title: Psychosocial effects of repetitive surgeries in children with early-onset scoliosis: are we putting them at risk?
abstract: BACKGROUND
  The use of growing instrumentation in children with early-onset scoliosis (EOS) has created interest in determining if these repetitive procedures are prompting the development of lasting psychosocial problems. Given the increasing role of this treatment modality in the management of EOS, this study aimed to assess the psychological status of this patient population and to determine factors associated with worse scores in various psychosocial domains.
  
  
  METHODS
  A cross-sectional assessment of 34 EOS patients was performed utilizing 2 well-established, caregiver-completed psychiatric instruments: the Child Behavior Checklist (CBCL) and the Strength and Difficulties Questionnaire. Scores were calculated for 15 CBCL and 6 Strength and Difficulties Questionnaire domains and subdomains and grouped as "Normal" or "Abnormal" according to published normative values. The prevalence of abnormal scores was within each instrument subdomain and was compared with the national norms. Domain scores were also correlated with age at first scoliosis surgery, total number of operative procedures, and total number of growing instrumentation surgeries.
  
  
  RESULTS
  A higher prevalence of Abnormal scores were found in multiple psychosocial domains in our cohort as compared with national normative data. Children with Abnormal CBCL "Total Problems" domain scores were younger at the time of first scoliosis surgery (2.50 vs. 5.52 y). Normal and Abnormal scoring groups showed significant differences in the number of (1) total surgeries; (2) total scoliosis surgeries; and (3) growing instrumentation surgeries in multiple domains on both instruments. Aggression, Rule-breaking, and Conduct were positively correlated with total number of surgeries.
  
  
  CONCLUSIONS
  Our findings showed a higher prevalence of Abnormal psychosocial scores in multiple domains in multioperated EOS patients as compared with national norms. Our findings suggest that EOS patients with abnormal psychosocial scores were younger at the time of their initial scoliosis surgery. The number of repetitive surgeries also correlated positively with 3 behavioral problem scores. Although healthier scores were seen in 1 positive behavioral domain in more operated children suggesting the potential for "posttraumatic growth," the other findings of this study are concerning given the increasing use of this treatment modality and indicate a need for ongoing screening and mental health care in this high-risk population.
  
  
  METHODS
  Level III--case-control.
authors.affiliation: *Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Medical Center ∥Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center §Department of Psychiatry and New York State Psychiatric Institute, Columbia University Medical Center, New York, NY †Division of Orthopaedics, School of Medicine, Southern Illinois University, Springfield, IL ‡Center for Anxiety and Related Disorders, Boston University, Boston, MA.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Brendan A
authors.initials: BA
authors.lastname: Williams
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Corona
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Comer
authors.forename: Prudence W
authors.initials: PW
authors.lastname: Fisher
authors.forename: Yuval
authors.initials: Y
authors.lastname: Neria
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Roye
authors.forename: David P
authors.initials: DP
authors.lastname: Roye
authors.forename: Michael G
authors.initials: MG
authors.lastname: Vitale
mesh_terms: D000293:Adolescent; D001852:Bone Lengthening / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D012086:Reoperation / Q000523:psychology*; D012600:Scoliosis / Q000523:psychology* / Q000601:surgery*; D011795:Surveys and Questionnaires