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Patient Self-Assessment of Appearance Is Improved More by All Pedicle Screw Than by Hybrid Constructs in Surgical Treatment of Adolescent Idiopathic Scoliosis

Smucny, Mia, BA*; Lubicky, John P., MD; Sanders, James O., MD; Carreon, Leah Y., MD, MSc§; Diab, Mohammad, MD*

doi: 10.1097/BRS.0b013e3181cdb4be

Study Design. A multicenter prospective cohort study.

Objective. To compare the effect of all pedicle screw versus hybrid constructs on patient self-assessment of appearance after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis (AIS). This will contribute to future cost-effective analyses on surgical management of AIS.

Summary of Background Data. For surgical management of AIS, the Spinal Appearance Questionnaire (SAQ) and the Scoliosis Research Society outcomes instrument (SRS-30) are reliable surveys of patient satisfaction, but neither tool has been used to assess outcome by implant type.

Methods. Patients received either all pedicle screws or hybrid instrumentation. Self-assessment of appearance pre- and after surgery was measured by SAQ and SRS-30. Statistical significance was evaluated through P values (P < 0.01 in the SAQ, P < 0.05 in the SRS-30) and effect sizes.

Results. There were 93 patients in the all pedicle screw cohort and 61 in the hybrid cohort. There were no significant preoperative differences between the cohorts in the SAQ or SRS-30. All pedicle screw patients tended to see more improvement in shoulder level than hybrid patients in 2 separate SAQ questions (P = 0.025, Cohen's D = 0.20; P = 0.013, D = 0.24). The screw patients also tended to have better scores than hybrid patients in the category, “looking better in clothes” (P = 0.017, V = 0.24) at 2 years postoperative. All pedicle screw patients self-reported significant greater improvement than hybrid patients in the SRS-30 Appearance and Mental domains (P = 0.016, ES = 0.038; P = 0.005, ES = 0.051). There were no significant differences between cohorts in age, gender, baseline curve, or major curve magnitude.

Conclusion. All pedicle screw constructs lead to better self-assessment of appearance in operative treatment of AIS, as determined by SAQ and SRS-30.

In this multicenter prospective study, patient self-assessment of appearance after posterior spine fusion was compared between all pedicle screw and hybrid cohorts using the Scoliosis Appearance Questionnaire and Scoliosis Research Society instrument-30. The screw cohort self-reported greater improvement than the hybrid cohort in shoulder deformity, Appearance, and Mental domains.

*School of Medicine, University of California, San Francisco, CA;

School of Medicine, Indiana University, Indianapolis, IN;

School of Medicine and Dentistry, University of Rochester, NY;

§Spine Institute, Leatherman Spine Center, Louisville, KY.

Address correspondence and reprint requests to Mohammad Diab, MD, University of California-San Francisco, Box 0728, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143–0728; E-mail:

Acknowledgment date: May 22,2009. Revision date: October 8,2009. Acceptance date: November 17, 2009.

The device(s)/drug(s) is/are FDA-approved by corresponding national agency for this indication.

Corporate/industry funds were received in support of this work. 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.

Supported by Medtronic Research Support.

This study received IRB approval from the University of California San Francisco Committee on Human Subjects Research, and all participating centers in the Spinal Deformity Study Group had IRB approval.

© 2011 Lippincott Williams & Wilkins, Inc.