Authors:
Corona J, Miller DJ, Downs J, Akbarnia BA, Betz RR, Blakemore LC, et al.
Authors notes:
The Journal of Bone & Joint Surgery. 2013;95(10):e67 1-10
Keywords:
Scoliosis, early-onset scoliosis, treatment, clinical uncertainty
Abstract:
Literature guiding the management of early-onset scoliosis consists primarily of studies with a low level of evidence.
Evaluation of clinical equipoise (i.e., when there is no known superiority among treatment modalities) allows for prioritization of research efforts.
The objective of this study was to evaluate areas of clinical uncertainty among pediatric spine surgeons regarding the treatment of early-onset scoliosis.
Collective equipoise was identified in numerous scenarios in the survey spanning a range of ages and magnitudes of scoliosis, and additional questions were identified during the nominal group technique.
Areas that had the greatest clinical uncertainty included the management of patients who have finished treatment with a growing-rod, timing of rod-lengthening intervals, and indications for spine-based and rib-based proximal instrumentation anchors.
The use of rib anchors compared with spine-based anchors was ranked highly for consideration in future clinical trials.
Variability in decision making with regard to the optimum treatment of certain subsets of patients with early-onset scoliosis reflects gaps in the available evidence.
Structured consensus methods identified priorities for higher levels of research in this area of scoliosis.
Higher-level studies, including randomized trials, should focus on answering the questions highlighted in this report.