Surgery of lumbar and thoracolumbar scolioses in adults over 50. Morbidity and survival in a multicenter retrospective cohort of 180 patients with a mean follow-up of 4.5 years - 15/08/12

Doi : 10.1016/j.otsr.2012.04.014

A. Blamoutier ^a,^⁎ , P. Guigui ^b, S. Charosky ^c, P. Roussouly ^d, D. Chopin ^e
Groupe d’Étude de la Scoliose (GES)
^a Spine Surgery Unit, Saint-Grégoire Private Hospital Center, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France
^b Department of Orthopaedic Surgery, Beaujon Hospital, Paris VII University, Paris Public Assistance Hospital Group, 100, boulevard du Général-Leclerc, 92110 Clichy, France
^c Du parc Private Hospital, 31, rue des Buchers, 31400 Toulouse, France
^d Des Massues Surgical Center, 92, rue Edmond-Locard, 69322 Lyon, France
^e Musculoskeletal Unit, Lille University Regional Hospital Center, 2, avenue Oscar-Lambret, 59037 Lille, France

Corresponding author.

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Summary

Introduction

The increasing life expectancy of the population and the improvement in surgical and medical management of elderly patients mean that the indication for surgical treatment of adult lumbar and thoracolumbar scolioses has been extended. However the benefit/risk ratio of these procedures is still under debate.

Materials and methods

We reviewed 180 patients, mean age 63years old with a minimum follow-up of 1year in a retrospective, continuous, multicenter study. The incidence rate of complications from surgery and the factors influencing their frequency were evaluated by uni- and multivariate analysis. The risk of a second operation was studied by actuarial survival analysis.

Results

After a mean follow-up of 4.5years, 79 patients (44%) presented with at least one complication, including 32% with a serious complication. The most frequent complications were mechanical. The risk factors were medical co-morbidities, the extent of fusion and the extent of the preoperative sagittal imbalance. A second operation was necessary in 25% of patients at 1year and 50% of patients at 6years of follow-up.

Discussion

Studies in the literature show that functional results are better with surgical treatment than with medical treatment in the management of thoracic spine and thoracolumbar deformities in patients over 50years old. An objective assessment of this deformity and associated co-morbidity should make it possible to reduce the rate of complications for this type of surgery.