Abstract
Purpose: The wait for surgical treatment of scoliosis is long in some countries, especially in those with publicly funded health care systems. Long wait times may have serious consequences if the deformity increases during the wait period. This study was undertaken to determine the surgeon’s perspective of the type and magnitude of surgery required with specific emphasis on peri – and post-operative measures, for patients with scoliosis on prolonged waitlist times (> 6 months) for surgery.
Method: Radiographs from 11 patients who had a Cobb angle of at least 50 degrees and had waited 6 or more months for scoliosis surgery selected from the scoliosis database. All patients had antero-posterior (AP), AP bending, and lateral radiographs taken when the primary curve magnitude was 50 degrees and at the time of pre-operative planning. 22 radiographic sets and a questionnaire were sent to three different surgeons. The surgeons were blinded to the fact that these sets contained films of the same patients at two different time points. The questionnaire requested information with regard to the type of surgery and instrumentation they would use, other peri-operative measures, and time taken to return to normal activities.
Results: The mean curve progression in the 11 patients was 25 degrees over the time on the waitlist, from an average of 50 degrees to 75 degrees. The type of surgery the surgeon would likely perform changed from posterior instrumentation and fusion with a screw construct in all patients to anterior release and posterior instrumentation and fusion with a screw construct in 8 of the 11 patients, in at least one surgeon’s opinion. The mean estimated operative time increased by 2 hours. The mean estimated length of stay at the hospital increased by 1 day, and the estimated level of difficulty of surgery increased from 3/10 to 5/10.
Conclusion: From a surgeon’s perspective, waits of 6 months or more for scoliosis surgery are unacceptable as they lead to the need for a second anterior procedure that probably would have not been necessary had the operation occurred earlier. It also leads to increased operative time, blood loss, length of stay, and difficulty of surgery. This, in turn, increases unwarranted risks and costs.
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