1
|
Pease TJ, Smith RA, Thomson A, Ye I, Nash A, Sabet A, Hoffman E, Banagan K, Koh E, Gelb D, Ludwig S. Lower socioeconomic status is not associated with severity of adolescent idiopathic scoliosis: a matched cohort analysis. Spine Deform 2023; 11:1071-1078. [PMID: 37052745 DOI: 10.1007/s43390-023-00686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/01/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Assessing the influence of socioeconomic status (SES) on the severity of adolescent idiopathic scoliosis (AIS) on initial presentation to the spinal surgeon remains a challenge. The area deprivation index (ADI) is a validated measure of SES that abstracts multiple domains of disadvantage into a single score. We hypothesized that patients with low SES (high ADI) present to the orthopedic clinic with more advanced curve pathology. METHODS We retrospectively reviewed patients diagnosed with AIS. Subjects were assigned ADI scores based on Zip codes. Matched cohorts of high and low ADI were generated using propensity scores. Bivariate and multivariate analyses were performed to identify factors impacting the magnitude of the curve at presentation. RESULTS A total of 425 patients with appropriate imaging were included. After matching, the study population was 69.2% female and 92.3% Black. The mean BMI percentile was 61.9. Medicaid covered 57.3% of subjects, and 42.7% had commercial insurance. The mean ADI was 55.5. The mean Cobb angle at presentation was 33.6 degrees. Cobb angle was significantly greater among female patients (36.0 degrees vs 28.0) and among patients with greater BMI percentile (β = 0.127), but was not significantly associated with ADI, race, or insurance type. ADI was not associated with the rate of surgery. CONCLUSION ADI is not predictive of curve severity in pediatric patients presenting to the clinic for AIS. Female sex and BMI are independently associated with advanced curvature. Public health workers, primary care providers, and surgeons should remain aware of the complex interactions of socioeconomic factors, BMI and sex when addressing barriers to timely care. LEVEL OF EVIDENCE Prognostic Level III.
Collapse
Affiliation(s)
- Tyler J Pease
- Department of Orthopaedic Surgery, Division of Spine Surgery, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Ste. 300, Baltimore, MD, 21201, USA
| | - Ryan A Smith
- Department of Orthopaedic Surgery, Division of Spine Surgery, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Ste. 300, Baltimore, MD, 21201, USA
| | - Alexandra Thomson
- Department of Orthopaedic Surgery, Division of Spine Surgery, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Ste. 300, Baltimore, MD, 21201, USA
| | - Ivan Ye
- Department of Orthopaedic Surgery, Division of Spine Surgery, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Ste. 300, Baltimore, MD, 21201, USA
| | - Alysa Nash
- Department of Orthopaedic Surgery, Division of Spine Surgery, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Ste. 300, Baltimore, MD, 21201, USA
| | - Andre Sabet
- Department of Orthopaedic Surgery, Division of Spine Surgery, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Ste. 300, Baltimore, MD, 21201, USA
| | - Eve Hoffman
- Department of Orthopaedic Surgery, Division of Spine Surgery, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Ste. 300, Baltimore, MD, 21201, USA
| | - Kelley Banagan
- Department of Orthopaedic Surgery, Division of Spine Surgery, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Ste. 300, Baltimore, MD, 21201, USA
| | - Eugene Koh
- Department of Orthopaedic Surgery, Division of Spine Surgery, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Ste. 300, Baltimore, MD, 21201, USA
| | - Daniel Gelb
- Department of Orthopaedic Surgery, Division of Spine Surgery, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Ste. 300, Baltimore, MD, 21201, USA
| | - Steven Ludwig
- Department of Orthopaedic Surgery, Division of Spine Surgery, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Ste. 300, Baltimore, MD, 21201, USA.
| |
Collapse
|
2
|
Catanzano AA, Sponseller PD, Newton PO, Bastrom TP, Bartley CE, Shah SA, Cahill PJ, Group HS, Yaszay B. Beware of open triradiate cartilage: 1 in 4 patients will lose > 10° of correction following posterior only fusion. Spine Deform 2023; 11:133-138. [PMID: 35978156 DOI: 10.1007/s43390-022-00565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE As 2-year follow-up may not be sufficient to assess the risk of curve progression following fusion in immature patients with adolescent idiopathic scoliosis (AIS), this study reports on 5-year outcomes of AIS patients, factoring in maturity and surgical approach, to determine whether immature patients are at risk of continued curve progression beyond 2 years. METHODS A multicenter database was reviewed for AIS patients who underwent spinal fusion with pedicle screw fixation and who had both 2 and 5-year follow-up. Radiographic and SRS-22 scores were compared between three groups: open triradiate cartilage-posterior fusion (OTRC-P), OTRC-combined anterior/posterior fusion (OTRC-APSF), and closed TRC (CTRC, matched to OTRC-P group). RESULTS 142 subjects were included (67 OTRC-P, 8 OTRC-APSF, 67 CTRC). Main curve type (p = 0.592) and size (p = 0.117) were not different between groups at all timepoints. Compensatory curve size was similar at all timepoints for OTRC-P and CTRC, with a slight increase for OTRC-APSF from immediate postoperative to 5 years. At 5 years, OTRC-P had > 10° loss of correction in 25% of patients, which was greater than in the CTRC (6%) and OTRC-APSF (0%) groups (p = 0.002). No significant differences were found in loss of correction of the compensatory curve or in SRS-22 scores between groups. CONCLUSIONS Compared to those with CTRC and those treated with anterior/posterior fusion, patients with OTRC treated with posterior fusion had an increased risk of main curve progression greater than 10°, with some continued loss of correction after 2 years. This did not appear to affect patient-reported outcomes.
Collapse
Affiliation(s)
- Anthony A Catanzano
- Department of Orthopedics, Duke Children's Hospital and Health Center, Durham, NC, USA
| | - Paul D Sponseller
- Department of Orthopedics, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - Peter O Newton
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA.,Department of Orthopedics, University of California, San Diego, CA, USA
| | - Tracey P Bastrom
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA
| | - Carrie E Bartley
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA
| | - Suken A Shah
- Department of Orthopedics, Nemours Children's Hospital, Wilmington, DE, USA
| | - Patrick J Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Burt Yaszay
- Division of Orthopedics and Sports Medicine, Seattle Children's Hospital, M/S OA.9.120, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.
| |
Collapse
|
3
|
Davies NR, Tello C, Piantoni L, Remondino R, Galaretto E, Wilson IAF, Rodriguez VV, Bersusky E, Noel M. Selective Fusion in Lenke 1 B/C: Before or After Menarche? Global Spine J 2021; 11:686-689. [PMID: 32875904 PMCID: PMC8165938 DOI: 10.1177/2192568220920564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
STUDY DESIGN A retrospective, comparative study. OBJECTIVE To determine the radiological behavior of the lumbar curve in selective fusions in premenarchal girls with adolescent idiopathic scoliosis (Lenke 1 B/C). METHODS A retrospective, comparative study was conducted. Selective fusion was performed in 21 patients younger than 18 years. The patients were divided into 2 groups: group A, after menarche (n = 12) and group B, before menarche (n = 9). Angles (preoperative, and at 1 and 2 years postoperatively) of the fused thoracic curves and the corresponding lumbar curves were measured and compared. For statistical analysis, the t test was used with a significance level of P < .05. RESULTS Mean preoperative angle value of the proximal/main thoracic curve was 61° in group A and 57° in group B (P = .44), and 21° and 20°, respectively, in the first year postoperatively (P = .61). Mean preoperative angle value of the lumbar curve was 43° in group A and 42° in group B (P = .87), while at 1 year after surgery, this curve was 19° in both groups (P = 0.91), and at 2 years postoperatively, the curve was 16° in group A and 17° in group B (P = .75). CONCLUSIONS Over a 2-year follow-up, we did not find significant radiological differences in lumbar curves between patients who underwent surgery before and after menarche.
Collapse
Affiliation(s)
- Nestor Ricardo Davies
- Hospital de Pediatría Prof Dr Juan P. Garrahan, Buenos Aires, Argentina,Davies Nestor Ricardo, Servicio de Patología Espinal, Hospital de Pediatría Prof Dr Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina.
| | - Carlos Tello
- Hospital de Pediatría Prof Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - Lucas Piantoni
- Hospital de Pediatría Prof Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - Rodrigo Remondino
- Hospital de Pediatría Prof Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - Eduardo Galaretto
- Hospital de Pediatría Prof Dr Juan P. Garrahan, Buenos Aires, Argentina
| | | | | | - Ernesto Bersusky
- Hospital de Pediatría Prof Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - Mariano Noel
- Hospital de Pediatría Prof Dr Juan P. Garrahan, Buenos Aires, Argentina
| |
Collapse
|
4
|
Wong CKH, Cheung PWH, Samartzis D, Luk KDK, Cheung KMC, Lam CLK, Cheung JPY. Mapping the SRS-22r questionnaire onto the EQ-5D-5L utility score in patients with adolescent idiopathic scoliosis. PLoS One 2017; 12:e0175847. [PMID: 28414745 PMCID: PMC5393614 DOI: 10.1371/journal.pone.0175847] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/31/2017] [Indexed: 12/03/2022] Open
Abstract
This is a prospective study to establish prediction models that map the refined Scoliosis Research Society 22-item (SRS-22r) onto EuroQoL-5 dimension 5-level (EQ-5D-5L) utility scores in adolescent idiopathic scoliosis (AIS) patients. Comparison of treatment outcomes in AIS can be determined by cost-utility analysis. However, the mainstay spine-specific health-related quality of life outcome measure, the SRS-22r questionnaire does not provide utility assessment. In this study, AIS patients were prospectively recruited to complete both the EQ-5D-5L and SRS-22r questionnaires by trained interviewers. Ordinary least squares regression was undertaken to develop mapping models, which the validity and robustness were assessed by using the 10-fold cross-validation procedure. EQ-5D-5L utility scores were regressed on demographics, Cobb angle, curve types, treatment modalities, and five domains of the SRS-22r questionnaire. Three models were developed using stepwise selection method. EQ-5D-5L scores were regressed on 1) main effects of SRS-22r subscale scores, 2) as per 1 plus squared and interaction terms, and 3) as per 2 plus demographic and clinical characteristics. Model goodness-of-fit was assessed using R-square, adjusted R-square, and information criteria; whereas the predictive performance was evaluated using root mean square error (RMSE), mean absolute error (MAE), and the proportion of absolute error within the threshold of 0.05 and 0.10. A total of 227 AIS patients with mean age of 15.6 years were recruited. The EQ-5D-5L scores were predicted by four domains of SRS-22r (main effects of ‘Function’, ‘Pain’, ‘Appearance’ and ‘Mental Health’, and squared term of ‘Function’ and ‘Pain’), and Cobb angle in Model 3 with the best goodness-of-fit (R-square/adjusted R-square: 62.1%/60.9%). Three models demonstrated an acceptance predictive performance in error analysis applying 10-fold cross-validation to three models where RMSE and MAE were between 0.063–0.065 and between 0.039–0.044, respectively. Model 3 was therefore recommended out of three mapping models established in this paper. To our knowledge, this is the first study to map a spine-specific health-related quality of life measure onto EQ-5D-5L for AIS patients. With the consideration and incorporation of demographic and clinical characteristics, over 60% variance explained by mapping model 3 enabled the satisfactory prediction of EQ-5D-5L utility scores from existing SRS-22r data for health economic appraisal of different treatment options.
Collapse
Affiliation(s)
- Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Keith Dip-Kei Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Kenneth M. C. Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
- * E-mail:
| |
Collapse
|
5
|
Negrini S, Negrini F, Fusco C, Zaina F. Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements. Spine J 2011; 11:369-80. [PMID: 21292562 DOI: 10.1016/j.spinee.2010.12.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 11/02/2010] [Accepted: 12/04/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT It is a broad consensus today that scoliosis curves cannot be improved through bracing, and the Scoliosis Research Society (SRS) methodological criteria for bracing have the avoidance of progression as their only objective. Consequently, in curves more than 45°, fusion is considered as basically the only possible treatment. PURPOSE The purpose of the study was to verify in a series of patients who utterly refused surgery if it was possible to achieve improvements of scoliosis of more than 45° through a complete conservative treatment (bracing and exercises). STUDY DESIGN/SETTING Retrospective cohort from a prospective database. PATIENT SAMPLE Out of 1,148 idiopathic scoliosis (IS) patients at the end of treatment, the sample comprised 28 subjects older than 10 years, still growing, with at least one curve above 45°, who had continually refused fusion. The group comprised 24 females and four males, including 14 in which previous brace treatments had failed; at the start of treatment, the age was 14.2±1.8 years and Cobb degrees in the curve were 49.4° (range, 45°-58°). Subgroups considered were gender, bone age, type of scoliosis, treatment used, and previous failed treatment. OUTCOME MEASURES Self-report measurement: SRS-22; physiological measures: Cobb degrees, Bunnell angle of trunk rotation (ATR), aesthetic index (AI), and sagittal plumb line distances. METHODS The methods comprised full-time treatment (23 or 24 hours per day) for 1 year with Risser cast, Lyon, or Sforzesco brace; weaning of 1 to 2 hours every 6 months; with strategies to maximize compliance through the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) management criteria applied and specific scientific exercises approach to scoliosis exercises (SEAS) performed. RESULTS Reported compliance in the 4.10±1.2 treatment years was 94%, with satisfaction regarding treatment and excellent results at the SRS-22. Two patients (7%) remained above 50° Cobb but six patients (21%) finished between 30° and 35° Cobb and 12 patients (43%) finished between 36° and 40° Cobb. Improvements have been found in 71% of patients and a 5° Cobb progression in one patient. Statistically, we found highly significant reductions of the main (-9.25°), average (-6.6°), thoracic (-7.8°), and lumbar (-15.9°) curves. Statistically significant improvements have been found for the AI and ATR, with a general decrease in plumb line distances. CONCLUSIONS Bracing can be successfully used in patients who do not want to undergo operations for IS with curves ranging between 45° and 60° Cobb, given sufficient clinical expertise to apply good braces and achieve great compliance. Future studies could demonstrate the percentages at which this result can be achieved.
Collapse
Affiliation(s)
- Stefano Negrini
- Rehabilitation Department, Italian Scientific Spine Institute, Via Bellarmino 13/1, Milan, Italy.
| | | | | | | |
Collapse
|
6
|
Abstract
ABSTRACTBRACING IS THE oldest treatment known for scoliotic spinal deformity. The relative advantages to the use of bracing have been directly related to the etiology of the deformity and the flexibility of the spine at the time that a decision is made regarding the use of a brace. In skeletally immature patients with adolescent idiopathic scoliosis, the advantages to bracing are clear. In many instances, prompt recognition and appropriate bracing can arrest the progression of this form of deformity, and, in so doing, the need for any surgery may be avoided completely. On the other hand, in skeletally mature adult deformity patients, bracing has almost no proven role in affecting the natural history of the disease. Likewise, infantile and congenital scoliosis routinely requires surgical correction to prevent curve progression. Lastly, although many surgeons use bracing in the postoperative management of patients with spinal deformity, the benefits of postoperative bracing remain debatable. By far, the best indication for bracing is treatment of the skeletally immature adolescent patient with an idiopathic flexible curve of less than 45 degrees magnitude.
Collapse
Affiliation(s)
- Robert F. Heary
- Department of Neurological Surgery, University of Medicine & Dentistry of New Jersey–New Jersey, Medical School, Newark, New Jersey
| | - Sanjeev Kumar
- Department of Neurological Surgery, University of Medicine & Dentistry of New Jersey–New Jersey, Medical School, Newark, New Jersey
| | - Christopher M. Bono
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|