Reliability and validity of Turkish version of the Scoliosis Japanese Questionnaire- 27 in patients with adolescent idiopathic scoliosis

BackgroundThe aim of this study was to evaluate the reliability and validity of an adapted Turkish version of the Scoliosis Japanese Questionnaire- 27 (SJ- 27).MethodsTranslation and retranslation of the English version of the SJ- 27 was conducted, and all steps of the cross-cultural adaptation process were performed. The Turkish version of the SJ- 27, the Scoliosis Research Society-22 (SRS- 22) questionnaire and the Short Form-36 (SF- 36) were performed to 139 patients with AIS. Reliability was assessed using the test–retest method (Pearson's correlation coefficient); internal consistency was analyzed using Cronbach's alpha. Validity was assessed by correlating the SJ- 27 with the SRS- 22 questionnaire and SF- 36.ResultsThe mean Cobb angles were 23.2 ± 8.3° and 19 ± 5.9° for thoracic and lumbar regions, respectively. The SJ- 27 showed excellent test/retest reliability with an Intraclass correlation coefficient of 0.99. Internal consistency of the SJ- 27 was found to be very good (Cronbach's alpha = 0.991). The SJ- 27 demonstrated very good construct validity with the SRS- 22 total score (r = 0.61). The similar domains of the SJ- 27 and SF- 36 questionnaire was correlated also in the study.ConclusionsThe Turkish version of the SJ- 27 to measure health related quality of life in adolescent idiopathic scoliosis was found to have very good validity, excellent reliability, and high internal consistency.     

Posterior all-pedicle screw instrumentation combined with multiple chevron and concave rib osteotomies in the treatment of adolescent congenital kyphoscoliosis

Background contextCongenital kyphoscoliosis is a disorder that often requires surgical treatment. Although many methods of surgical treatment exist, posterior-only vertebral column resection with instrumentation and fusion seem to have become the gold standard for very severe and very rigid curves. Multiple chevron and concave rib osteotomies have been previously reported to be effective in the treatment of neglected severe idiopathic curves. We hypothesized that this method may also be used successfully in the treatment of congenital kyphoscoliosis.PurposeTo evaluate the effectiveness and safety of multiple chevron osteotomies combined with concave rib osteotomy and posterior pedicle screw instrumentation.Study designRetrospective chart review in the spine service of a large university hospital.Patient sampleAdolescent patients undergoing a specific surgical treatment for the indication of rigid congenital kyphoscoliotic deformity.Outcome measuresRadiographic images were used for the measurement of deformity correction. The Turkish version of the Scoliosis Research Society 22 (SRS-22) Patient Questionnaire has been used as a clinical outcome measure in the patient population.MethodsA retrospective chart review was performed. Patients admitted to Hacettepe Hospital Spine Center during the period of 2005 to 2009 were included. Criteria for inclusion were as follows: adolescent age group (10–16 years); congenital kyphoscoliosis; formation and/or segmentation defect of at least two vertebral motion segments; surgical treatment of deformity by posterior all-pedicle screw instrumentation, multiple chevron osteotomies, and multiple concave rib osteotomies; follow-up of at least 24 months; and a complete set of preoperative, postoperative, and follow-up standing posteroanterior and lateral full spinal radiographs. The patients' hospital records and X-rays were reviewed. Duration of surgery, intraoperative blood loss, postoperative transfusion requirements, postoperative stay in postanesthesia care unit (PACU), time of hospitalization, and complications were recorded. Deformity in both coronal and sagittal planes was analyzed for correction and maintenance of the correction in preoperative, postoperative, and follow-up radiographs. Patients' health-related quality of life was assessed using the SRS-22 questionnaire at the final follow-up.ResultsEighteen patients met the inclusion criteria. Their average age was 13.6 years (range, 11–16 years). Chevron osteotomies were performed at apical segments (three to seven levels) and concave rib osteotomies at Cobb-to-Cobb (five to eight levels). No patient had preoperative cord compression because of the sharply angulated deformity or neurologic deficit. The average preoperative scoliosis was 66.0° (range, 31°–116°), 52.4° (range, 22°–85°) on flexibility X-rays, and became 24.9° (range, 12°–52°) postoperatively. The average preoperative global kyphosis (T2–T12) of 75.9° (range, 50°–106°) became 49.5° (range, 18°–66°). The average preoperative local kyphosis of 71.9° (range, 35°–114°) became 31.4° (range, ?44° to 64°). The average intraoperative bleeding was 989 cc, surgical time was 292 minutes, and intraoperative transfusion was 2.3 units. The maximum PACU stay was overnight. There were no neurologic complications except one pneumothorax and one pneumonia. The average follow-up was 34.3 months. At follow-up, average scoliosis was 27.5° (range, 10°–50°), global kyphosis was 50.3° (range, 28°–73°), and local kyphosis was 36.9°(range, ?36° to 58°). Performed on the last follow-up, the average scores for the five domains of SRS-22 were 4.3, 4.4, 4.2, 4.1, and 4.8 for function, pain, self-image, mental health, satisfaction, and total, respectively.ConclusionsMultiple chevron and concave rib osteotomies with posterior instrumentation provide an acceptable rate of deformity correction and maintenance of correction at 2 years with acceptable intraoperative bleeding, surgical time, postoperative morbidity, and rate of complications. It can be considered as an alternative in the treatment of rigid congenital curves involving more than three levels or multiple curves separated by at least two segments that would otherwise require multiple vertebral resections.     

Reliability and validity of the adapted Dutch version of the revised Scoliosis Research Society 22-item questionnaire

Background contextAs in other fields of medicine, there is an increasing interest among orthopedic surgeons to measure health-related quality of life in adolescent idiopathic scoliosis patients and to evaluate the burden of disease and the effectiveness of different treatment strategies. The development of the revised Scoliosis Research Society 22-item patient questionnaire (SRS-22r) enabled a comprehensive evaluation of health-related quality of life of these patients. Over the years, the SRS-22r gained wide acceptance and has been used in several different countries, languages, and cultures. The SRS-22r has not been translated into Dutch to date.PurposeTo translate the SRS-22r into Dutch and adapt it cross-culturally as outlined by international guidelines and to test its psychometric properties to measure health-related quality of life of adolescent idiopathic scoliosis patients in the Netherlands.Study design/settingA cross-sectional, multicenter validation study.Patient sampleA total of 135 adolescent idiopathic scoliosis patients (mean age 15.1 years old) of three major scoliosis centers in the Netherlands were enrolled in this study. Ninety-two (68%) subjects completed the Dutch SRS-22r, Child Health Questionnaire (CHQ)-CF87 (golden standard for adolescents), and Short Form (SF)-36 (golden standard for adults). Two weeks later, 73 (79%) of 92 respondents returned a second SRS-22r. Demographics, curve type, Risser stage, and treatment status were documented.Outcome measuresFloor and ceiling effects, internal consistency, reproducibility, concurrent validity, and discriminative ability of the Dutch version of the SRS-22r questionnaire.MethodsFor content analysis, SRS-22r domain scores (function, pain, self-image, mental health, and satisfaction with management) were explored and floor and ceiling effects were determined. Cronbach's α was calculated for internal consistency of each domain of the questionnaires and reproducibility was assessed by test-retest reliability analysis. Using Pearson's correlation coefficient, comparison of the domains of the Dutch SRS-22r with the domains of the SF-36 and Child Health Questionnaire-CF87 assessed the concurrent validity. Differences in SRS-22r domain scores between untreated patients with different curve severity determined the discriminative ability of the questionnaire.ResultsThe SRS-22r domains as well as the SF-36 and CHQ-CF87 domains demonstrated no floor effects, but the function, pain, and satisfaction with management domains had ceiling effects, indicating the proportion of subjects with the maximum score between 19.6% and 33.0%. Internal consistency was very satisfactory for all SRS-22r domains: Cronbach's α was between 0.718 and 0.852. By omitting question 15, the internal consistency of the function domain increased from 0.746 to 0.827. Test-retest reliability was ≥0.799 for all SRS-22r domains. The function, pain, mental health, and self-image domains correlated under the 0.001 significance level with the corresponding CHQ-CF87 and SF-36 domains. The satisfaction with management domain did not correlate with the other questionnaires. The SRS-22r had the ability to detect differences between groups with different curve severity; patients with a severe scoliotic curvature had significantly lower pain and self-image domain scores than patients with relatively mild scoliosis.ConclusionsThe Dutch SRS-22r had the properties needed for the measurement of patient perceived health-related quality of life of adolescent idiopathic scoliosis patients in the Netherlands. The Dutch SRS-22r could be used for the longitudinal follow-up of adolescent idiopathic scoliosis patients from adolescence to adulthood and for establishing the effects of conservative or invasive surgical treatment.     

Quality of life of patients with high-grade spondylolisthesis: minimum 2-year follow-up after surgical and nonsurgical treatments

Background contextSurgical intervention is generally indicated in a pediatric high-grade spondylolisthesis to prevent the progression of deformity or neurologic deterioration and improve the quality of life. However, the outcome of the treatment on the health-related quality of life (HRQOL) of patients with high-grade spondylolisthesis remains largely unknown.PurposeTo describe the changes in the HRQOL of patients with pediatric high-grade spondylolisthesis after surgical and nonsurgical managements.Study designObservational case series with a minimal of 2-year follow-up.Patient sampleTwenty-eight pediatric patients with high-grade spondylolisthesis from a single institution filled the inclusion criteria. Twenty-three patients were managed surgically and five were managed nonsurgically.Outcome measuresSelf-report measures: Scoliosis Research Society questionnaires (SRS-22). Neurologic examination, radiographic evaluation of slip grade.MethodsThe SRS-22 questionnaire was collected at the baseline (initial presentation for the nonsurgical group and preoperative visit for the surgical group) and at the last follow-up. Differences between baseline and last follow-up were evaluated in both groups. Correlation between the baseline score of SRS-22 score and improvement in the SRS-22 score was determined in surgical patients.ResultsIn surgical patients, total SRS-22 scores were 3.31±0.50 at the baseline and 4.26±0.50 at the last follow-up. In nonsurgical patients, total SRS-22 scores were 4.12±0.16 at the baseline and 4.14±0.38 at the last follow-up. Therefore, variation in the SRS-22 total score was +0.94±0.77 (p<.001) for surgical patients and +0.02 ± 0.35 (p=.854) for nonsurgical patients. Improvement of the SRS-22 score was correlated with a low baseline value of SRS-22 (R²=0.61; p<.001). There was no neurologic or slip deterioration during the follow-up for patients treated nonsurgically.ConclusionsThe HRQOL improves after a surgical intervention for high-grade spondylolisthesis. Patients with lower baseline HRQOL scores are those who benefit the most from surgery. Close observation is a safe and feasible option in selected patients with a good baseline HRQOL and no neurologic impairment.     

Cross-cultural French-Canadian adaptation and psychometric assessment of the Italian Spine Youth Quality of Life (ISYQOL) questionnaire

BACKGROUND CONTEXTIdiopathic scoliosis (IS) can significantly alter the quality of life of adolescents. Some of the available questionnaires in French measuring the quality of life in this population show weak psychometric properties. The newly developed Italian Spine Youth Quality of Life (ISYQOL) questionnaire promises better properties.PURPOSETo provide a French-Canadian version of the ISYQOL and to verify its psychometric characteristics.STUDY DESIGNProspective validation of a cross-cultural adaptation of the ISYQOL questionnaire.PATIENT SAMPLEA total of 111 participants with idiopathic scoliosis (77.5% female, 10–18 years old, mean Cobb angle=28°) were included in the study.OUTCOME MEASUREThe French-Canadian version of the Italian Spine Youth Quality of Life (ISYQOL-F) questionnaire.MATERIALS AND METHODSThe ISYQOL was translated into French using a forward-backward approach. We then verified the understanding of the translated items with two scoliosis experts and 10 adolescents. Afterward, 111 adolescents with IS were recruited by convenience at the scoliosis clinic and they completed the ISYQOL on three occasions (before seeing the specialist, 1 week, and 2 weeks after). Cronbach's alpha, intra-class (ICC), and Pearson correlation coefficients were used to respectively determine internal consistency, test-retest reliability, and concurrent validity with the SRS-22r and SF-12. The standard error of measurement (SEM) and 95% confidence minimal detectable change (MDC₉₅) were also calculated. The ceiling effect was quantified as the percentage of participants who scored the maximum on ISYQOL-F.RESULTSThe ISYQOL-F showed good internal consistency with a Cronbach alpha of 0.81 and 0.85 respectively for items 1–13 (n=55; ISYQOL-F mean score ± SD = 63.9±13.5) and 1–20 (n=56; ISYQOL-F mean score ± SD=60.7±10.3). Test-retest reliability was excellent (ICC_3,1=0.94). The SEM is 3.1 and the MDC₉₅ is 8.6. Correlations between ISYQOL-F and SRS-22r and between ISYQOL-F and SF-12 were moderate for total scores (r=0.56 and 0.50 respectively, p<.001), but low for each domain (between 0.20 and 0.48, p<.05). No significant ceiling effects were observed for ISYQOL-F (≤2.5%). In contrast, ceiling effects ranged from 3.6% to 30.6% for SRS-22r and 0%–68.5% for SF-12.CONCLUSIONSThe internal consistency and reliability of ISYQOL-F are good. The total score correlates moderately with the SRS-22r and SF-12. Unlike SRS-22r, the ISYQOL-F does not appear to have a ceiling effect. The ISYQOL–F may thus be suitable to assess quality of life in a population of French-Canadian adolescents with IS.     

SRS-22r legacy scores can be accurately translated to PROMIS scores in adult spinal deformity patients

BACKGROUND CONTEXTPatient-Reported Outcomes Measurement Information System (PROMIS) facilitates comparisons of treatment effectiveness across populations and diseases. In adult spinal deformity (ASD), the disease-specific Scoliosis Research Society-22r (SRS-22r) tool assesses outcomes. Existing data must be translated to PROMIS to make comparisons.PURPOSETo develop and validate a method to translate SRS-22r scores to PROMIS scores in surgical ASD patients.STUDY DESIGNRetrospective cohort study.PATIENT SAMPLEA total of 158 ASD surgery patients from an ongoing registry of patients who underwent spine surgery at a tertiary care center from 2015 to 2017 were included.OUTCOME MEASURESPROMIS and SRS-22r questionnaires were completed at 387 visits (150 preoperative [derivation sample]; 237 postoperative [validation sample]).METHODSUsing the derivation sample, we modeled PROMIS domains as functions of age and SRS-22r domains using linear regression. The most parsimonious model was selected. In the validation cohort, we used the derived regression equations to estimate PROMIS scores from SRS-22r scores.RESULTSThe following significant associations were found (p<.001): PROMIS Pain Interference is dependent on age and SRS-22r Pain, Physical Function, and Patient Satisfaction; PROMIS Physical Function is dependent on age and SRS-22r Pain and Physical Function; PROMIS Anxiety is dependent on SRS-22r Mental Health; PROMIS Depression is dependent on age and SRS-22r Mental Health; and PROMIS Satisfaction with Social Roles is dependent on age and SRS-22r Pain, Physical Function (p=.011), Mental Health, and Patient Satisfaction. Correlations were strong to very strong between estimated and actual PROMIS scores in the validation cohort (p<.001): Pain Interference, r=0.78; Physical Function, r=0.66; Anxiety, r=0.83; Depression, r=0.80; and Satisfaction with Social Roles, r=0.71.CONCLUSIONSPROMIS scores estimated from SRS-22r scores using our model correlate strongly with actual PROMIS scores. SRS-22r scores may be translated to PROMIS scores in all evaluated domains for ASD patients. Orthopedic surgeons can use this method to compare legacy measures with PROMIS scores.     

Validation of the Korean version of the Scoliosis Research Society-22 questionnaire

Introduction  

We evaluated the reliability and validity of an adapted Korean version of the Scoliosis Research Society-22 (SRS-22) questionnaire.     

顶椎楔形截骨术治疗重度僵硬型脊柱侧后凸畸形

目的探讨顶椎楔形截骨术治疗重度僵硬型脊柱侧后凸畸形的临床疗效。方法 2012年5月—2014年10月,采用经后路顶椎楔形截骨术治疗的23例重度僵硬型脊柱侧后凸畸形患者,其中9例为特发性,14例为先天性,侧凸及后凸顶椎均位于同一节段。术前、术后及随访期间分别拍摄站立位脊柱全长正侧位X线片,测量侧凸及后凸Cobb角,评价矫形效果;采用SRS-22问卷评分评定日常生活能力。结果手术时间270～570 min,平均387 min;术中出血量900～2 700 mL,平均1 701 mL。所有患者随访 24个月。侧凸Cobb角术前110.6°±23.4°,术后24个月41.4°±12.0°,矫正率为62.6%。后凸Cobb角术前91.5°±27.8°,术后24个月33.1°±14.7°,矫正率为63.8%。冠状面偏移术前(30.3±17.0)mm,术后24个月(19.6±15.1)mm;矢状面偏移术前(34.0±42.2)mm,术后24个月(10.3±15.9)mm。术后24个月SRS-22问卷各项得分及总分与术前相比均显著改善。所有患者术后12个月截骨部位均获得骨性融合。1例患者术后由于痰液阻塞出现肺不张,8例胸腔积液。1例发生神经系统并发症,术后3个月神经功能恢复至术前水平。结论顶椎楔形截骨术治疗重度僵硬型脊柱侧后凸畸形,矫形效果良好,能够实现冠状面和矢状面平衡的重建。     

Midterm surgical outcomes of a short fusion strategy for adolescent idiopathic scoliosis with Lenke 5C curve

BACKGROUND CONTEXTA previous study examined the short-term (2 years) outcomes of a short fusion strategy for Lenke type 5C curves. This strategy had a little less correction rate with no difference in coronal and sagittal balance and SRS-22 scores to those of a conventional strategy and was superior in operative time and intraoperative bleeding. However, its effectiveness in longer follow-up periods was unknown.PURPOSETo assess midterm surgical outcomes of a short fusion strategy for adolescent idiopathic scoliosis (AIS) with Lenke type 5C curve, involving posterior correction and fusion surgery (PSF) using pedicle-screw constructs.STUDY DESIGNRetrospective case series.PATIENT SAMPLETwenty-nine patients who underwent PSF for AIS with Lenke type 5C curve with a minimum 5-year follow-up.OUTCOME MEASURESRadiographic parameters and SRS-22.METHODSWe compared radiographic parameters and clinical outcomes between patients with an upper instrumented vertebra (UIV) at the end vertebra (EV) (n=12) and those treated by short fusion (S), with a UIV one level caudal to the EV (n=17).RESULTSA preoperative mean Cobb angle of 51.9±13.8° was corrected to 11.7±7.7° in the EV group, and an angle of 46.0±6.6° was corrected to 9.3±5.2° in the S group. The correction was maintained in both groups at the final follow-up, and the mean correction loss was 2.8±6.8° in the EV and 6.5±6.5° in the S group (p=.143). The mean correction rate at the final follow-up was not significantly different between the EV (71.4±11.8%) and S (64.9±13.7%) groups (p=.199). A Cobb angle of a thoracic curve was significantly improved immediately after surgery and maintained during the follow-up period in the both groups. Coronal and sagittal balance, thoracic kyphosis, lumbar lordosis, L4 tilt, UIV/LIV tilt, shoulder balance, and SRS-22 had no difference between the two groups.CONCLUSIONSThere was no difference in radiographic parameters and SRS-22 between patients treated with a UIV at the UEV and patients treated using a short fusion strategy, in which the UIV was one level caudal to the UEV. The short fusion strategy can be one of the alternatives in PSF for Lenke type 5C curves, at least in 5-year time frame.     

Predictors of persistent postoperative pain after surgery for idiopathic scoliosis

Purpose:To identify factors contributing to persistent postoperative pain in patients treated surgically for idiopathic scoliosis.Methods:In total, 280 patients aged ten through 25 years at surgery, were identified in the Swedish Spine registry; all having preoperative and postoperative visual analogue scale (VAS) for back pain scores. The patients were divided into a high and low postoperative pain group based on the reported postoperative VAS for back pain scores (by using 45 mm on the 0 mm to 100 mm VAS scale as a cut-off). The patient-reported questionnaire included VAS for back pain, the 3-level version of EuroQol 5-dimensional (EQ-5D-3L) instrument, the EuroQol VAS (EQ-VAS) and the Scoliosis Research Society 22r instrument (SRS-22r). Predictors of postoperative back pain were searched in the preoperative data.Results:The 67 (24%) patients that reported high postoperative VAS back pain (> 45 mm) also reported lower postoperative EQ-5D-3L, EQ-VAS and SRS-22r than patients with low postoperative VAS back pain (all p < 0.001). Two preoperative variables were independently associated with postoperative pain; each millimetre increase in preoperative VAS back pain (on the 0 mm to 100 mm scale) was associated with a higher risk of being in the high postoperative back pain group (odds ratio (OR) 1.03; 95% confidence interval (CI) 1.02 to 1.05) and each 1 point decrease on the preoperative SRS-22r mental health (scale from 1 to 5) was associated with a higher risk of being in the high postoperative back pain group (OR 1.68; 95% CI 1.03 to 2.73).Conclusion:High preoperative back pain and low preoperative mental health are independent predictors of back pain after surgery for idiopathic scoliosis.Level of Evidence:III     

Reliability and validity of an adapted Thai version of the Scoliosis Research Society-22 questionnaire

Purpose  

The Scoliosis Research Society-22 (SRS-22) questionnaire is a widely accepted questionnaire used to assess the health-related quality of life for scoliosis patients in the United States. However, its adaptation in other languages is necessary for its multinational use. A cross-sectional study was performed to evaluate the validity and reliability of an adapted Thai version of the SRS-22 questionnaire.     

The Scoliosis Research Society-22 questionnaire adapted for adolescent idiopathic scoliosis patients in China: reliability and validity analysis

Study design Outcome investigation to verify the internal consistency, reproducibility and validity of the adapted Chinese version of the Scoliosis Research Society-22 (SRS-22) questionnaire for measuring health-related quality of life (HRQoL) in children with idiopathic scoliosis. Objective To develop this questionnaire for the outcome measurement in treating Chinese adolescents with idiopathic scoliosis and evaluate its metric qualities. Summary of background data The SRS-22 questionnaire has proven to be a valid instrument for clinical assessment of patients with idiopathic scoliosis and has been successfully translated into Spanish and Turkish. In most developing countries, however, quality of life and psychological health have been poorly described when treating children with idiopathic scoliosis. Methods Trans-cultural adaptation of the SRS-22 questionnaire was carried out according to the International Quality of Life Assessment Project guidelines. The final version was approved by a committee of experts. The questionnaire was completed by 86 adolescents with idiopathic scoliosis who had been treated with a brace; this included 11 males and 75 females, aged from 10 to 18 years (mean 13.9 years). Curve magnitude ranged from 25° to 45° (mean 35.6°). A subgroup of 30 patients completed the questionnaire again in 3 or 4 weeks. Results Five common factors were acquired from factorial analysis, and the cumulative contribution ratio was 67.66%. The overall alpha coefficient of the questionnaire was 0.88. Coefficients for individual domains were as follows: function/activity, 0.70; pain, 0.80; self-image, 0.80; mental health, 0.88; and satisfaction, 0.81. The questionnaire as a whole had a test–retest correlation coefficient of 0.97. Test–retest correlation coefficients for individual domains were as follows: function, 0.85; pain, 0.96; self-image, 0.96; mental health, 0.95; and satisfaction, 0.91. Conclusion The Chinese version of the SRS-22 questionnaire is eligible in terms of reliability and validity, and can be used to measure HRQoL for adolescent idiopathic scoliosis patients in Mainland China. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Effect of long spinal fusion including the pelvis on activities of daily living related to lumbar spinal function in adults with spinal deformity

BackgroundSpinal sagittal malalignment is managed by long spinal fusion including the pelvis, which reduces lumbar spine range of motion and impairs the activities of daily living. This study aimed to evaluate the changes in activities of daily living after long spinal fusion in adults with spinal deformity, and clarify the improvement or deterioration in the specific activities of daily living postoperatively.MethodsWe retrospectively reviewed 40 adults who underwent long spinal fusion in a single institution between 2014 and 2016 (female/male, 39/1; mean age, 68.5 years; range, 52–79 years). Each patient undertook three self-assessed health-related quality of life measures preoperatively and again at 2-years postoperatively: Oswestry Disability Index (ODI), Scoliosis Research Society (SRS)-22 questionnaire, and Japanese Orthopaedic Association back pain evaluation questionnaire (JOABPEQ). Radiographic outcomes were measured preoperatively and at 2 years postoperatively.ResultsTotal ODI and all SRS-22 domains were improved at 2 years postoperatively. The JOABPEQ scores were also improved in all domains, except lumbar function. The change in pelvic incidence minus lumbar lordosis correlated with improvements in total ODI, SRS-22 function, and self-image scores. At 2 years postoperatively, satisfaction was correlated with total ODI, all SRS-22 domains, and the JOABPEQ pain domain. Subclass analysis of the JOABPEQ lumbar function domain at 2 years postoperatively revealed that 65% of patients had difficulty ‘putting on socks or stockings’, 42% had great difficulty ‘bending forward, kneeling, or stooping’, 32% reported improvement in ‘sit to stand’, and 32% reported deterioration in ‘putting on socks or stockings’ after surgery compared with before surgery. The JOABPEQ lumbar function domain was not correlated with the SRS-22 satisfaction domain.ConclusionsDespite restricting lumbar function, spinopelvic fusion improves health-related quality of life. Surgeons and patients should discuss potential changes and limitations in the activities of daily living after long spinal fusion including the pelvis.     

The timing of surgical staging has a significant impact on the complications and functional outcomes of adult spinal deformity surgery

Background contextTo our knowledge, the effect of the staging regimen on the surgical outcome in patients undergoing combined anterior/posterior surgery for the treatment of spinal deformity has not been previously studied.PurposeTo compare outcomes of anterior/posterior surgery for adult spinal deformity staged less than 21 days apart versus those 21 or more days apart.Study designA retrospective comparison study.Patient samplePatients aged 40 years or older who underwent combined anterior/posterior fusions for spinal deformities.Outcome measuresSelf-reported measures, physiological measures, and functional measures.MethodsWe retrospectively reviewed prospectively collected data for 63 consecutive patients (50 females and 13 males) older than 40 years who underwent combined anterior/posterior fusions for spinal deformities and who had a minimum of 2-year follow-up. We divided them into those who had surgery staged less than 21 days apart (Group 1, N=29) and those who had surgery staged 21 or more days apart (Group 2, N=34). The groups were not statistically different in age; preoperative American Society of Anesthesiologists, Scoliosis Research Society-22 (SRS-22) patient questionnaire, and Oswestry Disability Index (ODI) scores; number of previous surgeries; number of levels fused; or total operative time. Hotelling t square test and the chi-squared test were used to compare clinical and radiographic parameters, complications, and functional outcomes between groups (significance, p<.05).ResultsCompared with Group 1 patients, Group 2 (staged) patients had a lower total estimated blood loss (average, 4.5 L [range, 1.90–8.75 L] vs. 4 L [range, 1.8–10.1 L], respectively), fewer combined hospital days (average, 14 days [range, 7–70 days] vs. 12 days [range, 6–44 days], respectively), and fewer major complications (total, 10 [35%] vs. 6 [18%], respectively). Preoperative SRS-22 and ODI scores were significantly better in Group 2 than in Group 1 at 6 weeks (p<.001) and at final follow-up (p<.001), respectively.ConclusionFor patients who require both anterior and posterior surgery for spinal deformity correction, staging the two procedures 21 or more days apart decreases total perioperative transfusion requirements although significantly improving functional outcomes.     

Validity and responsiveness of PROMIS in adult spinal deformity: The need for a self-image domain

BACKGROUND CONTEXT

Validity and responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) have been investigated in several orthopaedic subspecialties. PROMIS has shorter completion time and greater research flexibility for the heterogeneous adult spinal deformity (ASD) population versus the Oswestry Disability Index (ODI) and Scoliosis Research Society 22-item questionnaire (SRS-22r).

Age variation in the minimum clinically important difference in SRS-22r after surgical treatment for adult spinal deformity – A single institution analysis in Japan

Background

The Scoliosis Research Society-22r (SRS-22r) has been shown to be reliable, valid and responsive to change in patients with adult spinal deformity (ASD) undergoing surgery. The minimum clinically important difference (MCID) quantifies a threshold value of improvement that is clinically relevant to the patient. Health-related quality of life scores depend on age. The purpose of this study was to assess MCID threshold values stratified by age for SRS-22r domains in patients with ASD undergoing surgical correction.

Population-based normative data for the Scoliosis Research Society 22r questionnaire in adolescents and adults,including a comparison with EQ-5D

Purpose

The Scoliosis Research Society (SRS) 22r questionnaire is a widely used instrument. To estimate the disorder´s impact on quality of life and to gain knowledge about treatment effects, normative values are needed.

Methods

Individuals were randomly invited from the general population. 272 individuals (145 females) answered the SRS-22r and EuroQol 5-dimensions (EQ-5D) questionnaires and stratified according to sex and age; ≤19 years (n = 61), 20–39 years (n = 66), 40–59 years (n = 84) and ≥60 years (n = 61). The correlation between SRS-22r and EQ-5D were analyzed.

Results

There were modest variations in mean SRS-22r scores (ranging between 4.3 and 4.7). EQ-5D followed the same pattern. The correlation between the SRS-22r was 0.62 (p = 0.001) and 0.61 (p < 0.001) for the EQ-5D UK tariff and EQ-5D Swedish tariff, respectively.

Conclusion

We provide the first SRS-22r normative data for adolescents and adults overall. We found a good correlation between SRS-22r and EQ-5D in individuals without spinal deformity.

     

How to select the lowest instrumented vertebra in Lenke type 5 adolescent idiopathic scoliosis patients?

BACKGROUND CONTEXTThe lowest instrumented vertebra (LIV) determination in Lenke type 5 Adolescent Idiopathic Scoliosis (AIS) requires a thorough understanding and prediction of the correction force on the LIV from coronal, sagittal, and axial plane. Although many LIV selection criteria have been reported, none of them comprehensively evaluated the multidimensional characteristics of the LIV till now.PURPOSETo develop and evaluate our LIV selection criteria in Lenke type 5 AIS patients using pedicle screw system via posterior approach.STUDY DESIGNA retrospective study.PATIENT SAMPLEAll consecutive patients with Lenke 5 curves who were treated with one-stage selective lumbar fusion using complete pedicle screw system in our center from January 2006 to December 2017, with minimum 2-year follow-up.OUTCOME MEASURESAge, gender and Risser grade, fused levels, operating time, intraoperative blood loss, complications, and Scoliosis Research Society (SRS)-22 questionnaires outcome were recorded. Coronal, sagittal, and axial parameters were measured from plain radiographs.METHODSA total of 138 consecutive patients with Lenke 5 curves treated with selective lumbar fusion were retrospectively analyzed, with minimum 2-year follow-up. Our LIV selection criteria include: (1) the most cephalad vertebrae touched by central sacrum vertical line (CSVL); (2) Nash-Moe rotation being equal or less than grade I on the standing AP radiograph; (3) CSVL cross between the two pedicles of LIV on concave bending film; (4) not at the apex of kyphosis. Radiographic data, operative data, perioperative complications and SRS-22 outcomes were collected and analyzed.RESULTSThe mean follow-up period was 50.9±24.7 months. The thoracolumbar/lumbar curve was corrected from 46.9°±8.9° before surgery to 5.5°±2.6° at the final follow-up. The C7-CSVL was 19.7±6.2 mm before surgery and 5.2±3.4 mm at the final follow-up. The LIV translation was corrected from 22.3 ±5.4 mm before surgery to 4.8 ± 2.6 mm at the final follow-up, with the correction rate of 78.4%. The LIV tilt was corrected from 21.6 ± 4.4° before surgery to 2.6 ± 2.3° at the final follow up, with the correction rate of 87.9%. Our LIV saved 0.3 level than SRS-last barely touching vertebra, 0.6 level than SRS-last substantially touching vertebra, 0.9 level than neutral vertebra, and 1.4 level than stable vertebra.CONCLUSIONThe present study indicates using our LIV criteria, our study achieved the correction rate of thoracolumbar/lumbar curve as 88.9%, with the rate of adding on or coronal imbalance as 8.7% (12/138). The criteria may provide important guidance for preoperative decision-making in Lenke 5 AIS patients, and more multicenter prospective studies with larger samples are needed to further validate the findings of this study.     

马方综合征脊柱侧凸患者术前SRS-22、SF-36问卷心理健康评分分析:与青少年特发性脊柱侧凸患者的比较

背景:脊柱畸形不仅影响青少年的外观,还会影响患者的心理健康。但关于马方综合征脊柱侧凸(MSS)畸形对青少年心理健康影响的文献报道并不多。目的:分析接受矫形手术的MSS患者术前SRS-22问卷和SF-36问卷中的心理健康评分情况,并与青少年特发性脊柱侧凸(AIS)患者进行比较。方法:回顾分析2010年9月至2014年8月在我院接受手术治疗的28例MSS患者的SRS-22问卷及SF-36问卷结果,其中男7例,女21例;术时年龄11~19岁,平均14.8岁。选取同期收治的56例AIS患者的资料进行配比,男7例,女49例;年龄11~17岁,平均14.3岁。比较两组患者的临床及影像学参数、SRS-22问卷和SF-36问卷中的心理健康评分的差异。结果:MSS组与AIS组患者SRS-22问卷心理健康平均得分分别为3.6±0.5和3.8±0.6,总得分分别为17.8±2.7和19.2±3.0。MSS组与AIS组患者SF-36心理健康最终得分分别为66.3±11.4和71.9±10.3。上述SRS-22问卷及SF-36问卷心理健康得分组间比较差异均有统计学意义(P<0.05)。得分差异主要来自于SRS-22问卷的Q20和SF-36问卷的Q9.8,其他问题得分差异无统计学意义。MSS组患者的上述心理健康评分与患者年龄、身高、体重指数、术前剃刀背高度、主弯冠状面Cobb角、顶椎偏距、术前冠状面躯干平衡情况、术前双肩及骨盆失平衡情况和矢状面胸后凸均无显著相关性(P>0.05)。结论:手术治疗的MSS患者的心理健康状况评分低于AIS患者,这种差异主要来源于问卷中有关愉快感受方面。MSS患者的心理健康状况评分与患者侧凸的临床及影像学参数无明显相关性。     

Meta-analysis on the efficacy and safety of anterior vertebral body tethering in adolescent idiopathic scoliosis

Purpose

In this meta-analysis, we analyzed the efficacy and safety of anterior vertebral body tethering in patients with adolescent idiopathic scoliosis.

Methods

We performed a literature search and analyzed the following data: baseline characteristics, efficacy measures (corrections of the main thoracic curve, proximal thoracic curve, and thoracolumbar curve, thoracic kyphosis, lumbosacral lordosis, rib hump, lumbar prominence and SRS-22 scores, and complications. Analyses were performed with Cochrane's Review Manager version 5.4.

Results

Twelve studies met the inclusion criteria. Significant corrections of the main thoracic (MD 22.51, 95% CI 12.93 to 32.09) proximal thoracic (MD 10.14°, 95% CI 7.25° to 13.02°), and thoracolumbar curve (MD 12.16, 95% CI 9.14 to 15.18) were found. No statistically significant corrections were observed on the sagittal plane assessed by thoracic kyphosis (MD − 0.60°, 95% CI − 2.45 to 1.26; participants = 622; studies = 4; I2 = 36%) and lumbosacral lordosis (MD 0.19°, 95% CI − 2.16° to 2.54°). Significant corrections were identified for rib hump (MD 5.26°, 95% CI 4.19° to 6.32°) and lumbar prominence (MD 1.20°, 95% CI 0.27° to 2.13°) at final follow-up. Significant improvements of total SRS-22 score (MD − 0.96, 95% CI − 1.10 to − 0.83) were achieved at final follow-up. The most common complication was overcorrection (8.0%) and tether breakage (5.9%), with a reoperation rate of 10.1%.

Conclusions

Anterior vertebral body tethering is effective to reduce the curve in the coronal plane and clinical deformity. Maximum correction is achieved at one year. The method should, however, be optimized to reduce the rate of complications.