Scoliosis Correction Objectives in Adolescent Idiopathic Scoliosis
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".