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Background To develop a priority-based patient/parent reported outcome measure for children with lower-limb differences (LD) by adapting the Gait Outcomes Assessment List (GOAL) questionnaire. Methods Guided by a conceptual framework of patient priorities, the GOAL questionnaire was iteratively modified and its sensibility evaluated by field-testing it on children with LD, and their parents. Cognitive interviews were conducted with a subgroup of these children, and an e-survey administered to a multidisciplinary group of health care professionals with expertise in paediatric LD. Findings were integrated to create the final version of the GOAL-LD. Results Twenty-five children (9–18 years), 20 parents, and 31 healthcare professionals evaluated the content and sensibility of the GOAL, with an emphasis on the relevance and importance of the items to patients’ health related quality of life (HRQL). This resulted in the retention of 26 of the original 50 items, elimination of 12, modification of 12, and addition of seven new items. The new 45-item GOAL-LD questionnaire was shown to be sensible, and its content deemed important. Conclusions The GOAL-LD questionnaire has a high level of face and content validity, and sensibility. It comprehensively captures the HRQL goals and outcomes that matter to children with LD and their parents. Following further psychometric evaluation, the GOAL-LD may serve as a much needed patient and parent reported outcome measure for this population.

PurposeThe objective of this retrospective chart and radiographic review was to present the clinical outcomes and complication rate of a staged approach to modern dual growing-rod (GR) surgery when treating children with severe early onset scoliosis.MethodsFifteen patients received a 6-mm dual GR system. During Stage 1, pairs of end vertebra were exposed in a subperiosteal fashion, instrumented, grafted, and fused. Stage 2 was performed, on average, 5 months later (range 8–35 weeks) and the fused foundations were connected with two growing rods under skull-femoral traction. Clinical and operative notes were reviewed and all complications were recorded. Radiographic measurements were assessed at pre-index, with intraoperative traction during Stage 1, post-Stage 2 and at most recent follow-up. Statistical analyses were performed to evaluate change in scoliosis and kyphosis.ResultsAt initial surgery, the average age was 8.17 ± 1.5 years. The mean Cobb angle was 88.1° ± 14.0°, corrected to 60.3° ± 8.7° (p < 0.001) with intraoperative traction in Stage 1, preserved after Stage 2 instrumentation (59.5° ± 9.6°, p = 0.69), and maintained with subsequent lengthenings (60.6° ± 12.8°, p = 0.73). Hyperkyphosis (11/15 patients) improved from 70.8° ± 15.7° to 46.6° ± 9.7° (p < 0.001). At minimum 2-year follow-up (range 24–80 months, mean 49.5), the complication rate was 14 (0.93 complications/patient), including 6 rod breakages, 6 superficial infections, and 2 deep infections. No anchor migration or pull-out was noted. Seven patients have undergone definitive posterior spinal fusion.ConclusionsStaged insertion of dual GR systems permits strong distraction, with acceptable correction of severe deformities and minimal complications.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

Purpose The study aims to establish the diagnostic accuracy of community spine x-rays for brace candidates. Methods A review of adolescent idiopathic scoliosis patients seen for initial visit at a tertiary care pediatric hospital was conducted ( n  = 170). The index test was the pre-referral community spine x-ray interpreted by a community radiologist. Measures of diagnostic accuracy for the index test were determined against the reference standard if images were obtained within 90 days ( n  = 111). The reference standard was the 3-foot standing EOS spine x-ray evaluated by spine specialists. Diagnostic criterion for a brace candidate was dichotomized by Cobb angle range (25–40°) according to Scoliosis Research Society criteria. Risser stage was not included given significant missing data in index reports. To mitigate the uncertainty around true progression, sensitivity analyses were conducted on a sub-sample of data when index test was within 60 days of the reference standard ( n  = 67). Results Accuracy of the community spine x-ray to detect a brace candidate was 65.8% (95% CI 56.2–74.5). Sensitivity of the index test was 65.4% with a false negative rate of 34.6%. Specificity was 66.1% with a false positive rate of 33.9%. Positive and negative predictive values were 63.0% and 68.4%, respectively. Of the total number of brace candidates ( n  = 52), 32.7% were missed because of underestimation in Cobb angle (95% CI 21.5–46.2). The proportion of missed brace candidates because of underestimation was unchanged with 60-day data ( p  = 0.37). Conclusions Inaccuracies in community spine radiology may lead to missed opportunities for non-operative treatment.

Purpose Primary care physicians rely on radiology reports to confirm a scoliosis diagnosis and inform the need for spine specialist referral. In turn, spine specialists use these reports for triage decisions and planning of care. The objectives were to determine (1) the adequacy of index images to inform treatment decisions at the initial consultation and (2) the utility of index radiology reports for appropriate triage decisions. Methods A retrospective chart review was conducted including all idiopathic scoliosis patients seen for initial consultation, aged three to 18 years, between January 1 and April 30, 2021. A score out of five was generated based on the adequacy of index images to provide accurate Cobb angle measurements and determine skeletal maturity. Index images were considered inadequate if repeat imaging was necessary. Index radiology reports, associated imaging, and new imaging, if obtained at the initial consultation, were compared. Results Of the 94 patients reviewed, 79% ( n  = 74) required repeat imaging at the initial consultation, of which 74% ( n  = 55) were due to insufficient quality and/or limited field of view. Of index images available for review at the initial consult ( n  = 80), 41.2% scored five out of five, and 32.5% scored two or below. Comparing index radiology reports to initial visit evaluation with ≤ 60 days between imaging ( n  = 49), discrepancies in Cobb angle were found in 24.5% (95% CI 14.6, 38.1) of patients. The Risser stage was reported in 14% of index radiology reports. Conclusion Although pre-referral pediatric spine radiographs serve a diagnostic purpose, most are inadequate for comprehensive idiopathic scoliosis evaluation. Level of evidence III.