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Right adolescent idiopathic thoracic curve (Lenke 1 A and B): does cost of instrumentation and implant density improve radiographic and cosmetic parameters?

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Abstract

In adolescent idiopathic scoliosis (AIS) there has been a shift towards increasing the number of implants and pedicle screws, which has not been proven to improve cosmetic correction. To evaluate if increasing cost of instrumentation correlates with cosmetic correction using clinical photographs. 58 Lenke 1A and B cases from a multicenter AIS database with at least 3 months follow-up of clinical photographs were used for analysis. Cosmetic parameters on PA and forward bending photographs included angular measurements of trunk shift, shoulder balance, rib hump, and ratio measurements of waist line asymmetry. Pre-op and follow-up X-rays were measured for coronal and sagittal deformity parameters. Cost density was calculated by dividing the total cost of instrumentation by the number of vertebrae being fused. Linear regression and spearman’s correlation were used to correlate cost density to X-ray and photo outcomes. Three independent observers verified radiographic and cosmetic parameters for inter/interobserver variability analysis. Average pre-op Cobb angle and instrumented correction were 54° (SD 12.5) and 59% (SD 25) respectively. The average number of vertebrae fused was 10 (SD 1.9). The total cost of spinal instrumentation ranged from $6,769 to $21,274 (Mean $12,662, SD $3,858). There was a weak positive and statistically significant correlation between Cobb angle correction and cost density (r = 0.33, p = 0.01), and no correlation between Cobb angle correction of the uninstrumented lumbar spine and cost density (r = 0.15, p = 0.26). There was no significant correlation between all sagittal X-ray measurements or any of the photo parameters and cost density. There was good to excellent inter/intraobserver variability of all photographic parameters based on the intraclass correlation coefficient (ICC 0.74–0.98). Our method used to measure cosmesis had good to excellent inter/intraobserver variability, and may be an effective tool to objectively assess cosmesis from photographs. Since increasing cost density only improves mildly the Cobb angle correction of the main thoracic curve and not the correction of the uninstrumented spine or any of the cosmetic parameters, one should consider the cost of increasing implant density in Lenke 1A and B curves. In the area of rationalization of health care expenses, this study demonstrates that increasing the number of implants does not improve any relevant cosmetic or radiographic outcomes.

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References

  1. Cuartas E, Rasouli A, O’Brien M, Shufflebarger HL (2009) Use of all-pedicle-screw constructs in the treatment of adolescent idiopathic scoliosis. J Am Acad Orthop Surg 17(9):550–561

    PubMed  Google Scholar 

  2. Kim YJ, Lenke LG, Kim J, Bridwell KH, Cho SK, Cheh G et al (2006) Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 31(3):291–298

    Article  Google Scholar 

  3. Hicks JM, Singla A, Shen FH, Arlet V (2010) Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976) 35(11):E465–E470

    Article  Google Scholar 

  4. Di Silvestre M, Parisini P, Lolli F, Bakaloudis G (2007) Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976) 32(15):1655–1661

    Article  Google Scholar 

  5. Asher M, Lai SM, Burton D, Manna B (2004) Maintenance of trunk deformity correction following posterior instrumentation and arthrodesis for idiopathic scoliosis. Spine (Phila Pa 1976) 29(16):1782–1788

    Article  Google Scholar 

  6. Goldberg CJ, Moore DP, Fogarty EE, Dowling FE (2001) Adolescent idiopathic scoliosis: the effect of brace treatment on the incidence of surgery. Spine (Phila Pa 1976) 26(1):42–47

    Article  CAS  Google Scholar 

  7. Iwahara T, Imai M, Atsuta Y (1998) Quantification of cosmesis for patients affected by adolescent idiopathic scoliosis. Eur Spine J 7(1):12–15

    Article  PubMed  CAS  Google Scholar 

  8. Negrini S, Grivas TB, Kotwicki T, Maruyama T, Rigo M, Weiss HR (2006) Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper. Scoliosis 1:4

    Article  PubMed  Google Scholar 

  9. Theologis TN, Jefferson RJ, Simpson AH, Turner-Smith AR, Fairbank JC (1993) Quantifying the cosmetic defect of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 18(7):909–912

    Article  CAS  Google Scholar 

  10. Zaina F, Negrini S, Atanasio S (2009) TRACE (trunk aesthetic clinical evaluation), a routine clinical tool to evaluate aesthetics in scoliosis patients: development from the aesthetic index (AI) and repeatability. Scoliosis 4:3

    Article  PubMed  Google Scholar 

  11. Donaldson S, Hedden D, Stephens D, Alman B, Howard A, Narayanan U et al (2007) Surgeon reliability in rating physical deformity in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 32(3):363–367

    Article  Google Scholar 

  12. Tredwell SJ, Bannon M (1988) The use of the ISIS optical scanner in the management of the braced adolescent idiopathic scoliosis patient. Spine (Phila Pa 1976) 13(10):1104–1105

    Article  CAS  Google Scholar 

  13. Weisz I, Jefferson RJ, Turner-Smith AR, Houghton GR, Harris JD (1988) ISIS scanning: a useful assessment technique in the management of scoliosis. Spine (Phila Pa 1976) 13(4):405–408

    Article  CAS  Google Scholar 

  14. Sahlstrand T (1986) The clinical value of Moire topography in the management of scoliosis. Spine (Phila Pa 1976) 11(5):409–417

    Article  CAS  Google Scholar 

  15. Clements DH, Betz RR, Newton PO, Rohmiller M, Marks MC, Bastrom T (2009) Correlation of scoliosis curve correction with the number and type of fixation anchors. Spine (Phila Pa 1976) 34(20):2147–2150

    Article  Google Scholar 

  16. Quan GM, Gibson MJ (2010) Correction of main thoracic adolescent idiopathic scoliosis using pedicle screw instrumentation: does higher implant density improve correction? Spine (Phila Pa 1976) 35(5):562–567

    Article  Google Scholar 

  17. Arlet V, Shilt J, Bersusky E, Abel M, Ouellet JA, Evans D et al (2008) Experience with an online prospective database on adolescent idiopathic scoliosis: development and implementation. Eur Spine J 17(11):1497–1506

    Article  PubMed  Google Scholar 

  18. Rhee JM, Bridwell KH, Won DS, Lenke LG, Chotigavanichaya C, Hanson DS (2002) Sagittal plane analysis of adolescent idiopathic scoliosis: the effect of anterior versus posterior instrumentation. Spine (Phila Pa 1976) 27(21):2350–2356

    Article  Google Scholar 

  19. Snyder RG, Spencer ML, Owings CL et al (1979) Anthropometry of infants, children and youths to age 18 for product safety design SP-450. Society of Automotive Engineers, Warrendale

  20. Bunnell WP (1993) Outcome of spinal screening. Spine (Phila Pa 1976) 18(12):1572–1580

    Article  CAS  Google Scholar 

  21. Bunnell WP (1984) An objective criterion for scoliosis screening. J Bone Joint Surg Am 66(9):1381–1387

    PubMed  CAS  Google Scholar 

  22. D’Andrea LP, Betz RR, Lenke LG, Clements DH, Lowe TG, Merola A et al (2000) Do radiographic parameters correlate with clinical outcomes in adolescent idiopathic scoliosis? Spine (Phila Pa 1976) 25(14):1795–1802

    Article  Google Scholar 

  23. Kim YJ, Lenke LG, Cho SK, Bridwell KH, Sides B, Blanke K (2004) Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 29(18):2040–2048

    Article  Google Scholar 

  24. Vora V, Crawford A, Babekhir N, Boachie-Adjei O, Lenke L, Peskin M et al (2007) A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: myth or reality. Spine (Phila Pa 1976) 32(17):1869–1874

    Article  Google Scholar 

  25. Aaro S, Ohlen G (1983) The effect of Harrington instrumentation on the sagittal configuration and mobility of the spine in scoliosis. Spine (Phila Pa 1976) 8(6):570–575

    Article  CAS  Google Scholar 

  26. Burton DC, Asher MA, Lai SM (1999) The selection of fusion levels using torsional correction techniques in the surgical treatment of idiopathic scoliosis. Spine (Phila Pa 1976) 24(16):1728–1739

    Article  CAS  Google Scholar 

  27. Cochran T, Irstam L, Nachemson A (1983) Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion. Spine (Phila Pa 1976) 8(6):576–584

    Article  CAS  Google Scholar 

  28. Takahashi S, Delecrin J, Passuti N (1997) Changes in the unfused lumbar spine in patients with idiopathic scoliosis. A 5- to 9-year assessment after cotrel-dubousset instrumentation. Spine (Phila Pa 1976) 22(5):517,23; discussion 524

  29. Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY et al (2007) Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976) 32(4):448–452

    Article  Google Scholar 

  30. LR A Jr, Lenke LG, Keeler KA, Kim YJ, Buchowski JM, Cheh G et al (2008) Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs: minimum three-year follow-up of one hundred fourteen cases. Spine (Phila Pa 1976) 33(14):1598–1604

    Article  Google Scholar 

  31. Dobbs MB, Lenke LG, Kim YJ, Kamath G, Peelle MW, Bridwell KH (2006) Selective posterior thoracic fusions for adolescent idiopathic scoliosis: comparison of hooks versus pedicle screws. Spine (Phila Pa 1976) 31(20):2400–2404

    Article  Google Scholar 

  32. Luhmann SJ, Lenke LG, Kim YJ, Bridwell KH, Schootman M (2005) Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees: is anterior release necessary? Spine (Phila Pa 1976) 30(18):2061–2067

    Article  Google Scholar 

  33. Rumsey N, Harcourt D (2004) Body image and disfigurement: issues and interventions. Body Image 1(1):83–97

    Article  PubMed  Google Scholar 

  34. Danielsson AJ, Wiklund I, Pehrsson K, Nachemson AL (2001) Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J 10(4):278–288

    Article  PubMed  CAS  Google Scholar 

  35. Orvomaa E (1998) Psychological evaluations of patients operated for idiopathic scoliosis by the Harrington method. Int J Rehabil Res 21(2):169–178

    Article  PubMed  CAS  Google Scholar 

  36. Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV (2003) Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA 289(5):559–567

    Google Scholar 

  37. Payne WK III, Ogilvie JW, Resnick MD, Kane RL, Transfeldt EE, Blum RW (1997) Does scoliosis have a psychological impact and does gender make a difference? Spine (Phila Pa 1976) 22(12):1380–1384

    Article  Google Scholar 

  38. Kotwicki T, Negrini S, Grivas TB, Rigo M, Maruyama T, Durmala J et al (2009) Methodology of evaluation of morphology of the spine and the trunk in idiopathic scoliosis and other spinal deformities—6th SOSORT consensus paper. Scoliosis 4:26

    Article  PubMed  Google Scholar 

  39. Asghar J, Samdani AF, Pahys JM, D’Andrea LP, Guille JT, Clements DH et al (2009) Computed tomography evaluation of rotation correction in adolescent idiopathic scoliosis: a comparison of an all pedicle screw construct versus a hook-rod system. Spine (Phila Pa 1976) 34(8):804–807

    Article  Google Scholar 

  40. Raso VJ, Lou E, Hill DL, Mahood JK, Moreau MJ, Durdle NG (1998) Trunk distortion in adolescent idiopathic scoliosis. J Pediatr Orthop 18(2):222–226

    Article  PubMed  CAS  Google Scholar 

  41. King HA (1988) Selection of fusion levels for posterior instrumentation and fusion in idiopathic scoliosis. Orthop Clin North Am 19(2):247–255

    PubMed  CAS  Google Scholar 

  42. Margulies JY, Floman Y, Robin GC, Neuwirth MG, Kuflik P, Weidenbaum M et al (1998) An algorithm for selection of instrumentation levels in scoliosis. Eur Spine J 7(2):88–94

    Article  PubMed  CAS  Google Scholar 

  43. Winter RB (1989) The idiopathic double thoracic curve pattern. Its recognition and surgical management. Spine (Phila Pa 1976) 14(12):1287–1292

    Article  CAS  Google Scholar 

  44. Shufflebarger HL, Macagno A, Marks M, Bastrom T, Betz RR, Newton PO, et al (2009) Left shoulder elevation (LSE): an unexpected consequence of surgical correction of Lenke 1 curves. American Academy of Orthopaedic Surgeons, Las Vegas

  45. Arlet V, Ouellet JA, Shilt J, Shen FH, Wood K, Chan D et al (2009) Subjective evaluation of treatment outcomes of instrumentation with pedicle screws or hybrid constructs in Lenke Type 1 and 2 adolescent idiopathic scoliosis: what happens when judges are blinded to the instrumentation? Eur Spine J 18(12):1927–1935

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded in part by Synthes through a research salary grant.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, Charlottesville, VA, 22903, USA

    Scott Yang, Sean M. Jones-Quaidoo, Matthew Eager, Justin W. Griffin, Vasantha Reddi, Wendy Novicoff & Vincent Arlet

  2. St. Alphonsus Regional Medical Center, Boise, ID, USA

    Jeffrey Shilt

  3. Garrahan Paediatric Hospital, Buenos Aires, Argentina

    Ernesto Bersusky

  4. University of Sao Paulo, Sau Paulo, Brazil

    Helton Defino

  5. McGill University, Montreal, QC, Canada

    Jean Ouellet

  6. King Saud University, Riyadh, Saudi Arabia

    Vincent Arlet

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  1. Scott Yang
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  11. Vincent Arlet
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Correspondence to Vincent Arlet.

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Yang, S., Jones-Quaidoo, S.M., Eager, M. et al. Right adolescent idiopathic thoracic curve (Lenke 1 A and B): does cost of instrumentation and implant density improve radiographic and cosmetic parameters?. Eur Spine J 20, 1039–1047 (2011). https://doi.org/10.1007/s00586-011-1808-4

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  • DOI: https://doi.org/10.1007/s00586-011-1808-4

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