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Thread: Selected abstract conclusions from 2012 SRS meeting

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    Selected abstract conclusions from 2012 SRS meeting

    http://www.srs.org/professionals/mee...al-program.pdf

    This is just what caught my eye among the first 125 abstracts. There are plenty more I need to review. I just read the titles and conclusions in most cases because I am trying to get through all of them!

    - Claim that Schroth type 3C curve responds to Schroth PT

    - No low risk Scoliscore patients ended up with a curve >25* at maturity in a study

    - less disc degeneration and lower back pain in surgical versus matched non-fuse patients

    - 3D assessments (e.g., rotation, hypokyphosis, etc.) help determine progressive versus non-progressive AIS

    - additional radiographic risk factors to avoid to prevent adding on in T curves

    - if you only want the T curve fused in a false double, you better get someone who has mucho experience - they tend to do selective T fusions much more than less experienced surgeons who fuse well into the lumbar. (I am extremely relieved that our surgeon did a selective fusion on my one kid with a false double. He is non SRS but we were referred to him by an SRS surgeon.)

    - significant loss of correction (10* - 15*) in T curves with late implant removal (10 years)

    - 20 - 40 year olds had more rigid curves, worse correction, more complications and longer fusions than kids. (I have noted the longer fusions in adults versus kids from testimonials and it seems there is now data for this.)

    - of adults who get surgery, all had lower reported HRQOL (quality of life) than unfused (? have to check) and the scores were worse for older versus younger.

    - 40 Shilla patients with at least 5 years of f/u - looks okay despite some complications.

    - compared growth rods to casting - mixed results.

    - both VEPTR and growth rods are viable but mixed bag of differences

    - segmental self growing rods looking good

    - MRCGR (a magnetically-expanded growth rod system - NOT MAGEC) looks promising

    - tethering might be better than VBS in terms of greater initial correction and better control on subsequent progression

    - finding correlates (the noun, not the verb) to PJK incidence

    - pain in upper back strongly correlated with PJK

    - new susceptibility locus for AIS found

    - new DNA markers related to AIS progression

    - first study to find mutations in certain genes causes AIS

    - discovery of particular gene mutation implicates a specific developmental pathway (axial development) in IS pathogenesis. Have to do more work to see how rare this is.

    - evidence for disordered bone structure in AIS in girls - indicates abnormalities in bone metabolism and disturbance on leptin signaling

    - review of 108,419 (!) surgical cases

    - 340 cases of Scoliscore intermediate risk group (51 - 180) - risk varies tremendously in this group. Linear increase in risk of progression with score. Exponential increase in risk of progression to surgical range with score.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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    There is some great info here Sharon, thx for throwing this up.

    Some data on pros and cons of pelvic anchors and the L5 question down around page 177. What they have learned in the last 10 years.

    My eyes are roasted...I cant read anymore today.

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
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    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

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    Thanks for posting! I learned that old isn't good, going to rehab after surgery isn't good, being >90yo at surgery definitely isn't good....I'm exhausted from reading! Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone + prayer

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    I wrote:

    - of adults who get surgery, all had lower reported HRQOL (quality of life) than unfused (? have to check) and the scores were worse for older versus younger.
    I re-read the abstract. This study was of "adult spinal deformity" and therefore is not relevant to IS. I assume it is adult onset, pathology, whatever.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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    Oh I forgot to mention there was a study of VBS done in nine patients by someone who is not Betz/Luhmann/<insert name of VBS expert>. VBS did not halt progression or prevent surgery in 7 of these patients who started out with moderate T curves. Now they have to match that against similar patients who were operated on by Betz/Luhmann/<insert name of VBS expert> to see if the results are operator dependent in my opinion. This guy may simply have documented an unfortunate learning curve.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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    I wrote:

    - if you only want the T curve fused in a false double, you better get someone who has mucho experience - they tend to do selective T fusions much more than less experienced surgeons who fuse well into the lumbar. (I am extremely relieved that our surgeon did a selective fusion on my one kid with a false double. He is non SRS but we were referred to him by an SRS surgeon.)
    It is important to point out that selective thoracic fusion is considered the optimal treatment. So apparently, only the experienced guys are comfortable doing the optimal treatment. This situation sounds completely unacceptable because apparently it is better to NOT fuse into the lumbar on these false doubles and indeed there is a study showing the lumbars under selectively fused T curves in false doubles are stable for at least a few decades (the length of study) in all patients in the study (I don't remember how they were selected). Wait a minute... here it is:

    http://journals.lww.com/spinejournal...horacic.5.aspx

    Lumbar Curve Is Stable After Selective Thoracic Fusion for Adolescent Idiopathic Scoliosis: A 20-Year Follow-up

    Larson, A. Noelle MD*; Fletcher, Nicholas D. MD†; Daniel, Cindy‡; Richards, B. Stephens MD‡
    Collapse Box
    Abstract

    Study Design. A retrospective cohort study comparing long-term clinical and radiographical outcomes using selective thoracic instrumented fusion versus long instrumented fusion for the treatment of adolescent idiopathic scoliosis (AIS).

    Objective. To evaluate long-term behavior of the lumbar curve in patients with AIS treated with selective thoracic fusion and to assess clinical outcome measures in this patient population compared with those patients treated with fusion in the lumbar spine.

    Summary of Background Data. Selective thoracic fusion for the treatment of AIS preserves motion segments, but leaves residual lumbar deformity. Long-term results of selective fusion using segmental fixation are limited.

    Methods. Nineteen patients with AIS treated with selective thoracic fusion and 9 patients treated with a long fusion returned at a mean 20 years (range, 14–24 years) postoperatively for radiographs, clinical evaluation, and outcome surveys (Short Form-12, Scoliosis Research Society-24, Spinal Appearance Questionnaire, Oswestry Disability Index, and visual analogue scale for pain and stiffness). Curve types were Lenke 1B, 1C, or 3C. All patients underwent posterior fusion with Texas Scottish Rite Hospital or Cotrel-Dubousset hook-rod instrumentation.

    Results. The selective thoracic fusion group had no significant progression in the lumbar curve magnitude and no worsening of L4 obliquity to the pelvis between initial postoperative and 20-year follow-up. Mean preoperative lumbar curve magnitude (mean, 44°; range, 32–64) corrected 43% on initial postoperative films versus 38% at latest follow-up. Mean L4 obliquity to the pelvis, trunk shift, sagittal balance, and coronal balance were stable over time. Outcome scores between the 2 groups were similar. Scores in long fusion group, when compared with the selective group, were higher for 2 Scoliosis Research Society domains: self-image after surgery (P = 0.005) and function after surgery (P = 0.0006).

    Conclusion. Spinal balance and correction of the lumbar curve remain stable over time in selective thoracic fusion. Those with selective fusions have outcome measures comparable with those with long fusions.

    And another...

    http://www.ncbi.nlm.nih.gov/pubmed/21030900

    Spine (Phila Pa 1976). 2010 Nov 15;35(24):2128-33.
    Predicting the outcome of selective thoracic fusion in false double major lumbar "C" cases with five- to twenty-four-year follow-up.
    Chang MS, Bridwell KH, Lenke LG, Cho W, Baldus C, Auerbach JD, Crawford CH 3rd, O'Shaughnessy BA.
    Source

    Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
    Abstract
    STUDY DESIGN:

    Retrospective radiographic and clinical study.
    OBJECTIVE:

    To examine the long-term outcome of selective thoracic fusion (STF) performed for lumbar "C" modifier curves in adolescent idiopathic scoliosis.
    SUMMARY OF BACKGROUND DATA:

    The efficacy of STF in lumbar "C" false double major curves is controversial. We examined the 5- to 24-year outcomes of patients with "C" lumbar curves who underwent STF at a single institution to determine which factors help predict successful outcome.
    METHODS:

    Thirty-two patients (age, 14.8 ± 2.0 years) with a lumbar "C" modifier underwent primary STF and had minimum 5-year follow-up (mean, 6.8 years). All patients were fused distally to either T12 or L1. At latest follow-up, 18 were considered successful (group S), 2 required reoperation to accommodate worsening deformity (group R), and 12 were considered marginal outcomes (group M), as defined by >3 cm coronal imbalance (n = 5), >5 mm worsening of lumbar apical vertebra translation compared with preoperative (n = 4), >1 Nash-Moe grade worsening of lumbar apical vertebra rotation (n = 1), >10° thoracolumbar junction kyphosis which was at least 5° worse than preoperative (n = 5), and lumbar Cobb angle >5° worse than preoperative (n = 2). Clinical outcomes were determined by Scoliosis Research Society (SRS)-30 at final follow-up.
    RESULTS:

    Of the multiple factors considered, 2-month postoperative standing lumbar sagittal alignment was most predictive for long-term outcome (P < 0.019 by Kruskal-Wallis ANOVA). Satisfactory outcomes had statistically significantly greater T12-S1 lordosis than those that were marginal (64.8° (group S) vs. 52.0° (group M); P = 0.014) or required reoperation (64.8° [group S] vs. 38.0° [group R]; P < 0.001). Traditionally considered variables such as apical vertebra rotation, apical vertebra translation, Cobb angle magnitudes, coronal and sagittal balance, and their respective thoracic-to-lumbar ratios were not independently significant.
    CONCLUSION:

    Selective thoracic fusions performed for lumbar "C" modifier scoliotic deformities generally have excellent long-term radiographic and SRS-30 outcomes at 5- to 24-year follow-up. Care should be taken to ensure that overcorrection of the thoracic curve is not performed beyond the ability of the lumbar curve to compensate. Furthermore, consideration of selective thoracic fusion should not be ruled out simply because the patient may have a somewhat stiff lumbar curve based on side-bending radiographs.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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    Quote Originally Posted by Pooka1 View Post
    Oh I forgot to mention there was a study of VBS done in nine patients by someone who is not Betz/Luhmann/<insert name of VBS expert>. VBS did not halt progression or prevent surgery in 7 of these patients who started out with moderate T curves. Now they have to match that against similar patients who were operated on by Betz/Luhmann/<insert name of VBS expert> to see if the results are operator dependent in my opinion. This guy may simply have documented an unfortunate learning curve.
    Interesting, indeed. I know that in Philly, where the vast majority of VBS surgeries to date have been performed, they have compiled data over the past decade or so. In fact, a few years ago, after analyzing this data which included outcomes on hundreds of patients (9 is a very small number), they changed the criteria to recommend VBS mainly only to patients with curves 35 degrees or less. Apparently, the success rate was much lower in the 35+ range.

    So, I guess a lot would depend - as you mentioned - on many variables (when the surgeries where performed, by whom, etc.).
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    Quote Originally Posted by Pooka1 View Post
    I wrote:



    I re-read the abstract. This study was of "adult spinal deformity" and therefore is not relevant to IS. I assume it is adult onset, pathology, whatever.
    I have a scoliosis curve [and DDD and arthritis], and my pain doctor said that if I go for surgical opinions, to make sure that I see an "adult deformity spinal surgeon". Also, there are many adults with scoliosis spinal deformities whose scoliosis started in their teens, but never had surgery.You would have to read the details of the "sample" to know just who he is sampling in the study. I am sure that there are other "adult deformities" that are not scoliosis. Might be a mixed bag of different adults w/ spinal deformities....some of whom have scoliosis whether adult onset or child onset.
    Susan
    Last edited by susancook; 09-06-2012 at 09:22 PM. Reason: poor spelling ;+[ and one incorrect word
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone + prayer

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    Quote Originally Posted by susancook View Post
    I have a scoliosis curve [and DDD and arthritis], and my pain doctor said that if I go for surgical opinions, to make sure that I see an "adult deformity spinal surgeon". Also, there are many adults with scoliosis spinal deformities whose surgery started in ther teens, but never had surgery.You would have to read the details of the "sample" to know just who he is sampling in the study. I am sure that there are other "adult deformities" that are not scoliosis. Might be a mixed bag of different adults w/ spinal deformities....some of whom have scoliosis whether adult onset or child onset.
    Susan
    I think you are exactly right. In the abstract, it said that the patients were a mixed bag of etiologies or diagnoses or something like that so that is important to any variability they observed. Not sure they should be crunching all the data together if so. I'm not sure how a car crash victim with fractures in their spine relates to adult onset scoliosis relates to spondylolisthesis relates to etc. etc.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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    Quote Originally Posted by susancook View Post
    I have a scoliosis curve [and DDD and arthritis], and my pain doctor said that if I go for surgical opinions, to make sure that I see an "adult deformity spinal surgeon". Also, there are many adults with scoliosis spinal deformities whose surgery started in ther teens, but never had surgery.You would have to read the details of the "sample" to know just who he is sampling in the study. I am sure that there are other "adult deformities" that are not scoliosis. Might be a mixed bag of different adults w/ spinal deformities....some of whom have scoliosis whether adult onset or child onset.
    Susan
    While I think this is generally a good strategy, if everyone lived by this, Lenke would still be doing only kids.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
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    Quote Originally Posted by Pooka1 View Post
    I think you are exactly right. In the abstract, it said that the patients were a mixed bag of etiologies or diagnoses or something like that so that is important to any variability they observed. Not sure they should be crunching all the data together if so. I'm not sure how a car crash victim with fractures in their spine relates to adult onset scoliosis relates to spondylolisthesis relates to etc. etc.
    I have worked as a researcher, and you bring up an extremely valuable point as did the person [maybe it was you] above who noted that the N=9 in one study may have very limited generalizability. About 6 months ago when I joined the group here, I mentioned that I was having some bouts of severe back pain with my scoliosis "S" curse of 25* and 36*. My scoliosis is postmenopausal late onset degenerative scoliosis, diagnosed when I was 65. There were many on the blog who questioned why my surgeon would do surgery with such a small curve and that I shouldn't have such pain with such a small curve as theirs was much larger and they had no pain. All scoliosis is not the same and it would be difficult to generalize findings of studies of people with adolescent onset scoliosis to my older group. Collapsing groups of people with different etiologies of spine deformity into a sample and then reporting the research outcome, one might think has generalizability to ALL spinal deformity people is fraught with error. One of the studies presented at the conference compared outcomes of young spinal surgery patients with older spine surgical persons. There were significant differences in the findings of the two groups. Also, in the conference, there was someone who stated that 2 groups were different, but then when you read on [I pulled up the whole research article on the web], the difference was not statistically different. If there is a difference in two groups, that is not statistically significant, as a researcher you may say that there appears to be a "trend", but you need to go on to say that the difference between the groups was not statistically significant and that research needs to continue, perhaps with a larger sample size which might indeed show a difference. Enough Stats 101 lecturing....Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone + prayer

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    Quote Originally Posted by LindaRacine View Post
    While I think this is generally a good strategy, if everyone lived by this, Lenke would still be doing only kids.
    Linda, Unsure what you mean. Please clarify. Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone + prayer

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    Quote Originally Posted by Pooka1 View Post
    http://www.srs.org/professionals/mee...al-program.pdf


    - No low risk Scoliscore patients ended up with a curve >25* at maturity

    - 340 cases of Scoliscore intermediate risk group (51 - 180) - risk varies tremendously in this group. Linear increase in risk of progression with score. Exponential increase in risk of progression to surgical range with score.
    Just found out that Axial Biotech sold ScoliScore for a small fraction of their investment.

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    I'm sarcastic... what's your super power? --Unknown
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    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
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    Quote Originally Posted by susancook View Post
    Linda, Unsure what you mean. Please clarify. Susan
    I was responding to your statement that you were told to find an adult scoliosis surgeon. Dr Lenke's background is in pediatrics, but he is undoubtedly one of the top adult revision surgeons in the world.

    Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
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    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

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    Quote Originally Posted by LindaRacine View Post
    I was responding to your statement that you were told to find an adult scoliosis surgeon. Dr Lenke's background is in pediatrics, but he is undoubtedly one of the top adult revision surgeons in the world.

    Linda
    Thanks. My point was that he was trying to tell me not to just see a doctor that does orthopedic surgery or just general back surgery, but to see a "deformity" specialist, in my case that takes care of older persons. I was a little bit upset initially that he said that I should see a "deformity" spine doctor. So, that means that I am deformed? Not ready for that label. I stepped back and understood his intent of his statement, but still find the label of "deformity specialist" as my doctor an uncomfortable one. Maybe it's semantics....
    Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone + prayer

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