Effectiveness and safety of surgical interventions for treating adolescent idiopathic scoliosis: a Bayesian meta-analysis

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Abstract

Background

Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity in children and adolescents which presents as complex three-dimensional (3D) deformity of the spine and rib cage. This study aimed to estimate the effectiveness and safety of surgical interventions for AIS using Bayesian meta-analysis.

Methods

The PubMed, EMBASE, and Cochrane Controlled Register of Trials were searched through Oct 1, 2019, without language restrictions. Relevant studies evaluating combined effectiveness and safety of surgical interventions for AIS were included according to eligibility criteria. The primary outcome measures included pulmonary function (change of absolute forced vital capacity and forced expiratory volume in 1 second from pre-operation to post-operation) and incidence of complications. The secondary outcome measure was change of Cobb angle from pre-operation to post-operation. Data was pooled using a random effects model in pairwise meta-analysis. Bayesian meta-analysis combined direct and indirect evidence using a Bayesian framework.

Results

Twenty-eight case-controlled studies with totally 1970 participants were included. This Bayesian meta-analysis combining direct and indirect evidences indicated that posterior fusion with instrumentation without thoracoplasty (PSF) had the highest probability to achieve better pulmonary function and lower complication rate; video assisted anterior fusion with instrumentation without thoracoplasty (VAT) had the highest probability to obtain better Cobb angle correction based on analysis of rank probability.

Conclusion

This Bayesian meta-analysis demonstrated that PSF had the highest probability to achieve better post-surgical pulmonary function and lower complication rate, which gives a practical recommendation of PSF as a primary surgical treatment for AIS. The results also support statistics that current surgeries adopted more PSF but less open anterior approach surgery and thoracoplasty. More research work is required to address the effectiveness and safety of VAT for treating AIS more convincingly.

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Most cited references 48

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Adolescent idiopathic scoliosis.

Stuart L. Weinstein, Lori Dolan, Jack Cheng … (2008)

Adolescent idiopathic scoliosis (AIS) affects 1-3% of children in the at-risk population of those aged 10-16 years. The aetiopathogensis of this disorder remains unknown, with misinformation about its natural history. Non-surgical treatments are aimed to reduce the number of operations by preventing curve progression. Although bracing and physiotherapy are common treatments in much of the world, their effectiveness has never been rigorously assessed. Technological advances have much improved the ability of surgeons to safely correct the deformity while maintaining sagittal and coronal balance. However, we do not have long-term results of these changing surgical treatments. Much has yet to be learned about the general health, quality of life, and self-image of both treated and untreated patients with AIS.

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Animal models of osteoarthritis: classification, update, and measurement of outcomes

Emmanuel Kuyinu, Ganesh Narayanan, Lakshmi Nair … (2016)

Osteoarthritis (OA) is one of the most commonly occurring forms of arthritis in the world today. It is a debilitating chronic illness causing pain and immense discomfort to the affected individual. Significant research is currently ongoing to understand its pathophysiology and develop successful treatment regimens based on this knowledge. Animal models have played a key role in achieving this goal. Animal models currently used to study osteoarthritis can be classified based on the etiology under investigation, primary osteoarthritis, and post-traumatic osteoarthritis, to better clarify the relationship between these models and the pathogenesis of the disease. Non-invasive animal models have shown significant promise in understanding early osteoarthritic changes. Imaging modalities play a pivotal role in understanding the pathogenesis of OA and the correlation with pain. These imaging studies would also allow in vivo surveillance of the disease as a function of time in the animal model. This review summarizes the current understanding of the disease pathogenesis, invasive and non-invasive animal models, imaging modalities, and pain assessment techniques in the animals.

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Adolescent idiopathic scoliosis.

Jack C Y Cheng, René Castelein, Winnie Chu … (2015)

Adolescent idiopathic scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle - a measure of spinal curvature - of ≥10(°). AIS affects between 1% and 4% of adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible.

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Author and article information

Contributors

Bo Li: libo8588@hotmail.com

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 2 July 2020

Publication date PMC-release: 2 July 2020

Publication date Collection: 2020

Volume: 21

Electronic Location Identifier: 427

Affiliations

[1 ]GRID grid.459540.9, ISNI 0000 0004 1791 4503, Department of Orthopedics, , Guizhou Provincial People’s Hospital, ; No.83 Zhongshan East Road, Guiyang, 550000 Guizhou China

[2 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Epidemiology, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, MD 21205 USA

[3 ]GRID grid.410652.4, ISNI 0000 0004 6003 7358, Department of Orthopedics, , The People’s Hospital of Guangxi Zhuang Autonomous Region, ; Nanning, 530021 Guangxi China

Article

Publisher ID: 3233

DOI: 10.1186/s12891-020-03233-1

PMC ID: 7333422

PubMed ID: 32615956

SO-VID: f593e29a-0a00-4103-af78-82ab5d1c4851

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 12 December 2019

Date accepted : 24 March 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 81960404

Award Recipient : Long Chen

Funded by: Guizhou Province High-level Overseas Talents Innovation and Entrepreneurship Project

Award ID: (2019) 05

Award Recipient : Long Chen

Funded by: Doctoral Fund of Guizhou Provincial People's Hospital

Award ID: GZSYBS[2017] 04

Award Recipient : Long Chen

Funded by: Scientific and Technological Research Project for Traditional Chinese Medicine and Folk Medicine of Guizhou Provincial Administration of Traditional Chinese Medicine

Award ID: QZYY-2018-003

Award Recipient : Long Chen

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: adolescent idiopathic scoliosis,surgical interventions,pulmonary function,complications,cobb angle,bayesian meta-analysis

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ScienceOpen disciplines: Orthopedics

Keywords: adolescent idiopathic scoliosis, surgical interventions, pulmonary function, complications, cobb angle, bayesian meta-analysis

Effectiveness and safety of surgical interventions for treating adolescent idiopathic scoliosis: a Bayesian meta-analysis

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Abstract

Background

Methods

Results

Conclusion

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Orthopedics

Most cited references 48

Adolescent idiopathic scoliosis.

Animal models of osteoarthritis: classification, update, and measurement of outcomes

Adolescent idiopathic scoliosis.

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