Publication: Factors influencing magnitude of curve correction in patients with adolescent idiopathic scoliosis undergoing posterior spinal correction and fusion
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Date
2022
Authors
Soundararajan, Sundaresan
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Abstract
Introduction Curve correction magnitude is an important primary radiological outcome that is measured in patients with Adolescent Idiopathic Scoliosis (AIS) who have underwent posterior spinal correction and fusion (PSCF). However, factors that influence this outcome have not been extensively studied. We attempted to identify pre-operative factors that have significant influence on this outcome with the aim of better understanding the relationship between these variables and possibly improve the surgical outcomes and patient satisfaction. Materials and methods All patients with the diagnosis of AIS who underwent PSCF from the year 2004 to 2020 were recruited for this study. Patients with non-idiopathic causes of scoliosis or who had undergone anterior spinal release prior to surgical correction were excluded. Their pre-operative factors namely age, gender, pre-operative Cobb angle, curve flexibility, Lenke classification, Risser sign and experience of the surgeon performing the surgeries along with the percentage of curve correction were analyzed. All parameters were measured and statistical analysis (IBM SPSS Statistics Version 27) using t test and Pearson correlation was performed to look for correlation significance. A step-wise multiple linear regression model was then run to determine the independent factors that were highly correlated and predictive of the curve correction magnitude. Descriptive analysis of the numerical variable was presented as mean (standard deviation). Results A total of 41 patients was available for this study. The mean age of the cohort was 15.1 years old ± 2.1 with the mean age for males 15.5 ± 1 years old and 15.2 ± 2.2 for females. The mean pre-operative Cobb angle, post-operative Cobb angle, curve flexibility and magnitude of curve correction (MCC) was 63.05± 23.3°, 29.45± 20.5°, 32.3± 13.7% and 56.26± 14.4% respectively. Pearson correlation showed no significant correlation between Lenke classification and Risser signs with the magnitude of curve correction. A step-wise multiple linear regression showed pre-operative Cobb angle and curve flexiblity to be the most important predictor of magnitude of curve correction, with R2 value of 0.328 (p<0.001). Age, gender and surgeon experience had no influence on the amount of curve correction achieved. MCC can be predicted using the formula: 46.06 + (-0.182 X Pre-op Cobb angle) + (0.672 X Curve flexibility). Conclusion Pre-operative Cobb angle and curve flexibility were the most important predictors of magnitude of curve correction in patients with AIS undergoing single stage PSCF.
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Keywords
Adolescent Idiopathic Scoliosis , Curve severity