Hiroko Matsumoto1,2, Adam N Fano3, Theodore Quan3, Behrooz A Akbarnia4, Laurel C Blakemore5, John M Flynn6, David L Skaggs7, John T Smith8, Brian D Snyder9,10, Paul D Sponseller11, Richard E McCarthy12, Peter F Sturm13, David P Roye9,14, John B Emans9,10, Michael G Vitale9,14. 1. Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA. hiroko.matsumoto@childrens.harvard.edu. 2. Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA. hiroko.matsumoto@childrens.harvard.edu. 3. Department of Orthopedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA. 4. Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, 92037, USA. 5. Pediatric Specialists of Virginia, Fairfax, VA, 22031, USA. 6. Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA. 7. Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. 8. Department of Orthopaedics, University of Utah, Salt Lake City, UT, 84113, USA. 9. Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA. 10. Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA. 11. Division of Pediatric Orthopaedics, Johns Hopkins University, Baltimore, MD, 21287, USA. 12. Department of Orthopaedics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, 72205, USA. 13. Department of Orthopedic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, 45229, USA. 14. Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA.
Abstract
PURPOSE: Consensus and uncertainty in early onset scoliosis (EOS) treatment were evaluated in 2010. It is currently unknown how treatment preferences have evolved over the past decade. The purpose of this study was to re-evaluate consensus and uncertainty among treatment options for EOS patients to understand how they compare to 10 years ago. METHODS: 11 pediatric spinal surgeons (similar participants as in 2010) were invited to complete a survey of 315 idiopathic and neuromuscular EOS cases (same cases as in 2010). Treatment options included the following: conservative management, distraction-based methods, growth guidance/modulation, and arthrodesis. Consensus was defined as ≥ 70% agreement, and uncertainty was < 70%. Associations between case characteristics and consensus for treatments were assessed via chi-squared and multiple regression analyses. Case characteristics associated with uncertainty were described. RESULTS: Eleven surgeons [31.7 ± 7.8 years of experience] in the original 2010 cohort completed the survey. Consensus for conservative management was found in idiopathic patients aged ≤ 3, whereas in 2010, some of these cases were selected for surgery. There is currently consensus for casting idiopathic patients aged 1 or 2 with moderate curves, whereas in 2010, there was uncertainty between casting and bracing. Among neuromuscular cases with consensus for surgery, arthrodesis was chosen for patients aged 9 with larger curves. CONCLUSION: Presently, preferences for conservative management have increased in comparison to 2010, and casting appears to be preferred over bracing in select infantile cases. Future research efforts with higher levels-of-evidence should be devoted to elucidate the areas of uncertainty to improve care in the EOS population. LEVEL OF EVIDENCE: Level V.
PURPOSE: Consensus and uncertainty in early onset scoliosis (EOS) treatment were evaluated in 2010. It is currently unknown how treatment preferences have evolved over the past decade. The purpose of this study was to re-evaluate consensus and uncertainty among treatment options for EOS patients to understand how they compare to 10 years ago. METHODS: 11 pediatric spinal surgeons (similar participants as in 2010) were invited to complete a survey of 315 idiopathic and neuromuscular EOS cases (same cases as in 2010). Treatment options included the following: conservative management, distraction-based methods, growth guidance/modulation, and arthrodesis. Consensus was defined as ≥ 70% agreement, and uncertainty was < 70%. Associations between case characteristics and consensus for treatments were assessed via chi-squared and multiple regression analyses. Case characteristics associated with uncertainty were described. RESULTS: Eleven surgeons [31.7 ± 7.8 years of experience] in the original 2010 cohort completed the survey. Consensus for conservative management was found in idiopathic patients aged ≤ 3, whereas in 2010, some of these cases were selected for surgery. There is currently consensus for casting idiopathic patients aged 1 or 2 with moderate curves, whereas in 2010, there was uncertainty between casting and bracing. Among neuromuscular cases with consensus for surgery, arthrodesis was chosen for patients aged 9 with larger curves. CONCLUSION: Presently, preferences for conservative management have increased in comparison to 2010, and casting appears to be preferred over bracing in select infantile cases. Future research efforts with higher levels-of-evidence should be devoted to elucidate the areas of uncertainty to improve care in the EOS population. LEVEL OF EVIDENCE: Level V.
Authors: Vidyadhar V Upasani; Kevin C Parvaresh; Jeff B Pawelek; Patricia E Miller; George H Thompson; David L Skaggs; John B Emans; Michael P Glotzbecker Journal: Spine Deform Date: 2016-08-21
Authors: Behrooz A Akbarnia; Jeff B Pawelek; Kenneth M C Cheung; Gokhan Demirkiran; Hazem Elsebaie; John B Emans; Charles E Johnston; Gregory M Mundis; Hilali Noordeen; David L Skaggs; Paul D Sponseller; George H Thompson; Burt Yaszay; Muharrem Yazici Journal: Spine Deform Date: 2014-10-27
Authors: Malick Bachabi; Anna McClung; Jeff B Pawelek; Ron El Hawary; George H Thompson; John T Smith; Michael G Vitale; Behrooz A Akbarnia; Paul D Sponseller Journal: J Pediatr Orthop Date: 2020-03 Impact factor: 2.324
Authors: James O Sanders; Jacques D'Astous; Marcie Fitzgerald; Joseph G Khoury; Shyam Kishan; Peter F Sturm Journal: J Pediatr Orthop Date: 2009-09 Impact factor: 2.324
Authors: Nicholas D Fletcher; Anna McClung; Karl E Rathjen; Jaime R Denning; Richard Browne; Charles E Johnston Journal: J Pediatr Orthop Date: 2012 Oct-Nov Impact factor: 2.324