PDF(Pubmed)
Abstract：
Background: The implications of delaying surgical intervention for patients with adolescent idiopathic scoliosis (AIS) wishing to undergo vertebral body tethering (VBT) have not yet been explored. It is important to understand how these delays can impact surgical planning and patient outcomes. Methods: This was a retrospective review that analyzed all AIS patients treated between 2015 and 2021 at a single tertiary center. Time to surgery from initial surgical consultation and ultimate surgical plan were assessed. Patient characteristics, potential risk factors associated with increased curve progression, and reasons for delay were also analyzed. Results: 174 patients were evaluated and 95 were scheduled for VBT. Four patients later required a change to posterior spinal fusion (PSF) due to excessive curve progression. Patients requiring PSF were shown to have significantly longer delays than those who received VBT. Additionally, longer delays, younger age, greater curve progression, and lower skeletal maturity were correlated with significant curve progression (≥5 degrees). Conclusions: Surgical delays for AIS patients awaiting VBT may lead to significant curve progression and necessitate more invasive procedures. Patients with longer delays experienced an increased risk of needing PSF instead of VBT. Of those requiring PSF, the majority were due to insurance denials. Optimizing surgical timing and shared decision-making among patients, families, and healthcare providers are essential for achieving the best outcomes.
摘要：
背景：对于希望接受椎体束缚（VBT）的青少年特发性脊柱侧凸（AIS）患者，延迟手术干预的意义尚未探讨。重要的是要了解这些延迟如何影响手术计划和患者结果。方法：这是一项回顾性研究，分析了2015年至2021年在单个三级中心接受治疗的所有AIS患者。评估从最初的手术咨询到手术的时间和最终的手术计划。患者特征,与曲线进展增加相关的潜在风险因素，并分析了延误的原因。结果：174例患者进行了评估，95例患者计划进行VBT。由于过度的曲线进展，四名患者后来需要改变后路脊柱融合术（PSF）。与接受VBT的患者相比，需要PSF的患者的延误时间明显更长。此外,更长的延迟，年龄较小,更大的曲线进展，较低的骨骼成熟度与显着的曲线进展（≥5度）相关。结论：等待VBT的AIS患者的手术延迟可能会导致明显的曲线进展，并需要更多的侵入性手术。延误时间较长的患者需要PSF而不是VBT的风险增加。在那些需要PSF的人中，大多数是由于保险否认。优化手术时机和患者之间的共同决策，家庭,和医疗保健提供者对于实现最佳结果至关重要。
