Evidence-Based Medicine Analysis of All Pedicle Screw Constructs in Adolescent Idiopathic Scoliosis
Bibliographic record
Abstract
In Brief Study Design. Focus paper. Objective. To evaluate the current evidence-based medicine (EBM) literature in the use of pedicle screw constructs in patients with adolescent idiopathic scoliosis. Summary of Background. EBM has evolved over the past 20 years to provide a framework for the evaluation of therapy and the application of that assessment to a particular patient or a disease. Application of EBM analysis to spinal instrumentation, and specifically to pedicle screw constructs, is challenging. Methods. Cochrane database, Ovid Medline, and PubMed were searched using the terms “pedicle screws” and “adolescent idiopathic scoliosis.” The reference list of the major papers by authors Lenke, Suk, and Kim were hand searched. Relevant articles were retained if they described a pedicle screw construct to correct AIS or compared pedicle screw constructs with another technique. Articles that did not have patients with adolescent idiopathic scoliosis in their subject groups or did not use pedicle screws as a part of their deformity correction were excluded from the study. Results. Based on the search strategy described above, 40 articles met the inclusion criteria and were selected for review in this manuscript. Of these, 32 studies are retrospective reviews including 2 studies that do not define their data collection technique. Six studies have a prospective study design, 1 is a case report, and 1 is a cadaveric study. Conclusion. In the absence of evidence from randomized trials, surgeons must rely on the best available information to guide patient management decisions. Although there have been many publications on the topic of all pedicle screw constructs in AIS, evidence regarding the advantage of all pedicle screw constructs remain limited to case series, biomechanical studies, and expert opinions. This review evaluates the current evidence-based medicine literature in the use of pedicle screw constructs in patients with adolescent idiopathic scoliosis. In the absence of evidence from randomized trials, surgeons must rely on the best available information for patient management. The evidence remains limited to case series, biomechanical studies, and expert opinions.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".