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Arthroplasty, Replacement↗
Biomedical subjects
Larry Lenke
Publications and source records attributed to Larry Lenke.
Use of video-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery.
STUDY DESIGN: A case series of idiopathic scoliosis patients treated with thoracoscopic anterior instrumentation was compared to a similar group of patients treated by open anterior instrumentation. OBJECTIVES: To evaluate the morbidity associated with thoracoscopic instrumentation compared to the open approach for thoracic scoliosis. METHODS: A consecutive group of thoracoscopically treated patients with Lenke 1 adolescent idiopathic scoliosis was compared to similar patients gathered from the DePuy-AcroMed Harms Study Group database. Perioperative outcome measures as well as early postoperative functional outcomes (pulmonary function, shoulder strength) were compared. RESULTS: There were 38 thoracoscopic instrumentation cases with greater than 6 months' follow-up that were compared to 68 anterior open instrumentation cases. The radiographic outcomes were similar (60% +/- 11% vs. 59% +/- 17% thoracic curve correction for the thoracoscopic and open groups, respectively). The reduction in forced vital capacity was significantly (P = 0.01) greater in the open group (0.6 +/- 0.3 L) compared to the endoscopic group (0.4 +/- 0.3 L). There was a trend towards greater return of shoulder girdle strength and range of motion 6 weeks after surgery in the thoracoscopic patients. CONCLUSION: The thoracoscopic approach for instrumentation of scoliosis has advantages of reduced chest wall morbidity compared with the open thoracotomy method but allows comparable curve correction.
Adolescent↗
A multicenter study analyzing the relationship of a standardized radiographic scoring system of adolescent idiopathic scoliosis and the Scoliosis Research Society outcomes instrument.
STUDY DESIGN: A multicenter study examining the association between radiographic and outcomes measures in adolescent idiopathic scoliosis. OBJECTIVES: To evaluate the association between an objective radiographic scoring system and patient quality of life measures as determined by the Scoliosis Research Society outcomes instrument. SUMMARY OF BACKGROUND DATA: Although surgical correction of scoliosis has been reported to be positively correlated with patient outcomes, studies to date have been unable to demonstrate an association between radiographic measures of deformity and outcomes measures in patients with adolescent idiopathic scoliosis. METHODS: A standardized radiographic deformity scoring system and the Scoliosis Research Society outcome tool were used prospectively in seven scoliosis centers to collect data on patients with adolescent idiopathic scoliosis. A total of 354 data points for 265 patients consisting of those with nonoperative or preoperative curves >or=10 degrees, as well as those with surgically treated curves, were analyzed. Correlation analysis was performed to identify significant relationships between any of the radiographic measures, the Harms Study Group radiographic deformity scores (total, sagittal, coronal), and the seven Scoliosis Research Society outcome domains (Total Pain, General Self-Image, General Function, Activity, Postoperative Self-Image, Postoperative Function, and Satisfaction) as well as Scoliosis Research Society outcomes instrument total scores. Radiographic measures that were identified as significantly correlated with Scoliosis Research Society outcome scores were then entered into a stepwise regression analysis. RESULTS: The coronal measures of thoracic curve and lumbar curve magnitude were found to be significantly correlated with the Total Pain, General Self-Image, and total Scoliosis Research Society scores (P < 0.0001). The thoracic and upper thoracic curve magnitudes were also correlated with General Function (P < 0.002). The "coronal" subscore as well as the "total" score of the Harms Study Group radiographic scoring system were also significantly correlated with these Scoliosis Research Society domain and total scores. No radiographic measures taken after surgery were significantly correlated with the postoperative domains of the Scoliosis Research Society outcomes instrument. Stepwise regression analysis of these radiographic measures as predictors of Scoliosis Research Society scores resulted in adjusted R2 values of 0.03-0.07 (P < 0.0001). Although these results show that a significant association exists between the radiographic Cobb angle measure of the scoliosis and the Scoliosis Research Society outcomes scores, the low R2 values indicate that variables other than the radiographic appearance of the deformity (e.g., psychosocial, functional) must also be affecting these scores. CONCLUSION: The Cobb angle measure of the major deformity has a small, but statistically significant, correlation with the reported Total Pain, General Self-Image, and General Function as measured by the Scoliosis Research Society outcomes instrument. None of the radiographic measures in this population correlated with postoperative domain scores of the Scoliosis Research Society outcomes tool.
Adolescent↗