Modified Scoliosis Research Society Research Articles

Signficant Femoral Version Abnormalities and Patient-Reported Quality of Life.

The purpose of this study was to determine how the Limb Deformity-Modified Scoliosis Research Society (LD-SRS) and Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire scores differ between patients with femoral version abnormalities and healthy control subjects. A retrospective database review identified patients with femoral version abnormalities between December 2018 and September 2022. A total of 21 adult patients scheduled for femoral derotational osteotomy and 33 control subjects were included. All individuals completed the LD-SRS and PROMIS questionnaires. Patients with femoral version abnormalities reported significantly worse scores than control subjects on all LD-SRS and PROMIS domains: LD-SRS (Total [3.46 ± 0.66 vs. 4.58 ± 0.37, P < 0.001]; Function/Activity [3.48 ± 0.83 vs. 4.44 ± 0.4, P < 0.001]; Mental Health [3.41 ± 0.96 vs. 4.3 ± 0.73, P < 0.001]; Pain [3.55 ± 0.9 vs. 4.81 ± 0.31, P < 0.001]; and Self-Image/Appearance [3.37 ± 0.79 vs. 4.75 ± 0.43, P < 0.001]) and PROMIS (Function [41.6 ± 7.58 vs. 60.0 ± 7.28, P < 0.001]; Pain Intensity [45.85 ± 8.04 vs. 33.7 ± 4.89, P < 0.001]; Pain Interference [56.78 ± 9.63 vs. 42.8 ± 6.6, P < 0.001]; Global Mental Health [47.97 ± 9.68 vs. 55.3 ± 7.81, P = 0.004]; and Global Physical Health [45.23 ± 7.49 vs. 58.2 ± 7.07, P < 0.001]). Patients with femoral version abnormalities reported markedly worse quality of life as measured on the LD-SRS and PROMIS scores compared with healthy control subjects. The combination of these two surveys effectively captures the multifaceted quality-of-life-deficit individuals with excessive femoral version may experience.

Patients With Lower Limb Deformity Report Worse Quality of Life Than Control Subjects Regardless of Degree of Deformity.

Introduction:The purpose of this study was to determine how Limb Deformity Modified Scoliosis Research Society (LD-SRS) scores differ between patients with different types and degrees of limb deformity compared with control subjects.Methods:Patients who were >17 years and scheduled for reconstructive surgery for limb lengthening or angular deformity with internal and/or external fixation and healthy control subjects were prospectively enrolled. Patients completed the LD-SRS preoperatively. Mechanical axis deviation (MAD) and leg length discrepancy (LLD) were recorded preoperatively. Participants were stratified into five groups based on their diagnosis. ANOVA was used to test for associations between LD-SRS scores and diagnosis as well as mechanical axis deviation.Results:Patients with LLD, angular deformity, or combined LLD and angular deformity reported significantly worse scores than control subjects in LD-SRS Function/Activity, Pain, Self-Image/Appearance, and total score (P < 0.001 for all). Patients with short stature reported significantly worse LD-SRS Self-Image/Appearance (P < 0.001) and total score compared with control subjects (P = 0.015). There was a significant correlation between LLD and LD-SRS Self-Image/Appearance in the LLD and angular deformity group (r = −0.359, P = 0.043).Discussion:Although LD-SRS scores were worse in patients with limb deformity compared to controls, LD-SRS scores were not related to the degree of deformity in most patients, indicating that patient self-perception may be a construct unrelated to objective radiographic or clinical findings.

Metacarpal Lengthening in Adults With Brachymetacarpia.

Metacarpal lengthening by distraction osteogenesis has been well documented in pediatric patients but limited in older patients. Fewer studies have assessed the success of the procedure through outcome measure scores. The purpose of this study is to assess the outcomes of distraction osteogenesis in skeletally mature adults with brachymetacarpia and patients' perspectives on their satisfaction through outcome measure scores. Retrospective chart review of a consecutive series of metacarpal lengthenings for the treatment of brachymetacarpia was performed. Key parameters collected include starting metacarpal length, amount lengthened, range of motion of metacarpophalangeal joint, type of fixator used, distraction time, and total time in fixator. Relevant comorbidities and complications encountered were recorded as well. The Body Image Quality of Life Inventory (BIQLI) and Limb Deformity Modified Scoliosis Research Society (LD-SRS) score were given to evaluate patients' perspectives on their satisfaction of surgery. Seven metacarpal lengthenings were performed in 4 adult females (average age: 22.8 years) between 2005 and 2016. The average amount lengthened was 1.5 cm (range, 1.2-2.1 cm), corresponding to a mean percent lengthening of 44.4% (range, 33.3%-57.1%). The mean distraction rate was 0.432 mm/day (range, 0.286-0.724 mm/day). The mean distraction time was 38 days (range, 28-55 days). External fixation index was 71.8 days/cm (range, 53.5-99.2 days/cm). No functional loss was observed. Progressive distraction osteogenesis can obtain functionally successful results and improvement in aesthetics and body image without severe complications in skeletally mature adults with brachymetacarpia.

Validation of a modified Scoliosis Research Society instrument for patients with limb deformity: The limb deformity-Scoliosis Research Society (LD-SRS) score

Background: Despite the large negative effect of limb deformity on health-related quality of life (QoL), there exists no patient-reported instrument to quantify this impact. Rather, limb deformity research has been performed using global QoL measurements concurrently with joint-specific and/or arthritis outcome scales, thereby requiring the completion of multiple instruments. Furthermore, joint- and arthritis-specific instruments focus on the impact pain has on function, whereas limb deformities may be pain-free with greater social and functional impairment. The purpose of this study was to validate a patient-reported instrument to quantify limb deformity-related QoL. Materials and Methods: Because of the similarities with regard to pain, function, and body image between limb deformity and scoliosis, the Scoliosis Research Society-30 (SRS-30) spine deformity instrument was modified such that the words back and trunk were replaced with limb to create a novel instrument: the limb deformity-SRS (LD-SRS). Testing for construct validity (both convergent and discriminant), reliability, floor and ceiling effects, and minimal clinically important difference (MCID) was performed in a validation cohort of 62 subjects aged 18 years or older with nonarthritic, unilateral lower extremity deformity. Results: Scale reliability was excellent (test-retest reliability, intraclass correlation coefficient = 0.977; internal consistency, Cronbach's alpha = 0.906), scores were normally distributed, and there were no floor or ceiling effects. There was also robust construct validity: convergent validity testing revealed positive correlations between the LD-SRS and all short-form-36 domains, the American Academy of Orthopaedic Surgeons-Lower Limb Module, and higher scores in those who were postcorrection. Discriminant validity was demonstrated with no correlations between the LD-SRS and subject age, sex, body mass index, surgeon-scored Limb Lengthening and Reconstruction Society-AIM Index, or surgeon-generated deformity measurements. MCID was calculated to be 0.3 (on a 4.0-point scale). Conclusions: The LD-SRS score is a reliable and valid instrument to measure limb deformity-related QoL in patients with nonarthritic lower extremity deformity. It is a valuable tool which allows clinicians to quantify patients' deformity-related QoL with a single instrument, rather than repurposing scales which have been validated for other conditions and have limited applicability to the unique challenges of treating patients with a lower limb deformity. Level of Evidence: Diagnostic, Level 2.

Study of Hyperkyphosis, Exercise and Function (SHEAF) Protocol of a Randomized Controlled Trial of Multimodal Spine-Strengthening Exercise in Older Adults With Hyperkyphosis.

Hyperkyphosis negatively affects health status, physical mobility, and quality of life, but there is no standard protocol for treating people with hyperkyphosis. Treatment options include targeted exercise. This single-site randomized controlled trial (RCT) will determine the efficacy of a targeted multimodal spine-strengthening exercise program, compared with no exercise intervention, among community-dwelling men and women aged ≥60 years. The RCT is a parallel-group design, with 1:1 randomization to exercise and attentional control groups. The study will be conducted at one primary site (one academic medical center partnered with one local community medical center). One hundred men and women, aged ≥60 years, with thoracic kyphosis ≥40 degrees will be randomized. The targeted multimodal spine-strengthening exercise intervention includes exercise and postural training delivered by a physical therapist in a group of 10 participants, 3 times a week for 6 months. Controls receive monthly health education meetings in a group of 10 participants and monthly calls from the study coordinator to monitor physical activity and any adverse events. The primary outcome is change in Cobb angle of kyphosis measured from lateral spine radiographs at baseline and 6 months. Secondary outcomes include change in physical function (assessed with the modified Physical Performance Test, Timed "Up & Go" Test, timed loaded standing, 4-m walk, and Six-Minute Walk Test) and health-related quality of life (assessed with the modified Scoliosis Research Society instrument [SRS-30] self-image domain and Patient Reported Outcomes Measurement Information System [PROMIS] global health and physical function indexes). Additional secondary outcomes include pain, physical activity level, spinal flexion and extension muscle strength, paraspinal extensor muscle density, and adverse events. Blinding of the participants and instructors providing the intervention is not possible. The efficacy of a high-quality, adequately powered exercise intervention in men and women with kyphosis ≥40 degrees will be evaluated to determine whether targeted multimodal spine-strengthening exercise reduces hyperkyphosis in older adults and improves important secondary outcomes of physical function and health-related quality of life.

Anterior or Posterior Surgery for Right Thoracic Adolescent Idiopathic Scoliosis (AIS)? A Prospective Cohorts’ Comparison Using Radiologic and Functional Outcomes

Prospective cohort study. Prospectively compare patient-reported as well as clinical and radiologic outcomes after anterior or posterior surgery for right thoracic adolescent idiopathic scoliosis (AIS) in a single center by the same surgeons. Anterior and posterior spinal instrumentation and arthrodesis are both well-established treatments of thoracic AIS. The majority of studies comparing the 2 approaches have focused on radiographic outcomes. There remains a paucity of prospectively gathered patient-reported outcomes comparing surgical approaches. Forty-two consecutive patients with right thoracic AIS were treated in a single center by one of 2 surgeons with either anterior (n=18) or posterior (n=24) approaches and followed up for over 2 years. Radiographic, clinical, and patient-reported outcomes of the Modified Scoliosis Research Society Outcome Instrument were gathered and analyzed by an independent surgeon. Patients reported significant improvements in all areas of the Modified Scoliosis Research Society Outcome Instrument, especially pain and self-image domains. There were no significant differences in the degree of improvement in any domains between the groups. Posterior and anterior surgery corrected rib hump by 53% and 61%, respectively (P=0.4). The Main thoracic curve Cobb angle was corrected from 69 to 26 degrees (62%) by posterior surgery and 61 to 23 degrees (64%) by anterior surgery (P=0.6). Posterior surgery significantly reduced kyphosis and lumbosacral lordosis. Anterior surgery had no overall affect of sagittal alignment but seemed able to correct those hypokyphotic preoperatively. Complications differed and were largely approach-related--intrathoracic in anterior and wound-related in posterior surgery. Patients with right thoracic AIS of differing curve types but otherwise similar preoperatively demonstrated that anterior and posterior surgery are largely equivalent. Patient-reported outcomes are improved similarly by either approach. Both offer excellent radiographic and trunk deformity correction. Differences in the effect of sagittal alignment, operative time, and complications should be considered when selecting approach.

Effectiveness of Providence nighttime bracing in patients with adolescent idiopathic scoliosis.

Interest has increased in adolescent idiopathic scoliosis braces that are worn only part time. One such brace, the Providence brace, is being used with increasing frequency despite limited literature evaluating its ability to alter the natural course of disease. The authors retrospectively identified 34 patients meeting modified Scoliosis Research Society (SRS) inclusion criteria who were treated with the Providence brace. In accordance with SRS criteria, patients were followed for progression more than 5°, progression to more than 45°, and recommendation for or performance of surgical fusion. Seventeen (50%) patients progressed more than 5°, and 9 (26%) progressed to more than 45° and had fusion surgery recommended or performed. Noncompliance was associated with progression to more than 45° (P=.045) and having fusion surgery recommended or performed (P=.045). Males had a higher rate of progression more than 5° than did females (100% vs 41%; P=.015). This is only the second study of the Providence brace to be guided by SRS criteria. The somewhat higher rates of progression more than 5° reported in these 2 studies compared with those reported in earlier studies likely result from this distinction. This study suggests a rate of progression that is similar to or lower than rates reported in natural history studies, possibly supporting the efficacy of the Providence brace. Additional studies using SRS criteria, including high-quality randomized, controlled trials, will be important to further understanding the relative effectiveness of this and other bracing protocols.

Vertical expandable prosthetic titanium rib device insertion: does it improve pulmonary function?

Purpose Vertical expandable prosthetic titanium rib (VEPTR) insertion and expansion has been advocated to increase thoracic volume and pulmonary function in patients with thoracic insufficiency syndrome. We reviewed our experience with VEPTR implantation to determine if lung function and growth is augmented, to determine the children's functional status, and if the scoliosis is controlled. Methods From 2006 to 2010, 29 insertions and 57 expansions were performed in 26 patients at our institution. Demographic data were reviewed in conjunction with complications, scoliosis angles, pulmonary function tests (PFTs), and computed tomography–guided 3D reconstructions to determine lung volumes; and quality of life scores were determined using a modified Scoliosis Research Society (SRS) questionnaire preoperatively and postoperatively. The groups were also stratified by age (because of lung growth potential), disease (congenital or infantile scoliosis, Jeune syndrome, neuromuscular, other structural thoracic disorders), and sex. Analyses using SPSS (SPSS, Chicago, Ill) were performed with P < .05 considered significant. Results Each patient underwent 3.03 ± 1.8 surgeries, spending 0.97 ± 1.8 days in the intensive care unit and 4.41 ± 6 days in the hospital for each procedure. Mean age was 90.7 ± 41 months. Of the 36 complications, most were because of infection (12), half requiring operative repair (hardware removal). The average PFT percent predicted values for forced expiratory volume in 1 second, forced vital capacity, and RV were 54.6 ± 22, 58.1 ± 24, and 145.3 ± 112, respectively, preoperatively and 51.8 ± 20, 55.9 ± 20, and 105.6 ± 31, respectively, postoperatively. The lung volumes measured by computed tomography when corrected for age do not increase significantly postoperatively. The mean Cobb measurement for the preoperative major curves was 64.7° and postoperatively was 46.1° for those curves measured preoperatively, for a 29% curve improvement. All postoperative curves had a mean of 56.4° and 58.1° at final follow-up, a 3% curve increase. The SRS scores for patients remained unchanged and no statistical difference was seen from preoperative to postoperative values. No statistically significant difference was seen in complications, PFT (forced expiratory volume in 1 second, forced vital capacity, RV), lung volumes, scoliosis angles, and SRS scores between sex, age, and disease categories. Conclusion There was mild improvement in scoliosis angles but no improvement in lung function and volume. Scoliosis Research Society scores indicate that the children have near normal function both before and after VEPTR placement. Pulmonary function, lung volume, and patient subjective assessments did not increase dramatically after VEPTR placement, although scoliosis angles improved.

Adapted Simplified Chinese (Mainland) Version of Scoliosis Research Society-22 Questionnaire

Validation study to define validity and reliability of an adapted and translated questionnaire. This study attempted to validate the traditional Chinese (Hong Kong) version of the modified Scoliosis Research Society (SRS) Outcomes Instrument, SRS-22, into simplified Chinese for use in mainland China. Although a traditional Chinese (Hong Kong) adaptation of the SRS-22 has been previously validated, no culturally adapted, validated SRS-22 exists for use in mainland China. Adhering to International Quality of Life Assessment Project guidelines, the adapted traditional Chinese SRS-22 was translated into simplified Chinese while referencing the original English questionnaire. To examine the psychometric properties and clinical application of the adapted simplified Chinese SRS-22, a survey was conducted in a group of randomly selected 87 patients previously surgically treated at an outpatient clinic. Reliability assessment of the simplified Chinese version of the SRS-22 was determined by calculating Cronbach's alpha and intraclass coefficient (ICC) values. Concurrent validity was evaluated by comparing SRS-22 domains with relevant domains of the simplified Short-Form-36 questionnaire; correlation was made using Pearson correlation coefficients. Cronbach's alpha, applied to each of the 22 questions of the adapted SRS-22, revealed very satisfactory internal consistency (Cronbach's alpha = 0.80-0.89) for function/activity and pain, and good consistency (Cronbach's alpha = 0.50-0.79) for the remaining domains. The test/retest reproducibility was found to be good (ICC > or =0.40-0.75) in the function/activity domain, and excellent (ICC > or =0.75) in the remaining domains. In terms of concurrent validity, 3 domains had excellent correlation, while 10 had good correlation, and 21 had moderate correlation. The authors report the validation of a simplified Chinese SRS-22 for use in mainland China, which is culturally relevant, reliable, repeatable, psychometrically sound, and suitable for immediate clinical use.

Cosmetic and functional outcomes following paramedian and anterolateral retroperitoneal access in anterior lumbar spine surgery

In this paper, the authors review the functional and cosmetic outcomes and complications in 300 patients who underwent treatment for lumbar spine disease via either an anterior paramedian or conventional anterolateral retroperitoneal approach. Seven surgeons performed anterior lumbar surgeries in 300 patients between August 2004 and December 2006. One hundred and eighty patients were treated with an anterior paramedian approach, and 120 patients with an anterolateral retroperitoneal approach. An access surgeon was used in 220 cases (74%). Postoperative evaluation in all patients consisted of clinic visits, assessment with the modified Scoliosis Research Society-30 instrument, as well as a specific questionnaire relating to wound appearance and patient satisfaction with the wound. At a mean follow-up of 31 months (range 12-47 months), the mean Scoliosis Research Society-30 score (out of 25) was 21.2 in the patients who had undergone the anterior paramedian approach and 19.4 in those who had undergone the anterolateral retroperitoneal approach (p = 0.005). The largest differences in quality of life measures were observed in the areas of pain control (p = 0.001), self-image (p = 0.004), and functional activity (p = 0.003), with the anterior paramedian group having higher scores in all 3 categories. Abdominal bulging in the vicinity of the surgical site was the most common wound complication observed and was reported by 22 patients in the anterolateral retroperitoneal group (18%), and 2 patients (1.1%) in the anterior paramedian group. Exposures of >or= 3 levels with the anterolateral approach were associated with abdominal bulging (p = 0.04), while 1- or 2-level exposures were not (p > 0.05). Overall satisfaction with incisional appearance was higher in patients with an anterior paramedian incision (p = 0.001) and with approaches performed by an access surgeon (p = 0.004). Patients who undergo an anterior paramedian approach to the lumbar spine have a higher quality of life and better cosmetic outcomes than patients undergoing an anterolateral retroperitoneal approach.

Cantilever Bending Technique for Treatment of Large and Rigid Scoliosis

Retrospective review of a consecutive clinical series. To assess the efficacy and clinical value of cantilever bending technique as a technique for correcting large (> or =70 degrees ) and rigid (flexibility < or =30%) scoliosis. Scoliosis correction by current methods is a compromise between the rigidity of the deformity and corrective forces provided by these methods. For large and rigid scoliosis, the rigidity of the deformity cannot be overcome enough to achieve satisfactory correction. Thus, anterior release procedures are usually necessary to make the curves more flexible and thus improve correction. The cantilever bending technique provides powerful corrective forces for overcoming the rigidity of the deformity and obviates the need for anterior release procedures. The utility and efficacy of the method alone without anterior release for treating large and rigid deformity has not been demonstrated. A total of 41 consecutive patients undergoing cantilever bending technique for the management of large and rigid scoliosis of any etiology (congenital, idiopathic, or neuromuscular) were included. Radiographic studies, complications, and satisfaction assessment using the modified Scoliosis Research Society Instrument were used to assess outcomes. The mean Cobb angle of the major curves was 98 degrees (range 75-133 degrees ). The deformity correction was 67.1% (range 51-74%). Coronal imbalance was 2.5 cm before and 0.8 cm after surgery. No major complication occurred. Satisfactory correction was achieved in all patients and without anterior release in all but one patient. Regardless of the etiology of their deformities, all patients were very satisfied with their outcomes. The cantilever bending technique is an effective procedure for the management of large and rigid scoliosis regardless of etiology. The clinical value of the procedure was demonstrated by reduced need for anterior release, fewer complications, and high rates of patient satisfaction.

One-stage posterior decompression-stabilization and trans-sacral interbody fusion after partial reduction for severe L5-S1 spondylolisthesis.

A retrospective clinical study was conducted. To evaluate the clinical and radiologic outcomes of one-stage posterior decompression-stabilization after partial reduction and trans-sacral interbody fusion with a titanium cage for severe L5-S1 spondylolisthesis. Trans-sacral interbody fusion for the management of severe L5-S1 spondylolisthesis with or without partial reduction and pedicular fixation has been previously described. The use of a trans-sacral titanium cage has not been previously reported. Fifteen patients with severe L5-S1 spondylolisthesis were treated consecutively with posterior decompression, partial reduction, pedicular fixation, and posterior lumbar interbody fusion using a trans-sacral titanium cage. The mean age at the time of surgery was 22.4 years (range, 11-37 years). The mean follow-up period was 31.4 months (range, 12-58 months). Nine patients had severe back pain and six patients radicular pain. Three patients had a partial unilateral L5 motor deficit and two an L5 sensory deficit. Five patients had extremely tight hamstrings. The mean preoperative percentage of slipping was 69.3% (range, 53-91%). Patients were evaluated for complications and fusions, and outcomes were collected using the modified Scoliosis Research Society Outcomes Instrument. At follow-up, all patients, except one with major vascular complications, were extremely or reasonably satisfied with the surgery. All patients showed improvements in radiologic indexes and stable fusion at the final follow-up examination. Posterior decompression and partial reduction followed by circumferential stabilization performed in one stage combining pedicle fixation with trans-sacral titanium cage interbody fusion is an effective and safe technique for the management of severe spondylolisthesis.

Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis: a study of long-term clinical radiographic outcomes.

A case series of adults with surgical treatment for adult idiopathic thoracolumbar and/or lumbar scoliosis, low back pain, and spinal stenosis was studied. To assess pain relief, curve correction, and complications after combined procedures consisting of decompression, spine fusion, and stabilization. Only one publication has focused specifically at this group, and this was before the advent of modern segmental instrumentation. This is the first report of long-term follow-up evaluation in such a patient population. This study included 16 patients who underwent elective anterior and posterior surgical reconstruction for adult idiopathic thoracolumbar and/or lumbar scoliosis, spinal stenosis, and low back pain with a minimum follow-up period of 2 years. Radiographic findings, clinical results, and long-term outcome data were obtained using the Modified Scoliosis Research Society outcome instrument and the Oswestry Disability Back Pain Questionnaire. Restoration of coronal and sagittal balance, or improvement thereof, was achieved in all the patients with balance problems. There was significant improvement in all outcome domains. Overall, 94% of the patients were satisfied with the surgery. Ten major complications occurred in 10 patients, 8 of whom required additional surgery. There were two minor complications. Combined symptoms of back pain and spinal stenosis require complex reconstructive surgery in adults with idiopathic thoracolumbar and/or lumbar scoliosis. Significant pain relief, functional restoration, and satisfaction can be achieved and maintained over the long term in the properly selected patient.

9:46 Validation of the modified Scoliosis Research Society outcomes instrument (SRS-22) for adult deformity

Purpose of study: The modified Scoliosis Research Society (MSRS) outcomes instrument (SRS-22) had been validated as an outcomes tool for adolescent idiopathic scoliosis. There is no validated disease-specific outcomes instrument for adult scoliosis. The purpose of this paper is to determine the reliability and validity of the modified Scoliosis Research Society questionnaire for adults with scoliosis.Methods used: Reliability of the modified SRS instrument in adults was tested using Cronbach's alpha test of internal consistency and calculation of test-retest parity. The validity of the modified SRS instrument in adults was determined by criterion validity in the domains of pain, function, self-image, and mental health compared with matched domains in the Short Form (SF)-36.of findings: A total of 146 adults with scoliosis were included (133 female and 13 male). The average age was 47.1 years (range, 18 to 86 years). Cronbach's alpha analysis of internal consistency within each domain demonstrates intercorrelation values (μ) greater than 0.75 for each domain of the MSRS. Pearson correlation coefficients with comparable domains within the SF-36 demonstrate high correlation in domains representing pain (r=0.8), function (r=0.85), mental health (r=0.89) and self-image (r=0.63). Total score correlates highly with every domain of the SF-36 (r=0.6 to 0.8). Test-retest analysis in 36 patients who completed questionnaires at both time points demonstrated high correlations for each domain (r=0.83 to 0.94). A floor effect was seen in less than 2% of patients in each domain of the MSRS. A ceiling effect was seen in less than 10% of patients in each domain of the MSRS.Relationship between findings and existing knowledge: Adult spinal deformity is significantly different from adolescent deformity in that affected patients characteristically present with pain and limitation of function. The MSRS questionnaire is a reliable instrument in adults, as demonstrated by a high degree of internal consistency and reproducibility. In adults with scoliosis, the MSRS questionnaire correlated highly with the SF-36 standard. In adolescent deformity, the purpose of surgical intervention is usually to prevent future consequences of progressive deformity. Therefore, the MSRS instrument may underestimate the value of surgery to the adolescent. The application of a disease-specific outcomes instrument to adults with deformity will permit standardization of outcomes assessment in adult deformity surgery.Overall significance of findings: The MSRS is a valid, reliable and reproducible outcomes instrument for adult deformity. This study supports the use of the MSRS questionnaire in the adult spinal deformity population.Disclosures: No disclosure.Conflict of interest: No conflicts.

9:43 Discrimination validity of the modified Scoliosis Research Society outcomes instrument in adults with scoliosis

Purpose of study: The modified Scoliosis Research Society (MSRS) questionnaire has been proposed as an instrument for measurement of disease-specific health status in patients with scoliosis. The purpose of this study is to report the discrimination validity of the MSRS instrument in differentiating between adults with and without scoliosis and to define the relationship between outcome domains and specific radiographic parameters of spinal deformity.Methods used: Adults with scoliosis and age/gender-matched controls were studied in an observational study. Discrimination validity of the MSRS questionnaire was determined by comparing the means of responses in each domain between adults with scoliosis and a control group without scoliosis. Pearson correlation analysis was used to determine the relationship of each domain of the MSRS and Short Form (SF)-36 questionnaires compared with radiographic process variables, including sagittal balance, coronal balance and major curve magnitude.of findings: A total of 180 adults were included, 146 with scoliosis and 34 without. Average age was 47 years (18 to 86 years), with 165 females and 15 males. Adults with scoliosis scored significantly lower on the MSRS and the SF-36 questionnaires in all domains: Pain (p=.0001), Function (p=.0001), Self-image (p=.0001) and Mental Health (p=.012). Pearson correlation analysis demonstrated no significant correlation between any radiographic process measure and any specific domain within the MSRS and SF-36 instruments (r<0.25).Relationship between findings and existing knowledge: Previous literature has reported that scoliosis may have a limited impact on pain and function in adults. These results suggest that adult deformity has a significant and measurable impact on affected patients compared with controls. There is a poor correlation between radiographic parameters of deformity and outcome domains, including Pain, Function, Self-image, Mental Health and Satisfaction with Surgery. This finding suggests that no one process variable is most predictive of outcome using a self-assessment disease-specific instrument.Overall significance of findings: Adult patients with scoliosis have significant pain and limited function compared with unaffected controls. Process variables including radiographic measures correlate poorly with patient self-assessment of outcome.Disclosures: No disclosures.Conflict of interest: No conflicts.

Does instrumented anterior scoliosis surgery lead to kyphosis, pseudarthrosis, or inadequate correction in adults?

Retrospective review of cases in which a single solid rod was used for the anterior correction of thoracolumbar and lumbar idiopathic scoliosis in adults. To evaluate the efficacy and outcomes in these patients. Anterior spinal fusion with instrumentation has been found to be kyphogenic in the treatment of scoliosis. Recent reports have shown an extremely high rate of pseudarthrosis and implant failure even in adolescents who have undergone anterior spinal fusion with a single flexible or rigid rod. Fifteen consecutive adult patients with (average age, 37.5 years) had undergone anterior spinal fusion with a rigid rod were included in this study. One was lost to follow-up, leaving 14 patients with a complete radiographic follow-up of 44 months and clinical follow-up of 61 months. Patients were sent the Modified Scoliosis Research Society (SRS) Outcomes Instrument, charts were reviewed, and preoperative, postoperative, and final follow-up films of the entire spine were evaluated by independent reviewers uninvolved in the care of the patients. The average preoperative major curve was 50 degrees, which improved to 16 degrees at follow-up (a 66% correction). The average correction of the upper compensatory curve and lower fractional curve were 40% and 61%, respectively. The thoracolumbar sagittal plane alignment was maintained or improved in all patients (i.e., this surgery did not induce kyphosis in any patient). On average 0.9 levels were "saved" compared with levels chosen by the authors for posterior surgery. All patients achieved a solid fusion. Follow-up Modified SRS questionnaires revealed a satisfaction score 4.5 out of a possible score of 5, a pain score of 4.1 out of 5, a self-image score of 4.1 out of 5, a function score of 4.1 out of 5, and a mental health score of 4.0 out of 5, with an overall score of 82%. All patients but one were satisfied or extremely satisfied with the results of surgery. There was no incidence of implant breakage. The results of anterior spinal fusion using a single solid rod in adults with idiopathic scoliosis in this series are excellent, with 100% fusion rate, no development of kyphosis, and no incidence of hardware failure.

Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy.

Retrospective review of a consecutive clinical series. To evaluate the efficacy of the transpedicular wedge resection osteotomy as a technique for correction of sagittal and coronal deformity and to assess the clinical value of the procedure as assessed by patient satisfaction. The transpedicular wedge resection osteotomy is a well-established procedure for management of fixed sagittal deformity in ankylosing spondylitis. The utility of the procedure for applications in fixed deformity other than ankylosing spondylitis has not been demonstrated, and the efficacy of the procedure in the correction of coronal deformity has not been reported. A total of 13 consecutive cases undergoing transpedicular wedge resection osteotomy for the management of sagittal deformity of any etiology were reviewed. Radiographic studies, complications, and satisfaction assessment using the modified Scoliosis Research Society instrument were the outcome parameters measured. Etiologies of deformity included postsurgical, ankylosing spondylitis, idiopathic, and infectious. Measurement of C7 sagittal plumb line to sacrum improved 63% at the most recent follow-up. Lumbar lordosis increased from -15.5 degrees to -45.4 degrees. Coronal balance was improved in all patients who had preoperative imbalance, with an average improvement of 60% maintained at follow-up. Patient satisfaction was high in all patients and not dependent on the etiology of deformity. The transpedicular wedge resection osteotomy is an effective procedure for the management of fixed sagittal deformity and is generalizable for multiple etiologies. Simultaneous correction of coronal deformity is possible. The clinical value of the procedure is demonstrated in high rates of patient satisfaction.