Does the Quality of Life in Operated Patients with Adolescent Idiopathic Scoliosis correspond with the Radiographic Parameters?

Saudi patients outcomes after surgical treatment of adolescent idiopathic scoliosis

BACKGROUND

In order to improve post-operative patient's quality-of-life, attention must be paid to the identification of factors that play a role in patient's satisfaction with surgical treatment. Patient satisfaction with the outcomes of scoliosis surgery has not been addressed so comprehensively in Saudi literature, as well as the effect of patient satisfaction on the different domains of the SRS-22 questionnaire and radiographic parameters is yet to be reported locally. The aim of this study is to explore such findings especially in our population.

METHODS

A retrospective cohort study was conducted at two of the largest centers of spine surgery in the Kingdom of Saudi Arabia. A total of 316 eligible patients were selected via consecutive sampling technique. Data were collected from eligible patients who fit our inclusion criteria, which includes patients with adolescent idiopathic scoliosis aged from 10 to 21 years. Student t test, Pearson's and Spearman's correlation coefficients statistical tests were used.

RESULTS

There were 283 (89.6%) females and 33 (10.4%) male patients with a mean age of 15.09 (± 2.27 SD) years. All the domains of SRS-22 showed significantly higher scores 2-year postoperatively, when compared with preoperative values (P < 0.001). The change in all SRS-22 domains correlated positively and significantly with the 2-year postoperative satisfaction using Pearson's correlation coefficient (P < 0.05); the total score showed the highest correlation followed by the self-image domain. The major Cobb angle correction percentage correlated significantly (P < 0.05) solely with the change in pain domain.

CONCLUSION

Self-image correlated highly and significantly with patient satisfaction postoperatively. It also had the biggest influence SRS-22 scores postoperatively in conjunction with satisfaction scores. That is an indication of the role it plays in patient satisfaction and quality-of-life postoperatively, which may influence the surgical decision making.

Comparison of Changes in SRS-22 Values with Improvement in Cobb Angles after Posterior Fusion Surgery in Adolescent Idiopathic Scoliosis

INTRODUCTION

The purpose of this study was to evaluate the relationship between the correction rate in Cobb angle and the improvement in quality of life profile in terms of Scoliosis Research Society (SRS)-22 values.

PATIENTS AND METHODS

Between January 2007 and December 2013, posterior instrumentation and fusion was performed to 30 patients with adolescent idiopathic scoliosis (AIS). Patients were grouped according to their improvement rate in Cobb angles after surgery. Patients with an improvement rate of > 80% were grouped as Group A; those with an improvement rate of > 60% and ≤ 80% as Group B and those with an improvement rate of ≤ 60% were grouped as Group C. The SRS-22 questionnaire of these three groups was calculated and their relationship with the improvement in Cobb angle was evaluated.

RESULTS

No statistical difference was found among the three groups in terms of pain, appearance, function, spirit, satisfaction, and SRS-22 values (all p > 0.05).

CONCLUSION

The results of this study demonstrate that the degree of correction rate does not correlate with the degree of improvement in the SRS-22 questionnaire in patients with AIS that underwent posterior fusion and instrumentation.

Rod derotation and translation techniques provide comparable functional outcomes for surgical correction of adolescent idiopathic scoliosis - A retrospective, cross-sectional study

OBJECTIVES

To compare the functional outcome of the two most commonly used methods of Adolescence Idiopathic Scoliosis (AIS) correction surgery using rod rotation and translation techniques from a single center in Indonesia.

METHOD

We performed retrospective, cross-sectional study of patients with AIS who underwent deformity correction surgery by either technique in Fatmawati General Hospital from January 2016 to March 2018. All patients were asked to complete scoliosis research society (SRS)-22 questionnaire.

RESULT

Both methods of surgical correction yielded similar functional outcome as recorded in SRS-22 score, 3.67 for rod derotation technique and 3.44 for translation technique (p = 0.235).

CONCLUSION

Both rod derotation and translation technique resulted in equally desirable quality of life for AIS patients, in line with what would be expected from the literatures. Neither technique can be judged superior to the other. Therefore, the decision to use rotation or translation technique, as well as to compliment it with additional correction methods, should be made by the surgeon according to personal preference, experience, and comfort.

No added value of 2-year radiographic follow-up of fusion surgery for adolescent idiopathic scoliosis

PURPOSE

For fusion surgery in adolescent idiopathic scoliosis (AIS) consensus exists that a 2-year radiographic follow-up assessment is needed. This standard lacks empirical evidence. The purpose of this study was to investigate the radiographic follow-up after corrective surgery in AIS, from pre-until 2 years postoperative.

METHODS

In this historical cohort study, 63 patients surgically treated for AIS, age ≤ 25 years, with 2-year radiographic follow-up, were enrolled. The primary outcome measure was the major Cobb angle. Secondary outcomes were coronal and sagittal spino-pelvic parameters, including proximal junction kyphosis (PJK) and distal adding-on. Change over time was analyzed using a repeated measures ANOVA.

RESULTS

The major curve Cobb angle showed a statistically significant change for pre- to 1 year postoperative, but not for 1- to 2-year follow-up. Seven out of 63 patients did show a change exceeding the error of measurement (5°) from 1- to 2-year follow-up (range -8° to +7°), of whom 2 patients showed curve progression and 5 showed improvement. PJK or distal adding-on was not observed.

CONCLUSIONS

No statistically significant changes in major curve Cobb angle were found during postsurgical follow-up, or in adjacent non-fused segments. The findings of this study are not supportive for routine radiographs 2 years after fusion surgery in AIS patients.

Is the apical vertebra the most rotated vertebra in the scoliotic curve?

OBJECTIVE

The aim of this study was to determine if the apical vertebra (AV) in patients with adolescent idiopathic scoliosis (AIS) is the most rotated vertebra in the scoliotic segment.

METHODS

A total of 158 patients with AIS (Cobb angle range 20°-101°) underwent biplanar radiography with 3D reconstructions of the spine and calculation of vertebral axial rotations. The type of major curvature was recorded (thoracic, thoracolumbar, or lumbar), and both major and minor curvatures were included. The difference of levels (DL) between the level of maximal vertebral rotation (LMVR) and the AV was calculated as follows: DL = 0 if LMVR and AV were the same, DL = 1 if LMVR was directly above or below the AV, and DL = 2 if LMVR was separated by 1 vertebra or more from the AV. To investigate which factors explained the divergence of the LMVR from the AV, multinomial models were computed.

RESULTS

The distribution of the DL was as follows: for major curvatures, 143 were DL = 0, 11 were DL = 1, and 4 were DL = 2; and for minor curvatures, 53 were DL = 0, 9 were DL = 1, and 31 were DL = 2. The determinants of a DL = 2 (compared with DL = 0) were lumbar curvature (compared with thoracic; adjusted OR 0.094, p = 0.001), major curvature (compared with minor; adjusted OR 0.116, p = 0.001), and curvatures with increasing apical vertebral rotation (adjusted OR 0.788, p < 0.001).

CONCLUSIONS

This study showed that the AV is the most rotated vertebra in the majority of major curvatures, while in minor curvatures, the most rotated vertebra appears to be the junctional vertebra between major and minor curvatures in a significant proportion of cases.

Data-driven Classification of the 3D Spinal Curve in Adolescent Idiopathic Scoliosis with an Applications in Surgical Outcome Prediction

Adolescent idiopathic scoliosis (AIS) is a three-dimensional (3D) deformity of the spinal column. For progressive deformities in AIS, the spinal fusion surgery aims to correct and stabilize the deformity; however, common surgical planning approaches based on the 2D X-rays and subjective surgical decision-making have been challenged by poor clinical outcomes. As the suboptimal surgical outcomes can significantly impact the cost, risk of revision surgery, and long-term rehabilitation of adolescent patients, objective patient-specific models that predict the outcome of different treatment scenarios are in high demand. 3D classification of the spinal curvature and identifying the key surgical parameters influencing the outcomes are required for such models. Here, we show that K-means clustering of the isotropically scaled 3D spinal curves provides an effective, data-driven method for classification of patients. We further propose, and evaluate in 67 right thoracic AIS patients, that by knowing the patients’ pre-operative and early post-operation clusters and the vertebral levels which were instrumented during the surgery, the two-year outcome cluster can be determined. This framework, once applied to a larger heterogeneous patient dataset, can further isolate the key surgeon-modifiable parameters and eventually lead to a patient-specific predictive model based on a limited number of factors determinable prior to surgery.