Long-Term Health-Related Quality of Life After Harrington Instrumentation and Fusion for Adolescent Idiopathic Scoliosis: A Minimum 40-Year Follow-up.
Journal
The Journal of bone and joint surgery. American volume
ISSN: 1535-1386
Titre abrégé: J Bone Joint Surg Am
Pays: United States
ID NLM: 0014030
Informations de publication
Date de publication:
01 06 2022
01 06 2022
Historique:
entrez:
1
6
2022
pubmed:
2
6
2022
medline:
7
6
2022
Statut:
ppublish
Résumé
Despite its importance for clinical decisions, the long-term consequences of posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS), particularly in the lower lumbar spine, remain unclear. This study evaluates the long-term health-related quality of life and the need for a further surgical procedure in patients treated with Harrington instrumentation from 1961 to 1977 according to the lowest instrumented vertebra (LIV) and in comparison with age-matched norms. A search was performed to identify and contact the 314 identified patients with AIS treated with PSIF by Dr. L.A. Goldstein. The assessment included identified subsequent spine surgery, the Oswestry Disability Index (ODI), Scoliosis Research Society-7 (SRS-7), EuroQol-5 Dimensions (EQ-5D), and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29). The health-related quality of life was compared with U.S. norms and, within the cohort, was compared by patient factors, LIV, and subsequent spine surgery. In this study, 134 patients (42.7%) were identified; 24 (7.6%) had died, 81 (25.8%) consented to participate in the study, and 29 (9.2%) declined participation. The mean follow-up was 45.4 years (range, 40 to 56 years). There were 81 patients who completed the surveys, 77 patients who completed the SRS-7, 77 patients who completed the ODI, and 76 patients who completed the PROMIS-29 and EQ-5D. There were 12.8% of patients with LIV L3 or proximal and 36.4% with LIV L4 or distal who had an additional surgical procedure (odds ratio, 3.98). Comparing the ODI of patients who had undergone an additional surgical procedure with those who had not showed 42% and 73% minimal disability, 53% and 23% moderate disability, and 5% and 2% severe disability. Of the patients who had not undergone an additional surgical procedure, those with LIV L3 or proximal had mean scores of 14.12 points for the ODI and 23.3 points for the SRS-7 and those with LIV L4 or distal had mean scores of 17.9 points for the ODI and 22.7 points for the SRS-7; these differences were not significant. The mean PROMIS-29 and EQ-5D scores were not different from normal U.S. age-based means. Patients with AIS treated with PSIF at a mean 45-year follow-up and LIV L4 or distal had a higher rate of undergoing an additional surgical procedure than those with LIV L3 or proximal. Patients undergoing an additional surgical procedure had lower health-related quality of life than those who did not. Despite this, there was no difference in health-related quality of life for patients with LIV L4 or distal compared with patients with LIV L3 or proximal. This cohort of patients with AIS treated with PSIF demonstrates normal self-reported health-related quality of life compared with the age-matched general population. These long-term outcomes of PSIF for AIS are encouraging. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Sections du résumé
BACKGROUND
Despite its importance for clinical decisions, the long-term consequences of posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS), particularly in the lower lumbar spine, remain unclear. This study evaluates the long-term health-related quality of life and the need for a further surgical procedure in patients treated with Harrington instrumentation from 1961 to 1977 according to the lowest instrumented vertebra (LIV) and in comparison with age-matched norms.
METHODS
A search was performed to identify and contact the 314 identified patients with AIS treated with PSIF by Dr. L.A. Goldstein. The assessment included identified subsequent spine surgery, the Oswestry Disability Index (ODI), Scoliosis Research Society-7 (SRS-7), EuroQol-5 Dimensions (EQ-5D), and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29). The health-related quality of life was compared with U.S. norms and, within the cohort, was compared by patient factors, LIV, and subsequent spine surgery.
RESULTS
In this study, 134 patients (42.7%) were identified; 24 (7.6%) had died, 81 (25.8%) consented to participate in the study, and 29 (9.2%) declined participation. The mean follow-up was 45.4 years (range, 40 to 56 years). There were 81 patients who completed the surveys, 77 patients who completed the SRS-7, 77 patients who completed the ODI, and 76 patients who completed the PROMIS-29 and EQ-5D. There were 12.8% of patients with LIV L3 or proximal and 36.4% with LIV L4 or distal who had an additional surgical procedure (odds ratio, 3.98). Comparing the ODI of patients who had undergone an additional surgical procedure with those who had not showed 42% and 73% minimal disability, 53% and 23% moderate disability, and 5% and 2% severe disability. Of the patients who had not undergone an additional surgical procedure, those with LIV L3 or proximal had mean scores of 14.12 points for the ODI and 23.3 points for the SRS-7 and those with LIV L4 or distal had mean scores of 17.9 points for the ODI and 22.7 points for the SRS-7; these differences were not significant. The mean PROMIS-29 and EQ-5D scores were not different from normal U.S. age-based means.
CONCLUSIONS
Patients with AIS treated with PSIF at a mean 45-year follow-up and LIV L4 or distal had a higher rate of undergoing an additional surgical procedure than those with LIV L3 or proximal. Patients undergoing an additional surgical procedure had lower health-related quality of life than those who did not. Despite this, there was no difference in health-related quality of life for patients with LIV L4 or distal compared with patients with LIV L3 or proximal. This cohort of patients with AIS treated with PSIF demonstrates normal self-reported health-related quality of life compared with the age-matched general population. These long-term outcomes of PSIF for AIS are encouraging.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 35648066
doi: 10.2106/JBJS.21.00763
pii: 00004623-202206010-00006
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
995-1003Informations de copyright
Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.
Déclaration de conflit d'intérêts
Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H27).
Références
Harrington PR. Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am. 1962 Jun;44-A:591-610.
Tambornino JM, Armbrust EN, Moe JH. Harrington instrumentation in correction of scoliosis. A comparison with cast correction. J Bone Joint Surg Am. 1964 Mar;46:313-21.
King HA, Moe JH, Bradford DS, Winter RB. The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Joint Surg Am. 1983 Dec;65(9):1302-13.
Goldstein LA, Evarts CM. Follow-up notes on articles previously published in the journal. Further experiences with the treatment of idiopathic scoliosis by cast correction and spine fusion with fresh autogenous iliac bone grafts. J Bone Joint Surg Am. 1966 Jul;48(5):962-6.
Goldstein LA. Surgical management of scoliosis. J Bone Joint Surg Am. 1966;48(1):167-96.
Shands AR, Barr JS, Colonna P, Noall L. End-result study of the treatment of idiopathic scoliosis: report of the Research Committee of the American Orthopaedic Association. J Bone Joint Surg Am. 1941;23(4):963-77.
Potter BK, Lenke LG, Kuklo TR. Prevention and management of iatrogenic flatback deformity. J Bone Joint Surg Am. 2004 Aug;86(8):1793-808.
Louie PK, Iyer S, Khanna K, Harada GK, Khalid A, Gupta M, Burton D, Shaffrey C, Lafage R, Lafage V, Dewald CJ, Schwab FJ, Kim HJ. Revision strategies for Harrington rod instrumentation: radiographic outcomes and complications. Global Spine J. 2020 Oct 1;2192568220960759:2192568220960759.
Merriman M, Hu C, Noyes K, Sanders J. Selection of the lowest level for fusion in adolescent idiopathic scoliosis-a systematic review and meta-analysis. Spine Deform. 2015 Mar;3(2):128-35.
Heath Measures. PROMIS. Accessed 2021 Oct 29. https://www.healthmeasures.net/explore-measurement-systems/promis
Gershon RC, Rothrock N, Hanrahan R, Bass M, Cella D. The use of PROMIS and assessment center to deliver patient-reported outcome measures in clinical research. J Appl Meas. 2010;11(3):304-14.
Brooks RG, Rabin R, De Charro F. The measurement and valuation of health status using EQ-5D: a European perspective: evidence from the EuroQol BIOMED Research Programme. Kluwer Academic; 2003.
Kind P, Brooks R, Rabin R. EQ-5D concepts and methods: a developmental history. Springer; 2005.
Szende A, Oppe M, Devlin NJ. EuroQol Group. EQ-5D value sets: inventory, comparative review, and user guide. Springer; 2007.
Vianin M. Psychometric properties and clinical usefulness of the Oswestry Disability Index. J Chiropr Med. 2008 Dec;7(4):161-3.
Caronni A, Zaina F, Negrini S. Improving the measurement of health-related quality of life in adolescent with idiopathic scoliosis: the SRS-7, a Rasch-developed short form of the SRS-22 questionnaire. Res Dev Disabil. 2014 Apr;35(4):784-99.
Jain A, Sponseller PD, Negrini S, Newton PO, Cahill PJ, Bastrom TP, Marks MC; Harms Study Group. SRS-7: a valid, responsive, linear, and unidimensional functional outcome measure for operatively treated patients with AIS. Spine (Phila Pa 1976). 2015 May 1;40(9):650-5.
Jain A, Lafage V, Kelly MP, Hassanzadeh H, Neuman BJ, Sciubba DM, Bess S, Shaffrey CI, Ames CP, Scheer JK, Burton D, Gupta MC, Hart R, Hostin RA, Kebaish KM; International Spine Study Group. Validity, reliability, and responsiveness of SRS-7 as an outcomes assessment instrument for operatively treated patients with adult spinal deformity. Spine (Phila Pa 1976). 2016 Sep 15;41(18):1463-8.
Danielsson AJ, Hasserius R, Ohlin A, Nachemson AL. Health-related quality of life in untreated versus brace-treated patients with adolescent idiopathic scoliosis: a long-term follow-up. Spine (Phila Pa 1976). 2010 Jan 15;35(2):199-205.
Danielsson AJ, Nachemson AL. Radiologic findings and curve progression 22 years after treatment for adolescent idiopathic scoliosis: comparison of brace and surgical treatment with matching control group of straight individuals. Spine (Phila Pa 1976). 2001 Mar 1;26(5):516-25.
Danielsson AJ, Nachemson AL. Childbearing, curve progression, and sexual function in women 22 years after treatment for adolescent idiopathic scoliosis: a case-control study. Spine (Phila Pa 1976). 2001 Jul 1;26(13):1449-56.
Danielsson AJ, Nachemson AL. Back pain and function 22 years after brace treatment for adolescent idiopathic scoliosis: a case-control study-part I. Spine (Phila Pa 1976). 2003 Sep 15;28(18):2078-85, discussion 2086.
Danielsson AJ, Wiklund I, Pehrsson K, Nachemson AL. Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J. 2001 Aug;10(4):278-88.
Cochran T, Irstam L, Nachemson A. Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion. Spine (Phila Pa 1976). 1983 Sep;8(6):576-84.
Moskowitz A, Moe JH, Winter RB, Binner H. Long-term follow-up of scoliosis fusion. J Bone Joint Surg Am. 1980 Apr;62(3):364-76.
Remes V, Helenius I, Schlenzka D, Yrjönen T, Ylikoski M, Poussa M. Cotrel-Dubousset (CD) or Universal Spine System (USS) instrumentation in adolescent idiopathic scoliosis (AIS): comparison of midterm clinical, functional, and radiologic outcomes. Spine (Phila Pa 1976). 2004 Sep 15;29(18):2024-30.
Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000 Nov 15;25(22):2940-52, discussion 2952.
Rose AJ, Bayliss E, Huang W, Baseman L, Butcher E, García RE, Edelen MO. Evaluating the PROMIS-29 v2.0 for use among older adults with multiple chronic conditions. Qual Life Res. 2018 Nov;27(11):2935-44.
Huang W, Rose AJ, Bayliss E, Baseman L, Butcher E, Garcia RE, Edelen MO. Adapting summary scores for the PROMIS-29 v2.0 for use among older adults with multiple chronic conditions. Qual Life Res. 2019 Jan;28(1):199-210.
Rubery PT, Lander ST, Mesfin A, Sanders JO, Thirukumaran CP. Mismatch between pelvic incidence and lumbar lordosis is the key sagittal plane determinant of patient outcome at minimum 40 years after instrumented fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2022 Mar 1;47(5):E169-76.
Bell F, Miller ML, editors. Life Tables for the United States Social Security Area 1900-2100. 2002. Accessed 2022 Mar 10. https://www.ssa.gov/OACT/NOTES/as120/LifeTables_Body.html
Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA. 2003 Feb 5;289(5):559-67.