Adolescent idiopathic scoliosis case panel discussions

Background: A variety of options are available when deciding on the operative treatment of adolescent idiopathic scoliosis (AIS). These include preoperative decisions, intraoperative techniques and postoperative management. METHODS: A case-based discussion of two AIS patients chosen by the moderator were presented to three expert panelists as part of the premeeting course at the 2009 Annual Meeting of the Pediatric Orthopaedic Society meeting. The panelists had seen the preoperative radiographs and clinical photos prior to the panel discussion but did not see the treatment approach by the moderator prior to the meeting. The panel discussion was recorded and the transcription was then edited to include comments from the audience. RESULTS: The panelists first commented on some common preoperative, intraoperative and postoperative strategies including the use of spinal cord monitoring, anchor type, use of cross links and drains. A primary thoracic and a primary thoracolumbar/lumbar curve were presented. The panelists discussed their treatment strategy for each case and comments/questions from the audience were addressed. The panelists then commented on similar cases they had prepared for the meeting. CONCLUSIONS: Planning operative treatment of AIS requires careful preoperative assessment of the patients clinical deformity and radiographs. There is significant variation amongst expert, experienced surgeons when choosing the surgical approach, anchor type, fusion levels, use of cross links, etc. However, all panelists agree that safety is of paramount importance and relies on, meticulous preoperatively planning, careful intraoperative surgical technique, accurate intraoperative spinal cord monitoring and fastidious postoperative followup.