Skip Navigation LinksHome > March 2014 - Volume 34 - Issue 2 > Psychosocial Effects of Repetitive Surgeries in Children Wit...
Journal of Pediatric Orthopaedics:
doi: 10.1097/BPO.0b013e3182a11d73

Psychosocial Effects of Repetitive Surgeries in Children With Early-Onset Scoliosis: Are We Putting Them at Risk?

Matsumoto, Hiroko MA*; Williams, Brendan A. BA*; Corona, Jacqueline MD; Comer, Jonathan S. PhD; Fisher, Prudence W. PhD§; Neria, Yuval PhD§; Roye, Benjamin D. MD, MPH*,∥; Roye1, David P. MD*,∥; Vitale, Michael G. MD, MPH*,∥

Collapse Box


Background: The use of growing instrumentation in children with early-onset scoliosis (EOS) has created interest in determining if these repetitive procedures are prompting the development of lasting psychosocial problems. Given the increasing role of this treatment modality in the management of EOS, this study aimed to assess the psychological status of this patient population and to determine factors associated with worse scores in various psychosocial domains.

Methods: A cross-sectional assessment of 34 EOS patients was performed utilizing 2 well-established, caregiver-completed psychiatric instruments: the Child Behavior Checklist (CBCL) and the Strength and Difficulties Questionnaire. Scores were calculated for 15 CBCL and 6 Strength and Difficulties Questionnaire domains and subdomains and grouped as “Normal” or “Abnormal” according to published normative values. The prevalence of abnormal scores was within each instrument subdomain and was compared with the national norms. Domain scores were also correlated with age at first scoliosis surgery, total number of operative procedures, and total number of growing instrumentation surgeries.

Results: A higher prevalence of Abnormal scores were found in multiple psychosocial domains in our cohort as compared with national normative data. Children with Abnormal CBCL “Total Problems” domain scores were younger at the time of first scoliosis surgery (2.50 vs. 5.52 y). Normal and Abnormal scoring groups showed significant differences in the number of (1) total surgeries; (2) total scoliosis surgeries; and (3) growing instrumentation surgeries in multiple domains on both instruments. Aggression, Rule-breaking, and Conduct were positively correlated with total number of surgeries.

Conclusions: Our findings showed a higher prevalence of Abnormal psychosocial scores in multiple domains in multioperated EOS patients as compared with national norms. Our findings suggest that EOS patients with abnormal psychosocial scores were younger at the time of their initial scoliosis surgery. The number of repetitive surgeries also correlated positively with 3 behavioral problem scores. Although healthier scores were seen in 1 positive behavioral domain in more operated children suggesting the potential for “posttraumatic growth,” the other findings of this study are concerning given the increasing use of this treatment modality and indicate a need for ongoing screening and mental health care in this high-risk population.

Level of Evidence: Level III—case-control.

© 2014 by Lippincott Williams & Wilkins

The Pediatric Orthopaedic Society of North America (POSNA)
is a group of healthcare professionals, primarily pediatric orthopaedic surgeons, dedicated to advancing musculoskeletal care of children and adolescents. JPO is our official member journal. 
Like us on facebook and become a member today!


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.