More potential confounders for AIS curve progression studies

[Pooka1]

http://journals.lww.com/spinejournal...and.98499.aspx

The Association of Patient Characteristics and Spinal Curve Parameters with Lenke Classification Types
Sponseller, Paul D. MD; Flynn, John M. MD; Newton, Peter O. MD; Marks, Michelle C. MA, PT; Bastrom, Tracey P. MA; Petcharaporn, Maty BS; McElroy, Mark J. MS; Lonner, Baron S. MD; Betz, Randal R. MD; the Harms Study Group
Published Ahead-of-Print
Collapse Box
Abstract

Study Design. Retrospective review

Objective. To determine the association of patient characteristics and spinal curve parameters with Lenke curve types.

Summary of Background Data. The Lenke curve classification may be used for surgical planning and clinical research.

Methods. We retrospectively reviewed the records of 1912 patients with adolescent idiopathic scoliosis who underwent initial surgery at <=21 years; collected data on patient age, patient gender, primary curve magnitude (<50[degrees], 50[degrees] to 75[degrees], and >75[degrees]), and SRS-22 outcome score; and compared that data by Lenke curve type. ANOVA and chi-square tests were used as appropriate (significance level, P <= 0.005).

Results. Lenke types vary by gender: males had more major thoracic (types 1 - 4) than major thoracolumbar/lumbar (types 5 and 6) curves, fewer lumbar C-modifiers (32% vs. 44%), and less apical lumbar translation (1.1 vs. 1.7 cm). Lenke types vary by frequency: the most common type was 1 (50%); the least common, 4 (4%). Lenke types vary by magnitude: type 4 had the greatest percentage of large curves (52% of curves >75o), most smaller curves were types 1 and 5, and type 4 had the largest mean magnitude (78[degrees] +/- 17[degrees]). Lenke types vary by patient age: type-5 curves occurred in the oldest patients (average age at surgery: 15.4 +/- 2.2 vs. 14.3 +/- 14.6 years for all others), despite having the lowest mean magnitude (P = 0.001); curve size was negatively correlated with age at surgery (r = -0.16, P = 0.001). Lenke types vary by patient self-image: patients with type-4 curves had lower preoperative SRS outcome scores for self-image than did patients with type-1 curves (P = 0.005).

Conclusion. Lenke types vary by gender, frequency magnitude, patient age, and patient self-image, which should be considered in designing studies.

(C) 2011 Lippincott Williams & Wilkins, Inc.

Here are the curve types:

http://www.spinal-deformity-surgeon....curvatures.gif

1 - T
2 - double T
3 - double major (T > L)
4 - triple major
5 - TL/L
6 - TL/L - T (L > T)

[titaniumed]

Lenke types vary by patient self-image: patients with type-4 curves had lower preoperative SRS outcome scores for self-image than did patients with type-1 curves (P = 0.005).

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

I think I’m the exception here. I didn’t have pain when I was dx’d at age 15, and had 2 balanced 50 degree curves. I’m either a Type 3 or type 4.

If there is no pain, and someone is suddenly diagnosed, how can SRS preoperative outcome scores be low? After I found out, a few days later, they are talking surgery. I had no idea what to think at that time....(1975)

My patient self image had nothing to do with the formation of my scoliosis. How could it?

SRS-22
http://www.hss.edu/files/SRS-22r_Pat...stionnaire.pdf

Ed

[titaniumed]

The SRS-22 form........sigh. I don’t like the test.

Question 4 is the key question, all the others are secondary and really don’t matter much.

Why bother asking someone how they would feel about living the rest of their lives with scoliosis? Is this a trick question? I’m pleased I have to deal with this, next question. (rude buzzer sound) This is not a multiple choice DMV type of question, there is a big difference. This is a person to person type of question that needs compassion. All this does is piss people off and it affects the rest of the test.

Because of this fact, I don’t trust the study.

Also, for some reason everyone thinks that medication intake is a gage on how much pain there is. This is wrong.

Anyone agree? Any adult scolis see this test years ago and think the same exact thing?

Ed