TY - JOUR
T1 - Increased cautiousness in adolescent idiopathic scoliosis patients concordant with syringomyelia fails to improve overall patient outcomes
AU - Pierce, Katherine E.
AU - Krol, Oscar
AU - Kummer, Nicholas
AU - Passfall, Lara
AU - O'Connell, Brooke
AU - Maglaras, Constance
AU - Alas, Haddy
AU - Brown, Avery E.
AU - Bortz, Cole
AU - Diebo, Bassel G.
AU - Paulino, Carl B.
AU - Buckland, Aaron J.
AU - Gerling, Michael C.
AU - Passias, Peter G.
N1 - Publisher Copyright:
© 2021 Wolters Kluwer Medknow Publications. All rights reserved.
PY - 2021/4
Y1 - 2021/4
N2 - Background: Adolescent idiopathic scoliosis (AIS) is a common cause of spinal deformity in adolescents. AIS can be associated with certain intraspinal anomalies such as syringomyelia (SM). This study assessed the rate o f SM in AIS patients and compared trends in surgical approach and postoperative outcomes in AIS patients with and without SM. Methods: The database was queried using ICD-9 codes for AIS patients from 2003-2012 (737.1-3, 737.39, 737.8, 737.85, and 756.1) and SM (336.0). The patients were separated into two groups: AIS-SM and AIS-N. Groups were compared using t-tests and Chi-squared tests for categorical and discrete variables, respectively. Results: Totally 77,183 AIS patients were included in the study (15.2 years, 64% F): 821 (1.2%)-AIS-SM (13.7 years, 58% F) and 76,362-AIS-N (15.2 years, 64% F). The incidence of SM increased from 2003-2012 (0.9 to 1.2%, P = 0.036). AIS-SM had higher comorbidity rates (79 vs. 56%, P < 0.001). Comorbidities were assessed between AIS-SM and AIS-N, demonstrating significantly more neurological and pulmonary in AIS-SM patients. 41.2% of the patients were operative, 48% of AIS-SM, compared to 41.6% AIS-N. AIS-SM had fewer surgeries with fusion (anterior or posterior) and interbody device placement. AIS-SM patients had lower invasiveness scores (2.72 vs. 3.02, P = 0.049) and less LOS (5.0 vs. 6.1 days, P = 0.001). AIS-SM patients underwent more routine discharges (92.7 vs. 90.9%). AIS-SM had more nervous system complications, including hemiplegia and paraplegia, brain compression, hydrocephalous and cerebrovascular complications, all P < 0.001. After controlling for respiratory, renal, cardiovascular, and musculoskeletal comorbidities, invasiveness score remained lower for AIS-SM patients (P < 0.001). Conclusions: These results indicate that patients concordant with AIS and SM may be treated more cautiously (lower invasiveness score and less fusions) than those without SM.
AB - Background: Adolescent idiopathic scoliosis (AIS) is a common cause of spinal deformity in adolescents. AIS can be associated with certain intraspinal anomalies such as syringomyelia (SM). This study assessed the rate o f SM in AIS patients and compared trends in surgical approach and postoperative outcomes in AIS patients with and without SM. Methods: The database was queried using ICD-9 codes for AIS patients from 2003-2012 (737.1-3, 737.39, 737.8, 737.85, and 756.1) and SM (336.0). The patients were separated into two groups: AIS-SM and AIS-N. Groups were compared using t-tests and Chi-squared tests for categorical and discrete variables, respectively. Results: Totally 77,183 AIS patients were included in the study (15.2 years, 64% F): 821 (1.2%)-AIS-SM (13.7 years, 58% F) and 76,362-AIS-N (15.2 years, 64% F). The incidence of SM increased from 2003-2012 (0.9 to 1.2%, P = 0.036). AIS-SM had higher comorbidity rates (79 vs. 56%, P < 0.001). Comorbidities were assessed between AIS-SM and AIS-N, demonstrating significantly more neurological and pulmonary in AIS-SM patients. 41.2% of the patients were operative, 48% of AIS-SM, compared to 41.6% AIS-N. AIS-SM had fewer surgeries with fusion (anterior or posterior) and interbody device placement. AIS-SM patients had lower invasiveness scores (2.72 vs. 3.02, P = 0.049) and less LOS (5.0 vs. 6.1 days, P = 0.001). AIS-SM patients underwent more routine discharges (92.7 vs. 90.9%). AIS-SM had more nervous system complications, including hemiplegia and paraplegia, brain compression, hydrocephalous and cerebrovascular complications, all P < 0.001. After controlling for respiratory, renal, cardiovascular, and musculoskeletal comorbidities, invasiveness score remained lower for AIS-SM patients (P < 0.001). Conclusions: These results indicate that patients concordant with AIS and SM may be treated more cautiously (lower invasiveness score and less fusions) than those without SM.
KW - Adolescent
KW - deformity
KW - idiopathic
KW - scoliosis
KW - syringomyelia
UR - http://www.scopus.com/inward/record.url?scp=85108141459&partnerID=8YFLogxK
U2 - 10.4103/jcvjs.jcvjs_25_21
DO - 10.4103/jcvjs.jcvjs_25_21
M3 - Article
AN - SCOPUS:85108141459
SN - 0974-8237
VL - 12
SP - 197
EP - 201
JO - Journal of Craniovertebral Junction and Spine
JF - Journal of Craniovertebral Junction and Spine
IS - 2
ER -