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Psychological Dysfunction in Children Who Require Repetitive Surgery for Early Onset Scoliosis

Flynn, John M. MD*; Matsumoto, Hiroko MA; Torres, Frances PhD; Ramirez, Norman MD*; Vitale, Michael G. MD, MPH§

Journal of Pediatric Orthopaedics: September 2012 - Volume 32 - Issue 6 - p 594–599
doi: 10.1097/BPO.0b013e31826028ea

Background: Little is known regarding the psychological dysfunction in children who require repetitive surgery for early onset scoliosis (EOS). This study was conducted to examine the neurobehavioral functioning of children with EOS at various stages of treatment with the rib-based growing rod system (RBGRS). We hypothesized that these children would demonstrate evidence of neurobehavioral dysfunction.

Methods: Twelve patients were included in the analyses. At the time of the evaluation, baseline clinical, and demographic information and the number of RBGRS-related surgeries were obtained. All patients were evaluated with semistuctured interviews by a pediatric clinical psychologist using the Behavior Assessment System for Children—2nd Edition-Spanish Version (BASC-2) psychological tool between 1.5 to 3 years from the initial RBGRS implantations.

Results: Of the 12 patients under investigation, 25% scored in a clinically significant range on at least 1 scale, 33% scored in an at-risk range on at least 1 scale, and 42% had normal range for all scales in the BASC-2 measurement. Patients who scored in a clinically significant range in at least 1 of the scales in the BASC-2 measurement were younger at initial RBGS implantation. They had more total surgeries and RBGRS surgeries than patients who did not score in the range.

Conclusions: Clinicians caring for children with EOS should have a heightened awareness for possible adverse psychological outcomes in this population and consider early referral for appropriate psychological assessment and care. Additional studies are necessary to further qualify and quantify the psychological effects of multiple anesthesia surgeries in EOS patients.

Level of Evidence: Level III.

*Department of Pediatric Orthopaedic Surgery, Hospital La Concepción, San Germán, Puerto Rico

Department of Orthopaedic Surgery

§Division of Pediatric Orthopaedic Surgery, Columbia University Medical Center, New York Presbiterian Morgan Stanley Children Hospital, New York, NY

Private Practice, San German, Puerto Rico

No financial disclosure.

M.G.V.: received royalties from Biomet Spine; is a consultant to Biomet spine and Stryker; is a Board Member of Pediatric Orthopedic Society of North America and Chest Wall Deformity Study Group. The remaining authors declare no conflict of interest.

Reprints: John M. Flynn, MD, Department of Pediatric Orthopaedic Surgery, Hospital La Concepción, San Germán, Puerto Rico 00683. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.