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Researchers Compare Scoliosis Correction Objectives Among Surgeons

Although many patients with adolescent idiopathic scoliosis (curvature of the spine), or AIS, can be treated without surgery, those who have a severe curvature or curvatures will need surgical correction. The goal of the surgery is not just to straighten out the curve, but to make sure the back is strong, and the patient has a balanced posture and can move well.

In deciding how to fuse the spine, surgeons have to decide how much of it to fuse; they would like to keep it as short as possible, but this may not provide enough stability to the spine. However, the longer the spinal fusion, the lower the mobility of the spine. To help make these decisions, the surgeons use the King and the Lenke classifications. The authors of this study investigated how the classifications were used by the surgeons in deciding on the surgery.

The researchers sent a survey to 50 surgeons in North America, France, Korea, and Japan, who were members of the Spinal Deformity Study Group (SDSG). The questionnaire asked the surgeons to rank their goals in treating scoliosis for the best outcome after surgery. The scoring ranged from 1 to 20, with the most important being 1, the least was 20. The surgeons were also asked to weight the correction of the spine: the coronal (front to back), sagittal (left and right), or transverse (top and bottom).

When the responses were received, the surgeons were sent a second survey that looked for more specific objectives. The surgeons were asked to weigh the importance of corrections in the 6 curves identified with the Lenke classification, using a scale of 1 to 5, where 5 was the most important and 1 the least.

Twenty-five surgeons returned the first survey and 10 responded to the second. The results of the first survey showed that the surgeons felt that the sagittal and coronal balance were the most important factors in their surgical decisions. All the other parameters varied across the board. The results from the second survey showed that certain curves were more important in their decision-making than were others.

The authors write this is the first time such a study was undertaken. The decision-making process lies greatly with the surgeons' training and experience. The authors point out that the study's drawbacks include the lack of x-rays in the ranking questionnaires, which could affect a surgeon's decision about fusion. The authors also state that the surgeons were all spinal surgeons with a specific interest in this area.

In conclusion, the researchers state that further research is needed as there is still a big variety in the way spinal fusion decisions are made by the surgeons.

References: Younes Majdouline MSc, et al. Scoliosis Correction Objectives in Adolescent Idiopathic Scoliosis. In Journal of Pediatric Orthopedics. October/November 2007. Vol. 27. No. 7. Pp. 775-780.

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