Announcement

Collapse
No announcement yet.

FAO Linda... older vs newer instrumentation

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • FAO Linda... older vs newer instrumentation

    I mentioned in some recent thread that I read a conclusion in a recent meeting abstract indicating that the older instrumentation was just as good as the newer in some cases. I finally found it and have highlighted the relevant sentences...

    http://www.srs.org/professionals/mee..._abstracts.pdf

    Paper #82

    A 13-14 Year Follow Up of Outcome for Fusions in Idiopathic Scoliosis
    Colin Nnadi, FRCS(Orth) (Queens Medical Campus); Prakash Jayakumar, MRCS; Satoshi Hori, BSc, MB, BS, MRCS; Adrian Casey;
    David Harrison, FRCS; Ben Taylor; Dimitri A. Raptis, MRCS

    Introduction: Corrective Scoliosis surgery has evolved since the introduction of the Harrington instrumentation system. Newer
    techniques of correction involve the use of segmental instrumentation which improves 3-dimensional correction. Previous
    studies have based outcome assessments of surgery on the older instrumentation systems such as the Harrington system using
    objective parameters such as radiographic data and health related quality of life measures. We now know that some of these
    parameters are only weakly linked to outcomes more relevant to patients. Health related quality of life assessments have
    addressed this issue considerably but still retain the drawback of not being specific to the condition being assessed. We have
    used a validated and reliable disease specific questionnaire to evaluate outcome.

    Methods: Over a 2 year period from 1993 to 1994, 101 patients with a diagnosis of Adolescent Idiopathic Scoliosis who had
    undergone surgery in a tertiary institution in the UK were identified. These patients were recontacted and evaluated using
    the Modified Scoliosis Research Society Questionnaire. Correlations between patient generated data and outcome were also
    evaluated.

    Results: There was an overall general satisfaction with surgery. No correlation was found between patient generated data and
    outcome except in patients with posterior instrumentation extending proximal to T4 vertebra. In this group of patients the
    outcome scores in 4 out of 5 domains of the questionnaire were significantly better than in other groups.

    Conclusion: Using a disease specific questionnaire to evaluate surgically treated Idiopathic Scoliosis we have identified the
    proximal extent of the fusion as the single variable to affect outcome. This contrasts with previous work which has focused on
    the distal extent of fusion. We have also shown that the Harrington system, contrary to opinion, compares favourably with the
    more modern instrumentation systems.


    Significance: The strength of our study is the focus on patient based evaluation of the effects of scoliosis surgery. Suprisingly,
    there are no significant differences in outcome between older and more modern corrective techniques despite the perceived
    theoretical advantages of the latter.


    -------------

    Now I am guessing this pertains only to T fusions given the known incidence of flatback syndrome with L fusions w/ Harrington rods (yes?) but they didn't mention that.
    Last edited by Pooka1; 10-13-2009, 06:28 AM.
    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."

  • #2
    Well, that explains why I didn't hear it (it was last year).

    The paper brings up far more questions than answers. For example, is it possible that the surgeons at this institution aren't (or weren't) very adept at implanting the newer hardware?

    I've read it a dozen times now, and I still can't make sense of this:
    No correlation was found between patient generated data and
    outcome except in patients with posterior instrumentation extending proximal to T4 vertebra. In this group of patients the
    outcome scores in 4 out of 5 domains of the questionnaire were significantly better than in other groups.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

    Comment


    • #3
      Very interesting.

      I am surprised by these findings.
      45L/40T
      Surgery 25/1/2010
      Australia

      Knowthyself

      Scoliosis Corrected 25/1/2010 by Dr Angus Gray, Prince of Wales Private Hospital, Sydney. Fused T3-L4.

      Comment

      Working...
      X