100S Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S

appropriate bracing treatment. The two have not been combined in

a study until now.

PURPOSE: To verify the efficacy of a complete, conservative treatment of

Adolescent Idiopathic Scoliosis (AIS) according to the best methodologi-

cal and management criteria defined in the literature.

STUDY DESIGN/SETTING: Retrospective study in a prospective database.

PATIENT SAMPLE: We included all AIS patients respecting the SRS

inclusion criteria (age 10 years or older; Risser test 0–2; Cobb degrees

25–40�; no prior treatment; less than one year post-menarchal) who had

reached the end of treatment since our institute database start in 2003.

Thus we had 44 females and four males, with an age of 12.861.6 at the

commencement of the study.

OUTCOME MEASURES: SRS criteria fro Bracing studies (unchanged;

worsened 6� or more; over 45� at the end of treatment; surgically treated;

two years’ follow-up); clinical criteria (ATR, Aesthetic Index, plumbline

distances); radiographic criteria (Cobb degrees); and ISICO criteria (opti-

mal; minimal).

METHODS: According to individual needs, two patients have been

treated with Risser casts followed by Lyon brace, 40 with Lyon or sport

braces (14 for 23 hours per day, 23 for 21 h/d, and seven for 18 h/d at

start), and two with exercises only (1 male, 1 female): these were excluded

from further analysis. Statistics. Paired ANOVA and t-test, Tukey-Kramer

and chi-square test.

RESULTS: Median reported compliance during the 4.261.4 treatment

years was 90% (range 5–106%). No patient progressed beyond 45�, norwas any patient fused, and this remained true at the two-year follow-up

for the 85% that reached it. Only two patients (4%) worsened, both with

single thoracic curve, 25–30�Cobb and Risser 0 at the start. We found sta-

tistically significant reductions of the scoliosis curvatures (-7.1�): thoracic(-7.3�), thoracolumbar (-8.4�) and lumbar (-7.8�), but not double major.

Statistically significant improvements have also been found for aesthetics

and ATR.

CONCLUSIONS: Respecting also SOSORT management criteria and

thus increasing compliance, the results of conservative treatment were

much better than what had previously been reported in the literature using

SRS criteria only.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2010.07.264

216. Impact of Upper Fusion Level on Outcome in the Setting of

Adult Spinal Deformity: Effectiveness of the Clinical Impact

Classification in Guiding Treatment

Frank Schwab, MD1, Virginie Lafage, PhD1, Steven Glassman, MD2,

Keith Bridwell, MD3, Jean-Pierre Farcy, MD1; 1NYU Hospital for Joint

Diseases, New York, NY, USA; 2Spine Institute for Special Surgery,

Louisville, KY, USA; 3WAUniversity School ofMedicine, St Louis, MO, USA

BACKGROUND CONTEXT: Adult spinal deformity (ASD) is complex

due to the range of deformity patterns and clinical presentation. The radio-

graphic Clinical Impact Classification was developed in a multicenter

effort to permit a relevant description of patients based upon health related

quality of life measures (HRQOL). While treatment approach has been

shown to correlate with Classification category, outcomes based upon

fusion level (upper instrumented vertebra: UIV) by Classification has not

been reported but is essential to develop treatment algorithms for surgical

treatment of ASD.

PURPOSE: To determine if the Clinical Impact Classification of ASD is

effective in guiding selection of the UIV for specific patient categories.

STUDY DESIGN/SETTING: Longitudinal prospective multi-center

consecutive case study.

All referenced figures and tables will be available at the Annual Mee

PATIENT SAMPLE: 1069 patients, 166 male and 903 female, (mean age

59.6 years, SD512).

OUTCOME MEASURES: SF-12, SRS outcomes instrument.

METHODS: 1069 patients, 166 male and 903 female, (mean age 59.6

years, SD512) with minimum 1-year follow up from a multi-center

ASD prospective database (inclusion criteria previously published) were

included in this study. The study group consisted only of long fusion cases

with a lower instrumented level of L5 or S1 and UIV of L1 or above.

Patients were classified according to the ASD Classification and UIV as

well as outcomes measures analyzed at baseline and follow up. An analysis

of variance (ANOVA) was applied to detect significant differences between

groups based upon outcomes change from baseline to follow up for each of

the following UIV groups: T1-3, T4-6, T9-11, T12-L1.

RESULTS: Of 1071 patients, distribution by UIV was as follows: T1-3

n5206, T4-6 n5242, T9-11 n5466, T12-L1 n5157. In comparing UIV,

no significant difference was noted in terms of global balance (N,P,VP) or

lumbar lordosis (A,B,C) modifiers across groups. However, by SF-12, SRS

pain and SRS activity scores, the T1-3 UIV group demonstrated the least im-

provement. Patients with significant sagittal global malalignment (VP5very

positive,O9.5 cm plumbline offset) noted greater improvement than other

categories of malalignment. By SRS mental score T12-L1 UIV had greater

improvement than T1-3 and T9-11 groups. However, when looking at the

subgroup of patients with marked sagittal malalignment (VP), T4-6 UIV

showed greater improvement than other UIV groups. The T9-11 UIV group

never outperformed all other UIV groups for any of the Classification

categories.

CONCLUSIONS: In this large multi-center prospective study, the appli-

cation of the Classification of Adult Spinal Deformity demonstrates signif-

icant differences in HRQOL outcomes by proximal fusion level for long

fusions ending at L5 or the sacrum. These findings lay an important

foundation for the development of treatment algorithms to guide surgical

planning. The T1-3 UIV group fared worst in this study, while patients

with marked sagittal malalignment benefited most from surgical interven-

tion. T4-9 as UIVoffers best outcomes when marked sagittal malalignment

is present. T9-11 as UIV was never the best in terms of outcome for any of

the Classification groups. However, ending fusion in the thoracolumbar

junction leads to favorable SRS mental component scores for patients

without significant malalignment.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2010.07.265

217. Comparative Analysis of Clinical Outcome and Perioperative

Complications in Primary vs. Revision Adult Scoliosis Surgery

Samuel K. Cho, MD, Keith H. Bridwell, MD, Lawrence G. Lenke, MD,

Christine R. Baldus, RN; Washington University, St. Louis, MO, USA

BACKGROUND CONTEXT: We compared clinical outcome and perio-

perative complications in adult patients who underwent primary (P) vs.

revision (R) scoliosis surgery.

PURPOSE: We hypothesized revision patients would have less improve-

ment in clinical outcome measures while having more perioperative

complications.

STUDY DESIGN/SETTING: A retrospective cohort study.

PATIENT SAMPLE: 250 adult patients (mean age 51.4 years) who under-

went primary vs. revision surgery (O6 levels) for idiopathic or de novo scoliosis.

OUTCOME MEASURES: SRS and ODI.

METHODS: Clinical and radiographic assessment of patients with a min-

imum 2-year f/u (mean 3.6 years) were performed.

RESULTS: There were 126 patients in P group and 124 in R group. Mean

age (P551.2612.1 vs. R551.6611.7 years, p50.79), f/u (P53.661.4 vs.

R53.661.4 years, p50.94), comorbidities (p50.43), and smoking status

ting and will be included with the post-meeting online content.