- Our NIH grant (“A Multicenter Prospective Study of Quality of Life in Adult Scoliosis” - R01 AR055176-01A2) is progressing well. We have five sites throughout North America and we are adding one more North American site and two Canadian sites for a total of eight sites. The purpose of our NIH grant is to optimize operative and nonoperative treatment for patients with adult symptomatic lumbar scoliosis (ASLS). Currently we are studying patients who have not had prior spinal surgery and are now presenting for consideration of operative treatment based on curve progression or increasing symptoms related to the deformity. We know that 80-85% of patients who have operative treatment for adult spinal deformity are greatly benefited from the operative treatment. It would appear that between 15-20% feel they are not that benefitted based on validated questionnaires. We are trying to figure out more precisely which patients do extremely well and which do not with operative treatment. We are looking into ways to further improve both operative and nonoperative outcomes for both patient groups. We are enrolling a total of 300 patients over three years and following those patients for a total of two to five years. Currently we are nine months into the enrollment period. This is a $2.5 million grant over five years.
- We have done several studies on both teenage adolescent idiopathic scoliosis and patients with adult spinal deformity and are submitted several abstracts to the Scoliosis Research Society for the annual meeting. Our principle findings are with the use of biologics and optimum fixation techniques we are dramatically lowering the nonunion/pseudarthrosis rate with adult spinal deformity fusions to the sacrum. We are finding that for most patients performing either anterior lumbar interbody fusion (ALIF) or transforaminal lumbar interbody fusion (TLIF) are not necessary. The surgeries are shorter, blood loss is less, the outcome is just as good and the surgery is less expensive if biologics are used as opposed to a smaller dose of biologics with TLIFs. In general, we are also finding that for both very long fusions to the sacrum (upper thoracic to the sacrum and pelvis) the nonunion/pseudarthrosis rate with the use of biologics are dramatically better than with using iliac bone and performing multiple levels anteriorly. There seem to be no complications referable to the use of biologics. The differences in fusion rates between the iliac crest group and the biologics group are highly significant, even though the iliac crest group had much more multilevel anterior surgery.
- We did a study of complications and outcomes of male compared to female patients with adult spinal deformity. Our postulate was that male patients would have substantially more complications. In the series of patients we studied, the complications and outcomes were equal for male and female patients. It may be we are somewhat more selective about which male patients we operate on, but prior to our study I believe the general concensus among spine surgeons throughout North America was that males have more complications with surgery.
- We did a study of what it takes to optimize shoulder height with operative treatment of thoracic idiopathic scoliosis. We found over 90% of patients had ideal shoulder height. We are able to identify the factors that led patients to have less than perfect shoulder height. Those patients at greater risk for not having perfect shoulder height postoperative and those who have substantial upper thoracic curves and substantial lumbar curves. This data will help us and other spine centers to optimize shoulder height and balance when treating teenage idiopathic scoliosis.
