Patient-reported Outcomes Following Surgical Intervention for Adolescent Idiopathic Scoliosis

Abstract

Study Design: This was a systematic review and meta-analysis. Objective: This study aims to perform a systematic review and quantitative meta-analysis of patient-reported outcome measures after spinal fusion for adolescent idiopathic scoliosis (AIS). Summary of Background Data: Radiographic correction of scoliosis is extensively reported in the literature but there is a need to study the impact of spinal fusion on patient-reported outcome measures. Prior reviews lacked homogeneity in outcome measures, did not perform quantitative meta-analysis of pooled effect size, or interpret the results in light of minimally clinically important difference thresholds. Materials and Methods: A systematic review of medical databases identified all studies that prospectively reported Scoliosis Research Society (SRS)-22 questionnaire data after spinal fusion for AIS. We screened 2314 studies for eligibility. Studies were included that reported preoperative and postoperative data at 24- or >60-month follow-up. Studies were excluded that failed to report means and SDs which were needed to calculate Cohen d effect sizes and 95% confidence intervals in estimating the magnitude and precision of the effect. Results: A total of 7 studies met eligibility criteria for inclusion in quantitative meta-analysis of effect sizes and 95% confidence intervals. Patients report large improvements in total score, self-image, and satisfaction; and moderate improvements in pain, function and mental health at 2 and 5 years after spinal fusion for AIS. All domains showed statistically significant improvement at all times except function at >60 months. All domains surpassed the minimally clinically important difference at all times except mental health. Conclusions: Moderate evidence suggests that spinal fusion improves quality of life for adolescents with idiopathic scoliosis in medium and long-term follow-up. Our results may help inform patient expectations regarding surgery. OCEMB Level of Evidence: Level I—systematic review and meta-analysis of prospective studies.

Cost-Utility Analysis of Anterior Vertebral Body Tethering versus Spinal Fusion in Idiopathic Scoliosis from a US Integrated Healthcare Delivery System Perspective

“…No death state was included in the model given that patients were young, and the procedures are not associated with a significant risk of death. 43,51 Also, there is unlikely to be a difference in mortality between the procedures. 52 Diagrams of the model structure for patients in the VBT and spinal fusion treatment groups are provided in Figure 2.…”

“…Data from NCT02897453 were used to derive the mean postoperative VBT utility, and data from Aghdasi et al to derive the mean postoperative spinal fusion and preoperative utilities. 39,43 This was a large meta-analysis that reported preference-based outcomes for 1494 pediatric and young adult patients that underwent spinal fusion for the treatment of IS, with a mean age of 14.6 years. 43 Cobb angle and Sanders stage was not reported for this population.…”

“…39,43 This was a large meta-analysis that reported preference-based outcomes for 1494 pediatric and young adult patients that underwent spinal fusion for the treatment of IS, with a mean age of 14.6 years. 43 Cobb angle and Sanders stage was not reported for this population. Scoliosis Research Society Outcomes Questionnaire (SRS-22r) scores were reported for both the NCT02897453 and Aghdasi et al cohorts.…”

“…Scoliosis Research Society Outcomes Questionnaire (SRS-22r) scores were reported for both the NCT02897453 and Aghdasi et al cohorts. 39,43 For VBT, scores from the NCT02897453 cohort were reported over a range of time points, from 27-89 months after index surgery. 39 For spinal fusion, Aghdasi et al reported three sets of mean scores from Quarterly probability of VBT revision 0.77% a (equivalent to a cumulative 2-year revision probability of 6.02%)…”

“…34,39 While costs associated with spinal fusion as a treatment for pediatric patients with IS have been reported in the literature, few cost-effectiveness analyses investigating spinal fusion in IS have been performed. [40][41][42][43] Additionally, to the best of our knowledge, there are no previous costing or cost-effectiveness analyses investigating VBT for the treatment of IS. VBT is associated with higher device costs compared with spinal fusion.…”