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Associations between three-dimensional measurements of the spinal deformity and preoperative SRS-22 scores in patients undergoing surgery for major thoracic adolescent idiopathic scoliosis

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Abstract

Study design

Retrospective study.

Objective

To analyze the relationships between three-dimensional (3D) measurements of spinal deformity and Scoliosis Research Society-22 (SRS-22) scores in preoperative patients with major thoracic adolescent idiopathic scoliosis (AIS).

Summary and background data

Previous studies reported 2D measurements were not or only weakly correlated with preoperative SRS-22 scores. However, 2D measures do not always accurately represent the 3D deformity.

Methods

A multicenter prospective registry of surgically treated AIS patients was reviewed for patients with right major thoracic AIS (Lenke type 1–4) who underwent biplanar radiography and completed the SRS-22 questionnaire preoperatively. For the 3D measurements, two reference frames were utilized: global (gravity/patient-based) and local (vertebra/disc-based). To obtain regional measurements, the individual segments in the appropriate reference plane were summed between the levels of interest. Patients were divided into two groups for each SRS-22 domain according to their scores: low (< 4) and high (≥ 4) score groups. Group differences and correlations with SRS-22 scores were analyzed with p < 0.01 as the threshold for significance.

Results

There were 405 eligible patients (mean age, 14.4 years). The mean 3D thoracic curve was 59° (45°–115°). The only significant group difference of 3D measurements occurred in the local lumbar lordosis (LL) with a small mean difference (− 3.4°, p = 0.008) in the mental health domain. In the correlation analyses, global and local thoracic kyphosis (TK) and TK/LL ratio demonstrated significant, but weak, correlations with function and total scores (|r|< 0.2, p < 0.01).

Conclusion

3D measurements of scoliosis severity have only weak associations with preoperative SRS-22 scores, which might indicate a limit to the discriminative capacity of the SRS-22 within surgical range major thoracic AIS curves. Interestingly, the sagittal plane was the principle 3D plane in which significant correlations existed.

Level of evidence

II, prognostic.

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Acknowledgements

Funding to support this study was received from the Rady Children’s Hospital Assaraf Family. Fund and from research grants to Setting Scoliosis Straight Foundation from DePuy Synthes. Spine, EOS imaging, K2M, Medtronic, NuVasive and Zimmer Biomet in support of Harms. Study Group research.

Harms Study Group Investigators: Aaron Buckland, MD; New York University Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia, Amit Jain, MD; Johns Hopkins Hospital, Baron Lonner, MD; Mount Sinai Hospital, Benjamin Roye, MD; Columbia University, Burt Yaszay, MD; Rady Children’s Hospital, Chris Reilly, MD; BC Children’s Hospital, Daniel Hedequist, MD; Boston Children’s Hospital, Daniel Sucato, MD; Texas Scottish Rite Hospital, David Clements, MD; Cooper Bone & Joint Institute New Jersey. Title Page: Firoz Miyanji, MD; BC Children’s Hospital, Harry Shufflebarger, MD; Nicklaus Children's Hospital, Jack Flynn, MD; Children’s Hospital of Philadelphia, Jahangir Asghar, MD; Cantor Spine Institute, Jean Marc Mac Thiong, MD; CHU Sainte-Justine, Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia, Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad, Keith Bachmann, MD; University of Virginia, Larry Lenke, MD; Columbia University, Mark Abel, MD; University of Virginia, Michael Glotzbecker, MD; Boston Children’s Hospital, Michael Kelly, MD; Washington University, Michael Vitale, MD; Columbia University, Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation, Munish Gupta, MD; Washington University, Nicholas Fletcher, MD; Emory University, Patrick Cahill, MD; Children’s Hospital of Philadelphia, Paul Sponseller, MD; Johns Hopkins Hospital, Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children, Peter Newton, MD; Rady Children’s Hospital, Peter Sturm, MD; Cincinnati Children’s Hospital, Randal Betz, MD; Institute for Spine & Scoliosis, Ron Lehman, MD; Columbia University, Stefan Parent, MD: CHU Sainte-Justine, Stephen George, MD; Nicklaus Children's Hospital, Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia, Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children, Tom Errico, MD; Nicklaus Children's Hospital, Vidyadhar Upasani, MD; Rady Children’s Hospital.

Funding

Funding was provided by Setting Scoliosis Straight Foundation.

Author information

Authors and Affiliations

  1. Orthopedics and Scoliosis Division, Rady Children’s Hospital, 3020 Children’s Way, MC 5062, San Diego, CA, 92123, USA

    Masayuki Ohashi, Tracey P. Bastrom, Carrie E. Bartley, Burt Yaszay, Vidyadhar V. Upasani & Peter O. Newton

  2. Department of Orthopedic Surgery, University of California, San Diego, CA, USA

    Burt Yaszay, Vidyadhar V. Upasani & Peter O. Newton

  3. Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan

    Masayuki Ohashi

Authors
  1. Masayuki Ohashi
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  2. Tracey P. Bastrom
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  3. Carrie E. Bartley
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  4. Burt Yaszay
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  5. Vidyadhar V. Upasani
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  6. Peter O. Newton
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Consortia

the Harms Study Group

  • Aaron Buckland
  • , Amer Samdani
  • , Amit Jain
  • , Baron Lonner
  • , Benjamin Roye
  • , Burt Yaszay
  • , Chris Reilly
  • , Daniel Hedequist
  • , Daniel Sucato
  • , David Clements
  • , Firoz Miyanji
  • , Harry Shufflebarger
  • , Jack Flynn
  • , Jahangir Asghar
  • , Jean Marc Mac Thiong
  • , Joshua Pahys
  • , Juergen Harms
  • , Keith Bachmann
  • , Larry Lenke
  • , Mark Abel
  • , Michael Glotzbecker
  • , Michael Kelly
  • , Michael Vitale
  • , Michelle Marks
  • , Munish Gupta
  • , Nicholas Fletcher
  • , Patrick Cahill
  • , Paul Sponseller
  • , Peter Gabos
  • , Peter Newton
  • , Peter Sturm
  • , Randal Betz
  • , Ron Lehman
  • , Stefan Parent
  • , Stephen George
  • , Steven Hwang
  • , Suken Shah
  • , Tom Errico
  •  & Vidyadhar Upasani

Corresponding author

Correspondence to Peter O. Newton.

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IRB approval was obtained for this study.

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Ohashi, M., Bastrom, T.P., Bartley, C.E. et al. Associations between three-dimensional measurements of the spinal deformity and preoperative SRS-22 scores in patients undergoing surgery for major thoracic adolescent idiopathic scoliosis. Spine Deform 8, 1253–1260 (2020). https://doi.org/10.1007/s43390-020-00150-0

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  • DOI: https://doi.org/10.1007/s43390-020-00150-0

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