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Article: Rib-on-Pelvis Deformity and Reported Pain in Neuromuscular Early-Onset Scoliosis
Title | Rib-on-Pelvis Deformity and Reported Pain in Neuromuscular Early-Onset Scoliosis |
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Authors | Desai, Vineet M.Bowen, MargaretAnari, Jason B.Flynn, John M.Brooks, Jaysson T.Snyder, BrianRamo, BrandonLi, YingAndras, Lindsay M.Truong, Walter H.Fitzgerald, RyanEl-Hawary, RonRoye, BenjaminYaszay, BurtKwan, Kenny Yat HongMcintosh, AmyNelson, SusanGupta, PurnenduErickson, MarkGarg, SumeetCahill, Patrick J. |
Keywords | early-onset scoliosis neuromuscular scoliosis quality of life |
Issue Date | 11-Jul-2024 |
Publisher | Lippincott, Williams & Wilkins |
Citation | Journal of Pediatric Orthopaedics, 2024 How to Cite? |
Abstract | Background: Neuromuscular early-onset scoliosis (N-EOS) often presents with a long sweeping thoracolumbar scoliosis and pelvic obliquity. With severe pelvic obliquity, the ribs come into contact with the high side of the pelvis, termed rib-on-pelvis deformity (ROP). The goal of this study is to evaluate whether ROP is associated with reported pain and other health-related quality of life (HRQOL) measures. We hypothesize that ROP is associated with increased pain and negative HRQOL. Methods: A multicenter international registry was queried for all nonambulatory patients with N-EOS from 2012 to 2022. Both surgical and nonsurgical patients were included. ROP was classified as a binary radiographic assessment of preoperative (surgical patients) and most recent follow-up (nonsurgical patients) upright radiographs. Reported pain and other HRQOL measures were assessed through the 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24). Patients with nonupright radiographs or EOSQ-24 questionnaires and corresponding radiographs >4 months apart were excluded. Results: Totally, 225 patients (8.4±3.1 y, 55% female) were included. The median major curve was 63.3 (IQR: 40.6 to 81.2) degrees and median pelvic obliquity was 15.5 degrees (IQR: 8.8 to 26.4). Eighty-three patients (37%) had ROP. ROP was associated with both frequency (P<0.001) and severity (P<0.001) of pain. ROP was associated with worse general health (P=0.01), increased difficulty with vocalization (P=0.02), increased frequency of shortness of breath (P=0.002), and increased difficulty sitting upright (P=0.04). Regarding overall EOSQ-24 domains, ROP was associated with worse general health, pain/discomfort, pulmonary function, and physical function (P<0.01). In a subanalysis of 76 patients who underwent surgical intervention with at least 2 years of follow-up, patients with preoperative ROP experienced significantly greater improvements in both frequency (P=0.004) and severity (P=0.001) of pain than the patients without preoperative ROP at 2 years postoperatively. Conclusions: The overall incidence of ROP in N-EOS is about 37%. ROP is associated with greater pain and worse HRQOL through the EOSQ-24 questionnaire. Furthermore, these patients experienced a greater reduction in pain after surgery. Clinicians and parents must be aware that ROP is possibly a pain generator, but responds positively to surgical intervention. Level of Evidence: Level III. |
Persistent Identifier | http://hdl.handle.net/10722/345710 |
ISSN | 2023 Impact Factor: 1.4 2023 SCImago Journal Rankings: 0.699 |
DC Field | Value | Language |
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dc.contributor.author | Desai, Vineet M. | - |
dc.contributor.author | Bowen, Margaret | - |
dc.contributor.author | Anari, Jason B. | - |
dc.contributor.author | Flynn, John M. | - |
dc.contributor.author | Brooks, Jaysson T. | - |
dc.contributor.author | Snyder, Brian | - |
dc.contributor.author | Ramo, Brandon | - |
dc.contributor.author | Li, Ying | - |
dc.contributor.author | Andras, Lindsay M. | - |
dc.contributor.author | Truong, Walter H. | - |
dc.contributor.author | Fitzgerald, Ryan | - |
dc.contributor.author | El-Hawary, Ron | - |
dc.contributor.author | Roye, Benjamin | - |
dc.contributor.author | Yaszay, Burt | - |
dc.contributor.author | Kwan, Kenny Yat Hong | - |
dc.contributor.author | Mcintosh, Amy | - |
dc.contributor.author | Nelson, Susan | - |
dc.contributor.author | Gupta, Purnendu | - |
dc.contributor.author | Erickson, Mark | - |
dc.contributor.author | Garg, Sumeet | - |
dc.contributor.author | Cahill, Patrick J. | - |
dc.date.accessioned | 2024-08-27T09:10:39Z | - |
dc.date.available | 2024-08-27T09:10:39Z | - |
dc.date.issued | 2024-07-11 | - |
dc.identifier.citation | Journal of Pediatric Orthopaedics, 2024 | - |
dc.identifier.issn | 0271-6798 | - |
dc.identifier.uri | http://hdl.handle.net/10722/345710 | - |
dc.description.abstract | <p>Background: Neuromuscular early-onset scoliosis (N-EOS) often presents with a long sweeping thoracolumbar scoliosis and pelvic obliquity. With severe pelvic obliquity, the ribs come into contact with the high side of the pelvis, termed rib-on-pelvis deformity (ROP). The goal of this study is to evaluate whether ROP is associated with reported pain and other health-related quality of life (HRQOL) measures. We hypothesize that ROP is associated with increased pain and negative HRQOL. Methods: A multicenter international registry was queried for all nonambulatory patients with N-EOS from 2012 to 2022. Both surgical and nonsurgical patients were included. ROP was classified as a binary radiographic assessment of preoperative (surgical patients) and most recent follow-up (nonsurgical patients) upright radiographs. Reported pain and other HRQOL measures were assessed through the 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24). Patients with nonupright radiographs or EOSQ-24 questionnaires and corresponding radiographs >4 months apart were excluded. Results: Totally, 225 patients (8.4±3.1 y, 55% female) were included. The median major curve was 63.3 (IQR: 40.6 to 81.2) degrees and median pelvic obliquity was 15.5 degrees (IQR: 8.8 to 26.4). Eighty-three patients (37%) had ROP. ROP was associated with both frequency (P<0.001) and severity (P<0.001) of pain. ROP was associated with worse general health (P=0.01), increased difficulty with vocalization (P=0.02), increased frequency of shortness of breath (P=0.002), and increased difficulty sitting upright (P=0.04). Regarding overall EOSQ-24 domains, ROP was associated with worse general health, pain/discomfort, pulmonary function, and physical function (P<0.01). In a subanalysis of 76 patients who underwent surgical intervention with at least 2 years of follow-up, patients with preoperative ROP experienced significantly greater improvements in both frequency (P=0.004) and severity (P=0.001) of pain than the patients without preoperative ROP at 2 years postoperatively. Conclusions: The overall incidence of ROP in N-EOS is about 37%. ROP is associated with greater pain and worse HRQOL through the EOSQ-24 questionnaire. Furthermore, these patients experienced a greater reduction in pain after surgery. Clinicians and parents must be aware that ROP is possibly a pain generator, but responds positively to surgical intervention. Level of Evidence: Level III.</p> | - |
dc.language | eng | - |
dc.publisher | Lippincott, Williams & Wilkins | - |
dc.relation.ispartof | Journal of Pediatric Orthopaedics | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | early-onset scoliosis | - |
dc.subject | neuromuscular scoliosis | - |
dc.subject | quality of life | - |
dc.title | Rib-on-Pelvis Deformity and Reported Pain in Neuromuscular Early-Onset Scoliosis | - |
dc.type | Article | - |
dc.identifier.doi | 10.1097/BPO.0000000000002768 | - |
dc.identifier.pmid | 38987900 | - |
dc.identifier.scopus | eid_2-s2.0-85198638088 | - |
dc.identifier.eissn | 1539-2570 | - |
dc.identifier.issnl | 0271-6798 | - |