vs. AdIS patients undergoing deformity surgery. The primary outcome was postoperative Cobb correction. Secondary outcomes included estimated blood loss (EBL), operative time, total instrumented levels, length of stay (LOS), and postoperative complications. Random-effects models were performed according to the method of DerSimonian and Laird.

Results

Of 190 identified articles, 14 fit the inclusion criteria. A total of 1788 patients were included, 1275(71.3%) with AIS, and 513(28.7%) with AdIS. There was a significant age difference between AIS and AdIS (15.3 vs. 36.7 years, mean difference (MD) = 21.3 years, 95%CI = 14.3–28.4,p < 0.001). Mean postoperative Cobb percentage correction was reported in 5 articles and was significantly higher in AIS (68.4%) vs. AdIS (61.4%) (MD = −7.2, 95%CI = −11.6,−2.7,p = 0.001). EBL was not significantly different between AIS and AdIS (695.6 mL vs 817.7 mL,p = 0.204). Furthermore, no difference was found in operative time (MD = 37.9 min,95%CI = −10.7;86.6,p = 0.127), total instrumented level (MD = 0.88,95%CI = −0.7,2.4,p = 0.273), and LOS (MD = 0.5, 95%CI = −0.2;1.2, p = 0.188). Four articles reported postoperative complications in AIS vs AdIS, with no difference in neurological deficit, instrumentation-related complications, and medical complications.

Conclusion

AIS patients had better radiographic correction compared to AdIS. Though no difference was found in perioperative outcomes and complications, these findings emphasize the importance of counseling patients regarding the optimal timing of surgical correction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Dunn J, Henrikson NB, Morrison CC et al (2018) Screening for adolescent idiopathic scoliosis: evidence report and systematic review for the US Preventive Services Task Force. JAMA 319:173–187. https://doi.org/10.1001/jama.2017.11669

    Article  PubMed  Google Scholar 

  2. Diarbakerli E, Grauers A, Danielsson A, Gerdhem P (2017) Adults with idiopathic scoliosis diagnosed at youth experience similar physical activity and fracture rate as controls. Spine (Phila Pa 1976) 42:E404–E410. https://doi.org/10.1097/BRS.0000000000001841

  3. Verla T, Adogwa O, Toche U et al (2016) Impact of increasing age on outcomes of spinal fusion in adult idiopathic scoliosis. World Neurosurg 87:591–597. https://doi.org/10.1016/j.wneu.2015.10.061

    Article  PubMed  Google Scholar 

  4. Kim YJ, Bridwell KH, Lenke LG et al (2005) Pseudarthrosis in primary fusions for adult idiopathic scoliosis: incidence, risk factors, and outcome analysis. Spine (Phila Pa 1976) 30:468–474. https://doi.org/10.1097/01.brs.0000153392.74639.ea

  5. Weiss H-R (2008) Adolescent idiopathic scoliosis (AIS) – an indication for surgery? A systematic review of the literature. Disabil Rehabil 30:799–807. https://doi.org/10.1080/09638280801889717

    Article  PubMed  Google Scholar 

  6. Negrini S (2008) Approach to scoliosis changed due to causes other than evidence: patients call for conservative (rehabilitation) experts to join in team orthopedic surgeons. Disabil Rehabil 30:731–741. https://doi.org/10.1080/09638280801889485

    Article  PubMed  Google Scholar 

  7. Peelle MW, Boachie-Adjei O, Charles G et al (2008) Lumbar curve response to selective thoracic fusion in adult idiopathic scoliosis. Spine J 8:897–903. https://doi.org/10.1016/j.spinee.2007.11.010

    Article  PubMed  Google Scholar 

  8. Takahashi S, Delécrin J, Passuti N (2002) Surgical treatment of idiopathic scoliosis in adults: an age-related analysis of outcome. Spine (Phila Pa 1976) 27:1742–1748. https://doi.org/10.1097/00007632-200208150-00011

  9. Chen Z-Q, Zhao Y-F, Bai Y-S et al (2011) Factors affecting curve flexibility in skeletally immature and mature idiopathic scoliosis. J Orthop Sci 16:133–138. https://doi.org/10.1007/s00776-011-0034-6

    Article  PubMed  Google Scholar 

  10. Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  11. Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  PubMed  Google Scholar 

  12. Deviren V, Patel VV, Metz LN et al (2008) Anterior arthrodesis with instrumentation for thoracolumbar scoliosis: comparison of efficacy in adults and adolescents. Spine (Phila Pa 1976) 33:1219–1223. https://doi.org/10.1097/BRS.0b013e318170fce0

  13. Lonner BS, Ren Y, Bess S et al (2019) Surgery for the adolescent idiopathic scoliosis patients after skeletal maturity: early versus late surgery. Spine Deform 7:84–92. https://doi.org/10.1016/j.jspd.2018.05.012

    Article  PubMed  Google Scholar 

  14. Zhu F, Bao H, Yan P et al (2017) Comparison of surgical outcome of adolescent idiopathic scoliosis and young adult idiopathic scoliosis: a match-pair analysis of 160 patients. Spine (Phila Pa 1976) 42:E1133–E1139. https://doi.org/10.1097/BRS.0000000000002106

  15. Lavelle W, Kurra S, Hu X, Lieberman I (2020) Clinical outcomes of idiopathic scoliosis surgery: is there a difference between young adult patients and adolescent patients? Cureus 12:e8118. https://doi.org/10.7759/cureus.8118

    Article  PubMed  PubMed Central  Google Scholar 

  16. Goshi K, Boachie-Adjei O, Moore C, Nishiyama M (2004) Thoracic scoliosis fusion in adolescent and adult idiopathic scoliosis using posterior translational corrective techniques (Isola): is maximum correction of the thoracic curve detrimental to the unfused lumbar curve? Spine J 4:192–201. https://doi.org/10.1016/j.spinee.2003.08.025

    Article  PubMed  Google Scholar 

  17. Bullmann V, Halm HF, Niemeyer T et al (2003) Dual-rod correction and instrumentation of idiopathic scoliosis with the Halm-Zielke instrumentation. Spine (Phila Pa 1976) 28:1306–1313. https://doi.org/10.1097/01.BRS.0000065571.58058.68

  18. Sciubba D, Jain A, Kebaish KM et al (2021) Development of a preoperative adult spinal deformity comorbidity score that correlates with common quality and value metrics: length of stay, major complications, and patient-reported outcomes. Global Spine J 11:146–153. https://doi.org/10.1177/2192568219894951

    Article  PubMed  Google Scholar 

  19. Enercan M, Ozturk C, Kahraman S et al (2013) Osteotomies/spinal column resections in adult deformity. Eur Spine J 22(Suppl 2):S254-264. https://doi.org/10.1007/s00586-012-2313-0

    Article  PubMed  Google Scholar 

  20. Berjano P, Aebi M (2015) Pedicle subtraction osteotomies (PSO) in the lumbar spine for sagittal deformities. Eur Spine J 24:49–57. https://doi.org/10.1007/s00586-014-3670-7

    Article  Google Scholar 

  21. Sansur CA, Smith JS, Coe JD et al (2011) Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine (Phila Pa 1976) 36:E593–597. https://doi.org/10.1097/BRS.0b013e3182059bfd

  22. Bari TJ, Hallager DW, Hansen LV et al (2021) Mechanical revision following pedicle subtraction osteotomy: a competing risk survival analysis in 171 consecutive adult spinal deformity patients. Spine Deform 9:191–205. https://doi.org/10.1007/s43390-020-00195-1

    Article  PubMed  Google Scholar 

  23. Chanbour H, Roth SG, LaBarge ME et al (2023) The postoperative course of mechanical complications in adult spinal deformity surgery. Spine Deform 11:175–185. https://doi.org/10.1007/s43390-022-00576-8

    Article  PubMed  Google Scholar 

Download references

Funding

This study did not receive funding from any institution or grant. No funds received to conduct the study.

Author information

Authors and Affiliations

  1. School of Medicine, Vanderbilt University, Nashville, TN, USA

    Jeffrey W. Chen

  2. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Hani Chanbour, Amir M. Abtahi, Scott L. Zuckerman & Byron F. Stephens

  3. School of Medicine, University of Minnesota, Minneapolis, MN, USA

    Rishabh Gupta

  4. School of Medicine, Meharry Medical College, Nashville, TN, USA

    Justine Izah

  5. School of Medicine, Tulane University, New Orleans, LA, USA

    Wilson E. Vaughan

  6. Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA

    Amir M. Abtahi, Scott L. Zuckerman & Byron F. Stephens

Authors
  1. Jeffrey W. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hani Chanbour
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rishabh Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Justine Izah
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wilson E. Vaughan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amir M. Abtahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Scott L. Zuckerman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Byron F. Stephens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Byron F. Stephens.

Ethics declarations

Conflict of interest

Dr. Stephens is a consultant for Nuvasive and Carbofix and receives institutional research support from Nuvasive and Stryker Spine. Dr. Zuckerman reports being an unaffiliated neurotrauma consultant for the National Football League. Dr. Abtahi received an institutional research support from Stryker Spine. No other perceived conflict of interest by any of the listed authors.

Ethical approval

Institutional review board (IRB) approval was not required for conducting this meta-analysis, and the review was not registered.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, J.W., Chanbour, H., Gupta, R. et al. Adult versus adolescent idiopathic scoliosis surgery: a meta-analysis of clinical and radiographic outcomes. Eur Spine J 33, 1637–1643 (2024). https://doi.org/10.1007/s00586-024-08177-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-024-08177-x

Keywords

Search

Navigation