Purpose We sought to identify correlations between working diagnosis, surgeon indication for obtaining spinal MRI and positive MRI findings in paediatric patients presenting with spinal disorders or complaints. Methods Surgeons recorded their primary indication for ordering a spinal MRI in 385 consecutive patients. We compared radiologist-reported positive MRI findings with surgeon response, indication, working diagnosis and patient demographics. Results The most common surgeon-stated indications were pain (70) and coronal curve characteristics (63). Radiologists reported 137 (36%) normal and 248 (64%) abnormal MRIs. In total, 58% of abnormal reports (145) did not elicit a therapeutic or investigative response, which we characterized as ‘clinically inconsequential’. In all, 42 of 268 (16%) presumed idiopathic scoliosis patients had intradural pathology noted on MRI. Younger age (10.3 years versus 12.0 years) was the only significant demographic difference between patients with or without intradural pathology. Surgeon indication ‘curve magnitude at presentation’ was associated with intradural abnormality identification. However, average Cobb angles between patients with or without an intradural abnormality was not significantly different (39° versus 37°, respectively). Back pain without neurological signs or symptoms was a negative predictor of intradural pathology. Conclusion Radiologists reported a high frequency of abnormalities on MRI (64%), but 58% of those were deemed clinically inconsequential. Patients with MRI abnormalities were two years’ younger than those with a normal or inconsequential MRI. ‘Curve magnitude at presentation’ in presumed idiopathic scoliosis patients was the only predictor of intrathecal pathology. ‘Pain’ was the only indication significantly associated with clinically inconsequential findings on MRI. Level of evidence: III
Purpose Magnetically controlled growing rods (MCGR) have become the dominant distraction-based implant for the treatment of early onset scoliosis (EOS). Recent studies, however, have demonstrated rising rates of implant failure beyond short-term follow-up. We sought to evaluate a single-center experience with MCGR for the treatment of EOS to define the rate of MCGR failure to lengthen, termed implant stall, over time. Methods A single-center, retrospective review was conducted identifying children with EOS undergoing primary MCGR implantation. The primary endpoint was the occurrence of implant stalling, defined as a failure of the MCGR to lengthen on three consecutive attempted lengthening sessions with minimum of 2 years follow-up. Clinical and radiographic variables were collected and compared between lengthening and stalled MCGRs. A Kaplan–Meier survival analysis was conducted to assess implant stalling over time. Results A total of 48 children met inclusion criteria (mean age 6.3 ± 1.8 years, 64.6% female). After a mean 56.9 months ( range of 27 to 90 months ) follow-up, 25 (48%) of children experienced implant stalling at a mean of 26.0 ± 14.1 months post-implantation. Kaplan–Meier survival analysis demonstrated that only 50% of MCGR continue to successfully lengthen at 2 years post-implantation, decreasing to < 20% at 4 years post-implantation. Conclusion Only 50% of MCGR continue to successfully lengthen 2 years post-implantation, dropping dramatically to < 20% at 4 years, adding to the available knowledge regarding the long-term viability and cost-effectiveness of MCGR in the management of EOS. Further research is needed to validate these findings.
Background:Thoracic spine height is cited as a crucial outcome measure in the treatment of early-onset scoliosis (EOS) because of its reported relationship to pulmonary function tests (PFTs). An 18-cm threshold has been proposed, although this single parameter might be overly simplistic for cases of different etiologies and deformity magnitude. We aimed to reevaluate pulmonary function in patients undergoing corrective surgery, assessing the role of residual scoliosis as well as spine elongationMethods:Patients undergoing EOS correction with a minimum of 5 years of follow-up since initial treatment were evaluated. Standard spirometry (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1]) was correlated to deformity magnitude and T1-T12 height. Patients were compared by age at first surgery (<5 or ≥5 years), final thoracic height (≤18 or >18 cm), and percentage of predicted pulmonary function (<60% or ≥60%).Results:Twenty-nine patients (15 congenital, 11 syndromic, and 3 idiopathic cases) were tested at a mean of 8.5 years following initial surgery. Twenty-two patients (mean initial age, 4.8 years) had growth-sparing instrumentation, and 7 patients (age, 5.1 years) had definitive fusion performed. Age at initial surgery was not associated with a difference in PFT results at the time of follow-up, and both age groups had ominously low percentages of predicted pulmonary-function volumes (50% to 55%). Only 18 of the 29 patients achieved a T1-T12 height of >18 cm. Those with a thoracic height of ≤18 cm had similar percentage-of-predicted spirometry results at the time of follow-up as those with greater thoracic height, possibly because of increased deformity correction. Only 14 of 29 patients had spirometry of ≥60% of predicted volume at the time of follow-up. These 14 had slightly smaller curves and slightly greater T1-T12 heights but significantly better spirometry results than the 15 subjects with <60% of predicted volume. For those with a T1-T12 height of ≤18 cm, the residual Cobb angle negatively correlated with spirometry results. In those with a final T1-T12 height of >18 cm, spirometry did correlate with thoracic height, especially when residual deformity was ≥60°.Conclusions:Regardless of thoracic height of ≤18 or >18 cm, with residual curves of >50o, pulmonary function was ominously low in fully half of the patients, raising doubt about the value of this threshold as an EOS outcome parameter.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Background: Patients with adolescent idiopathic scoliosis (AIS) often report chronic back pain; however, there is inadequate research on psychological factors associated with pain in this patient population. Pain catastrophizing, a psychological factor that describes a pattern of negative thoughts and feelings about pain, has been associated with poorer responses to medical treatment for pain. The purpose of this study was to report the prevalence of pain catastrophizing in the AIS population and assess its relationship with preoperative and postoperative self-reported outcomes. Methods: In this prospective cohort study of consecutive patients undergoing posterior spinal fusion (PSF) for AIS, patients experiencing clinically relevant pain catastrophizing, defined as a Pain Catastrophizing Scale for Children (PCS) score in the 75th percentile or higher, were compared with patients with normal PCS scores. Preoperative and 2-year postoperative Scoliosis Research Society Society Questionnaire-30 (SRS-30) scores were correlated with the preoperative PCS score. Results: One hundred and eighty-nine patients underwent PSF for AIS, and 20 (10.6%) were considered to be experiencing pain catastrophizing. Despite comparable demographic and radiographic variables, pain catastrophizing was associated with significantly lower preoperative scores than were found in the normal-PCS group in all SRS-30 domains, including pain (2.98 versus 3.95; p < 0.001), appearance (2.98 versus 3.48; p < 0.001), activity (3.51 versus 4.06; p < 0.001), mental health (3.12 versus 4.01; p < 0.001), and total score (3.18 versus 3.84; p < 0.001), except satisfaction (3.72 versus 3.69; p > 0.999). At 2 years, the pain catastrophizing group experienced significant improvement from their preoperative scores in most SRS-30 domains, including a large clinically relevant improvement in pain (from 2.98 preoperatively to 3.84 postoperatively; p < 0.001) and the total score (from 3.18 to 3.85; p < 0.001), but continued to have lower scores than the normal-PCS group for pain (3.84 versus 4.22; p = 0.028) and the total score (3.85 versus 4.15; p = 0.038). Receiver operating characteristic (ROC) curve analysis indicated that an SRS-30 pain score of <3.5 has good sensitivity for predicting pain catastrophizing (PCS ≥75th percentile). Conclusions: In this cohort, patients with AIS who exhibited pain catastrophizing experienced significant improvement in self-reported health 2 years after PSF. However, they did not have the same levels of self-reported health as the normal-PCS group. Pain catastrophizing may be identifiable by lower preoperative SRS-30 pain scores. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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