X-ref For other Roundups in this issue that cross-reference with Spine see: Children’s Orthopaedics Roundup 1; Research Roundup 6.
Shared decision-making in scoliosis surgery X-ref
Shared decision-making is a wholly unorthopaedic approach in many healthcare institutions. However, it is crucially important in everything from patient satisfaction through to medicolegal defensiveness. There are few more complex settings in which to attempt to achieve this than in spinal neuromuscular scoliosis surgery. The combination of complex decision-making, involvement usually of caregivers and a complicated risk benefit balance can make achieving a satisfactory decision rather difficult. Using a novel approach, spinal surgeons in Jacksonville (USA) report their efforts to apply a decision-making aid to this process.1 Their study reports the development of a decision aid using a multistep process of expert summation of current evidence, involvement of a multidisciplinary group and assessment against agreed decision aid standards. The aid was then utilised in a prospective fashion on 11 children, nine of whom opted for surgery following the process. The authors were able to report improvements in knowledge gain, satisfaction and decisional conflict by the caregivers in this particular setting. They conclude that the aid itself is a success and encourage the development of additional decision aids for other similar diagnoses.
Diabetes and outcomes in spinal surgery
Diabetes is associated with almost every complication imaginable, and diabetics come to accept that the nature of their metabolic disorder is such that complications are associated with simple surgery, and almost every organ is affected. Whilst there has been a reasonable focus on the effects of diabetes in terms of outcomes, there is little in the way of longer-term research establishing the effect (or otherwise) on surgical spinal outcomes. A study team from Nashville (USA) set out to evaluate the effect of diabetes in terms of outcome measures on a whopping cohort of 1005 patients, all having undergone …