56S Proceedings of the NASS 24th Annual Meeting / The Spine Journal 9 (2009) 1S–205S

radiographic and clinical outcomes. The necessity of bilateral pelvic in-

strumentation is called into question.

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

any applicable devices or drugs.

doi: 10.1016/j.spinee.2009.08.131

107. Does Appearance Influence Outcome in Adult Scoliosis

Steven Glassman, MD1, Leah Carreon, MD, MSC1, Justin Smith, MD, PhD2,

Frank Schwab, MD3, Se-Il Suk, MD, PhD4, William Horton, MD5,

Keith Bridwell, MD6; 1Louisville, KY, USA; 2Charlottesville, VA, USA;3Brooklyn, NY, USA; 4Seoul, South Korea; 5Emory University, Atlanta, GA,

USA; 6Washington University in St. Louis, St. Louis, MO, USA

BACKGROUND CONTEXT: Appearance is recognized as a pivotal is-

sue in the management of adolescent idiopathic scoliosis, whereas pain

and disability are usually considered the primary drivers for adult defor-

mity surgery. However, a recent study indicated that appearance was an

important consideration in surgical decision making for adult scoliosis as

well.

PURPOSE: To determine whether appearance, or change in appearance,

significantly affect HRQOL outcomes after adult scoliosis surgery.

STUDY DESIGN/SETTING: We reviewed prospectively collected data

from a group of adult scoliosis patients enrolled in a prospective multi-cen-

ter database for adult spinal deformity.

PATIENT SAMPLE: 188 patients (165 females and 23 males) with

a mean age of 49.7 years.

OUTCOME MEASURES: SRS-22, SF-12, and ODI were assessed on the

basis of net mean change from baseline to two years post-treatment.

METHODS: At baseline, associations between the SRS-22 Appearance

score and responses to the Appearance questions (Questions 4, 6, 10, 14

and 19) were evaluated. Associations between baseline SRS-22 Appear-

ance scores, SF-12 PCS, ODI and Radiographic parameters were also an-

alyzed. At two years, associations between change in SRS-22 Appearance

score and change in HRQOL measures, two-year SRS Satisfaction score

and radiographic parameters were evaluated. All associations were ana-

lyzed using Spearman correlations.

RESULTS: At baseline, all of the SRS-22 Appearance Domain questions

except ‘‘appearance in clothes’’ correlated well with the overall domain

score. There was a low degree of correlation between SRS Appearance

score and SF-12 PCS (0.344), ODI (-0.346), sagittal balance (-0.232)

and curve magnitude (-0.215). There was no correlation between coronal

balance and curve type. At two years post-op, there was a low correlation

between change in SRS-22 Appearance score and change in SF-12 PCS

(0.265) and change in ODI (0.269). Of the radiographic parameters, only

change in curve magnitude correlated with change in SRS-22 Appearance

score (0.242), and again the correlation was small.

CONCLUSIONS: While prior studies of adult scoliosis patients have in-

dicated that appearance is an important factor in their decision to undergo

scoliosis surgery, change in appearance appears to make a relatively minor

contribution to their post-surgical HRQOL outcomes. Concern regarding

appearance should be regarded with caution as a primary indication for

surgery in adult scoliosis patients.

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

any applicable devices or drugs.

doi: 10.1016/j.spinee.2009.08.132

Figure. Pre- and post-operative radiographs using S2AI sacopelvic fixation in a 64

yo female with degenerative scoliosis.

108. A New Low Profile Sacro-Pelvic Fixation Technique Using S2

ALAR Iliac (S2AI) Screws In Adult Deformity Fusion to the

Sacrum: A Prospective Study with Minimum 2-Year Follow-Up

Khaled Kebaish, MD1, Albert Pull Ter Gunne, MD1, Ahmed Mohamed,

MD1, Ryan Zimmerman, MD1, Phebe Ko1, Richard Skolasky, Jr., ScD1,

Joseph O’Brien, MD, MPH2, Paul Sponseller, MD1; 1Johns Hopkins

University, Baltimore, MD, USA; 2George Washington University,

Washington, DC, USA

BACKGROUND CONTEXT: Adult deformity patients undergoing long

posterior fusion to the sacrum often require additional fixation into the il-

ium. There are many techniques currently available, however most are

technically difficult and require additional exposure and complex connec-

tors that may affect the construct stability.

PURPOSE: Introduce a new technique for sacropelvic fixation that is

technically easy, reproducible and effective. Analyze the results of this

techniques and investigate its complications as compared with traditional

methods.

STUDY DESIGN/SETTING: Prospective study at a single academic

institution.

PATIENT SAMPLE: 52 consecutive adult patients undergoing long pos-

terior spinal fusions to the sacro-pelvis for spinal deformities. Pelvic fixa-

tion was achieved using bilateral S2 Alar Iliac (S2AI) screws.

OUTCOME MEASURES: Standard outcome measurements were used,

including the SRS22, Oswestry Disability Index (ODI), the short form-

12 (SF-12), the visual analogue scale (VAS) combined with a human out-

line to indicate their pain location. Radiographic data and perioperative

complications were analyzed.

METHODS: We prospectively reviewed 52 consecutive adults undergoing

long posterior fusion to the Sacrum using (S2AI) Screws. The technique

uses a starting point in the S2 Ala, directed toward the anterior inferior il-

iac spine, allowing an in-line anchor without additional tissue dissection.

Functional outcome, radiographic data and complications were collected.

46 patients completed 2 yrs follow-up, mean 2.5 yrs.

RESULTS: The mean age was 59.8 yrs (613.0, 23.8-80.8). 76.9% female,

45 patients had multiple co-morbidities. Mean radiographic changes were

(pre-/post; p-value): thoracic kyphosis 7.4� (34.2/41.3; p5.010), lumbar

lordosis 13.0� (34.3/47.3; p!.001), thoracic curve 10.9� (22.3/15.1;

p!.001), lumbar curve 15.1� (30.4/15.3; p!.001), pelvic obliquity 1.6

(65.1, -5.5-19.1; p5.046). At 2 yrs, 92% of the patients showed radio-

graphic fusion at L4-S1. One patient had unilateral loosening (2 mm) of

the S2AI screw, which was asymptomatic. Two patients had 3 (S2AI)

screws fracture, neither required revision. Re-operation was performed