Early Definitive Fusion Versus Magnetic Growing Rods in "Tweeners": What Do Parents Prefer?

Abstract

Introduction: In treating early-onset scoliosis (EOS), pediatric orthopaedic surgeons and families must often choose between growth-friendly interventions such as magnetically controlled growing rods (MCGR) and early definitive posterior spinal fusion (PSF). While each strategy has associated pros and cons, little is understood about the specific preferences of patients' families. Addressing potential nuances in these preferences is crucial for meaningful shared decision-making (SDM). To better understand the factors influencing family decisions, we conducted a choice-based conjoint (CBC) analysis to explore parents' preferences for PSF and MCGR as treatment options.

Methods: A survey was developed using Sawtooth Software (Lighthouse Studio version 9.2.0) to gather demographic information and preferences on surgical scenarios via CBC analysis. Anonymous participants, recruited via the Prolific crowdsourcing platform, qualified if they were US residents over 18 years of age with children aged 8 to 9. Data analysis involved the Hierarchical Bayes (HB) method to determine the desirability of 5 surgical attributes: curve correction, increase in spinal height, total number of surgeries, duration of treatment, and chance of complications.

Results: The study included 432 participants who prioritized the likelihood of complications (relative importance value of 37), followed by total number of surgeries (22), curve correction (21), spine height (12), and treatment duration (8). Female participants and those with daughters assigned significantly higher importance to the treatment's total number of surgeries (P<0.05). Simulator analysis showed that 86.6% of participants would hypothetically prefer PSF, while only 13.4% would opt for growing rods based on the modeled participant choices.

Conclusions: This CBC analysis suggests that parents of children with EOS requiring surgical intervention would prioritize complication minimization, reduction in total surgical procedures, and effective curve correction, demonstrating a marked preference for PSF. Notably, the sex of both the child and the parent influenced attribute preferences. These findings exemplify the utility of CBC analysis in orthopaedic care, allowing for a deeper understanding of family preferences and enhancing SDM by providing the ability to align surgical recommendations with specific family priorities.

Level of evidence: Level III.

Keywords: choice-based conjoint analysis; early-onset scoliosis; magnetically controlled growing rods; parental preferences; pediatric orthopaedics; posterior spinal fusion; shared decision-making; surgical decision-making.