Ethnic Variation in Satisfaction and Appearance Concerns in Adolescents With Idiopathic Scoliosis Undergoing Posterior Spinal Fusion With Instrumentation

Satisfaction following correction of spinal deformity: Cultural and regional effects on outcome

Corrective spine surgery for spinal deformities, such as adolescent idiopathic scoliosis (AIS) and adult spinal deformity (ASD), aims to enhance the quality of life by addressing physical impairments. However, the extent of patient satisfaction after surgery, which includes pain management, functional recovery, and psychological contentment, exhibits considerable variation across different cultural and geographical landscapes. This review describes the influence of cultural and regional disparities on postoperative satisfaction in AIS and ASD surgery with a particular emphasis on the disparities between the US and Japan. This review underscores the intricate relationship between surgical outcomes and patient-reported satisfaction metrics. The investigation reveals significant contrasts in patient satisfaction and clinical results between these 2 countries, attributed to divergent cultural expectations, lifestyle adaptations, and perceptions of bodily image. These distinctions are crucial for healthcare professionals to recognize, as they necessitate a culturally nuanced approach to patient care. This comparative review not only enhances the understanding of patient experiences across cultures but also provides valuable guidance for physicians in customizing their strategies to align with the varied expectations of their patients, thereby improving postoperative satisfaction and overall quality of life. This review emphasizes the necessity of a tailored and culturally sensitive approach to managing spinal deformities, underscoring the need to factor in cultural and regional elements to enhance patient satisfaction and surgical outcomes.

Evaluating consensus and uncertainty among treatment options for early-onset scoliosis: new generation and international perspectives

PURPOSE

It is currently unknown how treatment preferences differ between a senior group of U.S. spinal surgeons, a new generation of U.S. surgeons, and non-U.S. surgeons with regard to the treatment of early-onset scoliosis (EOS). The purpose of this study was to evaluate clinical consensus and uncertainty among treatment options for patients with EOS to understand how they compare between these three cohorts.

METHODS

11 senior pediatric spinal deformity surgeons in the U.S., 12 "junior" surgeons in the U.S., and 7 surgeons practicing in non-U.S. countries were invited to complete a survey of 315 idiopathic and neuromuscular EOS case scenarios. Treatment options included: conservative management, distraction-based methods, growth guidance/modulation, and arthrodesis. Consensus was defined as ≥ 70% agreement, and uncertainty was < 70%. Chi-squared and multiple regression analyses were performed to evaluate the associations between case characteristics and consensus for different treatments.

RESULTS

Although all 3 cohorts of surgeons chose conservative management most frequently, the non-U.S. cohort of surgeons chose distraction-based methods more often, particularly for neuromuscular cases. In both U.S. surgeon cohorts, there was consensus for conservative management in idiopathic patients aged 3 or younger regardless of other factors, whereas non-U.S. surgeons selected distraction-based methods for some of these patients.

CONCLUSION

Just as research studies are being conducted to find approaches to optimally manage the EOS population, future research efforts should focus on identifying the reasoning behind treatment preferences in different cohort of surgeons, as this will allow the interexchange of information which can ultimately improve EOS care.

LEVEL OF EVIDENCE

V.

Comparable satisfaction and clinical outcomes after surgery for adolescent idiopathic scoliosis in the adult (AISA) between the US and Japan

BACKGROUND

The impact of ethnicity on the surgery outcomes of adolescent idiopathic scoliosis in the adult (AISA) is poorly understood. This study aimed to compare the surgery outcomes for AISA between the United States (US) and Japan (JP).

METHODS

171 surgically treated AISA (20-40y) were consecutively collected from 2 separate multicenter databases. Patients were propensity-score matched for age, gender, curve type, levels fused, and 2y postop spinal alignment. Demographic and radiographic parameters were compared between the US and JP at baseline and 2y post-op.

RESULTS

A total of 108 patients were matched by propensity score (age; US vs. JP: 29 ± 6 vs. 29 ± 7y, females: 76 vs. 76%, curve type [Schwab-SRS TypeT; TypeD; TypeL; TypeN]: 35; 35; 30; 0 vs. 37; 33; 30; 0%)] levels fused: 10 ± 4 vs. 10 ± 4, 2y thoracic curve:17 ± 13 vs. 17 ± 12°, 2y CSVL: 10 ± 8 vs. 11 ± 9 mm). Similar clinical improvement was achieved between US and JP (function; 4.2 ± 0.9 vs 4.3 ± 0.6, p = 0.60, pain; 3.8 ± 0.9 vs 4.1 ± 0.8, p = 0.13, satisfaction; 4.3 ± 0.9 vs 4.2 ± 0.7, p = 0.61, total; 4.0 ± 0.8 vs 4.1 ± 0.5, p = 0.60). The correlation analyzes indicated that postoperative SRS-22 subdomains correlated differently with satisfaction (all subdomains moderately correlated with satisfaction in the US while only pain and mental health correlated moderately with satisfaction in JP ([function: r = 0.61 vs 0.29, pain: r = . 72 vs 0.54, self-image: r = 0.72 vs 0.37, mental health: r = 0.64 vs 0.55]).

CONCLUSIONS

Surgery for AISA was similarly effective in the US and JP. Satisfaction for spinal surgery among patients in different countries may not be different unless the procedure limits an individual's unique lifestyle that the patient expected to resume.

How much residual deformity is acceptable according to SRS-22r and satisfaction scores after posterior spinal fusion for Lenke type 1 and 2 curves in adolescent idiopathic scoliosis?

OBJECTIVE

In recent years, it has become possible to predict postoperative correction and residual deformity in adolescent idiopathic scoliosis (AIS) surgery based on the technique used and extent of fixation. However, the recommended degree of correction has not yet been established. In this study, the authors aimed to clarify the extent to which a residual postoperative deformity would be acceptable according to Scoliosis Research Society (SRS)-22r and satisfaction scores after AIS surgery.

METHODS

Overall, 92 patients who underwent posterior spinal fusion for Lenke type 1 or 2 AIS were retrospectively included. The Patient Acceptable Symptom State (PASS) cutoff values for each SRS-22r domain were calculated using receiver operating characteristic (ROC) curves to obtain predictive values of treatment satisfaction 2 years after surgery. Multivariate logistic regression analysis was performed with deformity parameters and demographic data as explanatory variables, and achieving the PASS cutoff value of each SRS-22r domain and treatment satisfaction were objective variables. Cutoff values were calculated using ROC analysis.

RESULTS

The PASS cutoff values for SRS-22r domains were 3.69 (area under the ROC curve [AUC] 0.86) for self-image, 4.25 (AUC 0.82) for mental health, and 4.22 (AUC 0.82) for the subtotal. The residual main thoracic Cobb angle was not remarkably related to SRS-22r or treatment satisfaction. The residual thoracolumbar/lumbar (TL/L) Cobb angle was significantly associated with treatment satisfaction, with a cutoff value of 12.5° (AUC 0.75). The parameters of deformity that were significantly associated with achieving the PASS cutoff value for self-image were the TL/L Cobb angle and main thoracic apical vertebral translation, although their respective AUCs were < 0.7.

CONCLUSIONS

In patients with Lenke type 1 and 2 AIS, the residual postoperative TL/L Cobb angle was significantly associated with achieving the PASS cutoff values for self-image and treatment satisfaction. Satisfaction with treatment was more likely when the TL/L Cobb angle was ≤ 12.5°.

Novel questionnaire to enhance brace wear adherence in patients with adolescent idiopathic scoliosis and the relationship of the quality of life

Bracing is an effective non-operative treatment, in patients with adolescent idiopathic scoliosis (AIS). The relationship between patients’ quality of life (QOL) and brace wear adherence has been reported. This study aims to determine brace wear adherence for AIS patients with novel questionnaire. A nested case-control study was conducted, included patient age 10-18 years, coronal Cobb angle 20-50°, and Risser grade 0-3. Correlation between patients’ QOL and the average hours of daily brace-wear were determined. Patients were divided into 3 groups based on brace wear adherence and were compared. QOL domains associated with the incompleteness of brace-wearing were determined by Cox proportional-hazards regression. Mean age of patients was 13.3 years (range 11-17.3 years) with initial Cobb angle of 33.5° (range 20-48°). There were significant negative correlations between total QOL scores and brace wearing time. Increased social domain scores was significantly associated with less brace wearing time (HR 1.5, 95% CI 1.12-2.04). Significant correlations between patients’ QOL and the average hours per day of brace wear. Poor social QOL have a significant impact on brace wear adherence.

Lower Satisfaction After Adult Spinal Deformity Surgery in Japan Than in the United States Despite Similar SRS-22 Pain and Function Scores: A Propensity-Score Matched Analysis

STUDY DESIGN

A multicenter retrospective case series.

OBJECTIVE

The purpose of this study was to compare the clinical outcomes of a surgical treatment for adult spinal deformity (ASD) in the United States (US) with those in Japan (JP) in a matched cohort.

SUMMARY OF BACKGROUND DATA

Surgical outcomes of thoracic-lumbar-sacral (TLS) spinal fusions in adult spinal deformity ASD patients who live in Asian countries are poorly understood.

METHODS

A total of 300 surgically treated ASDs of age more than 50 years with the lowest instrumented vertebra at the pelvis and a minimum follow-up of 2 years (2y) were consecutively included. Patients were propensity-score matched for age, sex, levels fused, and 2y postop sagittal spinal alignment. Demographic, surgical, and radiographic parameters were compared between the US and JP groups.

RESULTS

A total of 186 patients were matched by propensity score and were almost identical within these parameters: age (US vs. JP: 66 ± 8 vs. 65 ± 7 yr), sex (females: 90% vs. 89%), levels fused (10 ± 3 vs. 10 ± 2), 2y C7 sagittal vertical axis (C7SVA) (5 ± 5 vs. 5 ± 4 cm), 2y Pelvic incidence minus lumbar lordosis (9 ± 15° vs. 9 ± 15°), and 2y pelvic tilt (PT) (25 ± 10° vs. 24 ± 10°). Oswestry Disability Index (ODI) scores and Scoliosis Research Society patient questionnaire ((SRS-22) function and pain scores were similar at 2y between the US and JP groups (ODI: 27 ± 19% vs. 28 ± 14%, P = 0.72; SRS-22 function: 3.6 ± 0.9 vs. 3.6 ± 0.7, P = 0.54; SRS-22 pain: 3.6 ± 1.0 vs. 3.8 ± 0.8, P = 0.11). However, significantly lower satisfaction was observed in JP than in the US (SRS-22 satisfaction: 4.3 ± 0.9 vs. 4.0 ± 0.8, P < 0.01).

CONCLUSION

Surgical treatment for ASD was similarly effective in patients in the US and in JP. However, satisfaction scores were lower in JP compared with the US. Differences in lifestyle and cultural expectations may impact patient satisfaction following ASD surgery.

LEVEL OF EVIDENCE

3.

Does Symmetric Thoracic Fusion Make a Difference in Lenke 1 A/B AIS Patients?

STUDY DESIGN

A retrospective study.

OBJECTIVE

The aim of this study was to compare the long-term outcomes of correction surgery for Lenke 1 A/B scoliosis among those with symmetric fusion (SF), upper-dominant fusion (UF), and lower-dominant fusion (LF) in adolescent idiopathic scoliosis (AIS).

SUMMARY OF BACKGROUND DATA

Symmetric fusion, defined as equal number of vertebral levels included in instrumented fusion above and below the apical vertebra or disc of the primary curve, was a new concept raised in AIS selective fusion. Previous study showed that similar correction the effect on clinical outcomes of this fusion style.

METHODS

Preoperative, postoperative, and last follow-up radiographs of 117 consecutive patients with Lenke type 1A/B curves who underwent posterior selective thoracic instrumentation surgery were analyzed. Patients were divided into two groups (SF and nonsymmetric fusion [NSF]). Patients in NSF was further divided into two groups UF (more vertebrate was fused above the apex) and LF (more vertebrate was fused below the apex). Clinical outcomes and coronal decompensation including adding-on and trunk shift were analyzed and compared among three groups.

RESULTS

There was no significant difference between SF and NSF in magnitude of preoperative main thoracic curve (P = 0.69) and correction rate (P = 0.50). Distal adding-on was observed in 21 patients (17.9%), and coronal decompensation was observed in eight patients (6.8%) in all at final follow up. No significant differences were found between the two groups regarding adding-on phenomenon (P = 0.64) and coronal imbalance (P = 0.72). Significantly higher rates of adding-on were found in UF compared with SF and LF (P < 0.001). In a subgroup analysis between UF and LF in NSF patients, significant differences were found between two subgroups in the rate of trunk shift (P = 0.038). No significant differences in SRS-22 scores were observed among the three groups.

CONCLUSION

In Lenke 1A/B AIS with posterior selective fusion, SF provides no significant differences from NSF. However, in NSF, UF was found to be high risky of adding-on phenomenon.

LEVEL OF EVIDENCE

3.