Developing outcome measures for pediatric deformity surgery

STUDY DESIGN. Review article regarding the development of outcome measures for pediatric spinal deformity. OBJECTIVE. To discuss the role of patient-based outcomes and process measures in pediatric spinal deformity patients. SUMMARY OF BACKGROUND DATA. A number of health-related quality of life (HRQOL) questionnaires assess, from patients' perspectives, the effectiveness of spinal deformity correction. The SRS instrument is the most prominent HRQOL tool used in North American adolescent scoliosis studies today. However, these patient-based outcomes and perceptions do not necessarily correlate with process measurements, particularly in the area of increase spinal deformity correction being achieved with newer, more powerful, pedicle screw instrumentation. Furthermore, spinal deformity presenting during infancy or early childhood poses a particular challenge for developing useful evidence-based outcomes tools. METHODS. The rationale for patient-based outcome development in pediatric spinal deformity is discussed, along with its important association with process measures. RESULTS. Newer HRQOL tools are under development that may better recognize and differentiate changes in adolescent patients' appearances before and after surgery. For early-onset spinal deformity patients, newer process measures for periodic outcome assessment, such as volume measurement of lung parenchyma and spine/chest cage measurement, are being developed. CONCLUSION. Ultimately, both patient and process measures are necessary to fully evaluate the results of pediatric spinal deformity surgery.