Introduction: 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. Methods: 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. Results: 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. Conclusions 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.
Bibliographical noteFunding Information:
Author disclosures: CGTL (grant from Scoliosis Research Society); DWP (grant from Scoliosis Research Society; former board member for Scoliosis Research Society); CHC (grants from Scoliosis Research Society, NIH, OREF, Norton Community Trust Foundation; travel reimbursement for committee meetings from Scoliosis Research Society; consultancy from Alphatec Spine, Medtronic; employment with University of Louisville and Norton Healthcare; payment for lectures from Synthes Spine; travel accommodations/expenses from OREF, SRS, NASS, AAOS); JSS (consultancy for Biomet Spine, Medtronic, DePuy; employment with University of Virginia; expert testimony for multiple legal firms; grants from AANS/CNS Spins Joint Section, AOSpine NA; payment for lectures from Biomet Spine, AOSpine NA; ISSG [study group] support from DePuy Spine); JMB (board membership with Spine Deformity, Journal of Bone and Joint Surgery Orthopaedic Highlights: Spine, Complex Spine Study Group, St. Louis Spine Society; consultancy for Stryker, CoreLink, Inc., Globus, Medtronic; expert testimony for multiple entities; grants from Complex Spine Study Group, OREF; payment for lectures from Stryker, Globus, DePuy, K2M; travel accommodations from Global Spine Tumor Study Group, International Spine Study Group, Scoliosis Research Society); SD (grant from Scoliosis Research Society); SCY (grants from Scoliosis Research Society, NuVasive); ANL (grants from Scoliosis Research Society, OREFl employment with Mayo Clinic); JNS (grants from Scoliosis Research Society, NuVasive); ERGS (grant from SI-Bone).
- Adult degenerative scoliosis
- De novo scoliosis
- Surgical outcome
- Systematic review