title: Variability of expert opinion in treatment of early-onset scoliosis.
abstract: BACKGROUND
  In contrast with treatment recommendations for adolescent idiopathic scoliosis, there are no clear algorithms for treating patients with early-onset scoliosis. There has been rapid expansion of treatment options for children with early-onset scoliosis, including casting, growth rods, the vertical expandable prosthetic titanium rib, and anterior vertebral stapling.
  
  
  OBJECTIVE
  Given the range of treatment options, we assessed variability in decision making regarding treatment of patients with early-onset scoliosis.
  
  
  METHODS
  We presented 12 clinical and radiographic vignettes about patients with early-onset scoliosis to 13 experienced spine surgeons who are members of the Chest Wall and Spine Deformity Study Group. The reviewers were asked to choose type of treatment, type of construct, construct location, and whether a thoracotomy should be performed.
  
  
  RESULTS
  All 13 surgeons agreed regarding the need for surgery in eight of the 12 cases. When the reviewers chose surgery, 76% (40%-100%) selected the vertical expandable prosthetic titanium rib; of those selecting that approach, 61% (0%-100%) coincided on using it bilaterally. Agreement was 20% (0%-60%) for growing rods and 4% (0%-25%) for fusions. Among all cases, agreement regarding whether instrumentation should extend to the pelvis was 71% (50%-100%). In all but two cases, at least 85% of surgeons recommended against a thoracotomy.
  
  
  CONCLUSIONS
  Although most surgeons agreed about the indication for surgery, we found wide variability in choice of construct type, number of constructs, and level of instrumentation.
authors.affiliation: Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway 800 North, New York, NY 10032, USA. mgv1@columbia.edu
authors.forename: Michael G
authors.initials: MG
authors.lastname: Vitale
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Gomez
authors.forename: Hiroko
authors.initials: H
authors.lastname: Matsumoto
authors.forename: David P
authors.initials: DP
authors.lastname: Roye
mesh_terms: D017668:Age of Onset; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D015588:Observer Variation; D019637:Orthopedic Procedures / Q000295:instrumentation; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D012720:Severity of Illness Index; D013131:Spine / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D013908:Thoracotomy; D016896:Treatment Outcome
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