Skip to main content

Benchmarking surgical indications for adolescent idiopathic scoliosis across time, region, and patient population: a study of 4229 cases

Abstract

Purpose

There is no identified consensus for the curve magnitude at which an adolescent idiopathic scoliosis (AIS) patient is indicated for posterior spinal fusion (PSF). We aimed to identify a benchmark for curve magnitude at which fusion is indicated; we also aimed to evaluate which patients were being fused under 50°.

Methods

A prospective multicenter AIS database was queried to identify patients who underwent PSF for AIS. Clinical outcome and demographic information was collected along with anatomic area of the primary curve. Benchmarking was assessed by median and IQR. Patients were stratified by fusion prior to 50° or at 50° or more, and statistical analysis was performed to assess risk factors for fusion < 50°.

Results

4229 patients were included in the analysis. The median indication for PSF in the thoracic curve cohort was 55°, and in the lumbar curve cohort was 51°. Site-specific evaluation showed that two sites were more likely to fuse < 50° compared to all other sites (p < 0.05). Over time, the percentage of patients being fused < 50° has declined (p < 0.05). On univariate and multivariate analysis, lumbar curve location, increasing Risser score and female sex were all risk factors for fusion < 50° (p < 0.05). Low SRS-24 scores did not correlate to fusion below 50°.

Conclusion

There exist location-specific indications for posterior spinal fusion that vary throughout the country. Additionally, increasing maturity, female sex, and lumbar curve location are independent risk factors for fusion under 50°.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Availability of data and materials

This study was performed utilizing the Harms Study Group database.

References

  1. Weinstein SL (2019) The natural history of adolescent idiopathic scoliosis. J Pediatr Orthop 39(6):S44–S46. https://doi.org/10.1097/BPO.0000000000001350

    Article  PubMed  Google Scholar 

  2. Weinstein SL, Ponseti IV (1983) Curve progression in idiopathic scoliosis. J Bone Jt Surg Am 65(4):447–455

    CAS  Article  Google Scholar 

  3. Little DG, Song KM, Katz D, Herring JA (2000) Relationship of peak height velocity to other maturity indicators in idiopathic scoliosis in girls. J Bone Jt Surg Am 82(5):685–693. https://doi.org/10.2106/00004623-200005000-00009

    CAS  Article  Google Scholar 

  4. Nelson S, Sanders J. Idiopathic scoliosis. SRS Education Resource Center. https://educationresources.srs.org/adolescent-idiopathic-scoliosis/idiopathic-scoliosis. Accessed 15 Apr 2021

  5. Adolescent Idiopathic Scoliosis. Scoliosis Research Society. https://www.srs.org/professionals/online-education-and-resources/conditions-and-treatments/adolescent-idiopathic-scoliosis. Accessed 15 Apr 2021

  6. Weinstein SL, Zavala DC, Ponseti IV (1981) Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients. J Bone Jt Surg Am 63(5):702–712

    CAS  Article  Google Scholar 

  7. Ascani E, Bartolozzi P, Logroscino CA et al (1986) Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine (Phila Pa 1976) 11(8):784–789. https://doi.org/10.1097/00007632-198610000-00007

    CAS  Article  Google Scholar 

  8. Carman DL, Browne RH, Birch JG (1990) Measurement of scoliosis and kyphosis radiographs. Intraobserver and interobserver variation. J Bone Jt Surg Am 72(3):328–333

    CAS  Article  Google Scholar 

  9. Morrissy RT, Goldsmith GS, Hall EC et al (1990) Measurement of the Cobb angle on radiographs of patients who have scoliosis. Evaluation of intrinsic error. J Bone Jt Surg Am 72(3):320–327

    CAS  Article  Google Scholar 

  10. SRS Online Education: patient Reported outcomes. Scoliosis Research Society. https://www.srs.org/professionals/online-education-and-resources/patient-outcome-questionnaires. Accessed 30 Mar 2021

  11. Clark S (2008) Waiting times for scoliosis surgery. Lancet 371(9606):10–11. https://doi.org/10.1016/S0140-6736(08)60047-1

    Article  PubMed  Google Scholar 

  12. Ahn H, Kreder H, Mahomed N et al (2011) Empirically derived maximal acceptable wait times for surgery to treat adolescent idiopathic scoliosis. CMAJ 183(9):E565-570. https://doi.org/10.1503/cmaj.101511

    Article  PubMed  PubMed Central  Google Scholar 

  13. US Food and Drug Administration. The Tether—Vertebral Body Tethering System—H190005. https://www.fda.gov/medical-devices/recently-approved-devices/tethertm-vertebral-body-tethering-system-h190005, Accessed 30 Mar 2021

  14. Pesenti S, Jouve JL, Morin C et al (2015) Evolution of adolescent idiopathic scoliosis: results of a multicenter study at 20 years’ follow-up. Orthop Traumatol Surg Res 101(5):609–622. https://doi.org/10.1016/j.otsr.2015.05.004

    Article  Google Scholar 

  15. Ohashi M, Watanabe K, Hirano K et al (2018) Predicting factors at skeletal maturity for curve progression and low back pain in adult patients treated nonoperatively for adolescent idiopathic scoliosis with thoracolumbar/lumbar curves, a mean 25-year follow-up. Spine (Phila Pa 1976) 43(23):E1403–E1411. https://doi.org/10.1097/BRS.0000000000002716

    Article  Google Scholar 

  16. Weinstein SL, Dolan LA, Wright JG et al (2013) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 368(16):1512–1521. https://doi.org/10.1056/NEJMoa1307337

    CAS  Article  Google Scholar 

  17. Krakow AR, Magee LC, Cahill PJ et al (2021) Could have tethered: predicting the proportion of scoliosis patients most appropriate for thoracic anterior spinal tethering. Spine Deform. https://doi.org/10.1007/s43390-021-00296-5

    Article  PubMed  Google Scholar 

  18. Berliner JL, Verma K, Lonner BS et al (2013) Discriminative validity of the Scoliosis Research Society 22 questionnaire among five curve-severity subgroups of adolescents with idiopathic scoliosis. Spine J 12(2):127–133. https://doi.org/10.1016/j.spinee.2012.10.025

    Article  Google Scholar 

  19. Rushton RP, Grevitt MP (2013) What is the effect of surgery on the quality of life of the adolescent with adolescent idiopathic scoliosis? A review and statistical analysis of the literature. Spine (Phila Pa 1976) 39(9):786–794. https://doi.org/10.1097/BRS.0b013e3182837c95

    Article  Google Scholar 

  20. Bridwell KH, Bevern S, Glassman S et al (2007) Is the SRS-22 instrument responsive to change in adult scoliosis patients having primary spinal deformity surgery? Spine (Phila Pa 1976) 32(20):2220–2225. https://doi.org/10.1097/BRS.0b013e31814cf120

    Article  Google Scholar 

  21. Carreon LY, Sanders JO, Diab M et al (2010) The minimum clinically important difference in Scoliosis Research Society-22 appearance, activity, and pain domains after surgical correction of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 35:2079–2083. https://doi.org/10.1097/BRS.0b013e3181c61fd7

    Article  Google Scholar 

Download references

Funding

This study was performed utilizing the Harms Study Group database, and the main institution receives funding from the Setting Scoliosis Straight Foundation in support of Harms Study Group research.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to John M. Flynn.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethics approvals

The institutional review boards (IRBs) of each participating site approved the participation in the study prior to collection of patient data.

Consent to participate

Informed consent was obtained from all patients (or their legal guardians) at each participating institution at the onset of the study.

Consent for publication

Patients (or their legal guardians) were individually consented at each participating institution for inclusion of their data in published studies; all data are deidentified by the Harms Study Group database. There are no identifiable data or imaging included in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Heyer, J.H., Baldwin, K.D., Shah, A.S. et al. Benchmarking surgical indications for adolescent idiopathic scoliosis across time, region, and patient population: a study of 4229 cases. Spine Deform 10, 833–840 (2022). https://doi.org/10.1007/s43390-022-00480-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-022-00480-1

Keywords

  • Posterior spinal fusion
  • Adolescent idiopathic scoliosis
  • Surgical indications