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Surgery and other treatments offer viable options for adult scoliosis
2019/7/1 16:03:07

For years, spine surgeons have debated thebest methods for treating scoliosis in adults. Spinal curvature often resultsin more back pain, leg pain and other symptoms for adults than teens becauseadults also can have degeneration in the discs between vertebrae, and spinalstenosis -- a narrowing of the opening for the spinal nerves. Still, therehasn't been good evidence regarding whether it's better for adults withscoliosis to have corrective surgery or whether nonoperative treatment, such asphysical therapy or nerve injections, is adequate.

To help answer that question, doctors at ninecenters in North America followed more than 200 adults who had discomfort dueto lumbar scoliosis -- deformities affecting the lower part of the spine. TheNIH-funded trial ran from 2010-2017 and is the only government-funded study ofspinal deformity in adults.

The research effort -- led by spine surgeonKeith H. Bridwell, MD, at Washington University School of Medicine in St. Louis-- found that surgery usually helped patients improve. It helped correct theircurvature, and they had less pain. But the researchers also found that thosewho didn't have surgery usually did not go on to experience more severe pain ora more extreme spinal deformity during a two-year follow-up period. In fact,they found that the most important factor in deciding whether to operate wasthe extent of a patient's disability, and how much that disability interferedwith day-to-day life.

The new findings are published Feb. 20in The Journal of Boneand Joint Surgery.

"If patients are expecting less pain orbetter function, they probably won't see improvement unless they havesurgery," said Bridwell, the study's senior investigator and the J. AlbertKey Distinguished Professor of Orthopaedic Surgery. "On the other hand, ifpatients have adequate quality-of-life, and the goal is simply to keep themfrom getting worse, nonoperative treatment probably is fine."

Some 15 percent of adults in the U.S. havesome type of spine deformity, with lumbar scoliosis being the most common. Someadults have had scoliosis since adolescence; others develop the condition asadults. Many don't experience symptoms, but a significant percentage willdevelop back pain, leg pain and even lose up to four inches of trunk height --measured from the waist upwards -- due to the deformity.

"A fair number of doctors havesuggested doing surgery before a patient's condition deteriorates," saidthe study's first author, Michael P. Kelly, MD, an associate professor oforthopedic surgery and of neurological surgery at Washington University."But we found that, on average, patients are unlikely to rapidly getworse. Those who don't have severe pain and can easily carry out their dailyactivities seem to progress slowly and often their symptoms are not severeenough to undergo the risks of surgery."

Those risks include infection andsurgical complications, such as a failure of vertebrae to fuse together, whichoften means patients will need another operation.

The study enrolled 286 patients, with144 in the nonoperative group and 142 in the operative group. All weresymptomatic patients ages 40 to 80 who had at least a 30-degree curve in thelower spine. Their levels of disability were measured with spinal pain anddisability surveys. The nonoperative patients were treated with therapies suchas physical therapy, anti-inflammatory drugs and injections that deliver painmedications directly to nerve roots along the spinal column. During the studyperiod, 29 of the nonoperative patients changed their minds, or theirconditions deteriorated, and they decided to have surgery.

Bridwell said that, in general, patientswho had surgery experienced less pain following the operation and were betterable to function in day-to-day life two years later. However, during the studyperiod, 14 percent of the patients who had surgery required at least oneadditional operation to correct subsequent complications.

At the end of the study, the averagesurgery patient had improved. Meanwhile, those who didn't have surgery werefunctioning at about the same level after two years, but most had not gottenworse. Kelly and Bridwell said the satisfaction of individual patients withtheir degree of disability seems to be the best guide for determining whetherthey should choose to have surgery.