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      RADIOGRAPHIC IMPLICATIONS OF THE SURGICAL WAITING LIST FOR THE TREATMENT OF SPINAL DEFORMITY Translated title: IMPLICACIONES RADIOGRÁFICAS DE LA LISTA DE ESPERA QUIRÚRGICA PARA EL TRATAMIENTO DE DEFORMIDAD DE LA COLUMNA VERTEBRAL Translated title: IMPLICAÇÕES RADIOGRÁFICAS DA LISTA DE ESPERA CIRÚRGICA PARA TRATAMENTO DE DEFORMIDADE DA COLUNA VERTEBRAL

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          Abstract

          ABSTRACT Objective: The aim of this study was to evaluate the implications of long waiting times on surgery lists for the treatment of patients with scoliosis. Methods: Radiographs of 87 patients with scoliosis who had been on the waiting list for surgery for more than six months were selected. Two surgeons answered questionnaires analyzing the radiographs when entering the waiting list and the current images of each patient. Results: Data from 87 patients were analyzed. The mean waiting time for surgery was 21.7 months (ranging from seven to 32 months). The average progression of the Cobb angle in the curvature was 21.1 degrees. Delayed surgery implied changes in surgical planning, such as greater need of instrumentation, osteotomies, and double approach. Conclusions: Long waiting lists have a significant negative impact on surgical morbidity of patients with scoliosis, since they increase the complexity of the surgery. Level of evidence: IV. Type of study: Descriptive study.

          Translated abstract

          RESUMEN Objetivo: El objetivo de este estudio fue evaluar las implicaciones de los largos tiempos de espera en las listas de cirugía para el tratamiento de pacientes con escoliosis.. Métodos: Se seleccionaron radiografías de 87 pacientes con escoliosis que habían estado en la lista de espera para cirugía durante más de seis meses. Dos cirujanos respondieron cuestionarios analizando las radiografías al entrar en la lista de espera y las imágenes actuales de cada paciente. Resultados: Se analizaron los datos de 87 pacientes. El tiempo promedio de espera para la cirugía fue de 21,7 meses (variando de siete a 32 meses). La progresión promedio del ángulo de Cobb en la curvatura fue de 21,1 grados. La demora de la cirugía implicó cambios en la planificación quirúrgica, como mayor necesidad de instrumentación, osteotomías y doble vía de acceso. Conclusiones: Las largas listas de espera tienen un impacto negativo significativo en la morbilidad quirúrgica de los pacientes con escoliosis, ya que aumentan la complejidad de la cirugía. Nivel de evidencia: IV. Tipo de estudio: Estudio descriptivo.

          Translated abstract

          RESUMO Objetivo: A meta desse estudo foi avaliar as implicações das longas listas de espera de cirurgia no tratamento dos pacientes portadores de escoliose. Métodos: Foram selecionados radiografias de 87 pacientes portadores de escoliose que estavam na lista de espera por cirurgia há mais de seis meses. Dois cirurgiões responderam questionários, analisando as radiografias de entrada na lista de espera e as imagens atuais de cada paciente. Resultados: Dados de 87 pacientes foram analisados. A média de espera pela cirurgia foi de 21,7 meses (variando de sete a 32 meses). A média de progressão do ângulo de Cobb na curvatura foi de 21,1 graus. A demora pela cirurgia implicou em alterações no planejamento cirúrgico, como maior necessidade de instrumentação, osteotomias e dupla via de acesso. Conclusão: As longas listas de espera tem um significativo impacto negativo na morbidade cirúrgica dos pacientes com escoliose, por aumentar a complexidade da cirurgia. Nível de evidência: IV. Tipo de estudo: Estudo descritivo

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          Most cited references22

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          Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis.

          The lack of a reliable, universally acceptable system for classification of adolescent idiopathic scoliosis has made comparisons between various types of operative treatment an impossible task. Furthermore, long-term outcomes cannot be determined because of the great variations in the description of study groups. We developed a new classification system with three components: curve type (1 through 6), a lumbar spine modifier (A, B, or C), and a sagittal thoracic modifier (-, N, or +). The six curve types have specific characteristics, on coronal and sagittal radiographs, that differentiate structural and nonstructural curves in the proximal thoracic, main thoracic, and thoracolumbar/lumbar regions. The lumbar spine modifier is based on the relationship of the center sacral vertical line to the apex of the lumbar curve, and the sagittal thoracic modifier is based on the sagittal curve measurement from the fifth to the twelfth thoracic level. A minus sign represents a curve of less than +10 degrees, N represents a curve of 10 degrees to 40 degrees, and a plus sign represents a curve of more than +40 degrees. Five surgeons, members of the Scoliosis Research Society who had developed the new system and who had previously tested the reliability of the King classification on radiographs of twenty-seven patients, measured the same radiographs (standing coronal and lateral as well as supine side-bending views) to test the reliability of the new classification. A randomly chosen independent group of seven surgeons, also members of the Scoliosis Research Society, tested the reliability and validity of the classification as well. The interobserver and intraobserver kappa values for the curve type were, respectively, 0.92 and 0.83 for the five developers of the system and 0.740 and 0.893 for the independent group of seven scoliosis surgeons. In the independent group, the mean interobserver and intraobserver kappa values were 0.800 and 0.840 for the lumbar modifier and 0.938 and 0.970 for the sagittal thoracic modifier. These kappa values were all in the good-to-excellent range (>0.75), except for the interobserver reliability of the independent group for the curve type (kappa = 0.74), which fell just below this level. This new two-dimensional classification of adolescent idiopathic scoliosis, as tested by two groups of surgeons, was shown to be much more reliable than the King system. Additional studies are necessary to determine the versatility, reliability, and accuracy of the classification for defining the vertebrae to be included in an arthrodesis.
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            The prediction of curve progression in untreated idiopathic scoliosis during growth.

            We reviewed the cases of 727 patients with idiopathic scoliosis in whom the initial curve measured from 5 to 29 degrees. The patients were followed either to the end of skeletal growth or until the curve progressed. One hundred and sixty-nine patients (23.2 per cent) showed progression of the curve. The incidence of curve progression was found to be related to the pattern and magnitude of the curve, the patient's age at presentation, the Risser sign, and the patient's menarchal status. We found no correlation between progression of the curve and the patient's sex, Harrington factor, rotational prominence, family history, or radiographic measurements. A progression factor was calculated using the three strongest correlations available at initial examination: the magnitude of the curve, the Risser sign, and the patient's chronological age. A graph and nomogram are presented that can serve as a guide for advising patients' families and for planning continuing care.
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              The selection of fusion levels in thoracic idiopathic scoliosis.

              From the material and data reviewed in our study of 405 patients, it appears that postoperative correction of the thoracic spine approximately equals the correction noted on preoperative side-bending roentgenograms. Selective thoracic fusion can be safely performed on a Type-II curve of less than 80 degrees, but care must be taken to use the vertebra that is neutral and stable so that the lower level of the fusion is centered over the sacrum. The lumbar curve spontaneously corrects to balance the thoracic curve when selective thoracic fusion is performed and the lower level of fusion is properly selected. In Type-III, IV, and V thoracic curves the lower level of fusion should be centered over the sacrum to achieve a balanced, stable spine.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                coluna
                Coluna/Columna
                Coluna/Columna
                Sociedade Brasileira de Coluna (São Paulo, SP, Brazil )
                1808-1851
                2177-014X
                March 2018
                : 17
                : 1
                : 19-22
                Affiliations
                [1] Santo André São Paulo orgnameFaculdade de Medicina do ABC Brazil
                Article
                S1808-18512018000100019
                10.1590/s1808-185120181701179018
                45034a61-8b13-46a3-a3ea-060006b0dc90

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 24 April 2017
                : 31 May 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 4
                Product

                SciELO Brazil


                Scoliosis,Cuidados pré-operatórios,Tratamento,Listas de espera,Escoliose,Cuidados preoperatorio,Tratamiento,Escoliosis,Preoperative care,Treatment,Waiting list

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