Influence of Insurance Status on Curve Magnitude in Adolescent Idiopathic Scoliosis in Mainland China

Study Design: Retrospective cohort study. Objectives: To determine whether there is an association between insurance status and curve magnitude in idiopathic scoliosis pediatric patients in mainland China. Methods: Medical records of patients with adolescent idiopathic scoliosis in 4 tertiary spine centers across China from January 2013 to December 2017 were analyzed. Data was extracted on insurance status, curve magnitude, recommended treatment at presentation, source of referral, and treatment initiated. Additional information was collected for patients requiring corrective surgery, including time from recommendation for surgery to surgery and clinically relevant parameters such as, postoperative complications, and pre-/postoperative Scoliosis Research Society–22 scores were also collected for patients requiring corrective surgery. Results: Of the 1785 patients included, 1032 were Urban Resident Basic Medical Insurance Scheme (URBMS) insured and 753 were New Rural Cooperative Medical Scheme (NRCMS) insured. NRCMS patients presented with a larger major curve than URBMS patients (32.9° ± 15.1° vs 29.3° ± 12.6°, P = .028). For patients having surgery recommended, NRCMS patients presented with a larger mean Cobb angle at the first presentation (57.7° vs 50.9°, P < .0001) and at time of surgery (61.3° vs 52.2°, P < .0001), and experienced a significantly longer time from surgery recommendation to decision for surgery. Complication rates were comparable between the 2 groups, except for pulmonary complications (NRCMS 7.3% vs URBMS 2.8%, P = .04). Postoperatively, patients covered by NRCMS insurance experienced greater overall improvement in health-related quality of life and were less satisfied with the treatments. Conclusions: This study shows that health insurance may influence the severity of scoliosis on presentation, with implications on early diagnosis and surgery time.

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Is Lenke Rule About Selective Thoracic Fusion Applicable for Younger Adult Idiopathic Scoliosis Under 40 Years of Age: Comparison With Adolescent Patients

10.21203/rs.3.rs-154106/v1 ◽

2021 ◽

Author(s):

Honglei Yi ◽

Hu Chen ◽

Xinhui Wang ◽

Wei Zhang ◽

Hong Xia

Keyword(s):

Idiopathic Scoliosis ◽

Operating Time ◽

Operation Time ◽

Research Society ◽

Complication Rates ◽

Scoliosis Research Society ◽

Selective Thoracic Fusion ◽

Release Technique ◽

Curve Magnitude ◽

Significant Difference

Abstract Background To evaluate the surgical outcome of younger adult idiopathic scoliosis patients (YAdIS) with selective thoracic fusion by comparing with adolescent idiopathic scoliosis (AIS). Methods Seventy-two idiopathic scoliosis patients (36 adults and 36 adolescents) treated by posterior-only all-pedicle screw technique at the same institution were retrospective reviewed and matched by curve pattern and curve magnitude. Radiographic parameters were evaluated preoperatively, postoperatively and at ﬁnal follow-up. Operating time, blood loss, transfusion and complications were noted. Clinical outcome was assessed by Scoliosis Research Society-22 questionnaire (SRS-22). Results The major thoracic curves in YAdIS group and AIS group were 56.3°±9.7°, 53.3°±10.1° and corrected to 17.2°±7.3°, 14.9°±7.5° respectively without significant difference of correction rate (69.3% vs. 72.0%). For the lumbar curve, Cobb angles in two groups were 35.6° ± 10.1° and 31.4 ± 9.2° preoperatively, and was spontaneously corrected to 18.5° ± 9.0° and 12.6° ± 8.2°. Correction rates were 48.0% and 59.8% (P＜0.05). Coronal vertebra alignments (CVA) in YAdIS group were 20.6 ± 9.7 mm before surgery and 16.8 ± 7.9 mm after surgery (P＞0.05), while CVA in the AIS group was 17.8 ± 10.5 mm preoperatively and decreased to 9.7 ± 8.3 mm postoperatively (P＜0.05). However, sagittal parameters showed significant improvements in thoracic kyphosis in both groups (P＜0.05). Complication rates were 13.9% vs. 5.6% without significant difference. Preoperative SRS score was worse in the YAdIS group than the AIS group. However, there were no significant differences between the final SRS score. Conclusions YAdIS patients gained similar correction of major thoracic curve as AIS patients, although the curve were stiffer.However,more extensive release technique needed to be done which was associated with longer operation time hospital stay. YAdIS had more complications,though this difference was not statistically significant. Patients with lower SRS score in YAdIS can also be treated very well with selective thoracic fusion surgery.

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Complications following surgery for adolescent idiopathic scoliosis over a 13-year period

The Bone & Joint Journal ◽

10.1302/0301-620x.102b4.bjj-2019-1371.r1 ◽

2020 ◽

Vol 102-B (4) ◽

pp. 519-523

Author(s):

Kenny Y. H. Kwan ◽

Hui Y. Koh ◽

Kathleen M. Blanke ◽

Kenneth M. C. Cheung

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Neurological Deficit ◽

Complication Rate ◽

Perioperative Complications ◽

Research Society ◽

Morbidity And Mortality ◽

Complication Rates ◽

Scoliosis Research Society ◽

Age At Surgery

Aims The purpose of this study was to evaluate the incidence and analyze the trends of surgeon-reported complications following surgery for adolescent idiopathic scoliosis (AIS) over a 13-year period from the Scoliosis Research Society (SRS) Morbidity and Mortality database. Methods All patients with AIS between ten and 18 years of age, entered into the SRS Morbidity and Mortality database between 2004 and 2016, were analyzed. All perioperative complications were evaluated for correlations with associated factors. Complication trends were analyzed by comparing the cohorts between 2004 to 2007 and 2013 to 2016. Results Between 2004 and 2016, a total of 84,320 patients were entered into the database. There were 1,268 patients associated with complications, giving an overall complication rate of 1.5%. Death occurred in 12 patients (0.014%). The three most commonly reported complications were surgical site infection (SSI) (441 patients; 0.52%), new neurological deficit (293; 0.35%), and implant-related complications (172; 0.20%). There was a statistically significant but weak correlation between the occurrence of a SSI and the magnitude of the primary curve ( r = 0.227; p < 0.001), and blood loss in surgery ( r = 0.111; p = 0.038), while the occurrence of a new neurological deficit was correlated statistically significantly but weakly with age at surgery ( r = 0.147; p = 0.004) and magnitude of the primary curve ( r = 0.258; p < 0.001). The overall complication rate decreased from 4.95% during 2004 to 2007 to 0.98% during 2013 to 2016 (p = 0.023). Conclusion An overall complication rate of 1.5% was found in our series after surgery for AIS, with a reduction of complication rates found in the second period of the analysis. Cite this article: Bone Joint J 2020;102-B(4):519–523.

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Comparison of Changes in SRS-22 Values with Improvement in Cobb Angles after Posterior Fusion Surgery in Adolescent Idiopathic Scoliosis

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1401-0477 ◽

2021 ◽

Author(s):

Kadir Gem ◽

Sertan Hancioglu ◽

Abdulkadir Bilgiç ◽

Serkan Erkan

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Posterior Instrumentation ◽

Research Society ◽

Posterior Fusion ◽

Improvement Rate ◽

Scoliosis Research Society ◽

Correction Rate ◽

Group B

Abstract Introduction The purpose of this study was to evaluate the relationship between the correction rate in Cobb angle and the improvement in quality of life profile in terms of Scoliosis Research Society (SRS)-22 values. Patients and Methods Between January 2007 and December 2013, posterior instrumentation and fusion was performed to 30 patients with adolescent idiopathic scoliosis (AIS). Patients were grouped according to their improvement rate in Cobb angles after surgery. Patients with an improvement rate of > 80% were grouped as Group A; those with an improvement rate of > 60% and ≤ 80% as Group B and those with an improvement rate of ≤ 60% were grouped as Group C. The SRS-22 questionnaire of these three groups was calculated and their relationship with the improvement in Cobb angle was evaluated. Results No statistical difference was found among the three groups in terms of pain, appearance, function, spirit, satisfaction, and SRS-22 values (all p > 0.05). Conclusion The results of this study demonstrate that the degree of correction rate does not correlate with the degree of improvement in the SRS-22 questionnaire in patients with AIS that underwent posterior fusion and instrumentation.

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Screening for adolescent idiopathic scoliosis: an information statement by the scoliosis research society international task force

Scoliosis ◽

10.1186/1748-7161-8-17 ◽

2013 ◽

Vol 8 (1) ◽

Cited By ~ 45

Author(s):

Hubert Labelle ◽

Stephens B Richards ◽

Marinus De Kleuver ◽

Theodoros B Grivas ◽

Keith D K Luk ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Task Force ◽

Research Society ◽

Scoliosis Research Society

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What happens to the unfused upper thoracic curve after posterior spinal fusion for adolescent idiopathic scoliosis?

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.10.peds20671 ◽

2021 ◽

pp. 1-7

Author(s):

M. Omar Iqbal ◽

Amer F. Samdani ◽

Joshua M. Pahys ◽

Peter O. Newton ◽

Suken A. Shah ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Univariate Analysis ◽

Posterior Spinal Fusion ◽

Research Society ◽

Curve Correction ◽

Scoliosis Research Society ◽

Lenke Classification ◽

Upper Instrumented Vertebra ◽

Upper Thoracic

OBJECTIVE Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS. METHODS The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1–4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)–22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model. RESULTS The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement. CONCLUSIONS Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1–4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.

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