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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 1  |  Page : 29-31

Comparisons of health-related quality of life of adolescents with idiopathic scoliosis undergoing anterior spinal fusion with extrapleural and posterior lumbar spinal fusion with transpleural treatments using scoliosis research society-22 questionnaire


1 Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong SAR, China
2 Child Mixed Surgical, Orthopaedic and Adult Surgical Ward, Prince of Wales Hospital, Hong Kong SAR, China

Date of Submission10-Nov-2019
Date of Acceptance11-Apr-2021
Date of Web Publication16-Jun-2021

Correspondence Address:
Dr. Bobby Kin-Wah Ng
Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong SAR
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jotr.jotr_45_19

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  Abstract 


Background: Conventional posterior lumbar spinal fusion (PLSF) surgical treatment in severe adolescent idiopathic scoliosis (AIS) patients involved transpleural technique. AIS patients undergoing anterior spinal fusion (ASF) together with extrapleural treatments in the treatment of thoracolumbar scoliosis are well known for its effect in curve correction. Health-related quality of life (HRQOL) of patients after ASF and PLSF has yet to be explored. Subjects and Methods: Severe AIS patients underwent ASF with extrapleural or PLSF with transpleural treatments filled out Scoliosis Research Society-22 (SRS-22) questionnaire before and after surgery. HRQOL before and after surgery was compared. HRQOL between ASF and PLSF was also compared. Results: Twenty-eight patients (10 ASF extrapleural and 18 PLSF transpleural) filled out the SRS-22 questionnaire before and after surgery. No significant difference in function, pain, self-image, mental, satisfaction, and mean scores between ASF and PLSF. All mentioned domains and mean scores were significantly improved after surgery in both ASF and PLSF. Conclusions: Significant improvements in all HRQOL domains after either treatment after surgery were observed, while there was no difference when compared with each other postoperatively. ASF with extrapleural treatment provided same HRQOL as of PLSF.

Keywords: Adolescent idiopathic scoliosis, anterior fusion, corrective surgery, posterior fusion, quality of life


How to cite this article:
Ng BK, Chau WW, Hui AC, Wong CY, Shit FK. Comparisons of health-related quality of life of adolescents with idiopathic scoliosis undergoing anterior spinal fusion with extrapleural and posterior lumbar spinal fusion with transpleural treatments using scoliosis research society-22 questionnaire. J Orthop Traumatol Rehabil 2021;13:29-31

How to cite this URL:
Ng BK, Chau WW, Hui AC, Wong CY, Shit FK. Comparisons of health-related quality of life of adolescents with idiopathic scoliosis undergoing anterior spinal fusion with extrapleural and posterior lumbar spinal fusion with transpleural treatments using scoliosis research society-22 questionnaire. J Orthop Traumatol Rehabil [serial online] 2021 [cited 2021 Dec 9];13:29-31. Available from: https://www.jotr.in/text.asp?2021/13/1/29/318415




  Introduction Top


In severe adolescent idiopathic scoliosis (AIS), surgery is the approach to lessen the curve and prevent it from getting worse. Conventional posterior lumbar spinal fusion (PLSF) surgical treatment involved transpleural technique.[1] The transthoracic transpleural approach needs violation of thoracic cavity, cutting of diaphragm, and postoperative chest tube insertion which can be the source of pain and pulmonary complications, and necessitates prolonged immobilization, delays the fitting of a spinal orthosis, and is vulnerable to infection.[2],[3]

AIS patients undergoing anterior spinal fusion (ASF) together with extrapleural treatments in the treatment of thoracolumbar scoliosis is well known for its effect in curve correction. It has the advantage of preservation of mobile distal segments.[4],[5] It has always been a clinical impression that these patients recover quickly and have a more flexible spine comparing to patient who had posterior surgery, leading to suspected improved recovery period and their health-related quality of life (HRQOL) is virtually the same as normal adolescents. These have yet to be documented.

The objective of this study is to evaluate the HRQOL of AIS patient underwent ASF with extrapleural or PLSF with transpleural treatments before and after surgery.


  Subjects and Methods Top


Severe AIS patients underwent ASF with extrapleural or PLSF with transpleural treatments between year 2016 and 2017 were recruited in this study. Ethical approval was obtained from the ethics review board of the Joint NTEC/CUHK Ethics Committee (Research Ethics Committee approval number: 2019.213).

Patients with extrapleural and transpleural treated filled out Scoliosis Research Society-22 (SRS-22) questionnaire before and after surgery.

Scoliosis research society-22 questionnaire

SRS-22 questionnaire is a well-established validated HRQOL instruments published by Scoliosis Research Society.[6],[7],[8],[9],[10],[11],[12] SRS-22 questionnaire comprises 22 questions under five domains (function, pain, self-image, mental health, and satisfaction). Patients provided the answers on a 5-point Likert scale. Calculations of the five domain scores followed the scoring algorithms provided by SRS.[13] The SRS-22 questionnaire has been transformed to an electronic format.[14]

Statistical analysis

Demographic characteristics and surgical information were calculated using the Student's t-test or Chi-square test where appropriate.

Five SRS-22 domain and mean total scores were calculated. Five SRS-22 domain scores (function, pain, self-image, mental, and satisfaction), and mean score collected before surgery and after ASF with extrapleural or PLSF with transpleural treatment were compared using Student's t-tests. Moreover, HRQOL of the two treatments was also compared as well. Data analysis was carried out using IBM SPSS 25.0 (Armonk, New York, USA). A two-sided P ≤ 0.05 was considered statistically significant.


  Results Top


Twenty-eight patients (10 ASF extrapleural and 18 PLSF transpleural) were successfully filled out the SRS-22 questionnaire before and after surgery. Median years since surgery were 7.5. Demographic characteristics are tabulated in [Table 1]. There was no significant difference in their basic characteristics. The length of hospital stay for patients after extrapleural or transpleural treatment after the surgery did not achieve a significant difference. Similarly, the surgical information between the two groups did not show any significant difference also [Table 2].
Table 1: Demographic characteristics of adolescent idiopathic scoliosis patients treated with either anterior spinal fusion extrapleural or posterior lumbar spinal fusion transpleural approach

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Table 2: Surgical information in both surgical approaches

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There was no significant difference in function, pain, self-image, mental, satisfaction, and mean scores between patients treated with ASF extrapleural and PLSF transpleural [Table 3]. On the other side, all mentioned domains and mean scores were significantly improved after surgery for either treatment (all comparisons P < 0.01) [Table 3].
Table 3: Comparisons of health-related quality of life domain scores before and after surgery underwent anterior spinal fusion with extrapleural or posterior lumbar spinal fusion with transpleural treatments and between the two treatment

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  Discussion Top


In this study, HRQOL of severe AIS patients operated by ASF with extrapleural or PLSF transpleural were compared. The results showed significant improvements in all HRQOL domains after either treatment after surgery, while there was no difference when compared with each other postoperatively.

This is the first study to look for the changes in HRQOL of surgical patients after ASF extrapleural and PLSF transpleural treatments. Discussions on both extrapleural and transpleural treatments were few and all are surgery-centric.[5],[15] Searching for literatures on the comparisons of HRQOL after surgery under these two treatments found none. Function, pain, self-image, mental, and satisfaction significantly improved after extrapleural and transpleural treated. ASF approach was found to have better results in better 3-dimensional correction in AIS.[16] Reports show that ASF extrapleural approach has added advantages over PLSF transpleural of preservation of mobile distal segments, shorter surgical time, and decreased blood loss.[4],[5],[17] Despite this study could not prove our hypothesis of improved length of hospital stay (mean number of days: 9.40 vs. 10.91, P = 0.148), we suspect the difference in the number of days would come up with statistical difference under a large-scale study. A study with more patients in both groups to look for the difference is recommended in future.

Limitations

This is a small study with the limited number of cases in each group. That would affect the data generalizability of the results. The retrospective nature of this study is prone to missing information as well as systematic and information bias. Causation between HRQOL and treatments could not be established. However, we believe that this is the first report on the changes of HRQOL in severe AIS patients surgically corrected by either extrapleural or transpleural treatments.


  Conclusions Top


This is the first study to compare the HRQOL of severe AIS patients operated by ASF extrapleural and PLSF transpleural treatments. Both treatments showed significantly improvements in HRQOL after surgery and no different between the treatments. ASF extrapleural treatment warranted the HRQOL of the patients as of PLSF. Length of hospital stay improvement has yet to be proven under a larger scale study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ghafoor AU, Mayhew JF, Gentry WB, Schmitz ML. Transpleural subclavian central venous catheter placement in a child with scoliosis discovered during a thoracotomy. J Clin Anesth 2003;15:142-4.  Back to cited text no. 1
    
2.
Jain AK, Dhammi IK, Jain S, Kumar J. Simultaneously anterior decompression and posterior instrumentation by extrapleural retroperitoneal approach in thoracolumbar lesions. Indian J Orthop 2010;44:409-16.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Sersar SI, Mooty HA, Hafez MM, Ismail MF, Refaat AA, Ibrahim MF. PDA ligation: Trans or extrapleural approach. Ann Thorac Surg 2005;80:1976.  Back to cited text no. 3
    
4.
Islam S, Hresko MT, Fishman SJ. Extrapleural thoracoscopic anterior spinal fusion: A modified video-assisted thoracoscopic surgery approach to the pediatric spine. JSLS 2001;5:187-9.  Back to cited text no. 4
    
5.
Qiu Y, Zhu F, Wang B, Zhu Z, Yu Y, Sun X, et al. Mini-open anterior instrumentation with diaphragm sparing for thoracolumbar idiopathic scoliosis: Its technique and clinical results. Eur Spine J 2011;20:266-73.  Back to cited text no. 5
    
6.
Brewer P, Berryman F, Baker D, Pynsent P, Gardner A. Analysis of the Scoliosis Research Society-22 Questionnaire Scores: Is There a Difference Between a Child and Parent and Does Physician Review Change That? Spine Deform. 2014;2:34-39.  Back to cited text no. 6
    
7.
Asher M, Min Lai S, Burton D, Manna B. Scoliosis Research Society-22 Patient Questionnaire: Responsiveness to change associated with surgical treatment. Spine (Phila Pa 1976) 2003;28:70-3.  Back to cited text no. 7
    
8.
Asher M, Min Lai S, Burton D, Manna B. The reliability and concurrent validity of the Scoliosis Research Society-22 Patient Questionnaire for idiopathic scoliosis. Spine (Phila Pa 1976) 2003;28:63-9.  Back to cited text no. 8
    
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Cheung KM, Senkoylu A, Alanay A, Genc Y, Lau S, Luk KD. Reliability and concurrent validity of the adapted Chinese version of Scoliosis Research Society-22 (SRS-22) questionnaire. Spine (Phila Pa 1976) 2007;32:1141-5.  Back to cited text no. 9
    
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Climent JM, Bago J, Ey A, Perez-Grueso FJ, Izquierdo E. Validity of the Spanish version of the Scoliosis Research Society-22 (SRS-22) Patient Questionnaire. Spine (Phila Pa 1976) 2005;30:705-9.  Back to cited text no. 10
    
11.
Lee JS, Lee DH, Suh KT, Kim JI, Lim JM, Goh TS. Validation of the Korean version of the Scoliosis Research Society-22 questionnaire. Eur Spine J 2011;20:1751-6.  Back to cited text no. 11
    
12.
Li M, Wang CF, Gu SX, He SS, Zhu XD, Zhao YC, et al. Adapted simplified Chinese (Mainland) version of Scoliosis Research Society-22 Questionnaire. Spine (Phila Pa 1976) 2009;34:1321-4.  Back to cited text no. 12
    
13.
Scoliosis Research Society. Patient Outcome Questionnaires. Vol 20182003. https://www.srs.org/UserFiles/file/outcomes/srs-22_sample. pdf [Last assessed on 2019 Jun 29].  Back to cited text no. 13
    
14.
https://aisq.ort.cuhk.edu.hk/ [Last assessed on 2020 Jun 29].  Back to cited text no. 14
    
15.
Muschik MT, Kimmich H, Demmel T. Comparison of anterior and posterior double-rod instrumentation for thoracic idiopathic scoliosis: Results of 141 patients. Eur Spine J 2006;15:1128-38.  Back to cited text no. 15
    
16.
Franić M, Kovac V. Anterior instrumentation for correction of adolescent thoracic idiopathic scoliosis: Historic prospective study. Croat Med J 2006;47:239-45.  Back to cited text no. 16
    
17.
Freudenberger C, Lindley EM, Beard DW, Reckling WC, Williams A, Burger EL, et al. Posterior versus anterior lumbar interbody fusion with anterior tension band plating: Retrospective analysis. Orthopedics 2009;32:492.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Introduction
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