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Expert Consensus for Early Onset Scoliosis Surgery
Michael S Hughes1, Ishaan Swarup, Christopher A Makarewich
1Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA.
Journal of Pediatric Orthopedics
|November 27, 2019
Summary
Early-onset scoliosis (EOS) surgeons lack consensus on surgical standards despite advancements. A survey of experts revealed no agreement on any of the six representative cases, highlighting the need for evidence-based guidelines.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Scoliosis Research
Background:
- Despite advancements in early-onset scoliosis (EOS) classification and treatment options, surgical standards remain undefined among specialists.
- Rapid innovations in EOS care, including magnetically controlled growing rods and new pharmaceuticals, may have outpaced the development of best-practice guidelines.
- A need exists to identify areas of consensus and divergence in current surgical decision-making for EOS.
Purpose of the Study:
- To assess the current level of consensus among international early-onset scoliosis (EOS) experts regarding surgical indications and techniques for representative cases.
- To identify specific areas of agreement and disagreement in the surgical management of diverse EOS etiologies.
Main Methods:
- A survey was distributed to 20 leading EOS surgeons, presenting six representative clinical cases (idiopathic, neuromuscular, syndromic, congenital, thoracic dysplasia, spinal muscular atrophy).
- Respondents were queried on treatment choices, focusing on instrumentation and surgical approach.
- Consensus was defined as agreement among >80% of respondents; statistical analysis (chi-squared) examined treatment variations based on surgical experience.
Main Results:
- A 100% response rate was achieved, with participants averaging 23.9 years of experience.
- No consensus was reached for any of the six presented EOS cases, indicating significant variability in surgical decision-making.
- The congenital scoliosis case exhibited the most variability, while the spinal muscular atrophy case showed the closest to consensus; multiple surgical approaches were favored for all cases.
Conclusions:
- The study highlights a critical lack of consensus in the surgical treatment of early-onset scoliosis (EOS) across various etiologies.
- There is a clear need for a concerted effort to establish evidence-based best-practice guidelines for EOS surgical indications.
- Multicenter outcome data are essential to drive the development of standardized treatment protocols for EOS.
