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Adolescent Idiopathic Scoliosis: 5-year to 20-year Evidence-based Surgical Results.

Westrick ER, Ward WT.

J Pediatr Orthop. 2011; 31: S61-S68.

PMID: 21173621

This recent systematic review analyzed 39 level III/IV studies on surgery for AIS with a minimum of 5-year follow-up.  They found that surgery reliably arrests deformity progression but lacks evidence of any medical necessity.  This paper provides an excellent overview of the existing clinical literature – and its gaps.


Posted by on Nov 16, 2011 in AIS | 0 comments

Adolescent idiopathic scoliosis.

Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA.

Lancet.  2008; 371: 1527-1537.

PMID: 18456103

This high-quality narrative review covers the etiopathogenesis, natural history, non-operative treatment, and surgery of AIS.  AIS appears to have complex genetic causes and very variable natural history.  Evidence on physical therapy and bracing is weak;  surgery is radiographically effective but the health benefit remains unclear.  The best introduction to AIS.


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A Meta-analysis of the Clinical Effectiveness of School Scoliosis Screening.

Fong DY, Lee CF, Cheung KM, Cheng JC, Ng BK, Lam TP, Mak KH, Yip PS, Luk KD.

Spine.  2010; 35: 1061-1071.

PMID: 20393399

This paper presents a rigorous metaanalysis of the worldwide literature on school scoliosis screening, including 36 studies screening well over 1 million youths.  Most studies concluded that screening was effective, but the forward bending test led to over-referral.  This is a definitive overview of the accuracy of these screening programs.


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Complications in Spinal Fusion for Adolescent Idiopathic Scoliosis in the New Millennium. A Report of the Scoliosis Research Society Morbidity and Mortality Committee.

Coe JD, Arlet V, Donaldson W, Berven S, Hanson DS, Mudiyam R, Perra JH, Shaffrey CI.

Spine. 2006; 31: 345-9.

PMID:  16449909

This paper used a large patient registry to report on short-term complications from instrumented fusion for adolescent idiopathic scoliosis.  The overall complication rate was about 5% in anterior or posterior surgeries but 10% in combined approaches, with 0.03% mortality.  This study provides definitive complication rates for use in counseling patients.


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A Prospective Study of Brace Treatment Versus Observation Alone in Adolescent Idiopathic Scoliosis: A Follow-up Mean of 16 Years After Maturity.

Danielsson AJ, Hasserius R, Ohlin A, Nachemson AL.

Spine.  2007; 32: 2198-2207.

PMID: 17873811

This prospective study tested the Boston brace versus observation over sixteen years of follow-up. It found that small curves did not progress, braced patients did not require surgery, and 10% of observational patients required surgery during adolescence. This study provides valuable knowledge about natural history and bracing.


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Pediatric Pedicle Screws: Comparative Effectiveness and Safety: A Systematic Literature Review from the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America Task Force.

Ledonio CG, Polly DW Jr, Vitale MG, Wang Q, Richards BS.

J Bone Joint Surg Am.  2011; 93: 1227-1234.

PMID: 21776576

This recent systematic review from two professional societies analyzed pedicle screws in pediatric studies.  Placement accuracy was 95% for about 13,500 screws in 1350 mostly AIS patients.  Screws achieved greater correction than hooks or hybrids in over 800 AIS patients.  This paper provides strong evidence for screws in AIS surgery.


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Preoperative and Perioperative Factors Effect on Adolescent Idiopathic Scoliosis Surgical Outcomes.

Sanders JO, Carreon LY, Sucato DJ, Sturm PF, Diab M; Spinal Deformity Study Group.

Spine.  2010; 35: 1867-1871.

PMID: 20802382

This prospective multicenter study analyzed preoperative factors associated with poor outcomes after surgery for AIS.  BMI, trunk shift, and less curve correction were some of the factors associated with poor outcomes on SRS.  This study provides useful information for patient selection and quality improvement.


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Lenke Classification System of Adolescent Idiopathic Scoliosis: Treatment Recommendations.

Lenke LG.

Instr Course Lect.  2005; 54: 537-542.

PMID: 15948478

This paper is a guide to the well-established Lenke radiographic classification system by the inventor himself.  The strength of this system is that it is geared toward guiding surgical technique choices rather than being taxonomy for taxonomy’s sake.  This paper provides a system for matching surgical procedures to precise deformities.


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A Multicenter Study of the Outcomes of the Surgical Treatment of Adolescent Idiopathic Scoliosis Using the Scoliosis Research Society (SRS) Outcome Instrument.

Merola AA, Haher TR, Brkaric M, Panagopoulos G, Mathur S, Kohani O, Lowe TG,  Lenke LG, Wenger DR, Newton PO, Clements DH 3rd, Betz RR.

Spine.  2002; 27: 2046-2051.

PMID: 12634567

This prospective multicenter study evaluated surgery for AIS with 2-year follow-up.  Mean pain, function, activity, and self-image improved, but there was no correlation between magnitude of curve correction and any of these clinical outcomes.  Complication rates were missing.  Nonetheless, this is a good clinical study on surgery for AIS.


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Prevalence and Predictors of Pain in Surgical Treatment of Adolescent Idiopathic Scoliosis.

Landman Z, Oswald T, Sanders J, Diab M; Spinal Deformity Study Group.

Spine.  2011; 36: 825-829.

PMID: 21192302

This prospective multicenter study focused on pain in AIS patient undergoing surgery.  Older age, larger thoracic curve, and greater BMI were correlated with more pain.  Surgery reduced pain but not analgesic use. This clinical study provides information on pain in AIS patients that is useful for counseling and decision-making.


Posted by on Nov 16, 2011 in AIS | 0 comments