Pediatric Spine Foundation

Title: Uncorrected Pelvic Obliquity Is Associated with Worse Health-related Quality of Life (HRQoL) in Children and Their Caregivers at the End of Surgical Treatment for Early Onset Scoliosis (EOS

Authors: Hiroko Matsumoto, Adam N. Fano, Jacob Ball, Benjamin D. Roye, Ameeka George, Sumeet Garg, Mark Erickson, Amer Samdani, David Skaggs, David P. Roye, Michael G. Vitale, Pediatric Spine Study Group

Journal: J Pediatric Orthop

Date: April 01, 2022

Excerpt: Remaining Pelvic Obliquity (one hip higher than the other) at the end of surgical treatment is associated with worse HRQoL in ambulatory children and their caregivers. These results suggest that correction of PO should remain a primary goal of treatment in patients with EOS undergoing surgery.

Keywords: early onset scoliosis, pelvic obliquity, health-related quality of life, posterior spinal fusion, ambulatory patients

Summary:

Purpose

The reason for this study was to review if remaining pelvic obliquity after surgical treatment affects health-related quality of life (HRQoL) in patients that walk and have EOS. Pelvic obliquity (PO) refers to an imbalance of the pelvis or hips, which causes many physical difficulties including discomfort when sitting. To assess health-related quality of life, researchers used data from the 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24), a survey which measures parental burden, financial burden, and satisfaction in the children and their caregivers.

Results

  • Both absolute change and percent change in pelvic obliquity were largest in neuromuscular patients, followed by idiopathic, syndromic, and congenital. However, neuromuscular patients had the largest PO after surgery. PO is known to have a strong association with neuromuscular disease.
  • Preoperative PO, height before surgery, and lowest instrumented vertebra (LIV) location (LIV at L5 vs. above) were statistically associated with residual PO and lower postoperative HRQoL.
  • Children with higher residual PO had worse HRQoL. Specifically, those with high residual PO had lower HRQoL scores by 23.2 points for congenital patients, 16.1 points for Neuromuscular patients, 14.8 points for syndromic patients, and 15.0 points for idiopathic patients compared to patients with low residual PO.

Discussion Points

  • Congenital, syndromic, and idiopathic patients had better questionnaire scores in all sections of the EOSQ-24. In neuromuscular patients, improvements were only seen in the Parental Burden and Financial Burden sections. Neuromuscular disease patients often have high pelvic obliquity.
  • The findings of this study conclude that children with early onset scoliosis who have higher residual pelvic obliquity after surgical treatment tend to have worse health-related quality of life.
  • While there is a lot to consider in the treatment of EOS, these results suggest that correction of PO should remain a primary consideration in patients who walk and are going to have surgery.