title: Optimal surgical care for adolescent idiopathic scoliosis: an international consensus.
abstract: OBJECTIVE
  The surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for adolescents with AIS curves between 40° and 90° Cobb angle.
  
  
  METHODS
  From July 2012 to April 2013, the AOSpine Knowledge Forum Deformity performed a modified Delphi survey where current expert opinion from 48 experienced deformity surgeons, representing 29 diverse countries, was gathered. Four rounds were performed: three web-based surveys and a final face-to-face meeting. Consensus was achieved with ≥ 70% agreement. Data were analyzed qualitatively and quantitatively.
  
  
  RESULTS
  Consensus of what constitutes optimal care was reached on greater than 60 aspects including: preoperative radiographs; posterior as opposed to anterior (endoscopic) surgical approaches; use of intraoperative spinal cord monitoring; use of local autologous bone (not iliac crest) for grafts; use of thoracic and lumbar pedicle screws; use of titanium anchor points; implant density of <80% for 40°-70° curves; and aspects of postoperative care. Variability in practice patterns was found where there was no consensus. In addition, there was consensus on what does not constitute optimal care, including: routine pre- and intraoperative traction; routine anterior release; use of bone morphogenetic proteins; and routine postoperative CT scanning.
  
  
  CONCLUSIONS
  International consensus was found on many aspects of what does and does not constitute optimal operative care for adolescents with AIS. In the absence of current high-level evidence, at present, these expert opinion findings will aid health care providers worldwide define appropriate care in their regions. Areas with no consensus provide excellent insight and priorities for future research.
authors: Department of Orthopaedic Surgery, VU University Medicine Center, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands, m.dekleuver@vumc.nl.
authors: Marinus
authors: M
authors: de Kleuver
authors: Stephen J
authors: SJ
authors: Lewis
authors: Niccole M
authors: NM
authors: Germscheid
authors: Steven J
authors: SJ
authors: Kamper
authors: Ahmet
authors: A
authors: Alanay
authors: Sigurd H
authors: SH
authors: Berven
authors: Kenneth M
authors: KM
authors: Cheung
authors: Manabu
authors: M
authors: Ito
authors: Lawrence G
authors: LG
authors: Lenke
authors: David W
authors: DW
authors: Polly
authors: Yong
authors: Y
authors: Qiu
authors: Maurits
authors: M
authors: van Tulder
authors: Christopher
authors: C
authors: Shaffrey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D003697:Delphi Technique; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D065289:Pedicle Screws; D011182:Postoperative Care; D011300:Preoperative Care; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D013530:Surgical Wound Infection / Q000517:prevention & control