Adölesan İdiyopatik Skolyozlu Hastaların Yaşamlarını Daha Çok Etkileyen Nedir: Korse mi, Ameliyat mı?

Öz

Giriş: Skolyoz, omurganın lateral eğriliği ve rotasyonu ile karakterize bir deformitedir. Skolyoz tedavi yöntemleri gözlem, egzersiz ve cerrahi tedaviyi içerir. Bu çalışma, skolyozlu bireylerde destek ve cerrahinin posterior spinal enstrümantasyon ve posterior füzyon (PSIPF) ile birlikte ağrı, günlük yaşam aktiviteleri ve depresyon üzerindeki etkilerini karşılaştırmayı amaçlamaktadır. Yöntemler: Bu prospektif olarak planlanan çalışmada, Ocak 2023 ile Aralık 2024 arasında kliniğimizde düzenli olarak takip edilen ve ergenlik dönemi idiyopatik skolyoz (AIS) tanısı almış 184 skolyoz hastası arasından kriterleri karşılayan 105 hasta dahil edildi. Dahil etme kriterlerini karşılayan hastalar Koese ve Cerrahi Grubu olarak iki gruba ayrıldı. Her iki gruba da aynı araştırmacılar tarafından Görsel Analog Skala (VAS), Beck Depresyon Ölçeği (BDS) ve Skolyoz Araştırma Derneği 22 (SRS-22) anketi uygulandı ve veriler istatistiksel olarak karşılaştırıldı. p<0.05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Katılımcıların tanımlayıcı özellikleri açısından iki grup arasında anlamlı bir fark yoktu (p˃0,05). VAS ve BDS verileri, Cerrahi Grubunda Brace Grubuna kıyasla anlamlı şekilde azalmış idi (p<0,05). SRS-22'nin alt parametreleri arasında fonksiyon, ağrı ve memnuniyet verileri cerrahi grubunda brace grubuna kıyasla anlamlı şekilde iyileşmiş idi (p<0,05). Sonuç: Skolyoz tedavisinde PSIPF yöntemi ile cerrahi tedavi, brace tedavisine kıyasla fiziksel ve psikolojik iyileşmede daha etkili görünmektedir.

Anahtar Kelimeler

• Adölesan İdiyopatik Skolyoz
• Posterior Spinal Enstrümantasyon
• Korse
• SRS-22
• Beck Depresyon Ölçeği

What Affects the Lives of Patients with Adolescent Idiopathic Scoliosis More, Brace or Surgery?

Abstract

Aim: Scoliosis is a deformity characterized by lateral curvature and rotation of the spine. Scoliosis treatment modalities include observation, exercise, bracing, and surgery. This study aimed to compare the effects of bracing and surgery with posterior spinal instrumentation and posterior fusion (PSIPF) on pain, activities of daily living, and depression in individuals with scoliosis. Material and Method: In this prospectively planned study, 105 patients who met the criteria were included among 184 scoliosis patients who were diagnosed with adolescent idiopathic scoliosis (AIS) and followed up regularly in our clinic between January 2023 and December 2024. The patients who met the inclusion criteria were randomly divided into two groups Brace and Surgery Group. Visual Analog Scale (VAS), Beck Depression Scale (BDS), and Scoliosis Research Society 22 (SRS-22) questionnaire were administered to both groups by the same researchers and the data were compared statistically. A p-value <0.05 was considered statistically significant. Results: There was no significant difference between the two groups in terms of descriptive characteristics of the participants (p>0.05). VAS and BDS data were significantly decreased in the Surgery Group compared to the Brace Group (p<0.05). Among the sub-parameters of SRS-22, function, pain, and satisfaction data were significantly improved in the surgery group compared to the brace group (p<0.05). Conclusion: In the treatment of scoliosis, surgical treatment with the PSIPF method seems to be more effective in physical and psychological recovery compared to brace treatment.

Keywords

• Adolescent idiopathic scoliosis
• instrumentation
• braces
• spine
• deformity

Kaynakça

1. Cheng JC, Castelein RM, Chu WC, et al. Adolescent idiopathic scoliosis. Nat Rev Dis Primers. 2015;1:15030.
2. Maruyama T, Kitagawa T, Takeshita K, et al. Conservative treatment for adolescent idiopathic scoliosis: can it reduce the incidence of surgical treatment?. Pediatr Rehabil. 2003;6:215-9.
3. SOSORT guideline committee; Weiss HR, Negrini S, Rigo M, et al. Indications for conservative management of scoliosis (guidelines). Scoliosis. 2006;1:5.
4. Mohamed M, Jayesh T, Neil D, Sudarshan M. Adolescent idiopathic scoliosis: a review of current concepts. Orthopaedics and Trauma. 2020;34:338-45.
5. Addai D, Zarkos J, Bowey AJ. Current concepts in the diagnosis and management of adolescent idiopathic scoliosis. Childs Nerv Syst. 2020;36:1111-9.
6. Weinstein SL, Dolan LA, Cheng JC, et al. Adolescent idiopathic scoliosis. Lancet. 2008;371:1527-37.
7. Hoernschemeyer DG, Boeyer ME, Robertson ME, et al. Anterior vertebral body tethering for adolescent scoliosis with growth remaining: a retrospective review of 2 to 5-year postoperative results. J Bone Joint Surg Am. 2020;102:1169-76.
8. Jada A, Mackel CE, Hwang SW, et al. Evaluation and management of adolescent idiopathic scoliosis: a review. Neurosurg Focus. 2017;43:E2.

9. Richards BS, Bernstein RM, D'Amato CR, Thompson GH. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine (Phila Pa 1976). 2005;30:2068-77.
10. Negrini S, Donzelli S, Jurenaite G, et al. Efficacy of bracing in early infantile scoliosis: a 5-year prospective cohort shows that idiopathic respond better than secondary-2021 SOSORT award winner. Eur Spine J. 2021;30:3498-508.
11. Delgado DA, Lambert BS, Boutris N, et al. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2:e088.
12. Bock K, Bendstrup E, Hilberg O, Løkke A. Screening tools for evaluation of depression in chronic obstructive pulmonary disease (COPD). A systematic review. Eur Clin Respir J. 2017;4:1332931.
13. Alanay A, Cil A, Berk H, et al. Reliability and validity of adapted Turkish Version of Scoliosis Research Society-22 (SRS-22) questionnaire. Spine (Phila Pa 1976). 2005;30:2464-8.
14. Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3.
15. Cheung JPY, Cheung PWH. Supine flexibility predicts curve progression for patients with adolescent idiopathic scoliosis undergoing underarm bracing. Bone Joint J. 2020;102-B:254-60.
16. Parent S, Newton PO, Wenger DR. Adolescent idiopathic scoliosis: etiology, anatomy, natural history, and bracing. Instr Course Lect. 2005;54:529-36.
17. Negrini S, Atanasio S, Zaina F, et al. End-growth results of bracing and exercises for adolescent idiopathic scoliosis. Prospective worst-case analysis. Stud Health Technol Inform. 2008;135:395-408.
18. Upasani VV, Caltoum C, Petcharaporn M, et al. Adolescent idiopathic scoliosis patients report increased pain at five years compared with two years after surgical treatment. Spine (Phila Pa 1976). 2008;33:1107-12.
19. Helenius L, Diarbakerli E, Grauers A, et al. Back pain and quality of life after surgical treatment for adolescent idiopathic scoliosis at 5-year follow-up: comparison with healthy controls and patients with untreated idiopathic scoliosis. J Bone Joint Surg Am. 2019;101:1460-6. Erratum in: J Bone Joint Surg Am. 2021;103:e13.
20. Djurasovic M, Glassman SD, Sucato DJ, et al. Improvement in Scoliosis Research Society-22R pain scores after surgery for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2018;43:127-32.
21. Newton PO, Ohashi M, Bastrom TP, et al. Prospective 10-year follow-up assessment of spinal fusions for thoracic AIS: radiographic and clinical outcomes. Spine Deform. 2020;8:57-66.
22. Mariconda M, Andolfi C, Cerbasi S, Servodidio V. Effect of surgical correction of adolescent idiopathic scoliosis on the quality of life: a prospective study with a minimum 5-year follow-up. Eur Spine J. 2016;25:3331-40.
23. Duramaz A, Yılmaz S, Ziroğlu N, et al. The effect of deformity correction on psychiatric condition of the adolescent with adolescent idiopathic scoliosis. Eur Spine J. 2018;27:2233-40.
24. Bunge EM, Juttmann RE, de Kleuver M, et al.; NESCIO group. Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment. Eur Spine J. 2007;16:83-9.
25. Wang L, Wang YP, Yu B, et al. Relation between self-image score of SRS-22 with deformity measures in female adolescent idiopathic scoliosis patients. Orthop Traumatol Surg Res. 2014;100:797-801.
26. Asher M, Min Lai S, Burton D, Manna B. The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis. Spine (Phila Pa 1976). 2003;28:63-9.
27. Carreon LY, Sanders JO, Diab M, et al. The minimum clinically important difference in scoliosis research Society-22 appearance, activity, and pain domains after surgical correction of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2010;35:2079-83.
28. Andersen MØ, Thomsen K, Kyvik KO. Perceived health status in self-reported adolescent idiopathic scoliosis: a survey based on a population of twins. Spine (Phila Pa 1976). 2010;35:1571-4.
29. Tones M, Moss N, Polly DW Jr. A review of quality of life and psychosocial issues in scoliosis. Spine (Phila Pa 1976). 2006;31:3027-38.
30. Danielsson AJ. What impact does spinal deformity correction for adolescent idiopathic scoliosis make on quality of life? Spine (Phila Pa 1976). 2007;32:S101-8.
31. Mens RH, Bisseling P, de Kleuver M, van Hooff ML. Relevant impact of surgery on quality of life for adolescent idiopathic scoliosis: a registry-based two-year follow-up cohort study. Bone Joint J. 2022;104-B:265-73.