Adolescent Idiopathic Scoliosis

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Lawrence G Lenke - One of the best experts on this subject based on the ideXlab platform.

  • optimal surgical care for Adolescent Idiopathic Scoliosis an international consensus
    European Spine Journal, 2014
    Co-Authors: Marinus De Kleuver, Lawrence G Lenke, Manabu Ito, Stephen J Lewis, Niccole M Germscheid, Steven J Kamper, Ahmet Alanay, Sigurd Berven, Kenneth M C Cheung, David W Polly
    Abstract:

    Purpose The surgical management of Adolescent Idiopathic Scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for Adolescents with AIS curves between 40° and 90° Cobb angle.

  • genetic linkage localizes an Adolescent Idiopathic Scoliosis and pectus excavatum gene to chromosome 18 q
    Spine, 2009
    Co-Authors: Christina A. Gurnett, Keith H. Bridwell, Lawrence G Lenke, Farhang Alaee, Anne M Bowcock, Lisa M Kruse, Timothy R Kuklo, Scott J Luhmann, Matthew B. Dobbs
    Abstract:

    Study Design A single large family, in which Adolescent Idiopathic Scoliosis (AIS) and pectus excavatum (PE) segregate as an autosomal dominant condition, was evaluated. Genome-wide linkage analysis and candidate gene sequencing were performed.

  • non neurologic complications following surgery for Adolescent Idiopathic Scoliosis
    Journal of Bone and Joint Surgery American Volume, 2007
    Co-Authors: Leah Y Carreon, Lawrence G Lenke, Rolando M Puno, Stephen B Richards, Daniel J Sucato, John B Emans, Mark Erickson
    Abstract:

    Background: The reported prevalence of non-neurologic complications following corrective surgery for Adolescent Idiopathic Scoliosis ranges from 0% to 10%. However, most studies were retrospective evaluations of treatment techniques and did not focus solely on complications. The purpose of this study was to determine the prevalence of non-neurologic complications following surgery for Adolescent Idiopathic Scoliosis and to identify preoperative and operative factors that can increase this risk. Methods: The demographic data, medical and surgical histories, and prevalence of non-neurologic complications were reviewed in a prospective cohort of 702 patients who had undergone corrective surgery for Adolescent Idiopathic Scoliosis and were consecutively enrolled in a multicenter database. Results: There were 556 female and 146 male patients. The mean age at the time of surgery was 14.25 years (range, eight to eighteen years). Five hundred and twenty-three patients had only posterior spinal surgery, 105 had only anterior spinal surgery, and seventy-four had a combined anterior and posterior procedure. There was a total of 108 complications in eighty-one patients, for an overall prevalence of 15.4%. There were ten respiratory complications (1.42%), six cases of excessive bleeding (0.85%), five wound infections (0.71%), and five cases of wound hematoma, seroma, or dehiscence (0.71%). Five patients, two with an early infection and three with late failure of the implant, required a reoperation. Factors that did not correlate with an increased prevalence of complications were age, body mass index, presence of cardiac or respiratory disease, previous surgery, pulmonary function, surgical approach, number of levels fused, graft material, use of a diaphragmatic incision, Lenke curve type, or region of the major curve. Although the number of patients with renal disease was small, these patients were 7.90 times more likely to have a non-neurologic complication. Increased blood loss as well as prolonged operative and anesthesia times were associated with a higher prevalence of non-neurologic complications. Conclusions: The prevalence of non-neurologic postoperative complications following surgery for correction of Adolescent Idiopathic Scoliosis in this study was 15.4%. The few factors noted to significantly increase the rate of complications include a history of renal disease, increased operative blood loss, prolonged posterior surgery time, and prolonged anesthesia time. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

  • proximal junctional kyphosis in Adolescent Idiopathic Scoliosis following segmental posterior spinal instrumentation and fusion minimum 5 year follow up
    Spine, 2005
    Co-Authors: Yongjung J Kim, Keith H. Bridwell, Lawrence G Lenke, Junghoon Kim, Samuel K Cho
    Abstract:

    Study Design.A retrospective study.Objective.To analyze the long-term proximal junctional change in Adolescent Idiopathic Scoliosis (AIS) following segmental posterior spinal instrumentation and fusion 5 years or more after surgery.Summary of Background Data.No study has concentrated on time-depende

  • pulmonary function in Adolescent Idiopathic Scoliosis relative to the surgical procedure
    Journal of Bone and Joint Surgery American Volume, 2005
    Co-Authors: Yongjung J Kim, Keith H. Bridwell, Lawrence G Lenke, Kyoungnam L Kim, Karen Stegermay
    Abstract:

    Background: The long-term pulmonary function of patients with Adolescent Idiopathic Scoliosis undergoing surgical correction is uncertain. To our knowledge, no report has demonstrated the changes in pulmonary function five years or more following spinal arthrodesis with use of modern segmental spinal instrumentation techniques for the treatment of all types of Adolescent Idiopathic Scoliosis in a similar Adolescent population. Methods: One hundred and eighteen patients with Adolescent Idiopathic Scoliosis undergoing surgical treatment at a single institution were evaluated with pulmonary function tests to assess the absolute and percent-predicted value of forced vital capacity and forced expiratory volume in one second at the preoperative examination and at regular intervals postoperatively. The patients were divided into four groups depending upon the surgical procedure: Group 1 comprised forty-nine patients who had posterior spinal arthrodesis with iliac crest bone graft; Group 2, forty-one patients who had posterior spinal arthrodesis with thoracoplasty; Group 3, sixteen patients who had open anterior spinal arthrodesis with a rib resection thoracotomy; and Group 4, twelve patients who had combined anterior and posterior spinal arthrodesis with a rib resection thoracotomy and iliac crest bone graft, respectively. Results: A comparison of absolute pulmonary function values from the preoperative and final follow-up evaluations demonstrated a significant (p < 0.0001) increase in both the forced vital capacity and the forced expiratory volume in one second for Group 1, whereas no change was seen in those values for Groups 2, 3, and 4. A comparison of the changes in the percent-predicted pulmonary function values demonstrated significant (p < 0.05) decreases in forced vital capacity and forced expiratory volume in one second for Groups 2, 3, and 4, except for the latter value for Group 4, whereas Group 1 had no change. Conclusions: Patients who have had any type of chest cage disruption during the surgical treatment of Adolescent Idiopathic Scoliosis demonstrate no change in the absolute value and a significant decline in the percent-predicted value of pulmonary functions at five years following surgery. Chest cage preservation is recommended to maximize both absolute and percent-predicted pulmonary function values after surgical treatment of Adolescent Idiopathic Scoliosis. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Keith H. Bridwell - One of the best experts on this subject based on the ideXlab platform.

  • genetic linkage localizes an Adolescent Idiopathic Scoliosis and pectus excavatum gene to chromosome 18 q
    Spine, 2009
    Co-Authors: Christina A. Gurnett, Keith H. Bridwell, Lawrence G Lenke, Farhang Alaee, Anne M Bowcock, Lisa M Kruse, Timothy R Kuklo, Scott J Luhmann, Matthew B. Dobbs
    Abstract:

    Study Design A single large family, in which Adolescent Idiopathic Scoliosis (AIS) and pectus excavatum (PE) segregate as an autosomal dominant condition, was evaluated. Genome-wide linkage analysis and candidate gene sequencing were performed.

  • proximal junctional kyphosis in Adolescent Idiopathic Scoliosis following segmental posterior spinal instrumentation and fusion minimum 5 year follow up
    Spine, 2005
    Co-Authors: Yongjung J Kim, Keith H. Bridwell, Lawrence G Lenke, Junghoon Kim, Samuel K Cho
    Abstract:

    Study Design.A retrospective study.Objective.To analyze the long-term proximal junctional change in Adolescent Idiopathic Scoliosis (AIS) following segmental posterior spinal instrumentation and fusion 5 years or more after surgery.Summary of Background Data.No study has concentrated on time-depende

  • pulmonary function in Adolescent Idiopathic Scoliosis relative to the surgical procedure
    Journal of Bone and Joint Surgery American Volume, 2005
    Co-Authors: Yongjung J Kim, Keith H. Bridwell, Lawrence G Lenke, Kyoungnam L Kim, Karen Stegermay
    Abstract:

    Background: The long-term pulmonary function of patients with Adolescent Idiopathic Scoliosis undergoing surgical correction is uncertain. To our knowledge, no report has demonstrated the changes in pulmonary function five years or more following spinal arthrodesis with use of modern segmental spinal instrumentation techniques for the treatment of all types of Adolescent Idiopathic Scoliosis in a similar Adolescent population. Methods: One hundred and eighteen patients with Adolescent Idiopathic Scoliosis undergoing surgical treatment at a single institution were evaluated with pulmonary function tests to assess the absolute and percent-predicted value of forced vital capacity and forced expiratory volume in one second at the preoperative examination and at regular intervals postoperatively. The patients were divided into four groups depending upon the surgical procedure: Group 1 comprised forty-nine patients who had posterior spinal arthrodesis with iliac crest bone graft; Group 2, forty-one patients who had posterior spinal arthrodesis with thoracoplasty; Group 3, sixteen patients who had open anterior spinal arthrodesis with a rib resection thoracotomy; and Group 4, twelve patients who had combined anterior and posterior spinal arthrodesis with a rib resection thoracotomy and iliac crest bone graft, respectively. Results: A comparison of absolute pulmonary function values from the preoperative and final follow-up evaluations demonstrated a significant (p < 0.0001) increase in both the forced vital capacity and the forced expiratory volume in one second for Group 1, whereas no change was seen in those values for Groups 2, 3, and 4. A comparison of the changes in the percent-predicted pulmonary function values demonstrated significant (p < 0.05) decreases in forced vital capacity and forced expiratory volume in one second for Groups 2, 3, and 4, except for the latter value for Group 4, whereas Group 1 had no change. Conclusions: Patients who have had any type of chest cage disruption during the surgical treatment of Adolescent Idiopathic Scoliosis demonstrate no change in the absolute value and a significant decline in the percent-predicted value of pulmonary functions at five years following surgery. Chest cage preservation is recommended to maximize both absolute and percent-predicted pulmonary function values after surgical treatment of Adolescent Idiopathic Scoliosis. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

  • sagittal plane analysis of Adolescent Idiopathic Scoliosis the effect of anterior versus posterior instrumentation
    Spine, 2002
    Co-Authors: John M Rhee, Keith H. Bridwell, Douglas S Won, Lawrence G Lenke, Chatupon Chotigavanichaya, Darrell S Hanson
    Abstract:

    STUDY DESIGN Radiographic analysis of anterior and posterior instrumentation for Adolescent Idiopathic Scoliosis. OBJECTIVES To compare effects of anterior versus posterior instrumentation on sagittal plane parameters. SUMMARY OF BACKGROUND DATA The sagittal plane is critical to the long-term success of Scoliosis surgery, but few studies have compared the effect of anterior versus posterior instrumentation. METHODS Standing, full spine lateral radiographs of 110 consecutive patients (mean age 14 years) who had surgery for Adolescent Idiopathic Scoliosis between 1996 and 1998 at one institution with a minimum 24-month (mean 32 months) follow-up were evaluated. Fifty patients were instrumented anteriorly with single screw-rod constructs. Sixty patients were instrumented posteriorly with segmental implants (5.5 mm; hooks, wires, and/or pedicle screws). RESULTS At the final follow-up, the proximal junctional measurement (measured between the proximal instrumented vertebra and the segment two levels cephalad) increased most with posterior instrumentation (+7 degrees increase for posterior thoracic +1 degrees increase for anterior thoracic instrumentation, P= 0.02; +9 degrees increase for posterior thoracic and lumbar instrumentation vs. +4 degrees for anterior thoracolumbar instrumentation, P= 0.03). Thoracic kyphosis (T5-T12) increased significantly with anterior versus posterior thoracic instrumentation (+4 degrees vs. -2 degrees change, P= 0.04). Lumbar lordosis (T12-S1) was enhanced with either anterior or posterior instrumentation. No significant changes in distal junctional measurement (measured between the distal instrumented vertebra and the segment two levels caudal) were noted. The C7 sagittal plumbline remained negative in all groups at the final follow-up. CONCLUSION Anterior and posterior instrumentation had differential effects on the sagittal plane in patients with Adolescent Idiopathic Scoliosis. However, the overall magnitude of the differences was small. Properly performed, both approaches can result in acceptable sagittal profiles.

  • intraobserver and interobserver reliability of the classification of thoracic Adolescent Idiopathic Scoliosis
    Annual Meeting of the Scoliosis Research Society, 1998
    Co-Authors: Lawrence G Lenke, Keith H. Bridwell, Thomas G Lowe, Randal R Betz, David H Clements, Jurgen Harms, Harry L Shufflebarger
    Abstract:

    The system described by King et al. is the standard method for the classification of thoracic Adolescent Idiopathic Scoliosis. Although it is widely used and referenced, its reliability and reproducibility among Scoliosis surgeons are unknown. We used a Scoliosis case-presentation format to examine the interobserver and intraobserver reliability of the classification of thoracic Adolescent Idiopathic Scoliosis with the system of King et al. Eight active, current members of the Scoliosis Research Society reviewed twenty-seven full-length radiographs that had been made before operative correction of the scoliotic deformity. On the basis of these images, which included posteroanterior and lateral radiographs made with the patient standing as well as right and left forced-side-bending radiographs made with the patient supine, the reviewers assigned a type to each curve according to the classification system of King et al. Kappa coefficients were used to test statistical reliability. The mean interobserver reliability of the classification was only 64 per cent (range, 54 to 77 per cent) when the responses of seven of the reviewers were compared with those of one of the originators of the classification. The mean kappa coefficient was 0.49 (range, 0.27 to 0.73), which indicates poor reliability. When each reviewer's responses were compared with those of the other reviewers, the reliability was similarly poor (interobserver reliability, 55 per cent [range, 33 to 81 per cent] and mean kappa coefficient, 0.40 [range, 0.21 to 0.63]). Intraobserver reliability was evaluated in a trial in which five reviewers in a group setting were shown the same radiographs in a different order at two different viewings. Comparison of the results at the two viewings revealed a mean intraobserver reliability of 69 per cent (range, 56 to 85 per cent) and a mean kappa coefficient of 0.62 (range, 0.34 to 0.95), which indicates fair reliability. The current method of classification of Adolescent Idiopathic Scoliosis does not appear to have sufficient intraobserver or interobserver reliability among Scoliosis surgeons to portray curve types accurately. Thus, it may not help to guide treatment with use of modern spinal fixation methods.

Jack C. Y. Cheng - One of the best experts on this subject based on the ideXlab platform.

  • Adolescent Idiopathic Scoliosis
    Nature reviews. Disease primers, 2015
    Co-Authors: Jack C. Y. Cheng, Theodoros B Grivas, Matthew B. Dobbs, René M. Castelein, Winnie C. Chu, Aina J. Danielsson, Christina A. Gurnett, Keith D. Luk, Alain Moreau
    Abstract:

    Adolescent Idiopathic Scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle - a measure of spinal curvature - of ≥10(°). AIS affects between 1% and 4% of Adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible.

  • three dimensional characterization of torsion and asymmetry of the intervertebral discs versus vertebral bodies in Adolescent Idiopathic Scoliosis
    Spine, 2014
    Co-Authors: Tom P C Schlosser, René M. Castelein, Winnie C. Chu, Marijn Van Stralen, Rob C Brink, Tsz Ping Lam, Koen L Vincken, Jack C. Y. Cheng
    Abstract:

    STUDY DESIGN Cross-sectional study. OBJECTIVE To compare the relative contribution of the vertebral bodies and intervertebral discs with the 3-dimensional spinal deformity in Adolescent Idiopathic Scoliosis. SUMMARY OF BACKGROUND DATA There is an ongoing discussion about the causal role of skeletal growth processes in the etiopathogenesis of Adolescent Idiopathic Scoliosis. Contradictory findings have been reported on the individual contribution of the vertebral bodies as compared with the discs to the coronal deformity. As far as we know, the true 3-dimensional deformity of the discs and vertebral bodies have not yet been described. METHODS High-resolution computed tomographic scans of 77 patients with severe Adolescent Idiopathic Scoliosis were included. Torsion and anterior-posterior and right-left asymmetry of each individual vertebral body and intervertebral disc were studied from T2 to L5, using semiautomatic analysis software. True transverse sections were reconstructed along the anterior-posterior and right-left axis of all endplates. These "endplate-vectors" were calculated semiautomatically, taking rotation and tilt into account. Torsion was defined as the difference in axial rotation between 2 subsequent endplates. Asymmetry was defined as the relative anterior-posterior or right-left height difference of the discs and the vertebrae. RESULTS There were at least 3 times more torsion, anterior overgrowth, and coronal wedging in the discs than in the vertebrae in the thoracic as well as in the (thoraco) lumbar curves (P<0.001). These values correlated significantly with the Cobb angle (r≥0.37; P<0.001). Anterior overgrowth and coronal asymmetry were greater in the apical regions whereas torsion was most pronounced in the transitional segments between the curves. CONCLUSION The discs contribute more to 3-D deformity than the bony structures, and there is significant regional variability. This suggests an adaptive rather than an active phenomenon. LEVEL OF EVIDENCE 2.

  • Adolescent Idiopathic Scoliosis
    The Lancet, 2008
    Co-Authors: Stuart L Weinstein, Jack C. Y. Cheng, Aina J. Danielsson, Lori A Dolan, Jose A Morcuende
    Abstract:

    Adolescent Idiopathic Scoliosis (AIS) affects 1-3% of children in the at-risk population of those aged 10-16 years. The aetiopathogensis of this disorder remains unknown, with misinformation about its natural history. Non-surgical treatments are aimed to reduce the number of operations by preventing curve progression. Although bracing and physiotherapy are common treatments in much of the world, their effectiveness has never been rigorously assessed. Technological advances have much improved the ability of surgeons to safely correct the deformity while maintaining sagittal and coronal balance. However, we do not have long-term results of these changing surgical treatments. Much has yet to be learned about the general health, quality of life, and self-image of both treated and untreated patients with AIS.

  • Osteopenia in Adolescent Idiopathic Scoliosis: a histomorphometric study.
    Spine, 2001
    Co-Authors: Jack C. Y. Cheng, Shengping Tang, Xia Guo, Chun Wai Chan, Ling Qin
    Abstract:

    STUDY DESIGN Bone biopsies from iliac crest and spinous process of Adolescent Idiopathic Scoliosis patients were obtained intraoperatively for histology and histomorphometric analysis. OBJECTIVES To study the histologic features of cancellous bone and to correlate the histomorphometric variables with preoperative bone mineral density in patients with Adolescent Idiopathic Scoliosis. SUMMARY OF BACKGROUND DATA Low bone mineral density has been reported in Adolescent Idiopathic Scoliosis. However, there is limited information about the histopathologic changes. METHODS Undecalcified and decalcified bone specimens from iliac crest and spinous process of Adolescent Idiopathic Scoliosis patients obtained intraoperatively were stained with Goldner and hematoxylin & eosin stain, respectively. Results were correlated with bone mineral density of the lumbar spine (L2-L4) and proximal femur measured before surgery. RESULTS Bone histology showed significant less osteocyte count in the trabecular bone characterized with smooth and continuous borders in patients with Adolescent Idiopathic Scoliosis. Histomorphometry confirmed the lower static parameters. The results correlated well with the decreased bone mineral density. CONCLUSION Bone biopsy study suggested disturbance of bone turnover in patients with Adolescent Idiopathic Scoliosis. The abnormal metabolism might contribute to the low bone mineral density and play an important role in the etiology and pathogenesis of Adolescent Idiopathic Scoliosis.

André Kaelin - One of the best experts on this subject based on the ideXlab platform.

  • cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for Adolescent Idiopathic Scoliosis
    European Spine Journal, 2011
    Co-Authors: Federico Canavese, Katia Turcot, Vincenzo De Rosa, Geraldo De Coulon, André Kaelin
    Abstract:

    The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with Adolescent Idiopathic Scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic Adolescent Idiopathic Scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior-posterior and lateral radiographs of the entire spine were reviewed to assess the changes of cervical sagittal alignment. Thirty-two patients (3 boys, 29 girls) met the inclusion criteria for the study. The average pre-operative cervical sagittal alignment (CSA) was 4.0° ± 12.3° (range -30° to 40°) of lordosis. Postoperatively, the average CSA was 1.7° ± 11.4° (range -24° to 30°). After surgery, it was less than 20° in 27 patients (84.4%) and between 20° and 40° in 5 patients (15.6%). The results of the present study suggest that even if rod precontouring is performed and postoperative thoracic sagittal alignment is restored, improved or remains unchanged after significant correction of the deformity on the frontal plane, the inherent rigidity of the cervical spine limits changes in the CSA as the cervical spine becomes rigid over time.

  • Adolescent Idiopathic Scoliosis: Indications and efficacy of nonoperative treatment
    Indian Journal of Orthopaedics, 2011
    Co-Authors: Federico Canavese, André Kaelin
    Abstract:

    The strategy for the treatment of Idiopathic Scoliosis depends essentially upon the magnitude and pattern of the deformity, and its potential for progression. Treatment options include observation, bracing and/or surgery. During the past decade, several studies have demonstrated that the natural history of Adolescent Idiopathic Scoliosis can be positively affected by nonoperative treatment, especially bracing. Other forms of conservative treatment, such as chiropractic or osteopathic manipulation, acupuncture, exercise or other manual treatments, or diet and nutrition, have not yet been proven to be effective in controlling spinal deformity progression, and those with a natural history that is favorable at the completion of growth. Observation is appropriate treatment for small curves, curves that are at low risk of progression, and those with a natural history that is favorable at the completion of growth. Indications for brace treatment are a growing child presenting with a curve of 25°–40° or a curve less than 25° with documented progression. Curves of 20°–25° in patients with pronounced skeletal immaturity should also be treated. The purpose of this review is to provide information about conservative treatment of Adolescent Idiopathic Scoliosis. Indications for conservative treatment, hours daily wear and complications of brace treatment as well as brace types are discussed.

Peter O. Newton - One of the best experts on this subject based on the ideXlab platform.

  • A three-dimensional analysis of Scoliosis progression in non-Idiopathic Scoliosis: is it similar to Adolescent Idiopathic Scoliosis?
    Child's Nervous System, 2019
    Co-Authors: Keith R. Bachmann, Burt Yaszay, Carrie E. Bartley, Tracey P. Bastrom, Fredrick G. Reighard, Vidyadhar V. Upasani, Peter O. Newton
    Abstract:

    Purpose To evaluate the three-dimensional (3D) characteristics of spine deformity in patients with non-Idiopathic Scoliosis compared with those observed in patients with Adolescent Idiopathic Scoliosis (AIS).

  • Adolescent Idiopathic Scoliosis
    Nature Reviews Disease Primers, 2015
    Co-Authors: Jack C. Cheng, Theodoros B Grivas, Alain Moreau, Matthew B. Dobbs, René M. Castelein, Winnie C. Chu, Aina J. Danielsson, Christina A. Gurnett, Keith D. Luk, Peter O. Newton
    Abstract:

    Adolescent Idiopathic Scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle — a measure of spinal curvature — of ≥10^°. AIS affects between 1% and 4% of Adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible. Adolescent Idiopathic Scoliosis (AIS) is characterized by spinal curvature that develops early in adolescence. Although its causes are unknown, in this Primer, Cheng and colleagues discuss various hypotheses to explain the development and progression of AIS.

  • the effect of surgeon experience on outcomes of surgery for Adolescent Idiopathic Scoliosis
    Journal of Bone and Joint Surgery American Volume, 2014
    Co-Authors: Patrick J Cahill, Burt Yaszay, Tracey P. Bastrom, Baron S Lonner, Joshua M Pahys, Jahangir Asghar, Michelle C Marks, Suken A Shah, Harry L Shufflebarger, Peter O. Newton
    Abstract:

    Background: Single-surgeon series investigating the learning curve involved in surgery for spinal deformity may be confounded by changes in technology and techniques. Our objective with this multicenter, prospective study was to present a cross-sectional analysis of the impact of surgeon experience on surgery for Adolescent Idiopathic Scoliosis. Methods: All posterior-only surgical procedures for Adolescent Idiopathic Scoliosis performed in the 2007 to 2008 academic year, with a minimum of two years of patient follow-up, were included. Two groups were created on the basis of surgeon experience: a young surgeons’ group, which included patients of surgeons with less than five years of experience, and an experienced surgeons’ group, which included patients of surgeons with five or more years of experience. Results: Nine surgeons (four young and five experienced) operated on a total of one hundred and sixty-five patients with Adolescent Idiopathic Scoliosis. The surgeons’ experience ranged from less than one year to thirty-six years in practice. The two groups had similar preoperative curve-magnitude measurements, SRS-22 (Scoliosis Research Society-22) scores, and distribution by Lenke curve type. There were significant operative and postoperative differences. The young surgeons fused an average of 1.2 levels more than the experienced surgeons (p = 0.045). The mean intraoperative estimated blood loss (EBL) of the young surgeons’ group was more than twice that of the experienced surgeons’ group (2042 mL compared with 1013 mL; p < 0.001). The duration of surgery was 458 minutes for the young surgeons compared with 265 minutes for the experienced surgeons (p < 0.001). The overall SRS-22 scores were significantly worse in the young surgeons’ group (a mean of 4.1 compared with 4.5; p = 0.001). The difference between groups was also significant for the domains of pain (p = 0.016), self-image (p = 0.008), and function (p < 0.001). Complication rates did not differ significantly between the groups. Conclusions: Operative results and health-related quality of life following surgery for Adolescent Idiopathic Scoliosis were significantly and positively correlated with surgeon experience. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  • a multicenter study of the outcomes of the surgical treatment of Adolescent Idiopathic Scoliosis using the Scoliosis research society srs outcome instrument
    Spine, 2002
    Co-Authors: Andrew A Merola, Thomas R Haher, Mario Brkaric, Georgia Panagopoulos, Samir Mathur, Omid Kohani, Thomas G Lowe, Larry Lenke, Dennis R Wenger, Peter O. Newton
    Abstract:

    STUDY DESIGN: A multicenter study of the outcomes of the surgical treatment of Adolescent Idiopathic Scoliosis using the Scoliosis Research Society Questionnaire (SRS 24). OBJECTIVE: To evaluate the patient based outcome of the surgical treatment of Adolescent Idiopathic Scoliosis. SUMMARY OF BACKGROUND DATA: A paucity of information exists with respect to patient measures of outcome regarding the surgical treatment of Adolescent Idiopathic Scoliosis. To our knowledge, no prospective outcome study on this topic thus far exists. METHODS: Using the SRS 24 questionnaire, seven Scoliosis centers agreed to prospectively assess outcome for surgically treated patients with Adolescent Idiopathic Scoliosis. Data were collected before surgery and at 24 months after surgery. Data were analyzed using paired and independent samples t test for all seven SRS 24 questionnaire domains (Pain, General Self-Image, Postoperative Self-Image, Postoperative Function, Function From Back Condition, General Level of Activity, and Satisfaction) using Statistical Package for Social Science. The domains were analyzed with respect to the total cohort, gender, curve magnitude, and type of surgery using independent-samples t tests. RESULTS: A total of 242 patients were included in our analysis. A baseline preoperative pain level of 3.68 of 5 was found. This improved to 4.63 after surgery, representing an improvement of 0.95 points. Surgical intervention was associated with improving outcome when compared with preoperative status. Pain, General Self-Image, Function From Back Condition, and Level of Activity all demonstrated statistically significant improvement as compared with preoperative status (P < 0. 001). Overall, patients were highly satisfied with the results of surgery. CONCLUSION: Preoperative pain exists in our Adolescent Scoliosis population. Pain scores were improved in our study population at the 2-year postsurgical follow-up. Statistically significant improvements were likewise seen in the General Self-Image, Function From Back Condition, and Level of Activity domains. The present study demonstrates the ability of surgery to improve the outcome of patients afflicted with Adolescent Idiopathic Scoliosis.