Optimal surgical care for adolescent idiopathic scoliosis: an international consensus

Abstract

Purpose The surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for adolescents with AIS curves between 40°and 90°Cobb angle. Methods From July 2012 to April 2013, the AOSpine Knowledge Forum Deformity performed a modified Delphi survey where current expert opinion from 48 experienced deformity surgeons, representing 29 diverse countries, was gathered. Four rounds were performed: three web-based surveys and a final face-to-face meeting. Consensus was achieved with C70 % agreement. Data were analyzed qualitatively and quantitatively.Results Consensus of what constitutes optimal care was reached on greater than 60 aspects including: preoperative radiographs; posterior as opposed to anterior (endoscopic) surgical approaches; use of intraoperative spinal cord monitoring; use of local autologous bone (not iliac crest) for grafts; use of thoracic and lumbar pedicle screws; use of titanium anchor points; implant density of \80 % for 40°-70°curves; and aspects of postoperative care. Variability in practice patterns was found where there was no consensus. In addition, there was consensus on what does not constitute optimal care, including: routine pre-and intraoperative traction; routine anterior release; use of bone morphogenetic proteins; and routine postoperative CT scanning. operative care for adolescents with AIS. In the absence of current high-level evidence, at present, these expert opinion findings will aid health care providers worldwide define appropriate care in their regions. Areas with no consensus provide excellent insight and priorities for future research.

Three-dimensional EOS Analysis of Apical Vertebral Rotation in Adolescent Idiopathic Scoliosis

“…12 Routine usage of the postoperative CT scan is currently not recommended given high radiation exposure to the patients, especially in pediatric population. 13 For these reasons we choose the EOS imaging system (EOS imaging SA, Paris, France), 14 which simultaneously produces high-quality biplanar anteroposterior and lateral x-ray images of the whole body in a standing position, with approximately one tenth of the conventional radiography. 15 As these 2D images are automatically calibrated, by matching their anatomic landmarks on a working station, it also provides a 3D model of the whole spine.…”

Does higher screw density improve radiographic and clinical outcomes in adolescent idiopathic scoliosis? A systematic review and pooled analysis

“…26,32 Furthermore, an international consensus suggested that an implant density less than 80% was optimal (73% vs 27%) for moderate curves with a Cobb angle of 40°-70°. 5 As to sagittal correction, pooled data on thoracic kyphosis were available in 8 studies, involving a total of 475 patients, and no significant differences were found (p = 0.26, I 2 = 79%). The same conclusion was recorded in 2 additional studies (p = 0.15 and p = 0.37).…”

Die idiopathische Skoliose

“…Während Thorakalskoliosen häufig mit einer Abflachung der thorakalen Kyphose einhergehen, findet sich bei den Thorakolumbalskoliosen häufig eine Rotationskyphose im thorakolumbalen Übergang. Anzumerken ist, dass die konkavseitigen Pedikel so klein waren, dass diese überwiegend uninstrumentiert bleiben mussten [12].…”