Pediatric Orthopaedic Division, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
Spine (Phila Pa 1976). 2017 Aug 15;42(16):1233-1240. doi: 10.1097/BRS.0000000000002004.
Case control comparative series.
Describe surgical range adolescent idiopathic scoliosis (AIS) patients electing to forgo surgery and compare health-related quality-of-life outcomes to a similar cohort of operated AIS patients by the same single surgeon.
No data have been published either documenting SRS-22r scores of nonoperated patients with curves ≥40° or comparing these scores to a demographically similar operated cohort.
Individuals with curves ≥40°, age ≥18 years, and electing to forgo surgery were identified. All patients completed an SRS-22r questionnaire. This nonoperated cohort's SRS-22r scores were compared to those of a large demographically similar cohort operated by the same surgeon. Group differences between the SRS-22r scores were evaluated by comparing these to published Minimal Clinically Important Differences (MCID) for the SRS-22r.
One hundred ninety subjects with nonoperated curves were compared to 166 individuals who underwent surgery. The nonoperated cohort averaged 23.5 years of age, averaged 7.7 years since curve reached 40°, and had an average 50° Cobb angle at last follow-up. No statistical significant differences were found between the groups on the Pain, Function, or Mental Health domains of the SRS-22r. Statistically significant differences in favor of the operative cohort were found for self-image, satisfaction, and total score. The observed group differences did not meet the established thresholds for minimal clinically important differences in any of the domain scores, the average total score, or raw scores.
There are no meaningful clinically significant differences in SRS-22r scores at average 8-year follow-up between AIS patients with curves ≥40° treated with or without surgery. These data in conjunction with an absence of long-term evidence of serious medical consequences with nonsurgical management of curves ≥40° should encourage surgeons to reevaluate the benefits of routine surgical care.
病例对照比较系列。
描述选择不接受手术的青少年特发性脊柱侧凸（AIS）患者的手术范围，并通过同一位外科医生的相似手术 AIS 患者队列比较与健康相关的生活质量结果。
没有数据记录≥40°曲线的未手术患者的 SRS-22r 评分，也没有将这些评分与具有相似人口统计学的手术队列进行比较。
确定了曲线≥40°、年龄≥18 岁且选择不接受手术的个体。所有患者均完成了 SRS-22r 问卷。将这个未手术队列的 SRS-22r 评分与由同一位外科医生手术的大型相似人口统计学队列的评分进行比较。通过将这些评分与 SRS-22r 的最小临床重要差异（MCID）进行比较，评估 SRS-22r 评分之间的组间差异。
将 190 名未手术的患者与 166 名接受手术的患者进行比较。未手术组的平均年龄为 23.5 岁，曲线达到 40°后平均 7.7 年，最后一次随访时平均 Cobb 角为 50°。两组在 SRS-22r 的疼痛、功能或心理健康领域均无统计学显著差异。在自我形象、满意度和总分方面，手术组具有统计学上的显著优势。观察到的组间差异在任何领域评分、平均总分或原始评分中均未达到最小临床重要差异的既定阈值。
在平均 8 年随访时，接受或不接受手术治疗的 AIS 患者中，曲线≥40°的患者 SRS-22r 评分无明显临床意义差异。这些数据结合无手术管理≥40°曲线的长期严重医疗后果证据，应鼓励外科医生重新评估常规手术治疗的益处。
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