Abstract
Background: In contrast with treatment recommendations for adolescent idiopathic scoliosis, there are no clear algorithms for treating patients with early-onset scoliosis. There has been rapid expansion of treatment options for children with early-onset scoliosis, including casting, growth rods, the vertical expandable prosthetic titanium rib, and anterior vertebral stapling. Questions/purposes: Given the range of treatment options, we assessed variability in decision making regarding treatment of patients with early-onset scoliosis. Methods: We presented 12 clinical and radiographic vignettes about patients with early-onset scoliosis to 13 experienced spine surgeons who are members of the Chest Wall and Spine Deformity Study Group. The reviewers were asked to choose type of treatment, type of construct, construct location, and whether a thoracotomy should be performed. Results: All 13 surgeons agreed regarding the need for surgery in eight of the 12 cases. When the reviewers chose surgery, 76% (40%-100%) selected the vertical expandable prosthetic titanium rib; of those selecting that approach, 61% (0%-100%) coincided on using it bilaterally. Agreement was 20% (0%-60%) for growing rods and 4% (0%-25%) for fusions. Among all cases, agreement regarding whether instrumentation should extend to the pelvis was 71% (50%-100%). In all but two cases, at least 85% of surgeons recommended against a thoracotomy. Conclusions: Although most surgeons agreed about the indication for surgery, we found wide variability in choice of construct type, number of constructs, and level of instrumentation.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1317-1322 |
| Number of pages | 6 |
| Journal | Clinical Orthopaedics and Related Research |
| Volume | 469 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2011 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Orthopedics and Sports Medicine
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Variability of expert opinion in treatment of early-onset scoliosis. / Vitale, Michael G.; Gomez, Jaime A.; Matsumoto, Hiroko; Roye, David P.; Betz, Randal R.; Campbell, Robert M.; Emans, John B.; Flynn, John M.; Ramirez-Lluch, Norman; Snyder, Brian; Sturm, Peter F.; Song, Kit M.; Smith, John T.; Shilt, Jeffrey S.
In: Clinical Orthopaedics and Related Research, Vol. 469, No. 5, 05.2011, p. 1317-1322.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Variability of expert opinion in treatment of early-onset scoliosis
AU - Vitale, Michael G.
AU - Gomez, Jaime A.
AU - Matsumoto, Hiroko
AU - Roye, David P.
AU - Betz, Randal R.
AU - Campbell, Robert M.
AU - Emans, John B.
AU - Flynn, John M.
AU - Ramirez-Lluch, Norman
AU - Snyder, Brian
AU - Sturm, Peter F.
AU - Song, Kit M.
AU - Smith, John T.
AU - Shilt, Jeffrey S.
PY - 2011/5
Y1 - 2011/5
N2 - Background: In contrast with treatment recommendations for adolescent idiopathic scoliosis, there are no clear algorithms for treating patients with early-onset scoliosis. There has been rapid expansion of treatment options for children with early-onset scoliosis, including casting, growth rods, the vertical expandable prosthetic titanium rib, and anterior vertebral stapling. Questions/purposes: Given the range of treatment options, we assessed variability in decision making regarding treatment of patients with early-onset scoliosis. Methods: We presented 12 clinical and radiographic vignettes about patients with early-onset scoliosis to 13 experienced spine surgeons who are members of the Chest Wall and Spine Deformity Study Group. The reviewers were asked to choose type of treatment, type of construct, construct location, and whether a thoracotomy should be performed. Results: All 13 surgeons agreed regarding the need for surgery in eight of the 12 cases. When the reviewers chose surgery, 76% (40%-100%) selected the vertical expandable prosthetic titanium rib; of those selecting that approach, 61% (0%-100%) coincided on using it bilaterally. Agreement was 20% (0%-60%) for growing rods and 4% (0%-25%) for fusions. Among all cases, agreement regarding whether instrumentation should extend to the pelvis was 71% (50%-100%). In all but two cases, at least 85% of surgeons recommended against a thoracotomy. Conclusions: Although most surgeons agreed about the indication for surgery, we found wide variability in choice of construct type, number of constructs, and level of instrumentation.
AB - Background: In contrast with treatment recommendations for adolescent idiopathic scoliosis, there are no clear algorithms for treating patients with early-onset scoliosis. There has been rapid expansion of treatment options for children with early-onset scoliosis, including casting, growth rods, the vertical expandable prosthetic titanium rib, and anterior vertebral stapling. Questions/purposes: Given the range of treatment options, we assessed variability in decision making regarding treatment of patients with early-onset scoliosis. Methods: We presented 12 clinical and radiographic vignettes about patients with early-onset scoliosis to 13 experienced spine surgeons who are members of the Chest Wall and Spine Deformity Study Group. The reviewers were asked to choose type of treatment, type of construct, construct location, and whether a thoracotomy should be performed. Results: All 13 surgeons agreed regarding the need for surgery in eight of the 12 cases. When the reviewers chose surgery, 76% (40%-100%) selected the vertical expandable prosthetic titanium rib; of those selecting that approach, 61% (0%-100%) coincided on using it bilaterally. Agreement was 20% (0%-60%) for growing rods and 4% (0%-25%) for fusions. Among all cases, agreement regarding whether instrumentation should extend to the pelvis was 71% (50%-100%). In all but two cases, at least 85% of surgeons recommended against a thoracotomy. Conclusions: Although most surgeons agreed about the indication for surgery, we found wide variability in choice of construct type, number of constructs, and level of instrumentation.
UR - http://www.scopus.com/inward/record.url?scp=79955634486&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79955634486&partnerID=8YFLogxK
U2 - 10.1007/s11999-010-1540-0
DO - 10.1007/s11999-010-1540-0
M3 - Article
C2 - 20824404
AN - SCOPUS:79955634486
VL - 469
SP - 1317
EP - 1322
JO - Clinical Orthopaedics and Related Research
JF - Clinical Orthopaedics and Related Research
SN - 0009-921X
IS - 5
ER -