Heath-related quality of life and functional outcomes in patients with congenital or juvenile idiopathic scoliosis after an average follow-up of 25 years: a cohort study.

BACKGROUND CONTEXT: Congenital and juvenile scoliosis are both early-onset deformities that develop before the age of 10. Children are treated to prevent curve progression and problems in adulthood such as back pain and a decreased quality of life but literature on long-term outcomes remains scarce. PURPOSE: To evaluate the health-related quality of life (HRQoL) and potential disability of children with congenital scoliosis (CS) or juvenile idiopathic scoliosis (JIS) after a minimum of 20 years follow-up. STUDY DESIGN: Comparative cohort study. PATIENT SAMPLE: A consecutive cohort of CS and JIS patients were retrospectively identified from a single-center scoliosis database. Patients born between 1968 and 1981 and treated during skeletal growth were eligible for participation. OUTCOME MEASURES: HRQoL (SF-36, SRS-22r, ODI). METHODS: The primary aim was to evaluate the HRQoL of CS and JIS patients using the general SF-36 questionnaire. Both patient cohorts were compared with age-matched national norms. The secondary aim was to analyze the differences between conservatively and surgically treated patients using the scoliosis-specific Scoliosis Research Society-22r questionnaire (SRS-22r) and the Oswestry Disability Index (ODI). T-tests were used for statistical comparison. RESULTS: In total, 114 patients (67% of the eligible patients) completed the questionnaire, with a mean follow-up of 25.5±5.5 years after their final clinical follow-up. Twenty-nine patients with CS were included with a mean age of 44.4±3.8 years (79.3% female), and 85 patients with JIS with a mean age of 43.7±4.2 years (89.4% female). Of the SF-36 domains, only the vitality score (60.6±18.0 for CS and 58.1±17.6 for JIS cohort) and mental health score (70.0±18.4 for CS and 72.1±18.1 for JIS cohort) were significantly lower compared with the general population (68.6±19.3 for vitality, and 76.8±17.4 for mental health). These decreased scores were larger than the determined minimum clinically important difference threshold of 4.37. Surgically treated JIS patients had a significantly lower score on the SRS-22r pain domain than their nonsurgically treated peers (3.6±0.9 vs 4.1±0.7l p=.019). Surgically treated CS patients had a significantly higher score on the SRS-22r mental health domain than their nonsurgically treated peers (4.3±0.5 vs 3.5±1.0; p=.023). No significant differences were found in the other domains. CONCLUSIONS: Except for vitality and mental health domains, congenital and juvenile idiopathic scoliosis patients treated during skeletal growth had similar HRQoL on most SF-36 domains in adulthood compared with national norms. Surgical treated JIS patients experienced more pain compared with brace treated patients, while braced CS patients had a significantly lower mental scores compared with surgical treated patients. These long-term outcomes are essential to inform patients and can guide shared decision-making between clinicians and patients.

Validity and reliability of the adapted Dutch version of the Brace Questionnaire (BrQ).

BACKGROUND AND PURPOSE: The Brace Questionnaire (BrQ) is a disease-specific health-related quality of life (HRQOL) instrument for measuring perceived health status of scoliosis patients undergoing brace treatment. The purpose of this study is to evaluate the validity and reliability of a translated and culturally adapted Dutch version of the BrQ. PATIENTS AND METHODS: The original Greek BrQ was translated into Dutch and a cross-cultural adaptation and validation processes were conducted. Subsequently, 80 adolescent idiopathic scoliosis (AIS) patients undergoing active brace treatment were included from 4 scoliosis centers to evaluate the validity and reliability of the Dutch version of the BrQ. The questionnaire's floor and ceiling effects, internal consistency, and test-retest reliability were assessed. Concurrent validity was evaluated by comparing the BrQ with the revised Scoliosis Research Society 22-item questionnaire (SRS-22r) scores. RESULTS: The mean total BrQ score was 75.9 (standard deviation [SD] 11.3) and the mean domain scores varied between 3.4 (SD 0.9) and 4.2 (SD 0.7) for the domains "vitality" and "bodily pain," respectively. There were no floor and ceiling effects for the total BrQ score. The BrQ showed satisfactory internal consistency in most subdomains with a Cronbach's α ranging between 0.35 for the domain "general health perception" and 0.89 for the domain "self-esteem and aesthetics." Excellent test-retest reproducibility was observed for the total BrQ score (ICC 0.91), and the BrQ was successfully validated against the SRS-22r. CONCLUSION: The translated and culturally adapted Dutch version of the BrQ is a valid and reliable HRQOL instrument for AIS patients undergoing brace treatment.

Health-related quality of life of adult, non-surgically treated patients with idiopathic scoliosis and curves above 45°: a cross-sectional study at an average follow-up of 30 years.

BACKGROUND CONTEXT: Previous studies on the natural history of moderate to severe idiopathic scoliosis show contradictory results. Some studies reported an increased incidence of back pain and disability in severe curves, while other studies reported no difference in health-related quality of life (HRQoL) compared to age-matched adult controls. None of these studies addressed HRQoL using currently recommended and validated questionnaires. PURPOSE: To examine the long-term HRQoL in non-surgically treated adult idiopathic scoliosis patients with a curve of 45° or higher. METHODS: In this retrospective cohort study, all patients were retrospectively identified in the hospital's scoliosis database. Patients (1) with idiopathic scoliosis; (2) born before 1981 (to ensure 25-year follow-up after skeletal maturity); (3) with a curve of 45° or more by Cobb's method at the end of growth; and (4) no spinal surgical treatment were selected. Patients received digital questionnaires of the Short Form-36, Scoliosis Research Society-22, Oswestry Disability Index and Numeric Rating Scale. Outcomes of the SF-36 were compared with a national reference cohort. Additional measures with questions regarding choice of education and occupation were used. RESULTS: Forty-eight of 79 (61%) eligible patients completed the questionnaires, at an average follow-up time of 29.9 ± 7.7 years. Their average age was 51.9 ± 8.0, and median Cobb angle at adolescence was 48.5°. Five of the eight SF-36 subdomains were significantly lower in the scoliosis group compared to the nationwide cohort: physical functioning (73 vs 83, p = 0.011), social functioning (75 vs 84, p = 0.022), role physical functioning (63 vs 76, p = 0.002), role emotional functioning (73 vs 82, p = 0.032), and vitality (56 vs 69, p = < 0.001). The scoliosis-specific SRS-22r score of the patients was 3.7 ± 0.7 on a 0-5 scale. The mean NRS score for pain of all patients was 4.9 ± 3.2, and eight patients (17%) reported a NRS of 0 and 31 (65%) a NRS above 3. At the Oswestry Disability Index, 79% of the patients reported minimal disabilities. Thirty-three patients (69%) reported that their scoliosis had influenced their choice of education. Fifteen patients (31%) reported that their scoliosis had influenced their choice of work. CONCLUSION: Patients with idiopathic scoliosis and curves of 45° or higher have reduced HRQoL. Although many patients experience back pain, the disability reported on the ODI was limited. Scoliosis had noteworthy effect on choice of education.

Educating Parents Improves Their Ability to Recognize Adolescent Idiopathic Scoliosis: A Diagnostic Accuracy Study.

(1) In countries where scoliosis screening programs ended, the responsibility for detection shifted from healthcare professionals to parents. Since recognizing scoliosis is difficult for parents, more patients are presenting late. Increased awareness of scoliosis may favor earlier detection. This study examines the effect of educating parents to recognize scoliosis. (2) In this cross-sectional study a consecutive group of parents completed a digital assessment. They had to complete two identical series of fourteen cases (eight with scoliosis and six without). Each case displayed two photographs of the child's back; one in standing position and one during forward-bending. Based on visual inspection, parents had to indicate if the child had to be referred to a physician. After assessing the first series, information was given on how to detect scoliosis. Subsequently, parents assessed the second series of cases. Sensitivity and specificity were calculated before and after education. (3) A total of 100 parents completed the assessment. The sensitivity to detect scoliosis was slightly but significantly higher after education (68.8% versus 74.0%; p = 0.002), while specificity was not (74.0% versus 74.8%; p = 0.457). (4) This study showed that educating parents improved their ability to recognize scoliosis without increasing the false positive referral rate. Although written instructions can bridge the gap with professional screening programs, the overall sensitivity in this study remained low. Therefore, education can improve the awareness and ability to detect scoliosis, but will not replace screening by professionals.

Pulmonary function in children and adolescents with untreated idiopathic scoliosis: a systematic review with meta-regression analysis.

BACKGROUND CONTEXT: One of the controversies in untreated idiopathic scoliosis is the influence of curve size on respiratory function. Whereas scoliosis patients with curves over 90 to 100 degrees are agreed to be at risk for cardiorespiratory failure in later life, the impairment of curves below 90 degrees is generally considered mild. Although various studies showed that pulmonary function is affected in patients with scoliosis, quantification of the relation between curve size and pulmonary function is lacking. PURPOSE: This systematic review with meta-regression analysis aims to characterize the relation between pulmonary function tests and scoliosis severity in children and adolescents with idiopathic scoliosis. STUDY DESIGN: Systematic review with meta-regression analysis. METHODS: Pubmed, Embase, Cochrane, and CINAHL were systematically searched until November 3, 2020, for original articles that reported (1) severity of scoliosis quantified in Cobb angle, and (2) pulmonary function tests in children and adolescents with untreated idiopathic scoliosis. Exclusion criteria were other types of scoliosis, non-original data, post-treatment data, and case reports. All study designs were included, and relevant study details and patient characteristics were extracted. The primary outcome was the effect of Cobb angle on pulmonary function as expressed by the slope coefficient of a linear meta-regression analysis. RESULTS: A total of 126 studies, including 8,723 patients, were retrieved. Meta-regression analysis revealed a statistically significant inverse relation between thoracic Cobb angle and absolute and predicted forced vital capacity in 1 second, forced vital capacity, vital capacity, and total lung capacity. For these outcomes, the slope coefficients showed a decrease of 1% of the predicted pulmonary function per 2.6 to 4.5 degrees of scoliosis. A multivariable meta-regression analysis of potential confounders (age, year of publication, and kyphosis) hardly affected the majority of the outcomes. CONCLUSION: This meta-regression analysis of summary data (means) from 126 studies showed an inverse relationship between the thoracic Cobb angle and pulmonary function. In contrast to previous conclusions, the decline in pulmonary function appears to be gradual over the full range of Cobb angles between <20 and >120 degrees. These findings strengthen the relevance of minimizing curve progression in children with idiopathic scoliosis.

Spinal Growth in Patients With Juvenile Idiopathic Scoliosis Treated With Boston Brace: A Retrospective Study.

STUDY DESIGN: Retrospective comparative cohort. OBJECTIVE: The aim of this study was to determine whether spinal growth is restricted by brace treatment in patients with juvenile idiopathic scoliosis (JIS). SUMMARY OF BACKGROUND DATA: Spinal fusion can negatively affect spinal growth if performed before the growth spurt. Brace treatment is often given in this young population to control the spinal deformity while allowing spinal growth. It is unknown whether the applied pressure of brace treatment on spine results in growth restriction. The aim of the study is to evaluate spinal growth in braced JIS patients. METHODS: A total of 49 JIS patients treated with Boston brace were retrospectively selected from a scoliosis database. T1-T12/T1-S1 perpendicular and freehand (height following the curvature of the spine) height were measured on radiographs of patients that had reached skeletal maturity and were matched with 49 controls without scoliosis. Spinal growth was calculated from brace initiation until cessation and was compared with normal spinal growth values as reported by Dimeglio. RESULTS: The mean age of diagnosis was 7.4 years. The age of the braced scoliosis patients at skeletal maturity was 17.5 years. The average T1-T12 and T1-S1 freehand height measured by following the curvature of the scoliosis was 29.3 cm (±2.4) and 47.2cm (±4.0), respectively, and was not significant different from the control group. Brace treatment was initiated at a mean age of 11.2 and the mean age of cessation was 14.8. Spinal growth (freehand) during brace treatment was 1.10 cm/year for the thoracic spine and 1.78 cm/year for the full spine and was not significant different from normal values. CONCLUSION: No significant influence of bracing on spinal growth could be detected in this cohort of JIS patients. The spinal height measurements at skeletal maturity were similar to matched controls. In addition, spinal growth did not significantly differ from Dimeglio normal growth data, indicating that the effect of bracing on spinal growth is absent or minimal. LEVEL OF EVIDENCE: 3.

LETTER TO THE EDITOR CONCERNING: Effectiveness of the Rigo Chêneau versus Boston-style orthoses for adolescent idiopathicscoliosis: a retrospective study, by Minsk MK, Venuti KD, Daumit GL, Sponseller PD. Scoliosis Spinal Disord. 2017 Mar 20;12:7.

We have read with great interest the article by Minsk et al. in Scoliosis and Spinal Disorders. However, the authors reported a conclusion that is based on possible selection bias in surgical candidates. Physicians are trained in the interpretation of scientific articles; however, not everybody is able to do this. Especially in open access journals, a biased conclusion may have big consequences and may be misleading for patients and family members who can read these articles for free on the internet.

Is postoperative bracing after pedicle screw fixation of spine fractures necessary? Study protocol of the ORNOT study: a randomised controlled multicentre trial.

INTRODUCTION: The most common surgical treatment of traumatic spine fractures is through a posterior approach using pedicle screws and rods. Postoperative treatment protocols including the use of postoperative orthoses however differ between hospitals and surgeons. A three-point hyperextension orthosis is designed to support proper posture and unload the anterior column. Some motion remains when wearing an orthosis, and its main value in postoperative treatment is therefore believed to be pain relief and patient confidence. This could consequently shorten recovery time. On the other hand, an orthosis could also lead to muscle weakness and slow down recovery. Any orthosis-related complications might also be avoided. Additionally, recent studies on conservative fracture treatment show no difference in radiological outcomes with or without an orthosis. To date, no randomised studies have been performed on the use of postoperative orthoses. METHODS AND ANALYSIS: Patients undergoing posterior fixation with pedicle screws for a traumatic thoracolumbar fracture (T7-L4) will be included in this randomised controlled multicentre non-inferiority trial. Forty-six patients will be randomised 1:1 to one of the two parallel groups; one group will wear a postoperative orthosis for 6 weeks followed by 6 weeks of weaning and one group will not wear an orthosis. The primary outcome is pain at 6 weeks reported on the Numerical Rating Scale. Secondary outcomes consist of pain on other moments, analgesic use, complications and length of hospital stay, quality of life (EuroQuol 5 Dimensions), back pain-related function (Oswestry Disability Index) and radiological outcomes with a follow-up of 1 year. Orthosis compliance is monitored weekly in the orthosis group. ETHICS AND DISSEMINATION: The institutional review board (METc VUmc) approved this study on 11 October 2016 under case number 2016.389. After completion of the trial, the results will be offered to an international scientific journal for peer-reviewed publication. TRIAL REGISTRATION NUMBER: NCT03097081 and NTR6285; Pre-results.

Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia. Surgical technique.

BACKGROUND: Reconstructive surgical measures for treatment of posttraumatic deformities of the lateral tibial plateau are seldom reported on in the literature. We report the long-term follow-up results of a consecutive series of reconstructive osteotomies performed to treat depression and valgus malunions of the proximal part of the tibia. METHODS: From 1977 through 1998, a combination of an intra-articular elevation and a lateral opening wedge varus osteotomy of the proximal part of the tibia was performed in twenty-three consecutive patients. The patients were assessed clinically and radiographically at a minimum of five years postoperatively. RESULTS: A correction of the intra-articular depression and the valgus malalignment was achieved and the anatomic lower-extremity axis was restored in all patients. The clinical results were evaluated at a mean of thirteen years (range, two to twenty-six years) after the reconstructive osteotomy. Two patients had an early failure and were considered to have had a poor result. Two other patients had severe progression of osteoarthritis after the osteotomy, four had slight progression, and fifteen had no progression. There were no nonunions. There were two superficial wound infections, which were treated successfully without surgical intervention. According to the scale of Lysholm and Gillquist, the subjective result was excellent for seventeen patients (74%), good for three, fair for one, and poor for two. CONCLUSIONS: A knee-joint-preserving osteotomy can provide satisfactory results in active patients with painful posttraumatic lateral depression and valgus malunion of the proximal part of the tibia.

Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia.

BACKGROUND: Reconstructive surgical measures for treatment of posttraumatic deformities of the lateral tibial plateau are seldom reported on in the literature. We report the long-term follow-up results of a consecutive series of reconstructive osteotomies performed to treat depression and valgus malunions of the proximal part of the tibia. METHODS: From 1977 through 1998, a combination of an intra-articular elevation and a lateral opening wedge varus osteotomy of the proximal part of the tibia was performed in twenty-three consecutive patients. The patients were assessed clinically and radiographically at a minimum of five years postoperatively. RESULTS: A correction of the intra-articular depression and the valgus malalignment was achieved and the anatomic lower-extremity axis was restored in all patients. The clinical results were evaluated at a mean of thirteen years (range, two to twenty-six years) after the reconstructive osteotomy. Two patients had an early failure and were considered to have had a poor result. Two other patients had severe progression of osteoarthritis after the osteotomy, four had slight progression, and fifteen had no progression. There were no nonunions. There were two superficial wound infections, which were treated successfully without surgical intervention. According to the scale of Lysholm and Gillquist, the subjective result was excellent for seventeen patients (74%), good for three, fair for one, and poor for two. CONCLUSIONS: A knee-joint-preserving osteotomy can provide satisfactory results in active patients with painful posttraumatic lateral depression and valgus malunion of the proximal part of the tibia.

Treatment of a large intraosseous talar ganglion by means of hindfoot endoscopy.

We report on 2 patients with a large intraosseous ganglion of the talus who were treated by means of a 2-portal endoscopic approach of the hindfoot with the patient in the prone position. By means of this approach, it is possible to visualize, debride, and graft a large intraosseous talar lesion. In both patients, the lesions were treated successfully, with no recurrence at follow up.