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Does Decreased Surgical Stress Really Improve the Psychosocial Health of Early-onset Scoliosis Patients?

A Comparison of Traditional Growing Rods and Magnetically-controlled Growing Rods Patients Reveals Disappointing Results

Aslan, Cihan, MD; Olgun, Z. Deniz, MD; Ayik, Gokhan, MD; Karaokur, Remzi, MD; Ozusta, Seniz, PhD; Demirkiran, Gokhan Halil, MD; Unal, Fatih, MD; Yazici, Muharrem, MD

doi: 10.1097/BRS.0000000000002938
DEFORMITY
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Study Design. Cross-sectional case-control study.

Objective. Compare psychosocial profile of magnetically-controlled growing rod (MCGR) patients to traditional-growing rod (TGR) with an array of psychiatric tools, expecting improvement in MCGR due to decreased number of surgical procedures.

Summary of Background Data. TGR treatment has had positive clinical and radiographic results; however, upward of 10 surgical sessions and high complication rates have called into question the quality of life of these children. Improvement with the introduction of the MCGR is expected.

Methods. GR patients with minimum of 2-years follow-up were recruited. None had neurological conditions. All underwent testing with the Wechsler Intelligence Scale for Children-Revised, and only those in the normal range were included. Patients filled out questionnaires with mental health professionals to measure psychosocial status. MCGR patients’ results were compared to TGR patients.

Results. Twenty-seven patients met criteria (10 MCGR, 17 TGR): average age at enrollment 11.8 years (range 5.9–17). MCGR group was significantly younger (9.1 vs. 13.3 yr) and had significantly shorter follow-up (45.6 vs. 82.8 mo) (P < 0.05). TGR patients underwent an average of 16 surgical procedures, MCGR an average of 1.5 (including complications, P < 0.05). Age at index surgery (6 yr), preoperative and postoperative major curve magnitudes (60°, 40° respectively) were statistically similar.

There was no difference in current psychiatric diagnoses between the groups. MCGR patients scored worse than TGR patients in general functionality domains. TGR patients showed increased functionality and prosocial scores with increased number of procedures. This effect was not observed in MCGR.

Conclusions. The expected improvement in psychosocial status with the MCGR was not observed at a 31.6-month-follow-up. It appears that provided the patient spends enough time in the treatment process to notice benefit and does not experience major complications, noninvasiveness of lengthening procedures does not show up as an advantage with the psychosocial tools utilized in this study.

Level of Evidence: 3

The psychosocial state of patients undergoing magnetically-controlled rods were compared to those of traditional growing rods. Results reveal a disappointing lack of improvement in health-related quality of life.

Department of Child and Adolescent Mental Health, Hacettepe University School of Medicine, Ankara, Turkey

Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA

Department of Orthopaedics and Traumatology, Hacettepe University School of Medicine, Ankara, Turkey.

Address correspondence and reprint requests to Muharrem Yazici, MD, Professor, Department of Orthopaedics and Traumatology, Hacettepe University School of Medicine, Ankara 06100, Turkey; E-mail: mimyazici@gmail.com

Received 10 July, 2018

Revised 11 September, 2018

Accepted 26 October, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.