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Vertebral Body Stapling (VBS) vs. Bracing for Patients with High-Risk Moderate Idiopathic Scoliosis (IS)Laury Cuddihy, MD; Aina J. Danielsson, MD, PhD; Patrick J. Cahill, MD; John Richmond, MD; Amer F. Samdani, MD; Mary Jane Mulcahey,
PhD; Randal R. Betz, MD
United States
Summary: This is a retrospective comparison study of vertebral body stapling (VBS) versus bracing for patients with moderate
idiopathic scoliosis (IS) (25-44°) using identical inclusion criteria. The results of treatment of thoracic curves measuring 25-34°
and all lumbar curves, whether by VBS or bracing, appear to be similar. For thoracic curves 35-44°, the results were worst with
stapling, which has led to alternative fusionless surgery strategies.
Introduction: We retrospectively compared VBS versus bracing for patients with moderate IS to determine which is more effective
at maintaining or improving curve magnitude.
Methods: Inclusion Criteria: 1) Diagnosis of idiopathic scoliosis; 2) age ≥ 8 years 3) curve 25-44°; 4) Risser 0 or 1; 5) minimum
2-year follow-up. The VBS cohort was derived from a retrospective IRB-approved analysis of a consecutive series of 160 patients
of which 49 met the inclusion criteria. 43 of the 49 (88%) were available for follow-up. The bracing cohort (N=165) was derived
from a bracing database from Sweden. “Improvement” was defined as improvement in the pre-treatment Cobb angle of > 10°.
“No change” was defined as +10° to -10° change, inclusive. “Progression” was defined as worsening of the curve > 10°.
Results: The average age at initiation of treatment of the VBS group vs. the bracing group was 10.5 yrs vs. 12.7 yrs. Average
curve size was 31 vs. 32° and average follow-up was 41 vs. 43 months. For thoracic curves 25-34°, VBS had a success rate of 80%
versus 64% for bracing. In thoracic curves 35-44°, VBS and bracing had success rates of 18% and 57%, respectively. For lumbar
curves 25-34°, VBS had a 79% success rate versus 69% for bracing. For lumbar curves 35-44°, VBS had a 60% success rate versus
60% for bracing (Table 1).
Conclusion: In this comparison, the results for treatment of smaller thoracic curves (<35°) and all lumbar curves appear to be
similar for both VBS and bracing, suggesting that VBS could be used as an alternative to bracing. For thoracic curves 35-44°, the
results were poor with stapling, which has led to alternative fusionless strategies.
Are Surgical Results in Larger Curves Inferior to Those in Smaller Curves?James O. Sanders, MD; Lawrence G. Lenke, MD; John B. Emans, MD; Charles E. Johnston, MD; B. Stephens Richards, MD; Daniel J. Sucato,
MD, MS; Mohammad Diab, MD; Mark A. Erickson, MD; David W. Polly, MD
United States
Summary: Surgery in large curves (>70°) results in more frequent allogenic blood transfusion, osteotomy, complications,
longer surgical time, lower pulmonary function, larger residual curvature, and fusion into the lower lumbar spine than surgery
in smaller curves (<60°). Because the surgery is more complex and difficult for larger curves, early detection and referral for
scoliosis remains important for optimum surgical results.
Introduction: If surgical results in larger curves are inferior to those in smaller curves, then earlier detection and referral
should improve outcomes. The purpose of this study is to evaluate surgical results comparing larger to smaller curves.
Methods: From a prospectively collected database of adolescent idiopathic scoliosis surgery, patients with curves <60° (smaller
curves) preoperatively were compared to those >70° (larger curves) both for perioperative issues and 2 year postoperative
results. Chi-Square or Fisher’s Exact Tests were used for categorical comparisons, and unpaired t-tests or Wilcoxon Ranked Sums
for continuous variables.
Results: 1729 patients had main curves <60° and 414 had curves >70° preoperatively. Larger curves were more common in
non-Caucasians than Caucasians (p<0.0001) and in males than females (p=0.0253).
Patients with larger curves more frequently underwent osteotomies (p<0.0001), were more likely to receive perioperative allogenic
blood (p<0.0001), have longer operative times (347min vs. 272 min, p<0.0001), and experience complications (p=0.0022)
than patients with smaller curves. Compared to patients with smaller curves, pulmonary function was significantly lower both
preoperatively and postoperatively (p<0.001) for those with larger curves. They also had larger residual curves postoperatively
(p< 0.0001). For each Lenke curve type, there was a shift for larger curves to have instrumentation lower into the lumbar spine,
which was statistically significant for types 1, 2, 3, and 6.
On the other hand, those with larger curves had greater curve magnitude percent correction and improvement in SRS and
SAQ scores than those with smaller curves
Conclusion: Surgery for larger curves, which is more common in minority populations, is more likely to result in blood transfusion,
lower pulmonary function, complications, and fusion into the lower lumbar spine than surgery in smaller curves.Significance: Because surgery for larger curves is more difficult with potential long-term effects than surgery in smaller
curves, early detection and referral for scoliosis appears important for surgical results regardless of whether or not non-operative
treatment is effective.
Long-Term Clinical Outcomes of Surgery for Adolescent Idiopathic Scoliosis 21 to 41 Years Later
Tsutomu Akazawa, MD; Shohei Minami; Toshiaki Kotani; Kazuhisa Takahashi
Japan
Summary: Surgery had no effects on pain and mental health in middle age AIS patients 31 years later.
Introduction: Several long-term follow-up studies of surgically treated adolescent idiopathic scoliosis have been published
that report on clinical outcomes for patients who have reached their 20s or 30s. However, clinical outcomes when patients
reach middle age remain unknown. The purpose of this study was to determine the clinical outcome for a group of patients
surgically treated for adolescent idiopathic scoliosis who have reached middle age.
Methods: Two hundred fifty-six patients surgically treated for adolescent idiopathic scoliosis (AIS) between 1968 and 1988
were included in this study. All patients were less than 20 years-old when they underwent surgery. The SRS-22 Patient Questionnaire
and Roland-Morris Disability Questionnaire (RDQ) were used for evaluating long-term clinical outcomes. Sixty-six
(25.8%) of the 256 patients answered the questionnaires, comprising 62 females and 4 males with a mean age of 46.0 (range
34-56) years and a mean follow-up period of 31.5 (range 21-41) years. Seventy-six healthy age- and sex- matched individuals
were selected as a control (CTR) group, comprising 71 females and 5 males with a mean age of 46.6 (range 35-62) years.
Results: The SRS-22 responses showed that the AIS patients had significantly decreased function (AIS: 4.3±0.6, CTR: 4.7±0.5,
p<0.01) and decreased self-image (AIS: 3.0±0.8, CTR: 3.7±0.5, p<0.01) in comparison with the controls, but they identified no
significant differences between the two groups with respect to pain (AIS: 4.3±0.6, CTR: 4.2±0.5, p=0.14) or mental health (AIS:
3.9±0.9, CTR: 3.7±0.7, p=0.14). The RDQ responses showed that back pain was not significantly increased in the AIS group compared
with the CTR group (AIS: 1.8±3.5, CTR: 1.4±3.1, p=0.36).
Conclusion: Surgery had no demonstrable adverse effects on pain and mental health in these middle age AIS patients 31
years later (on average), but the AIS patients did have significantly lower function and lower self-image than the age- and sexmatched
healthy controls.
PhD; Randal R. Betz, MD
United States
Summary: This is a retrospective comparison study of vertebral body stapling (VBS) versus bracing for patients with moderate
idiopathic scoliosis (IS) (25-44°) using identical inclusion criteria. The results of treatment of thoracic curves measuring 25-34°
and all lumbar curves, whether by VBS or bracing, appear to be similar. For thoracic curves 35-44°, the results were worst with
stapling, which has led to alternative fusionless surgery strategies.
Introduction: We retrospectively compared VBS versus bracing for patients with moderate IS to determine which is more effective
at maintaining or improving curve magnitude.
Methods: Inclusion Criteria: 1) Diagnosis of idiopathic scoliosis; 2) age ≥ 8 years 3) curve 25-44°; 4) Risser 0 or 1; 5) minimum
2-year follow-up. The VBS cohort was derived from a retrospective IRB-approved analysis of a consecutive series of 160 patients
of which 49 met the inclusion criteria. 43 of the 49 (88%) were available for follow-up. The bracing cohort (N=165) was derived
from a bracing database from Sweden. “Improvement” was defined as improvement in the pre-treatment Cobb angle of > 10°.
“No change” was defined as +10° to -10° change, inclusive. “Progression” was defined as worsening of the curve > 10°.
Results: The average age at initiation of treatment of the VBS group vs. the bracing group was 10.5 yrs vs. 12.7 yrs. Average
curve size was 31 vs. 32° and average follow-up was 41 vs. 43 months. For thoracic curves 25-34°, VBS had a success rate of 80%
versus 64% for bracing. In thoracic curves 35-44°, VBS and bracing had success rates of 18% and 57%, respectively. For lumbar
curves 25-34°, VBS had a 79% success rate versus 69% for bracing. For lumbar curves 35-44°, VBS had a 60% success rate versus
60% for bracing (Table 1).
Conclusion: In this comparison, the results for treatment of smaller thoracic curves (<35°) and all lumbar curves appear to be
similar for both VBS and bracing, suggesting that VBS could be used as an alternative to bracing. For thoracic curves 35-44°, the
results were poor with stapling, which has led to alternative fusionless strategies.
Are Surgical Results in Larger Curves Inferior to Those in Smaller Curves?James O. Sanders, MD; Lawrence G. Lenke, MD; John B. Emans, MD; Charles E. Johnston, MD; B. Stephens Richards, MD; Daniel J. Sucato,
MD, MS; Mohammad Diab, MD; Mark A. Erickson, MD; David W. Polly, MD
United States
Summary: Surgery in large curves (>70°) results in more frequent allogenic blood transfusion, osteotomy, complications,
longer surgical time, lower pulmonary function, larger residual curvature, and fusion into the lower lumbar spine than surgery
in smaller curves (<60°). Because the surgery is more complex and difficult for larger curves, early detection and referral for
scoliosis remains important for optimum surgical results.
Introduction: If surgical results in larger curves are inferior to those in smaller curves, then earlier detection and referral
should improve outcomes. The purpose of this study is to evaluate surgical results comparing larger to smaller curves.
Methods: From a prospectively collected database of adolescent idiopathic scoliosis surgery, patients with curves <60° (smaller
curves) preoperatively were compared to those >70° (larger curves) both for perioperative issues and 2 year postoperative
results. Chi-Square or Fisher’s Exact Tests were used for categorical comparisons, and unpaired t-tests or Wilcoxon Ranked Sums
for continuous variables.
Results: 1729 patients had main curves <60° and 414 had curves >70° preoperatively. Larger curves were more common in
non-Caucasians than Caucasians (p<0.0001) and in males than females (p=0.0253).
Patients with larger curves more frequently underwent osteotomies (p<0.0001), were more likely to receive perioperative allogenic
blood (p<0.0001), have longer operative times (347min vs. 272 min, p<0.0001), and experience complications (p=0.0022)
than patients with smaller curves. Compared to patients with smaller curves, pulmonary function was significantly lower both
preoperatively and postoperatively (p<0.001) for those with larger curves. They also had larger residual curves postoperatively
(p< 0.0001). For each Lenke curve type, there was a shift for larger curves to have instrumentation lower into the lumbar spine,
which was statistically significant for types 1, 2, 3, and 6.
On the other hand, those with larger curves had greater curve magnitude percent correction and improvement in SRS and
SAQ scores than those with smaller curves
Conclusion: Surgery for larger curves, which is more common in minority populations, is more likely to result in blood transfusion,
lower pulmonary function, complications, and fusion into the lower lumbar spine than surgery in smaller curves.Significance: Because surgery for larger curves is more difficult with potential long-term effects than surgery in smaller
curves, early detection and referral for scoliosis appears important for surgical results regardless of whether or not non-operative
treatment is effective.
Long-Term Clinical Outcomes of Surgery for Adolescent Idiopathic Scoliosis 21 to 41 Years Later
Tsutomu Akazawa, MD; Shohei Minami; Toshiaki Kotani; Kazuhisa Takahashi
Japan
Summary: Surgery had no effects on pain and mental health in middle age AIS patients 31 years later.
Introduction: Several long-term follow-up studies of surgically treated adolescent idiopathic scoliosis have been published
that report on clinical outcomes for patients who have reached their 20s or 30s. However, clinical outcomes when patients
reach middle age remain unknown. The purpose of this study was to determine the clinical outcome for a group of patients
surgically treated for adolescent idiopathic scoliosis who have reached middle age.
Methods: Two hundred fifty-six patients surgically treated for adolescent idiopathic scoliosis (AIS) between 1968 and 1988
were included in this study. All patients were less than 20 years-old when they underwent surgery. The SRS-22 Patient Questionnaire
and Roland-Morris Disability Questionnaire (RDQ) were used for evaluating long-term clinical outcomes. Sixty-six
(25.8%) of the 256 patients answered the questionnaires, comprising 62 females and 4 males with a mean age of 46.0 (range
34-56) years and a mean follow-up period of 31.5 (range 21-41) years. Seventy-six healthy age- and sex- matched individuals
were selected as a control (CTR) group, comprising 71 females and 5 males with a mean age of 46.6 (range 35-62) years.
Results: The SRS-22 responses showed that the AIS patients had significantly decreased function (AIS: 4.3±0.6, CTR: 4.7±0.5,
p<0.01) and decreased self-image (AIS: 3.0±0.8, CTR: 3.7±0.5, p<0.01) in comparison with the controls, but they identified no
significant differences between the two groups with respect to pain (AIS: 4.3±0.6, CTR: 4.2±0.5, p=0.14) or mental health (AIS:
3.9±0.9, CTR: 3.7±0.7, p=0.14). The RDQ responses showed that back pain was not significantly increased in the AIS group compared
with the CTR group (AIS: 1.8±3.5, CTR: 1.4±3.1, p=0.36).
Conclusion: Surgery had no demonstrable adverse effects on pain and mental health in these middle age AIS patients 31
years later (on average), but the AIS patients did have significantly lower function and lower self-image than the age- and sexmatched
healthy controls.
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