Our Summary

This research looks at how the surgical approach to treating Adolescent Idiopathic Scoliosis (AIS) - an unexplained curvature of the spine in adolescents - has changed over the past 20 years. The researchers studied 1,819 AIS patients who had surgery between 1995 and 2013, investigating surgery methods, parameters during surgery, major complication rates, and outcomes.

They found that the average age for this surgery was 14.6 years, with 80.2% of patients being female, and these statistics stayed pretty consistent. Over the 20 years, the length of the surgery, the amount of blood loss, and the length of hospital stay all decreased. The use of antifibrinolytic, a type of medication to prevent bleeding, increased from 6.7% to 68.8% in the past 10 years. The number of spinal levels fused during surgery increased and the fusion was done more towards the lower end of the spine over time.

Previously, an anterior spinal fusion (ASF), a surgery done from the front of the body, was commonly used, but this has decreased to 0% in the last quartile of the study. The use of all screw constructs, a type of fixation device, in surgeries increased from 0% to 98.4%.

Additionally, the rate of major complications two years after surgery decreased over time from 18.7% to 5.1%. Improvements were also seen in pain, self-image, function, and total domains in patient-reported outcomes.

In summary, the surgical treatment of AIS has evolved over the past 20 years with less invasive surgery, less blood loss, shorter operation times and hospital stays, lower complication rates, and improved patient outcomes.

FAQs

  1. How has the surgical approach to treating Adolescent Idiopathic Scoliosis (AIS) evolved over the past 20 years?
  2. What changes have been observed in terms of surgery lengths, blood loss, and hospital stays for AIS surgery over the past two decades?
  3. What improvements in patient outcomes have been reported following changes in the surgical treatment of AIS?

Doctor’s Tip

One helpful tip a doctor might tell a patient about scoliosis surgery is to follow post-operative rehabilitation and physical therapy guidelines closely to ensure a successful recovery and optimal long-term outcomes. It is important to listen to your healthcare team, attend follow-up appointments, and communicate any concerns or changes in symptoms. Additionally, maintaining a healthy lifestyle with regular exercise and proper nutrition can support the healing process and overall spinal health.

Suitable For

Patients who are typically recommended for scoliosis surgery are those with Adolescent Idiopathic Scoliosis (AIS) who have a curvature of the spine that is severe and progressive, causing pain, difficulty breathing, or impacting their quality of life. Surgery may also be recommended for patients who have not responded to other forms of treatment such as bracing or physical therapy. Additionally, patients who have a significant curve that is at risk of worsening as they grow may also be considered for surgery. It is important for patients to discuss their individual case with a spine specialist to determine if surgery is the best treatment option for them.

Timeline

Before scoliosis surgery, a patient typically undergoes a thorough evaluation including physical examination, imaging studies like X-rays and MRI scans, and possibly other tests to determine the severity of the curvature and the best course of treatment. The patient and their family will also meet with the surgical team to discuss the procedure, potential risks and benefits, and what to expect during the recovery process.

After scoliosis surgery, the patient will typically spend a few days in the hospital for monitoring and pain management. They will gradually begin physical therapy to help strengthen their muscles and improve their range of motion. The patient will need to follow a strict post-operative care plan, which may include restrictions on physical activities, wearing a brace, and attending follow-up appointments with their surgeon to monitor their progress.

Over time, the patient should experience improvements in their spine alignment, pain levels, and overall function. With proper care and adherence to their treatment plan, the patient can expect to see long-term benefits from the surgery and a better quality of life.

What to Ask Your Doctor

Some questions a patient should ask their doctor about scoliosis surgery include:

  1. What surgical approach do you recommend for my specific case of scoliosis?
  2. What are the potential risks and complications associated with scoliosis surgery?
  3. How long will the surgery take and how long will I need to stay in the hospital?
  4. Will I need a blood transfusion during or after surgery?
  5. What type of fixation device will be used in my surgery?
  6. What can I expect in terms of pain management after surgery?
  7. What kind of physical therapy or rehabilitation will I need after surgery?
  8. How will you monitor my progress and adjust my treatment plan post-surgery?
  9. What are the long-term outcomes and potential limitations of scoliosis surgery for me?
  10. Are there any alternative treatments or non-surgical options I should consider before deciding on surgery?

Reference

Authors: Lonner BS, Ren Y, Yaszay B, Cahill PJ, Shah SA, Betz RR, Samdani AF, Shufflebarger HL, Newton PO. Journal: Spine (Phila Pa 1976). 2018 Mar 15;43(6):402-410. doi: 10.1097/BRS.0000000000002332. PMID: 28723878