Search

Introduction: Treatment of children with early onset scoliosis (EOS) seeks to improve natural history and health related quality of life (QOL). QOL measurement presents a significant challenge given the young age, comorbidities, and heterogeneity of this population. Objective: To develop a disease specific measure reflecting issues of importance to EOS patients and caretakers. Materials and Methods: Review of the literature and relevant measures informed development of semi-structured qualitative interviews. Interviews of caregivers of EOS patients were interpreted through the framework technique. A master-list of 75-items was created and responses were scaled on a 5-point Likert-scale. Psychometric analysis was performed to group items into domains, to maintain score distribution, to create a responsive instrument, and to identify question redundancy. Results: Content validation revealed 8-items with low content validity indices. Item distribution analysis demonstrated 19-items with skewed distribution. Item reliability demonstrated redundant items within domains (r≥0.5). Construct validity demonstrated unique domains measuring intended issues of interest. The resulting Early Onset Scoliosis Questionnaire (EOSQ) includes 33-items in 13-domains: General Health, Pain, Physical Function, Pulmonary Function, Daily Living, Fatigue, Emotion, Surgical Concerns, Satisfaction, Transfer, Financial Burden, Parental Burden, and Treatment Outcomes. Conclusion: The EOSQ reflects QOL and caregiver burden in the EOS population. The EOSQ will expand options for outcome assessment in this unique population. [ABSTRACT FROM AUTHOR]

Introduction: Electromyography (EMG) monitoring has been used to assess pedicle screw misplacement, its ability to reduce misplacement rates has been not well documented in pediatric spinal deformity surgery. Objectives: To evaluate the ability of EMG monitoring to improve pedicle screw placement. Materials and Methods: 31 patients (mean age: 14.6) who had EMG monitoring were identified and enrolled in the study. The mean preoperative Cobb angle was 60.3° (range: 50°–112°). AIS patients comprised 84%(26) of the cohort, neuromuscular 13%(4), and congenital/syndromic 3%(1). A total of 477 screws were placed and evaluated postoperatively by CT scan. Significant misplacement was considered to be >2mm medial breach or >4mm of lateral or anterior breach. Results: Mean EMG threshold was equivalent in the misplaced and non-misplaced groups (16.0 vs. 18.7,p=0.08). However when EMG values from the same patient were ranked relative to one another, misplacement rates varied significantly with respect to percentile. Screws with EMG values in the 10th percentile had a misplacement rate of 24.4% vs. 6.8% for screws with values above the 10th percentile (p<0.001). Overall, EMG readings below the 30th percentile had a significantly higher misplacement rate (p<0.02). Conclusion: Absolute EMG values do not correlate with misplacement rates. However, screws with EMG values in the lowest 30th percentile do have a significantly higher chance of misplacement, suggesting that these screws should be more carefully evaluated for pedicle breech at the time of surgery. Significance: Relative EMG values from the same patient may be used to improve pedicle screw placement. [ABSTRACT FROM AUTHOR]

Introduction : There is little research on the reliability, reproducibility and usefulness of assessing sagittal deformity from MRI studies Objectives: To establish a normal range of kyphosis as measured by MRI and to compare sagittal measurements obtained by MRI and standard radiographs in children with kyphosis and in normal children. Materials and Methods: Retrospective review identified 46 patients with no spinal deformity and 24 patients with increased kyphosis without significant frontal plane deformity who had spinal MRI. Sagittal measurements made via MRI were compared to measurements made from matched radiographs. Results: Normal range for kyphosis as measured by MRI was (T1-T12=13°-43°). In patients without frontal plane deformity, there were no significant differences in mean Cobb angle measured by x-rays and MRI in all locations (see table). In the kyphosis group there was a significant difference in T1-T12(p=.043) and T5-T12(p=.007) measurements(see table), however there was no significant difference in the T1–T5 measurements(p=.985, see table). Conclusion: In this cohort without frontal plane deformity, sagittal measurements on MRI did not differ significantly from plane x-ray measurements. In deformity patients there was no significant difference between measurements of the T1 to T5 kyphosis in plane x-ray and the MRI group indicating that the MRI can be used to assess the cephalad kyphosis when planning treatment. Significance: This study established a normal range of kyphosis measured by MRI and suggests that MRI can be used as a reliable measure to assess the proximal spine in cases where radiographs do not provide adequate visualization. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of children with early onset scoliosis (EOS) seeks to improve natural history and health related quality of life (QOL). QOL measurement presents a significant challenge given the young age, comorbidities, and heterogeneity of this population., Objective: To develop a disease specific measure reflecting issues of importance to EOS patients and caretakers., Materials and Methods: Review of the literature and relevant measures informed development of semi-structured qualitative interviews. Interviews of caregivers of EOS patients were interpreted through the framework technique. A master-list of 75-items was created and responses were scaled on a 5-point Likert-scale. Psychometric analysis was performed to group items into domains, to maintain score distribution, to create a responsive instrument, and to identify question redundancy., Results: Content validation revealed 8-items with low content validity indices. Item distribution analysis demonstrated 19-items with skewed distribution. Item reliability demonstrated redundant items within domains (r> or =0.5). Construct validity demonstrated unique domains measuring intended issues of interest. The resulting Early Onset Scoliosis Questionnaire (EOSQ) includes 33-items in 13-domains: General Health, Pain, Physical Function, Pulmonary Function, Daily Living, Fatigue, Emotion, Surgical Concerns, Satisfaction, Transfer, Financial Burden, Parental Burden, and Treatment Outcomes., Conclusion: The EOSQ reflects QOL and caregiver burden in the EOS population. The EOSQ will expand options for outcome assessment in this unique population.

Introduction: Decompensation of un-fused vertebrae is a potential complication of spinal instrumentation performed for adolescent idiopathic scoliosis (AIS). This can result in problems requiring revision surgery. The purpose of this study was to compare patients who decompensated in the sagittal/coronal plane and those who do not and to identify risk factors., Methods: The Spinal Deformity Study Group data-base for AIS identified 908 patients at 2 years post-op. Coronal measures analyzed included coronal balance (CB), coronal position of the lower instrumented vertebra (CPL) and LIV tilt angle (LTA). Sagittal measures included sagittal balance (SB) and distal-junctional kyphosis (DJK). The incidence of decompensation at 2 years was: CB-16.83%, LTA-37.53%, CPL-21.17%, negative SB-51.88%, positive SB-7.62%, DJK-6.8%. Decompensated patients were compared to those who were not using preoperative, and 4-16 weeks post-op values., Results: Numerous significant differences were found between patients who decompensated at 2 years and those who did not. CB was significantly influenced by larger height/weight, increased Cobb, preexisting CB and a thoracic LIV. In addition to other factors LTA decompensation was more likely to occur in JIS. CPL was associated with pelvic-obliquity and thoracic LIV. Post-operative sagittal balance could be predicted by pre-operative sagittal balance. DJK was also associated with larger weight and preoperative sagittal measures., Discussion and Conclusion: Less correction in sagittal/coronal planes is a risk factor for decompensation. Curve correction was significant in predicting coronal decompensation. Failure to control sagittal alignment was a risk factor in sagittal decompensation.