Vincent Arlet, MD, a spine surgeon with the University of Virginia School of Medicine recently developed an international online database called Scolisoft for scoliosis cases. The database includes case and outcomes data for different types of treatments for Adolescent Idiopathic Scoliosis, along with images of the patients' spine. Anyone can access the information by logging onto the website as a "guest." Physicians can add cases to the database by becoming a registered user of the site. Each physician requesting a "registered user" status must submit a complete case, and all cases are put through an extensive review before publishing in the database. Dr. Arlet discusses the advantages of a scoliosis database and the implications it has on the future of spine surgery.
Q: How can spine surgeons use Scolisoft for planning scoliosis cases?
Dr. Vincent Arlet: There are a ton of variations to scoliosis treatment and surgeons don't always know what type of procedure will work best for their patients. With Scolisoft, surgeons can find a case similar to that of the patient they want to treat, and decide whether to apply the same type of treatment or not.
This is a good tool for surgeons at all levels of experience because even though surgeons gain more and more experience, they have a tendency to forget what's been done in the past. Scolisoft allows physicians to look at previous cases and see the outcome ratings for surgeries similar to the ones they are planning. For example, if you want to do a correction for scoliosis and implant the rods that go from the middle to the bottom of the thoracic spine, you can look up previous cases where physicians did that, and find out whether the outcome was satisfactory or not. It gives you an immediate feedback for the
outcomes you are planning.
Q: How can spine surgeons incorporate the database into patient education at their practice?
VA: Surgeons can compare the patient's x-rays with similar images from the database and show the patient what they can expect for an outcome. In my practice for example, if a patient comes in with a 60 degree curve I will search the database and pull out 15 cases of patients with 60 degree curves in their spine. I will then pick the one that looks very similar to that patient I have in front of me, and show to the patient what he or she can reasonably expect from the surgery.
We also give patients a printed picture of the case if they want to review it and discuss the outcomes with their families. It helps them in their decision making.
Q: Why is a database for scoliosis important for spine surgeons?
VA: So far, there hasn't been a standardization of treatment for this type of surgery. When surgeons approach a case, they have to decide whether to do the surgery from the front or the back. We usually think that scoliosis treatment should be addressed from the back, but in selected cases you can do it from the front. The second decision the physician makes is the extent of the fusion, meaning the length of the rods and where the anchor should be located. All of these questions vary based on the surgeon's experience. However, surgeons who use Scolisoft have the experience of more than 300 cases in front of them. With such an extensive database, physicians will be able to decide which surgery gives the best outcomes for their patients.
Q: What implications does a scoliosis database have for the future of spine surgery advancement and research?
VA: Physicians doing research in scoliosis treatment can mine the database on a specific topic and have the material to answer their research question. When the physician is presenting his or her research at a conference or teaching a case on the road, he or she can use cases from the database to incorporate images into the program.
Additionally, Scolisoft can be used as an educational tool for young surgeons who don't have the experience of older surgeons. If you are planning on doing a surgery and you see on the database that the outcome of a similar surgery was not satisfactory, you won't repeat the mistake. With this tool, the younger surgeons have access to the experience of the older surgeons.
Q: When creating Scolisoft, how did you address the privacy issues set forth by HIPAA regulations?
VA: The project was through the University of Virginia. We initially went through the university's institutional review board and had to make sure the images complied with HIPAA. For a case to be uploaded, the patient must sign a waiver authorizing the surgeon to add the case to our database. Scoliosis has a cosmetic component, which means, some of the images of the patients could be an issue. However, we crop the patient's face out of the photographs to respect their privacy. When I see pictures on the database, I have no clue whether they are one of my patients or not.
Also, patient data in Scolisoft are totally de-identified. However, to add follow up data of patients in the database, each patient is given a code linked to their name. This information is kept in a separate location securely. To retrieve a patient’s identity in Scolisoft is impossible, unless one has access to the linked codes that are kept in a separate location.
Q: What are your goals for the future of Scolisoft?
VA: The goals are to increase the number of cases and to achieve standardization of treatment. We hope to improve patient care and keep teaching our younger generation about the best methods for scoliosis surgery. Ultimately, the database can help provide better satisfaction for the patient so he or she can see what to expect in terms of surgery. It has been a very interesting project and we are very excited about the database.
Learn more about Scolisoft.
Read more coverage on spine surgery:
- 3 Cutting-Edge Projects at the Southern California Center for Neuroscience and Spine
- Improving Patient Satisfaction: Endoscopic Spine Surgery
- Spine Education Labs Critical in Training for Cutting-Edge Procedures
Q: How can spine surgeons use Scolisoft for planning scoliosis cases?Dr. Vincent Arlet: There are a ton of variations to scoliosis treatment and surgeons don't always know what type of procedure will work best for their patients. With Scolisoft, surgeons can find a case similar to that of the patient they want to treat, and decide whether to apply the same type of treatment or not.
This is a good tool for surgeons at all levels of experience because even though surgeons gain more and more experience, they have a tendency to forget what's been done in the past. Scolisoft allows physicians to look at previous cases and see the outcome ratings for surgeries similar to the ones they are planning. For example, if you want to do a correction for scoliosis and implant the rods that go from the middle to the bottom of the thoracic spine, you can look up previous cases where physicians did that, and find out whether the outcome was satisfactory or not. It gives you an immediate feedback for the
outcomes you are planning.
Q: How can spine surgeons incorporate the database into patient education at their practice?
VA: Surgeons can compare the patient's x-rays with similar images from the database and show the patient what they can expect for an outcome. In my practice for example, if a patient comes in with a 60 degree curve I will search the database and pull out 15 cases of patients with 60 degree curves in their spine. I will then pick the one that looks very similar to that patient I have in front of me, and show to the patient what he or she can reasonably expect from the surgery.
We also give patients a printed picture of the case if they want to review it and discuss the outcomes with their families. It helps them in their decision making.
Q: Why is a database for scoliosis important for spine surgeons?
VA: So far, there hasn't been a standardization of treatment for this type of surgery. When surgeons approach a case, they have to decide whether to do the surgery from the front or the back. We usually think that scoliosis treatment should be addressed from the back, but in selected cases you can do it from the front. The second decision the physician makes is the extent of the fusion, meaning the length of the rods and where the anchor should be located. All of these questions vary based on the surgeon's experience. However, surgeons who use Scolisoft have the experience of more than 300 cases in front of them. With such an extensive database, physicians will be able to decide which surgery gives the best outcomes for their patients.
Q: What implications does a scoliosis database have for the future of spine surgery advancement and research?
VA: Physicians doing research in scoliosis treatment can mine the database on a specific topic and have the material to answer their research question. When the physician is presenting his or her research at a conference or teaching a case on the road, he or she can use cases from the database to incorporate images into the program.
Additionally, Scolisoft can be used as an educational tool for young surgeons who don't have the experience of older surgeons. If you are planning on doing a surgery and you see on the database that the outcome of a similar surgery was not satisfactory, you won't repeat the mistake. With this tool, the younger surgeons have access to the experience of the older surgeons.
Q: When creating Scolisoft, how did you address the privacy issues set forth by HIPAA regulations?
VA: The project was through the University of Virginia. We initially went through the university's institutional review board and had to make sure the images complied with HIPAA. For a case to be uploaded, the patient must sign a waiver authorizing the surgeon to add the case to our database. Scoliosis has a cosmetic component, which means, some of the images of the patients could be an issue. However, we crop the patient's face out of the photographs to respect their privacy. When I see pictures on the database, I have no clue whether they are one of my patients or not.
Also, patient data in Scolisoft are totally de-identified. However, to add follow up data of patients in the database, each patient is given a code linked to their name. This information is kept in a separate location securely. To retrieve a patient’s identity in Scolisoft is impossible, unless one has access to the linked codes that are kept in a separate location.
Q: What are your goals for the future of Scolisoft?
VA: The goals are to increase the number of cases and to achieve standardization of treatment. We hope to improve patient care and keep teaching our younger generation about the best methods for scoliosis surgery. Ultimately, the database can help provide better satisfaction for the patient so he or she can see what to expect in terms of surgery. It has been a very interesting project and we are very excited about the database.
Learn more about Scolisoft.
Read more coverage on spine surgery:
- 3 Cutting-Edge Projects at the Southern California Center for Neuroscience and Spine
- Improving Patient Satisfaction: Endoscopic Spine Surgery
- Spine Education Labs Critical in Training for Cutting-Edge Procedures