Christina K Hardesty1, Robert F Murphy2, Jeff B Pawelek3, Michael P Glotzbecker4, Pooria Hosseini5, Charles E Johnston6, John Emans7, Behrooz A Akbarnia3,8. 1. Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, RBC 6081, Cleveland, OH, 44106, USA. christina.hardesty@uhhospitals.org. 2. Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA. 3. San Diego Spine Foundation, San Diego, CA, USA. 4. Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, RBC 6081, Cleveland, OH, 44106, USA. 5. Department of Orthopaedic Surgery, St. Louis University, St. Louis, MO, USA. 6. Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX, USA. 7. Department of Orthopaedic Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA. 8. Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, USA.
Abstract
PURPOSE: Increasingly, patients with early onset scoliosis (EOS) are completing a growth friendly surgical program followed by observation, removal of implants or a definitive spinal fusion. These patients are colloquially referred to as "graduates". A standardized definition of a graduate is needed for research and comparing the outcomes, family counseling, and a better understanding of the population. METHODS: A 15-question electronic survey was completed by 39 experienced pediatric spine surgeons to identify factors salient to the definition of a graduate of EOS surgical programs. A Delphi/Nominal group technique session with nine questions was then performed face-to-face with 21 members of the Pediatric Spine Study Group to discuss and refine the definition. A follow-up electronic survey was then distributed to these same 21 members to gain consensus on the final definition. RESULTS: From the initial survey, it was identified that a graduate did not require definitive spinal fusion after a growing program. From the Delphi session, it was determined that skeletal maturity was the most important factor in defining a graduate. A strictly defined minimum length of follow-up was not felt to be a prerequisite for qualification of graduation. After the final electronic version was distributed, > 80% of respondents agreed upon the final definition, thereby achieving consensus. CONCLUSION: The Pediatric Spine Study Group recommends adoption of the following definition: a "graduate" is a patient who has undergone any surgical program to treat early onset scoliosis, and has reached skeletal maturity and does not have a planned surgical intervention for EOS in the future. LEVEL OF EVIDENCE: V.
PURPOSE: Increasingly, patients with early onset scoliosis (EOS) are completing a growth friendly surgical program followed by observation, removal of implants or a definitive spinal fusion. These patients are colloquially referred to as "graduates". A standardized definition of a graduate is needed for research and comparing the outcomes, family counseling, and a better understanding of the population. METHODS: A 15-question electronic survey was completed by 39 experienced pediatric spine surgeons to identify factors salient to the definition of a graduate of EOS surgical programs. A Delphi/Nominal group technique session with nine questions was then performed face-to-face with 21 members of the Pediatric Spine Study Group to discuss and refine the definition. A follow-up electronic survey was then distributed to these same 21 members to gain consensus on the final definition. RESULTS: From the initial survey, it was identified that a graduate did not require definitive spinal fusion after a growing program. From the Delphi session, it was determined that skeletal maturity was the most important factor in defining a graduate. A strictly defined minimum length of follow-up was not felt to be a prerequisite for qualification of graduation. After the final electronic version was distributed, > 80% of respondents agreed upon the final definition, thereby achieving consensus. CONCLUSION: The Pediatric Spine Study Group recommends adoption of the following definition: a "graduate" is a patient who has undergone any surgical program to treat early onset scoliosis, and has reached skeletal maturity and does not have a planned surgical intervention for EOS in the future. LEVEL OF EVIDENCE: V.
Authors: Kimberly L Kesling; John E Lonstein; Francis Denis; Joseph H Perra; James D Schwender; Ensor E Transfeldt; Robert B Winter Journal: Spine (Phila Pa 1976) Date: 2003-02-01 Impact factor: 3.468