Online library of adolescent idiopathic scoliosis cases could help make best surgical decisions


Spinal News International interviewed physician-inventor Vincent Arlet on his creation, Scolisoft, an online library of surgical cases of adolescent idiopathic scoliosis that can be queried with a click of a mouse. Scolisoft is available to the spinal deformity community and to anybody interested in scoliosis.

Why was Scolisoft necessary?


In the field of spinal surgery we have seen over the last 20 years tremendous improvements in surgical techniques, all for the benefit of the patient. However, despite these fantastic advances, outcome measures to judge the real benefit of the surgery have been scarce, and most of the literature on scoliosis surgery has relied on statistical analysis and X-rays, which in most cases were not relevant to the well-being of the individual patient and/or surgical outcome. In some manner, the literature on scoliosis surgery had been based purely on quantitative and statistical methods with p numbers and standard deviation, and with little emphasis on the “big picture” for the individual patient. In other words, there was a need for a qualitative tool that would judge the quality of each individual surgery. With a library of cases visible online with a click of a mouse, surgeons would be able to benchmark their own surgical cases to the database, compare different methods of treatment and be able to make the best decision as far as surgical treatment is concerned.


What was the background of the database?


When I was a paediatric orthopaedic and spine fellow in the Eighties, my passion for spinal deformities naturally led me to carry out some research to assess the outcomes of surgery of adolescent with idiopathic scoliosis. At that time, the only way to do it was to spend hours in the medical archives of the hospital trying to retrieve X-rays and medical records that were often incomplete. One of my mentors at that time, Jean Paul ­Padovani from Hospital For Sick Kids in Paris, France, had a large filing cabinet with thousands of slides of his patients that he had operated on. It was a privilege to review the very impressive slide collection of one of the leaders in the field of spine surgery at the time.


When I started my own independent practice at McGill in Canada in the early nineties, I naturally started to collect slides with clinical photographs and X-rays of my patients so that I could review all my surgical cases and continuously improve my surgeries. Then, when the computer technology became more available and ready, we thought that we could replace all the slides collections with a library of cases that we could query with a click of a mouse and have an instant answer on our screen without having to go to the medical archives. The concept of Scolisoft was therefore born. AOSpine got interested in Scolisoft and became instrumental in making this original concept a reality.


How does the database work?


There are two ways to log onto the system; as a guest using “guest” as a username and “guest” as the password, or as a registered user who has been granted such privileges by the Scolisoft Steering Committee. The main difference is that guests cannot enter any cases and can only perform a quick match survey. Once logged in, the system will lead you to the home page that displays a series of featured or teaching cases. The beauty of the teaching cases is that they encompass the most frequent types of adolescent idiopathic scoliosis. By clicking on any of these cases, the user will be able to view clinical photographs, X-rays and details of the whole case. Physicians can print the images and share them with patients.


One of the key features that Scolisoft offers to its users is the search option. This option provides the user and guest the possibility of querying the data bank for a case they may be confronted with. The user could be a spine surgeon who is about to proceed with surgery and would like to double check fusion levels and see the type of end result he or she may obtain. The user may be a patient undergoing a spinal fusion for scoliosis and would like to see the results of the surgery in X-rays and clinical photos, postoperatively. Let us imagine for example, that the user is looking for a left Lenke type 5 curve measuring between 40 and 55 degrees with an apex at the disc L1 or L1–L2. By clicking on the Quick Match tool and keying these different parameters, 12 cases that match the query criteria will be retrieved. It is then possible, looking at the display to judge the clinical and radiographic result. If the user is interested in an advanced query looking at other parameters such as days in the hospital, blood loss, complications, or a complex curve query parameters such as curve flexibility, stable vertebra, and secondary and or tertiary curve, he or she can do so in the advanced query search engine. A statistical package is also included in Scolisoft to get an idea of the percentage of curves corresponding to the query.


Who is using Scolisoft?


Scolisoft is being used for and by our patients, by our nurses, by researchers and by spine surgeons. Scolisoft is currently used by more than 90 spine and or paediatric surgeons who have registered on the system. More users may have used it without registering. More recently, we have noticed an overwhelming interest in Scolisoft among patients and their families, who wish to use it as a tool for educating themselves about surgical treatment of scoliosis.


What impact does Scolisoft have on medical education?


Its impact is immense for any nurse, researcher, resident spine fellow or spine surgeon interested in providing the best outcome for his patients including: selecting the appropriate fusion levels (so that they are not too long, not too short), inserting the appropriate numbers of implants and at the levels of strategic vertebrae. In our department at University of Virginia, we use Scolisoft as a teaching tool regularly, to teach our residents and fellows about scoliosis and its surgical outcomes. Scolisoft currently has a more than 290 detailed and comprehensive surgical ­ cases of scoliosis.


Is Scolisoft useful as a research tool? 


Absolutely. We have so far published five papers using the data in the database, and we have a few more to come. The database contains clinical photographs and X-rays taken before and after surgery and at follow-up period up to two years postoperation, measurements of various parameters, and surgical data such as days in hospital, blood loss, surgical time etc…  Such detailed data and images have been very useful in facilitating research.


What is the future of Scolisoft? 


Our plan is to expand the database and to other spine deformities such as adult scoliosis.


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