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Thread: Top surgeons don't know why their colleagues are not doing more STFs

  1. #1
    Join Date
    Jan 2008
    Location
    NC
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    8,903

    Top surgeons don't know why their colleagues are not doing more STFs

    Well, if Lenke and all those other top surgeons don't know why their colleagues are not following the recommendation to only fusion the thorax in false doubles then I suggest the guys ignoring the recommendations may not know either. Can't they just ask around at the next meeting? Maybe even buttonhole some of them? Wow.

    Selective Thoracic Fusion in Lenke 1C Curves: Prevalence and Criteria IMAST 2011 Paper #89
    Crawford, Charles H. III MD; Lenke, Lawrence G. MD; Sucato, Daniel J. MD, MS; Richards, B. Stephens III MD; Emans, John B. MD; Vitale, Michael G. MD; Erickson, Mark A. MD; Sanders, James O. MD
    Published Ahead-of-Print
    Abstract
    Study Design. Multicenter retrospective analysis of prospectively collected data.

    Objective. Evaluate radiographic and clinical characteristics of patients undergoing an STF for Lenke 1C curves.

    Summary of Background Data. Selective thoracic fusion (STF) of adolescent idiopathic scoliosis (AIS) has been advocated for the so-called "false double major" curve (Lenke 1C/King Type II). Despite these recommendations, many surgeons continue to perform non-selective fusions (NSF) for this curve type. It is unknown to what extent other factors influence the surgeon's fusion level selection.

    Methods. A prospective multicenter database included 264 patients with surgically treated Lenke 1C curves and were divided into two groups. The STF group included patients with the lowest instrumented vertebra (LIV) at or cephalad to L1, while the NSF group included patients with the LIV at or caudal to L3. Preoperative radiographic, clinical (scoliometer), Scoliosis Appearance Questionnaire (SAQ), and Scoliosis Research Society (SRS) questionnaires were analyzed and compared.

    Results. Only 138/264 patients (49%) underwent an STF. Gender ratio (90% vs. 86% female), average age (14.7 vs. 14.8 years), and preoperative main thoracic (MT) Cobb angles (56.0[degrees]+/-9.9 vs. 55.3[degrees]+/-11.4) were not significantly different (STF vs. NSF). However, the average thoracolumbar/lumbar (TL/L) preoperative Cobb angle was significantly smaller in the STF group (42.1[degrees]+/-8.6 vs. 47.0[degrees]+/-9.0; p<0.001) while the MT:TL/L Cobb ratio (1.35+/-0.20 vs. 1.18+/-0.15; p<0.001), apical vertebral translation and rotation (1.82+/-0.59 vs. 1.31+/-0.53; p<0.001), (1.16 vs. 0.98; p<0.001) were significantly greater in the STF group. Preoperative coronal balance, sagittal Cobb angles (including T10-L2 kyphosis) and Risser Grade were not significantly different. Preoperative TL/L scoliometer measures were significantly less in the STF group (8.1[degrees]+/-3.7 vs. 10.3[degrees]+/-5.4; p = 0.001). On the SAQ, the STF group had less desire for an appearance change.

    Conclusion. Despite the recommendation to fuse only the structural thoracic curve in a 1C curve, only 49% of patients were treated with an STF. An STF resulted in smaller TL/L Cobb angles, less TL/L clinical deformity, larger MT:TL/L ratios, and less desire for an appearance change.

    (C) 2013 Lippincott Williams & Wilkins, Inc.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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  2. #2
    Join Date
    Mar 2010
    Posts
    2,755
    Well it's got to be one of two, maybe three reasons:
    1. Old habits are hard to break.
    2. The surgeons feel that the longer fusions may reduce the need for further surgery.
    3. But, if they are going very far into the lumbar, their patients will likely need further surgery. I hate to think it, but maybe that's the reason. Repeat business. I know that's horrible of me, but these surgeries are very expensive.

    I met one of my doctor's patients while waiting for an x-ray. We got to talking and she said he fused only to L4 even though she needed a to the pelvis fusion. The reason? So she could keep skiing for a few more years. So they both went into it KNOWING she was going to need another fusion soon. That would not have been my choice. As TiEd has proven, if you are determined, you can continue to ski with your pelvis fused. So this was an idea that came from the doctor and she trusted his opinion and went with it. I'm not saying that the surgeon is a bad guy. He probably really believed it. But repeat business is good for the pocketbook of the doctor!
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