What are parents willing to accept? A prospective study of risk tolerance in AIS surgery

Lonner, Baron; Jain, Amit; Sponseller, Paul D.; Eaker, Lily; Samdani, Amer F.; Kelly, Michael P.; Castillo, Andrea; Marrache, Majd; Ames, Christopher P.; Shah, Suken A.

doi:10.1007/s43390-020-00216-z

Cited by 2 publications

(2 citation statements)

References 28 publications

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“…Clinical success can be defined by improvement of radiographic parameters, pain reduction, improved body image and durability of outcomes. Patient and family preferences and goals must be taken into account when recommending a procedure, acknowledging attributes and drawbacks as well as gaps in knowledge of a particular procedure and approach [ 3 , 4 ]. Some families may have an aversion to the idea of a spinal fusion procedure for their child, either due to perceived or actual negative impacts, its permanency, or a desire to maintain flexibility of the spine and leave options available for future innovations in the arena of pediatric scoliosis correction.…”

Section: Introductionmentioning

confidence: 99%

Vertebral Body Tethering in 49 Adolescent Patients after Peak Height Velocity for the Treatment of Idiopathic Scoliosis: 2–5 Year Follow-Up

Meyers

Eaker

Zhang

et al. 2022

JCM

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Vertebral Body Tethering (VBT) is a non-fusion surgical treatment for Adolescent Idiopathic Scoliosis (AIS) that elicits correction via growth modulation in skeletally immature patients. VBT after peak height velocity is controversial and is the subject of this study. A retrospective review of Risser 3–5 AIS patients treated with VBT, and min. 2-year FU was performed. Pre to post-op changes in clinical outcomes were compared using Student’s t-test or the Mann-Whitney test. A total of 49 patients met criteria, age 15.0 ± 1.9 years, FU 32.5 ± 9.1 months. For thoracic (T) major curvatures, T curvature improved from 51.1 ± 6.9° to 27.2° ± 8.1° (p < 0.01) and TL from 37.2° ± 10.7° to 19.2° ± 6.8° (p < 0.01). For thoracolumbar (TL) major curvatures, T improved from 37.2° ± 10.7° to 18.8° ± 9.4° (p < 0.01) and TL from 49.0° ± 6.4° to 20.1° ± 8.5° (p < 0.01). Major curve inclinometer measurements and SRS-22 domains, except activity, improved significantly (p ≤ 0.05). At the latest FU, one (2%) patient required fusion of the T curve and revision of the TL tether due to curve progression in the previously uninstrumented T curve and tether breakage (TB) in the TL. Twenty (41%) patients experienced TB. VBT in AIS patients with limited remaining skeletal growth resulted in satisfactory clinical outcomes at the latest FU.

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Section: Introductionmentioning

confidence: 99%

Vertebral Body Tethering in 49 Adolescent Patients after Peak Height Velocity for the Treatment of Idiopathic Scoliosis: 2–5 Year Follow-Up

Meyers

Eaker

Zhang

et al. 2022

JCM

Self Cite

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“…Similar surveys have been performed to determine whether families would consider enrollment in a scoliosis clinical trial 21,22 . Surveys of families undergoing fusion surgery for the treatment of AIS have shown that parents have increased willingness to allow their child to undergo fusion after careful education regarding the surgical risks 23 . Patient-preference studies have been conducted to inform medical device regulatory decisions for other conditions, including heart failure 24 and obesity 25 .…”

Section: Discussionmentioning

confidence: 99%

Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis

Larson,

Marks,

Gonzalez Sepulveda

et al. 2023

Journal of Bone and Joint Surgery

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Background: Vertebral body tethering and other non-fusion techniques for the treatment of pediatric idiopathic scoliosis are increasing in popularity. There is limited physician consensus on this topic as the result of a paucity of published data regarding which patients most benefit from non-fusion strategies. Thus, much of the decision-making is left to patients and parents, who must select a treatment based on their goals and values and the information available from health-care providers, the internet, and social media. We sought to understand patient and family preferences regarding the attributes of fusion versus non-fusion surgery that drive these choices. Methods: Patients and families were recruited from 7 pediatric spine centers and were asked to complete a survey-based choice experiment that had been jointly developed with the U.S. Food and Drug Administration (FDA) to evaluate patient preferences. Choices between experimentally designed alternatives were analyzed to estimate the relative importance of outcomes and requirements associated with the choice options (attributes). The attributes included appearance, confidence in the planned correction, spinal motion, device failure, reoperation, and recovery period. The inclusion criteria were (1) an age of 10 to 21 years and (2) a diagnosis of adolescent idiopathic scoliosis in patients who were considering, or who had already undergone, treatment with fusion or non-fusion surgery. Preference weights were estimated from the expected changes in choice given changes in the attributes. Results: A total of 344 respondents (124 patients, 92 parents, and 128 parent/patient dyads) completed the survey. One hundred and seventy-three patients were enrolled prior to surgery, and 171 were enrolled after surgery. Appearance and motion were found to be the most important drivers of choice. For the entire cohort, fusion was preferred over non-fusion. For patients who were considering surgery, the most important attributes were preservation of spinal motion and appearance. Conclusions: Patients and families seeking treatment for idiopathic scoliosis value appearance and preservation of spinal motion and, to a lesser extent, reoperation rates when considering fusion versus non-fusion surgery.

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What are parents willing to accept? A prospective study of risk tolerance in AIS surgery

Cited by 2 publications

References 28 publications

Vertebral Body Tethering in 49 Adolescent Patients after Peak Height Velocity for the Treatment of Idiopathic Scoliosis: 2–5 Year Follow-Up

Vertebral Body Tethering in 49 Adolescent Patients after Peak Height Velocity for the Treatment of Idiopathic Scoliosis: 2–5 Year Follow-Up

Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis

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