caa a22 4500 445832177 CHVBK 20180317145318.0 cr unu---uuuuu 170323e20110701xx s 000 0 eng 10.1007/s00586-011-1808-4 doi (NATIONALLICENCE)springer-10.1007/s00586-011-1808-4 Right adolescent idiopathic thoracic curve (Lenke 1 A and B): does cost of instrumentation and implant density improve radiographic and cosmetic parameters? [Elektronische Daten] [Scott Yang, Sean Jones-Quaidoo, Matthew Eager, Justin Griffin, Vasantha Reddi, Wendy Novicoff, Jeffrey Shilt, Ernesto Bersusky, Helton Defino, Jean Ouellet, Vincent Arlet] In adolescent idiopathic scoliosis (AIS) there has been a shift towards increasing the number of implants and pedicle screws, which has not been proven to improve cosmetic correction. To evaluate if increasing cost of instrumentation correlates with cosmetic correction using clinical photographs. 58 Lenke 1A and B cases from a multicenter AIS database with at least 3months follow-up of clinical photographs were used for analysis. Cosmetic parameters on PA and forward bending photographs included angular measurements of trunk shift, shoulder balance, rib hump, and ratio measurements of waist line asymmetry. Pre-op and follow-up X-rays were measured for coronal and sagittal deformity parameters. Cost density was calculated by dividing the total cost of instrumentation by the number of vertebrae being fused. Linear regression and spearman's correlation were used to correlate cost density to X-ray and photo outcomes. Three independent observers verified radiographic and cosmetic parameters for inter/interobserver variability analysis. Average pre-op Cobb angle and instrumented correction were 54° (SD 12.5) and 59% (SD 25) respectively. The average number of vertebrae fused was 10 (SD 1.9). The total cost of spinal instrumentation ranged from $6,769 to $21,274 (Mean $12,662, SD $3,858). There was a weak positive and statistically significant correlation between Cobb angle correction and cost density (r=0.33, p=0.01), and no correlation between Cobb angle correction of the uninstrumented lumbar spine and cost density (r=0.15, p=0.26). There was no significant correlation between all sagittal X-ray measurements or any of the photo parameters and cost density. There was good to excellent inter/intraobserver variability of all photographic parameters based on the intraclass correlation coefficient (ICC 0.74-0.98). Our method used to measure cosmesis had good to excellent inter/intraobserver variability, and may be an effective tool to objectively assess cosmesis from photographs. Since increasing cost density only improves mildly the Cobb angle correction of the main thoracic curve and not the correction of the uninstrumented spine or any of the cosmetic parameters, one should consider the cost of increasing implant density in Lenke 1A and B curves. In the area of rationalization of health care expenses, this study demonstrates that increasing the number of implants does not improve any relevant cosmetic or radiographic outcomes. Springer-Verlag, 2011 Spine nationallicence Scoliosis nationallicence Cosmetics nationallicence Instrumentation nationallicence Yang Scott Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut Jones-Quaidoo Sean Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut Eager Matthew Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut Griffin Justin Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut Reddi Vasantha Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut Novicoff Wendy Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut Shilt Jeffrey St. Alphonsus Regional Medical Center, Boise, ID, USA aut Bersusky Ernesto Garrahan Paediatric Hospital, Buenos Aires, Argentina aut Defino Helton University of Sao Paulo, Sau Paulo, Brazil aut Ouellet Jean McGill University, Montreal, QC, Canada aut Arlet Vincent Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut European Spine Journal Springer-Verlag 20/7(2011-07-01), 1039-1047 0940-6719 20:7<1039 2011 20 586 https://doi.org/10.1007/s00586-011-1808-4 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00586-011-1808-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Yang Scott Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Jones-Quaidoo Sean Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Eager Matthew Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Griffin Justin Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Reddi Vasantha Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Novicoff Wendy Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Shilt Jeffrey St. Alphonsus Regional Medical Center, Boise, ID, USA aut NATIONALLICENCE 700 1- Bersusky Ernesto Garrahan Paediatric Hospital, Buenos Aires, Argentina aut NATIONALLICENCE 700 1- Defino Helton University of Sao Paulo, Sau Paulo, Brazil aut NATIONALLICENCE 700 1- Ouellet Jean McGill University, Montreal, QC, Canada aut NATIONALLICENCE 700 1- Arlet Vincent Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, 22903, Charlottesville, VA, USA aut NATIONALLICENCE 773 0- European Spine Journal Springer-Verlag 20/7(2011-07-01), 1039-1047 0940-6719 20:7<1039 2011 20 586 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer