Abstract：
BACKGROUND: Since the outbreak of the COVID-19 pandemic, reduction of social activities and rapid adoption of telemedicine, decreasing face-to-face encounters seems to have negatively affected the timely Idiopathic Scoliosis (IS) referral with a spine specialist. We aim to document the progression of IS curves during COVID-19 pandemic reflected by the late presentation of patients at the initial visit with higher Cobb angles and to evaluate its influence on health-related quality of life scores.
METHODS: All IS patients scheduled for surgery between April 2019 and September 2021 were recruited in a prospective cohort study. The patients were divided into five cohorts of 6 month duration each according to their booking date: 2 periods before the 1st COVID-19 wave, one period during and two periods afterwards. In each cohort, patients were divided into 3: those who were scheduled for posterior spinal fusion (PSF) at 1st visit, those booked for vertebral body tethering (VBT) at 1st visit, and those scheduled for surgery but who have failed brace treatment. Variables included age, gender, Risser grade and preoperative SRS-22 scores. Chi2 and ANOVA tests were used for comparison.
RESULTS: 173 patients were analyzed. 33 patients (13.1 ± 3 y.o.) were scheduled between Apr and Sept 2019; 38 (13.1 y.o. ± 2) between Oct 2019 and Mar 2020; 31 (13.4 ± 3 y.o.) between Apr and Sept 2020; 30 (14.3 ± 2 y.o.) between Sept 2020 and Mar 2021; and 41 patients (13.8 ± 2 y.o.) between Apr and Sept 2021. Non-statistically significant differences were found between periods before, during or after the COVID-19 first wave regarding patients\' age, gender, Risser grade and SRS-22 scores. Average Cobb angles of patients at their 1st visit after the beginning of the COVID-19 pandemic were significantly higher than those before COVID-19 (52.2° ± 7° and 56.6° ± 13° vs 47.8° ± 12° and 45.2° ± 13°; p = 0.0001). More patients were booked for PSF (p < 0.0000) through the five evaluated periods, while the indication of VBT or surgery in patients previously braced progressively decreased.
CONCLUSIONS: Patients presented at the scoliosis clinic for the 1st time after the 1st COVID-19 wave with significantly larger Cobb angles, and likely contributed to an increased proportion of PSF, as the potential window for bracing or VBT was missed due to a delayed consultation.
METHODS: All IS patients scheduled for surgery between April 2019 and September 2021 were recruited in a prospective cohort study. The patients were divided into five cohorts of 6 month duration each according to their booking date: 2 periods before the 1st COVID-19 wave, one period during and two periods afterwards. In each cohort, patients were divided into 3: those who were scheduled for posterior spinal fusion (PSF) at 1st visit, those booked for vertebral body tethering (VBT) at 1st visit, and those scheduled for surgery but who have failed brace treatment. Variables included age, gender, Risser grade and preoperative SRS-22 scores. Chi2 and ANOVA tests were used for comparison.
RESULTS: 173 patients were analyzed. 33 patients (13.1 ± 3 y.o.) were scheduled between Apr and Sept 2019; 38 (13.1 y.o. ± 2) between Oct 2019 and Mar 2020; 31 (13.4 ± 3 y.o.) between Apr and Sept 2020; 30 (14.3 ± 2 y.o.) between Sept 2020 and Mar 2021; and 41 patients (13.8 ± 2 y.o.) between Apr and Sept 2021. Non-statistically significant differences were found between periods before, during or after the COVID-19 first wave regarding patients\' age, gender, Risser grade and SRS-22 scores. Average Cobb angles of patients at their 1st visit after the beginning of the COVID-19 pandemic were significantly higher than those before COVID-19 (52.2° ± 7° and 56.6° ± 13° vs 47.8° ± 12° and 45.2° ± 13°; p = 0.0001). More patients were booked for PSF (p < 0.0000) through the five evaluated periods, while the indication of VBT or surgery in patients previously braced progressively decreased.
CONCLUSIONS: Patients presented at the scoliosis clinic for the 1st time after the 1st COVID-19 wave with significantly larger Cobb angles, and likely contributed to an increased proportion of PSF, as the potential window for bracing or VBT was missed due to a delayed consultation.
摘要：
背景：自COVID-19大流行爆发以来，减少社交活动和快速采用远程医疗，减少面对面接触似乎对脊柱专科医生及时转诊的特发性脊柱侧凸(IS)产生了负面影响。我们的目标是记录COVID-19大流行期间IS曲线的进展，这反映在初次就诊时Cobb角较高的患者出现较晚，并评估其对健康相关生活质量评分的影响。
方法：所有计划于2019年4月至2021年9月进行手术的IS患者均纳入一项前瞻性队列研究。根据预约日期将患者分为五个队列，每个队列为期6个月：第一次COVID-19波之前的两个时期，期间和之后的两个时期。在每个队列中，患者分为3：在第一次就诊时计划进行后路脊柱融合术（PSF）的患者，那些在第一次访问时预订的椎体束缚（VBT），以及那些计划手术但支架治疗失败的人。变量包括年龄，性别,Riser分级和术前SRS-22评分。使用Chi2和ANOVA测试进行比较。
结果：对173例患者进行分析。计划在2019年4月至9月之间安排33例患者（13.1±3y.o.）；在2019年10月至2020年3月之间安排38例（13.1y.o.±2）；在2020年4月至2020年9月之间安排31例（13.4±3y.o.）；在2020年9月至2021年3月之间安排30例（14.3±2y.o.o.在以前的时期之间发现了无统计学意义的差异，在COVID-19关于患者年龄的第一波期间或之后，性别,Risser评分和SRS-22评分。在COVID-19大流行开始后第一次就诊时，患者的平均Cobb角显着高于COVID-19前(52.2°±7°和56.6°±13°vs47.8°±12°和45.2°±13°；p=0.0001)。在五个评估期间，更多的患者被预订了PSF(p<0.0000)，而VBT或手术的指征在以前的患者中逐渐减少。
结论：在第1次COVID-19波后第1次出现脊柱侧凸的患者，Cobb角明显更大，并可能导致PSF比例增加，由于延迟咨询，错过了支撑或VBT的潜在窗口。
方法：所有计划于2019年4月至2021年9月进行手术的IS患者均纳入一项前瞻性队列研究。根据预约日期将患者分为五个队列，每个队列为期6个月：第一次COVID-19波之前的两个时期，期间和之后的两个时期。在每个队列中，患者分为3：在第一次就诊时计划进行后路脊柱融合术（PSF）的患者，那些在第一次访问时预订的椎体束缚（VBT），以及那些计划手术但支架治疗失败的人。变量包括年龄，性别,Riser分级和术前SRS-22评分。使用Chi2和ANOVA测试进行比较。
结果：对173例患者进行分析。计划在2019年4月至9月之间安排33例患者（13.1±3y.o.）；在2019年10月至2020年3月之间安排38例（13.1y.o.±2）；在2020年4月至2020年9月之间安排31例（13.4±3y.o.）；在2020年9月至2021年3月之间安排30例（14.3±2y.o.o.在以前的时期之间发现了无统计学意义的差异，在COVID-19关于患者年龄的第一波期间或之后，性别,Risser评分和SRS-22评分。在COVID-19大流行开始后第一次就诊时，患者的平均Cobb角显着高于COVID-19前(52.2°±7°和56.6°±13°vs47.8°±12°和45.2°±13°；p=0.0001)。在五个评估期间，更多的患者被预订了PSF(p<0.0000)，而VBT或手术的指征在以前的患者中逐渐减少。
结论：在第1次COVID-19波后第1次出现脊柱侧凸的患者，Cobb角明显更大，并可能导致PSF比例增加，由于延迟咨询，错过了支撑或VBT的潜在窗口。
