Right adolescent idiopathic thoracic curve (Lenke 1 A and B): does cost of instrumentation and implant density improve radiographic and cosmetic parameters?

European Spine Journal

Helton Defino⁶  Matthew Eager³  Sean M. Jones-Quaidoo³  Justin W. Griffin³  Scott Yang³  Vincent Arlet²  Ernesto Bersusky¹  Wendy Novicoff³  Jean Ouellet⁵  Jeffrey Shilt⁴  Vasantha Reddi³ 

[1] Garrahan Paediatric Hospital, Buenos Aires, Argentina;King Saud University, Riyadh, Saudi Arabia;Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, Charlottesville, VA 22903 USA;St. Alphonsus Regional Medical Center, Boise, ID USA;McGill University, Montreal, QC Canada;University of Sao Paulo, Sau Paulo, Brazil

关键词: Spine;    Scoliosis;    Cosmetics;    Instrumentation;   

DOI  :  10.1007/s00586-011-1808-4

学科分类：骨科学

来源: Springer

【 摘 要 】

In adolescent idiopathic scoliosis (AIS) there has been a shift towards increasing the number of implants and pedicle screws, which has not been proven to improve cosmetic correction. To evaluate if increasing cost of instrumentation correlates with cosmetic correction using clinical photographs. 58 Lenke 1A and B cases from a multicenter AIS database with at least 3 months follow-up of clinical photographs were used for analysis. Cosmetic parameters on PA and forward bending photographs included angular measurements of trunk shift, shoulder balance, rib hump, and ratio measurements of waist line asymmetry. Pre-op and follow-up X-rays were measured for coronal and sagittal deformity parameters. Cost density was calculated by dividing the total cost of instrumentation by the number of vertebrae being fused. Linear regression and spearman’s correlation were used to correlate cost density to X-ray and photo outcomes. Three independent observers verified radiographic and cosmetic parameters for inter/interobserver variability analysis. Average pre-op Cobb angle and instrumented correction were 54° (SD 12.5) and 59% (SD 25) respectively. The average number of vertebrae fused was 10 (SD 1.9). The total cost of spinal instrumentation ranged from $6,769 to $21,274 (Mean $12,662, SD $3,858). There was a weak positive and statistically significant correlation between Cobb angle correction and cost density (r = 0.33, p = 0.01), and no correlation between Cobb angle correction of the uninstrumented lumbar spine and cost density (r = 0.15, p = 0.26). There was no significant correlation between all sagittal X-ray measurements or any of the photo parameters and cost density. There was good to excellent inter/intraobserver variability of all photographic parameters based on the intraclass correlation coefficient (ICC 0.74–0.98). Our method used to measure cosmesis had good to excellent inter/intraobserver variability, and may be an effective tool to objectively assess cosmesis from photographs. Since increasing cost density only improves mildly the Cobb angle correction of the main thoracic curve and not the correction of the uninstrumented spine or any of the cosmetic parameters, one should consider the cost of increasing implant density in Lenke 1A and B curves. In the area of rationalization of health care expenses, this study demonstrates that increasing the number of implants does not improve any relevant cosmetic or radiographic outcomes.

【 授权许可】

Unknown