Adolescent vs. Young Adult Idiopathic Scoliosis patients: how different are their two year postoperative radiographic and clinical outcomes?

Purpose: To compare the long-term outcomes among AIS (10-18 years) and young AdIS (YAdIS) (19-40 years) patients with minimum 2 year follow up.

Methods: A retrospective review of AIS and YAdIS patients who underwent primary corrective surgery at a single center was conducted. Demographic, radiographic, operative data, patient reported outcome measures (PROMs), including the ODI and SRS-22r, and long-term complications were collected. A 1:1 propensity score matched (PSM) analysis was implemented to limit selection bias by controlling for gender, curve type, total instrumented levels (TIL), and main coronal cobb angle.

Results: 95 patients (60 AIS, 35 YAdIS) were identified. Following PSM, 27 matched pairs were identified. AIS patients had greater LL (-55.6 ± 14.0 vs. -61.8 ± 11.7, p = 0.0486) at preop, less OR time (4.7 ± 1.2 h vs. 5.2 ± 1.5 h, p = 0.0468), intraoperative transfusion rates (70.4% vs. 96.3%, p = 0.0082), and postop Hb (9.0 ± 1.9 vs. 10.1 ± 1.4, p = 0.0280) and Hct (26.4 ± 5.4 vs. 29.7 ± 3.7, p = 0.0453). YAdIS patients had greater T2-T12 TK (42.7 ± 13.6 vs. 36.3 ± 11.0, p = 0.0412), T2-T5 TK (19.4 ± 9.4 vs. 13.3 ± 8.7, p = 0.0187), and TPA (12.4 ± 7.9 vs. 7.4 ± 8.9, p = 0.0200). There were no significant differences in baseline and 2 year follow up PROMs and in the rates of 2 year complications, including proximal/distal junctional kyphosis (PJK/DJK), pseudarthrosis, rod fracture, curve progression, and revision (p > 0.05).

Conclusion: Despite differences in operative characteristics, idiopathic scoliosis (IS) patients who underwent corrective surgery at a younger age had comparable PROMs and 2 year outcomes to older patients. Corrective fusion surgery is safe and effective in both adolescents and young adults and may avoid the higher complication rates seen in older adults.