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Major Complications at Two Years After Surgery Impact SRS Scores for Adolescent Idiopathic Scoliosis Patients

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Abstract

Study Design

Retrospective review of prospectively collected data.

Objective

To determine whether adolescent idiopathic scoliosis (AIS) patients with active complications at two-year follow-up demonstrate lower Scoliosis Research Society (SRS-22) questionnaire scores.

Summary of Background Data

There is limited evidence as to whether the SRS-22 is sensitive to complications in postoperative AIS patients.

Methods

Surgical patients with SRS-22 scores completed at two-year follow-up were included. Five groups were created: no complication, minor complication resolved by 2 years, major complication resolved by 2 years, minor complication active, and major complication active at 2 years. Likelihood of reaching a minimal clinically important difference (MCID) for pain (0.20) and self-image (0.98) was evaluated.

Results

1,481 patients were identified. Major complications active at two years existed in 2.2% of patients. These patients had the lowest score in all domains and total scores (p < .05). If a minor complication was active, scores were impacted for pain, self-image, satisfaction, and total (p < .05). No differences were found between no complication and resolved complications. Patients with active major complications were more likely to have a pain score that worsened from pre- to two years reaching MCID (52%) compared to the other four groups (range 18%–29%, odds ratio [OR] 3.6, p < .001). They also had a nonsignificant decreased rate of improvement of self-image score at an MCID level (42% vs. range 51%–66%, OR 0.56, p = .10).

Conclusions

When timing is considered, the SRS-22 demonstrates the ability to discriminate between patients with and without a complication. Active experience of a major complication impacted SRS-22 scores, in particular, the rate of worsening scores for pain, self-image, function, and total score.

Level of Evidence

Level III.

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Author information

Authors and Affiliations

  1. Rady Children’s Hospitale San Diego, 3020 Children’s Way, San Diego, CA, 92123, USA

    Tracey P. Bastrom MA, Burt Yaszay MD & Peter O. Newton MD

  2. Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA

    Suken A. Shah MD

  3. British Columbia Children’s Hospital, 4480 Oak St, Vancouver, BC, V6H 3N1, Canada

    Firoz Miyanji MD

  4. Scoliosis and Spine Associates, 820 2nd Ave, New York, NY, 10017, USA

    Baron S. Lonner MD

  5. Washington University, 1 Brookings Dr, St. Louis, MO, 63130, USA

    Michael P. Kelly MD

  6. Shriner’s Hospital for Children, 3551 N Broad St, Philadelphia, PA, 19140, USA

    Amer Samdani MD

  7. Nicklaus Children’s Hospital, 3100 S.W. 62nd Ave, Miami, FL, 33155, USA

    Jahangir Asghar MD

Authors
  1. Tracey P. Bastrom MA
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  2. Burt Yaszay MD
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  3. Suken A. Shah MD
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  4. Firoz Miyanji MD
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  5. Baron S. Lonner MD
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  6. Michael P. Kelly MD
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  7. Amer Samdani MD
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  8. Jahangir Asghar MD
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  9. Peter O. Newton MD
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Corresponding author

Correspondence to Burt Yaszay MD.

Additional information

Author disclosures: TPB (grants from Setting Scoliosis Straight Foundation to her institution, during the conduct of the study), BY (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and personal fees from K2M and DePuy Synthes Spine; personal fees from NuVasive, Medtronic, Orthopediatrics, Stryker, and Globus; grants from Setting Scoliosis Straight Foundation, outside the submitted work; in addition, BY has a patent K2M with royalties paid), SAS (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from DePuy Synthes Spine and K2M, outside the submitted work), FM (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), BSL (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from Setting Scoliosis Straight Foundation; personal fees from DePuy Synthes Spine, K2M, Paradigm Spine, Spine Search, and Ethicon; nonfinancial support from Spine Deformity Journal; grants from John and Marcella Fox Fund Grant, grants from Orthopaedic Research and Education Foundation [OREF]; personal fees from Zimmer Biomet and Apifix, outside the submitted work), MPK (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from AOSpine, BJC Foundation, and Cervical Spine Research Society [CSRS], outside the submitted work), AS (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from DePuy Synthes Spine, Ethicon, Globus Medical, Misonix, Stryker, and Zimmer Biomet; other from Setting Scoliosis Straight Foundation, Scoliosis Research Society, and Children’s Spine Study Group, outside the submitted work), JA (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees and non-financial support from Omega innovative Technologies, personal fees from Life Spine, personal fees from Globus Medical, outside the submitted work), PON (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation; other from Rady Children’s Specialists; grants, personal fees, and nonfinancial support from DePuy Synthes Spine; grants and other from SRS; grants from EOS imaging; personal fees from Thieme Publishing; grants from NuVasive; other from Electrocore; personal fees from Cubist; other from International Pediatric Orthopedic Think Tank; grants, nonfinancial support, and other from Orthopediatrics; grants, personal fees, and nonfinancial support from K2M; grants and nonfinancial support from Alphatech, outside the submitted work; in addition, PON has a patent “Anchoring Systems and Methods for Correcting Spinal Deformities” (8540754) with royalties paid to DePuy Synthes Spine, a patent “Low Profile Spinal Tethering Systems” (8123749) licensed to DePuy Spine, a patent “Screw Placement Guide” (7981117) licensed to DePuy Spine, a patent “Compressor for Use in Minimally Invasive Surgery” (7189244) licensed to DePuy Spine, and a patent “Posterior Spinal Fixation” pending to K2M).

The study was conducted at Rady Children’s Hospital, San Diego, CA.

IRB approval was obtained for this study.

Funding was received from DePuy Synthes Spine by Setting Scoliosis Straight to support Harms Study Group Research.

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Bastrom, T.P., Yaszay, B., Shah, S.A. et al. Major Complications at Two Years After Surgery Impact SRS Scores for Adolescent Idiopathic Scoliosis Patients. Spine Deform 7, 93–99 (2019). https://doi.org/10.1016/j.jspd.2018.05.009

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  • DOI: https://doi.org/10.1016/j.jspd.2018.05.009

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