Impact of the Suspension of Elective Surgeries for Adolescent Idiopathic Scoliosis during the COVID-19 Pandemic

Castanheira, Matheus Neves; Nardone, Giovanni Salvatore; Luciano, Rafael de Paiva; Leite, Márcio Squassoni

doi:10.1055/s-0042-1756318

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Revista Brasileira de Ortopedia

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Original Article • Rev Bras Ortop 58 (3) • May-Jun 2023 • https://doi.org/10.1055/s-0042-1756318 copy

Impact of the Suspension of Elective Surgeries for Adolescent Idiopathic Scoliosis during the COVID-19 Pandemic ^* * Study developed at the Orthopedics and Traumatology Service, Hospital Municipal Universitário de Taubaté, Taubaté, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives

This study evaluated the radiographic progressions of scoliotic curves higher than 40° in patients with adolescent idiopathic scoliosis (AIS). These subjects waited for the surgical procedure while elective surgeries were on hold during the COVID-19 pandemic. Inadditiontoradiographicprogressions, this studydescribed the quality of life of these patients.

Methods

This study is a retrospective cohort assessing 29 AIS patients with surgical indications registered in the Brazilian public healthcare service. We compared the scoliotic radiographic measurements in two moments: at the beginning of the interruption of elective surgeries due to the COVID-19 pandemic and when these procedures resumed.

Results

When comparing the radiographic measurements before and after the suspension of assessments for elective surgeries, we observed a significant increase in main curve angles ( p < 0.001), with variations ranging from 0 to 68° and a median valueof10°.Insecondary curves, weobserved anincreaseinangles fromthe proximal thoracic ( p < 0.001) and lumbar ( p = 0.001) regions. However, the increase in the main thoracic region was not significant ( p = 0.317).

Conclusion

The suspension of elective surgeries for AIS resulted in a significant increase in the radiographic values of patients' spine deformities. This increase harmed the quality of life of these subjects and their families.

adolescent; scoliosis; elective surgical procedures; unified health system

Gender
Female	25 (86.2%)
Male	4 (13.8%)
Age (years old)
Mean (SD)	15.8 (2.8)
Median (Q1; Q3)	15.0 (14.0; 17.0)
Minimum and maximum values	11.0; 23.0
Age at menarche (years old) (n = 25)
Mean (SD)	12.2 (1.3)
Median (Q1; Q3)	12.0 (11.0; 13.0)
Minimum and maximum values	10.0; 15.0
Family member with AIS
No	23 (79.3%)
Yes	6 (20.7%)
Time between evaluations (months)
Mean (SD)	23.6 (7.1)
Median (Q1; Q3)	22.0 (18.0; 25.0)
Minimum and maximum values	15.0; 39.0

Previous Risser index
0	4 (13.8%)
3	6 (20.7%)
4	7 (24.1%)
5	12 (41.4%)
Current Risser index
3	2 (6.9%)
4	6 (20.7%)
5	21 (72.4%)
Curve type/Main curve
Thoracic (Apex = T2-T11/T12 disc)	24 (82.8%)
Thoracolumbar (Apex = T12-L1)	2 (6.9%)
Lumbar (Apex = L1-L2 disc-L4)	3 (10.3%)
Lenke classification
Main thoracic	9 (31.0%)
Double thoracic	5 (17.2%)
Main double	11 (37.9%)
Triple curve	1 (3.4%)
Lumbar curve with rigid main thoracic curve	3 (10.3%)
Lumbar modifier
Type A	7 (24.1%)
Type B	7 (24.1%)
Type C	15 (51.7%)
Sagittal modifier
Negative	1 (3.4%)
Neutral	25 (86.2%)
Positive	3 (10.3%)
Treatment
No	24 (82.8%)
Brace	3 (10.3%)
Brace (irregularly used)	2 (6.9%)

Angles	Time		Range	p value
	1 ^st evaluation	2 ^nd evaluation	(2 ^nd - 1 ^st evaluation)
Main curve
Mean (SD)	60.9 (12.8)	75.0 (18.8)	14.1 (16.4)	< 0.001
Median (Q1; Q3)	60.0 (52.0; 68.0)	75.0 (60.0; 87.0)	10.0 (2.0; 20.0)
Minimum and maximum values	40.0; 95.0	44.0; 126.0	0.0; 68.0
Proximal thoracic
Mean (SD)	25.5 (8.0)	29.6 (10.7)	4.0 (5.4)	< 0.001
Median (Q1; Q3)	28.0 (20.0; 30.0)	30.0 (23.0; 35.0)	3.0 (0.0; 5.0)
Minimum and maximum values	14.0; 41.0	14.0; 60.0	0.0; 20.0
Main thoracic (n = 4)
Mean (SD)	37.5 (12.6)	42.0 (19.7)	4.5 (9.0)	0.317
Median (Q1; Q3)	40.0 (30.0; 45.0)	40.0 (30.0; 54.0)	0.0 (0.0; 9.0)
Minimum and maximum values	20.0; 50.0	20.0; 68.0	0.0; 18.0
Lumbar (n = 25)
Mean (SD)	39.5 (16.3)	46.8 (17.2)	7.3 (9.9)	0.001
Median (Q1; Q3)	30.0 (28.0; 55.0)	45.0 (30.0; 60.0)	5.0 (0.0; 8.0)
Minimum and maximum values	20.0; 70.0	24.0; 75.0	0.0; 38.0

Awaiting list of scoliosis patients
Number	Gender	Age	Time between evaluations	Curve type/ Main curve	Lenke classifications	Difference in main curve angle	Difference in secondary curve angle	Current Risser index	Previous Risser index
1	F	15	3 years, 3 months	Left lumbar	6CN	T11-L3 = 20°	C7-T4 = 0/T4-T10 = 18°	5	3
2	F	21	1 year, 10 months	Right thoracic	1C-	T5-T11=0	T1-T5 = 0/T12-L4 = 0	5	5
3	F	16	1 year, 3 months	Right thoracic	1CN	T5-T12=0	C7-T5 = 0/ T12-L4 = 0	5	5
4	M	20	2 years	Right thoracic	3CN	T7-T12=10°	T2-T7 = 0/T12-L4 = 0	5	4
5	F	23	2 years, 11 months	Right thoracic	1CN	T6-T12=5°	T1-T5 = 0/T12-L4 = 0	5	5
6	F	13	2 years, 10 months	Right thoracic	4C+	T5-T12=68°	T1-T5 = 16° / L1-L5 = 38°	5	0
7	F	15	1 year, 6 months	Right thoracic	3CN	T5-T11= 10°	T1-T5 = 3° / T11-L4= 7°	4	4
8	F	21	2 years, 11 months	Left lumbar	6BN	T12-L4=2°	T2-T5 = 0/ T5-T12 = 0	5	5
9	F	15	2 years, 5 months	Right thoracic	1BN	T5-L1 = 8°	T2-T5 = 5° / L1-L5 = 5°	5	4
10	M	15	2 years, 1 month	Right thoracic	1BN	T5-T12=25°	T2-T5 = 3° / T12-L5 = 10°	4	0
11	F	15	1 year, 5 months	Right thoracic	3CN	T5-T11=23°	T2-T5 = 4°/T11-L4 = 16°	4	3
12	F	11	1 year, 10 months	Right thoracic	3A+	T4-T10=43°	T2-T4 = 8°/T10-L5 = 8°	4	3
13	M	17	1 year, 4 months	Right thoracic	2AN	T7-L2 = 12°	T2-T7 = 4°/ L2-L5 = 0	5	5
14	M	15	1 year, 9 months	Right thoracic	2BN	T5-T12=18°	T1-T5 = 11° / T12-L4 = 0	4	5
15	F	15	1 year, 5 months	Right thoracic	1BN	T9-L3=0	T4-T9 = 0/ L3-L5 = 0	5	4
16	F	17	1 year, 11 months	Right thoracic	3CN	T4-T11=7°	T1-T4 = 0/ T12-L5 = 0	5	5
17	F	14	2 years, 11 months	Right thoracic	2BN	T6-L2=48°	T2-T7 = 13° / L2-L5 = 24°	4	3
18	F	17	1 year, 10 months	Right thoracic	1AN	T6-L1 = 5°	T1-T7 = 0/ L1-L5: 5°	5	5
19	F	14	1 year, 6 months	Right thoracic	3CN	T6-T11: 1°	T1- T5 = 2°/T12-L4 =3°	5	4
20	F	13	1 year, 11 months	Right thoracic	1AN	T6-L1 = 12°	T1-T6 = 10°/T11-L4 = 6°	5	3
21	F	13	1 year, 4 months	Right thoracic	3CN	T3-T10=2°	C7-T3 = 0/T10-L4 = 0	5	4
22	F	13	2 years	Right thoracic	3AN	T4-T12 = 35°	C7-T4 = 7°/ T12-L5 = 28°	3	0
23	F	14	1 year, 6 months	Right thoracic	1AN	T6-T12 = 2°	T1-T6 = 3° / T1 2-L4 = 5°	5	5
24	F	17	1 year, 8 months	Right thoracic	2AN	T5-T12 = 11°	T2-T6 = 20° / L1-L5 = 8°	5	4
25	F	19	3 years, 1 month	Right thoracic	3BN	T5-T11= 10°	T1-T5 = 3°/T11-L4 = 0°	5	5
26	F	16	1 year, 7 months	Right thoracic	3CN	T4-T11=0	T1-T4 = 0/ T11-L4 = 4°	5	5
27	F	15	1 year ,7 months	Right thoracic	2CN	T10-L3=6°	T1-T6= 0/ T6-T10 = 0	5	5
28	F	13	1 year, 7 months	Right thoracic	3C+	T7-T12=20°	T1-T7= 5° / T1 2-L5 = 15°	3	0
29	F	15	1 year, 9 months	Left lumbar	6CN	T12-L3 = 5°	T1-T6= 0/ T6-T12 = 0	5	3

Function/activity
Mean (SD)	16.4 (4.5)
Median (Q1; Q3)	16.0 (14.0; 19.0)
Minimum and maximum values	8.0; 25.0
Pain
Mean (SD)	16.2 (5.2)
Median (Q1; Q3)	16.0 (11.0; 21.0)
Minimum and maximum values	8.0; 25.0
Self-image/appearance
Mean (SD)	11.1 (4.0)
Median (Q1; Q3)	9.0 (8.0; 14.0)
Minimum and maximum values	5.0; 21.0
Mental health
Mean (SD)	15.1 (4.5)
Median (Q1; Q3)	15.0 (12.0; 19.0)
Minimum and maximum values	6.0; 22.0
Subtotal
Mean (SD)	58.8 (15.1)
Median (Q1; Q3)	60.0 (46.0; 65.0)
Minimum and maximum values	28.0; 89.0
Treatment satisfaction
Mean (SD)	7.4 (1.6)
Median (Q1; Q3)	8.0 (6.0; 8.0)
Minimum and maximum values	4.0; 10.0
Total
Mean (SD)	66.2 (15.9)
Median (Q1; Q3)	68.0 (52.0; 73.0)
Minimum and maximum values	32.0; 97.0

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Matheus Neves Castanheira, Resident doctor of Serviço de Ortopedia e Traumatología do Hospital Municipal UniversitáriodeTaubaté, Rua AntônioWladimirdoPrado,N27, Quiririm, 12043-460, Taubaté, SP, Brazil (e-mail: neves_mp@hotmail.com).

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Impact of the Suspension of Elective Surgeries for Adolescent Idiopathic Scoliosis during the COVID-19 Pandemic * * Study developed at the Orthopedics and Traumatology Service, Hospital Municipal Universitário de Taubaté, Taubaté, SP, Brazil.

Abstract

Objectives

Methods

Results

Conclusion

Impact of the Suspension of Elective Surgeries for Adolescent Idiopathic Scoliosis during the COVID-19 Pandemic ^* * Study developed at the Orthopedics and Traumatology Service, Hospital Municipal Universitário de Taubaté, Taubaté, SP, Brazil.