Adult Degenerative Scoliosis Surgical Outcomes: A Systematic Review and Meta-analysis
Tóm tắt
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. 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. 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. 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.
Tài liệu tham khảo
Aebi M. The adult scoliosis. Eur Spine J 2005;14:925–48.
Birknes JK, White AP, Albert TJ, et al. Adult degenerative scoliosis: a review. Neurosurgery 2008;63:94–103.
Bradford DS, Tay BK, Hu SS. Adult scoliosis: surgical indications, operative management, complications, and outcomes. Spine (Phila Pa 1976) 1999;24:2617–29.
Ploumis A, Transfledt EE, Denis F. Degenerative lumbar scoliosis associated with spinal stenosis. Spine J 2007;7:428–36.
Smith JS, Shaffrey CI, Kuntz CT, et al. Classification systems for adolescent and adult scoliosis. Neurosurgery 2008;63:16–24.
Kobayashi T, Atsuta Y, Takemitsu M, et al. A prospective study of de novo scoliosis in a community based cohort. Spine 2006;31:178–82.
Schwab F, Dubey A, Pagala M, et al. Adult scoliosis: a health assessment analysis by SF-36. Spine 2003;28:602–6.
Vanderpool DW, James JI, Wynne-Davies R. Scoliosis in the elderly. J Bone Joint Surg Am 1969;51:446–55.
Bridwell KH, Berven S, Edwards II C, et al. The problems and limitations of applying evidence-based medicine to primary surgical treatment of adult spinal deformity. Spine (Phila Pa 1976) 2007;32:S135–9.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986 Sep;7(3):177–88.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003 Sep 6;327(7414):557–60.
Yadla S, Maltenfort MG, Ratliff JK, et al. Adult scoliosis surgery outcomes: a systematic review. Neurosurg Focus 2010 Mar;28(3):E3.
Prommahachai A, Wittayapirot K, Jirarattanaphochai K, et al. Correction with instrumented fusion versus non-corrective surgery for degenerative lumbar scoliosis: a systematic review. J Med Assoc Thai. 2010 Aug;93(8):920–9.
Crandall DG, Revella J. Transforaminal lumbar interbody fusion versus anterior lumbar interbody fusion as an adjunct to posterior instrumented correction of degenerative lumbar scoliosis: three year clinical and radiographic outcomes. Spine 2009;34:2126–33.
Glassman SD, Carreon LY, Djurasovic M, et al. Lumbar fusion outcomes stratified by specific diagnostic indication. Spine J 2009;9:13–21.
Berven SH, Deviren V, Mitchell B, et al. Operative management of degenerative scoliosis: an evidence-based approach to surgical strategies based on clinical and radiographic outcomes. Neurosurg Clin North Am 2007;18:261–72.
Cho KJ, Suk SI, Park SR, et al. Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine 2007;32:2232–7.
Cho KJ, Suk SI, Park SR, et al. Short fusion versus long fusion for degenerative lumbar scoliosis. Eur Spine J 2008;17:650–6.
Cho KJ, Suk SI, Park SR, et al. Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis. Eur Spine J 2009;18:531–7.
Di Silvestre M, Lolli F, Bakaloudis G, et al. Dynamic stabilization for degenerative lumbar scoliosis in elderly patients. Spine 2010;35: 227–34.
Grubb SA, Lipscomb HJ, Suh PB. Results of surgical treatment of painful adult scoliosis. Spine 1994;19:1619–27.
Hasegawa K, Homma T. One-stage three-dimensional correction and fusion: a multilevel posterior lumbar interbody fusion procedure for degenerative lumbar kyphoscoliosis: technical note. J Neurosurg 2003;99:125–31.
Keorochana G, Tawonsawatruk T, Laohachareonsombat W, et al. The results of decompression and instrumented fusion with pedicular screw plate system in degenerative lumbar scoliosis patients with spinal stenosis: a prospective observational study. J Med Assoc Thai 2010;93:457–61.
Khan SN, Hofer MA, Gupta MC. Lumbar degenerative scoliosis: outcomes of combined anterior and posterior pelvis surgery with minimum 2-year follow-up. Orthopedics 2009 Apr;32(4):258–62.
Kluba T, Dikmenli G, Dietz K, et al. Comparison of surgical and conservative treatment for degenerative lumbar scoliosis. Arch Orthop Trauma Surg 2009;129:1–5.
Li G, Passias P, Kozanek M, et al. Adult scoliosis in patients over sixty-five years of age: outcomes of operative versus nonoperative treatment at a minimum two-year follow-up. Spine 2009;34: 2165–70.
Matsumura A, Namikawa T, Terai H, et al. The influence of approach side on facet preservation in microscopic bilateral decompression via a unilateral approach for degenerative lumbar scoliosis: clinical article. J Neurosurg Spine 2010;13:758–65.
McPhee IB, Swanson CE. The surgical management of degenerative lumbar scoliosis: posterior instrumentation alone versus two stage surgery. Bull Hosp Jt Dis 1998;57:16–22.
Ploumis A, Albert TJ, Brown Z, et al. Healos graft carrier with bone marrow aspirate instead of allograft as adjunct to local autograft for posterolateral fusion in degenerative lumbar scoliosis: a minimum 2-year follow-up study. J Neurosurg Spine 2010;13:211–5.
Scheufler KM, Cyron D, Dohmen H, et al. Less invasive surgical correction of adult degenerative scoliosis, part I: technique and radiographic results. Neurosurgery 2010;67:696–710.
Scheufler KM, Cyron D, Dohmen H, et al. Less invasive surgical correction of adult degenerative scoliosis. Part II: complications and clinical outcome. Neurosurgery 2010;67:1609–21.
Smith JS, Shaffrey CI, Berven S, et al. Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery 2009;65:86–94.
Tormenti MJ, Maserati MB, Bonfield CM, et al. Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurg Focus 2010 Mar;28(3):E7.
Transfeldt EE, Topp R, Mehbod AA, et al. Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. Spine 2010;35:1872–5.
Tsai TH, Huang TY, Lieu AS, et al. Functional outcome analysis: instrumented posterior lumbar interbody fusion for degenerative lumbar scoliosis. Acta Neurochir (Wien) 2011;153:547–55.
Wang MY, Mummaneni PV. Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes. Neurosurg Focus 2010;28:E9.
Wu CH, Wong CB, Chen LH, et al. Instrumented posterior lumbar interbody fusion for patients with degenerative lumbar scoliosis. J Spinal Disord Tech 2008;21:310–5.
Zurbriggen C, Markwalder TM, Wyss S. Long-term results in patients treated with posterior instrumentation and fusion for degenerative scoliosis of the lumbar spine. Acta Neurochir 1999;141:21–6.
Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 2007;356:2257–70.
Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 2008;33:2789–800.
Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA 2006;296:2451–9.
Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 2009;91:1295–304.
Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976) 2010;35:1329–38.
Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 2008;358:794–810.
Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes ResearchTrial (SPORT): a randomized trial. JAMA 2006;296:2441–50.
Djurasovic M, Glassman SD, Dimar II JR, et al. Changes in the Oswestry Disability Index that predict improvement after lumbar fusion. J Neurosurg Spine 2012;17:486–90.
Copay AG, Subach BR, Glassman SD, et al. Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 2007;7:541–6.
Carragee EJ, Cheng I. Minimum acceptable outcomes after lumbar spinal fusion. Spine J 2010;10:313–20.
Carreon LY, Sanders JO, Diab M, et al. The minimum clinically important difference in Scoliosis Research Society-22 Appearance, Activity, And Pain domains after surgical correction of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2010;35:2079–83.
Parker SL, Adogwa O, Paul AR, et al. Utility of minimum clinically important difference in assessing pain, disability, and health state after transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis. J Neurosurg Spine 2011;14:598–604.
Carreon LY, Bratcher KR, Canan CE, et al. Differentiating minimum clinically important difference for primary and revision lumbar fusion surgeries. J Neurosurg Spine 2013;18:102–6.