Abstract
Introduction
Idiopathic scoliosis is a lateral curvature of the spine >10° as measured on a frontal plane radiograph by the Cobb angle. Important variables in assessing the risk of curve progression include a young age at presentation, female sex, a large amount of growth remaining, the rate of growth, the curve magnitude, and the curve location. Curves >20° have an inherently low risk of progression. Surgery is indicated for curves >50° or rapidly progressing curves. The timing of surgery is paramount in order to intervene in cases where rapid progression is evident to prevent further deterioration. There is a greater likelihood for more complex surgery to be required in major curves. At present, there are severe restrictions on resources to cater for patients with scoliosis. As a result, patients spend excessive periods on waiting lists prior to having their procedure. The aim of this study is to analyse the progression of curves of patients while on the waiting list and assess the cost implications of curve deterioration.
Methods
A retrospective analysis of 40 cases of adolescent idiopathic scoliosis performed from between 2007-2010 was carried out. All radiographs at the time of being placed on the waiting list and the time of admission were reviewed to assess the Cobb angle. The radiographs were analysed independently by three spinal surgeons to determine what level of surgical intervention they would recommend at each time point. The final procedure performed was also recorded. A cost analysis was carried out of all of the expenses that are incurred as part of scoliosis surgery, including length of hospital stay, intensive care admission, spinal monitoring, implant cost, and the requirement for multiple procedures.
Results
The average time on the waiting list was 12 months (range 6 – 16 months). Comparison of radiographs at the time of listing and time of admission revealed a deterioration of the Cobb angle by an average of 12°. The average Cobb angle at time of surgery was 78° (range 55° - 96°). Analysis of cost implications revealed an increase in cost based on implant requirements, length of stay and intensive care admission estimated at 25%.
Conclusion
The results of this study demonstrate that there is a significant deterioration of scoliosis curvature in patients while on the waiting list. The consequence of this progression results in longer operative time, increased requirement for intensive care beds, an increase in requirements for additional levels of pedicle instrument, and a prolonged length of stay. The implications of the deterioration in curvature result in an increase in overall cost estimated at 25%. Waiting list initiatives established over the past 6 months have reduced the waiting list to 6-9 months. Further efforts to continue this initiative are likely to give rise to further cost reductions and result in more manageable curvatures being dealt with in a timely fashion.
