Optimal surgical care for adolescent idiopathic scoliosis: an international consensus

Marinus de Kleuver, Stephen J. Lewis, Niccole M. Germscheid, Steven J. Kamper, Ahmet Alanay, Sigurd H. Berven, Kenneth M. Cheung, Manabu Ito, Lawrence G. Lenke, David W. Polly, Yong Qiu, Maurits van Tulder, Christopher Shaffrey

Research output: Contribution to journalReview article

48 Citations (Scopus)

Abstract

Purpose: The surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for adolescents with AIS curves between 40° and 90° Cobb angle.

Methods: From July 2012 to April 2013, the AOSpine Knowledge Forum Deformity performed a modified Delphi survey where current expert opinion from 48 experienced deformity surgeons, representing 29 diverse countries, was gathered. Four rounds were performed: three web-based surveys and a final face-to-face meeting. Consensus was achieved with ≥70 % agreement. Data were analyzed qualitatively and quantitatively.

Results: Consensus of what constitutes optimal care was reached on greater than 60 aspects including: preoperative radiographs; posterior as opposed to anterior (endoscopic) surgical approaches; use of intraoperative spinal cord monitoring; use of local autologous bone (not iliac crest) for grafts; use of thoracic and lumbar pedicle screws; use of titanium anchor points; implant density of <80 % for 40°–70° curves; and aspects of postoperative care. Variability in practice patterns was found where there was no consensus. In addition, there was consensus on what does not constitute optimal care, including: routine pre- and intraoperative traction; routine anterior release; use of bone morphogenetic proteins; and routine postoperative CT scanning.

Conclusions: International consensus was found on many aspects of what does and does not constitute optimal operative care for adolescents with AIS. In the absence of current high-level evidence, at present, these expert opinion findings will aid health care providers worldwide define appropriate care in their regions. Areas with no consensus provide excellent insight and priorities for future research.

Original languageEnglish (US)
Pages (from-to)2603-2618
Number of pages16
JournalEuropean Spine Journal
Volume23
Issue number12
DOIs
StatePublished - Nov 20 2014

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Scoliosis
Expert Testimony
Bone Morphogenetic Proteins
Postoperative Care
Traction
Titanium
Health Personnel
Spinal Cord
Thorax
Transplants
Bone and Bones
Surveys and Questionnaires

Keywords

  • Adolescent idiopathic scoliosis
  • Consensus
  • Delphi
  • Optimal care
  • Surgery

Cite this

de Kleuver, M., Lewis, S. J., Germscheid, N. M., Kamper, S. J., Alanay, A., Berven, S. H., ... Shaffrey, C. (2014). Optimal surgical care for adolescent idiopathic scoliosis: an international consensus. European Spine Journal, 23(12), 2603-2618. https://doi.org/10.1007/s00586-014-3356-1

Optimal surgical care for adolescent idiopathic scoliosis : an international consensus. / de Kleuver, Marinus; Lewis, Stephen J.; Germscheid, Niccole M.; Kamper, Steven J.; Alanay, Ahmet; Berven, Sigurd H.; Cheung, Kenneth M.; Ito, Manabu; Lenke, Lawrence G.; Polly, David W.; Qiu, Yong; van Tulder, Maurits; Shaffrey, Christopher.

In: European Spine Journal, Vol. 23, No. 12, 20.11.2014, p. 2603-2618.

Research output: Contribution to journalReview article

de Kleuver, M, Lewis, SJ, Germscheid, NM, Kamper, SJ, Alanay, A, Berven, SH, Cheung, KM, Ito, M, Lenke, LG, Polly, DW, Qiu, Y, van Tulder, M & Shaffrey, C 2014, 'Optimal surgical care for adolescent idiopathic scoliosis: an international consensus', European Spine Journal, vol. 23, no. 12, pp. 2603-2618. https://doi.org/10.1007/s00586-014-3356-1
de Kleuver M, Lewis SJ, Germscheid NM, Kamper SJ, Alanay A, Berven SH et al. Optimal surgical care for adolescent idiopathic scoliosis: an international consensus. European Spine Journal. 2014 Nov 20;23(12):2603-2618. https://doi.org/10.1007/s00586-014-3356-1
de Kleuver, Marinus ; Lewis, Stephen J. ; Germscheid, Niccole M. ; Kamper, Steven J. ; Alanay, Ahmet ; Berven, Sigurd H. ; Cheung, Kenneth M. ; Ito, Manabu ; Lenke, Lawrence G. ; Polly, David W. ; Qiu, Yong ; van Tulder, Maurits ; Shaffrey, Christopher. / Optimal surgical care for adolescent idiopathic scoliosis : an international consensus. In: European Spine Journal. 2014 ; Vol. 23, No. 12. pp. 2603-2618.
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abstract = "Purpose: The surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for adolescents with AIS curves between 40° and 90° Cobb angle.Methods: From July 2012 to April 2013, the AOSpine Knowledge Forum Deformity performed a modified Delphi survey where current expert opinion from 48 experienced deformity surgeons, representing 29 diverse countries, was gathered. Four rounds were performed: three web-based surveys and a final face-to-face meeting. Consensus was achieved with ≥70 {\%} agreement. Data were analyzed qualitatively and quantitatively.Results: Consensus of what constitutes optimal care was reached on greater than 60 aspects including: preoperative radiographs; posterior as opposed to anterior (endoscopic) surgical approaches; use of intraoperative spinal cord monitoring; use of local autologous bone (not iliac crest) for grafts; use of thoracic and lumbar pedicle screws; use of titanium anchor points; implant density of <80 {\%} for 40°–70° curves; and aspects of postoperative care. Variability in practice patterns was found where there was no consensus. In addition, there was consensus on what does not constitute optimal care, including: routine pre- and intraoperative traction; routine anterior release; use of bone morphogenetic proteins; and routine postoperative CT scanning.Conclusions: International consensus was found on many aspects of what does and does not constitute optimal operative care for adolescents with AIS. In the absence of current high-level evidence, at present, these expert opinion findings will aid health care providers worldwide define appropriate care in their regions. Areas with no consensus provide excellent insight and priorities for future research.",
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AU - de Kleuver, Marinus

AU - Lewis, Stephen J.

AU - Germscheid, Niccole M.

AU - Kamper, Steven J.

AU - Alanay, Ahmet

AU - Berven, Sigurd H.

AU - Cheung, Kenneth M.

AU - Ito, Manabu

AU - Lenke, Lawrence G.

AU - Polly, David W.

AU - Qiu, Yong

AU - van Tulder, Maurits

AU - Shaffrey, Christopher

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Y1 - 2014/11/20

N2 - Purpose: The surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for adolescents with AIS curves between 40° and 90° Cobb angle.Methods: From July 2012 to April 2013, the AOSpine Knowledge Forum Deformity performed a modified Delphi survey where current expert opinion from 48 experienced deformity surgeons, representing 29 diverse countries, was gathered. Four rounds were performed: three web-based surveys and a final face-to-face meeting. Consensus was achieved with ≥70 % agreement. Data were analyzed qualitatively and quantitatively.Results: Consensus of what constitutes optimal care was reached on greater than 60 aspects including: preoperative radiographs; posterior as opposed to anterior (endoscopic) surgical approaches; use of intraoperative spinal cord monitoring; use of local autologous bone (not iliac crest) for grafts; use of thoracic and lumbar pedicle screws; use of titanium anchor points; implant density of <80 % for 40°–70° curves; and aspects of postoperative care. Variability in practice patterns was found where there was no consensus. In addition, there was consensus on what does not constitute optimal care, including: routine pre- and intraoperative traction; routine anterior release; use of bone morphogenetic proteins; and routine postoperative CT scanning.Conclusions: International consensus was found on many aspects of what does and does not constitute optimal operative care for adolescents with AIS. In the absence of current high-level evidence, at present, these expert opinion findings will aid health care providers worldwide define appropriate care in their regions. Areas with no consensus provide excellent insight and priorities for future research.

AB - Purpose: The surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for adolescents with AIS curves between 40° and 90° Cobb angle.Methods: From July 2012 to April 2013, the AOSpine Knowledge Forum Deformity performed a modified Delphi survey where current expert opinion from 48 experienced deformity surgeons, representing 29 diverse countries, was gathered. Four rounds were performed: three web-based surveys and a final face-to-face meeting. Consensus was achieved with ≥70 % agreement. Data were analyzed qualitatively and quantitatively.Results: Consensus of what constitutes optimal care was reached on greater than 60 aspects including: preoperative radiographs; posterior as opposed to anterior (endoscopic) surgical approaches; use of intraoperative spinal cord monitoring; use of local autologous bone (not iliac crest) for grafts; use of thoracic and lumbar pedicle screws; use of titanium anchor points; implant density of <80 % for 40°–70° curves; and aspects of postoperative care. Variability in practice patterns was found where there was no consensus. In addition, there was consensus on what does not constitute optimal care, including: routine pre- and intraoperative traction; routine anterior release; use of bone morphogenetic proteins; and routine postoperative CT scanning.Conclusions: International consensus was found on many aspects of what does and does not constitute optimal operative care for adolescents with AIS. In the absence of current high-level evidence, at present, these expert opinion findings will aid health care providers worldwide define appropriate care in their regions. Areas with no consensus provide excellent insight and priorities for future research.

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KW - Delphi

KW - Optimal care

KW - Surgery

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