Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA.
Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA.
Spine Deform. 2023 Jan;11(1):11-25. doi: 10.1007/s43390-022-00561-1. Epub 2022 Aug 10.
Consensus and uncertainty in early onset scoliosis (EOS) treatment were evaluated in 2010. It is currently unknown how treatment preferences have evolved over the past decade. The purpose of this study was to re-evaluate consensus and uncertainty among treatment options for EOS patients to understand how they compare to 10 years ago.
11 pediatric spinal surgeons (similar participants as in 2010) were invited to complete a survey of 315 idiopathic and neuromuscular EOS cases (same cases as in 2010). Treatment options included the following: conservative management, distraction-based methods, growth guidance/modulation, and arthrodesis. Consensus was defined as ≥ 70% agreement, and uncertainty was < 70%. Associations between case characteristics and consensus for treatments were assessed via chi-squared and multiple regression analyses. Case characteristics associated with uncertainty were described.
Eleven surgeons [31.7 ± 7.8 years of experience] in the original 2010 cohort completed the survey. Consensus for conservative management was found in idiopathic patients aged ≤ 3, whereas in 2010, some of these cases were selected for surgery. There is currently consensus for casting idiopathic patients aged 1 or 2 with moderate curves, whereas in 2010, there was uncertainty between casting and bracing. Among neuromuscular cases with consensus for surgery, arthrodesis was chosen for patients aged 9 with larger curves.
Presently, preferences for conservative management have increased in comparison to 2010, and casting appears to be preferred over bracing in select infantile cases. Future research efforts with higher levels-of-evidence should be devoted to elucidate the areas of uncertainty to improve care in the EOS population.
Level V.
2010 年评估了早发性脊柱侧凸（EOS）治疗中的共识和不确定性。目前尚不清楚过去十年中治疗偏好是如何演变的。本研究的目的是重新评估 EOS 患者治疗选择的共识和不确定性，以了解它们与 10 年前相比有何不同。
邀请 11 名儿科脊柱外科医生（与 2010 年相同的参与者）完成了一项针对 315 例特发性和神经肌肉性 EOS 病例（与 2010 年相同的病例）的调查。治疗选择包括以下几种：保守治疗、牵引法、生长引导/调节和融合术。共识定义为≥70%的一致性，不确定性<70%。通过卡方检验和多元回归分析评估病例特征与治疗共识之间的关系。描述与治疗不确定性相关的病例特征。
在最初的 2010 队列中，有 11 名外科医生[31.7±7.8 年的经验]完成了调查。对于年龄≤3 岁的特发性患者，保守治疗的共识得以达成，而在 2010 年，这些病例中的一些选择了手术治疗。目前对于年龄为 1 或 2 岁、中度曲线的特发性患者，使用石膏固定有共识，但在 2010 年，对于石膏固定和支具固定之间存在不确定性。在具有手术共识的神经肌肉性病例中，对于年龄为 9 岁、曲线较大的患者，选择融合术。
与 2010 年相比，目前对保守治疗的偏好有所增加，并且在选择婴儿病例时，石膏固定似乎优于支具固定。未来应投入更高水平证据的研究工作，以阐明不确定性领域，改善 EOS 人群的治疗效果。
V 级。
