Skip to main content
SpringerLink
Log in

Preoperative curves of greater magnitude (>70°) in adolescent idiopathic scoliosis are associated with increased surgical complexity, higher cost of surgical treatment and a delayed return to function

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Surgical procedures to correct larger curve magnitudes >70° in patients with adolescent idiopathic scoliosis (AIS) are still common; despite their increased complexity, limited research has assessed the effect of preoperative curve severity on outcomes.

Aim

This study aimed to examine the impact of preoperative curves >70° vs. those ≤70° on perioperative, functional and financial outcomes in patients with AIS undergoing posterior spinal fusion (PSF).

Methods

Seventy seven eligible AIS patients who underwent PSF were prospectively followed-up, until return to preoperative function was reported. Preoperative curves >70° vs. ≤70° were analysed in relation to surgical duration, estimated blood loss, perioperative complications, length of hospitalisation, return to function and cost of surgical treatment per patient.

Results

Severe preoperative curves >70°, identified in 21 patients (27.3 %), were associated with significantly longer surgical duration (median 6.5 vs. 5 h, p = 0.001) and increased blood loss (median 1250 vs. 1000 ml, p = 0.005)—these patients were 2.1 times more likely to receive a perioperative blood product transfusion (Relative Risk 2.1, CI 1.4–2.7, p = 0.004). Curves >70° were also associated with a significantly delayed return to school/college, and an increased cost of surgical treatment (€33,730 vs. €28,620, p < 0.0001).

Conclusion

Surgeons can expect a longer surgical duration, greater intraoperative blood loss and double the blood product transfusion risk when performing PSF procedures on AIS patients with curves greater than 70° vs. those ≤70°. Surgical correction for curves >70°, often as a result of lengthy surgical waiting lists, also incurs added expense and results in a partial delay in early functional recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lonstein JE, Carlson JM (1984) The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 66(7):1061–1071

    CAS  PubMed  Google Scholar 

  2. Weinstein SL, Dolan LA, Cheng JCY, Danielsson A, Morcuende JA (2008) Adolescent idiopathic scoliosis. Lancet 371:1527–1537

    Article  PubMed  Google Scholar 

  3. Luhmann SJ, Lenke LG, Kim YJ, Bridwell KH, Schootman M (2005) Thoracic adolescent idiopathic scoliosis curves between 70° and 100°—is anterior release necessary? Spine 30(18):2061–2067

    Article  PubMed  Google Scholar 

  4. Ege T, Bilgic S, Ersen O, Yurttas Y, Oguz E, Sehirlioglu A, Kazanci A (2012) The importance and efficacy of posterior only instrumentation and fusion for severe idiopathic scoliosis. Turk Neurosurg 22(5):641–644

    PubMed  Google Scholar 

  5. Potaczek T, Jasiewicz B, Tesiorowski M, Zarzycki D, Szcześniak A (2009) Treatment of idiopathic scoliosis exceeding 100 degrees—comparison of different surgical techniques. Ortop Traumatol Rehabil 11(6):485–494

    PubMed  Google Scholar 

  6. Kuklo TR, Lenke LG, O’Brien MF, Lehman RA, Polly DW Jr, Schroeder TM (2005) Accuracy and efficacy of thoracic pedicle screws in curves more than 90 degrees. Spine 30(2):222–226

    Article  PubMed  Google Scholar 

  7. Ahn H, Kreder H, Mahomed N, Beaton D, Wright JG (2011) Empirically derived maximal acceptable wait time for surgery to treat adolescent idiopathic scoliosis. CMAJ 183(9):E565–E570

    Article  PubMed  PubMed Central  Google Scholar 

  8. Varghese R, Miyanji F, Reilly CW, Shah S, Samdani AF, Newton PO, Mulpuri K (2011) Impact of surgical waitlist times on scoliosis surgery: surgeon’s perspective. J Bone Joint Surg Br 93-B((Suppl IV)):578

    Google Scholar 

  9. Wilson PL, Newton PO, Wenger DR, Haher T, Merola A, Lenke L, Lowe T, Clements D, Betz R (2002) A multicentre study analyzing the relationship of a standardized radiographic scoring system of adolescent idiopathic scoliosis and the Scoliosis Research Society outcomes instrument. Spine 27(18):2036–2040

    Article  PubMed  Google Scholar 

  10. Parent EC, Hill D, Mahood J, Moreau M, Raso J, Lou E (2009) Discriminative and predictive validity of the scoliosis research society-22 questionnaire in management and curve-severity subgroups of adolescents with idiopathic scoliosis. Spine 34(22):2450–2457

    Article  PubMed  Google Scholar 

  11. Johnston CE, Richards BS, Sucato DJ, Bridwell KH, Lenke LG, Erickson M, Spinal Deformity Study Group (2011) Correlation of preoperative deformity magnitude and pulmonary function tests in adolescent idiopathic scoliosis. Spine 36(14):1096–1102

    Article  PubMed  Google Scholar 

  12. Smiljanić I, Kovac V, Cimić M (2009) Changes in pulmonary functional parameters after surgical treatment of idiopathic scoliosis. Coll Antropol 33(Suppl 2):145–152

    PubMed  Google Scholar 

  13. Burton DC, Sama AA, Asher MA, Burke SW, Boachie-Adjei O, Huang RC, Green DW, Rawlins BA (2005) The treatment of large (>70 degrees) thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis: when is anterior release indicated? Spine 30(17):1979–1984

    Article  PubMed  Google Scholar 

  14. Soegaard R, Christensen FB, Christiansen T, Bünger C (2007) Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain. Eur Spine J 16(5):657–668

    Article  PubMed  PubMed Central  Google Scholar 

  15. Miyanji F, Slobogean GP, Samdani AF, Betz RR, Reilly CW, Slobogean BL, Newton PO (2012) Is larger scoliosis curve magnitude associated with increased perioperative health-care resource utilization?: a multicenter analysis of 325 adolescent idiopathic scoliosis curves. J Bone Joint Surg Am 94(9):809–813

    Article  PubMed  Google Scholar 

  16. Tarrant RC, O’Loughlin PF, Lynch S, Queally JM, Sheeran P, Moore DP, Kiely PJ (2014) Timing and predictors of return to short-term functional activity in adolescent idiopathic scoliosis after posterior spinal fusion: a prospective follow-up study. Spine 39(18):1471–1478

    Article  PubMed  Google Scholar 

  17. Ylikoski M (2003) Height of girls with adolescent idiopathic scoliosis. Eur Spine J 12(3):288–291

    PubMed  PubMed Central  Google Scholar 

  18. Model of Care for Elective Surgery, Including Implementation Guide. The National Clinical Programme in Surgery (2011) Health Service Executive, Royal College of Surgeons in Ireland and the College of Anaesthetists of Ireland, pp 25. http://www.hse.ie/eng/about/Who/clinical/natclinprog/surgery/caremodel/electsurg.pdf. Accessed 21 Dec 2015

  19. Guay J, Haig M, Lortie L, Guertin MC, Poitras B (1994) Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth 41(9):775–781

    Article  CAS  PubMed  Google Scholar 

  20. Lalenti MN, Lonner BS, Verma K, Dean L, Valdevit A, Errico T (2013) Predicting operative blood loss during spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop 33(4):372–376

    Article  Google Scholar 

  21. Kamerlink JR, Quirno M, Auerbach JD, Milby AH, Windsor L, Dean L, Dryer JW, Errico TJ, Lonner BS (2010) Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases. J Bone Joint Surg Am 92(5):1097–1104

    Article  PubMed  Google Scholar 

  22. Wang Y, Fei Q, Qiu G, Lee CI, Shen J, Zhang J, Zhao H, Zhao Y, Wang H, Yuan S (2008) Anterior spinal fusion versus posterior spinal fusion for moderate lumbar/thoracolumbar adolescent idiopathic scoliosis: a prospective study. Spine 33(20):2166–2172

    Article  PubMed  Google Scholar 

  23. Roach JW, Mehlman CT, Sanders JO (2011) Does the outcome of adolescent idiopathic scoliosis surgery justify the rising cost of the procedures? J Pediatr Orthop 31(1 Suppl):S77–S80

    Article  PubMed  Google Scholar 

  24. Clark S (2008) Waiting times for scoliosis surgery. Lancet 371(9606):10–11

    Article  PubMed  Google Scholar 

  25. Miyanji F, Newton PO, Samdani AF, Shah SA, Vargehese RA, Reilly CW, Milpuri K (2014) The impact of surgical waitlist times on scoliosis surgery: the surgeon’s perspective. Spine 1:40(11):823–828

  26. Fabricant PD, Admoni S, Green DW, Ipp LS, Widmann RF (2012) Return to athletic activity after posterior spinal fusion for adolescent idiopathic scoliosis: analysis of independent predictors. J Pediatr Orthop 32(3):259–265

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are very grateful to the National Children’s Research Centre for funding this study. They also thank the participants and their families for their co-operation throughout the study, as well as the clinical and administrative staff at Our Lady’s Children’s Hospital and the Blackrock Clinic for their valuable support and assistance. A special thanks to Ms. Paula Smith and Ms. Natalie Barry for their help with the collection of surgical waiting time data, and Mr. Sam Lynch for checking the radiographs.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Our Lady’s Children’s Hospital, Crumlin, Dublin, 12, Ireland

    R. C. Tarrant, J. M. Queally, P. F. O’Loughlin, D. P. Moore & P. J. Kiely

  2. The National Children’s Research Centre, Crumlin, Dublin, 12, Ireland

    R. C. Tarrant

  3. Department of Anaesthetics, Our Lady’s Children’s Hospital, Crumlin, Dublin, 12, Ireland

    P. Sheeran

  4. Blackrock Clinic, Blackrock, Co, Dublin, Ireland

    P. Sheeran, D. P. Moore & P. J. Kiely

Authors
  1. R. C. Tarrant
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. M. Queally
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. F. O’Loughlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Sheeran
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. P. Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. J. Kiely
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. C. Tarrant.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tarrant, R.C., Queally, J.M., O’Loughlin, P.F. et al. Preoperative curves of greater magnitude (>70°) in adolescent idiopathic scoliosis are associated with increased surgical complexity, higher cost of surgical treatment and a delayed return to function. Ir J Med Sci 185, 463–471 (2016). https://doi.org/10.1007/s11845-015-1391-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-015-1391-5

Keywords

Search

Navigation