Scoliosis Correction Objectives in Adolescent Idiopathic Scoliosis
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Notice bibliographique
Résumé
BACKGROUND: A recent study revealed large variability among a group of 32 spine surgeons in the preoperative instrumentation strategies for the same 5 adolescent idiopathic scoliosis (AIS) patients. The surgical plans were determined to be surgeon and curve-type dependent. It is hypothesized that this variability may be attributed to different objectives for correction. This study is presented to document and analyze 3-dimensional (3-D) surgical correction goals for AIS as determined by a sample of experienced spine surgeons. METHODS: Fifty surgeons from the Spinal Deformity Study Group were surveyed and asked to rank 20 parameters of scoliosis correction and to provide weights for correction in the coronal, sagittal, and transverse planes and for mobility (number of unfused vertebrae) according to their importance for an optimal 3-D correction. Responders were also asked to complete a more detailed survey where the correction objectives were assessed for each of the 6 Lenke curve types. Importance and variability of the correction parameters were evaluated using median (M) and interquartile range (IQR) of the rank (1-20). Intraobserver reliability was assessed by means of intraclass correlation coefficients. RESULTS: Twenty-five surgeons completed the first questionnaire. There was overall agreement that sagittal (M, 1; IQR, 1) and coronal (M, 2; IQR, 0.5) balance were the most important parameters for an optimal correction. Apical vertebral rotation was the least important. All other parameters were highly variable. The Cobb angles were moderately important, with ranks between 8 and 11 (IQR, 3-5.75). Lumbar lordosis (M, 6.5; IQR, 6.5) had a better rank and consensus than thoracic kyphosis (M, 13; IQR, 10). Results for individual parameters were in agreement with the weights given for an optimal 3-D correction in the coronal (36%) and sagittal (34%) planes. A subgroup of 10 surgeons completed the second survey. Mobility was more important for Lenke curve types 3 to 6 than for types 1 and 2 (P < 0.032). The coronal plane was more important for curve types 2 and 4 than for the other types (P < 0.032). The intraobserver reliability for determining the different parameters of scoliosis correction was poor to moderate. CONCLUSIONS: There is a large variability in scoliosis correction objectives. The variability is both surgeon and curve-type dependent. The variability in instrumentation goals may explain the documented variability of spine instrumentation strategies among surgeons. Aside from achieving sagittal and coronal balance, the goals of surgical correction in AIS remain to be further determined and agreed upon by a consensus of spine deformity surgeons. LEVEL OF EVIDENCE: Level V.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle