MedicalResearch.com Interview with:
Dr. Baron Lonner MD
Professor of Orthopaedic Surgery
Mount Sinai Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Adolescent idiopathic scoliosis is the most common form of scoliosis, lateral curvature of the spine, in the pediatric population. 2-3% of adolescents are affected and approximately 10% of patients require surgery. Operative treatment has traditionally involved a spinal fusion with the use of metallic implants. I personally have been practicing spine surgery with an emphasis on the treatment of the pediatric patient with scoliosis for over twenty years. During the course of my own practice, I have seen significant changes in the way my colleagues and I operatively manage adolescent idiopathic scoliosis (AIS). Being part of a group of surgeons from around the world who contribute clinical data on patients with AIS, with a database of nearly 3000 patients, a group called the Harms Study Group after Professor Jurgen Harms of Germany, an innovator in this area, and housed within the larger Setting Scoliosis Straight Foundation, I felt, now, as we reached the twenty year mark of data collection in January 2015, was the moment to look at trends in our collective experience.
Our goal was to evaluate changes in the surgical approach to AIS over this time span and to assess whether or not these changes have been associated with improvements in outcomes for the patient including decreases in complication rates. Perhaps we could learn lessons from this data, contributed by leaders in the treatment of AIS, that might inform future innovations and to be confirmatory of the trajectory of our approach to these patients.
MedicalResearch.com: What are the main findings?
Response: We divided the past 20 years from 1996 into 5 year quartiles. In the first quartile, the vast majority of surgery was done from an anterior approach from the side of the patientfor all curve types.
By the last quartile, no surgery was done from the anterior approach, all was done from the back (posterior) approach with a small percentage having an anterior release procedure in which a scope is used and small incisions are made in the patients side in order to remove discs within the curvature to make it more flexible to facilitate the correction.
• The use of pedicle screws instead of hooks used earlier in the study period was almost 100% by the last quartile.
• The use of thoracoplasty, resection of several ribs to decrease the rib hump commonly seen in patients with scoliosis, decreased from 80% to 20% from the first to 4th quartiles.
• Spinal fusions actually increased in length for the most common curve type from 8 to 10 levels.
• Blood loss decreased from 130cc per level fused to 80cc per level fused.
• Operative time decreased from nearly 400 to 300 minutes for the procedure.
• Perhaps most importantly, major complication rates decreased from 19% to 5%, with neurological complications decreasing from 7% to 2% and reapportions from 12% to 3%.
• Finally, patient reported outcomes improved slightly from the earliest phase of the study period until the last.
MedicalResearch.com: What should readers take away from your report?
Response: Safety and operative morbidity as well as outcomes have been improving in the treatment of AIS. However, number of levels fused has increased.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Further research is warranted into innovative non-fusion correction techniques once the FDA of the U.S. approves a pathway for doing so. These promising techniques offer the benefits of preserving flexibility and growth and may result in less adjacent segment degenerative disc disease that can result following a spinal fusion in the adjacent, non-fused motion segments of the spine.
Disclosures: Consultant for Depuy Synthes Spine, Ethicon, Zimmer Biomet Spine
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Citation: Abstract presented at AAOS meeting Thursday, March 16th
Evolution of Surgery for Adolescent Idiopathic Scoliosis over 20 Years: Have Outcomes Improved? #676
Baron Lonner, MD, Professor, Orthopaedics, Icahn School of Medicine at Mount Sinai
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