The impacts of waiting for surgical correction of Adolescent Idiopathic Scoliosis and its repercussions for publicly funded health systems: systematic review

Systematic review and meta-analysis for the proximal junctional kyphosis in adolescent idiopathic scoliosis

Objective

The risk factors of PJK (proximal junctional kyphosis) related to AIS (adolescent idiopathic scoliosis) are inconsistent due to heterogeneity in study design, diagnostic criteria, and population. Therefore, the meta-analysis was conducted to investigate the factors affecting PJK after posterior spinal fusion for AIS patients.

Methods

We implemented a systematic search to obtain potential literature relevant to PJK in AIS surgery. Then, a meta-analysis was performed to assess the incidence of PJK and its risk factors.

Results

We retrieved 542 articles, and 24 articles were included. The PJK incidence was 17.67%. The use of hooks at UIV (upper instrumented vertebrae) (p = 0.001) could prevent PJK. Before surgery, the larger TK (thoracic kyphosis) (p < 0.001), GTK (global thoracic kyphosis) (p < 0.001), and LL (lumbar lordosis) (p < 0.001) were presented in the PJK group. Immediately post-operatively, in the PJK group, the following parameters were higher: TK (p = 0.001), GTK (p < 0.001), LL (p = 0.04), PJA (proximal junctional angle) (p < 0.001), and PJA-RCA (rod contouring angle) (p = 0.001). At the final follow-up, the following parameters were higher in the PJK group: TK (p < 0.001), GTK (p < 0.001), LL (P < 0.001), and PJA (P < 0.001). Sub-group analysis detected that before surgery, the following parameters were larger in the PJK group: TK (p < 0.001), LL (p = 0.005), and PJA (p = 0.03) in Lenke type 5 AIS patients. Immediately post-operatively, in the PJK group, the following parameters were higher: TK (p < 0.001), LL (p = 0.005), and PJA (p < 0.001). At the final follow-up, the following parameters were higher in the PJK group: TK (p < 0.001), LL (p < 0.001), and PJA (p < 0.001).

Conclusion

The individuals with larger preoperative TK were more susceptible to PJK, and PJA was mainly influenced by the adjacent segments rather than the whole sagittal alignment. Using hooks or claws at UIV should prevent PJK.

An Examination of the Number of Adolescent Scoliotic Curves That Are Braceable at First Presentation to a Scoliosis Service

Adolescent idiopathic scoliosis (AIS) affects between 0.5% and 5.2% of adolescents and is progressive in two-thirds of cases. Bracing is an effective non-operative treatment for AIS and has been shown to prevent up to 72% of curves from requiring surgery. This paper explores the presentation of AIS in the UK and identifies who would be suitable for bracing, as per guidelines published by the Scoliosis Research Society (SRS) and British Scoliosis Society (BSS), through curve severity and skeletal maturity at presentation. There were 526 patients with AIS eligible for inclusion across three tertiary referral centres in the UK. The study period was individualised to each centre, between January 2012 and December 2021. Only 10% were appropriate for bracing via either SRS or BSS criteria. The rest were either too old, skeletally mature or had a curve size too large to benefit. By the end of data collection, 38% had undergone surgery for their scoliosis. In the UK, bracing for AIS is only suitable for a small number at presentation. Future efforts to minimise delays in specialist review and intervention will increase the number of those with AIS suitable for bracing and reduce the number and burden of operative interventions for AIS in the UK.