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Purpose <p>This study is focused entirely on the changes in self-image scores which occur when spinal deformity surgery is performed for primary (AdIS) and revision (rAdIS) patients with adult idiopathic scoliosis, by an all-posterior approach.</p> Methods <p>Single-surgeon, single-center retrospective review of a consecutive series of adult idiopathic scoliosis (AdIS) patients treated with posterior spinal fusion (PSF) from 2015 to 2022. Patient-reported SRS-22 Self-Image, radiographic, and perioperative outcomes were recorded preoperatively and at 2-year follow-up. Patients undergoing primary surgery (AdIS) were compared to revision surgery (rAdIS) patients.</p> Results <p>123 patients were included, 75 primary (AdIS) and 48 revision (rAdIS) patients. Primary AdIS patients had larger preoperative major coronal curve magnitude (63° vs. 49<sup>°</sup>, <i>p</i> &lt; 0.0001), though smaller curves at 2&#xa0;years (21° vs. 31<sup>°</sup>, <i>p</i> = 0.0002). Primary patients had less preoperative PI-LL mismatch (14° vs. 30<sup>°</sup>, <i>p</i> &lt; 0.0001), though similar postoperative mismatch (17° vs. 15<sup>°</sup>, <i>p</i> = 0.4339). AdIS had negative sagittal alignment preoperative compared to positive alignment in rAdIS patients (CrSVA-H -15&#xa0;mm vs. 12&#xa0;mm, <i>p</i> &lt; 0.0001), though similar sagittal alignment postoperative (CrSVA-H -9&#xa0;mm vs. -17&#xa0;mm, <i>p</i> = 0.4035). Both groups had similar EBL (1400&#xa0;mL vs. 1600&#xa0;mL, <i>p</i> = 0.1011), OR times (8&#xa0;h vs. 8.4&#xa0;h, <i>p</i> = 0.3160) and levels fused (16.4 vs. 15.2, <i>p</i> = 0.1249). AdIS had fewer three-column osteotomies (7% vs. 21%, <i>p</i> = 0.0192) and pelvic instrumentation (87% vs. 98%, <i>p</i> &lt; 0.0489). Postoperatively, AdIS patients demonstrated higher self-image scores than rAdIS patients (4.2 vs. 3.5, <i>p</i> &lt; 0.0001). From baseline to 2-year follow-up, the magnitude of improvement was greater in AdIS patients (1.7 vs. 1.2, <i>p</i> = 0.0155) compared to rAdIS patients.</p> Conclusion <p>Primary and revision AdIS patients had similar preoperative self-image scores, though larger coronal curves were seen in the primary patients, and more positive sagittal alignment were seen in the revision patients. Primary patients experienced greater improvement in self-image scores following PSF. Although global sagittal correction is achieved after revision surgery, the coronal correction obtained after primary surgery may play a larger role in self-image improvement.</p>

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Revision older adult idiopathic scoliosis patients show less improvement in self-image scores than primary patients following posterior spinal fusion

  • 期刊论文

  • 发表日期：

    2026年5月25日

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  • Taylor Jackson,
  • Fthimnir M. Hassan,
  • Omar Taha,
  • Matthew Weintraub,
  • Mehdi Elfilali,
  • Edwin Kulubya,
  • Erik Lewerenz,
  • Justin L. Reyes,
  • Riley Sevensky,
  • Amrit Singh,
  • Josephine Coury,
  • Andrew Zhang,
  • Michael Strong,
  • Joseph M. Lombardi,
  • Zeeshan M. Sardar,
  • Ronald A. Lehman,
  • Lawrence G. Lenke

摘要

Purpose

This study is focused entirely on the changes in self-image scores which occur when spinal deformity surgery is performed for primary (AdIS) and revision (rAdIS) patients with adult idiopathic scoliosis, by an all-posterior approach.

Methods

Single-surgeon, single-center retrospective review of a consecutive series of adult idiopathic scoliosis (AdIS) patients treated with posterior spinal fusion (PSF) from 2015 to 2022. Patient-reported SRS-22 Self-Image, radiographic, and perioperative outcomes were recorded preoperatively and at 2-year follow-up. Patients undergoing primary surgery (AdIS) were compared to revision surgery (rAdIS) patients.

Results

123 patients were included, 75 primary (AdIS) and 48 revision (rAdIS) patients. Primary AdIS patients had larger preoperative major coronal curve magnitude (63° vs. 49°, p < 0.0001), though smaller curves at 2 years (21° vs. 31°, p = 0.0002). Primary patients had less preoperative PI-LL mismatch (14° vs. 30°, p < 0.0001), though similar postoperative mismatch (17° vs. 15°, p = 0.4339). AdIS had negative sagittal alignment preoperative compared to positive alignment in rAdIS patients (CrSVA-H -15 mm vs. 12 mm, p < 0.0001), though similar sagittal alignment postoperative (CrSVA-H -9 mm vs. -17 mm, p = 0.4035). Both groups had similar EBL (1400 mL vs. 1600 mL, p = 0.1011), OR times (8 h vs. 8.4 h, p = 0.3160) and levels fused (16.4 vs. 15.2, p = 0.1249). AdIS had fewer three-column osteotomies (7% vs. 21%, p = 0.0192) and pelvic instrumentation (87% vs. 98%, p < 0.0489). Postoperatively, AdIS patients demonstrated higher self-image scores than rAdIS patients (4.2 vs. 3.5, p < 0.0001). From baseline to 2-year follow-up, the magnitude of improvement was greater in AdIS patients (1.7 vs. 1.2, p = 0.0155) compared to rAdIS patients.

Conclusion

Primary and revision AdIS patients had similar preoperative self-image scores, though larger coronal curves were seen in the primary patients, and more positive sagittal alignment were seen in the revision patients. Primary patients experienced greater improvement in self-image scores following PSF. Although global sagittal correction is achieved after revision surgery, the coronal correction obtained after primary surgery may play a larger role in self-image improvement.