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      Adolescent idiopathic scoliosis: surgical treatment and quality of life Translated title: Escoliose idiopática do adolescente: tratamento cirúrgico e qualidade de vida

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          ABSTRACT

          OBJECTIVES:

          The purpose of this study was to determine the influence of perioperative factors and their impact on clinical and functional outcomes in Brazilian patients with adolescent idiopathic scoliosis (AIS).

          METHODS:

          We performed a prospective study with 49 consecutive AIS patients who underwent spine fusion and had a minimum 2 year follow-up. Clinical and radiographic data were correlated to SRS-30 scores in order to predict postoperative results.

          RESULTS:

          There was a negative association between patient age at the time of surgery and back pain. We also observed higher scores in the "satisfaction" domain in patients who underwent surgery after 15 years of age (p < 0.05). The average SRS-30 "mental health" score was significantly higher in males than in females (p= 0.035). Patients treated with braces had worse results than those who did not use them (p= 0.005).

          CONCLUSIONS:

          Posterior spine fusion led to improvement of all domains of the SRS-30 questionnaire. Clinical results were influenced by age, sex and the use of braces prior to surgery. There was no correlation between curve correction and presence of perioperative complications. Level of Evidence IV, Case Series.

          RESUMO

          OBJETIVO:

          A finalidade deste estudo foi determinar a influência dos fatores perioperatórios e seu impacto sobre os desfechos clínicos e funcionais em pacientes brasileiros com escoliose idiopática do adolescente (EIA).

          MÉTODOS:

          Foi realizado um estudo prospectivo com 49 pacientes consecutivos com EIA submetidos à fusão da coluna vertebral, com seguimento de no mínimo dois anos. Os dados clínicos e radiográficos foram correlacionados com o escore SRS-30 para predizer os resultados pós-operatórios.

          RESULTADOS:

          Houve uma associação negativa entre a idade do paciente no momento da cirurgia e dor nas costas. Observamos também escore mais alto no domínio "satisfação" nos pacientes operados depois dos 15 anos de idade (p < 0,05). O escore médio de "saúde mental" do SRS-30 foi significativamente superior em homens com relação às mulheres (p= 0,035). Os pacientes tratados com órteses tiveram resultados piores comparados com aqueles que não usaram (p= 0,005).

          CONCLUSÃO:

          Artrodese posterior levou à melhora de todos os domínios do questionário SRS-30. Os resultados clínicos foram influenciados por idade, sexo e uso de órtese antes da cirurgia. Não houve correlação entre a correção da curva e a presença de complicações perioperatórias. Nível de Evidência IV, Série de Casos.

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          Most cited references20

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          Effects of bracing in adolescents with idiopathic scoliosis.

          The role of bracing in patients with adolescent idiopathic scoliosis who are at risk for curve progression and eventual surgery is controversial. We conducted a multicenter study that included patients with typical indications for bracing due to their age, skeletal immaturity, and degree of scoliosis. Both a randomized cohort and a preference cohort were enrolled. Of 242 patients included in the analysis, 116 were randomly assigned to bracing or observation, and 126 chose between bracing and observation. Patients in the bracing group were instructed to wear the brace at least 18 hours per day. The primary outcomes were curve progression to 50 degrees or more (treatment failure) and skeletal maturity without this degree of curve progression (treatment success). The trial was stopped early owing to the efficacy of bracing. In an analysis that included both the randomized and preference cohorts, the rate of treatment success was 72% after bracing, as compared with 48% after observation (propensity-score-adjusted odds ratio for treatment success, 1.93; 95% confidence interval [CI], 1.08 to 3.46). In the intention-to-treat analysis, the rate of treatment success was 75% among patients randomly assigned to bracing, as compared with 42% among those randomly assigned to observation (odds ratio, 4.11; 95% CI, 1.85 to 9.16). There was a significant positive association between hours of brace wear and rate of treatment success (P<0.001). Bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. The benefit increased with longer hours of brace wear. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and others; BRAIST ClinicalTrials.gov number, NCT00448448.).
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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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              Curve progression in idiopathic scoliosis.

              One hundred and thirty-three curves in 102 patients who were followed for an average of 40.5 years were evaluated to quantitate curve progression after skeletal maturity and for prognostic factors leading to curve progression. Sixty-eight per cent of the curves progressed after skeletal maturity. In general, curves that were less than 30 degrees at skeletal maturity tended not to progress regardless of curve pattern. In thoracic curves the Cobb angle, apical vertebral rotation, and the Mehta angle were important prognostic factors. In lumbar curves the degree of apical vertebral rotation, the Cobb angle, the direction of the curve, and the relationship of the fifth lumbar vertebra to the intercrest line were of prognostic value. Translatory shifts played an important role in curve progression. Curves that measured between 50 and 75 degrees at skeletal maturity, particularly thoracic curves, progressed the most.
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                Author and article information

                Journal
                Acta Ortop Bras
                Acta Ortop Bras
                aob
                Acta Ortopedica Brasileira
                ATHA EDITORA
                1413-7852
                1809-4406
                May-Jun 2017
                May-Jun 2017
                : 25
                : 3
                : 85-89
                Affiliations
                [1 ]Faculdade de Medicina do ABC, Santo André, SP, Brazil
                [2 ]Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, "Pavilhão Fernandinho Simonsen", SP, Brazil
                Author notes
                Correspondence: Av. Príncipe de Galés, 821, Vila Príncipe de Gales, Santo André, SP, Brazil. 09060-650. lucino.miller@ 123456uol.com.br

                AUTHORS' CONTRIBUTIONS: Each author made significant individual contributions to this manuscript. MD (0000-0001-5457-8527)* conducted the bibliographic research. ANM (0000-0001-86791859)* and LYJA (0000-0002-8489-5256)* were the main contributors in writing the manuscript and in evaluating the data from the statistical analysis. LMRR (0000-0001-6891-5395)* and AOG (000-0003-3143-2845)* conducted surgery, monitored patients, collected clinical data, performed the manuscript review and contributed to the study's intellectual concept. *ORCID (Open Researcher and Contributor ID).

                All authors declare no potential conflict of interest related to this article.

                Author information
                http://orcid.org/0000-0001-6891-5395
                http://orcid.org/000-0003-3143-2845
                http://orcid.org/0000-0001-86791859
                http://orcid.org/000-0001-5457-8527
                http://orcid.org/0000-0002-8489-5256
                Article
                10.1590/1413-785220172503157788
                5474410
                28642668
                a9b57cd0-6053-4348-9c61-dc1a98a9d2af

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 15 December 2015
                : 10 November 2016
                Page count
                Figures: 0, Tables: 6, Equations: 0, References: 20, Pages: 5
                Categories
                Original Article

                scoliosis,adolescent,spinal fusion,pedicle screws,treatment outcome

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