PMID- 34822135 OWN - NLM STAT- MEDLINE DCOM- 20220421 LR - 20220518 IS - 2212-1358 (Electronic) IS - 2212-134X (Linking) VI - 10 IP - 3 DP - 2022 May TI - Distal adding-on in adolescent idiopathic scoliosis results in diminished health-related quality of life at 10 years following posterior spinal fusion. PG - 515-526 LID - 10.1007/s43390-021-00432-1 [doi] AB - PURPOSE: The purpose of this study was to investigate associations between the various definitions of adding-on identified in the literature and HRQoL at 10 years following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) to identify a clinically relevant definition. METHODS: In this retrospective cohort study, patients with Lenke type 1 or 2 AIS with 10-year follow-up after PSF were identified in a multicenter registry. Adding-on was identified independently using 5 published definitions and expert spine surgeons' visual confirmation. Worsening of HRQoL was defined as a preoperative to 10-year postoperative decrease in SRS-22 domain score >/= the minimal clinically important difference (MCID). RESULTS: One hundred fifty patients were included, and 118 had HRQoL data available for the main analysis. Worsening pain was noted in 49 (41.5%) patients, appearance in 1 (0.8%), and activity in 70 (59.3%) from preoperative to postoperative. 4 of the 5 definitions of adding-on demonstrated no evidence of association with worsening HRQoL. By Cho's definition (either 1. >/= 5 degrees increase in Cobb angle AND increase in number of vertebrae in curve distally, or 2. >/= 5 degrees increase in angulation of 1st disc below LIV), adding-on (27 patients, 22.9%) was associated with an increased risk of worsening pain (59.3% vs. 36.3%, p = 0.033) and activity (77.8% vs. 53.8%, p = 0.026). There was no evidence of association with changes in appearance. Risk of worsening pain and activity was increased by 1.75 and 1.51 times (p = 0.023 and p = 0.002), respectively. CONCLUSION: Cho's definition of adding-on was associated with worsening HRQoL at 10 years following PSF for Lenke type 1 and 2 AIS. Consistent use of this definition will allow us to compare studies and obtain meaningful information in this population. LEVEL OF EVIDENCE: Level II. CI - (c) 2021. The Author(s), under exclusive licence to Scoliosis Research Society. FAU - Roye, Benjamin D AU - Roye BD AD - Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA. bdr5@cumc.columbia.edu. AD - Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA. bdr5@cumc.columbia.edu. FAU - Matsumoto, Hiroko AU - Matsumoto H AD - Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA. AD - Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. FAU - Fano, Adam N AU - Fano AN AD - Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA. FAU - Marciano, Gerard F AU - Marciano GF AD - Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA. FAU - Iyer, Rajiv R AU - Iyer RR AD - Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA. FAU - Boby, Afrain AU - Boby A AD - Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA. FAU - Bainton, Nicole AU - Bainton N AD - Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA. FAU - Lenke, Lawrence G AU - Lenke LG AD - Division of Spinal Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA. AD - The Daniel and Jane Och Spine Hospital at New York-Presbyterian/Allen, New York, NY, USA. FAU - Newton, Peter O AU - Newton PO AD - Department of Orthopedics, Rady Children's Hospital, San Diego, CA, USA. FAU - Vitale, Michael G AU - Vitale MG AD - Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA. AD - Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA. LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. DEP - 20211125 PL - England TA - Spine Deform JT - Spine deformity JID - 101603979 SB - IM MH - Adolescent MH - Humans MH - *Kyphosis MH - Pain MH - Quality of Life MH - Retrospective Studies MH - *Scoliosis/surgery MH - *Spinal Fusion/adverse effects/methods MH - Thoracic Vertebrae/surgery OTO - NOTNLM OT - Adding-on OT - Adolescent idiopathic scoliosis (AIS) OT - Health-related quality of life (HRQoL) OT - Posterior spinal fusion (PSF) EDAT- 2021/11/26 06:00 MHDA- 2022/04/22 06:00 CRDT- 2021/11/25 12:23 PHST- 2021/07/09 00:00 [received] PHST- 2021/10/16 00:00 [accepted] PHST- 2021/11/26 06:00 [pubmed] PHST- 2022/04/22 06:00 [medline] PHST- 2021/11/25 12:23 [entrez] AID - 10.1007/s43390-021-00432-1 [pii] AID - 10.1007/s43390-021-00432-1 [doi] PST - ppublish SO - Spine Deform. 2022 May;10(3):515-526. doi: 10.1007/s43390-021-00432-1. Epub 2021 Nov 25.