The Prevalence of Cancer in Dutch Female Patients with Idiopathic Scoliosis Compared with the General Population

Background and Objectives: Epidemiological studies have demonstrated the potential oncogenic effects of cumulative radiation exposure, particularly during childhood. One group experiencing repeated exposure to radiation at an early age for multiple years is patients treated for idiopathic scoliosis (IS). This study aimed to determine the relationship between childhood radiological exposure and adult cancer prevalence in children treated for IS. Materials and Methods: Data from 337 predominantly female patients treated at our hospital between January 1981 and January 1995 were gathered and compared to the Dutch national cancer rates. The standardized prevalence ratios for cancer in IS patients were compared with the cancer prevalence rates from the general Dutch population. Results: The overall cancer prevalence in women was 5.0%, with no significant difference compared to the general population (p = 0.425). The results of this study do not suggest that female patients treated for idiopathic scoliosis during childhood have an increased risk of cancer later in life. Conclusion: Despite being the largest recent study in its field, the modest participant number limits its ability to draw conclusions. However, the detailed data collected over a long observation period, alongside data from a period with comparable radiation rates, contributes to refining clinical practice and laying the groundwork for future systematic reviews.

Heath-related quality of life and functional outcomes in patients with congenital or juvenile idiopathic scoliosis after an average follow-up of 25 years: a cohort study

BACKGROUND CONTEXT

Congenital and juvenile scoliosis are both early-onset deformities that develop before the age of 10. Children are treated to prevent curve progression and problems in adulthood such as back pain and a decreased quality of life but literature on long-term outcomes remains scarce.

PURPOSE

To evaluate the health-related quality of life (HRQoL) and potential disability of children with congenital scoliosis (CS) or juvenile idiopathic scoliosis (JIS) after a minimum of 20 years follow-up.

STUDY DESIGN

Comparative cohort study.

PATIENT SAMPLE

A consecutive cohort of CS and JIS patients were retrospectively identified from a single-center scoliosis database. Patients born between 1968 and 1981 and treated during skeletal growth were eligible for participation.

OUTCOME MEASURES

HRQoL (SF-36, SRS-22r, ODI).

METHODS

The primary aim was to evaluate the HRQoL of CS and JIS patients using the general SF-36 questionnaire. Both patient cohorts were compared with age-matched national norms. The secondary aim was to analyze the differences between conservatively and surgically treated patients using the scoliosis-specific Scoliosis Research Society-22r questionnaire (SRS-22r) and the Oswestry Disability Index (ODI). T-tests were used for statistical comparison.

RESULTS

In total, 114 patients (67% of the eligible patients) completed the questionnaire, with a mean follow-up of 25.5±5.5 years after their final clinical follow-up. Twenty-nine patients with CS were included with a mean age of 44.4±3.8 years (79.3% female), and 85 patients with JIS with a mean age of 43.7±4.2 years (89.4% female). Of the SF-36 domains, only the vitality score (60.6±18.0 for CS and 58.1±17.6 for JIS cohort) and mental health score (70.0±18.4 for CS and 72.1±18.1 for JIS cohort) were significantly lower compared with the general population (68.6±19.3 for vitality, and 76.8±17.4 for mental health). These decreased scores were larger than the determined minimum clinically important difference threshold of 4.37. Surgically treated JIS patients had a significantly lower score on the SRS-22r pain domain than their nonsurgically treated peers (3.6±0.9 vs 4.1±0.7l p=.019). Surgically treated CS patients had a significantly higher score on the SRS-22r mental health domain than their nonsurgically treated peers (4.3±0.5 vs 3.5±1.0; p=.023). No significant differences were found in the other domains.

CONCLUSIONS

Except for vitality and mental health domains, congenital and juvenile idiopathic scoliosis patients treated during skeletal growth had similar HRQoL on most SF-36 domains in adulthood compared with national norms. Surgical treated JIS patients experienced more pain compared with brace treated patients, while braced CS patients had a significantly lower mental scores compared with surgical treated patients. These long-term outcomes are essential to inform patients and can guide shared decision-making between clinicians and patients.

Health-related quality of life of adult, non-surgically treated patients with idiopathic scoliosis and curves above 45°: a cross-sectional study at an average follow-up of 30 years

BACKGROUND CONTEXT

Previous studies on the natural history of moderate to severe idiopathic scoliosis show contradictory results. Some studies reported an increased incidence of back pain and disability in severe curves, while other studies reported no difference in health-related quality of life (HRQoL) compared to age-matched adult controls. None of these studies addressed HRQoL using currently recommended and validated questionnaires.

PURPOSE

To examine the long-term HRQoL in non-surgically treated adult idiopathic scoliosis patients with a curve of 45° or higher.

METHODS

In this retrospective cohort study, all patients were retrospectively identified in the hospital's scoliosis database. Patients (1) with idiopathic scoliosis; (2) born before 1981 (to ensure 25-year follow-up after skeletal maturity); (3) with a curve of 45° or more by Cobb's method at the end of growth; and (4) no spinal surgical treatment were selected. Patients received digital questionnaires of the Short Form-36, Scoliosis Research Society-22, Oswestry Disability Index and Numeric Rating Scale. Outcomes of the SF-36 were compared with a national reference cohort. Additional measures with questions regarding choice of education and occupation were used.

RESULTS

Forty-eight of 79 (61%) eligible patients completed the questionnaires, at an average follow-up time of 29.9 ± 7.7 years. Their average age was 51.9 ± 8.0, and median Cobb angle at adolescence was 48.5°. Five of the eight SF-36 subdomains were significantly lower in the scoliosis group compared to the nationwide cohort: physical functioning (73 vs 83, p = 0.011), social functioning (75 vs 84, p = 0.022), role physical functioning (63 vs 76, p = 0.002), role emotional functioning (73 vs 82, p = 0.032), and vitality (56 vs 69, p =  < 0.001). The scoliosis-specific SRS-22r score of the patients was 3.7 ± 0.7 on a 0-5 scale. The mean NRS score for pain of all patients was 4.9 ± 3.2, and eight patients (17%) reported a NRS of 0 and 31 (65%) a NRS above 3. At the Oswestry Disability Index, 79% of the patients reported minimal disabilities. Thirty-three patients (69%) reported that their scoliosis had influenced their choice of education. Fifteen patients (31%) reported that their scoliosis had influenced their choice of work.

CONCLUSION

Patients with idiopathic scoliosis and curves of 45° or higher have reduced HRQoL. Although many patients experience back pain, the disability reported on the ODI was limited. Scoliosis had noteworthy effect on choice of education.

Screening for adolescent idiopathic scoliosis is more accurate when performed by healthcare professionals compared to untrained parents: a diagnostic accuracy study

BACKGROUND

Many countries ended their professional scoliosis screening due to ongoing controversies. Discontinuation resulted in a shift of screening responsibility from trained healthcare professionals to untrained parents.

PURPOSE

To compare the diagnostic accuracy of picture-based scoliosis screening between parents and healthcare professionals.

METHODS

In this cross-sectional diagnostic accuracy study, parents and healthcare professionals assessed pictures of 28 children (20 AIS & 8 non-scoliosis). Each child had two photographs (standing position & full-flexion during forward-bending test) that were presented simultaneously. Lumbar and thoracic curves were represented with a range in severity (10 to > 40°). The assessors had to answer whether they detected an abnormality that ought to be referred to a specialist. Measures of accuracy were calculated for both groups and various curve severities.

RESULTS

All pictures were assessed by 101 parents and 122 healthcare professionals. The sensitivity for detecting scoliosis was significantly lower in untrained parents (63.8%, [95% CI: 61.7-65.9%]) compared to healthcare professionals (73.4%, [95% CI: 71.6-75.2%]; p < 0.001), while the specificity was not significantly different (63.6%, [95% CI: 60.2-66.9%] vs. 65.3%, [95% CI: 62.2-68.3%]; p = 0.49). Healthcare professionals consistently recognized the gibbus as a warning sign when referring patients, while untrained parents highlighted various regions, including the spine, gibbus and scapula regions.

CONCLUSION

The sensitivity of screening for scoliosis was significantly lower when it was performed by parents, while the false-positive rate was similar to healthcare professionals. The window of opportunity for conservative treatment may be missed when parents rather than professionals are responsible for screening.

Long-term clinical outcome of minimally invasive versus open single-level transforaminal lumbar interbody fusion for degenerative lumbar diseases: a meta-analysis

BACKGROUND CONTEXT

Minimally invasive surgical transforaminal lumbar interbody fusion (MIS-TLIF) was developed in addition to open-TLIF to minimize iatrogenic soft-tissue damage. A potential disadvantage of MIS-TLIF is inadequate visualization, which may lead to incomplete neural decompression and a less robust arthrodesis. This may cause long-term problems and result in decreased patient satisfaction.

PURPOSE

To evaluate the long-term clinical outcome, measured by patient-reported outcomes (PROMs), of patients with degenerative lumbar diseases treated with single-level TLIF (open vs. minimally invasive) with a minimum follow-up of 2-years.

STUDY DESIGN

Meta-analysis.

METHODS

The systematic review was conducted according to the PRISMA guidelines. Relevant studies were identified from Pubmed, MEDLINE, EMBASE, Scopus, Web of Science, and CENTRAL from the date of inception to August 2019. The inclusion criteria were (1) longitudinal comparative studies of MIS-TLIF versus open-TLIF approach for degenerative spine disease (2) outcomes reported as PROMs, (3) minimum follow-up of 2-years.

RESULTS

Sixteen studies were included in the analysis. In total, 1,321 patients were included (660 MIS-TLIF& 661 open-TLIF). The following PROMS were analyzed: EQ-5D, SF, ODI, and VAS. Both techniques resulted in significant improvement in PROM, which remained significant at 2-years follow-up. However, no significant differences were found in all PROMs at 2-years follow-up. Both treatments resulted in a high rate of spinal fusion (80.5% vs. 91.1%; p=.29) and low rate of reoperation (3.0% vs. 2.4%; p=.50) or adjacent segment disease (12.6% vs. 12.40%; p=.50).

CONCLUSIONS

MIS-TLIF and open-TLIF have comparable long-term clinical outscomes. Both operations can significantly reduce pain and positively improve PROMs. No significant differences were found between both treatments in clinical outcomes at a follow-up of minimal 2-years. Therefore, MIS-TLIF seems to be an effective and safe alternative to traditional open-TLIF in the long-term.

Time Is Brain: Prehospital Emergency Medical Services Response Times for Suspected Stroke and Effects of Prehospital Interventions

OBJECTIVES

To compare prehospital time for patients with suspected stroke in Florida with the American Stroke Association (ASA) time benchmarks, and to investigate the effects of dispatch notification and stroke assessment scales on prehospital time.

PATIENTS AND METHODS

A retrospective analysis was performed using data from Florida's Emergency Medical Services Tracking and Reporting System database. All patients with suspected stroke transported to a treatment center from January 1, 2018, through December 31, 2018, were analyzed. Time intervals from 911 call to hospital arrival were evaluated and compared with ASA benchmarks.

RESULTS

In 2018, 11,577 patients with suspected stroke were transported to a hospital (mean age, 71.5±15.7 years; 51.5% women). The median alarm-to-hospital time was 33.98 minutes (27.8 to 41.4), with a total emergency medical services (EMS) time of 32.30 minutes (26.5 to 39.478). The on-scene time was the largest time interval with a median of 13.28 minutes (10.0 to 17.4). Emergency medical services encounters met the ASA benchmarks for time in 58% to 62% of the EMS encounters in Florida (recommended 90%; P<.001). The total EMS time was reduced when a stroke notification was reported by the dispatch center (32.00 minutes vs 32.62 minutes; P=.006) or when a stroke assessment scale was used by the EMS personnel (31.88 minutes vs 32.96 minutes; P=.005).

CONCLUSION

This study reveals a substantial opportunity for improvement in stroke care in Florida. Two prehospital EMS stroke interventions seem to reduce prehospital time for patients with suspected stroke. Adoption of these interventions might improve the stroke systems of care.

The Effect of Plating on Adjacent Segments in Anterior Cervical Discectomy and Fusions in Patients with Degenerative Spine Disease: A Retrospective Cohort Study

Introduction

Plate distance is correlated with an increased incidence of adjacent segment pathologies (ASP). However, a correct plate-to-disk distance >5 mm is often not achieved. Therefore, this study aimed to quantify the effect of short plate-to-disk distance on the development of ASP using epidemiological measures in patients with cervical degenerative spine disease undergoing single-level anterior cervical discectomy and fusion (ACDFs).

Methods

Medical records of all patients with cervical degeneration undergoing single-level ACDF with plating (between January 2015 and December 2017), and a follow-up of at least 1 year, were reviewed retrospectively. Radiologic and clinical outcomes were assessed preoperatively, postoperatively, and at last follow-up. The plate-to-adjacent disk distance was measured, and epidemiological measures were calculated to quantify the risk on adjacent-level ossification development (ALOD) and adjacent segment degeneration (ASD).

Results

Thirty-eight (47.5%) of the 80 patients developed ALOD, and 12 (15.0%) developed ASD after a 2-year follow-up. The incidence of ALOD was significantly lower if the plate was >5 mm away from the adjacent disk space compared to <5 mm (cranial adjacent segment, 22.5% vs. 51.3% [P=0.010] and caudal, 21.4% vs. 47.8% [P=0.029]). A correct plate-to-disk distance resulted in a relative risk reduction of 57.2% for the cranial segment and 56.0% for the caudal segment, with a number needed to treat of 4. The ASD was only observed in the cranial adjacent segments, and a correct plate-to-disk distance resulted in a relative risk reduction of 32.1% and a number needed to treat of 18.

Conclusions

Only four patients need to be treated with a correct plate-to-disk distance to avoid one case of ALOD. Therefore, it is advisable to keep the plate at a distance >5 mm away from the adjacent disk.

Spinal Growth in Patients With Juvenile Idiopathic Scoliosis Treated With Boston Brace: A Retrospective Study

STUDY DESIGN

Retrospective comparative cohort.

OBJECTIVE

The aim of this study was to determine whether spinal growth is restricted by brace treatment in patients with juvenile idiopathic scoliosis (JIS).

SUMMARY OF BACKGROUND DATA

Spinal fusion can negatively affect spinal growth if performed before the growth spurt. Brace treatment is often given in this young population to control the spinal deformity while allowing spinal growth. It is unknown whether the applied pressure of brace treatment on spine results in growth restriction. The aim of the study is to evaluate spinal growth in braced JIS patients.

METHODS

A total of 49 JIS patients treated with Boston brace were retrospectively selected from a scoliosis database. T1-T12/T1-S1 perpendicular and freehand (height following the curvature of the spine) height were measured on radiographs of patients that had reached skeletal maturity and were matched with 49 controls without scoliosis. Spinal growth was calculated from brace initiation until cessation and was compared with normal spinal growth values as reported by Dimeglio.

RESULTS

The mean age of diagnosis was 7.4 years. The age of the braced scoliosis patients at skeletal maturity was 17.5 years. The average T1-T12 and T1-S1 freehand height measured by following the curvature of the scoliosis was 29.3 cm (±2.4) and 47.2cm (±4.0), respectively, and was not significant different from the control group. Brace treatment was initiated at a mean age of 11.2 and the mean age of cessation was 14.8. Spinal growth (freehand) during brace treatment was 1.10 cm/year for the thoracic spine and 1.78 cm/year for the full spine and was not significant different from normal values.

CONCLUSION

No significant influence of bracing on spinal growth could be detected in this cohort of JIS patients. The spinal height measurements at skeletal maturity were similar to matched controls. In addition, spinal growth did not significantly differ from Dimeglio normal growth data, indicating that the effect of bracing on spinal growth is absent or minimal.

LEVEL OF EVIDENCE

3.

Prevalence and risk factors for neural axis anomalies in idiopathic scoliosis: a systematic review

BACKGROUND

There is ongoing controversy about the routine use of magnetic resonance imaging (MRI) preoperatively in patients with presumed idiopathic scoliosis (IS). Routine MRI can help identify possible causes for the deformity and detect anomalies that could complicate deformity surgery. However, routine MRI increases health-care costs significantly and may reveal mild variations from normal findings without clinical relevance, which can still lead to anxiety and influence decision-making.

PURPOSE

Given the necessity to make evidence-based decisions both in the light of quality of care and cost control, the aim of this review is to report the prevalence of neural axis anomalies in IS and to identify risk factors associated with these anomalies.

STUDY DESIGN

A systematic review was carried out.

METHODS

An electronic search of PubMed, Embase, Cochrane, and Cinahl until May 2017 was performed. Studies were assessed by two reviewers independently according to predetermined inclusion (MRI in presumed IS) and exclusion criteria (diagnosis other than IS).

RESULTS

Fifty-one studies were included comprising 8,622 patients. In 981 patients, anomalies were found, resulting in an overall prevalence of 11.4%. The prevalence was 10.5%, 9.0%, and 14.2% when screening was performed of all IS patients, preoperative patients, or patients with presumed risk factors. The prevalence of a syrinx (3.7%), an Arnold-Chiari malformation (3.0%), or a combination of both (2.5%) was highest. Less frequent diagnoses included tethered cord (0.6%), an incidental malignancy (0.3%), and split cord malformations (0.2%). Risk factors for intraspinal anomalies included early-onset scoliosis, male gender, atypical curves, thoracic kyphosis, and abnormal neurologic findings such as reflexes and sensation.

CONCLUSIONS

This systematic review shows that a significant number of patients have intraspinal anomalies on preoperative MRI in (presumed) IS. The prevalence of finding spinal axis abnormalities increases in preselected patient groups with specific risk factors.

LETTER TO THE EDITOR CONCERNING: Effectiveness of the Rigo Chêneau versus Boston-style orthoses for adolescent idiopathicscoliosis: a retrospective study, by Minsk MK, Venuti KD, Daumit GL, Sponseller PD. Scoliosis Spinal Disord. 2017 Mar 20;12:7

We have read with great interest the article by Minsk et al. in Scoliosis and Spinal Disorders. However, the authors reported a conclusion that is based on possible selection bias in surgical candidates. Physicians are trained in the interpretation of scientific articles; however, not everybody is able to do this. Especially in open access journals, a biased conclusion may have big consequences and may be misleading for patients and family members who can read these articles for free on the internet.