When Do Patients Return to Physical Activities and Athletics After Scoliosis Surgery?: A Validated Patient Questionnaire Based Study.

STUDY DESIGN: A retrospective chart review with a survey. OBJECTIVES: This study seeks to determine time of return to normal, physical and athletic activities, and delaying factors after all pedicle screw fixation. SUMMARY OF BACKGROUND DATA: Return to athletic activity after posterior spine fusion (PSF) in adolescent idiopathic scoliosis (AIS) is largely dependent on a surgeon's philosophy. Some allow contact and collision sports by 6 and 12 months, while others avoid contact sports for 1 year and never allow collision sports. We have utilized a patient driven self-directed approach. METHODS: The sports activity questionnaire (SAQ) was developed and activities were categorized into normal (school, gym, and backpack), physical (running, bending, and bicycling) and athletics (AAP criteria: noncontact, contact and collision sports). SAQ was validated through the "test-retest" method on 25 patients and retesting after 3 weeks to minimize recall bias. Questions with kappa >0.7 were included. Patient demographics, x-ray measurements, and perioperative details were recorded. RESULTS: Ninety five patients completed the SAQ. By 3 months; 77% (72/93) returned to school, 60% (54/90) to bending, 52% (48/93) to carrying backpacks, 43% (37/87) to running, and 37% (30/81) to gym. By 6 months, 54% (27/50) returned to noncontact sports, and 63% (21/33) to contact sports. 79% and 53% returned to preoperative level of contact and noncontact sports, respectively. Higher body mass index (BMI) was a risk for delayed return (>3 mo) to school and gym (P < 0.05), while fusion below L2 and younger age for running, bending, and carrying backpacks (P < 0.05). In contrast, there was no patient/curve characteristics associated with a delay to sports. Lowest instrumented vertebra (LIV), Lenke types were not risk factors. There was no correction loss, implant failure, or complications. CONCLUSION: Patients return to athletics much earlier than expected; a quarter returned by 3 months, and over half by 6 months. Age and LIV are determinants for return to "physical activity." LEVEL OF EVIDENCE: 3.

Minimally Invasive Surgery in Patients With Adolescent Idiopathic Scoliosis: Is it Better than the Standard Approach? A 2-Year Follow-up Study.

STUDY DESIGN: This is a retrospective controlled study. OBJECTIVE: To compare the safety and efficacy of minimally invasive surgery (MIS) for the surgical management of adolescent idiopathic scoliosis (AIS) to the standard open posterior approach (PSF). SUMMARY OF BACKGROUND DATA: MIS approaches offer the potential to reduce soft-tissue trauma, intraoperative blood loss, and surgical-site infection. Thus far, MIS has been successfully utilized for the surgical correction of multilevel spine pathology in adults. It is not yet known if these results can be replicated in the surgical management of AIS. MATERIALS AND METHODS: Seven MIS patients were compared with 15 PSF patients using minimum 2-year follow-up data. Parameters studied included preoperative patient and deformity characteristics, perioperative details, extent of deformity correction, and complications. Data were compared using Mann-Whitney tests for continuous variables and Fisher exact tests for categorical variables. RESULTS: The MIS and PSF groups were similar for all preoperative characteristics collected (P>0.05). MIS patients had fewer fixation points (P=0.015), but a longer median operative time (P=0.011). There was no significant difference in estimated blood loss (EBL) (P=0.051), EBL/fixation point (P=0.204), or amount of fluids administered (P=0.888). Postoperative recovery did not differ between the 2 groups in number of intensive care unit days (P=0.362), length of hospital stay (P=0.472), time to mobilization (P=1.00), Visual Analogue Scale pain scores (P=0.698), or patient-controlled analgesia (P=1.00). The MIS technique had similar deformity correction, screw placement accuracy, and fusion status when compared with the PSF group. MIS patients had lower blood transfusion rate (P=0.02), shorter fusion (P=0.046) and fewer pedicle screws (P=0.015). CONCLUSIONS: The short-term advantages seen in MIS for adult scoliosis were not as obvious in our series. We found similar deformity correction and adequate fusion, however shortcomings related to learning curve, and instrumentation persist. MIS surgery is an innovative treatment for AIS that is technically feasible with significantly lower transfusion rate, shorter fusion lenghts and lesser pedicle screw fixation. Despite these advanatges, its role in AIS is currently difficut to define.

Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis.

Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

Comparative analysis of perioperative differences between hybrid versus pedicle screw instrumentation in adolescent idiopathic scoliosis.

STUDY DESIGN: Retrospective review of patients with adolescent idiopathic scoliosis (AIS). OBJECTIVE: The objective of the study was to compare perioperative parameters and outcomes between pedicle screw and hybrid instrumentation for the treatment of AIS. SUMMARY OF BACKGROUND DATA: Pedicle screws have been shown to allow for better correction and fewer revisions than hybrid systems. However, no study has compared perioperative parameters and their effects on patient morbidity between these 2 types of instrumentation. METHODS: Fifty-six pediatric patients with AIS were included in the study. Twenty-seven patients were treated with hybrid instrumentation and 29 patients were treated with all pedicle screw (APS) instrumentation. Intraoperative and perioperative measures were compared. RESULTS: The mean preoperative major Cobb angle was 58.7 degrees in the hybrid group and 54.5 degrees in the APS group (P = 0.222). Patients in the hybrid group required more time in the intensive care unit (2.0 vs. 1.1 d, P = 0.041), more time to initial mobilization (5.1 vs. 2.1 d, P < 0.001), and more days using patient-controlled analgesia (5.7 vs. 4.4 d, P = 0.020). The hybrid group averaged less estimated blood loss than the APS group (619.6 vs. 947.4 mL, P = 0.011). There was no difference in surgical time (P = 0.183) or length of stay (P = 0.072) between the groups. Thoracolumbosacral orthoses were used in 81.5% of patients in the hybrid group, but in no patients in the APS group (P < 0.001). Postoperative complications occurred in 37.0% of patients in the hybrid group and 17.2% of patients in the APS group (P = 0.095). CONCLUSIONS: This study demonstrates several advantages of pedicle screw constructs over hybrid constructs in the surgical treatment of AIS. The benefits of pedicle screw systems extend directly to the patient and can lower the overall cost of treatment.

Minimally invasive scoliosis surgery: an innovative technique in patients with adolescent idiopathic scoliosis.

Minimally invasive spine surgery is becoming more common in the treatment of adult lumbar degenerative disorders. Minimally invasive techniques have been utilized for multilevel pathology, including adult lumbar degenerative scoliosis. The next logical step is to apply minimally invasive surgical techniques to the treatment of adolescent idiopathic scoliosis (AIS). However, there are significant technical challenges of performing minimally invasive surgery on this patient population. For more than two years, we have been utilizing minimally invasive spine surgery techniques in patients with adolescent idiopathic scoliosis. We have developed the present technique to allow for utilization of all standard reduction maneuvers through three small midline skin incisions. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, and allows adequate facet osteotomy to enable fusion. There are multiple potential advantages of this technique, including: less blood loss, shorter hospital stay, earlier mobilization, and relatively less pain and need for pain medication. The operative time needed to complete this surgery is longer. We feel that a minimally invasive approach, although technically challenging, is a feasible option in patients with adolescent idiopathic scoliosis. Although there are multiple perceived benefits, long term data is needed before it can be recommended for routine use.