Selection of the Lowest Level for Fusion in Adolescent Idiopathic Scoliosis—A Systematic Review and Meta-Analysis

Merriman, Matthew; Hu, Calvin; Noyes, Katia

doi:10.1016/j.jspd.2014.06.010

Cited by 13 publications

(6 citation statements)

References 46 publications

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“…Patients with AIS treated with LIV from L4 or caudally had worse ODI scores than those treated with LIV from L3 or cranially, according to Lander et al ,15 who also found that these patients were more likely to need additional surgical treatment. However, despite the tendency for patients whose fusion reached the L4 or L5 level to endure greater pain, a meta-analysis revealed no statistically significant correlation between the distal fusion level and the incidence of later back pain 16. In our study, the SRS-22 pain domain and RDQ questionnaire results for the patients with AIS who underwent surgery at least 40 years prior have remained stable for the past 13 years.…”

Section: Discussioncontrasting

confidence: 59%

“…However, despite the tendency for patients whose fusion reached the L4 or L5 level to endure greater pain, a meta-analysis revealed no statistically significant correlation between the distal fusion level and the incidence of later back pain. 16 In our study, the SRS-22 pain domain and RDQ questionnaire results for the patients with AIS who underwent surgery at least 40 years prior have remained stable for the past 13 years. However, the ODI score results deteriorated over the past 8 years.…”

Section: Discussionmentioning

confidence: 59%

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Health-Related Quality of Life of Patients With Adolescent Idiopathic Scoliosis at Least 40 Years After Surgery

Akazawa

Kotani

Sakuma

et al. 2022

Spine

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Study Design. Retrospective study. Objective. The aim was to clarify the health-related quality of life (QOL) of patients who had adolescent idiopathic scoliosis (AIS) at a minimum of 40 years after surgery. Summary of Background Data. The postoperative health-related QOL of middle-aged patients with AIS has been reported to be good, but that of middle-aged and older patients with AIS has yet to be completely explored. Materials and Methods. We included 179 patients with AIS who underwent spinal fusion(s) between 1968 and 1982. We conducted three surveys in 2009, 2014, and 2022. Patients self-administered both the Scoliosis Research Society-22 and the Roland-Morris Disability questionnaires three times (in 2009, 2014, and 2022) and the Oswestry Disability Index (ODI) questionnaire was self-administered in 2014 and 2022. We considered patients who responded to all three surveys in 2009, 2014, and 2022. Results. For the Scoliosis Research Society-22 questionnaires, no significant differences were detected among the three time points (2009, 2014, and 2022) for total scores, function domain, pain domain, self-image domain, mental domain, or satisfaction domain. The results of the Roland-Morris Disability Questionnaire were also not significantly different among the surveys over time. The ODI questionnaires revealed a significant worsening of the 2022 results compared with the 2014 results. Eight patients (29.6%) who had an ODI deterioration of 10% or more had numerically fewer mobile lumbar disks than those with <10% deterioration of the ODI, although the difference did not reach statistical significance. Conclusion. Among patients with AIS who underwent spinal fusion(s) between 1968 and 1982, we found health-related QOL to be maintained over the last 13 years. Relatively good QOL was appreciated in this population of patients who are now middle-aged and older.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 59%

Health-Related Quality of Life of Patients With Adolescent Idiopathic Scoliosis at Least 40 Years After Surgery

Akazawa

Kotani

Sakuma

et al. 2022

Spine

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“…Second, does Harrington instrumentation extending into the lumbar spine with correction by distraction and resultant lumbar flattening result in poor long-term outcomes 7,8 ? A 2015 systematic review and meta-analysis of medium-term, 20-year follow-up was unable to confirm or refute an association between lower levels of instrumentation and increasing pain or disability 9 .…”

mentioning

confidence: 99%

Long-Term Health-Related Quality of Life After Harrington Instrumentation and Fusion for Adolescent Idiopathic Scoliosis

Lander

Thirukumaran

Saleh

et al. 2022

Journal of Bone and Joint Surgery

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Background:Despite its importance for clinical decisions, the long-term consequences of posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS), particularly in the lower lumbar spine, remain unclear. This study evaluates the long-term health-related quality of life and the need for a further surgical procedure in patients treated with Harrington instrumentation from 1961 to 1977 according to the lowest instrumented vertebra (LIV) and in comparison with age-matched norms.Methods:A search was performed to identify and contact the 314 identified patients with AIS treated with PSIF by Dr. L.A. Goldstein. The assessment included identified subsequent spine surgery, the Oswestry Disability Index (ODI), Scoliosis Research Society-7 (SRS-7), EuroQol-5 Dimensions (EQ-5D), and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29). The health-related quality of life was compared with U.S. norms and, within the cohort, was compared by patient factors, LIV, and subsequent spine surgery.Results:In this study, 134 patients (42.7%) were identified; 24 (7.6%) had died, 81 (25.8%) consented to participate in the study, and 29 (9.2%) declined participation. The mean follow-up was 45.4 years (range, 40 to 56 years). There were 81 patients who completed the surveys, 77 patients who completed the SRS-7, 77 patients who completed the ODI, and 76 patients who completed the PROMIS-29 and EQ-5D. There were 12.8% of patients with LIV L3 or proximal and 36.4% with LIV L4 or distal who had an additional surgical procedure (odds ratio, 3.98). Comparing the ODI of patients who had undergone an additional surgical procedure with those who had not showed 42% and 73% minimal disability, 53% and 23% moderate disability, and 5% and 2% severe disability. Of the patients who had not undergone an additional surgical procedure, those with LIV L3 or proximal had mean scores of 14.12 points for the ODI and 23.3 points for the SRS-7 and those with LIV L4 or distal had mean scores of 17.9 points for the ODI and 22.7 points for the SRS-7; these differences were not significant. The mean PROMIS-29 and EQ-5D scores were not different from normal U.S. age-based means.Conclusions:Patients with AIS treated with PSIF at a mean 45-year follow-up and LIV L4 or distal had a higher rate of undergoing an additional surgical procedure than those with LIV L3 or proximal. Patients undergoing an additional surgical procedure had lower health-related quality of life than those who did not. Despite this, there was no difference in health-related quality of life for patients with LIV L4 or distal compared with patients with LIV L3 or proximal. This cohort of patients with AIS treated with PSIF demonstrates normal self-reported health-related quality of life compared with the age-matched general population. These long-term outcomes of PSIF for AIS are encouraging.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…The findings presented here are in line with previous reviews investigating the pathophysiology and treatment of AIS. However, we chose a rather pragmatic approach: while other works focus on specific subsets of evidence such as anatomical abnormalities or treatments (i.e., [ 83 , 84 ]), our review prioritized the assessment methods. Thus, our results provide a clear, data-driven outlook that leaves less room for subjective inference.…”

Section: Discussionmentioning

confidence: 99%

Neurophysiological, balance and motion evidence in adolescent idiopathic scoliosis: A systematic review

Paramento,

Passarotto,

Maccarone

et al. 2024

PLoS ONE

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Background Adolescent idiopathic scoliosis (AIS) is a spinal deformity that affects approximately 4% of the world’s population. Several hypotheses regarding the etiology of AIS have been investigated. In the last decades, impaired visual-spatial perception, alterations in spatial body orientation and sensory integration deficits have been documented. Objective We aimed to summarize the neurophysiological, balance, and motion evidence related to AIS published in the last fifteen years, between January 2008 and April 2023. Both observational and interventional studies were considered. Only studies using quantitative assessment methods, such as electroencephalography (EEG), electromyography (EMG), magnetic resonance imaging (MRI), somatosensory evoked potentials, force platform, or motion capture, were included. Methods 1250 eligible records identified from online database searching were filtered by duplicate removal, title and abstract screening, and qualitative analysis. 61 articles met the inclusion criteria (i.e., Cobb range 10°-35°, age range 10-18 years) and were summarized. Results We found significant evidence of impaired standing balance in individuals with AIS who greatly rely on visual and proprioceptive information to stay upright. EMG studies frequently reported an increased activity on the convex side of the intrinsic spinae muscles. EEG data show increased delta and theta power, higher alpha peak frequencies, and significant suppression in the alpha and beta bands in subjects with AIS during standing tasks. MRI studies report changes in white matter structures, differences in the vestibular system, and abnormal cortical activations over motor-related areas in subjects with AIS. Bracing appears to be an effective treatment for AIS, leading to improvements in static balance and gait. Methodological issues prevent reliable conclusions about the effects of other treatment options. Conclusions This review underscores the importance of quantitative assessment methods to explore the etiology and pathophysiology of AIS. Further research is needed to measure the impact of physical therapy and orthotic treatments on the neurophysiological mechanisms of the disease.

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Selection of the Lowest Level for Fusion in Adolescent Idiopathic Scoliosis—A Systematic Review and Meta-Analysis

Cited by 13 publications

References 46 publications

Health-Related Quality of Life of Patients With Adolescent Idiopathic Scoliosis at Least 40 Years After Surgery

Health-Related Quality of Life of Patients With Adolescent Idiopathic Scoliosis at Least 40 Years After Surgery

Long-Term Health-Related Quality of Life After Harrington Instrumentation and Fusion for Adolescent Idiopathic Scoliosis

Neurophysiological, balance and motion evidence in adolescent idiopathic scoliosis: A systematic review

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