Risks and long-term complications of adolescent idiopathic scoliosis surgery versus non-surgical and natural history outcomes

Abstract

Licensee OA Publishing London 2013. Creative Commons Attribution License (CC-BY) For citation purposes: Weiss HR, Moramarco M, Moramarco K. Risks and long-term complications of adolescent idiopathic scoliosis surgery versus non-surgical and natural history outcomes. Hard Tissue 2013 Apr 30;2(3):27. Abstract Introduction Recently, a paper was published containing the long-term results of the first 'modern' double rod instru-mentation, the Cotrel–Dubousset instrumentation. Results showed an unexpected high rate of reoperation of nearly 50% due to late infections or chronic back pain occurring after surgery. Further research into the long-term complications of spinal fusion surgery in adolescent idiopathic scoliosis (AIS) patients is necessary, with special attention to more recent instrumentations. This critical re-view discusses risks and long-term complications of AIS surgery ver-sus non-surgical and natural history outcomes. Materials and methods The previous systematic review on long-term complications, as they might develop over a lifetime, was published in 2008. The first author conducted a PubMed search to locate additional studies related to long-term outcomes of AIS surgical com-plications published after August 2008. Target publications were pro-spective or retrospective papers on complications in spinal fusion sur-gery for AIS with a minimum follow-up of 10 years and prospective or retrospective papers on reoperation rates in spinal fusion surgery for AIS with a minimum follow-up of 10 years. Results No paper with the topic on complica-tions and a long-term follow-up of at least 10 years was found. Two papers were found with the topic of reop-eration rates and a long-term follow-up of at least 10 years. Reoperation rates were reported between 12.9% and 47.5%. Discussion In the relatively benign population of AIS patients, according to the find-ings within this review, it may be concluded that the long-term out-come of surgery for AIS is worse than the long-term consequences of the condition itself. Conclusion A medical indication for AIS spinal fusion surgery does not exist, ex-cept in extreme cases. The rate of complications of spinal fusion sur-gery appears to increase with time. The risk/reward relationship of spi-nal fusion surgery is unfavourable for the AIS patient, except in rare cases. There is no evidence that spi-nal fusion surgery improves quality of life for AIS patients versus natu-ral history. The risks and long-term costs, in terms of pain and suffering, after spinal fusion surgery exceeds what is reasonable for AIS patients, putting the common practice of sur-gery in question, except in extreme cases.