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Delay to Surgery Greater Than 6 Months Leads to Substantial Deformity Progression and Increased Intervention in Immature Adolescent Idiopathic Scoliosis (AIS) Patients: A Retrospective Cohort Study

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Abstract

Design

A retrospective, multi-institution series of adolescent idiopathic scoliosis (AIS) patients whose date of surgery exceeded six months from date of surgical recommendation were identified. A case-matched comparison of surgical outcomes of skeletally immature patients who delayed surgery versus a cohort of nondelayed patients.

Objectives

We sought to identify 1) whether patients at risk for significant curve progression when delaying surgery could be identified with available clinical and radiographic data and 2) whether patients who delay surgery have longer fusions/more complex procedures.

Background

Multiple factors can lead to a delay in treatment of AIS once surgical treatment is recommended, and larger Cobb magnitudes have been associated with a more complex surgery.

Methods

143 AIS patients who delayed surgery had deformity progression (major Cobb angle change over time) analyzed by Risser grade, triradiate cartilage (TRC) status, and menarche status. Comparison of at-risk patients with regard to surgical outcomes to a cohort of matched patients who had not delayed surgery.

Results

Risser 0 patients (n = 34) had a greater major Cobb progression than Risser 1—5 patients (n = 109): mean 1.6°/mo versus 0.4°/ mo, p < .001. Twenty-eight premenarchal patients had significantly greater increases in Cobb angle measures than their postmenarchal counterparts (n = 86) (13.2° vs. 4.3°, p < .001). An open TRC also conferred increasing rate of progression. Radiographic variables of stable vertebra and last vertebra touched by central sacral vertical line were more likely to change in immature patients, but we did not demonstrate longer fusions or higher estimated blood loss as a result when compared to nondelayed, age-matched peers.

Conclusion

AIS patients who are premenarchal, TRC open, or Risser 0 who delay surgery greater than 6 months risk clinically significant Cobb angle progression, which is statistically greater than their more mature peers. Clinical ramifications of this remain unclear. Skeletally mature patients do not progress rapidly, allowing elective timing of surgical intervention.

Level of Evidence

Level III.

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Author information

Authors and Affiliations

  1. Texas Scottish Rite Hospital for Children, 2222 Welborn Street, 75219, Dallas, TX, USA

    Brandon Ramo MD, Dong-Phuong Tran MS & Kaitlyn Brown BS

  2. Texas Tech Health Science Center, Paul L. Foster School of Medicine, 5001 El Paso Dr, 79905, El Paso, TX, USA

    Anil Reddy BS

  3. Children’s Hospital Colorado, 13123 E 16th Ave, 80045, Aurora, CO, USA

    Cameron Niswander BA, Mark Erickson MD & Sumeet Garg MD

Authors
  1. Brandon Ramo MD
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  2. Dong-Phuong Tran MS
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  3. Anil Reddy BS
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  4. Kaitlyn Brown BS
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  5. Cameron Niswander BA
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  6. Mark Erickson MD
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  7. Sumeet Garg MD
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Corresponding author

Correspondence to Brandon Ramo MD.

Additional information

Author disclosures: BR (none), DPT (none), AR (none), KB (none), CN (none), ME (other from POSNA Board of Directors, personal fees from Spineform, personal fees from Biomet, outside the submitted work), SG (personal fees from Medtronic, personal fees from Robert P Schuster, personal fees from Decision Support in Medicine, personal fees from Mighty Oak Medical, outside the submitted work).

IRB approval: Full approval was acquired from the University of Texas Southwestern IRB.

Funding source: No external funding was used.

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Ramo, B., Tran, DP., Reddy, A. et al. Delay to Surgery Greater Than 6 Months Leads to Substantial Deformity Progression and Increased Intervention in Immature Adolescent Idiopathic Scoliosis (AIS) Patients: A Retrospective Cohort Study. Spine Deform 7, 428–435 (2019). https://doi.org/10.1016/j.jspd.2018.09.012

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  • DOI: https://doi.org/10.1016/j.jspd.2018.09.012

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