Scoliosis correction objectives in adolescent idiopathic scoliosis. 2007

Younes Majdouline, and Carl-Eric Aubin, and Martin Robitaille, and John F Sarwark, and Hubert Labelle
Department of Mechanical Engineering, Ecole Polytechnique de Montréal, Canada.

BACKGROUND A recent study revealed large variability among a group of 32 spine surgeons in the preoperative instrumentation strategies for the same 5 adolescent idiopathic scoliosis (AIS) patients. The surgical plans were determined to be surgeon and curve-type dependent. It is hypothesized that this variability may be attributed to different objectives for correction. This study is presented to document and analyze 3-dimensional (3-D) surgical correction goals for AIS as determined by a sample of experienced spine surgeons. METHODS Fifty surgeons from the Spinal Deformity Study Group were surveyed and asked to rank 20 parameters of scoliosis correction and to provide weights for correction in the coronal, sagittal, and transverse planes and for mobility (number of unfused vertebrae) according to their importance for an optimal 3-D correction. Responders were also asked to complete a more detailed survey where the correction objectives were assessed for each of the 6 Lenke curve types. Importance and variability of the correction parameters were evaluated using median (M) and interquartile range (IQR) of the rank (1-20). Intraobserver reliability was assessed by means of intraclass correlation coefficients. RESULTS Twenty-five surgeons completed the first questionnaire. There was overall agreement that sagittal (M, 1; IQR, 1) and coronal (M, 2; IQR, 0.5) balance were the most important parameters for an optimal correction. Apical vertebral rotation was the least important. All other parameters were highly variable. The Cobb angles were moderately important, with ranks between 8 and 11 (IQR, 3-5.75). Lumbar lordosis (M, 6.5; IQR, 6.5) had a better rank and consensus than thoracic kyphosis (M, 13; IQR, 10). Results for individual parameters were in agreement with the weights given for an optimal 3-D correction in the coronal (36%) and sagittal (34%) planes. A subgroup of 10 surgeons completed the second survey. Mobility was more important for Lenke curve types 3 to 6 than for types 1 and 2 (P < 0.032). The coronal plane was more important for curve types 2 and 4 than for the other types (P < 0.032). The intraobserver reliability for determining the different parameters of scoliosis correction was poor to moderate. CONCLUSIONS There is a large variability in scoliosis correction objectives. The variability is both surgeon and curve-type dependent. The variability in instrumentation goals may explain the documented variability of spine instrumentation strategies among surgeons. Aside from achieving sagittal and coronal balance, the goals of surgical correction in AIS remain to be further determined and agreed upon by a consensus of spine deformity surgeons. METHODS Level V.

UI MeSH Term Description Entries
D008297 Male Males
D010818 Practice Patterns, Physicians' Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided. Clinical Practice Patterns,Physician's Practice Patterns,Clinical Practice Pattern,Pattern, Clinical Practice,Patterns, Clinical Practice,Practice Pattern, Clinical,Practice Patterns, Clinical,Practice Patterns, Physician's,Prescribing Patterns, Physician,Physician Practice Patterns,Physician Prescribing Pattern,Physician Prescribing Patterns,Physician's Practice Pattern,Physicians' Practice Pattern,Physicians' Practice Patterns,Practice Pattern, Physician's,Practice Pattern, Physicians',Practice Patterns, Physician,Prescribing Pattern, Physician
D011795 Surveys and Questionnaires Collections of data obtained from voluntary subjects. The information usually takes the form of answers to questions, or suggestions. Community Survey,Nonrespondent,Questionnaire,Questionnaires,Respondent,Survey,Survey Method,Survey Methods,Surveys,Baseline Survey,Community Surveys,Methodology, Survey,Nonrespondents,Questionnaire Design,Randomized Response Technique,Repeated Rounds of Survey,Respondents,Survey Methodology,Baseline Surveys,Design, Questionnaire,Designs, Questionnaire,Methods, Survey,Questionnaire Designs,Questionnaires and Surveys,Randomized Response Techniques,Response Technique, Randomized,Response Techniques, Randomized,Survey, Baseline,Survey, Community,Surveys, Baseline,Surveys, Community,Techniques, Randomized Response
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D012600 Scoliosis An appreciable lateral deviation in the normally straight vertical line of the spine. (Dorland, 27th ed) Scolioses
D015203 Reproducibility of Results The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results. Reliability and Validity,Reliability of Result,Reproducibility Of Result,Reproducibility of Finding,Validity of Result,Validity of Results,Face Validity,Reliability (Epidemiology),Reliability of Results,Reproducibility of Findings,Test-Retest Reliability,Validity (Epidemiology),Finding Reproducibilities,Finding Reproducibility,Of Result, Reproducibility,Of Results, Reproducibility,Reliabilities, Test-Retest,Reliability, Test-Retest,Result Reliabilities,Result Reliability,Result Validities,Result Validity,Result, Reproducibility Of,Results, Reproducibility Of,Test Retest Reliability,Validity and Reliability,Validity, Face
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D019637 Orthopedic Procedures Procedures used to treat and correct deformities, diseases, and injuries to the MUSCULOSKELETAL SYSTEM, its articulations, and associated structures. Orthopedic Surgery,Surgery, Orthopedic,Orthopedic Rehabilitation Surgery,Orthopedic Surgical Procedures,Orthopedic Procedure,Orthopedic Rehabilitation Surgeries,Orthopedic Surgeries,Orthopedic Surgical Procedure,Procedure, Orthopedic,Procedure, Orthopedic Surgical,Procedures, Orthopedic,Procedures, Orthopedic Surgical,Rehabilitation Surgeries, Orthopedic,Rehabilitation Surgery, Orthopedic,Surgeries, Orthopedic,Surgeries, Orthopedic Rehabilitation,Surgery, Orthopedic Rehabilitation,Surgical Procedure, Orthopedic,Surgical Procedures, Orthopedic

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