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Larson AN, Marks MC, Gonzalez Sepulveda JM, Newton PO, Devlin VJ, Peat R, Tarver ME, Babalola O, Chen AL, Gebben D, Cahill P, Shah S, Samdani A, Bachmann K, Lonner B. Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis: What Trade-Offs in Outcomes Are Acceptable for the Patient and Family? J Bone Joint Surg Am 2024; 106:2-9. [PMID: 37943944 DOI: 10.2106/jbjs.23.00503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Vertebral body tethering and other non-fusion techniques for the treatment of pediatric idiopathic scoliosis are increasing in popularity. There is limited physician consensus on this topic as the result of a paucity of published data regarding which patients most benefit from non-fusion strategies. Thus, much of the decision-making is left to patients and parents, who must select a treatment based on their goals and values and the information available from health-care providers, the internet, and social media. We sought to understand patient and family preferences regarding the attributes of fusion versus non-fusion surgery that drive these choices. METHODS Patients and families were recruited from 7 pediatric spine centers and were asked to complete a survey-based choice experiment that had been jointly developed with the U.S. Food and Drug Administration (FDA) to evaluate patient preferences. Choices between experimentally designed alternatives were analyzed to estimate the relative importance of outcomes and requirements associated with the choice options (attributes). The attributes included appearance, confidence in the planned correction, spinal motion, device failure, reoperation, and recovery period. The inclusion criteria were (1) an age of 10 to 21 years and (2) a diagnosis of adolescent idiopathic scoliosis in patients who were considering, or who had already undergone, treatment with fusion or non-fusion surgery. Preference weights were estimated from the expected changes in choice given changes in the attributes. RESULTS A total of 344 respondents (124 patients, 92 parents, and 128 parent/patient dyads) completed the survey. One hundred and seventy-three patients were enrolled prior to surgery, and 171 were enrolled after surgery. Appearance and motion were found to be the most important drivers of choice. For the entire cohort, fusion was preferred over non-fusion. For patients who were considering surgery, the most important attributes were preservation of spinal motion and appearance. CONCLUSIONS Patients and families seeking treatment for idiopathic scoliosis value appearance and preservation of spinal motion and, to a lesser extent, reoperation rates when considering fusion versus non-fusion surgery.
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Affiliation(s)
- A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Peter O Newton
- Setting Scoliosis Straight Foundation, El Cajon, California
- Division of Orthopedics, Rady Children's Hospital, San Diego, California
| | - Vincent J Devlin
- Office of Product Evaluation and Quality, Office of Health Technology-6: Orthopedic Devices, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Raquel Peat
- Office of Product Evaluation and Quality, Office of Health Technology-6: Orthopedic Devices, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Michelle E Tarver
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Olufemi Babalola
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Allen L Chen
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - David Gebben
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Patrick Cahill
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Suken Shah
- Department of Orthopaedic Surgery, Nemours Children's Hospital, Wilmington, Delaware
| | - Amer Samdani
- Department of Pediatric Orthopedic Surgery, Shriners Children's Philadelphia, Philadelphia, Pennsylvania
| | - Keith Bachmann
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Baron Lonner
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY
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Meyers J, Eaker L, Zhang J, di Pauli von Treuheim T, Lonner B. Vertebral Body Tethering in 49 Adolescent Patients after Peak Height Velocity for the Treatment of Idiopathic Scoliosis: 2-5 Year Follow-Up. J Clin Med 2022; 11:jcm11113161. [PMID: 35683548 PMCID: PMC9181769 DOI: 10.3390/jcm11113161] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 02/05/2023] Open
Abstract
Vertebral Body Tethering (VBT) is a non-fusion surgical treatment for Adolescent Idiopathic Scoliosis (AIS) that elicits correction via growth modulation in skeletally immature patients. VBT after peak height velocity is controversial and is the subject of this study. A retrospective review of Risser 3−5 AIS patients treated with VBT, and min. 2-year FU was performed. Pre to post-op changes in clinical outcomes were compared using Student’s t-test or the Mann-Whitney test. A total of 49 patients met criteria, age 15.0 ± 1.9 years, FU 32.5 ± 9.1 months. For thoracic (T) major curvatures, T curvature improved from 51.1 ± 6.9° to 27.2° ± 8.1° (p < 0.01) and TL from 37.2° ± 10.7° to 19.2° ± 6.8° (p < 0.01). For thoracolumbar (TL) major curvatures, T improved from 37.2° ± 10.7° to 18.8° ± 9.4° (p < 0.01) and TL from 49.0° ± 6.4° to 20.1° ± 8.5° (p < 0.01). Major curve inclinometer measurements and SRS-22 domains, except activity, improved significantly (p ≤ 0.05). At the latest FU, one (2%) patient required fusion of the T curve and revision of the TL tether due to curve progression in the previously uninstrumented T curve and tether breakage (TB) in the TL. Twenty (41%) patients experienced TB. VBT in AIS patients with limited remaining skeletal growth resulted in satisfactory clinical outcomes at the latest FU.
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