Safety and Radiological Outcomes of Posterior-Based Minimally Invasive Scoliosis Surgery in Young Adult Idiopathic Scoliosis: A Comparative Study Based on Age
Dong Yun Kim, Hong Jin Kim, Jae Hyuk Yang, Jungwook Lim, Jaeyoung Kim, Jin-Hyok Kim, Seung Woo SuhBACKGROUND AND OBJECTIVES:
Minimally invasive scoliosis surgery (MISS) may address both recovery and cosmetic concerns of young adult idiopathic scoliosis (YAdIS) patients through minimized surgical incisions, while increased rigidity of curves associated with skeletal maturation has limited the application of MISS in this population. The aim of this study was to compare surgical outcomes after posterior-based MISS across different age groups, with particular emphasis on the effectiveness in YAdIS patients.
METHODS:
A retrospective analysis was conducted of 354 patients with moderate-to-severe, flexible idiopathic scoliosis who underwent posterior-based MISS between 2015 and 2023. Patients were stratified into 3 groups according to age at the time of surgery: younger adolescent idiopathic scoliosis (AIS) (10-14 years, n = 118), older AIS (15-18 years, n = 109), and YAdIS (19-40 years, n = 127). Demographics, perioperative metrics, radiographic correction, and complication rates were compared across the groups.
RESULTS:
Although YAdIS patients exhibited a lower correction rate than younger AIS patients (mean difference, −8.0%; 95% CI, −10.9 to −5.1) and older AIS patients (mean difference, −4.4%; 95% CI, −7.1 to −1.7), they achieved a clinically acceptable final Cobb angle (younger AIS: 19.4° ± 7.4°, older AIS: 21.6° ± 6.9°, YAdIS: 23.7° ± 7.7°). YAdIS and older AIS patients required longer operative times and underwent a higher number of rib resections by thoracoplasty than younger patients. Crucially, however, there were no significant differences in estimated blood loss, length of hospital stays, or major complication rates among the groups (
CONCLUSION:
While age-related rigidity results in slightly diminished correction and longer operative times, MISS maintains equivalent overall outcomes in YAdIS patients to those of adolescents. Therefore, MISS presents a safe and effective surgical option for YAdIS patients with retained curve flexibility.