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Adolescent idiopathic scoliosis - to operate or not? A debate article.

Weiss HR, Bess S, Wong MS, Patel V, Goodall D, Burger E - Patient Saf Surg (2008)

Bottom Line: Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental impact on young patients.While advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome, the opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome.In the present paper, the authors were invited to debate the opposite positions of "pro" versus "contra" surgical treatment of AIS, based on the currently available evidence and published guidelines.

View Article: PubMed Central - HTML - PubMed

Affiliation: Asklepios Katharina Schroth Spinal Deformities Rehabilitation Center, D-55566 Bad Sobernheim, Germany. hr.weiss@asklepios.com.

ABSTRACT
Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental impact on young patients. Despite vast clinical research and published treatment guidelines and algorithms, the optimal therapeutic choice for these patients remains highly controversial. While advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome, the opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome. In the present paper, the authors were invited to debate the opposite positions of "pro" versus "contra" surgical treatment of AIS, based on the currently available evidence and published guidelines.

No MeSH data available.


Related in: MedlinePlus

Selected case examples of patients who underwent spinal fusion surgery for curvatures between 50 and 60 degrees (upper panels, A-D). As shown in the examples in the lower panels (F-I), a ribhump may remain visible despite surgical correction. The patient in panel E was operated for a curve of 32 degrees thoracic and 28 degrees lumbar and had a progression of the thoracic curve to more than 50 degrees after operation. As all of the patients on this picture are still young, a further clinical (and radiological) deterioration may be expected.
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Figure 4: Selected case examples of patients who underwent spinal fusion surgery for curvatures between 50 and 60 degrees (upper panels, A-D). As shown in the examples in the lower panels (F-I), a ribhump may remain visible despite surgical correction. The patient in panel E was operated for a curve of 32 degrees thoracic and 28 degrees lumbar and had a progression of the thoracic curve to more than 50 degrees after operation. As all of the patients on this picture are still young, a further clinical (and radiological) deterioration may be expected.

Mentions: Despite the application of force to straighten and de-rotate the spine during surgery, the rib hump can deteriorate after surgery. Even when rib hump magnitude improves postoperatively, much of the correction can be lost and in many patients appears worse than before the surgery (figure 4, panels A-E). In response, surgeons increasingly use costoplasty to assure an improved appearance, by excising the ribs that comprise the prominence. This procedure can in actual fact cause a progressive scoliosis [52] and the destabilising effects of rib removal can also result in a disabling condition called 'flail chest' in which the normal function of the rib cage is permanently compromised. Rib resection excises a substantial part of the functional components of the chest but the effects on chest expansion have not been documented. However, this procedure has been shown to reduce the volume of the chest cage and to substantially impair pulmonary function [67,86].


Adolescent idiopathic scoliosis - to operate or not? A debate article.

Weiss HR, Bess S, Wong MS, Patel V, Goodall D, Burger E - Patient Saf Surg (2008)

Selected case examples of patients who underwent spinal fusion surgery for curvatures between 50 and 60 degrees (upper panels, A-D). As shown in the examples in the lower panels (F-I), a ribhump may remain visible despite surgical correction. The patient in panel E was operated for a curve of 32 degrees thoracic and 28 degrees lumbar and had a progression of the thoracic curve to more than 50 degrees after operation. As all of the patients on this picture are still young, a further clinical (and radiological) deterioration may be expected.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572584&req=5

Figure 4: Selected case examples of patients who underwent spinal fusion surgery for curvatures between 50 and 60 degrees (upper panels, A-D). As shown in the examples in the lower panels (F-I), a ribhump may remain visible despite surgical correction. The patient in panel E was operated for a curve of 32 degrees thoracic and 28 degrees lumbar and had a progression of the thoracic curve to more than 50 degrees after operation. As all of the patients on this picture are still young, a further clinical (and radiological) deterioration may be expected.
Mentions: Despite the application of force to straighten and de-rotate the spine during surgery, the rib hump can deteriorate after surgery. Even when rib hump magnitude improves postoperatively, much of the correction can be lost and in many patients appears worse than before the surgery (figure 4, panels A-E). In response, surgeons increasingly use costoplasty to assure an improved appearance, by excising the ribs that comprise the prominence. This procedure can in actual fact cause a progressive scoliosis [52] and the destabilising effects of rib removal can also result in a disabling condition called 'flail chest' in which the normal function of the rib cage is permanently compromised. Rib resection excises a substantial part of the functional components of the chest but the effects on chest expansion have not been documented. However, this procedure has been shown to reduce the volume of the chest cage and to substantially impair pulmonary function [67,86].

Bottom Line: Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental impact on young patients.While advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome, the opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome.In the present paper, the authors were invited to debate the opposite positions of "pro" versus "contra" surgical treatment of AIS, based on the currently available evidence and published guidelines.

View Article: PubMed Central - HTML - PubMed

Affiliation: Asklepios Katharina Schroth Spinal Deformities Rehabilitation Center, D-55566 Bad Sobernheim, Germany. hr.weiss@asklepios.com.

ABSTRACT
Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental impact on young patients. Despite vast clinical research and published treatment guidelines and algorithms, the optimal therapeutic choice for these patients remains highly controversial. While advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome, the opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome. In the present paper, the authors were invited to debate the opposite positions of "pro" versus "contra" surgical treatment of AIS, based on the currently available evidence and published guidelines.

No MeSH data available.


Related in: MedlinePlus