Fig. 1 AP radiographs of the spine of a patient treated with a clip/staple device for a rapidly progressing scoliosis curve. A, The preoperative curve was 37°. B, The curve was 26° immediately after surgery. C, At 3 months after surgery, the curve was 30°. D, At 6 months after surgery, the curve was 30°. E, At 1 year after surgery, the curve was 32°.Reproduced from Jain V, Lykissas M, Trobisch P, et al. Surgical Aspects of Spinal Growth Modulation in Scoliosis Correction. Instr Course Lect 2014;63:335-344.

AAOS Now

Published 12/1/2015
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Peter Pollack

Number of Pediatric Scoliosis Cases Rises

Database review examines trends in pediatric spine surgery

"Over the past 15 years, the treatment of scoliosis has changed dramatically," explained Jeffrey R. Sawyer, MD, during the Scoliosis Research Society 2015 annual meeting. "We've seen increasing volume as well as a relative increase in volume among younger patients."

Dr. Sawyer presented data from his study, "Changing Trends in Pediatric Spine Surgery in the United States: 1997–2012," which looks at recent trends in pediatric spine surgery in the United States. Because the lack of a national current procedural terminology (CPT) database makes an exact determination of volume practically impossible, the research team reviewed data from the Kids' Inpatient Database (KID), using ICD-9 codes to identify early onset scoliosis cases (defined as age younger than 10 years with any etiology). KID is part of the Healthcare Cost and Utilization Project, and is the largest publicly available pediatric inpatient care database in the United States.

"Given the fact that most pediatric spine surgery right now is performed in an inpatient setting, we believe the KID data set offers an acceptable reference," he said.

"During the study period, we found that the total annual number of discharges remained relatively stable, at around 6 million," said Dr. Sawyer. "This was a period of slow growth among the overall pediatric population. However, over that time we saw a 9 percent increase in orthopaedic discharges, and a 180 percent increase in scoliosis-related discharges, from 10,009 in 1997 to 28,064 in 2012."

Dr. Sawyer noted that in 2012, scoliosis-related discharges comprised 43 percent of overall orthopaedic discharges.

Idiopathic scoliosis
During the study period, the number of cases of idiopathic scoliosis increased 131 percent.

"The greatest volume increase was in older age groups—10 to 14 years  and 15 to 18 years," he said. "The greatest relative increase was among children 4 years or younger, which grew 384 percent. We found that 70 percent of the discharges were from children's hospitals, and the rate of government-insured discharges for idiopathic scoliosis increased from 32 percent in 1997 to 47 percent in 2012."

Congenital scoliosis
The researchers found that the number of discharges for congenital scoliosis rose from 1,878 in 1997 to 2,936 in 2012—an increase of 56 percent. The greatest volume increase was in the 10- to 14-year age group, and the greatest percentage increase in the 1- to 4-year (325 percent) and the 5- to 10-year (329 percent) groups. Overall, 77 percent of discharges were from children's hospitals, and the rate of government-insured patients increased from 43 percent in 1997 to 50 percent in 2012.

Neuromuscular scoliosis
Finally, in terms of neuromuscular scoliosis, the research team found that the number of discharges increased from 244 to 1,241 (409 percent). The greatest volume increases were among 5- to 10-year olds (329 percent) and 10- to 14-year-olds (325 percent). Again, 77 percent of discharges were from children's hospitals, and the number of patients covered through government insurance increased slightly, from 46 percent in 1997 to 48 percent in 2012.

"While 43 percent of the orthopaedic discharges were for scoliosis, this represented only 0.5 percent of total annual pediatric discharges," said Dr. Sawyer. "Given that scoliosis care can be expensive, the condition affects a small percentage of the overall pediatric population, and 50 percent of it is paid for by government insurance, it will be important in the future for us to be able to quantify the impact and quality of the care we provide, especially with early onset scoliosis.

"Limitations of our study include the fact that it is a retrospective database review, and the data to this point reflect discharges, not number of patients," he continued. "Due to the lack of CPT data, we can't really determine what procedures these children had, other than their being admitted to the hospital. We are working on trying to solve both these issues.

"The 2015 database has not yet been released," he noted, "and the effect of magnetic devices is essentially unknown and won't really be reflected until the 2018 database comes out."

Dr. Sawyer's coauthors include John A. Heflin, MD; Michael G. Vitale, MD, MPH; Amer F. Samdani, MD; and Jessica V. Morgan, BS. The authors' disclosure information can be accessed at www.aaos.org/disclosure

Peter Pollack is the electronic content specialist for AAOS Now. He can be reached at ppollack@aaos.org

Bottom Line

  • Total pediatric discharges remained stable over a 15-year period, but orthopaedic discharges increased.
  • In 2012, scoliosis-related discharges accounted for 43 percent of overall pediatric orthopaedic discharges.
  • The majority of orthopaedic discharges are for idiopathic scoliosis, followed by congenital and neuromuscular scoliosis.