Long-Term Complications and Risks of Surgery for Adolescent Idiopathic Scoliosis

Background: The long-term findings of the first ‘modern’ double rod instrumentation, the Cotrel-Debousset (CD) instrumentation, were recently published in a paper. Due to late infections or chronic back pain that developed after surgery, the results revealed an unexpectedly high rate of reoperation of nearly 50%. More research into the long-term complications of spinal fusion surgery in patients with Adolescent Idiopathic Scoliosis (AIS) is required, with a focus on newer instrumentation.

Materials and Methods: In 2008, a systematic study on long-term complications as they could evolve over the course of a lifetime was published. The first author used PubMed to look for studies published after August 2008 that looked at long-term results of AIS surgical complications. (1) prospective or retrospective papers with a minimum follow-up of 10 years on complications in spinal fusion surgery for AIS, and (2) prospective or retrospective papers with a minimum follow-up of 10 years on reoperation rates in spinal fusion surgery for AIS.

There was no paper that dealt with problems and had a long-term follow-up of at least 10 years. Two papers were discovered that dealt with reoperation rates and had at least a 10-year follow-up period. The reoperation rate ranged from 12.9 percent to 47.5 percent.

Discussion: Since there is no proof of surgical correction in patients with AIS, and post-surgical complications are reported to be about 50% over a lifetime, claims for AIS surgery as a medical indication should be limited to the most severe curvatures. According to the results of this study, the long-term outcome of AIS surgery is greater than the long-term effects of the disease itself in the relatively benign population of AIS patients.

Conclusions: Except in serious cases, there is no medical indication for AIS spinal fusion surgery. The rate of spinal fusion surgery complications appears to be increasing over time. Except in exceptional circumstances, the risk/benefit ratio of spinal fusion surgery is unfavourable for AIS patients. In comparison to natural history, there is no evidence that spinal fusion surgery increases AIS patients’ quality of life. The complications and long-term costs of spinal fusion surgery in terms of pain and discomfort outweigh what is reasonable for AIS patients, calling the procedure into question, even in serious cases.

Author (s) Details

Hans-Rudolf Weiss
Schroth Best Practice Academy, Neu-Bamberg, Germany.

Marc Moramarco
Scoliosis 3DC, 3 Baldwin Green Common, Suite 204, Woburn, USA.

Kathryn Moramarco
Scoliosis 3DC, 3 Baldwin Green Common, Suite 204, Woburn, USA.

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