Risks and long-term complications of adolescent idiopathic scoliosis surgery versus non-surgical and natural history outcomes

Abstract Introduction Recently, a paper was published containing the long-term results of the first ‘modern’ double rod instrumentation, the Cotrel–Dubousset instrumentation. Results showed an unexpected high rate of reoperation of nearly 50% due to late infections or chronic back pain occurring after surgery. Further research into the longterm complications of spinal fusion surgery in adolescent idiopathic scoliosis (AIS) patients is necessary, with special attention to more recent instrumentations. This critical review discusses risks and long-term complications of AIS surgery versus nonsurgical and natural history outcomes. Materials and methods The previous systematic review on long-term complications, as they might develop over a lifetime, was published in 2008. The first author conducted a PubMed search to locate additional studies related to longterm outcomes of AIS surgical complications published after August 2008. Target publications were prospective or retrospective papers on complications in spinal fusion surgery for AIS with a minimum followup of 10 years and prospective or retrospective papers on reoperation rates in spinal fusion surgery for AIS with a minimum follow-up of 10 years. Results No paper with the topic on complications and a long-term follow-up of at least 10 years was found. Two papers were found with the topic of reoperation rates and a long-term followup of at least 10 years. Reoperation rates were reported between 12.9% and 47.5%. Discussion In the relatively benign population of AIS patients, according to the findings within this review, it may be concluded that the long-term outcome of surgery for AIS is worse than the long-term consequences of the condition itself. Conclusion A medical indication for AIS spinal fusion surgery does not exist, except in extreme cases. The rate of complications of spinal fusion surgery appears to increase with time. The risk/reward relationship of spinal fusion surgery is unfavourable for the AIS patient, except in rare cases. There is no evidence that spinal fusion surgery improves quality of life for AIS patients versus natural history. The risks and long-term costs, in terms of pain and suffering, after spinal fusion surgery exceeds what is reasonable for AIS patients, putting the common practice of surgery in question, except in extreme cases.