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Scoliosis and Spinal Disorders
Published in: Scoliosis and Spinal Disorders 1/2016

Open Access 01-12-2016 | Research

Fifteen to twenty-five year functional outcomes of twenty-two patients treated with posterior Cotrel-Dubousset type instrumentation: a limited but detailed review of outcomes

Authors: William F. Lavelle, Andy A. Beltran, Allen L. Carl, Richard L. Uhl, Khalid Hesham, Stephen A. Albanese

Published in: Scoliosis and Spinal Disorders | Issue 1/2016

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Abstract

Background

Long-term outcomes of patients undergoing extensive fusions for adolescent idiopathic scoliosis (AIS) have conflicting results. Moskowitz found uninstrumented scoliosis fusion patients had similar back pain as a normal age matched population. Recently, long-term outcomes of patients with Harrington rod instrumentation were reviewed and found similar functional outcome scores to non-scoliosis patients, with trending toward worse outcomes when fusions extended to L4. Our study examined long-term functional outcomes of patients treated with Cotrel-Dubousset (CD) instrumentation and determined whether distal level of instrumented fusion (L4 and L5) correlate with increased back pain or lower functional level.

Methods

Retrospective review of AIS surgeries from 1986 to 1996 was undertaken. Patient demographics and surgical data were collected via case-note audit. Patients were contacted and asked to complete a series of functional outcome questionnaires including visual analog scales (VAS) for pain, Short-Form 36 (SF-36), Scoliosis Research Society 22 (SRS-22) and Oswestry Disability Index (ODI) for function. ANOVA technique categorically compared outcome scores to most distal levels of fusion. Linear regression compared patient reported outcomes to time elapsed since surgery. Statistical significance was p < 0.05.

Results

One hundred twelve patients were identified, 50 patients were contacted, and 22 agreed to participation and completed a full assessment. Follow-up time since surgery ranged from 15 to 26 years and age ranged from 30 to 43 years. Six patients reported daily VAS back pain of ≥5; with a mean of 2.5. Back pain was not associated with level of distal fusion (p = 0.92). ODI was 15.36, with six patients' ODI >20. No relationship was shown between ODI and distal level of fusion (p = 0.72). SF-36 and SRS 22 values were also not related to distal level of instrumentation. Patient reported VAS back pain scores (r2 = 0.18, p = 0.05), ODI (r2 = 0.09, p = 0.17), and SF-36 and SRS-22 were not worse in patients with longer follow-up over time. Back pain and certain functional score subcategories of the SF-36 and SRS-22 trended toward improved results over time.

Conclusions

Most patients who underwent multi-segment spinal fixation appeared to do well long-term, with minimal back pain. Lowest instrumented segment did not appear to be associated with increased back pain after 15 to 25 years follow-up.
Literature
1.
Hibbs RA. An operation for progressive spinal deformities: a preliminary report of three cases from the service of the orthopaedic hospital. 1911. Clin Orthop Relat Res. 2007;460:17–20.CrossRefPubMed
2.
Harrington PR. Treatment of scoliosis: correctional and internal fixation by spine instrumentation. J Bone Joint Surg Am. 1962;44-A:591–610.CrossRefPubMed
3.
Haher T, Merola A, Zipnick RI, Gorup J, Mannor D, Orchowski J. Meta-anaylsis of surgical outcome in adolescent idiopathic scoliosis. A 35-year English literature review of 11,000 patients. Spine. 1995;20(14):1575–84.CrossRefPubMed
4.
Cotrel Y, Dubousset J. A new technic for segmental spinal osteosynthesis using the posterior approach. Rev Chir Orthop Reparatrice Appar Mot. 1984;70(6):489–94. French.PubMed
5.
Merola AA, Haher TR, Brkaric M, Panagopoulos G, Mathur S, Kohani O, et al. A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument. Spine. 2002;27(18):2046–51.CrossRefPubMed
6.
Risser JC. Scoliosis treated by cast correction and spine fusion. Clin Orthop Relat Res. 1976;116:86–94.
7.
Moskowitz A, Moe JH, Winter RB, Binner H. Long-term follow-up of scoliosis fusion. J Bone Joint Surg Am. 1980;62(3):364–76.CrossRefPubMed
8.
Cochran T, Irstam L, Nachemson A. Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion. Spine. 1983;8(6):576–84.CrossRefPubMed
9.
Connolly PJ, Von Schroeder HP, Johnson GE, Kostuik JP. Adolescent idiopathic scoliosis. Long-term effect of instrumentation extending to the lumbar spine. J Bone Joint Surg Am. 1995;77(8):1210–6.CrossRefPubMed
10.
Bartie BJ, Lonstein JE, Winter RB. Long-term follow-up of adolescent idiopathic scoliosis patients who had Harrington instrumentation and fusion to the lower lumbar vertebrae: is low back pain a problem? Spine. 2009;34(24):E873–8.CrossRefPubMed
11.
Ogon M, Krismer M, Sollner W, Kantner-Rumplmair W, Lampe A. Chronic low back pain measurement with visual analogue scales in different settings. Pain. 1996;64(3):425–8.CrossRefPubMed
12.
Mohan AL, Das K. History of surgery for the correction of spinal deformity. Neurosurg Focus. 2003;14(1):e1.CrossRefPubMed
13.
Protopsaltis T, Schwab F, Bronsard N, Smith JS, Klineberg E, Mundis G, Ryan DJ, Hostin R, Hart R, Burton D, Ames C, Shaffrey C, Bess S, Errico T, Lafage V, International Spine Study Group. The T1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life. J Bone Joint Surg Am. 2014;96(19):1631–40.CrossRefPubMed
14.
Steinmetz MP, Raipal S, Trost G. Segmental spinal instrumentation in the management of scoliosis. Neurosurgery. 2008;63(3 Suppl):131–8.CrossRefPubMed
Metadata
Title
Fifteen to twenty-five year functional outcomes of twenty-two patients treated with posterior Cotrel-Dubousset type instrumentation: a limited but detailed review of outcomes
Authors
William F. Lavelle
Andy A. Beltran
Allen L. Carl
Richard L. Uhl
Khalid Hesham
Stephen A. Albanese
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Scoliosis and Spinal Disorders / Issue 1/2016
Electronic ISSN: 2397-1789
DOI
https://doi.org/10.1186/s13013-016-0079-6

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