1
|
Lonner B, Eaker L, Hoernschemeyer D, Zhang J, Wilczek A, Elliot P, Boeyer ME, Fletcher ND, Alanay A, Yilgor C, Newton P, Miyanji F. Double major curvature treated with vertebral body tethering of both curves: how do outcomes compare to posterior spinal fusion? Spine Deform 2024; 12:651-662. [PMID: 38285163 DOI: 10.1007/s43390-023-00803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Vertebral body tethering (VBT) is a non-fusion alternative to posterior spinal fusion (PSF). There have been few reports on VBT of two curvatures. We aim to compare the radiographic outcomes between VBT and PSF in patients with double curvatures in which both curves were instrumented. METHODS 29 AIS patients matched by Lenke, age (± 2 years), triradiate cartilage closure status, major Cobb angle (± 8°), and T5-T12 kyphosis (± 10°). Variables were compared using Wilcoxon rank-sum tests, Student's t tests, and chi-Square. Clinical success was defined as major curve < 35°. RESULTS Group baseline demographics were similar. Major thoracic (T) curve types had significantly better major (VBT 51.5 ± 7.9° to 31.6 ± 12.0° [40%] vs. PSF 54.3 ± 7.4° to 17.4 ± 6.5° [68%]; p = 0.0002) and secondary curve correction in the PSF group. 71% of major T VBT patients were clinically successful versus 100% of PSF. Major thoracolumbar (TL) curve types experienced comparable major (VBT 52.3 ± 7.0° to 18.3 ± 11.4° (65%) vs. PSF 53.0 ± 5.2° to 23.8 ± 10.9° (56%); p = 0.2397) and secondary curve correction. 92% of major TL VBT patients were clinically successful versus 75% in the PSF group. There was no difference in T5-12 kyphosis or lumbar lordosis between groups for any curve type. There were 4 patients (13.8%) with major complications in the VBT group compared to 0 (0%) in the PSF. CONCLUSION Patients with double major AIS who underwent VBT with major T curve types had less correction than PSF; however, those with major TL curves experienced similar radiographic outcomes regardless of procedure. Complications were greater for VBT.
Collapse
Affiliation(s)
- Baron Lonner
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA.
| | - Lily Eaker
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA
| | | | - Jessica Zhang
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA
| | - Ashley Wilczek
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA
| | - Patrick Elliot
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Melanie E Boeyer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Nicholas D Fletcher
- Department of Orthopaedics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Peter Newton
- Department of Orthopaedics, Rady Children's Hospital, San Diego, CA, USA
| | - Firoz Miyanji
- Department of Orthopedics, British Columbia Children's Hospital, Vancouver, BC, Canada
| |
Collapse
|
2
|
Meyers J, Eaker L, Samdani A, Miyanji F, Herrera M, Wilczek A, Alanay A, Yilgor C, Hoernschemeyer D, Shah S, Newton P, Lonner B. Anterior vertebral body tethering shows clinically comparable shoulder balance outcomes to posterior spinal fusion. Spine Deform 2024:10.1007/s43390-024-00847-6. [PMID: 38517667 DOI: 10.1007/s43390-024-00847-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/14/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE Posterior spinal fusion (PSF) is the current gold standard in surgical treatment for adolescent idiopathic scoliosis. Vertebral body tethering (VBT) is a fusionless alternative. Shoulder balance is an important metric for outcomes and patient satisfaction. Here we compare shoulder balance outcomes between PSF and VBT. METHODS In this retrospective review, the pre-operative and post-operative absolute radiographic shoulder height (|RSH|) of 45 PSF patients were compared to 46 VBT patients. Mean values were compared and then collapsed into discrete groups (|RSH| GROUP) and compared. Patients were propensity score matched. Regression models based on pretest-posttest designs were used to compare procedure type on post-operative outcomes. RESULTS Pre-operatively there were no differences in |RSH| between PSF and VBT, however, at latest post-operative follow-up PSF maintained a larger |RSH| imbalance compared to VBT (0.91 cm vs 0.63 cm, p = 0.021). In an ANCOVA regression, PSF was associated with a larger |RSH| imbalance compared to VBT, F(1, 88) = 5.76, p = 0.019. An ordinal logistic regression found that the odds ratio of being in a worse |RSH| GROUP for PSF vs VBT is 2.788 (95% CI = 1.099 to 7.075), a statistically significant effect χ2(1) = 4.658, p = 0.031. Results were similar in subgroup analyses of Lenke 1 and Lenke 2 patients, though to less statistical significance. CONCLUSION While PSF was found to be associated with worse |RSH| outcomes, the actual numbers (2-3 mm) are unlikely to be clinically meaningful. Thus, in this analysis, VBT can be said to show comparable shoulder balance outcomes to PSF.
Collapse
Affiliation(s)
- James Meyers
- Department of Orthopaedics, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th St., 4th Floor, New York, NY, 10029, USA
| | - Lily Eaker
- Department of Orthopaedics, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th St., 4th Floor, New York, NY, 10029, USA
| | - Amer Samdani
- Department of Neurosurgery, Shriners Hospital-Philadelphia, Philadelphia, PA, USA
| | - Firoz Miyanji
- Department of Orthopedics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Michael Herrera
- Department of Orthopaedics, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th St., 4th Floor, New York, NY, 10029, USA
| | - Ashley Wilczek
- Department of Orthopaedics, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th St., 4th Floor, New York, NY, 10029, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Suken Shah
- Department of Orthopaedics, Nemours Children's Hospital, Wilmington, DE, USA
| | - Peter Newton
- Department of Orthopaedics, Rady Children's Hospital, San Diego, CA, USA
| | - Baron Lonner
- Department of Orthopaedics, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th St., 4th Floor, New York, NY, 10029, USA.
| |
Collapse
|
3
|
Hoernschemeyer DG, Elliott P, Lonner BS, Eaker L, Boeyer ME. Bilateral vertebral body tethering: identifying key factors associated with successful outcomes. Eur Spine J 2024; 33:723-731. [PMID: 38180517 DOI: 10.1007/s00586-023-08074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/25/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The treatment of operative double major pediatric spinal deformities (e.g., Lenke 3 or 6) with bilateral vertebral body tethering (VBT) can be significantly more challenging when compared to other deformity patterns (e.g., Lenke 1) or treatment with a posterior spinal fusion. We aimed to identify preoperative and perioperative characteristics that were associated with successful postoperative outcomes in patients treated with both a thoracic and thoracolumbar (e.g., bilateral) tether. METHODS We retrospectively assessed radiographic and clinical data from patients enrolled in a large multi-center study who had a minimum postoperative follow-up of two years. Standard radiographic parameters were extracted from standing spine and left hand-wrist radiographs at various timepoints. We classified patients based on their preoperative deformity pattern (Primary Thoracic [TP] vs. Primary Thoracolumbar [TLP]) and assessed: (1) deformity balance, (2) tilt of the transitional vertebra, and (3) postoperative success. RESULTS We analyzed data from thirty-six patients (TP: 19 and TLP: 17). We observed no relationship between deformity balance at first erect and postoperative success (p = 0.354). Patients with a horizontal transitional vertebra at first erect were significantly (p = 0.001) more likely to exhibit a successful outcome when compared to those who exhibited a tilted transitional vertebra (83% vs. 62%). Patients who had TLP were also more likely to exhibit a successful outcome when compared to patients who exhibited TP (76% vs. 50%). CONCLUSION These data indicate that double major deformities can be successfully treated with VBT, particularly for those who exhibit TLP.
Collapse
Affiliation(s)
| | - Patrick Elliott
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Baron S Lonner
- Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Lily Eaker
- Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Melanie E Boeyer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
- Missouri Orthopaedic Institute, 1100 Virginia Ave, Columbia, MO, 65212, USA.
| |
Collapse
|
4
|
Silk ZM, Tishelman JC, Eaker L, Lonner B. Reducing Uncertainty in Anterior Vertebral Body Tethering: Predicting Postoperative Curvature With Fulcrum Bending Radiographs. Global Spine J 2024; 14:219-224. [PMID: 35510409 PMCID: PMC10676183 DOI: 10.1177/21925682221100444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES Mid-term Anterior Vertebral Body Tethering (AVBT) results demonstrate an acceptable degree of clinical success, yet the revision rate remains notably higher than fusion. Fulcrum-bending radiographs have previously been shown to more reliably predict radiological outcomes in Adolescent Idiopathic Scoliosis (AIS) as compared to supine-lateral bending radiographs. This study aims to discern how Fulcrum Flexibility Rate (FFR) correlates with Correction Rate (CR) and establish whether this can reliably predict residual deformity following AVBT surgery. METHODS A review of 38 consecutive AIS patients undergoing thoracic AVBT between 2015 - 2020 was performed. Preoperative (standing and fulcrum-bending) and postoperative (first-erect) radiographs were evaluated for curve magnitude using the Cobb-method. The FFR, CR and Fulcrum Bending Correction Index (FBCI) were calculated. Patients were also percentile-ranked according to their FFR and dichotomized into flexible and rigid cohorts for comparison. Student t-test, Pearson correlation and linear stepwise regression was applied. RESULTS AVBT resulted in a significant improvement in the major Cobb angle (Preoperative: 50.9±7.5° vs Postoperative: 19.9±9.4°; P < .0001) with a mean FBCI of 98.0%. Bivariate correlation revealed a moderate relationship between fulcrum-bending and first-erect Cobb angle (r = .5306, P = .0006). Linear regression demonstrated a predictive relationship between fulcrum-bending and first-erect Cobb using the equation 'Postoperative Cobb = 7.5 + .65(Fulcrum-bending Cobb).' CONCLUSION This is the first study to demonstrate the ability of fulcrum-bending radiographs to predict early radiographic outcomes following AVBT, 'timepoint-zero' for the growth modulation process.
Collapse
Affiliation(s)
| | - Jared C. Tishelman
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Lily Eaker
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Baron Lonner
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
5
|
Treuheim TDPV, Eaker L, Markowitz J, Shankar D, Meyers J, Lonner B. Anterior Vertebral Body Tethering for Scoliosis Patients With and Without Skeletal Growth Remaining: A Retrospective Review With Minimum 2-Year Follow-Up. Int J Spine Surg 2023; 17:6-16. [PMID: 36113952 PMCID: PMC10025839 DOI: 10.14444/8357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Anterior vertebral body tethering (AVBT) has been approved for skeletally immature (IM) adolescent idiopathic scoliosis patients, but the role of AVBT in patients with minimal remaining skeletal growth is controversial. The purpose of this study was to compare minimum 2-year (YR2) outcomes in skeletally IM patients vs those with minimal remaining skeletal growth. METHODS Patients with single thoracic AVBT were grouped by their preoperative (PR) skeletal maturity: IM (n = 16, Risser 0-2) vs mature (M, n = 19, Risser 3-5). Outcomes were assessed at PR, first erect (FE), and YR2. Median (range) was compared with nonparametric tests (P < 0.05). RESULTS The PR age was 12.5 (9-16) vs 15 (12-18) years with major Cobb 51° (36°-69°) and 49° (40°-69°) for IM and M, respectively. At FE, there was no difference in correction; however, at YR2, the IM group yielded a lower residual curve (15° [-16° to 38°] vs 29° [12°-42°], P = 0.008). Thoracolumbar/lumbar curves were corrected without group differences. Clinically successful correction (<35°) (15 [94%] vs 15 [79%]) and suspected cord breakages (2 [13%] vs 2 [12%]) were similar at YR2. Two overcorrections occurred, both in IM patients. Scoliosis Research Society-22 outcomes at final follow-up were similar between groups. No revision reoperations or conversions to spinal fusion were needed. CONCLUSIONS Skeletally IM patients benefit from greater growth-modulated curve correction than M patients, however, at the increased risk of overcorrection. M patients maintained clinically significant correction at latest follow-up. Longer-term follow-up is required to determine durability of outcomes for patients undergoing AVBT who have minimal remaining growth at the time of index surgery. CLINICAL RELEVANCE This study is relevant to spine surgeons, spine physiotherapists, and patients with idiopathic scoliosis. It offers evidence of clinical correction of scoliosis in mature patients. LEVEL OF EVIDENCE: 3
Collapse
Affiliation(s)
| | - Lily Eaker
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Jonathan Markowitz
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Dhruv Shankar
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - James Meyers
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Baron Lonner
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
6
|
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: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
|
7
|
Lonner B, Weiner DA, Miyanji F, Hoernschemeyer DG, Eaker L, Samdani AF. Vertebral Body Tethering: Rationale, Results, and Revision. Instr Course Lect 2022; 71:413-425. [PMID: 35254798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Vertebral body tethering is a nonfusion technique for the surgical correction of adolescent idiopathic scoliosis. For skeletally immature patients for whom vertebral body tethering is indicated, it is an alternative option to the gold standard posterior spinal fusion (PSF) and may at least partially preserve motion in instrumented segments of the spine. Benefits of the procedure include the possibility of avoiding the long-term sequelae of PSF such as adjacent segment disease and proximal junctional kyphosis. Recent retrospective case series of vertebral body tethering have shown promising results with correction rates up to 70% but greater variability in outcomes compared with PSF. The complication profile of the procedure also appears to differ from PSF with tether breakage and overcorrection as primary concerns in addition to approach-related complications. Although early outcomes have been promising, additional studies to optimize surgical timing, long-term outcomes, and the possible role of tethering in the more skeletally mature patient are required.
Collapse
|
8
|
Lonner B, Jain A, Sponseller P, Eaker L, Samdani A, Kelly M, Castillo A, Marrache M, Ames CP, Shah SA. What are parents willing to accept? A prospective study of risk tolerance in AIS surgery. Spine Deform 2021; 9:381-386. [PMID: 33048337 DOI: 10.1007/s43390-020-00216-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Surgical treatment of Adolescent Idiopathic Scoliosis (AIS) involves healthy individuals with spinal deformity. Parents are responsible for surgical consent on behalf of their children, a burden which causes trepidation and concern. Therefore, explanation of operative risk is a critical component of informed consent and parent decision-making. We set out to quantify parental risk aversion (RA). METHODS RA questionnaires were administered preoperatively to parents of 58 AIS patients undergoing spinal fusion (SF). RA is the likelihood of a parent to consent to their child's SF (1- least likely, 10- most) with increasing allotments of data about potential complications at each stage (S1-complication named, S2-explained, S3-incidence given, S4-all information). A statistically significant mean difference in answers for each stage was assessed using paired sample t test or Wilcoxon rank t test. Normality was assessed by performing Shapiro-Wilk test. RESULTS AIS patients (age 14.2 years, 85% female, major curve 61°) were included. Mean scores for each of the stages were 4.4 ± 3.1, 4.9 ± 3.1, 6.5 ± 3.0, 6.6 ± 3.0, respectively. Highest and lowest RA were reported for death and infection, respectively. The greatest increase in likelihood to proceed with surgery was seen after education on malposition of implants and on death, 2.6 and 2.5, respectively (p < 0.001). The lowest increase in likelihood to proceed with surgery was seen after education on infection, 1.5 (p < 0.001). For all complications, there was an increase in parent willingness to proceed after providing descriptions and occurrence rate with a mean increase from S1 to S4 of 2.1 (95% CI 1.4-2.4), p < 0.001. CONCLUSION As more detailed information was made available regarding potential complications with SF for AIS, parental RA toward surgery decreased and their willingness to proceed with surgery for their child improved.
Collapse
Affiliation(s)
- Baron Lonner
- Department of Orthopedic Surgery, Minimally Invasive Scoliosis Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA.
| | - Amit Jain
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Paul Sponseller
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Lily Eaker
- Department of Orthopedic Surgery, Minimally Invasive Scoliosis Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Amer Samdani
- Shriners Hospitals for Children, Philadelphia, PA, USA
| | - Michael Kelly
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Andrea Castillo
- Department of Orthopedic Surgery, Minimally Invasive Scoliosis Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Majd Marrache
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Christopher P Ames
- Department of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, USA
| | - Suken A Shah
- Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| |
Collapse
|
9
|
Lonner B, Castillo A, Jain A, Sponseller P, Samdani A, Kelly M, Ames C, Eaker L, Marrache M, Shah SA. The patient generated index and decision regret in adolescent idiopathic scoliosis. Spine Deform 2020; 8:1231-1238. [PMID: 32588338 DOI: 10.1007/s43390-020-00155-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/06/2020] [Indexed: 11/27/2022]
Abstract
HYPOTHESIS AIS patients and their parents will have distinct perspectives regarding the impact of AIS on patients' lives. INTRODUCTION Current outcome assessment tools for AIS do not fully assess patient-specific disease impact and fail to distinguish between patient and parent perspectives. Patient Generated Index (PGI) has been used in other disease states to assess individual experiences. This study assesses PGI in operative AIS patients and their parents. DESIGN Level 1, prospective multi-center study. METHODS 44 AIS patient and parent pairs completed the PGI questionnaire comprised of three stages (S1, S2, S3) and decision regret (DR). S1 asks for five areas of the patient's life most affected by AIS and a 6th encompassing all other areas of their lives affected, S2 focuses on the magnitude of effect, S3 identifies desire to improve affected areas and DR if the surgery did not improve the specific area. S1 free responses were organized into 14 domains. Descriptive statistics were reported for stage scores; free-response format of PGI and DR limited ability for paired sample t test analysis. RESULTS Mean age at surgery was 14.3 years, 84% female, and mean major curve magnitude was 61°. The three most common patient-reported concerns prior to surgery were (in descending order): sports, general function, and general fitness. However, the three most common parent-reported concerns were (in descending order): general function, sports, and appearance. Patients reported self-esteem and parents reported physical appearance as the most affected domain (S2). Patients reported pain and self-esteem and parents reported sleep and self-esteem as main operative aspirations (S3). Decision regret was the highest for uncertainty of future health in patients and sleep in parents. CONCLUSION AIS patients and their parents reported different concerns and DR regarding surgical treatment. PGI provides insight into patient and parent views toward the disease as well as treatment aspirations.
Collapse
Affiliation(s)
- Baron Lonner
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA.
| | - Andrea Castillo
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Amit Jain
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Paul Sponseller
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Amer Samdani
- Shriners Hospitals for Children, Philadelphia, PA, USA
| | - Michael Kelly
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Christopher Ames
- Department of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Lily Eaker
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Majd Marrache
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Suken A Shah
- Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| |
Collapse
|