Overview of the changes in adolescent idiopathic scoliosis patients after posterior fusion surgery

Abstract

Surgical approaches are used for the treatment of curvatures above 45 degrees in adolescent idiopathic scoliosis (AIS), which is defined as a 3-dimensional deformity of the spine and seen in adolescence. Posterior spinal fusion (PSF) surgery, which is accepted as the gold standard for AIS operative treatment, gives successful results in terms of deformity correction, but besides it can affect people's body structure and functions, activity levels, and participation in social life. When the changes in AIS patients after PSF surgery are overviewed within the framework of the International Classification of Functioning, Disability, and Health; it is seen that individuals with AIS experience movement limitations in the fusion and adjacent segments, pain, scapula and postural stabilization problems, and a decrease in aerobic capacity. These changes in body structure and functions may cause intervertebral disc and musculoskeletal problems in the future and may affect the activity levels of individuals and their participation in social life. Therefore, these issues should be considered when a postoperative rehabilitation program is designed. Also, because there are no long-term results in the studies evaluating scapula muscle activity, postural control and balance, physical activity, return to sports, and quality of life, there is a need for further studies specifically evaluating these parameters.

Keywords

• spinal surgery
• posture
• function
• disability
• participation

References

1. Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. The lancet. 2008;371(9623):1527-1537.
2. Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis and spinal disorders. 2018;13(1):1-48.
3. Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis. 2006;1(1):1-10.
4. Grivas TB, Vasiliadis E, Mouzakis V, Mihas C, Koufopoulos G. Association between adolescent idiopathic scoliosis prevalence and age at menarche in different geographic latitudes. Scoliosis. 2006;1(1):1-12.
5. Huitema G, Willems PC, van Rhijn L, Kleijnen J, Shaffrey CI. Anterior versus posterior spinal correction and fusion for adolescent idiopathic scoliosis. Cochrane Database of Systematic Reviews. 2014;(9)
6. Pehlivanoglu T, Oltulu I, Erdag Y, et al. Comparison of clinical and functional outcomes of vertebral body tethering to posterior spinal fusion in patients with adolescent idiopathic scoliosis and evaluation of quality of life: preliminary results. Spine Deformity. 2021;9(4):1175-1182.
7. Barsotti CEG, Junior CABB, Andrade RM, Torini AP, Ribeiro AP. The effect of direct vertebral rotation on the spine parameters (coronal and sagittal) in adolescent idiopathic scoliosis. Journal of Back and Musculoskeletal Rehabilitation. 2020;(Preprint):1-8.
8. Kepler CK, Meredith DS, Green DW, Widmann RF. Long-term outcomes after posterior spine fusion for adolescent idiopathic scoliosis. Current opinion in pediatrics. 2012;24(1):68-75.

9. Darnis A, Grobost P, Roussouly P. Very long-term clinical and radiographic outcomes after posterior spinal fusion with pedicular screws for thoracic adolescent idiopathic scoliosis. Spine Deformity. 2021;9(2):441-449.
10. Zhang Q, Chon T, Zhang Y, Baker JS, Gu Y. Finite element analysis of the lumbar spine in adolescent idiopathic scoliosis subjected to different loads. Comput Biol Med. Sep 2021;136:104745.
11. Bartie BJ, Lonstein JE, Winter RB. Long-term follow-up of adolescent idiopathic scoliosis patients who had Harrington instrumentation and fusion to the lower lumbar vertebrae: is low back pain a problem? Spine. 2009;34(24):E873-E878.
12. Takayama K, Nakamura H, Matsuda H. Low back pain in patients treated surgically for scoliosis: longer than sixteen-year follow-up. Spine (Phila Pa 1976). Sep 15 2009;34(20):2198-204.
13. Harding IJ, Charosky S, Vialle R, Chopin DH. Lumbar disc degeneration below a long arthrodesis (performed for scoliosis in adults) to L4 or L5. European Spine Journal. 2008;17(2):250-254.
14. Danielsson AJ, Romberg K, Nachemson AL. Spinal range of motion, muscle endurance, and back pain and function at least 20 years after fusion or brace treatment for adolescent idiopathic scoliosis: a case-control study. Spine. 2006;31(3):275-283.
15. Wilk B, Karol LA, Johnston CE, 2nd, Colby S, Haideri N. The effect of scoliosis fusion on spinal motion: a comparison of fused and nonfused patients with idiopathic scoliosis. Spine (Phila Pa 1976). Feb 1 2006;31(3):309-14.
16. Ohashi M, Bastrom TP, Marks MC, Bartley CE, Newton PO. The benefits of sparing lumbar motion segments in spinal fusion for adolescent idiopathic scoliosis are evident at 10 years postoperatively. Spine. 2020;45(11):755-763.
17. Hadgaonkar S, Shah S, Bhilare P, et al. Clinical and radiological factors associated with postoperative shoulder imbalance and correlation with patient-reported outcomes following scoliosis surgery. Journal of Orthopaedics. 2020;21:465-472.
18. Magermans D, Chadwick E, Veeger H, Van Der Helm F. Requirements for upper extremity motions during activities of daily living. Clinical biomechanics. 2005;20(6):591-599.
19. Mahaudens P, Dalemans F, Banse X, Mousny M, Cartiaux O, Detrembleur C. Gait in patients with adolescent idiopathic scoliosis. Effect of surgery at 10 years of follow-up. Gait & Posture. 2018;61:141-148.
20. Pasha S, Smith L, Sankar WN. Bone remodeling and disc morphology in the distal unfused spine after spinal fusion in adolescent idiopathic scoliosis. Spine deformity. 2019;7(5):746-753.
21. de Abreu DCC, Gomes MM, de Santiago HAR, da Silva Herrero CFP, Porto MA, Defino HLA. What is the influence of surgical treatment of adolescent idiopathic scoliosis on postural control? Gait & posture. 2012;36(3):586-590.
22. Yagi M, Ohne H, Kaneko S, Machida M, Yato Y, Asazuma T. Does corrective spine surgery improve the standing balance in patients with adult spinal deformity? Spine J. Jan 2018;18(1):36-43.
23. Li Y, Kakar RS, Fu Y-C, et al. Postural control of individuals with spinal fusion for adolescent idiopathic scoliosis. Clinical Biomechanics. 2019;61:46-51.
24. Kruger KM, Garman CMR, Krzak JJ, et al. Effects of Spinal Fusion for Idiopathic Scoliosis on Lower Body Kinematics During Gait. Spine Deform. Jul-Aug 2018;6(4):441-447.
25. Pesenti S, Prost S, Pomero V, et al. Early dynamic changes within the spine following posterior fusion using hybrid instrumentation in adolescents with idiopathic scoliosis: a gait analysis study. Archives of Orthopaedic and Trauma Surgery. 2021:1-9.
26. Lorente A, Barrios C, Burgos J, et al. Cardiorespiratory function does not improve 2 years after posterior surgical correction of adolescent idiopathic scoliosis. Spine. 2017;42(18):1391-1397.
27. Akazawa T, Kotani T, Sakuma T, et al. Bone mineral density and physical performance of female patients 27 years or longer after surgery for adolescent idiopathic scoliosis. Asian Spine Journal. 2017;11(5):780.
28. Kakar RS, Li Y, Brown CN, Oswald TS, Simpson KJ. Spine and lower extremity kinematics exhibited during running by adolescent idiopathic scoliosis patients with spinal fusion. Spine deformity. 2019;7(2):254-261.
29. Li Y, Kakar RS, Walker MA, et al. Intratrunk coordination during high-effort treadmill running in individuals with spinal fusion for adolescent idiopathic scoliosis. Journal of Applied Biomechanics. 2017;33(6):437-445.
30. Kakar RS, Li Y, Brown CN, Kim S-H, Oswald TS, Simpson KJ. Spine kinematics exhibited during the stop-jump by physically active individuals with adolescent idiopathic scoliosis and spinal fusion. The Spine Journal. 2018;18(1):155-163.
31. Kakar RS, Simpson KJ, Das BM, Brown CN. Review of physical activity benefits and potential considerations for individuals with surgical fusion of spine for scoliosis. International journal of exercise science. 2017;10(2):166.
32. Fabricant PD, Admoni S-h, Green DW, Ipp LS, Widmann RF. Return to athletic activity after posterior spinal fusion for adolescent idiopathic scoliosis: analysis of independent predictors. Journal of Pediatric Orthopaedics. 2012;32(3):259-265.
33. Barile F, Ruffilli A, Manzetti M, et al. Resumption of sport after spinal fusion for adolescent idiopathic scoliosis: a review of the current literature. Spine Deformity. 2021;9(5):1247-1251.
34. Kino K, Fujiwara K, Fujishiro T, et al. Health-related quality of life, including marital and reproductive status, of middle-aged Japanese women with posterior spinal fusion using Cotrel-Dubousset instrumentation for adolescent idiopathic scoliosis: Longer than 22-year follow-up. Journal of Orthopaedic Science. 2020;25(5):820- 824.
35. Rodrigues LMR, Gotfryd AO, Machado AN, Defino M, Asano LYJ. Adolescent idiopathic scoliosis: surgical treatment and quality of life. Acta Ortop Bras. May-Jun 2017;25(3):85-89.
36. Akazawa T, Kotani T, Sakuma T, et al. Midlife changes of health-related quality of life in adolescent idiopathic scoliosis patients who underwent spinal fusion during adolescence. European Journal of Orthopaedic Surgery & Traumatology. 2018;28(2):177-181.
37. Tsutsui S, Pawelek J, Bastrom T, et al. Dissecting the effects of spinal fusion and deformity magnitude on quality of life in patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976). Aug 15 2009;34(18):E653-8.