Investigation of project management aspects of anterior surgical approach in adolescence idiopathic scoliosis treatment

Running head: BIOMEDICAL ENGINEERING
Biomedical Engineering
Name of student:
Name of university:
Author note:

1BIOMEDICAL ENGINEERING
Abstract
Adolescence Idiopathic Scoliosis (AIS) is a multi-factorial health condition that causes almost
80% of the spine deformity among the adolescence. The main treatment options that are
available for scoliosis is observation, bracing and then surgery. The principal objective of AIS
surgery is solid fusion and proper trunk. There are three different types of solid fusion namely
anterior spinal fusion, posterior spinal fusion and thorasocopic spinal fusion, The aim of the
research is to elucidate the usefulness and efficacy of all these three forms of fusion surgeries
that are used for treating AIS. The result of this comparative study will then be utilised to frame
a proper project management framework for successful implementation of the surgical procedure
and thereby attaining success in treating AIS. In order to achieve the aims and the objectives of
the research, the researcher has followed a systematic review approach. The comparative study
revealed that anterior spine surgery is better than the other two surgeries in the domain of the
blood loss, pulmonary functions and recovery rate. Following the identification of the best spinal
surgery form, project management principal was proposed for proper implementation of the
spinal surgery techniques.

2BIOMEDICAL ENGINEERING
Table of Contents
Chapter 1- Introduction....................................................................................................................4
1.1 The background for the investigation....................................................................................4
1.2 Research Aim.........................................................................................................................4
1.3 Research objectives...............................................................................................................5
1.4 Research questions and the hypothesis..................................................................................5
1.5 Most commonly used surgical methods to correct AIS.........................................................5
1.6 Outcomes and results.............................................................................................................6
1.7 Significance...........................................................................................................................6
Chapter 2: Literature review............................................................................................................7
2.1 Concept of management........................................................................................................7
2.2 Project Management Theory..................................................................................................9
2.3 Literature Gap......................................................................................................................13
2.4 Summary..............................................................................................................................13
Chapter 3: Research Methodology................................................................................................15
3.1 Research philosophy............................................................................................................15
3.2 Research approach...............................................................................................................15
3.3 Research strategy.................................................................................................................15
3.3.1 Inclusion criteria...........................................................................................................16
3.3.2 Exclusion criteria..........................................................................................................16

3BIOMEDICAL ENGINEERING
3.4 Data collection tools............................................................................................................16
3.5 Time plan.............................................................................................................................16
3.6 Ethical Consideration...........................................................................................................17
3.7 Tasks....................................................................................................................................17
Chapter 4 Posterior spine surgery..................................................................................................18
Chapter 5 Thoracoscopic spine surgery.........................................................................................23
Chapter 6 Anterior spine surgery...................................................................................................27
Chapter 7 Detail comparison between these three surgeries (posterior, thoracoscopic surgery and
anterior)..........................................................................................................................................32
Chapter 8: Why anterior surgery is better than remaining two.....................................................37
Chapter 10: use project management principles to get quick recovery in anterior surgery compare
to remaining surgery......................................................................................................................42
Chapter 11: Recommendations and conclusion.............................................................................46
References......................................................................................................................................50

4BIOMEDICAL ENGINEERING
Topic: Investigation of project management aspects of the anterior surgical approach in
adolescence idiopathic scoliosis treatment
Chapter 1- Introduction
1.1 The background for the investigation
Scoliosis in patients aged between 10 and 18 years is known as adolescent scoliosis and the
underlying causes of the same are multi-factorial. The most commonly occurring form of
scoliosis in the adolescent period is adolescence idiopathic scoliosis (AIS), and what makes the
condition stand out from other forms of scoliosis is that that the cause of this condition remains
unknown. The condition is a three-dimensional health condition that corresponds to almost 80%
of all spine deformity cases. The prevalence of AIS is described as 2-3% on a global scale.
Around 0.5% of these cases are known to be progressive and require surgical treatment. The
symptoms of the condition do not lead to neurologic conditions. However the visible symptoms
related to the conditions are distinct (Lee et al., 2016). Treatment options to address concerns in
adolescent idiopathic scoliosis is divided into three main categories; observation, bracing and
surgery. The decision regarding treatment is based on the risk of curvature progression. The main
objective of AIS surgery is to achieve a proper trunk and solid fusion. Nevertheless, it has been
reported that though good radiological and clinical outcomes have been achieved, quality of life
for patients as determined by self-evaluation is poor (Sudo et al., 2016).
1.2 Research Aim
The first aim of the research was to comprehend the usefulness and efficacy of the three
forms of surgery, namely, anterior, posterior, and thoracic approach for treating AIS, and
undertake a comparative study of the three surgical forms. The second aim was to understand the

5BIOMEDICAL ENGINEERING
project management principles that can be applied for getting quick recovery in anterior surgery
as compared to other surgical forms.
1.3 Research objectives
 To recognize the effectiveness of anterior surgical procedure for AIS
 To understand the effectiveness of posterior surgical procedure for AIS
 To identify the effectiveness of thoracic surgical procedure for AIS
 To highlight why anterior surgery is better than remaining two
 To assess the project management principles that can be applied for getting quick
recovery in anterior surgery
1.4 Research questions and the hypothesis
The research questions that was addressed through the paper are
 Why anterior surgery is better than remaining two surgical forms?
 What are the project management principles to get quick recovery in anterior surgery
compare to remaining surgery?
The hypothesis considered for the research was that “anterior surgery is better than
remaining two surgical forms”.
1.5 Most commonly used surgical methods to correct AIS
Surgical treatment for patients with AIS is considered for those whose curves are greater than
45 degree with continual growth in this angle. The goal of such surgery can be understood to be
two-fold. The first aim is to achieve prevention of curve progression. The second aim is to
achieve curve correction. The three commonly used surgical methods to correct AIS are as
follows-

6BIOMEDICAL ENGINEERING
 Posterior spine surgery
 Anterior spine surgery
 Thoracoscopic spine surgery
1.6 Outcomes and results
The results of the study would be elementary in indicating the form of surgery that is
most appropriate for adolescence idiopathic scoliosis. Based on the research it would be easier to
understand whether anterior adolescence idiopathic scoliosis surgery is better as compared to
thoracic and posterior adolescence idiopathic scoliosis. The project management techniques that
are useful and effective in this regard would also be highlighted.
1.7 Significance
The significance of the study lies in the fact that on the basis of the results of the study
important changes can be brought about in practice of undertaking surgery for treating
adolescence idiopathic scoliosis. Healthcare organizations can consider changes in project
management practice in this regard and consider resource allocation accordingly.

7BIOMEDICAL ENGINEERING
Chapter 2: Literature review
2.1 Concept of management
Following a robust management method is pivotal in the successful completion of
surgery in healthcare settings. The healthcare landscape is changing in a rapid manner and an
increased focus is being given at present on access to quality care, reduction of care costs and
prevention of surgical complications. Despite immense opportunities for healthcare professionals
to engage in care techniques, varied constraints hamper progress to a considerable extent. Herein
lays the need of a strong project management strategy that involves application of suitable tools,
skills, knowledge and techniques for project activities for meeting the goal of care being
provided. Project management reflects the domains of quality, scope, integration, cost,
procurement, human resources, communications and risk management (Shirley, 2016).
Project management is referred to the practice of initiation, planning, execution, control
and closing of a work to achieve a set of goals and to meet a set of criteria within a stipulated
time. Such a management approach is needed for producing an end-result that suits the purpose
of the task being done. Healthcare practices such as surgeries are a leading domain at the
contemporary era and is growing effectively. With the shift towards need of safe practices the
need of effective management is harnessed. Cost of healthcare practices is also an issue at
present as a large number of advanced tools and aids are costly to be used at large (Ginter, 2018).
For effectively fulfilling their goals of better patient outcomes, surgeons treating
adolescence idiopathic scoliosis choose to work in teams of clinician from different fields.
Though teams augment the ability and skills of a surgeon in the care process, the added role of
addressing group workflow and managing team dynamics might pose significant challenges. For