Treatment Of Adolescent Idiopathic Scoliosis Research Articles

Evidence for Conservative Treatment of Adolescent Idiopathic Scoliosis - Update 2015 (Mini-Review).

Idiopathic scoliosis predominantly afflicts adolescents. Adolescents with mild curvatures do not generally have any symptoms. However spinal fusion is indicated when the deformity exceeds 45°. Treatment is thus necessary to prevent and/or reduce the progression of curvatures to that below which surgery is indicated. Conservative treatment of adolescent idiopathic scoliosis includes observation, scoliosis-specific exercises (SSE) and bracing. There is increasing evidence suggesting that SSE and brace treatment can significantly limit the progression of spinal curvatures. In growing adolescents with curvatures more than 20°, bracing is indicated and should be used in conjunction with SSE. The effectiveness of bracing varies according to the type of brace applied to the patient. In general rigid braces are preferable to soft flexible braces, as the latter falls short of halting curvatures progression. Also, preliminary evidence suggests that asymmetric braces which enable over-correction provide more correction when compared with symmetrical braces. Recently it has also been reported that high quality bracing can also reduce curvatures exceeding 45° in over 70% of growing adolescents. This new knowledge might possibly increase the threshold of surgical indications to beyond 50° or above in the near future.

Neural Complications of Surgical Treatment of Adolescent Idiopathic Scoliosis: a Single Center Experience

Objective: Adolescent idiopathic scoliosis surgery presents a challenge to anesthetist due to the extensive nature of the surgery and the constraints on anesthetic techniques of intraoperative neurophysiological monitoring of the spinal cord. Intraoperative neurophysiological monitoring combining both somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) have become a standard of care by preventing neurologic sequela and lesions of the spinal cord. The objective of this article was to assess the incidence of neural complications in surgical treatment of adolescent idiopathic scoliosis surgery in a single institution and investigate possible factors associated with it. Methods: Medical records of 216 patients who underwent adolescent idiopathic scoliosis surgery with posterior spinal fusion were retrospectively reviewed from January 2009 to October 2013. Patients were monitored using electrophysiological methods including SSEPs and transcranial electric MEPs simultaneously. Results: Neurophysiologic monitoring changes were seen in 5 patients (2.3%): 4 (75%) women and 1 (25%) men. Out of the 5 patients with significant signal alert, 3 patients presented changes in Tc-MEPs and 2 patients in Tc-MEPs and SSEPs. 3 patients presented intraoperative significant changes in neurophysiologic signals that improved following corrective actions by surgeons and correction of hemodynamic parameters by anesthesiologists with no postoperative neurologic deficits; 2 did not show any reversal of the signals after systemic intervention and developed postoperative neurologic deficits consisting of transient paraparesis (0.92%). Conclusion: This study indicates that early detection of neurophysiological changes using a multimodal approach with SSEPs and Tc-MEPs affords the surgical team an opportunity to perform rapid intervention to prevent injury progression or the possibility to reverse impeding neurologic sequela.

Comparison of Clinical and Radiologic Outcome of Adolescent Idiopathic Scoliosis Treated with Hybrid Hook-Screw Instrumentation versus Universal Clamp System.

Background. In surgical treatment of adolescent idiopathic scoliosis (AIS), hybrid universal clamp system has been used by some authors. We aimed to compare the clinical and radiologic outcome of hybrid universal clamp with hybrid thoracic hook lumbar screw. Methods. A prospective study was performed on 56 consecutive patients with AIS, who had alternatively undergone a posterior spinal fusion and instrumentation with hybrid thoracic hook lumbar screw system (28 patients: group A) and hybrid universal clamp system (28 patients: group B) between June 2006 and January 2014 at Imam Reza University Hospital and had been followed up for more than two years. The comparison was according to radiographic changes, operative time, intraoperative blood loss, complications, and Scoliosis Research Society (SRS-22) outcome scores. Results. The preoperative mean curve Cobb angle was 58° ± 7° (42°–74°) in group A and 60° ± 9° (46°–75°) in group B. The mean final coronal curve correction was 60.4% and 75.5% in groups A and B, respectively (P = 0.001). Postoperative SRS outcome scores were also comparable. Conclusion. Universal clamp instrumentation had a significantly better curve correction and lower complication rate compared with hybrid thoracic hook lumbar screw. Both instrumentation methods had similar operative time, intraoperative blood loss, and postoperative SRS outcome scores.

Impact of Rotation Correction after Brace Treatment on Prognosis in Adolescent Idiopathic Scoliosis.

Study DesignLevel 4 retrospective review.PurposeBrace treatment is the standard nonoperative treatment for adolescent idiopathic scoliosis (AIS). Rotation correction is also important, because AIS involves a rotation deformity. The purpose of this study was to evaluate the impact of rotation correction after Osaka Medical College (OMC) brace treatment on clinical outcomes in AIS.Overview of LiteratureBrace treatment has a significant effect on the progression of AIS. However, few reports have examined rotation correction after brace treatment.MethodsA total of 46 patients who wore the OMC brace were retrospectively reviewed. The curve magnitude was determined according to the Cobb method, and the rotation angle of the apical vertebrae was measured by the modified Nash-Moe method. Based on the difference in the rotation angle before and after the initial brace treatment, patients were divided into two groups. Group A (n=33) was defined as no change or improvement of the rotation angle; group B (n=13) was defined as deterioration of the rotation angle. If the patients had curve or rotation progression of 5° or more at skeletal maturity, or had undergone surgery, the treatment was considered a failure.ResultsDifferences of rotation angle between before and after the initial brace treatment were 2°±2° in group A and –3°±2° in group B (p<0.001). The rates of treatment failure were 42% in group A and 77% in group B (p<0.05). This study included 25 patients with Lenke type 1 (54%). Group A (24%) with Lenke type 1 also had a significantly better success rate of brace treatment than group B (75%) (p<0.05).ConclusionsInsufficient rotation correction increased brace treatment failure. Better rotation correction resulted in a higher success rate of brace treatment in patients with Lenke type 1.

A Cost-Effective Technique for Spinal Instrumentation in the Treatment of Adolescent Idiopathic Scoliosis.

Surgical treatment for adolescent idiopathic scoliosis (AIS) has evolved over the past decades to the point where instrumented arthrodesis with all pedicle screw and rod constructs is commonplace. Although these constructs provide superb correction and fixation, their financial burden is substantial. Here, we present a more cost-effective technique using a combination of pedicle screws (serving as the construct base), a sagittal precontoured unit rod, and sublaminar wires to provide segmental correction for the surgical treatment of AIS. Retrospective analyses of 42 patients treated with this construct were reviewed with a minimum 2-year follow-up. Correction in both coronal and sagittal planes was assessed radiographically and blood loss, operative time, complications, and cost were reviewed from hospital records. We conclude that this technique provides comparable correction to all pedicle screw constructs with similar blood loss and operative time, but with substantially decreased implant cost. The mean implant cost was $8910.83 ± $184.26.

Surgical Consent of Children and Guardians for the Treatment of Adolescent Idiopathic Scoliosis is Incompletely Informed.

Prospective, multicenter cohort analysis. Assess children and guardian's comprehension of surgical consent for adolescent idiopathic scoliosis (AIS) surgery and factors associated with their comprehension. Informed consent is essential to the ethical practice of surgery. Little is known about how informed are children and guardians when consenting to operation for AIS. Guardians and their children (10-18 yr) undergoing spinal fusion for AIS were prospectively evaluated at 4 institutions. Each child and guardian was asked to complete a questionnaire of the risks, benefits and expected results of operative treatment and a self-assessment of overall comprehension. A site-survey questionnaire regarding teaching methods, timing between teaching and consent, and healthcare provider involved in the consent process was also used. Significance was assessed using logistic regression examining factors associated with good (≥6 scores correct) and poor (<6 scores correct) comprehension. One hundred seventy six pairs of patient/guardian were enrolled. Fifty-seven patient/guardian questionnaires were discarded due to incompleteness. A greater percentage of guardians had good overall comprehension of the surgical consent (patients: 59.7%; guardian: 71.4%). Post-operative mobility (patient 31%; guardian 42%) was poorly understood. Surgical risks (i.e., neurologic injury, infection, hardware failure, future sequelae) were modestly understood (40-70% correct). Factors associated with better understanding were older patient age (>12 yr), guardian with a college degree, obtaining consent by the attending surgeon and at a separate preoperative visit than the time of teaching, the use of visual aids, and participation in a "peer-support group" preoperatively. There was a trend toward guardians' and patients' self-assessment of understanding mirroring their respective objective performances. Patients who undergo surgical intervention for AIS and their guardians understand approximately 60% of the surgical consent. The use of preoperative multimodal teaching techniques and "peer-support groups" may improve patient and guardian comprehension.

Evaluation of Limited Screw Density Pedicle Screw Constructs in Posterior Fusions for Adolescent Idiopathic Scoliosis

Study designRetrospective case series. ObjectivesTo compare radiographic and clinical outcomes in posterior spine fusions with pedicle screw instrumentation of varying screw densities in the treatment of adolescent idiopathic scoliosis (AIS). Summary of background dataPosterior spinal fusion with pedicle screw instrumentation is the mainstay of surgical treatment for AIS. The most commonly used construct consists of screws placed at every level on the concave side of the deformity and nearly every level on the convex side. However, some surgeons have begun using constructs with fewer pedicle screws. The literature comparing outcomes of these differing pedicle screw constructs is limited. MethodsFifty-two consecutive cases of posterior spinal fusions for AIS performed by four surgeons were reviewed. High screw density constructs were used in 26 cases and limited screw density constructs in 26 cases. Construct characteristics and radiographic measurements were compared preoperatively and at last follow-up. Operative time and estimated costs were also evaluated. Student t tests were used to compare the groups with p < .05 considered significant. ResultsThere was no significant difference in magnitude of correction for the high versus limited screw density group initially (38.5° vs. 34.9°, p = .093) or at final follow-up (36.9° vs. 32.2°, p = .054). Sagittal alignment, coronal balance, and translation of the major apical vertebra were comparable and stable in both groups. The high versus limited screw density group utilized significantly more pedicle screws (16.8 vs. 11.6 screws, p < .0001), had longer operative times (309 vs. 267 minutes, p = .007), and had additional estimated direct costs of $5,800. ConclusionsExcellent curve correction, stability, and balance can be achieved using fewer screws than commonly used in posterior pedicle screw fusions for AIS. Operative time is reduced, and risk and cost are decreased with the use of limited screw density constructs. Level of EvidenceIII.

Rod rotation and differential rod contouring followed by direct vertebral rotation for treatment of adolescent idiopathic scoliosis: effect on thoracic and thoracolumbar or lumbar curves assessed with intraoperative computed tomography

Background ContextAlthough direct vertebral rotation (DVR) is now used worldwide for the surgical treatment of adolescent idiopathic scoliosis (AIS), the benefit of DVR in reducing vertebral body rotation in these patients has not been determined. PurposeWe investigated a possible additive effect of DVR on further reduction of vertebral body rotation in the axial plane following intraoperative rod rotation or differential rod contouring in patients undergoing surgical treatment for AIS. Study Design/SettingThe study was a prospective computed tomography (CT) image analysis. Patient SampleWe analyzed the results of the two intraoperative procedures in 30 consecutive patients undergoing surgery for AIS (Lenke type I or II: 15; Lenke type V: 15). Outcome MeasuresThe angle of reduction of vertebral body rotation taken by intraoperative CT scan was measured and analyzed. Pre- and postoperative responses to the Scoliosis Research Society 22 Questionnaire (SRS-22) were also analyzed. MethodsTo analyze the reduction of vertebral body rotation with rod rotation or DVR, intraoperative cone-beam CT scans of the three apical vertebrae of the major curve of the scoliosis (90 vertebrae) were taken pre-rod rotation (baseline), post-rod rotation with differential rod contouring, and post-DVR in all patients. The angle of vertebral body rotation in these apical vertebrae was measured and analyzed for statistical significance. Additionally, differences between thoracic curve scoliosis (Lenke type I or II; 45 vertebrae) and thoracolumbar or lumbar curve scoliosis (Lenke type V; 45 vertebrae) were analyzed. Pre- and postoperative SRS-22 scores were evaluated in all patients. ResultsThe mean (90 vertebrae) vertebral body rotation angles at baseline, post-rod rotation or differential rod contouring, and post-rod rotation or differential rod contouring or post-DVR were 17.3°, 11.1°, and 6.9°, respectively. The mean reduction in vertebral body rotation with the rod rotation technique was 6.8° for thoracic curves and 5.7° for thoracolumbar or lumbar curves (p<.00005). The mean additional reduction in rotation with the DVR technique was 3.4° for thoracic curves and 4.9° for thoracolumbar or lumbar curves (p<.00005). Direct vertebral rotation displayed a slightly but significantly greater additive effect in reducing rotation following initial reduction with rod rotation or differential rod contouring in thoracolumbar or lumbar than in thoracic curves. In the SRS-22 results, postoperative self-image was significantly better than preoperative image in both groups. ConclusionsDirect vertebral rotation contributed an additional reduction in vertebral body rotation in thoracic and thoracolumbar or lumbar curves. The DVR technique is likely to be more useful in thoracolumbar or lumbar curve scoliosis than in thoracic curve scoliosis.

The Distance from Bench to Bedside: Commentary on an article by Benjamin D. Roye, MD, MPH, et al.: "An Independent Evaluation of the Validity of a DNA-Based Prognostic Test for Adolescent Idiopathic Scoliosis".

The holy grail of adolescent idiopathic scoliosis treatment lies in the ability to determine the risk of curve progression. Will the patient with a mild scoliosis eventually require a surgical intervention for a large magnitude deformity, or will the curve remain stable throughout growth and require no particular treatments? Risk of progression is central to the decision to apply an often cumbersome spine brace until the completion of growth and/or to expose the patient to repeated radiographic examinations for the purpose of monitoring changes in the curve. Previous studies had established that the risk of scoliosis progression was related to the patient’s residual growth, sex, curve location, and curve magnitude1-3. However, as modern research into the architecture of human DNA advanced, the understanding of curve progression found roots in a tale of gene diversity. It was hypothesized that groups of genes may conspire to determine scoliosis progression, and the greater the number of specific gene variations that a patient has, the more likely that patient is to progress to a large magnitude curve. In 2010, Ward et al. validated a genetic test of fifty-three single-nucleotide polymorphisms from a saliva sample (ScoliScore) that appeared to risk-stratify adolescents into those whose curves will never progress and those whose curves will inevitably progress4. Suddenly, a noninvasive, reportedly reliable method was available to determine which …

The Evidence Base for the Prognosis and Treatment of Adolescent Idiopathic Scoliosis: The 2015 Orthopaedic Research and Education Foundation Clinical Research Award.

We present a summary of our research into the natural history and treatment of adolescent idiopathic scoliosis (AIS). This work has answered critical clinical questions and in aggregate has substantially contributed to the evidence base for the prognosis and treatment of AIS. Evidence-based practice has been defined by Straus and Sackett1 as the best research evidence when combined with clinical experience (based on knowledge and experience developed over time from practice, including inductive reasoning) and patient circumstances. The first step in pediatric evidence-based practice is to understand the natural history of the disease or condition in order to learn the adult consequences of the condition. We need to understand what we are trying to prevent with treatment. The second step is to determine the outcomes of treatments to establish that treatment has favorably altered the natural history without introducing iatrogenic complications. The focus of our research over the last thirty-eight years has been to establish the evidence base for a variety of pediatric orthopaedic conditions. We present an overview of our research contributing to the current evidence for the prognosis and treatment of AIS. Arthur Steindler, MD, cared for a large number of patients with AIS between 1932 and 1948 and kept meticulous records of their initial presentation and subsequent visits. Our research was possible because of these records and the loyalty of these patients to Dr. Steindler and the University of Iowa. AIS is characterized by a lateral curvature of the spine of 10° or greater with rotation of the vertebrae. The diagnosis is made when other causes of scoliosis have been ruled out. Two to three percent of children younger than sixteen years of age will have a curvature of 10° or greater, and 0.3% to 0.5% will have a curvature of 20°, the size at which …

An initial biomechanical investigation of fusionless anterior tether constructs for controlled scoliosis correction

Background ContextConservative treatment for adolescent idiopathic scoliosis is often unsuccessful and requires surgical intervention. Theoretically, anterior fusionless surgery can achieve correction as the patient grows to skeletal maturity. PurposeThe objective of the present study was to determine differences in range of motion (ROM) between multiple anterior tether constructs and tensioning techniques. Coronal plane Cobb angles were evaluated. Study Design/SettingThis is a cadaveric biomechanical study. MethodsCadaveric spines underwent biomechanical testing to investigate two factors relevant to anterior tether reconstruction: (1) effect of fixation at the T4, superior, and T12, inferior, levels (S-I), as opposed to fixation at all T4–T12 continuous levels (Cont.); and (2) tensioning of the tether sequentially (SEQ T) or only at terminal points (T). Reconstructions were conducted at Cont., and ROM and coronal plane Cobb angles were measured. Rigid rods (R) were used as control for the tether. Funding for the present study was provided by Globus Medical, Inc., and three of five authors are employees of Globus Medical, Inc. ResultsNormalized lateral bending ROM for intact was 100(±33)%. The S-I R construct reduced motion to 39(±8)%. Tethering at terminal points resulted in ROM for S-I T and S-I No T of 61(±21)% and 70(±17)%, respectively. Screws placed at every level resulted in motion of 28(±9)% for the Cont. R construct, and a stepwise increase in motion to 44(±15)%, 47(±18)%, and 71(±19)%, respectively, for Cont. SEQ T, Cont. T, and Cont. No T. These relative trends were the same in all loading modes. Average change in overall coronal plane Cobb angle from intact was 4.6(±3.2)° and 9.9(±5.5)° for Cont. T and Cont. SEQ T constructs, respectively. ConclusionsTensioned tether constructs allowed greater ROM than rigid constructs, and no significant difference in ROM was noted between tensioning techniques. Sequential tensioning can produce greater correction with no biomechanical advantage.

The effectiveness of selective thoracic fusion for treating adolescent idiopathic scoliosis: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The objective of this review is to assess the effectiveness of selective thoracic fusion as a form of treatment in adolescent idiopathic scoliosis. This will be compared with all other forms of operative management for major structural thoracic curves. INCLUSION CRITERIA Types of participants A comprehensive and exhaustive literature search will be conducted for studies that include children aged 10-18 years with adolescent idiopathic scoliosis who have a scoliosis curve with a thoracic component that is described as structural (as described by the Lenke classification). In addition those with congenital, neuromuscular or syndromic causes for their scoliosis or any previous spinal fusion will be excluded. Types of intervention This review will consider studies that evaluate fusion of the thoracic curve with distal fusion no lower than L1. Both anterior and posterior approaches will be included; however any patient who receives both will be excluded. All forms of instrumentation for fusion such as pedicle screws, hooks and rods will be included. This will be compared where possible to any other surgical fusion for a structural thoracic curve. This will include studies that compare selective and non-selective spinal fusion in the same article, or selective spinal fusion only, but not non-selective spinal fusion only. Types of outcomes Primary outcomes include: Functional/Quality of life survey (SRS- 22, SRS-24, SRS-30 or similar). Complication rate – including, but not limited to, adding on, coronal imbalance, junctional kyphosis and re-operation. Respiratory function. Secondary outcomes include: Postoperative main thoracic Cobb angle, and average change in angle. Postoperative compensatory lumbar Cobb angle, and average change in angle. Coronal balance. Sagittal balance. Apical vertebral rotation and change.

Natural History of Adolescent Idiopathic Scoliosis in Skeletally Mature Patients: A Critical Review.

The surgical treatment of adolescent idiopathic scoliosis is dependent on several factors, including curve type and magnitude, degree of curve progression, skeletal maturity, and other considerations, such as pain and cosmesis. The most common indication for surgery is curve progression. Most authors agree that surgical treatment should be considered in skeletally mature patients with curves > 50° because of the risk of progression into adulthood. Furthermore, most authors would agree that curves measuring < 40° to 45° in skeletally mature patients should be observed. When a skeletally mature patient with a curve measuring between 45° to 55° is presenting to an orthopaedic surgeon, it is not uncommon that the patient has no pain, no progression, and no imbalance. The generally accepted belief has been that curves that reach 50° are likely to progress into adulthood, progressing at a rate of 1° per year, based largely on the Iowa studies. However, the level of evidence for this is relatively weak, and the existing literature is equivocal in supporting the practice of performing surgery on these patients.

How Effective Is Providence Night-time Bracing in Treatment of Adolescent Idiopathic Scoliosis?

Since 2008, the primary nonsurgical treatment of adolescent idiopathic scoliosis (AIS) in the southern part of Denmark went from full-time bracing with Boston brace to Providence night-time bracing.

Development and assessment of a digital X-ray software tool to determine vertebral rotation in adolescent idiopathic scoliosis

Background ContextThe amount of vertebral rotation in the axial plane is of key importance in the prognosis and treatment of adolescent idiopathic scoliosis (AIS). Current methods to determine vertebral rotation are either designed for use in analogue plain radiographs and not useful in digital images, or lack measurement precision and are therefore less suitable for the follow-up of rotation in AIS patients. PurposeThis study aimed to develop a digital X-ray software tool with high measurement precision to determine vertebral rotation in AIS, and to assess its (concurrent) validity and reliability. Study Design/settingIn this study a combination of basic science and reliability methodology applied in both laboratory and clinical settings was used. MethodsSoftware was developed using the algorithm of the Perdriolle torsion meter for analogue AP plain radiographs of the spine. Software was then assessed for (1) concurrent validity and (2) intra- and interobserver reliability. Plain radiographs of both human cadaver vertebrae and outpatient AIS patients were used. Concurrent validity was measured by two independent observers, both experienced in the assessment of plain radiographs. Reliability-measurements were performed by three independent spine surgeons. ResultsPearson correlation of the software compared with the analogue Perdriolle torsion meter for mid-thoracic vertebrae was 0.98, for low-thoracic vertebrae 0.97 and for lumbar vertebrae 0.97. Measurement exactness of the software was within 5° in 62% of cases and within 10° in 97% of cases. Intraclass correlation coefficient (ICC) for inter-observer reliability was 0.92 (0.91–0.95), ICC for intra-observer reliability was 0.96 (0.94–0.97). ConclusionsWe developed a digital X-ray software tool to determine vertebral rotation in AIS with a substantial concurrent validity and reliability, which may be useful for the follow-up of vertebral rotation in AIS patients.

Postoperative Transfusion Rates, Complications and Hospital Charges following Surgical Treatment of Adolescent Idiopathic Scoliosis in the United States from 1997 to 2012

Postoperative Transfusion Rates, Complications and Hospital Charges following Surgical Treatment of Adolescent Idiopathic Scoliosis in the United States from 1997 to 2012

What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?

There is substantial heterogeneity in the number of screws used per level fused in adolescent idiopathic scoliosis (AIS) surgery. Assuming equivalent clinical outcomes, the potential cost savings of using fewer pedicle screws were estimated using a medical decision model with sensitivity analysis. Descriptive analyses explored the annual costs for 5710 AIS inpatient stays using discharge data from the 2009 Kids' Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), which is a national all-payer inpatient database. Patients between 10 and 17 years of age were identified using the ICD-9-CM code for idiopathic scoliosis (737.30). All inpatient stays were assumed to represent 10-level fusions with pedicle screws for AIS. High screw density was defined at 1.8 screws per level fused, and the standard screw density was defined as 1.48 screws per level fused. The surgical return for screw malposition was set at $23,762. A sensitivity analysis was performed by varying the cost per screw ($600-$1000) and the rate of surgical revisions for screw malposition (0.117%-0.483% of screws; 0.8%-4.3% of patients). The reported outcomes include estimated prevented malpositioned screws (set at 5.1%), averted revision surgeries, and annual cost savings in 2009 US dollars, assuming similar clinical outcomes (rates of complications, revision) using a standard- versus high-density pattern. The total annual costs for 5710 AIS hospital stays was $278 million ($48,900 per patient). Substituting a high for a standard screw density yields 3.2 fewer screws implanted per patient, with 932 malpositioned screws prevented and 21 to 88 revision surgeries for implant malposition averted, and a potential annual cost savings of $11 million to $20 million (4%-7% reduction in the total cost of AIS hospitalizations). Reducing the number of screws used in scoliosis surgery could potentially decrease national AIS hospitalization costs by up to 7%, which may improve the safety and efficiency of care. However, such a screw construct must first be proven safe and effective.

Reliability and Validity of an Adapted Arabic Version of the Scoliosis Research Society-22r Questionnaire

Cross-sectional validation and reliability assessment study of Arabic version of Scoliosis Research Society-22 (SRS-22r) Questionnaire. To develop and validate the Arabic version of the SRS-22r questionnaire. The diagnosis and treatment of adolescent idiopathic scoliosis may influence patient quality of life. SRS-22r is an internationally validated questionnaire used to assess function/activity, pain, self-image, and mental health of patients with scoliosis. It has been translated into several languages but not into Arabic language. Therefore, a valid health-related quality-of-life outcome questionnaire for patients with spinal deformity is still lacking in Arabic language. The English version of SRS-22r questionnaire was translated, back-translated, and culturally adapted to Arabic language. Then, 81 patients with idiopathic adolescent scoliosis were allocated randomly into either the reliability testing group (group 1) or the validity testing group (group 2). Group 1 patients completed Arabic version of SRS-22r questionnaire twice with 1-week interval in-between. Cronbach α and intraclass correlation coefficient were measured to determine internal consistency and temporal reliability. Group 2 patients completed the Arabic version of SRS-22r questionnaire and the previously validated Arabic version of 36-Item Short Form Health Survey (Short Form-36) questionnaire concurrently, and Pearson correlation coefficient was obtained to assess validity. Content analysis, internal consistency reliability, test/retest reproducibility (intraclass correlation coefficient range: 0.82-0.90), and test of concurrent validity showed satisfactory results. Function/activity and satisfaction with management domains had a lower Cronbach α (0.58 and 0.44, respectively, vs. 0.71-0.85 range for others). Self-image/appearance and satisfaction with management had a lower correlation with domains of the 36-Item Short Form Health Survey. An Arabic version of the SRS-22r questionnaire has been developed and validated. This questionnaire will aid health care workers and researchers in evaluation of patient perception of the deformity, satisfaction with treatment, and quality of life in Arabic-speaking populations. 3.

Selective Thoracic Fusion Provides Similar Health-Related Quality of Life but Can Cause More Lumbar Disc and Facet Joint Degeneration: A Comparison of Adolescent Idiopathic Scoliosis Patients With Normal Population 10 Years After Surgery

ObjectivesTo evaluate the long-term behavior of the lumbar curve in patients with adolescent idiopathic scoliosis treated with selective thoracic fusion and to assess the clinical and radiologic outcomes in this fusion group compared with an age- and gender-matched group. Summary of Background DataSelective thoracic fusion for the treatment of adolescent idiopathic scoliosis (AIS) preserves lumbar motion segments but leaves a residual deformity. By avoiding fusion of the lumbar spine, a greater mobility may be preserved, which may be an advantage in long-term follow-up in terms of degenerative changes in unfused segments. MethodsGroup A included 25 AIS patients with mean a age of 23.8 years and a mean 11.4 years of follow-up. Group B included 30 age- and gender-matched subjects without any deformity. Preoperative, postoperative, and follow-up radiographs were reviewed. All patients had MRIs taken at the final follow-up in order to evaluate disc degeneration (DD) and facet joint degeneration (FJD) at the unfused lumbar spine. Clinical evaluation was done by using Scoliosis Research Society–22R, Oswestry Disability Index, and numerical rating scale. ResultsSagittal and coronal balance and lowest instrumented vertebra disc angulation were stable over time. Mean grading of lumbar DD was 2.16 (2–4) in Group A and 1.86 (1–3) in Group B. Lumbar FJDs were 2.05 (1–4) in Group A and 1.60 (1–3) in Group B. There was significant difference between the two groups for DD except for the L4–L5 level (p = .26). FJD was significantly higher in the L1–L2 and L2–L3 levels (L1–L2, p = .002, L2–L3, p = .002) but not for the other levels. Outcome scores were similar without significant differences between the two groups (p > .05). ConclusionSelective thoracic fusion provides satisfactory outcomes at more than 10 years of follow-up. Our study demonstrated a moderate increase in the rate of disc degeneration in the unfused segments. Facet joint degeneration was significant at the upper two levels adjacent to the lowest instrumented vertebra.

Radiological Outcomes in Adolescent Idiopathic Scoliosis Patients More Than 22 Years After Treatment

Study DesignLongitudinal cohort. ObjectivesTo evaluate the long-term radiologic outcomes in adolescent idiopathic scoliosis (AIS) patients more than 22 years after treatment. Summary of Background DataAlthough treatment for AIS is prophylactic and is aimed at preventing curve progression, very few studies report long-term outcomes of treatment. MethodsAIS patients treated with Boston brace or posterior spinal fusion (PSF) with Harrington–dorso-transverse traction (DTT) instrumentation from 1983 to 1990 were requested to return to clinic. Subsequently, 36-inch standing radiographs were obtained after patient consent. Cobb angles were compared with pretreatment and immediate posttreatment radiographs. Any evidence of adjacent-level disease or local kyphosis was also noted. ResultsOne hundred fifty-nine (78%) of 219 patients were available for follow-up, 66 braced and 93 surgical. There were 85 females with an average age at surgery of 14.3 years and an average age at follow-up of 37.6 years. The mean length of follow-up was 24.5 years (range, 22–30 years). There was a statistically significant curve progression of 2.9° in the PSF group. There was a greater degree of curve progression in the braced group (5.5°), but this was not statistically significant. Proximal segment degeneration was seen in 8 (5%), 2 in the brace cohort and 6 in the PSF cohort. Distal segment degeneration was seen in 26 (16%) patients, 4 treated with brace and 22 treated with PSF. No patient developed proximal junction kyphosis. Three patients in the PSF cohort required additional surgery for distal adding-on. Four patients had a noncontiguous L5–S1 fusion, three from the PSF cohort and one from the braced cohort. ConclusionIn this cohort with an average follow-up of 24.5 years, with 78% available for follow-up, both the braced and surgically treated patients had a very small degree of curve progression, with a small incidence of distal segment degeneration and reoperation. Level of EvidenceIII.