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Evaluating consensus and uncertainty among treatment options for early-onset scoliosis: new generation and international perspectives

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Abstract

Purpose

It is currently unknown how treatment preferences differ between a senior group of U.S. spinal surgeons, a new generation of U.S. surgeons, and non-U.S. surgeons with regard to the treatment of early-onset scoliosis (EOS). The purpose of this study was to evaluate clinical consensus and uncertainty among treatment options for patients with EOS to understand how they compare between these three cohorts.

Methods

11 senior pediatric spinal deformity surgeons in the U.S., 12 “junior” surgeons in the U.S., and 7 surgeons practicing in non-U.S. countries were invited to complete a survey of 315 idiopathic and neuromuscular EOS case scenarios. Treatment options included: conservative management, distraction-based methods, growth guidance/modulation, and arthrodesis. Consensus was defined as ≥ 70% agreement, and uncertainty was < 70%. Chi-squared and multiple regression analyses were performed to evaluate the associations between case characteristics and consensus for different treatments.

Results

Although all 3 cohorts of surgeons chose conservative management most frequently, the non-U.S. cohort of surgeons chose distraction-based methods more often, particularly for neuromuscular cases. In both U.S. surgeon cohorts, there was consensus for conservative management in idiopathic patients aged 3 or younger regardless of other factors, whereas non-U.S. surgeons selected distraction-based methods for some of these patients.

Conclusion

Just as research studies are being conducted to find approaches to optimally manage the EOS population, future research efforts should focus on identifying the reasoning behind treatment preferences in different cohort of surgeons, as this will allow the interexchange of information which can ultimately improve EOS care.

Level of evidence

V.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author, TQ, upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

We would like to thank Noriaki Kawakami MD, Amer Samdani MD, Jeffrey Sawyer MD, Robert Murphy MD, Patrick Cahill MD, Sumeet Garg MD, Joshua Pahys MD, Klane White MD, Jaime Gomez MD, Jason Anari MD, Jaysson Brooks MD, Kenneth Cheung MD, Haemish Crawford MD, Ron El-Hawary MD, Alaaeldin Ahmad MD, David Farrington MD, Jwalant Mehta MD, and Purnendu Gupta MD for their contribution to the manuscript.

Funding

This work was conducted without the support of additional funding.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA

    Adam N. Fano, Theodore Quan, Lisa Bonsignore-Opp, Benjamin D. Roye, Michael G. Vitale & Hiroko Matsumoto

  2. Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA

    Benjamin D. Roye & Michael G. Vitale

  3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA

    Hiroko Matsumoto

Authors
  1. Adam N. Fano
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Contributions

ANF, TQ, LB-O, BDR, MGV, and HM: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data. ANF, TQ, LB-O, BDR, MGV, and HM: Drafted the work or revised it critically for important intellectual content. ANF, TQ, LB-O, BDR, MGV, and HM: Approved of the version to be published. ANF, TQ, LB-O, BDR, MGV, and HM: Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Theodore Quan.

Ethics declarations

Conflict of interest disclosures (includes financial disclosures)

Dr. Roye reports grants from Pediatric Orthopaedic Society of North America, Orthopaedic Scientific Research Foundation, and Scoliosis Research Society outside the submitted work. Dr. Vitale reports non-financial support from Pediatric Spine Foundation, during the conduct of the study; grants from Setting Scoliosis Straight Foundation, grants and other from Children’s Spine Foundation, grants from Orthopaedic Scientific Research Foundation, grants and other from POSNA, other from OMeGA, personal fees from Stryker, personal fees from Biomet, personal fees from Nuvasive outside of the submitted work. Dr. Matsumoto reports personal fees from Pediatric Spine Foundation, grants from Scoliosis Research Society, grants from Pediatric Orthopaedic Society of North America outside the submitted work.

Copyright and patient information

No copyrighted materials or patient information is included in this manuscript submission.

Ethics approval

This study was approved by the participating sites and by the Columbia University Institutional Review Board under protocol AAAS6106. It was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to participate

This study qualifies for a waiver of consent because it is a survey of surgeons and does not involve patient participation. There is no potential to adversely affect the rights or welfare of subjects since this is a survey to gather surgeon opinion, with no patient data being collected or intervention being tested.

Consent for publication

No patient identifying information is included in the article. Not applicable.

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Fano, A.N., Quan, T., Bonsignore-Opp, L. et al. Evaluating consensus and uncertainty among treatment options for early-onset scoliosis: new generation and international perspectives. Spine Deform 11, 1271–1282 (2023). https://doi.org/10.1007/s43390-023-00713-x

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  • DOI: https://doi.org/10.1007/s43390-023-00713-x

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