# The Degree of Correction Correlation with Clinical Outcomes in Adult Scoliosis Patients after Posterior Instrumentation Surgery

## Authors

- Emre Bal ([ORCID](https://orcid.org/0000-0003-3403-8069)) — Fatih Sultan Mehmet Education and Training Hospital Orthopedics and Traumatology Department, Istanbul, TURKEY
- Onur Cetin ([ORCID](https://orcid.org/0000-0002-3986-2527)) — Istanbul Medipol University, Camlica Hospital, Orthopedics and Traumatology Department, Istanbul, TURKEY

## Article information

- **Journal:** The Ulutas Medical Journal (Ulutas Med J), ISSN 2149-388X
- **Issue:** Volume 9, Issue 3 (2023), pages 202–207
- **Article type:** Original Article
- **Published online:** 2023-09-13
- **DOI:** [10.5455/umj.20230921092721](https://doi.org/10.5455/umj.20230921092721)
- **Licence:** [CC BY-NC 4.0](https://creativecommons.org/licenses/by-nc/4.0/)
- **Article page:** https://www.ulutasmedicaljournal.com/?mno=170390
- **PDF:** https://www.ulutasmedicaljournal.com/pdf/170390.pdf

## Abstract

Introduction: Restoring sagittal and coronal parameters is a primary concern in adult scoliosis surgery, yet it remains challenging due to the matured bony structure. This study aims to analyze the relationship between clinical outcomes and the degree of correction achieved through posterior instrumentation surgery in adult scoliosis. Materials and Methods: This study evaluated the clinical and radiological results of 27 adult scoliosis patients who underwent posterior instrumentation, decompression, and correction surgery. Preoperative and follow-up X-rays were performed to assess Cobb angle, sagittal balance, and coronal balance. Visual Analog Score (VAS) and Oswestry Disability Index (ODI) were evaluated preoperatively and at follow-up. Results: The study comprised 27 patients (18 female, 9 male) with a mean age of 68.2 years. Preoperative Cobb angle averaged 42.4°, reducing to 5.9° at final follow-up. Sagittal balance decreased from 30.6 mm preoperatively to 9.7 mm at final follow-up. Coronal balance improved from 22.3 mm preoperatively to 10.5 mm at 2-year follow-up. Preoperative Cobb angle showed a strong correlation with preoperative ODI (p=0.028) and postoperative ODI (p=0.014). Preoperative sagittal balance also correlated strongly with pre and postoperative ODI. However, postoperative Cobb angle and sagittal balance did not correlate with postoperative ODI (p

## Keywords

Posterior instrumentation; deformity correction; clinical outcome; Cobb angle; Scoliosis

## How to cite

Bal E, Cetin O. The Degree of Correction Correlation with Clinical Outcomes in Adult Scoliosis Patients after Posterior Instrumentation Surgery. Ulutas Med J. 2023;9(3):202-207. doi:10.5455/umj.20230921092721

## References

1. Bunnell WP. The natural history of idiopathic scoliosis before skeletal maturity. Spine. 1986;11(8):773-6. https://doi.org/10.1097/00007632-198610000-00003
2. Kostuik JP, Bentivoglio J. The incidence of low-back pain in adult scoliosis. Spine. 1981;6(3):268-73. https://doi.org/10.1097/00007632-198105000-00009
3. Pérennou D, Marcelli C, Hérisson C, Simon L. Adult lumbar scoliosis. Epidemiologic aspects in a low-back pain population. Spine. 1994;19(2):123-8. https://doi.org/10.1097/00007632-199401001-00001
4. Takahashi S, Delécrin J, Passuti N. Surgical treatment of idiopathic scoliosis in adults: an age-related analysis of outcome. Spine. 2002;27(16):1742-8. https://doi.org/10.1097/00007632-200208150-00011
5. Bradford DS, Tay BK, Hu SS. Adult scoliosis: surgical indications, operative management, complications, and outcomes. Spine. 1999;24(24):2617. https://doi.org/10.1097/00007632-199912150-00009
6. GRUBB SA, LIPSCOMB HJ, COONRAD RW. Degenerative adult onset scoliosis. Spine. 1988;13(3):241-5. https://doi.org/10.1097/00007632-198803000-00004
7. Grubb SA, Lipscomb HJ, Suh PB. Results of surgical treatment of painful adult scoliosis. Spine. 1994;19(14):1619-27. https://doi.org/10.1097/00007632-199407001-00011
8. Dick J, Boachie-Adjei O, Wilson M. One-stage versus two-stage anterior and posterior spinal reconstruction in adults. Comparison of outcomes including nutritional status, complications rates, hospital costs, and other factors. Spine. 1992;17(8 Suppl):S310-6. https://doi.org/10.1097/00007632-199208001-00017
9. Kim YJ, Lenke LG, Bridwell KH, Kim KL, Steger-May K. Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. JBJS. 2005;87(7):1534-41. https://doi.org/10.2106/00004623-200507000-00016
10. Lippman CR, Spence CA, Youssef AS, Cahill DW. Correction of adult scoliosis via a posterior-only approach. Neurosurgical focus. 2003;14(1):1-6. https://doi.org/10.3171/foc.2003.14.1.6
11. Shimode M, Kojima T, Sowa K. Spinal wedge osteotomy by a single posterior approach for correction of severe and rigid kyphosis or kyphoscoliosis. Spine. 2002;27(20):2260-7. https://doi.org/10.1097/00007632-200210150-00015
12. Glassman SD, Schwab FJ, Bridwell KH, Ondra SL, Berven S, Lenke LG. The selection of operative versus nonoperative treatment in patients with adult scoliosis. Spine. 2007;32(1):93-7. https://doi.org/10.1097/01.brs.0000251022.18847.77
13. Glassman SD, Berven S, Kostuik J, Dimar JR, Horton WC, Bridwell K. Nonsurgical resource utilization in adult spinal deformity. Spine. 2006;31(8):941 -7. https://doi.org/10.1097/01.brs.0000209318.32148.8b
14. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. Journal of children's orthopaedics. 2013;7(1):3-9. https://doi.org/10.1007/s11832-012-0457-4
15. Kelly A, Younus A, Lekgwara P. Adult degenerative scoliosis– A literature review. Interdisciplinary Neurosurgery. 2020; 20:100661. https://doi.org/10.1016/j.inat.2019.100661
16. Aebi M. The adult scoliosis. European spine journal. 2005; 14:925-48. https://doi.org/10.1007/s00586-005-1053-9
17. Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurgical focus. 2010;28(3):E1. https://doi.org/10.3171/2010.1.focus09271
18. Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery. 2014;74(1):112-20. https://doi.org/10.1227/neu.0000000000000182o
19. Jackson RP, Simmons EH, Stripinis D. Incidence and severity of back pain in adult idiopathic scoliosis. Spine. 1983;8(7):749-56. https://doi.org/10.1097/00007632-198310000-00011
20. Nachemson A. Adult scoliosis and back pain. Spine. 1979;4(6):513-7. https://doi.org/10.1097/00007632-197911000-00011
21. Smith JS, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, et al. Outcomes of operative and nonoperative treatment for adult spinal deformity: a prospective, multicenter, propensity-matched cohort assessment with minimum 2-year follow-up. Neurosurgery. 2016;78(6):851-61. https://doi.org/10.1227/neu.0000000000001349
22. Yadla S, Maltenfort MG, Ratliff JK, Harrop JS. Adult scoliosis surgery outcomes: a systematic review. Neurosurgical focus. 2010;28(3):E3. 207 77 Correction and Outcome Correlation in Scoliosis Emre Bal and Onur Çetin https://doi.org/10.3171/2009.12.focus09254
23. Ledonio CG, Polly Jr DW, Crawford III CH, Duval S, Smith JS, Buchowski JM, et al. Adult degenerative scoliosis surgical outcomes: A systematic review and meta-analysis. Spine Deformity. 2013;1(4):248-58. https://doi.org/10.1016/j.jspd.2013.05.001
24. Koller H, Pfanz C, Meier O, Hitzl W, Mayer M, Bullmann V, et al. Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients. European Spine Journal. 2016;25:532-48. https://doi.org/10.1007/s00586-015-3898-x
25. Cankaya D, Balci M, Deveci A, Yoldas B, Tuncel A, Tabak Y. Better life quality and sexual function in men and their female partners with short-segment posterior fixation in the treatment of thoracolumbar junction burst fractures. European Spine Journal. 2016;25:1128-34. https://doi.org/10.1007/s00586-015-4145-1
26. Lee BH, Moon S- H, Suk K-S, Kim H-S, Yang J-H, Lee H-M. Lumbar spinal stenosis: pathophysiology and treatment principle: a narrative review. Asian Spine Journal. 2020;14(5):682. https://doi.org/10.31616/asj.2020.0472
27. Amundsen T, Weber H, Lilleas F, Nordal HJ, Abdelnoor M, Magnaes B. Lumbar spinal stenosis: clinical and radiologic features. Spine. 1995;20(10):1178-86. https://doi.org/10.1097/00007632-199505150-00013
