Fast-Tracking the road to Scoliosis Surgery

Aim

To improve equity, safety, and efficiency of surgical waitlist management by proactively identifying scoliosis patients at risk of disease progression and prioritising access to clinical surveillance, imaging and surgical care.

Outcomes

• Identified a subgroup of surgical waitlist patients at high risk of curve progression during delays to surgery.
• Implemented targeted surveillance and prioritised MRI access for high-risk patients.
• Enabled earlier clinical escalation and informed surgical prioritisation
• Reduced reliance on routine radiographic surveillance to reduce radiation exposure by incorporating MRI-based risk stratification.
• Established a scalable framework for risk-informed waitlist management that may be applicable to other conditions and specialities.

Background

Surgical waitlists remain a persistent challenge across Queensland Health, driven by increasing demand, constrained capacity, and unavoidable delays in definitive treatment. When disease progression continues during the waiting period, delays may lead to worse clinical outcomes, increased procedural complexity, and higher downstream healthcare costs.

Adolescent Idiopathic Scoliosis (AIS) represents a clear example of this challenge. In skeletally immature patients, spinal deformity may progress substantially while awaiting corrective surgery. Progression during this period is associated with increased curve magnitude, requiring longer fusion constructs with higher complication risks, blood loss and inpatient stays. Further resulting in poorer post-operative spinal curve correction and reduced patient-reported outcomes. Despite this, current waitlist management approaches largely rely on chronological booking order, with limited capacity identify and dynamically reassess surgical access during prolonged waiting periods. Frequent radiographic surveillance is neither feasible nor desirable due to clinic demands and cumulative radiation exposure.

This central problem addressed by this project was the absence of a structured, evidence-informed mechanism to identify which patients on a surgical waitlist are most vulnerable to clinically meaningful progression, and to align surveillance and access pathways accordingly. This, combined with emerging evidence, indicates that Apical Vertebral Rotation (AVR), measured on routine preoperative MRI, is associated with curve progression and can be combined with growth-related metrics to estimate risk. MRI offers a radiation-free modality already embedded in preoperative workflows to identify spinal cord issues, but it is underutilised for understanding deformity and progression.

This project sought to translate predictive progression into a practical, patient-centred model of care, shifting waitlist management from a passive system to an active, risk-informed process that supports safer and more equitable access to MRI and, subsequently, surgery.

Discussion

Successful implementation of this project required strong clinical leadership, cross-disciplinary collaboration, and an organisational culture receptive to innovation in patient flow and access. Further recognising that implementation is an ongoing process with continued potential to optimise the patient pathway.

A key lesson learned was that without data collection, many opportunities to identify and optimise patient care can go unnoticed. Similarly, the patient pathway is often reliant on multiple hospital teams with engagement from radiology services, spine surgeons, nursing co-ordinators and administrators required to streamline care.

This quality improvement and research initiative was established from a clinician-research position that provided the time and resources to focus on this issue. Recognising that investing in these opportunities is what can drive organisational change. However, its limitations can be ensuring that research outcomes provide sustainable improvements beyond clinician rotational training.

Overall, this approach to identifying high-risk patients has broader applicability across Queensland Health. Any condition in which disease progression occurs during waiting periods presents an opportunity to collect and analyse the characteristics driving it. Further providing the link between governance and the clinician so that patients may benefit from similar risk-informed surveillance and prioritisation models.

Next steps include formal evaluation of patient outcomes, refinement of escalation thresholds, and exploration of digital integration into referral and waitlist systems. There is also potential to expand this framework into a system-wide model for proactive waitlist management, supporting safer, more equitable access to care.

References

Pontes, M. D. de S., Soeira, T. P., Sampaio, M. L., Pratali, R. de R., Pompeu, Y. A., & Herrero, C. F. P. da S. (2022). [Review of The impacts of waiting for surgical correction of Adolescent Idiopathic Scoliosis and its repercussions for publicly funded health systems: systematic review]. European Spine Journal, 32(2), 617. Springer Science+Business Media. https://doi.org/10.1007/s00586-022-07487-2

Ramo, B., Tran, D.-P., Reddy, A. V. G., Brown, K., Niswander, C., Erickson, M., & Garg, S. (2019). Delay to surgery greater than 6 months leads to substantial deformity progression and increased intervention in immature adolescent idiopathic scoliosis (AIS) patients: A retrospective cohort study. Spine Deformity, 428. Retrieved from https://doi.org/10.1016/j.jspd.2018.09.012