Impact of the COVID-19 Pandemic on Middle-Aged and Older Patients With Adolescent Idiopathic Scoliosis Who Underwent Spinal Fusion: A Questionnaire-Based Survey.

Purpose To investigate the impact of the COVID-19 pandemic on middle-aged and older patients with adolescent idiopathic scoliosis (AIS) who underwent spinal fusion. Methods The subjects were 252 AIS patients who underwent spinal fusion between 1968 and 1988. The surveys were performed before the COVID-19 pandemic (a primary survey in 2014) and during the pandemic (a secondary survey in 2022). The self-administered questionnaires were mailed to the patients. We analyzed 35 patients (33 females and two males) who replied to both surveys. Results The pandemic had low impacts on 11 patients (31.4%). Two patients reported refraining from seeing a doctor because they were concerned about going to the clinic or hospital, eight reported that the pandemic impacted their work, and five reported fewer opportunities to go out (based on multiple-choice answers). Twenty-four patients reported that their lives were unaffected by the pandemic. No significant differences were detected between both surveys for Scoliosis Research Society-22 (SRS-22) in any domains (function, pain, self-image, mental, or satisfaction). The Oswestry Disability Index (ODI) questionnaires revealed a significant worsening of the survey during the pandemic compared with the survey before the pandemic. There was no significant difference in the impact of the pandemic between the ODI deterioration group (27.8%) and the ODI stable group (35.3%). Conclusion The COVID-19 pandemic had a low impact on 31.4% of middle-aged and older patients with AIS who underwent spinal fusion. The impact of the pandemic did not significantly differ between the groups with ODI deteriorations and the groups with stable ODI. The pandemic had a smaller impact on AIS patients at a minimum of 33 years after surgery.

Idiopathic Scoliosis Trends One Year After COVID-19: A Retrospective Study.

Introduction The reorganization of healthcare services during the COVID-19 pandemic was associated with compromised management of conditions not related to the pandemic. Methods A retrospective descriptive case series study was carried out that included patients followed up at the Spine Deformities (SD) consultation at Centro Hospitalar e Universitário Lisboa Central from January 2019 through December 2021 regarding diagnosis, treatment, referral, and the number of consultations performed. Results Referrals significantly dropped in 2020 (p<0.001). The average number of consultations per patient was found to not vary significantly in 2020 despite the reorganization of our healthcare unit due to the pandemic. 22% of the consultations were performed online. Idiopathic scoliosis (IS) was the primary diagnosis in 50% of the patients observed for the first time during the three-year time period. An increase of 18% was found in the number of IS patients that required bracing in 2021. However, late referrals, defined as the patient meeting surgical criteria at the time of initial presentation, did not increase. Conclusion Despite the significant decrease in primary care referrals during 2020, an overcompensation increase in referrals was not observed in 2021. However, the increase in the percentage of patients needing bracing might reflect a delayed initial presentation to the SD consultation.

Genetic variants associated with the occurrence and progression of adolescent idiopathic scoliosis: a systematic review protocol.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is a structural lateral spinal curvature of ≥ 10° with rotation. Approximately 2-3% of children in most populations are affected with AIS, and this condition is responsible for approximately $1.1 billion in surgical costs to the US healthcare system. Although a genetic factor for AIS has been demonstrated for decades, with multiple potentially contributory loci identified across populations, treatment options have remained limited to bracing and surgery. METHODS: The databases MEDLINE (via PubMed), Embase, Google Scholar, and Ovid MEDLINE will be searched and limited to articles in English. We will conduct title and abstract, full-text, and data extraction screening through Covidence, followed by data transfer to a custom REDCap database. Quality assessment will be confirmed by multiple reviewers. Studies containing variant-level data (i.e., GWAS, exome sequencing) for AIS subjects and controls will be considered. Outcomes of interest will include presence/absence of AIS, scoliosis curve severity, scoliosis curve progression, and presence/absence of nucleotide-level variants. Analyses will include odds ratios and relative risk assessments, and subgroup analysis (i.e., males vs. females, age groups) may be applied. Quality assessment tools will include GRADE and Q-Genie for genetic studies. DISCUSSION: In this systematic review, we seek to evaluate the quality of genetic evidence for AIS to better inform research efforts, to ultimately improve the quality of patient care and diagnosis. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration #CRD42021243253.

Self-reported physical activities in patients with adolescent idiopathic scoliosis-A cross-sectional observational study

Introduction: The impact of idiopathic scoliosis on exercise and activities of affected adolescents are not well-documented. The aim of this study was to assess the self-reported physical activity (PA) of patients with Adolescent Idiopathic Scoliosis (AIS) in Hong Kong. Materials and Methods: This was an observational, cross-sectional study conducted at a scoliosis clinic in a tertiary referral centre in Hong Kong. Patients referred from the Hong Kong Scoliosis School Screening Programme were consecutively recruited and asked to fill in the Chinese-translated version of the Paffenbarger Physical Activity Questionnaire (PPAQ) online. Details included flights of stairs climbed, city blocks walked, and frequency, duration and intensity of sporting activities were recorded, from which a Physical Activity Index (PAI) in kilocalories/week (kcal/week) was calculated. The PAI provides an estimate of the total energy expenditure of the subject. Radiographic data including Cobb angles and region of major curve, and anthropometric data was collected from routine clinical examinations. Results: 33 male (mean age = 14.6 ± 1.84) and 102 female (mean age = 13.2 ± 1.46) were included in the study. The mean BMI of male patients was 17.3 ± 2.2 kg/m2, and that of females was 18.0 ± 3.06 kg/m2, both of which are classified as underweight. 64 patients had a mild Cobb angle (10°-24.9°), 52 had a moderate Cobb angle (25°-39.9°) and 17 had a severe Cobb angle (>40°). In terms of PA, 72 patients (53%) reported participation in yearly PA activity excluding physiotherapy and mandatory physical education classes, and 55 (40.7%) in weekly PA that caused sweating, increased heart rate and shortness of breath. The 80 patients that did not participate in any PA were asked to provide reasons for their lack of physical activity. 30% of patients reported "lack of time" and 16.3% reported "laziness". Other reasons include lack of interest (6.3%), the COVID pandemic (2.5%) and being unfit (5%). A Physical Activity Index (PAI) in kcal/week was calculated based on subjects' answers to flights of stairs climbed, city blocks walked and sporting activities. Patients that were unable to provide a numerical answer to such questions were excluded from the PAI calculations. 113 PAIs were calculated, with a mean of 2611.2 ± 5009.4 kcal/week, and a median of 1128.4 kcal/week. 48 patients (42.5%) expended under 1000 kcal/week, 30 patients (26.5%) expended 1000-2000 kcal/week, 21 patients (18.6%) expended 2000-4000 kcal/week, and 14 patients (12.4%) expended over 4000kcal/week. According to the WHO guidelines on Physical Activity and Sedentary Behavior, PA recommendations for children and adolescents include 60 minutes of moderate-to-vigorous-intensity PA per day, which totals to 365 hours per week. Only 2 patients fulfilled this criterion. Conclusion: Adolescents with AIS in Hong Kong exhibited a wide range of PA levels. However, the majority of AIS patients in this study did not participate adequate physical activity according to WHO guidelines. Further studies are required to correlate if AIS negatively impacted on their motivation to participate in physical activities and exercises.

A Dangerous Curve: Impact of the COVID-19 Pandemic on Brace Treatment in Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Observational Cohort study. OBJECTIVES: We aim to document the abandon and irregular compliance rate towards brace treatment during the COVID-19 pandemic and its impact on AIS progression. METHODS: We reviewed a database of AIS patients recruited between March and September 2020. We included AIS patients under brace treatment according to SRS criteria. The patients were divided in 2 cohorts: those with self-reported Good-Compliance (GC) to treatment and those who had a Bad-Compliance (BC). Data analysis included biometric and radiographic data at first visit and last follow-up and percentage of progression. Unpaired student-t tests and Chi2 were used for comparison. RESULTS: 152 patients met inclusion criteria. 89 patients (age:12.1y.o.±1.4) reported good adherence to treatment, while 63 patients (age:12.7y.o.±1.8) were not compliant. Within the BC group, 18 patients reported irregular brace wear, while 45 had completely abandoned treatment (abandon rate of 29%). The GC cohort started treatment with a mean main thoracic (MT) curve of 26° and finished with 27°. The mean difference between measurements was +.65°±7.5; mean progression rate was -4.6%. However, the BC cohort started with a mean MT curve of 27° and finished with 32°, with a mean increase of +5°±8 and a mean progression rate of -13%. The differences between the 2 cohorts were statistically significant (P = .0002). Six patients from the BC group progressed and were offered surgery. CONCLUSION: The abandon rate of brace treatment in AIS significantly increased during the first wave of COVID-19 pandemic. Patients who voluntarily discontinued treatment had significant increases in curve progression and surgical indication rates. LEVEL OF EVIDENCE: III.