Abstract
Introduction
The surgical approach to adult deformities is challenging both in terms of surgical planning and of amount of complications. Current literature shows potential benefits in surgical correction of adult deformities; recovery of both frontal and sagittal balance seems to be the key for satisfactory outcomes.
Patients and Methods
In this retrospective study, from an initial pattern of 30 patients, 12 selected patients were considered. All patients, average age 57 years, underwent adult scoliosis surgical correction. We evaluated the clinical outcomes in correlation with restoring of the sagittal balance and the rate of complications and mechanical failure. Previous surgery was not an exclusion criteria. Average follow-up was 8.2 months (range, 3–20 months). Clinical evaluation was performed by using Visual Analog Score test, Oswestry Disability Index, and Quality of Life test. Radiological measures were performed by software Surgimap Spine.
Results
In 10 cases (83% of patients), we observed agreement between clinical and radiological outcomes (we focused in particular on sagittal balance). To a satisfactory recovery of sagittal balance, in eight cases we found improvement at clinical tests while in two cases to a poor balance correction, the patients' quality of life did not improve. In only two cases (16% of patients), we found disagreement between the two parameters indicated (sagittal balance and quality of life). In our series, five patients had mechanical failures: four of them did not improve their sagittal balance at postoperative X-ray.
Conclusion
The purpose of this study was to validate the hypothesis that good clinical results in adult deformities correction are better achieved when restoration of sagittal balance is obtained. The large agreement among quality of life evaluation and recovery of sagittal balance we observed in this preliminary series of selected patients seems to hold it up. Moreover, the respect of physiological pelvic parameters seems to reduce the number of adverse events in terms of mechanical failures and consequently the number of reoperations; its indeed necessary to underline how 100% of patients whose sagittal balance did not improve with surgery had mechanical failure of instrumentation. Only one patient with acceptable sagittal parameters needed reoperation because of breaking of the rods.