Letter to the Editor: Optimizing deformity correction: a retrospective comparative analysis of two techniques in high-magnitude curves in adolescent idiopathic scoliosis
Article information
Dear Editor,
I am writing in regard to the article titled “Optimising deformity correction: a retrospective comparative analysis of two techniques in high magnitude curves in adolescent idiopathic scoliosis” [1]. The authors address a critical area of spinal deformity correction, but several methodological and analytical aspects warrant further discussion to strengthen the study’s findings.
Firstly, the study’s retrospective design and sequential allocation of patients to the T and TP groups may introduce selection bias. Patients in the TP group, treated later in the study period, could have benefited from the surgical team’s increasing expertise, potentially confounding the outcomes. This concern is consistent with prior studies where sequential patient inclusion introduced unintended bias [1,2]. To mitigate this concern, the authors should consider employing quantitative bias analysis, which could help adjust for any unmeasured biases in retrospective studies [3].
The small sample size (24 patients) raises concerns about the study’s statistical power to detect clinically meaningful differences. Previous studies, such as those by Zhou et al. [4], emphasize the importance of larger cohorts in scoliosis research to draw reliable conclusions. A post hoc power analysis would help validate the robustness of the findings and determine whether the observed differences are truly meaningful. Ensuring sufficient statistical power is critical for drawing valid conclusions from the data [5].
Secondly, the reported greater intraoperative blood loss in the TP group compared to the T group (880.44±9.80 mL versus 690.72±10.28 mL, p=0.042) highlights a significant complication [1]. Providing additional details on blood management strategies, including transfusion thresholds and hemodynamic stabilization protocols, would better contextualize these findings. Existing literature on perioperative management, such as by Pizones et al. [6], demonstrates how optimized protocols can mitigate risks during complex spinal surgeries.
While radiological outcomes were measured comprehensively, they alone may not fully capture patient-centered improvements. Incorporating validated tools such as the Scoliosis Research Society-22 questionnaire could provide valuable insights into functional outcomes and quality of life post-surgery [7]. As highlighted by Joarder et al. [8], patient-reported outcome measures are crucial for evaluating the holistic success of scoliosis interventions. These metrics would complement radiological findings and offer a holistic evaluation of intervention success.
The 2-year follow-up period, while commendable, limits the ability to assess long-term outcomes such as adjacent segment degeneration and implant-related complications. Longer follow-up studies, as emphasized by Zhou et al. [4] and Teixeira da Silva et al. [9], are crucial for establishing the durability of surgical techniques. Additionally, the absence of a standalone PO group restricts the ability to isolate the effects of combining intraoperative traction (IOT) with PO. Previous research has demonstrated the value of isolating variables for a more nuanced interpretation of outcomes [10].
In conclusion, the study by Kulkarni et al. [1] highlights the potential synergy between IOT and PO, achieving significant improvements in correction indices and sagittal alignment. I hope the suggestions provided here will contribute to the ongoing refinement of research in this field.
Notes
Conflict of Interest
No potential conflict of interest relevant to this article was reported.
Author Contributions
Both authors contributed equally to the conceptualization, original draft writing, and reviewing and editing.