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Barile F, Ruffilli A, Morandi Guaitoli M, Viroli G, Ialuna M, Manzetti M, Cerasoli T, Artioli E, Traversari M, Mazzotti A, Faldini C. Long-term follow-up of adolescent idiopathic scoliosis surgery with Harrington instrumentations: a systematic review and meta-analysis. Musculoskelet Surg 2024:10.1007/s12306-024-00836-y. [PMID: 38806854 DOI: 10.1007/s12306-024-00836-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE In the 1960s, Harrington instrumentation (HRI) revolutionized the surgical treatment of adolescent idiopathic scoliosis (AIS). Despite the transition to more innovative techniques, concerns regarding its impact on sagittal alignment, associations with low back pain, and correction loss have consistently persisted. The aim of this meta-analysis is precisely to evaluate the clinical and radiological outcomes, as well as the complications of patients treated with HRI over an extended follow-up period. A systematic search of articles about AIS patients who underwent HRI and reported long-term outcomes (> 10 years) was conducted on electronic databases according to PRISMA guidelines. Data regarding radiographic and clinical outcomes were extracted and meta-analyses were performed. Eleven studies comprising 644 patients were included. The mean follow-up ranged from 10.8 to 51.7 years. Radiographic analysis revealed a decrease in the main curve Cobb angle from 60.6° to 38.3°, with a correction loss of - 9.49° between postoperative and last follow-up. Concerning sagittal parameters, preoperative thoracic kyphosis was 19.65° at last follow-up, and preoperative lumbar lordosis was 42.94°. Additional spine surgeries were required in 42% of patients. Clinical outcomes varied among studies, but overall, HRI patients showed comparable quality of life and function to controls, although a higher incidence of low back pain was reported. Patients who underwent HRI exhibited suboptimal correction of rib deformity and a flattened sagittal spinal alignment. However, they generally displayed favourable long-term functional outcomes. Despite the implant's tendency to reduce lumbar curvature, patients achieved good clinical outcomes and functional scores comparable to age-matched individuals, suggesting that disability is not an inevitable consequence of lumbar flattening.
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Affiliation(s)
- F Barile
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
| | - A Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
| | - M Morandi Guaitoli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy.
| | - G Viroli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
| | - M Ialuna
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
| | - M Manzetti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
| | - T Cerasoli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
| | - E Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
| | - M Traversari
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
| | - A Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
| | - C Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
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Joo P, Maqsoodi N, Sulovari A, Omar A, Section J, Sanders J, Rubery P, Menga E, Mesfin A. Ultralong Follow-Up of Spinal Fusion for Adolescent Idiopathic Scoliosis: Harrington Instrumentation vs Uninstrumented Fusion. Int J Spine Surg 2022; 16:8328. [PMID: 35878905 PMCID: PMC9807042 DOI: 10.14444/8328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Harrington instrumentation for adolescent idiopathic scoliosis (AIS) was revolutionary and allowed patients to mobilize faster as compared with patients treated with uninstrumented fusion. However, Harrington instrumentation provided correction of the deformity in 1 plane, resulting in limited sagittal plane control. Patients who received these 2 surgeries are aging, and to date, ultralong follow-up of these patients has not been reported. OBJECTIVE The purpose of this study was to evaluate long-term patient-reported outcomes and radiographic parameters after Harrington nonsegmental distraction instrumentation vs uninstrumented fusion in the treatment of AIS. METHODS Fourteen adult patients with AIS who were previously instrumented (n = 7) or uninstrumented (n = 7) were identified. Recent x-ray image measurements such as pelvic incidence (PI), sagittal vertical axis (SVA), pelvic tilt (PT), lumbar lordosis (LL), and pelvic incidence minus lumbar lordosis (PI-LL) were used to analyze deformities. Scoliosis Research Society-7 (SRS-7), Neck Disability Index (NDI), and Oswestry Disability Index (ODI) were used to evaluate patient-reported outcomes. Complications and rates of revision surgery were also evaluated. RESULTS The mean age was 67.1 ± 5 years in the instrumented group and 64.1 ± 9 years in the uninstrumented group. There were no significant differences between instrumented and uninstrumented in SRS-7 (23.4 ± 2.9 vs 23.6 ± 2.6, P = 0.93), NDI (5.7 ± 4.5 vs 10.6 ± 4.5, P = 0.08), and ODI (9.7 ± 13.7 vs 9.4 ± 8.7, P = 0.99). Radiographic measurements of instrumented vs uninstrumented resulted in comparable PT (24.0 ± 7.9 vs 30.5 ± 4.7, P = 0.09), PI (61.3 ± 16.9 vs 67.2 ± 9.5, P = 0.47), LL (34.9 ± 14.4 vs 42.8 ± 11.0, P = 0.29), PI-LL (26.4 ± 25.1 vs 24.3 ± 10.4, P = 0.43), and SVA (38.1 ± 30.1 vs 52.3 ± 21.6, P = 0.37). There were 2 patients in the instrumented group who developed adjacent segment disease that required operative intervention compared with none in the uninstrumented group (P = 0.46). CONCLUSION In long-term follow-up of instrumented and uninstrumented fusion, patients had similar patient-reported outcomes and radiographic parameters, although the instrumented cohort had higher rates of adjacent segment disease. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Peter Joo
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Noorullah Maqsoodi
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Aron Sulovari
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Adan Omar
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Jarren Section
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - James Sanders
- Department of Orthopaedics, University of North Carolina at Chapel Hill Medical Center, Chapel Hill, NC, USA
| | - Paul Rubery
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Emmanuel Menga
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Addisu Mesfin
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
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Larson AN, Baky F, Ashraf A, Baghdadi YM, Treder V, Polly DW, Yaszemski MJ. Minimum 20-Year Health-Related Quality of Life and Surgical Rates After the Treatment of Adolescent Idiopathic Scoliosis. Spine Deform 2019; 7:417-427. [PMID: 31053312 DOI: 10.1016/j.jspd.2018.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/28/2018] [Accepted: 09/02/2018] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN Longitudinal cohort. OBJECTIVES To determine the patient-reported functional outcomes and need for related surgical procedures in a US cohort of adolescent idiopathic scoliosis (AIS) patients with minimum 20-year follow-up. SUMMARY OF BACKGROUND DATA There is limited information regarding the long-term outcomes of scoliosis treatment in the US population. METHODS A novel population of patients who underwent pediatric treatment for AIS with minimum 20-year follow-up was identified. Search of a single-center diagnostic registry generated 337 patients who fulfilled the inclusion criteria (AIS, curve magnitude >35°, and childhood treatment with bracing, surgery, or observation from 1975 to 1992). Any additional spine surgery as well as EQ5D, ODI, SRS 22, SAQ were determined. A total of 180 patients were included (mean of 30-year follow-up, range 20-37). Childhood treatment entailed bracing (41 patients), surgery (103 patients), and observation (36 patients). RESULTS During the study period, only 1 of the 41 bracing patients underwent additional scoliosis-related spine surgery, whereas 5 of the 36 patients in the observation cohort underwent scoliosis surgery as adults. Seven of 103 childhood surgical patients required additional revision surgery as adults. Fifteen patients (4 braced, 7 fusion, and 4 observed) underwent chest wall surgery as adults. SRS scores were around 10% worse compared to population-based controls, with the exception of SRS mental health scores, which were similar to controls. Overall, 5.6% of patients were on disability, with no difference between operative and nonoperative groups. CONCLUSION We found a low rate of adult scoliosis surgery in the braced population, and a low rate of revision surgery at the 30-year follow-up in patients undergoing spine fusion for AIS between 1975 and 1992. No detected differences in patient-reported outcomes were found between the braced, surgical, and observed populations at a mean of 30 years' follow-up. LEVEL OF EVIDENCE Level III, therapeutic.
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Affiliation(s)
- A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Fady Baky
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Ali Ashraf
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Yaser M Baghdadi
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Vickie Treder
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - David W Polly
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Michael J Yaszemski
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
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SRS-22r Scores in Nonoperated Adolescent Idiopathic Scoliosis Patients With Curves Greater Than Forty Degrees. Spine (Phila Pa 1976) 2017; 42:1233-1240. [PMID: 28796720 DOI: 10.1097/brs.0000000000002004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case control comparative series. OBJECTIVE Describe surgical range adolescent idiopathic scoliosis (AIS) patients electing to forgo surgery and compare health-related quality-of-life outcomes to a similar cohort of operated AIS patients by the same single surgeon. SUMMARY OF BACKGROUND DATA No data have been published either documenting SRS-22r scores of nonoperated patients with curves ≥40° or comparing these scores to a demographically similar operated cohort. METHODS Individuals with curves ≥40°, age ≥18 years, and electing to forgo surgery were identified. All patients completed an SRS-22r questionnaire. This nonoperated cohort's SRS-22r scores were compared to those of a large demographically similar cohort operated by the same surgeon. Group differences between the SRS-22r scores were evaluated by comparing these to published Minimal Clinically Important Differences (MCID) for the SRS-22r. RESULTS One hundred ninety subjects with nonoperated curves were compared to 166 individuals who underwent surgery. The nonoperated cohort averaged 23.5 years of age, averaged 7.7 years since curve reached 40°, and had an average 50° Cobb angle at last follow-up. No statistical significant differences were found between the groups on the Pain, Function, or Mental Health domains of the SRS-22r. Statistically significant differences in favor of the operative cohort were found for self-image, satisfaction, and total score. The observed group differences did not meet the established thresholds for minimal clinically important differences in any of the domain scores, the average total score, or raw scores. CONCLUSION There are no meaningful clinically significant differences in SRS-22r scores at average 8-year follow-up between AIS patients with curves ≥40° treated with or without surgery. These data in conjunction with an absence of long-term evidence of serious medical consequences with nonsurgical management of curves ≥40° should encourage surgeons to reevaluate the benefits of routine surgical care. LEVEL OF EVIDENCE 3.
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Riouallon G, Odent T, Elie C, Padovani JP, Rigault P, Pouliquen JC, Glorion C. Anterior screw-plate fixation in adolescent idiopathic scoliosis: 15-year outcomes. Orthop Traumatol Surg Res 2016; 102:227-32. [PMID: 26922041 DOI: 10.1016/j.otsr.2015.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 11/21/2015] [Accepted: 12/15/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Few published data are available on long-term outcomes of anterior spinal fusion for adolescent idiopathic scoliosis (AIS). The objective of this single-centre retrospective study was to assess clinical and radiological outcomes of one-stage anterior spinal fusion achieved using precontoured titanium anterior screw-plates. HYPOTHESIS Our hypothesis was that anterior instrumentation produced both good functional outcomes and good correction in the coronal and sagittal planes. MATERIAL AND METHODS This procedure was performed in 111 patients between 1975 and 1993. Among them, those who underwent a comprehensive evaluation at least 15 years later were included. The SRS-30 questionnaire and Oswestry Disability Index (ODI) were used to assess functional outcomes. Radiographic outcomes were evaluated on antero-posterior and lateral full-spine radiographs obtained pre-operatively, post-operatively, and at last follow-up. RESULTS The study included 35 patients, who were re-evaluated after a mean of 21 years (15-31 years). Mean pre-operative Cobb's angle was 44°, mean age at surgery was 14.7 years, mean SRS-30 score was 3.65/5, and mean ODI was 14.9%. At last follow-up, mean Cobb's angle was 14.7° and 25 patients exhibited coronal misalignment with a mean deviation of 12mm. In the sagittal plane, the mean sagittal vertical axis (SVA) measured using the C7 plumb line was -28mm, with 8mm of anterior translation compared to the post-operative value (36mm). The functional outcome assessed using the SRS-30 score correlated significantly with pelvic tilt and anterior SVA translation. CONCLUSION Anterior spinal fusion produces good long-term functional outcomes in AIS. Correction is both satisfactory and sustained. Anterior SVA translation over time may be associated with better functional outcomes. LEVEL OF EVIDENCE IV (retrospective study).
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Affiliation(s)
- G Riouallon
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - T Odent
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - C Elie
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - J-P Padovani
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - P Rigault
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - J-C Pouliquen
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - C Glorion
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Simony A, Christensen SB, Carreon LY, Andersen MO. Radiological Outcomes in Adolescent Idiopathic Scoliosis Patients More Than 22 Years After Treatment. Spine Deform 2015; 3:436-439. [PMID: 27927529 DOI: 10.1016/j.jspd.2015.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/25/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
Abstract
STUDY DESIGN Longitudinal cohort. OBJECTIVES To evaluate the long-term radiologic outcomes in adolescent idiopathic scoliosis (AIS) patients more than 22 years after treatment. SUMMARY OF BACKGROUND DATA Although treatment for AIS is prophylactic and is aimed at preventing curve progression, very few studies report long-term outcomes of treatment. METHODS AIS patients treated with Boston brace or posterior spinal fusion (PSF) with Harrington-dorso-transverse traction (DTT) instrumentation from 1983 to 1990 were requested to return to clinic. Subsequently, 36-inch standing radiographs were obtained after patient consent. Cobb angles were compared with pretreatment and immediate posttreatment radiographs. Any evidence of adjacent-level disease or local kyphosis was also noted. RESULTS One hundred fifty-nine (78%) of 219 patients were available for follow-up, 66 braced and 93 surgical. There were 85 females with an average age at surgery of 14.3 years and an average age at follow-up of 37.6 years. The mean length of follow-up was 24.5 years (range, 22-30 years). There was a statistically significant curve progression of 2.9° in the PSF group. There was a greater degree of curve progression in the braced group (5.5°), but this was not statistically significant. Proximal segment degeneration was seen in 8 (5%), 2 in the brace cohort and 6 in the PSF cohort. Distal segment degeneration was seen in 26 (16%) patients, 4 treated with brace and 22 treated with PSF. No patient developed proximal junction kyphosis. Three patients in the PSF cohort required additional surgery for distal adding-on. Four patients had a noncontiguous L5-S1 fusion, three from the PSF cohort and one from the braced cohort. CONCLUSION In this cohort with an average follow-up of 24.5 years, with 78% available for follow-up, both the braced and surgically treated patients had a very small degree of curve progression, with a small incidence of distal segment degeneration and reoperation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ane Simony
- Center for Spine Research and Surgery, Lillebaelt Hospital, Ostre Hougvej 55, DK-5500 Middelfart, Denmark.
| | - Steen Bach Christensen
- Center for Spine Research and Surgery, Lillebaelt Hospital, Ostre Hougvej 55, DK-5500 Middelfart, Denmark; Department of Orthopaedic Surgery, University Hospital - Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Leah Y Carreon
- Center for Spine Research and Surgery, Lillebaelt Hospital, Ostre Hougvej 55, DK-5500 Middelfart, Denmark
| | - Mikkel Osterheden Andersen
- Center for Spine Research and Surgery, Lillebaelt Hospital, Ostre Hougvej 55, DK-5500 Middelfart, Denmark
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Merriman M, Hu C, Noyes K, Sanders J. Selection of the Lowest Level for Fusion in Adolescent Idiopathic Scoliosis-A Systematic Review and Meta-Analysis. Spine Deform 2015; 3:128-135. [PMID: 27927303 DOI: 10.1016/j.jspd.2014.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 06/03/2014] [Accepted: 06/24/2014] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN A systematic review of studies reporting pain as a long-term outcome after spinal fusion surgery for treatment of adolescent idiopathic scoliosis. OBJECTIVE To identify studies that report pain after spinal fusion surgery for scoliosis based on the distal extent of fusion and to combine results to determine if there is an increased incidence of back pain in patients treated with fusion to the lower lumbar spine. SUMMARY OF BACKGROUND DATA The methods and results of existing studies are inconsistent and only occasionally reach statistical significance. No thorough review of the available information has been published. METHODS An electronic literature search was performed to identify studies that met predetermined eligibility criteria. Data extracted included number of cases fused to L3 or above, to L4 or L5, and the number of those cases experiencing pain. Further, when possible, the pain variable was stratified into severe or mild categories to allow a more specific subanalysis. RESULTS Eight studies met inclusion criteria. The meta-analysis for occurrence of pain, the primary outcome, resulted in a final odds ratio of 1.29 (95% CI 0.91-1.82, n = 1,155). When pain was stratified according to severity and only those cases in the severe category considered for meta-analysis, the resulting odds ratio was 1.43 (95% CI 0.72-2.82, n = 900). Neither analysis reached statistical significance. CONCLUSIONS Although there was a trend toward increased pain in patients whose fusion extended to L4 or L5, there was no statistically significant association between the distal level of fusion and incidence of subsequent back pain, both with and without stratification according to severity of back pain. Because of the limitations of published research, the effect of fusion into the lower lumbar spine on back pain is unknown. Higher quality studies with long-term follow-up and consistent reporting of outcomes are needed.
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Affiliation(s)
- Matthew Merriman
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA.
| | - Calvin Hu
- Department of Orthopedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Katia Noyes
- Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - James Sanders
- Department of Orthopedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY 14642, USA; Golisano Children's Hospital, Rochester, NY 14642, USA
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Mid- to long-term outcomes in adolescent idiopathic scoliosis after instrumented posterior spinal fusion: a meta-analysis. Spine (Phila Pa 1976) 2013; 38:E113-9. [PMID: 23124268 DOI: 10.1097/brs.0b013e31827ae3d0] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Meta-analysis on mid- to long-term outcomes in adolescent idiopathic scoliosis after instrumented posterior spinal fusion. OBJECTIVE To compare mid- to long-term outcomes and complications of the most commonly used instrumentation systems in adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA A meta-analysis of mid- to long-term results of different methods of instrumentation, including the most currently used all-pedicle screw construct, is lacking. METHODS A structured literature review was conducted for studies concerning management of patients with adolescent idiopathic scoliosis with instrumented posterior fusion. Pooled means, standard deviations, and sample sizes were either identified or calculated on the basis of the results of each study. RESULTS Meta-analyses were performed on outcomes from 27 studies. Overall, 1613 patients who had been treated with Harrington rods, 361 patients who had undergone Cotrel-Dubousset instrumentation, and 298 patients who managed with all-pedicle screw constructs were reviewed. The mean follow-up was 14.9 years. Cotrel-Dubousset and pedicle screw instrumentations achieved a significantly greater degree of correction of the thoracic curve than Harrington rods (40.3° vs. 14.7°; P < 0.001 and 21.9° vs. 14.7°; P = 0.005, respectively). Cotrel-Dubousset technique achieved a significantly higher degree of correction than all-pedicle screw construct in both the thoracic (40.3° vs. 21.9°, respectively; P < 0.001) and lumbar curves (37.2° vs. 16°, respectively; P < 0.001). Similarly, Cotrel-Dubousset construct achieved a greater correction of both thoracic kyphosis (33.5° vs. 23°, respectively; P < 0.001) and lumbar lordosis (46° vs. 50.7°, respectively; P = 0.002) than pedicle screws. All-pedicle screw fixation was associated with the lower risk of pseudarthrosis, infection, neurological deficit, and reoperation. CONCLUSION This study confirms the negative effect of Harrington rods on sagittal alignment. We further found that the degree of correction in the coronal and sagittal planes was higher after Cotrel-Dubousset instrumentation than all-pedicle screw fixation. All-pedicle screw constructs offered the lower risk of mid- to long-term complications and revision surgery.
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Bas T, Franco N, Bas P, Bas JL. Pain and disability following fusion for idiopathic adolescent scoliosis: prevalence and associated factors. EVIDENCE-BASED SPINE-CARE JOURNAL 2012; 3:17-24. [PMID: 23230414 PMCID: PMC3516455 DOI: 10.1055/s-0031-1298614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Study design: Retrospective prognostic study. Objectives: To describe the prevalence of pain following fusion for adolescent idiopathic scoliosis and to identify factors associated with pain and disability. Methods: From 126 consecutive patients surgically treated for scoliosis between 1997 and 2007, 104 (82.5%) completed SRS-22 and ODI questionnaires at a last follow-up (mean, 4.8 years; range 1–11.2 years). Prevalence of pain and disability were determined from SRS questions 1 and 9 respectively, with “any” pain or decrease in activity considered clinically significant. SRS Pain Domain Scores (PDS) were also evaluated. Results: Most participants reported “no pain” (38.5%) or “mild pain” (30.8%) and 72.1% of participants reported a current work/school activity level of 100% normal. An association between instrument type and the presence of any pain in the previous 6 months was noted (P = .022). Instrument type was the only factor that was significantly associated with the PDS (P = .0052). Conclusions: The high percentage of patients reporting no pain or mild pain may suggest overall success of the procedures. Although an association between instrument type and pain was seen, unmeasured factors that contributed to the decision of what instrument to use may confound the relationship. From these data a causal inference cannot be made.
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Affiliation(s)
- Teresa Bas
- Spinal Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Does the Lower Instrumented Vertebra Have an Effect on Lumbar Mobility, Subjective Perception of Trunk Flexibility, and Quality of Life in Patients With Idiopathic Scoliosis Treated by Spinal Fusion? ACTA ACUST UNITED AC 2012; 25:437-42. [PMID: 21959839 DOI: 10.1097/bsd.0b013e3182318622] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Quality of life in patients treated surgically for scoliosis: longer than sixteen-year follow-up. Spine (Phila Pa 1976) 2009; 34:2179-84. [PMID: 19713874 DOI: 10.1097/brs.0b013e3181abf684] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To evaluate the long-term quality of life (QOL) of patients treated surgically for scoliosis. SUMMARY OF BACKGROUND DATA Measures of long-term outcome after surgery for scoliosis have focused mainly on radiologic changes. However, QOL issues such as working status and marital status are the subjects of greatest concern for patients who will undergo surgical treatment for scoliosis. METHODS Thirty-two patients treated surgically for scoliosis between 1976 and 1989 were included in this study. The mean duration of follow-up was 21.1 years. Eighteen patients had adolescent idiopathic scoliosis, 8 congenital scoliosis, and 6 symptomatic scoliosis. We evaluated long-term outcome by direct interview with patients. Working status, marital status, and childbearing were determined in addition to clinical and radiologic evaluation. Patients were also asked to fill out the short form (SF)-36 and Scoliosis Research Society (SRS)-22 questionnaires. RESULTS Twenty-seven patients (84.4%) were or had been engaged in various occupations without marked difficulty. Although none of the male patients was married, 62.5% of the female patients were married. Half of the female patients had delivered babies after surgery, and the mean number of such children was 1.83. On the SF-36, none of the scores for subjects with idiopathic or congenital scoliosis were markedly different from those for age-matched healthy controls. Multivariate logistic regression analysis revealed that marked preoperative Cobb angle and positive sagittal balance at the most recent follow-up were significantly associated with increased odds ratio for poor scores on the SRS-22. CONCLUSION We evaluated long-term QOL in patients treated surgically for scoliosis, and found that it was not impaired, particularly in the case of patients with idiopathic or congenital scoliosis. Larger preoperative Cobb angle and positive sagittal balance at the most recent follow-up were related to poor outcome in QOL as assessed by the SRS-22.
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Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To evaluate long-term outcome regarding low back pain (LBP) in patients treated surgically for scoliosis. SUMMARY OF BACKGROUND DATA Measures of long-term outcome after surgery for scoliosis have focused mainly on radiologic changes. However, subjective symptoms such as LBP after surgical treatment are of great concern to patients who undergo surgical treatment for scoliosis. METHODS Thirty-two patients treated surgically for scoliosis between 1976 and 1989 were included in this study. The mean duration of follow-up was 21.1 years. Eighteen patients had adolescent idiopathic scoliosis, 8 had congenital scoliosis, and 6 had symptomatic scoliosis. We evaluated long-term outcome by direct interview. Degree of LBP was evaluated by visual analogue scale score and Moskowitz classification in addition to clinical and radiologic evaluation. Patients were also asked to complete the SF-36 questionnaire. RESULTS Mean visual analogue scale score at the latest follow-up was 21 (0-80), and 15% of patients had occasional or frequent LBP in Moskowitz classification. On the SF-36, score for bodily pain was not markedly different from that for age-matched controls. Among radiologic findings, level of distal fusion had no effect on the incidence or severity of LBP. Furthermore, preoperative Cobb angle, latest Cobb angle, and degenerative changes of subjacent segment each exhibited no correlation with degree of LBP, either. On the other hand, sagittal balance was a factor affecting LBP following scoliosis surgery. CONCLUSION We evaluated long-term outcomes regarding LBP following scoliosis surgery. Regardless of residual back deformity, LBP was found to be no more frequent than in the normal population in Japan. Positive sagittal balance at the latest follow-up was a factor significantly contributing to LBP following scoliosis surgery.
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Canlas BR, Yap ANB, Fernando BY, Paiso JMS. Spinal cord stimulation for control of low back pain after multiple corrective surgeries for severe scoliosis: report of a case. Pain Pract 2009; 9:404-5. [PMID: 19740272 DOI: 10.1111/j.1533-2500.2009.00300.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Weiss HR. Adolescent idiopathic scoliosis (AIS) - an indication for surgery? A systematic review of the literature. Disabil Rehabil 2008; 30:799-807. [PMID: 18432438 DOI: 10.1080/09638280801889717] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Historically, the treatment options for AIS, the most common form of scoliosis are: Exercises, in-patient rehabilitation, braces and surgery. While there is evidence in the form of prospective controlled studies that Scoliosis Intensive Rehabilitation (SIR) and braces can alter the natural history of the condition, there is no review on prospective controlled trials for surgical treatment. The aim of this review was to perform a systematic search of the Pub Med literature to reveal the evidence on scoliosis surgery. METHODS A systematic review has been performed using the Pub Med database. Literature has been searched for the outcome parameter; 'rate of progression' and only prospective controlled studies that have considered the treatment versus the natural history have been included. RESULTS No controlled study, not in the short, mid or long term, searched within the review, has been found to reveal evidence to support the hypothesis that the effects of surgery as a treatment option for AIS is superior to natural history. CONCLUSIONS No evidence has been found in terms of prospective controlled studies to support surgical intervention from the medical point of view. In the light of the unknown long-term effects of surgery and in concluding on the lack of evidence already found that surgery might change the signs and symptoms of scoliosis, a randomized controlled trial (RCT) is long overdue. Until such a time that such evidence exists, there can be no medical indication for surgery. The indications for surgery are limited for cosmetic reasons in severe cases and only if the patient and the family agree with this.
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Affiliation(s)
- Hans-Rudolf Weiss
- Asklepios Katharina Schroth, Spinal Deformities Rehabilitation Centre, Bad Sobernheim, Germany.
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Weiss HR, Goodall D. Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature. SCOLIOSIS 2008; 3:9. [PMID: 18681956 PMCID: PMC2525632 DOI: 10.1186/1748-7161-3-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 08/05/2008] [Indexed: 01/03/2023]
Abstract
Background Spinal fusion surgery is currently recommended when curve magnitude exceeds 40–45 degrees. Early attempts at spinal fusion surgery which were aimed to leave the patients with a mild residual deformity, failed to meet such expectations. These aims have since been revised to the more modest goals of preventing progression, restoring 'acceptability' of the clinical deformity and reducing curvature. In view of the fact that there is no evidence that health related signs and symptoms of scoliosis can be altered by spinal fusion in the long-term, a clear medical indication for this treatment cannot be derived. Knowledge concerning the rate of complications of scoliosis surgery may enable us to establish a cost/benefit relation of this intervention and to improve the standard of the information and advice given to patients. It is also hoped that this study will help to answer questions in relation to the limiting choice between the risks of surgery and the "wait and see – observation only until surgery might be recommended", strategy widely used. The purpose of this review is to present the actual data available on the rate of complications in scoliosis surgery. Materials and methods Search strategy for identification of studies; Pub Med and the SOSORT scoliosis library, limited to English language and bibliographies of all reviewed articles. The search strategy included the terms; 'scoliosis'; 'rate of complications'; 'spine surgery'; 'scoliosis surgery'; 'spondylodesis'; 'spinal instrumentation' and 'spine fusion'. Results The electronic search carried out on the 1st February 2008 with the key words "scoliosis", "surgery", "complications" revealed 2590 titles, which not necessarily attributed to our quest for the term "rate of complications". 287 titles were found when the term "rate of complications" was used as a key word. Rates of complication varied between 0 and 89% depending on the aetiology of the entity investigated. Long-term rates of complications have not yet been reported upon. Conclusion Scoliosis surgery has a varying but high rate of complications. A medical indication for this treatment cannot be established in view of the lack of evidence. The rate of complications may even be higher than reported. Long-term risks of scoliosis surgery have not yet been reported upon in research. Mandatory reporting for all spinal implants in a standardized way using a spreadsheet list of all recognised complications to reveal a 2-year, 5-year, 10-year and 20-year rate of complications should be established. Trials with untreated control groups in the field of scoliosis raise ethical issues, as the control group could be exposed to the risks of undergoing such surgery.
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Affiliation(s)
- Hans-Rudolf Weiss
- Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Korczakstr, 2, D-55566, Bad Sobernheim, Germany.
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Danielsson AJ. What impact does spinal deformity correction for adolescent idiopathic scoliosis make on quality of life? Spine (Phila Pa 1976) 2007; 32:S101-8. [PMID: 17728675 DOI: 10.1097/brs.0b013e318134ed0e] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN : Literature review. OBJECTIVE : To identify scientifically sound studies that have reported changes in quality of life (QOL) after spinal deformity correction in patients with adolescent idiopathic scoliosis (AIS) and to discuss these findings. SUMMARY OF BACKGROUND DATA : Few studies have been published. Most are retrospective cohort studies and lack both preoperative and postoperative data for the outcome in terms of QOL. METHODS : A review of existing literature with the emphasis on spinal fusion for AIS and outcome as measured by health-related QOL was performed. RESULTS : Thirteen studies of various quality were found after reviewing the papers. Only 3 of them contained both preoperative and postoperative data on QOL, using the SRS-22/-24. They all reported a statistically significant improvement in some of the domain scores. The clinical implications of these findings are unclear, as the minimal clinically important differences for SRS-22/-24 have not yet been established. CONCLUSION : Weak evidence (Level IV) exists in the literature that spinal deformity correction for AIS does not significantly impact QOL in short-term or mid-term. The interpretation of this must be that there were no serious adverse events after surgery.
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Affiliation(s)
- Aina J Danielsson
- Department of Orthopedics, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden.
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Negrini S, Grivas TB, Kotwicki T, Maruyama T, Rigo M, Weiss HR. Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper. SCOLIOSIS 2006; 1:4. [PMID: 16759352 PMCID: PMC1475888 DOI: 10.1186/1748-7161-1-4] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 04/10/2006] [Indexed: 01/03/2023]
Abstract
Background Medicine is a scientific art: once science is not clear, choices are made according to individual and collective beliefs that should be better understood. This is particularly true in a field like adolescent idiopathic scoliosis, where currently does not exist definitive scientific evidence on the efficacy either of conservative or of surgical treatments. Aim of the study To verify the philosophical choices on the final outcome of a group of people believing and engaged in a conservative treatment of idiopathic scoliosis. Methods We performed a multifaceted study that included a bibliometric analysis, a questionnaire, and a careful Consensus reaching procedure between experts in the conservative treatment of scoliosis (SOSORT members). Results The Consensus reaching procedure has shown to be useful: answers changed in a statistically significant way, and 9 new outcome criteria were included. The most important final outcomes were considered Aesthetics (100%), Quality of life and Disability (more than 90%), while more than 80% of preferences went to Back Pain, Psychological well-being, Progression in adulthood, Breathing function, Scoliosis Cobb degrees (radiographic lateral flexion), Needs of further treatments in adulthood. Discussion In the literature prevail outcome criteria driven by the contingent treatment needs or the possibility to have measurement systems (even if it seems that usual clinical and radiographic methods are given much more importance than more complex Disability or Quality of Life instruments). SOSORT members give importance to a wide range of outcome criteria, in which clinical and radiographic issues have the lowest importance. Conclusion We treat our patients for what they need for their future (Breathing function, Needs of further treatments in adulthood, Progression in adulthood), and their present too (Aesthetics, Disability, Quality of life). Technical matters, such as rib hump or radiographic lateral alignment and rotation, but not lateral flexion, are secondary outcomes and only instrumental to previously reported primary outcomes. We advocate a multidimensional, comprehensive evaluation of scoliosis patients, to gather all necessary data for a complete therapeutic approach, that goes beyond x-rays to reach the person and the family.
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Affiliation(s)
| | - Theodoros B Grivas
- Orthopaedic Department "Thriasion" General Hospital, Magula, Athens, Greece
| | | | - Toru Maruyama
- Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | | | - Hans Rudolf Weiss
- Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Bad Sobernheim, Germany
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