Minimum 20-Year Health-Related Quality of Life and Surgical Rates After the Treatment of Adolescent Idiopathic Scoliosis

Larson, A. Noelle; Baky, Fady; Ashraf, Ali; Baghdadi, Yaser M. K.; Treder, Vickie M.; Polly, David W.; Yaszemski, Michael J.

doi:10.1016/j.jspd.2018.09.003

Cited by 32 publications

(25 citation statements)

References 39 publications

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“…Contradictory reports on the resultant disability compared to the general population, and between scoliosis patients depending on curve type, need further investigation. Larson et al 26 published a long-term 20-year follow-up study, showing that patients with AIS reported lower SRS-22r scores on the function, pain, and self-image domains, when compared to normative data. 26 Other studies have similarly found greater disability in patients with a scoliosis than in those without.…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life in patients 40 years after diagnosis of an idiopathic scoliosis

Ragborg

Dragsted

Ohrt-Nissen

et al. 2023

The Bone & Joint Journal

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Aims Only a few studies have investigated the long-term health-related quality of life (HRQoL) in patients with an idiopathic scoliosis. The aim of this study was to investigate the overall HRQoL and employment status of patients with an idiopathic scoliosis 40 years after diagnosis, to compare it with that of the normal population, and to identify possible predictors for a better long-term HRQoL. Methods We reviewed the full medical records and radiological reports of patients referred to our hospital with a scoliosis of childhood between April 1972 and April 1982. Of 129 eligible patients with a juvenile or adolescent idiopathic scoliosis, 91 took part in the study (71%). They were evaluated with full-spine radiographs and HRQoL questionnaires and compared with normative data. We compared the HRQoL between observation (n = 27), bracing (n = 46), and surgical treatment (n = 18), and between thoracic and thoracolumbar/lumbar (TL/L) curves. Results The mean time to follow-up was 40.8 years (SD 2.6) and the mean age of patients was 54.0 years (SD 2.7). Of the 91 patients, 86 were female (95%) and 51 had a main thoracic curve (53%). We found a significantly lower HRQoL measured on all the Scoliosis Research Society 22r instrument (SRS-22r) subdomains (p < 0.001) with the exception of mental health, than in an age-matched normal population. Incapacity to work was more prevalent in scoliosis patients (21%) than in the normal population (11%). The median SRS-22r subscore was 4.0 (interquartile range (IQR) 3.3 to 4.4) for TL/L curves and 4.1 (IQR 3.8 to 4.4) for thoracic curves (p = 0.300). We found a significantly lower self-image score for braced (median 3.6 (IQR 3.0 to 4.0)) and surgically treated patients (median 3.6 (IQR 3.2 to 4.3)) than for those treated by observation (median 4.0 (IQR 4.1 to 4.8); p = 0.010), but no statistically significant differences were found for the remaining subdomains. Conclusion In this long-term follow-up study, we found a significantly decreased HRQoL and capacity to work in patients with an idiopathic scoliosis 40 years after diagnosis. Cite this article: Bone Joint J 2023;105-B(2):166–171.

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Section: Discussionmentioning

confidence: 99%

Health-related quality of life in patients 40 years after diagnosis of an idiopathic scoliosis

Ragborg

Dragsted

Ohrt-Nissen

et al. 2023

The Bone & Joint Journal

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“…At the time of these analyses, studies reporting clinical outcomes for the VBT procedure include relatively small patient numbers, [34][35][36][37][38] with a small subset of those who reported key patient-reported outcomes 34,35 needed for a costeffectiveness analysis as compared to the extensive reporting of studies describing spinal fusion for pediatric patients with IS spanning decades and large sample sizes. 7,43 Also, studies reporting clinical outcomes for the VBT procedure provide a maximum length of follow-up of 7 years, whereas the base case time horizon for the CUA was 15 years.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Curves with Cobb angles of greater than 50° at skeletal maturity result in lasting deformity, impaired pulmonary function and reduced health-related quality of life (HRQoL) if left untreated. 7,8 Despite this, there are limited definitive treatment options available for patients who are skeletally immature other than bracing or spinal fusion. 9 When bracing has failed, or if the spinal curve is rapidly progressing, surgical treatment is usually recommended for Cobb angles greater than 45-50° to prevent subsequent progression.…”

Section: Introductionmentioning

confidence: 99%

“…9 When bracing has failed, or if the spinal curve is rapidly progressing, surgical treatment is usually recommended for Cobb angles greater than 45-50° to prevent subsequent progression. 7,10,11 The goal of surgical intervention is to correct the deformity and stabilize the spinal curve to prevent further curve progression; with spinal fusion, this is typically achieved with posterior instrumentation with rods anchored to the spine with pedicle screws ( Figure 1A). 5,12 Spinal fusion results in decreased spinal mobility and range of motion over the instrumented levels, with loss of motion increasing with each additional lower instrumented vertebra in pediatric patients with IS.…”

Section: Introductionmentioning

confidence: 99%

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Cost-Utility Analysis of Anterior Vertebral Body Tethering versus Spinal Fusion in Idiopathic Scoliosis from a US Integrated Healthcare Delivery System Perspective

Polly¹,

Larson²,

Samdani³

et al. 2021

CEOR

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Anterior vertebral body tethering (VBT) is a non-fusion, minimally invasive, growth-modulating procedure with some early positive clinical outcomes reported in pediatric patients with idiopathic scoliosis (IS). VBT offers potential health-related quality of life (HRQoL) benefits over spinal fusion in allowing patients to retain a greater range of motion after surgery. We conducted an early cost-utility analysis (CUA) to compare VBT with fusion as a first-choice surgical treatment for skeletally immature patients (age >10 years) with moderate to severe IS, who have failed nonoperative management, from a US integrated healthcare delivery system perspective. Patients and Methods: The CUA uses a Markov state transition model, capturing a 15year period following index surgery. Transition probabilities, including revision risk and subsequent fusion, were based on published surgical outcomes and an ongoing VBT observational study (NCT02897453). Patients were assigned utilities derived from published patient-reported outcomes (PROs; SRS-22r mapped to EQ-5D) following fusion and the above VBT study. Index and revision procedure costs were included. Probabilistic (PSA) and deterministic sensitivity analyses (DSA) were performed. Results: VBT was associated with higher costs but also higher quality-adjusted life years (QALYs) than fusion (incremental costs: $45,546; QALYs gained: 0.54). The subsequent incremental cost-effectiveness ratio for VBT vs fusion was $84,391/QALY gained. Mean PSA results were similar to the base case, indicating that results were generally robust to uncertainty. The DSA indicated that results were most sensitive to variations in utility values. Conclusion: This is the first CUA comparing VBT with fusion in pediatric patients with IS and suggests that VBT may be a cost-effective alternative to fusion in the US, given recommended willingness-to-pay thresholds ($100,000-$150,000). The results rely on HRQoL benefits for VBT compared with fusion. For improved model accuracy, further analyses with longer-term PROs for VBT, and comparative effectiveness studies, would be needed.

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“…Adequate results are obtained with posterior spinal fusion with reoperation rates between 4-25% at long-term followup. 5,[20][21][22] Modern fusion approaches provide excellent and durable curve correction but limit spinal motion over the instrumented vertebrae and sacrifice normal spinal anatomy. Associated risks include neurologic injury, pseudarthrosis, adjacent segment disease, and potential for revision surgery and long-term complications.…”

Section: Discussionmentioning

confidence: 99%

Anterior Lumbar Vertebral Body Tethering in Adolescent Idiopathic Scoliosis

Baker

Milbrandt

Potter

et al. 2020

Journal of the Pediatric Orthopaedic Society of North America

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Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity in children. The traditional treatment for curves greater than 50 degrees is posterior spinal fusion with pedicle instrumentation for prevention of curve progression later in life. However, there is growing interest in non-fusion techniques such as anterior vertebral body tethering. Despite the common presentation of thoracolumbar and lumbar curves in AIS, descriptions of anterior vertebral body tethering for AIS have been largely limited to the thoracic vertebrae. The goal of this paper is to describe the technique of lumbar anterior vertebral body tethering which involves a combined thoracoscopic and mini-open approach to the spine with a transdiaphragmatic tether. The technique and reduction are aided by CT navigation and a radiolucent hinged spine surgery table. Dissemination of successful techniques is essential to advance non-fusion care for idiopathic scoliosis.

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Minimum 20-Year Health-Related Quality of Life and Surgical Rates After the Treatment of Adolescent Idiopathic Scoliosis

Cited by 32 publications

References 39 publications

Health-related quality of life in patients 40 years after diagnosis of an idiopathic scoliosis

Health-related quality of life in patients 40 years after diagnosis of an idiopathic scoliosis

Cost-Utility Analysis of Anterior Vertebral Body Tethering versus Spinal Fusion in Idiopathic Scoliosis from a US Integrated Healthcare Delivery System Perspective

Anterior Lumbar Vertebral Body Tethering in Adolescent Idiopathic Scoliosis

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