Transitional care into adulthood: Management of adolescent idiopathic scoliosis

Abstract

Adolescent idiopathic scoliosis (AIS) represents a frequently encountered pathology in pediatric neurosurgical clinics that involve complex surgical counselling and intervention into adulthood. Transition of care strategies to monitor these patients over time and determine optimal care frameworks for surgical, medical, and psychosocial management, however, has not been uniformly integrated into adult healthcare systems. Further, limited studies discuss models of transitional care for pediatric spinal pathologies that discuss management trees for postoperative pediatric patients or those newly diagnosed with AIS in adulthood. The purpose of this review is to identify challenges these patients may face transitioning into adult healthcare systems, including 1) postoperative care and complication surveillance 2) new diagnoses in adulthood 3) indications and options for operative intervention and 4) health-related quality of life (HRQoL) with psychosocial domain outcomes. We analyzed the natural history and adulthood management for AIS using PRIMSA guidelines through PubMed and Ovid databases to identify studies that met our search criteria. A total of 15 studies met inclusion criteria for both searches and were incorporated into final analysis. Reoperation was observed in as high as 20% of patients. Five studies found that adult surgical intervention was associated with higher rates of complications, longer operative times, longer hospital stays, and more neurologic complications when compared with adolescent operation. Satisfaction scores were also higher for those with AIS who were treated surgically in adolescence compared to those who were braced or observed. Adolescent idiopathic scoliosis patients should be monitored into adulthood to screen for neurological deterioration, postoperative complications, and indications for surgical intervention. Neurosurgeons should engage multidisciplinary care teams for medical management of functional and mental health domains, and counsel surgical intervention based on individual radiographic, clinical, and assessments of HRQoL.