Disagreements in surgical planning still exist between spinal surgeons in adolescent idiopathic scoliosis: a multisurgeon assessment

Abstract

Determining a surgical plan for the treatment of adolescent idiopathic scoliosis (AIS) can be challenging. Despite treatment recommendations and classification systems (such as the Lenke classification system) there is still no consensus on the optimal surgical plan for each curve type. The main objective of this study is to analyze the disagreements in surgical planning between spinal surgeons in AIS. In a monthly meeting, four orthopaedic spine surgeons from different institutions analyzed a consecutive series of AIS patients. The differences in surgical plans were evaluated for each patient. The primary physician of the patient presented the case and specifically stated the Lenke type of the deformity in the presentation. We wanted to specifically document the disagreements between surgeons despite knowing the Lenke type of the deformity. One hundred consecutive AIS patients were reviewed over a 10-month period. There was a difference of at least one surgical plan from at least one surgeon in 31 of the cases; 30 of these disagreements in surgical planning were about fusion levels; 19 of these 30 disagreements were in only the upper instrumented vertebra (UIV), while seven were disagreements in only the lowest instrumented vertebra (LIV). In four cases, both the UIV and LIV levels varied. There was at least one difference in surgical planning in 31 of the 100 cases (31 %). This shows that despite treatment algorithms and the Lenke classification system, disagreements in surgical planning still exist between spinal surgeons.