METAANALYSIS OF SURGICAL OUTCOME IN ADOLESCENT IDIOPATHIC SCOLIOSIS -A 35-YEAR ENGLISH LITERATURE-REVIEW OF 11,000 PATIENTS

Study Design. Meta-analysis of the English literature on the surgical treatment of adolescent idiopathic scoliosis. Objective. To gather com parable data from a number of different sources and combine the data t o Create a larger, more statistically significant pool of information for the analysis of surgical outcome. Summary of Background Data. Meta -analysis is a technique of scientific literature review used in outco me evaluation of medical treatment. This technique has been applied to the surgical outcome of adolescent idiopathic scoliosis. Methods. A s tructured literature review was performed that cross-referenced Englis h literature articles pertaining to the surgical treatment of adolesce nt idiopathic scoliosis with a focus on patient-based outcomes. Measur es of patient satisfaction were compared with process measures of care . Results. A number of patients (10,989) were reviewed in 139 patient populations. Unspecified curve types (9424) and King curve types (1565 ) were reviewed over a 35-year period from 1958 to 1993. Of the patien ts, 87.32% were studied retrospectively and 12.70% prospectively. Effe ct-weighted follow-up was 6.8 years. Only studies with complete proces s and patient data for unspecified or King curve types were included f or satisfaction correlation calculations. Pearson product moment corre lation for n = 33 studies, n' = 2926 patients revealed a positive r' = 0.628 correlation between degree of curve correction and percent sati sfaction per study. To determine the degree of curvature correction : resulting in patient satisfaction, a stepwise multiple linear regressi on analysis was performed with level of : confidence (P less than or e qual to 0.05). Of significance was that the degree of curvature correc ted accounted for all the satisfaction variance predicted. A significa nt correlation exists between degree of curve correction and percent o f patients satisfied. The percent of correction and the Group type (ei ther unspecified or King classified), did not significantly alter this prediction. The best predictor of satisfaction appears to be degree o f curve correction according to these data. Conclusion. Patients appea r to be more satisfied by the magnitude of curve correction rather tha n the percent of curve correction. The degree of curvature before surg ery did not predict patient satisfaction. Pearsons r' = 0.045. Satisfa ction appears to be best predicted by the degree of correction only an d not by the percent curve correction, the curve magnitude before surg ery, nor the Group type (King, unspecified). Patient satisfaction is s ubjective. It does not reflect the benefits of surgery with respect to the future preservation of pulmonary function in thoracic curves nor the prevention of osteoarthritis in lumbar, curves.