Purpose:

To report radiographic and functional outcomes, with an average follow-up of 20 years, of adolescents treated surgically for thoracic idiopathic scoliosis by hybrid construct using only pedicular screws for the distal fixation.

Methods:

We retrospectively reviewed 109 patients. Radiographic data were evaluated on fullspine radiographs (Cobb angle, pelvic incidence, sacral slope, pelvic tilt, thoracic kyphosis, lumbar lordosis). Clinical data were evaluated with ODI, SF-12, SRS-30 and Analog Pain Scale. Disc height and listhesis below the arthrodesis were measured.

Results:

We analyzed 90 women and 19 men with a mean age of 16.9 y.o. at surgery. Radiographic data were assessed for 46 patients after 17.4 years. Mean preoperative Cobb angle was 58°, mean correction 40.1% with 5.3° of loss at final FU. Lumbar lordosis and thoracic kyphosis increased significantly at last FU. Degenerative changes below the arthrodesis were reported in 5 cases. Clinical data were assessed for 42 patients after 19.9 years: SRS-30 3.8; ODI 12.3%; SF-12 PCS 48.6 and MCS 46. Low back pain was reported in 69% of cases with low intensity (3.1). The lowest instrumented vertebrae did not influence significantly the functional outcome.

Conclusions:

The correction of thoracic AIS with lumbar or thoracolumbar pedicle screw instrumentation provides good radiological and clinical outcomes at very long term. The reduction in the coronal plane is stable; the HRQoL is quite as good as the general population. The degenerative evolution below remain relatively rare, therefore global sagittal balance is not modified.