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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*,∥

Journal of Pediatric Orthopaedics: March 2014 - Volume 34 - Issue 2 - p 172–178
doi: 10.1097/BPO.0b013e3182a11d73

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.

*Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Medical Center

Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Medical Center

§Department of Psychiatry and New York State Psychiatric Institute, Columbia University Medical Center, New York, NY

Division of Orthopaedics, School of Medicine, Southern Illinois University, Springfield, IL

Center for Anxiety and Related Disorders, Boston University, Boston, MA

Supported by a grant from AO Spine International. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

H.M. has research support from SRS, POSNA, CWSDRF and CPIRF. B.D.R. has research support from SRS and POSNA. He is a consultant for Biomet. D.P.R. Jr. is a consultant for Stryker but receives no financial reimbursement other than travel expenses. He has research support from SRS, POSNA, CPIRF, and CWSDRF. D.P.R. is a member of the board of directors of SICOT. M.G.V. receives royalty from Biomet and a consultant for Stryker and Bioment. He receives research support from SRS, POSNA and CWSDRF. He is a member of the board of directors for CWSDSG and POSNA. Furthermore, D.P.R., M.G.V. have received travel support from the SDSG and CWSDSG in the past. The Division of Pediatric Orthopaedics at Columbia University has received support from OMeGA, Biomet, Stryker and OREF for the fellowship program. The other authors have no conflict of interest to declare.

Reprints: Hiroko Matsumoto, MA, Division of Pediatric Orthopaedic Surgery, 3959 Broadway, 8-North, New York, NY 10032. E-mail:

© 2014 by Lippincott Williams & Wilkins