- Email: [email protected]
24. Untreated adolescent idiopathic scoliosis in adulthood: how often do these patients require surgery?
S12
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S1−S58
and ilium. While positive outcomes for improved pain and reduced opioid consumption have been associated with SIF, there is a lack of research concerning the effects of SIF on functional biomechanics such as gait performance. PURPOSE: To quantify the effects of SIF on biomechanical gait parameters of SIJD patients at three months postoperative follow-up compared to their preoperative state. STUDY DESIGN/SETTING: Non-randomized, prospective, concurrent cohort study. PATIENT SAMPLE: Twelve symptomatic SIJD patients. OUTCOME MEASURES: Spatiotemporal parameters, gait range-ofmotion (RoM) parameters, and patient-reported outcomes. METHODS: Clinical gait analysis was performed one week before surgery (Pre) and three months after surgery (Post). Each patient performed a series of over-ground gait trials at a comfortable, self-selected speed. Data were collected using a motion capture system and three force plates. Back and leg Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Fear Avoidance Beliefs Questionnaire (FABQ), Tampa Scale for Kinesiophobia (TSK), and Demoralization Scale (DS) scores were also collected at both time points. RESULTS: Patients showed increased cadence (Pre: 98.39 vs Post: 106.95 steps/min, p=0.018) and walking speed (Pre: 0.87 vs Post: 1.03 m/s, p=0.013). Patients also showed decreases in stride time (Pre: 1.28 vs Post: 1.14 s, p=0.015), step time (Pre: 0.65 vs Post: 0.58 s, p=0.015), and double-support time (Pre: 0.37 vs Post: 0.29 s, p=0.024). Patients show significant decreases in both knee RoM (Pre: 15.25 vs Post: 10.79˚, p=0.02) and head motion (Pre: 4.80 vs Post: 3.18 ˚, p=0.045) in the coronal plane. VAS leg pain score (Pre: 4.25 vs Post: 2.69, p=0.032) improved significantly postoperatively. CONCLUSIONS: SIJD patients treated with SIF showed significant improvements in functional gait and leg pain at their three-month followup. The results suggest that SIF provides improved lateral stability which in turn results in more efficient knee motion and improved cadence and step efficiency. The improved leg VAS scores reflect this notion as well. The lack of more pronounced improvements in gait and reported outcomes may be due to insufficient follow-up time to account for a full recovery following SIF. This study may serve as a basis for future diagnostic techniques which utilize gait pattern evaluation as an indicator for early development of SIJD. The findings of this study highlight the impacts that SIJD can have on patients daily lives and reinforces the importance of recognizing the SIJ as a contributor to the functional ability of an individual. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
PATIENT SAMPLE: A total of 249 patients (pts) identified and 214 pts with ODI scores available were analyzed. OUTCOME MEASURES: ODI score with respect to age, curve size, and curve location. Surgical rates in adults with AIS. METHODS: All unoperated adult (≥20yrs) AIS pts seen in a tertiary deformity clinic from 2008-2018 were reviewed. Demographics, curve size [thoracic (T) and thoracolumbar (TL)], comorbidities, and ODI were collected. ODI scores ≥20 and ≥30 were analyzed across 3 age groups: 20-39 yrs (G1), 40-59 yrs (G2), and ≥60 yrs (G3). Differences between categorical and continuous variables were analyzed. Subgroup analyses based on ODI score groups, T vs TL curves, and pts progressing to surgery with T ≥50˚ and/or TL ≥40˚ only were also analyzed. Significance was defined as p<0.05. RESULTS: A total of 249 consecutive AIS pts were seen by one author over 10 yrs. Two hundred fourteen pts had ODI scores and were included. Mean age was 41 yrs (84% female). ODI scores had positive correlations with age, BMI, and curve size (p<.001). Seventeen pts (7.9%) progressed to surgery. Pts with ODI ≥20 and ≥30 were as follows: G1 (47/108, 17/ 108); G2 (36/60, 20/60); G3 (37/46, 25/46). The percentage of scores <30 for G1, G2, G3 was 84%, 67%, and 46%, respectively. Comparing frequency of <30 to ≥30 showed significance within each group (<.001) with G1 and G2 containing a greater number of pts below 30. When comparing T and TL Cobb, there was no difference between curve size (47.7o vs 47.7o, p=.988); however, mean ODI was different (T=20.07; TL=25.02, p=.018). ODI positively correlated with T Cobb (Pearson r=.235, p=0.028) and TL Cobb (Pearson r=.236, p=0.005). Among pts with T ≥50˚ and/or TL ≥40˚, only 13/127 (10%) pts underwent surgery. Among the 127 pts with “surgical-size” Cobb(s), a subgroup analysis showed no difference in age or Cobb between Surgical (OP) and NonSurgical (NONOP) pts. ODI was significantly higher in OP (mean: 46.9) vs NONOP (mean: 22.8), (p<.001). CONCLUSIONS: ODI scores positively correlated with age, BMI, and coronal Cobb in adults with AIS. Pts age 20-59 tended to have ODI scores lower than 30. Despite “surgical size” curves, few (10%) adults seeking evaluation for scoliosis went on to surgery and those who did reported higher ODI scores than their nonsurgical counterparts. Pediatric deformity surgeons can use this information when counseling skeletally mature AIS patients and their families regarding the need for surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
https://doi.org/10.1016/j.spinee.2019.05.036
25. Use of precontoured titanium alloy rods to induce thoracic kyphosis after sequential posterior release: a cadaveric spine study Jinhui Shi, MD1, Nathaniel R. Ordway, MS2, Mike H. Sun, MD3, Stephen A. Albanese, MD2, Swamy Kurra, MD4, William F. Lavelle, MD5; 1 SUNY Upstate University Hospital, Syracuse, NY, US; 2 SUNY Upstate Medical University, Syracuse, NY, US; 3 Upstate Medical University Orthopedics, East Syracuse, NY, US; 4 Syracuse, NY, US; 5 Upstate Orthopedics, East Syracuse, NY, US
24. Untreated adolescent idiopathic scoliosis in adulthood: how often do these patients require surgery? Jace Erwin, BS1, Brandon B. Carlson, MD, MPH2, Joshua Bunch, MD3, Robert S. Jackson, MD4, Douglas C. Burton, MD4; 1 Kansas City, KS, US; 2 Marc A. Asher Comprehensive Spine Center, Kansas City, KS, US; 3 University of Kansas Health Systems, Kansas City, KS, US; 4 University of Kansas Medical Center, Kansas City, KS, US BACKGROUND CONTEXT: Weinstein and Ponsetti demonstrated that despite increased pain, adults with previously unoperated adolescent idiopathic scoliosis (AIS) typically lead normal functioning lives. The Oswestry Disability Index (ODI) is a validated questionnaire for assessing back disability with 0-20 indicating minimal disability. A score of >30 has been used in past FDA trials as an inclusion criterion for surgical studies. We predict that increasing ODI scores will correlate with age, curve size, curve location and progression to surgery. PURPOSE: To analyze ODI scores in unoperated adults with AIS to better understand the natural history and its potential correlation with progression to surgery. STUDY DESIGN/SETTING: Single center retrospective study.
https://doi.org/10.1016/j.spinee.2019.05.037
BACKGROUND CONTEXT: Implications for failure to restore normal thoracic kyphosis (TK) in treating adolescent idiopathic scoliosis are just beginning to be understood. Techniques for releasing the rigid spine have included ligamentous releases and discectomy procedures, as well as bony resection; however, the extent these releases improve the ability for a precontoured rod to induce thoracic kyphosis has been lacking. PURPOSE: Evaluate the ability of precontoured rods to induce thoracic kyphosis in a cadaveric spine and determine the effectiveness of sequential posterior releasing procedures. STUDY DESIGN/SETTING: In vitro biomechanical study. OUTCOME MEASURES: Sagittal Cobb measurement of T4-12 construct as well as superior, mid and inferior regions. METHODS: Dissected 6 fresh thoracolumbar (T3-L2) spine specimens and acquired lateral and anteroposterior radiographs to: confirm all levels
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S1−S58
and ilium. While positive outcomes for improved pain and reduced opioid consumption have been associated with SIF, there is a lack of research concerning the effects of SIF on functional biomechanics such as gait performance. PURPOSE: To quantify the effects of SIF on biomechanical gait parameters of SIJD patients at three months postoperative follow-up compared to their preoperative state. STUDY DESIGN/SETTING: Non-randomized, prospective, concurrent cohort study. PATIENT SAMPLE: Twelve symptomatic SIJD patients. OUTCOME MEASURES: Spatiotemporal parameters, gait range-ofmotion (RoM) parameters, and patient-reported outcomes. METHODS: Clinical gait analysis was performed one week before surgery (Pre) and three months after surgery (Post). Each patient performed a series of over-ground gait trials at a comfortable, self-selected speed. Data were collected using a motion capture system and three force plates. Back and leg Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Fear Avoidance Beliefs Questionnaire (FABQ), Tampa Scale for Kinesiophobia (TSK), and Demoralization Scale (DS) scores were also collected at both time points. RESULTS: Patients showed increased cadence (Pre: 98.39 vs Post: 106.95 steps/min, p=0.018) and walking speed (Pre: 0.87 vs Post: 1.03 m/s, p=0.013). Patients also showed decreases in stride time (Pre: 1.28 vs Post: 1.14 s, p=0.015), step time (Pre: 0.65 vs Post: 0.58 s, p=0.015), and double-support time (Pre: 0.37 vs Post: 0.29 s, p=0.024). Patients show significant decreases in both knee RoM (Pre: 15.25 vs Post: 10.79˚, p=0.02) and head motion (Pre: 4.80 vs Post: 3.18 ˚, p=0.045) in the coronal plane. VAS leg pain score (Pre: 4.25 vs Post: 2.69, p=0.032) improved significantly postoperatively. CONCLUSIONS: SIJD patients treated with SIF showed significant improvements in functional gait and leg pain at their three-month followup. The results suggest that SIF provides improved lateral stability which in turn results in more efficient knee motion and improved cadence and step efficiency. The improved leg VAS scores reflect this notion as well. The lack of more pronounced improvements in gait and reported outcomes may be due to insufficient follow-up time to account for a full recovery following SIF. This study may serve as a basis for future diagnostic techniques which utilize gait pattern evaluation as an indicator for early development of SIJD. The findings of this study highlight the impacts that SIJD can have on patients daily lives and reinforces the importance of recognizing the SIJ as a contributor to the functional ability of an individual. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
PATIENT SAMPLE: A total of 249 patients (pts) identified and 214 pts with ODI scores available were analyzed. OUTCOME MEASURES: ODI score with respect to age, curve size, and curve location. Surgical rates in adults with AIS. METHODS: All unoperated adult (≥20yrs) AIS pts seen in a tertiary deformity clinic from 2008-2018 were reviewed. Demographics, curve size [thoracic (T) and thoracolumbar (TL)], comorbidities, and ODI were collected. ODI scores ≥20 and ≥30 were analyzed across 3 age groups: 20-39 yrs (G1), 40-59 yrs (G2), and ≥60 yrs (G3). Differences between categorical and continuous variables were analyzed. Subgroup analyses based on ODI score groups, T vs TL curves, and pts progressing to surgery with T ≥50˚ and/or TL ≥40˚ only were also analyzed. Significance was defined as p<0.05. RESULTS: A total of 249 consecutive AIS pts were seen by one author over 10 yrs. Two hundred fourteen pts had ODI scores and were included. Mean age was 41 yrs (84% female). ODI scores had positive correlations with age, BMI, and curve size (p<.001). Seventeen pts (7.9%) progressed to surgery. Pts with ODI ≥20 and ≥30 were as follows: G1 (47/108, 17/ 108); G2 (36/60, 20/60); G3 (37/46, 25/46). The percentage of scores <30 for G1, G2, G3 was 84%, 67%, and 46%, respectively. Comparing frequency of <30 to ≥30 showed significance within each group (<.001) with G1 and G2 containing a greater number of pts below 30. When comparing T and TL Cobb, there was no difference between curve size (47.7o vs 47.7o, p=.988); however, mean ODI was different (T=20.07; TL=25.02, p=.018). ODI positively correlated with T Cobb (Pearson r=.235, p=0.028) and TL Cobb (Pearson r=.236, p=0.005). Among pts with T ≥50˚ and/or TL ≥40˚, only 13/127 (10%) pts underwent surgery. Among the 127 pts with “surgical-size” Cobb(s), a subgroup analysis showed no difference in age or Cobb between Surgical (OP) and NonSurgical (NONOP) pts. ODI was significantly higher in OP (mean: 46.9) vs NONOP (mean: 22.8), (p<.001). CONCLUSIONS: ODI scores positively correlated with age, BMI, and coronal Cobb in adults with AIS. Pts age 20-59 tended to have ODI scores lower than 30. Despite “surgical size” curves, few (10%) adults seeking evaluation for scoliosis went on to surgery and those who did reported higher ODI scores than their nonsurgical counterparts. Pediatric deformity surgeons can use this information when counseling skeletally mature AIS patients and their families regarding the need for surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
https://doi.org/10.1016/j.spinee.2019.05.036
25. Use of precontoured titanium alloy rods to induce thoracic kyphosis after sequential posterior release: a cadaveric spine study Jinhui Shi, MD1, Nathaniel R. Ordway, MS2, Mike H. Sun, MD3, Stephen A. Albanese, MD2, Swamy Kurra, MD4, William F. Lavelle, MD5; 1 SUNY Upstate University Hospital, Syracuse, NY, US; 2 SUNY Upstate Medical University, Syracuse, NY, US; 3 Upstate Medical University Orthopedics, East Syracuse, NY, US; 4 Syracuse, NY, US; 5 Upstate Orthopedics, East Syracuse, NY, US
24. Untreated adolescent idiopathic scoliosis in adulthood: how often do these patients require surgery? Jace Erwin, BS1, Brandon B. Carlson, MD, MPH2, Joshua Bunch, MD3, Robert S. Jackson, MD4, Douglas C. Burton, MD4; 1 Kansas City, KS, US; 2 Marc A. Asher Comprehensive Spine Center, Kansas City, KS, US; 3 University of Kansas Health Systems, Kansas City, KS, US; 4 University of Kansas Medical Center, Kansas City, KS, US BACKGROUND CONTEXT: Weinstein and Ponsetti demonstrated that despite increased pain, adults with previously unoperated adolescent idiopathic scoliosis (AIS) typically lead normal functioning lives. The Oswestry Disability Index (ODI) is a validated questionnaire for assessing back disability with 0-20 indicating minimal disability. A score of >30 has been used in past FDA trials as an inclusion criterion for surgical studies. We predict that increasing ODI scores will correlate with age, curve size, curve location and progression to surgery. PURPOSE: To analyze ODI scores in unoperated adults with AIS to better understand the natural history and its potential correlation with progression to surgery. STUDY DESIGN/SETTING: Single center retrospective study.
https://doi.org/10.1016/j.spinee.2019.05.037
BACKGROUND CONTEXT: Implications for failure to restore normal thoracic kyphosis (TK) in treating adolescent idiopathic scoliosis are just beginning to be understood. Techniques for releasing the rigid spine have included ligamentous releases and discectomy procedures, as well as bony resection; however, the extent these releases improve the ability for a precontoured rod to induce thoracic kyphosis has been lacking. PURPOSE: Evaluate the ability of precontoured rods to induce thoracic kyphosis in a cadaveric spine and determine the effectiveness of sequential posterior releasing procedures. STUDY DESIGN/SETTING: In vitro biomechanical study. OUTCOME MEASURES: Sagittal Cobb measurement of T4-12 construct as well as superior, mid and inferior regions. METHODS: Dissected 6 fresh thoracolumbar (T3-L2) spine specimens and acquired lateral and anteroposterior radiographs to: confirm all levels
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.