What Factors Influence Delayed Referral to Spinal Surgeon in Adolescent Idiopathic Scoliosis?

Abstract

Study Design. Retrospective review with qualitative phone interview. Objective. This study aims to identify the factors leading to delayed diagnosis or referral to a spinal surgeon in patients who subsequently require surgery for adolescent idiopathic scoliosis (AIS). Summary of Background Data. AIS can be effectively treated with bracing to prevent curve progression in skeletally immature patients. Australia currently has in place a national self-detection screening program to diagnose AIS. Methods. A retrospective review was performed for patients who underwent surgery for scoliosis at Princess Margaret Hospital for Children and Royal Perth Hospital between June 1, 2010 and May 27, 2014. Data were retrieved from the digital medical record and a semistructured phone interview was used to determine path to diagnosis and referral. Results. Mean Cobb angle at first specialist review was 49.5° ± 14.0° for patients who subsequently required surgery for AIS. These patients experienced an average interval of 20.7 months from detection of symptoms to review in a specialist clinic. Conclusion. In a condition in which early detection and intervention may halt progression of disease, AIS is detected relatively late and there are specific delays to diagnosis and referral to specialist clinics. Level of Evidence: 4

The impact of COVID-19 on idiopathic scoliosis referrals: cause for concern

“…The upper limit (75th percentile) of the curve magnitude IQR is higher and the large magnitude outliers are more extreme On-line learning and lock down measures, including activity cancellations, have further limited opportunities for early diagnosis. Although scoliosis referrals are ultimately made by PCPs, it is not uncommon for a curvature to first be noted by an individual that is not a health-care professional [8,22]. Opportunities for curve recognition include social activities and organized sport.…”

The Relationship Between Body Mass Index and the Magnitude of Curve at Diagnosis of Adolescent Idiopathic Scoliosis: A Retrospective Chart Review

“…While the benefits of universal screening programs have been debated, 4–6 early detection of AIS is important so that appropriate management pathways can be initiated, especially those at highest risk for progression. 7 As summarized by the Scoliosis Research Society, risk of progression is higher in the in those who develop scoliosis at a young age, in the presence of skeletal immaturity, and when curve angle is ≥20 degrees at presentation. 8 Recent research has identified additional factors, such as spinal flexibility, that may be important to predict curve progression/successful outcomes with bracing 9 , 10 In addition to facilitating the initiation of bracing (when indicated 11 ), early identification allows for earlier introduction of other conservative approaches.…”

“… 11 Barriers to early identification and referral for further management should be identified and addressed. 7 …”

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