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The Adolescent Idiopathic Scoliosis International Disease Severity Study: Do Operative Curve Magnitude and Complications Vary by Country?

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Abstract

Background

The prevalence of adolescent idiopathic scoliosis (AIS) in diverse regions of the world has been studied. Access to care varies widely, and differences in disease severity and operative treatment outcomes are not well understood. This study aimed to determine variation in disease presentation and operative complications for AIS patients from an international cohort.

Methods

This is a retrospective study carried out at seven surgical centers in the United States (Manhattan and Miami), Ghana, Pakistan, Spain, Egypt, and China. A total of 541 consecutive patients with AIS were evaluated. Preoperative major curve magnitude, operative parameters, and complications were compared among sites using analysis of variance with post hoc tests and Pearson correlation coefficients. Univariate and multivariate forward stepwise binary logistic regressions determined the variables most predictive of complications.

Results

Countries with lowest-access to care (Ghana, Egypt, and Pakistan) displayed larger curves, more levels fused, longer operative time (OT), and greater estimated blood loss (EBL) than the other countries (p ≤ .001). Increasing curve magnitude was correlated with greater levels fused, longer OT, and greater EBL in all groups (p = .01). In the univariate regression analysis, Cobb magnitude, levels fused, EBL, and OT were associated with complication occurrence. Only OT remained significantly associated with complication occurrence after adjusting for Cobb magnitude, levels fused, and site (odds ratio [OR] = 1.005, 95% confidence interval 1.001-1.007, p = .003). Complications were greatest in Pakistan and Ghana (21.7% and 13.5%, respectively) and lowest in Miami (6.5%).

Conclusions

Larger curve magnitudes in the least-access countries correlated with more levels fused, longer OT, and greater EBL, indicating that increased curve magnitude at surgery could explain the difference in operative morbidity between low- and high-access countries. With OT as the prevailing predictive factor of complications, we suggest that increased curve magnitude leads to longer OTs and more complications. A lack of access to orthopedic care may be the largest contributor to the postponement of treatment.

Level of Evidence

Level II.

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References

  1. Rogala EJ, Drummond DS, Gurr J. Scoliosis: incidence and natural history. A prospective epidemiological study. J Bone Joint Surg Am 1978;60:173–6.

    Article  CAS  PubMed  Google Scholar 

  2. Adobor RD, Rimeslatten S, Steen H, Brox JI. School screening and point prevalence of adolescent idiopathic scoliosis in 4000 Norwegian children aged 12 years. Scoliosis 2011;6:23.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Jenyo MS, Asekun-Olarinmoye EO. Prevalence of scoliosis in secondary school children in Osogbo, Osun State, Nigeria. Afr J Med Med Sci 2005;34:361–4.

    CAS  PubMed  Google Scholar 

  4. Chen Z, Tang NL, Cao X, et al. Promoter polymorphism of matrilin-1 gene predisposes to adolescent idiopathic scoliosis in a Chinese population. Eur J Hum Genet 2009;17:525.

    Article  PubMed  CAS  Google Scholar 

  5. Suh SW, Modi HN, Yang JH, Hong JY. Idiopathic scoliosis in Korean schoolchildren: a prospective screening study of over 1 million children. Eur Spine J 2011;20:1087–94.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Reamy BV, Slakey JB. Adolescent idiopathic scoliosis: review and current concepts. Am Fam Physician 2001;64:L111–6.

    CAS  PubMed  Google Scholar 

  7. Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis 2006; 1:2.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop 2012;7:3–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Labelle H, Richards SB, De Kleuver M, et al. Screening for adolescent idiopathic scoliosis: an information statement by the scoliosis research society international task force. Scoliosis 2013;8:17.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Grivas TB, Vasiliadis E, Mouzakis V, et al. Association between adolescent idiopathic scoliosis prevalence and age at menarche in different geographic latitudes. Scoliosis 2006;1:9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nery LS, Halpern R, Nery PC, et al. Prevalence of scoliosis among school students in a town in southern Brazil. Sao Paulo Med J 2010;128:69–73.

    Article  PubMed  Google Scholar 

  12. Adobor RD, Rimeslatten S, Steen H, Brox JI. School screening and point prevalence of adolescent idiopathic scoliosis in 4000 Norwegian children aged 12 years. Scoliosis 2011;6:1–7.

    Article  Google Scholar 

  13. Ueno M, Takaso M, Nakazawa T, et al. A 5-year epidemiological study on the prevalence rate of idiopathic scoliosis in Tokyo: school screening of more than 250,000 children. J Orthop Sci 2011;16:1–6.

    Article  PubMed  Google Scholar 

  14. Daffner SD, Beimesch CF, Wang JC. Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis. Spine (Phila Pa 1976) 2010;35:1165–9.

    Article  Google Scholar 

  15. Kamerlink JR, Quirno M, Auerbach JD, et al. Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases. J Bone Joint Surg Am 2010;92:1097–104.

    Article  PubMed  Google Scholar 

  16. Blewett LA, Johnson PJ, Mach AL. Immigrant children’s access to health care: differences by global region of birth. J Health Care Poor Underserved 2010;21(2 suppl):13–31.

    PubMed  PubMed Central  Google Scholar 

  17. Watanabe K, Lenke L, Bridwell KH, et al. Cross-cultural comparison of the Scoliosis Research Society outcomes instrument between American and Japanese idiopathic scoliosis patients. Are there differences? Spine (Phila Pa 1976) 2007;32:2711–4.

    Article  Google Scholar 

  18. Peters DH, Garg A, Bloom G, et al. Poverty and access to health care in developing countries. Ann N Y Acad Sci 2008;1136:161–71.

    Article  PubMed  Google Scholar 

  19. Naicker S, Plange-Rhule J, Tutt RC, Eastwood JB. Shortage of healthcare workers in developing countries—Africa. Ethn Dis 2009;19:60.

    Google Scholar 

  20. World Health Organization. Global atlas of the health workforce, http://www.who.int/hrh/en; 2005. Accessed 15.03.2013.

  21. Luboga S, Macfarlane SB, von Schreeb J, et al. Increasing access to surgical services in sub-Saharan Africa: priorities for national and international agencies recommended by the Bellagio Essential Surgery Group. PLoS Med 2009;6:e1000200.

    Article  Google Scholar 

  22. Ozgediz D, Riviello R. The “other” neglected diseases in global public health: surgical conditions in sub-Saharan Africa. PLoS Med 2008;5:e121.

    Article  Google Scholar 

  23. Ozgediz D, Jamison D, Cherian M, McQueen K. The burden of surgical conditions and access to surgical care in low- and middle-income countries. Bull World Health Organ 2008;86:646–7.

    Google Scholar 

  24. Kushner AL, Cherian MN, Noel L, et al. Addressing the Millennium Development Goals from a surgical perspective: essential surgery and anesthesia in 8 low-and middle-income countries. Arch Surg 2010;145:154.

    Article  Google Scholar 

  25. Skinner J, Chandra A, Goodman D, Fisher ES. The elusive connection between health care spending and quality. Health Aff 2009;28:w119–23.

    Article  Google Scholar 

  26. Hastings DW, Cable S, Zahran S. The globalization of a minor sport: the diffusion and commodification of masters swimming. Soc Spectrum 2005;25:133–54.

    Google Scholar 

  27. Salisu A, Prinz V. Healthcare in Ghana. Austrian Red Cross ACCORD Report. ECOI (European Country of Origin Information Network) 2009. https://www.ecoi.net/en/file/local/1093121/90_1236873017_accord-health-care-in-ghana-20090312.pdf.

  28. Hahm HC, Ozonoff A, Gaumond J, Sue S. Perceived discrimination and health outcomes a gender comparison among Asian-Americans nationwide. Womens Health Issues 2010;20:350–8.

    Article  Google Scholar 

  29. Cooper H. Investigating socio-economic explanations for gender and ethnic inequalities in health. Soc Sci Med 2002;54:693–706.

    Google Scholar 

  30. Fong DYT, Luk KDK. Should screening for scoliosis be conducted? ArgoSpine News & Journal 2012;24:46–9.

    Article  Google Scholar 

  31. Fong DYT, Lee CF, Cheung KMC, et al. A meta-analysis of the clinical effectiveness of school scoliosis screening. Spine (Phila Pa 1976) 2010;35:1061.

    Article  Google Scholar 

  32. Luk KD, Lee CF, Cheung KM, et al. Clinical effectiveness of school screening for adolescent idiopathic scoliosis: a large population-based retrospective cohort study. Spine 2010;35:1607–14.

    Article  PubMed  Google Scholar 

  33. Huber M, Stanicole A, Bremner J, Wahlbeck K; Quality in and Equality of Access to Healthcare Services. Social Affairs and Equal Opportunities. Luxembourg: European Commission Directorate-General for Employment; 2008. p. 196–201. https://www.euro.centre.org/downloads/detail/882.

    Google Scholar 

  34. Hee HT, Yu ZR, Wong HK. Comparison of segmental pedicle screw instrumentation versus anterior instrumentation in adolescent idiopathic thoracolumbar and lumbar scoliosis. Spine (Phila Pa 1976) 2007;32:1533–42.

    Article  Google Scholar 

  35. Newton PO, Shea KG, Granlund KF. Defining the pediatric spinal thoracoscopy learning curve: sixty-five consecutive cases. Spine 2000;25:1028–35.

    Article  CAS  PubMed  Google Scholar 

  36. Vincent A, Jiang L, Quellet J. Is there a need for anterior release for 70–90° thoracic curves in adolescent scoliosis? Eur Spine J 2004;13:740–5.

    Article  Google Scholar 

  37. Niemeyer T, Freeman BJ, Grevitt MP, Webb JK. Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformity. Eur Spine J 2000;9:499–504.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Swaminathan R, Rama R, Shanta V. Lack of active follow-up of cancer patients in Chennai, India: implications for population-based survival estimates. Bull World Health Organ 2008;86:509–15.

    Article  PubMed  Google Scholar 

  39. Lonner BS, Scharf C, Antonacci D, et al. The learning curve associated with thoracoscopic spinal instrumentation. Spine (Phila Pa 1976) 2005;30:2835–40.

    Article  Google Scholar 

  40. Lonner BS, Auerbach JD, Estreicher MB, Kean KE. Thoracic pedicle screw instrumentation the learning curve and evolution in technique in the treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2009;34:2158–64.

    Article  Google Scholar 

  41. Cahill PJ, Pahys JM, Asghar J, et al. The effect of surgeon experience on outcomes of surgery for adolescent idiopathic scoliosis. J Bone Joint Surg 2014;96:1333–9.

    Article  PubMed  Google Scholar 

  42. Verma K, Errico TJ, Vaz KM, Lonner BS. A prospective, randomized, double-blinded single-site control study comparing blood loss prevention of tranexamic acid (TXA) to epsilon aminocaproic acid (EACA) for corrective spinal surgery. BMC Surg 2010;10:13.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Betz RR, Shufflebarger H. Anterior versus posterior instrumentation for the correction of thoracic idiopathic scoliosis. Spine (Phila Pa 1976) 2001;26:1095–100.

    Article  CAS  Google Scholar 

  44. Coe JD, Arlet V, Donaldson W, et al. Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 2006;31:345–9.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedics & Rehabilitation, Yale New Haven Hospital, 20 York Street, New Haven, CT, 06510, USA

    Courtney Toombs MD

  2. Mount-Sinai Beth Israel Medical Center, Department of Orthopedics, 281 1st Ave, New York, NY, 10003, USA

    Baron Lonner MD

  3. Nairobi Spine and Orthopaedic Centre, Department of Orthopaedics, Fortis Suites, 1st Floor, Hospital Rd, Nairobi, Kenya

    Akil Fazal MD

  4. FOCOS Orthopaedic Hospital, 8 Teshie Street, Pantang, Kanda, Accra, Ghana

    Oheneba Boachie-Adjei MD

  5. Pediatric Orthopedics & Scoliosis Center, Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA, 92123, USA

    Tracey Bastrom MA

  6. Department of Traumatology, Orthopaedic Surgery and Emergency, Hospital Vall d’Hebron, Passeig de la Vall d’Hebron, 119-129, Barcelona, 08035, Spain

    Ferran Pellise MD

  7. Department of Orthopaedics, Tanta University, El-Gaish, Tanta Qism 2, Tanta, Gharbia Governorate, Tanta, Egypt

    Mohamed Ramadan MD

  8. Department of Orthopaedics and Traumatology, Cairo University, 1 Gamaa Street, Giza, Cairo, P.O. Box 12613, Egypt

    Wael Koptan MD & Yasser ElMiligui MD

  9. Spine Surgery, Nanjing University Drum Tower Hospital, 321 Zhongshan Rd, Gulou Qu, Nanjing Shi, Jiangsu Sheng, 210008, China

    Feng Zhu MD & Yong Qiu MD

  10. Division of Pediatric Spinal Surgery, Miami Children’s Hospital, 3100 SW 62nd Ave, Miami, FL, 33155, USA

    Harry Shufflebarger MD

  11. 820 2nd Avenue, Suite 7A, New York, NY, 10017, USA

    Baron Lonner MD

Authors
  1. Courtney Toombs MD
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  2. Baron Lonner MD
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  3. Akil Fazal MD
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  4. Oheneba Boachie-Adjei MD
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  5. Tracey Bastrom MA
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  6. Ferran Pellise MD
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  7. Mohamed Ramadan MD
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  8. Wael Koptan MD
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  9. Yasser ElMiligui MD
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  10. Feng Zhu MD
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  11. Yong Qiu MD
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  12. Harry Shufflebarger MD
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Corresponding author

Correspondence to Baron Lonner MD.

Additional information

Author disclosures: CT (none), BL (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from Setting Scoliosis Straight Foundation, John and Marcella Fox Fund Grant, and Orthopaedic Research and Education Foundation [OREF]; personal fees from DePuy Synthes Spine, K2M, Paradigm Spine, Spine Search, Ethicon, Zimmer Biomet, Apifix, and Unyq Align; nonfinancial support from Spine Deformity journal, outside the submitted work), AF (none), OBA (grants, personal fees, and other from K2M; other from WEIGAO, outside the submitted work), TB (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), FP (personal fees from DePuy Synthes Spine; grants from DePuy Synthes Spine, Medtronic, and Zimmer-Biomet, outside the submitted work), MR (none), WK (none), YE (none), FZ (none), YQ (none), HS (personal fees and royalties from DePuy Synthes and K2M).

Funding: Grant from DePuy Spine to Setting Scoliosis Straight Foundation in support of the Harms Study Group’s research.

IRB Approval: Institutional review board approval was obtained for this study from the NYU Langone Medical Center IRB on behalf of the study group.

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Toombs, C., Lonner, B., Fazal, A. et al. The Adolescent Idiopathic Scoliosis International Disease Severity Study: Do Operative Curve Magnitude and Complications Vary by Country?. Spine Deform 7, 883–889 (2019). https://doi.org/10.1016/j.jspd.2019.04.004

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  • DOI: https://doi.org/10.1016/j.jspd.2019.04.004

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