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Katz AD, Song J, Hasan S, Galina JM, Virk S, Silber JS, Essig D, Sarwahi V. Navigated versus conventional pediatric spinal deformity surgery: Navigation independently predicts reoperation and infectious complications. J Craniovertebr Junction Spine 2023; 14:165-174. [PMID: 37448507 PMCID: PMC10336894 DOI: 10.4103/jcvjs.jcvjs_28_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/09/2023] [Indexed: 07/15/2023] Open
Abstract
Context Literature on treating pediatric spinal deformity with navigation is limited, particularly using large nationally represented cohorts. Further, the comparison of single-institution data to national-level database outcomes is also lacking. Aim (1) To compare navigated versus conventional posterior pediatric deformity surgery based on 30-day outcomes and perioperative factors using the National Surgical Quality Improvement Program (NSQIP) database and (2) to compare the outcomes of the NSQIP navigated group to those of fluoroscopy-only and navigated cases from a single-institution. Settings and Design Retrospective cohort study. Subjects and Methods Pediatric patients who underwent posterior deformity surgery with and without navigation were included. Primary outcomes were 30-day readmission, reoperation, morbidity, and complications. The second part of this study included AIS patients < 18 years old at a single institution between 2015 and 2019. Operative time, length of stay, transfusion rate, and complication rate were compared between single-institution and NSQIP groups. Statistical Analysis Used Univariate analyses with independent t-test and Chi-square or Fisher's exact test was used. Multivariate analyses through the application of binary logistic regression models. Results Part I of the study included 16,950 patients, with navigation utilized in 356 patients (2.1%). In multivariate analysis, navigation predicted reoperation, deep wound infection, and sepsis. After controlling for operative year, navigation no longer predicted reoperation. In Part II of the study, 288 single institution AIS patients were matched to 326 navigation patients from the NSQIP database. Operative time and transfusion rate were significantly higher for the NSQIP group. Conclusions On a national scale, navigation predicted increased odds of reoperation and infectious-related events and yielded greater median relative value units (RVUs) per case but had longer operating room (OR) time and fewer RVUs-per-minute. After controlling for operative year, RVUs-per-minute and reoperation rates were similar between groups. The NSQIP navigated surgery group was associated with significantly higher operative time and transfusion rates compared to the single-institution groups.
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Affiliation(s)
- Austen D. Katz
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Junho Song
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Sayyida Hasan
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Jesse M. Galina
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Sohrab Virk
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Jeff Scott Silber
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - David Essig
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Vishal Sarwahi
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
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Chotigavanichaya C, Adulkasem N, Pisutbenya J, Ruangchainikom M, Luksanapruksa P, Wilartratsami S, Ariyawatkul T, Korwutthikulrangsri E. Comparative effectiveness of different pedicle screw density patterns in spinal deformity correction of small and flexible operative adolescent idiopathic scoliosis: inverse probability of treatment weighting analysis. Eur Spine J 2023:10.1007/s00586-023-07615-6. [PMID: 36995418 DOI: 10.1007/s00586-023-07615-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 01/30/2023] [Accepted: 02/18/2023] [Indexed: 03/31/2023]
Abstract
PURPOSES An optimal pedicle screw density for spinal deformity correction in adolescent idiopathic scoliosis (AIS) remains poorly defined. We compared radiographic correction, operative time, estimated blood loss, and implant cost among different screw density patterns in operatively treated AIS patients. METHODS A retrospective observational cohort study of AIS patients who underwent posterior spinal fusion using all-pedicle screw instrumentation was conducted from January 2012 to December 2018. All patients were categorized into three different pedicle screw density groups: the very low density (VLD), the low density (LD), and the high density (HD) group. The comparative effectiveness between each pairwise comparison was performed under the inverse probability of the treatment weighting method to minimize the possible confounders imbalance among treatment groups. The primary endpoints in this study were the degrees of correction and deformity progression at 2 years postoperatively. RESULTS A total of 174 AIS patients were included in this study. The adjusted treatment effects demonstrated similar degrees of deformity correction after 2 years in the three treatment groups. However, the VLD and LD group slightly increased the curve progression at 2 years compared to the HD group by 3.9° (p = 0.005) and 3.2° (p = 0.044), respectively. Nevertheless, the limited screw density patterns (VLD and LD) significantly reduced the operative time, estimated blood loss, and implant cost per operated level. CONCLUSION The limited pedicle screw pattern (VLD and LD) in relatively flexible AIS spinal deformity correction results in similar coronal and sagittal radiological outcomes while reducing operative time, estimated blood loss, and implant cost compared to the high-density pedicle screw instrumentation.
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Affiliation(s)
- Chatupon Chotigavanichaya
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Nath Adulkasem
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Jirachai Pisutbenya
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Monchai Ruangchainikom
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Panya Luksanapruksa
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Sirichai Wilartratsami
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Thanase Ariyawatkul
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Ekkapoj Korwutthikulrangsri
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
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153
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Li J, Lin Z, Ma Y, Li W, Yu M. How to make a more optimal surgical plan for Lenke 5 adolescent idiopathic scoliosis patients: a comparative study based on the changes of the sagittal alignment and selection of the lowest instrumented vertebra. J Orthop Surg Res 2023; 18:224. [PMID: 36944979 PMCID: PMC10032010 DOI: 10.1186/s13018-023-03680-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/05/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The treatment of patients with Lenke 5 adolescent idiopathic scoliosis (AIS) is closely related to the pelvic because the spine-pelvis is an interacting whole. Besides, the choice of fusion segment is a significant issue; with the optimal choice, there will be fewer complications and restoring the pelvic morphology to some extent. This study aims to analyze the impact of changes in sagittal parameters and selection of the lowest instrumented vertebra (LIV) on spine and pelvic morphology for better surgical strategy. METHOD Ninety-four patients with Lenke 5 AIS who underwent selective posterior thoracolumbar/lumbar (TL/L) curve fusion were included in the study and grouped according to pelvic morphology and position of LIV. Spinopelvic parameters were measured preoperatively, postoperatively, and at the latest follow-up. The patient's preoperative and last follow-up quality of life was assessed with the MOS item short-form health survey (SF-36) and scoliosis research society 22-item (SRS-22). RESULT Patients being posterior pelvic tilt had the oldest mean age (P = 0.010), the smallest lumbar lordosis (LL) (P = 0.036), the smallest thoracic kyphosis (TK) (P = 0.399) as well as the smallest proximal junctional angle (PJA) while those being anterior pelvic tilt had the largest PJA. The follow-up TK significantly increased in both groups of anterior and normal pelvic tilt (P < 0.039, P < 0.006) while no significant changes were observed in the posterior pelvic tilt group. When LIV is above L4, the follow-up PJA was larger than other groups (P = 0.049, P = 0.006). When LIV is below L4, the follow-up TK and PT were larger and LL was smaller than other groups(P < 0.05). The SF-36 and SRS-22 scores were better in the LIV = L4 group than in other groups at the last follow-up (P < 0.05). CONCLUSION The correction of TK and LL after surgery can improve pelvic morphology. Besides, LIV is best set at L4, which will facilitate the recovery of TK, the improvement of symptoms, and the prevention of complications and pelvic deformities. Level of evidence Level III.
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Affiliation(s)
- Junyu Li
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing, China
| | - Zhengting Lin
- Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, 100191, Beijing, China
| | - Yinghong Ma
- Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, 100191, Beijing, China
| | - Weishi Li
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing, China
| | - Miao Yu
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing, China.
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154
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Okuwaki S, Kotani T, Sunami T, Sakuma T, Iijima Y, Okuyama K, Akazawa T, Inage K, Shiga Y, Minami S, Ohtori S, Yamazaki M. Associated factors and effects of coronal vertebral wedging angle in thoracic adolescent idiopathic scoliosis. J Orthop Sci 2023:S0949-2658(23)00074-X. [PMID: 36934061 DOI: 10.1016/j.jos.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) causes vertebral wedging, but associated factors and the impact of vertebral wedging are still unknown. We investigated associated factors and effects of vertebral wedging in AIS using computed tomography (CT). METHODS Preoperative patients (n = 245) with Lenke types-1 and 2 were included. Vertebral wedging, lordosis, and rotation of the apical vertebra were measured by preoperative CT. Skeletal maturity and radiographic global alignment parameters were evaluated. Multiple regression analysis was performed on associated factors for vertebral wedging. Side-bending radiographs were evaluated using multiple regression analysis to calculate the percentage of reduction of Cobb angles to determine curve flexibility. RESULTS The mean vertebral wedging angle was 6.8 ± 3.1°. Vertebral wedging angle was positively correlated with proximal thoracic (r = 0.40), main thoracic (r = 0.54), and thoracolumbar/lumbar curves (r = 0.38). By multiple regression, the central sacral vertical line (p = 0.039), sagittal vertical axis (p = 0.049), main thoracic curve (p = 0.008), and thoracolumbar/lumbar curve (p = 0.001) were significant factors for vertebral wedging. In traction and side-bending radiographs there were positive correlations between curve rigidity and the vertebral wedging angle (r = 0.60, r = 0.59, respectively). By multiple regression, thoracic kyphosis (p < 0.001), lumbar lordosis (p = 0.013), sacral slope (p = 0.006), vertebral wedging angle (p = 0.003), and vertebral rotation (p = 0.002) were significant factors for curve flexibility. CONCLUSIONS Vertebral wedging angle was found to be highly correlated to coronal Cobb angle, with larger vertebral wedging indicating less flexibility.
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155
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Lee CS, Hwang CJ, Lee DH, Cho JH, Park S. Risk Factors and Exit Strategy of Intraoperative Neurophysiological Monitoring Alert During Deformity Correction for Adolescent Idiopathic Scoliosis. Global Spine J 2023:21925682231164344. [PMID: 36916149 DOI: 10.1177/21925682231164344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To elucidate the risk factors of intraoperative neurophysiological monitoring (IONM) alert during deformity correction surgery for adolescent idiopathic scoliosis (AIS) and to describe the outcomes of patients who underwent staged correction surgery due to IONM alert during the initial procedure. METHODS We reviewed 1 024 patients with idiopathic scoliosis who underwent deformity correction and were followed-up for ≥1 year. The pre-and postoperative Cobb angle of the major structural curve, operative time, estimated blood loss (EBL), number of levels fused, event that caused the IONM alert, and intervention required for the recovery of the signal were recorded. Patients who received IONM alerts (alert group) and those who did not (non-alert group) during the operation were compared. RESULTS Compared to the non-alert group, the alert group had a significantly greater preoperative Cobb angle of the major structural curve (P < .001), number of levels fused (P = .003), operative time (P < .001), and EBL (P < .001). The percentage of correction did not significantly differ between the 2 groups (P = .348). Eight patients (.8%) underwent a staged operation because the IONM signal alert hindered correction of the deformity. The percentage of correction of patients who underwent staged operation was 64.9 ± 15.1%, and no permanent neurologic deficits occurred. CONCLUSIONS A greater magnitude of preoperative deformity and surgical extent increases the risk of cord injury identified by IONM alerts during correction of deformities in patients with AIS. However, in patients in whom the IONM alert cannot be recovered or reproduced by proceeding with deformity correction, surgeons can minimize the risk by aborting the initial procedure and completing the correction using staged operations.
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Affiliation(s)
- Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang-Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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156
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Ng PTT, Straker L, Tucker K, Izatt MT, Claus A. Advancing Use of DEXA Scans to Quantitatively and Qualitatively Evaluate Lateral Spinal Curves, for Preliminary Identification of Adolescent Idiopathic Scoliosis. Calcif Tissue Int 2023; 112:656-665. [PMID: 36907926 DOI: 10.1007/s00223-023-01075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023]
Abstract
Dual-energy X-ray absorptiometry (DEXA) scan is an emerging screening method for identifying likely adolescent idiopathic scoliosis (AIS). Using DEXA in an unbiased population sample (the Raine Study), we aimed to report the inter-rater reliability and minimal detectable change (MDC95) for scoliosis curve angle measurement, identify likely AIS prevalence, and the concordance between reported AIS diagnosis and DEXA-identified likely AIS. Scoliosis curve angles were measured using the modified Ferguson method on DEXA scans (n = 1238) at age 20 years. For curve angle inter-rater reliability, two examiners measured angles (6-40°) on 41 scans. Likely, AIS was determined with quantitative and qualitative criteria (modified Ferguson angles ≥ 10° and expert review of spinal curves).The inter-rater reliability for scoliosis curve angle measurement was good-excellent (ICC: 0.82; 95% CI: 0.71-0.89; p < 0.001), and MDC95 was 6.2°. The prevalence of likely AIS was 2.1% (26/1238). Diagnosis of AIS was reported despite little or no scoliosis curve (< 3.8°) for 20 participants (1.6%), and diagnosis of AIS was not reported despite scoliosis curve ≥ 10° for 11 participants (0.9%). Results support the use of modified Ferguson method to measure scoliosis curve angles on DEXA. There is potential utility for using a combination of quantitative measurement and qualitative criteria to evaluate DEXA images, to identify likely AIS for reporting prevalence. Without formal school screening, the analysis of DEXA in this population sample suggested that relying on current health professional diagnosis alone could result in 2.5% of this cohort being at risk of false positive diagnosis or delay in necessary management due to non-diagnosis of AIS.
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Affiliation(s)
- P T T Ng
- Laboratory for Motor Control and Pain Research, School of Biomedical Sciences, The University of Queensland, St. Lucia, Brisbane, QLD, Australia.
- Physiotherapy Department, KK Women's and Children's Hospital, Singapore, Singapore.
| | - L Straker
- School of Allied Health, Curtin University, Bentley, Perth, WA, Australia
| | - K Tucker
- Laboratory for Motor Control and Pain Research, School of Biomedical Sciences, The University of Queensland, St. Lucia, Brisbane, QLD, Australia
| | - M T Izatt
- Biomechanics and Spine Research Group, Queensland University of Technology at the Centre for Children's Health Research, South Brisbane, Brisbane, QLD, Australia
| | - A Claus
- School of Health & Rehabilitation Sciences, The University of Queensland, St. Lucia, Brisbane, QLD, Australia
- Tess Cramond Pain and Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
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157
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Colón LF, Powell C, Wilson A, Burgan T, Quigley R. Rapid recovery pathway without epidural catheter analgesia for surgical treatment of adolescent idiopathic scoliosis: a comparative study. Spine Deform 2023; 11:373-81. [PMID: 36152234 DOI: 10.1007/s43390-022-00587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/10/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To assess effectiveness of a rapid recovery pathway (RRP) without epidural catheter analgesia (ECA) or intravenous patient controlled analgesia (PCA) in accelerating recovery and decreasing opioid consumption in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF). METHODS A retrospective cohort study included collection of demographics, ECA use, IV PCA, postoperative opioid consumption, postoperative pain scores, and reoperation rate. Opioid consumption was calculated using morphine milligram equivalents (MME). Hospital length of stay (HLOS) and first reported ambulation with physical therapy (PT) were also recorded. RESULTS 53 patients were included, with 18 in the RRP group. Patient characteristics were comparable between the groups, except in ECA use and BMI. The RRP group consumed less total MME from postoperative day (POD) 0 to 2 (mean difference 61.6 MME; 95% CI 37.1-86.1 MME; p < 0.001). In addition, the RRP group had significantly shorter HLOS (2.5 vs 4.0 days; p < 0.001). There were no differences in VAS scores between the two groups. A subset analysis comparing patients who did and did not receive ECA showed that ECA resulted in overall higher inpatient MME and HLOS. A prediction model was developed using multiple regression based on the different medications used for multimodal analgesia (MMA) in the RRP. CONCLUSIONS An RRP without the use of ECA or IV PCA can provide adequate analgesia in patients with AIS undergoing PSF while lowering inpatient narcotic consumption and accelerating immediate postoperative recovery.
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158
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Cherian D, Anderson JT, Price N, Sherman A. Surgeon and SterEOS agreement of spinal sagittal plane parameters in patients with adolescent idiopathic scoliosis. Spine Deform 2023; 11:335-340. [PMID: 36318383 DOI: 10.1007/s43390-022-00606-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/17/2022] [Indexed: 02/10/2023]
Abstract
PURPOSE To compare agreement between surgeons and sterEOS sagittal plane measurements. METHODS EOS radiographs of 74 patients with adolescent idiopathic scoliosis were reviewed. The measurements were generated by two surgeons and compared to sterEOS. Intraclass correlations (ICC) were calculated. Agreement was also analyzed for the following subgroups: Cobb angle < 70° vs ≥ 70°, lumbar modifier A vs B/C, and BMI of < 24.5 kg/m2 vs ≥ 24.5 kg/m2. Agreement was poor if the ICC was < 0.5, moderate if 0.5-0.75, good if 0.75-0.9, and excellent if > 0.9. Paired t tests were performed to compare the surgeon's and sterEOS means. RESULTS For the surgeons, agreement was good (0.75-0.89) except for pelvic tilt (PT) and sacral slope (SS), which were excellent (0.91-0.92). Agreement between the surgeons and sterEOS were good (0.78-0.9) except PT and SS, which were excellent (0.91-0.93). Agreement was negatively affected for T4-T12 kyphosis, PI, and SS in the ≥ 70°group, LL when BMI was ≥ 24.5 kg/m2, and LL, PI, and SS in the lumbar modifier B/C group. The ICCs overlapped with the 95% confidence intervals (95% CI). Paired t-test showed a significant difference for T4-T12 kyphosis (p < 0.001). This was also true in the < 70° group (p < 0.001), the ≥ 70° group (p = 0.04), and the BMI < 24.5 kg/m2 group. PT was significantly different for the ≥ 70° group. CONCLUSIONS There was good to excellent agreement between the surgeons and surgeons and sterEOS. Some variables may affect agreement. The surgeons overestimated T4-T12 kyphosis.
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Affiliation(s)
- Daniel Cherian
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, MO, USA
| | - John T Anderson
- Department of Orthopaedic Surgery, Section of Spine Surgery, University of Missouri-Kansas City School of Medicine, Children's Mercy-Kansas City, 2401 Gillham Rd. 2nd floor Annex, Kansas City, MO, 64108, USA.
| | - Nigel Price
- Department of Orthopedics and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Ashley Sherman
- Health Services and Outcomes Research, Children's Mercy-Kansas City, Kansas City, MO, USA
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Shin JI, Leggett AR, Berg AR, Kaushal NK, Vives MJ. Efficacy and safety of intrawound antibiotics in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis: a nationwide database study. Spine Deform 2023; 11:313-8. [PMID: 36178631 DOI: 10.1007/s43390-022-00585-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/10/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To assess the efficacy and safety of intrawound antibiotics in posterior fusions for adolescent idiopathic scoliosis (AIS). METHODS The NSQIP-Pediatric databases 2016-2018 were utilized. Patients 10 years of age or older with AIS who underwent posterior fusion were selected and divided into two cohorts based on the receipt of intrawound antibiotics. Patient characteristics and complications were compared. Multivariate analyses were performed to determine the efficacy and safety of intrawound antibiotics. RESULTS A total of 4203 patients received intrawound antibiotics while 879 patients did not. The intrawound antibiotic group had longer constructs, higher blood loss, and longer operative times, factors historically associated with higher infection rates. Those that received intrawound antibiotics had SSI rate of 0.69%, while its counterpart had 0.57% (p = 0.689). The reoperation rates were 1.12% and 1.25% (p = 0.735), for those with and without intrawound antibiotics, respectively. In multivariate analyses, intrawound antibiotics use was not found to be a significant predictor for SSI, any complications, reoperation and readmission. CONCLUSION The current study represents the largest AIS surgery cohort studied to evaluate the efficacy of intrawound antibiotics. Our analysis failed to demonstrate association between the use of intrawound antibiotics and reduction in SSI. While other studies have reported seroma, wound dehiscence and renal failure with the practice, we did not observe an increased rate of such complications. This study highlights the difficulty of understanding the role for individual infection prevention measures in current surgical settings, where the SSI rate for the control group was substantially lower than 1%.
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160
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Nokariya S, Kotani T, Sakuma T, Iijima Y, Okumura T, Katogi T, Okuwaki S, Miyagi M, Inoue G, Akazawa T, Shiga Y, Minami S, Ohtori S, Takaso M. Trunk flexibility using a sit-and-reach test after surgery for adolescent idiopathic scoliosis. Spine Deform 2023; 11:297-303. [PMID: 36331800 DOI: 10.1007/s43390-022-00608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Spinal fusion reduces flexibility, but we do not have detailed knowledge that accounts for growth or sex differences. We sought to determine trunk flexibility pre- and postoperatively in patients with adolescent idiopathic scoliosis (AIS). METHODS We included data from 109 patients with AIS in this retrospective, single-center observational study. Patients had performed a sit-and-reach (SR) test preoperatively, and 1 and 2 years postoperatively, and measurements were standardized to Z scores according to age and sex. The patient data were divided into three groups according to the level of lower instrumented vertebra (LIV): (1) Group A (fusion above L2); (2) Group B (fusion to L2), and (3) Group C (fusion to L3 or L4). The change in the Z score for various levels was determined and compared. RESULTS The preoperative Z score for all patients was -0.622. At 2 years postoperatively, the Z score in Groups A and B was not significantly different from the preoperative score; in Group C, the Z score decreased by 1 year postoperatively, improved during the second year, but remained significantly lower than the preoperative score. Our study was the first to assess trunk flexibility using the SR test in patients with scoliosis. CONCLUSIONS Preoperatively, patients with AIS had lower SR test Z-scores than the general population, indicating a lower trunk flexibility in these patients. At 2 years after surgery in these patients, trunk flexibility had returned to preoperative levels when LIV was at L2 or above, but when LIV was at L3 or L4, trunk flexibility was less than it was preoperatively. LEVEL OF EVIDENCE Prognostic Level II: retrospective study.
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Affiliation(s)
- Shun Nokariya
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai Sakura-Shi, Sakura, Chiba, 285-8765, Japan
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai Sakura-Shi, Sakura, Chiba, 285-8765, Japan.
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai Sakura-Shi, Sakura, Chiba, 285-8765, Japan
| | - Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai Sakura-Shi, Sakura, Chiba, 285-8765, Japan
| | - Taro Okumura
- Department of Physical Therapy, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Takehide Katogi
- Department of Physical Therapy, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Shun Okuwaki
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai Sakura-Shi, Sakura, Chiba, 285-8765, Japan
| | - Masayuki Miyagi
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Gen Inoue
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tsutomu Akazawa
- Department of Orthopedic Surgery, School of Medicine, St. Marianna University, Kawasaki, Japan
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai Sakura-Shi, Sakura, Chiba, 285-8765, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masashi Takaso
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Tetreault T, Darland H, Vu A, Carry P, Garg S. Adolescent athletes return to sports rapidly after posterior spine fusion for idiopathic scoliosis: a prospective cohort study. Spine Deform 2023; 11:383-390. [PMID: 36197603 DOI: 10.1007/s43390-022-00592-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 09/17/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE No consensus exists regarding the timing for return to sports after PSF for patients with AIS. Return-to-play protocols are based on expert opinion and vary widely. The purpose of this study was to determine how rapidly athletes return to baseline sports activity following posterior spinal fusion for adolescent idiopathic scoliosis. METHODS Athletes were consecutively enrolled. Inclusion criteria included competition at a junior varsity level or greater for ≥ 3 months yearly, major Cobb angle of 40-75°, age 10-18 years, and one year of follow-up. Athletes completed preoperative sports performance and Patient Reported Outcomes Measurement Information System (PROMIS) physical activity, pain interference, and depressive symptoms questionnaires. Self-assessments were repeated monthly until one year after PSF. RESULTS Twenty-six athletes were enrolled. The median time to return to sport was 2.7 months [range: 0.6-13 months]. At twelve months, 24 of 26 [90.1%; 95% CI 36.9-74.9%] athletes reported they had returned to the sport at their presurgical level of play. Participation in contact sports was associated with a longer return to sport relative to participation in non-contact/limited contact sports [Hazard Ratio: 0.37, 95% 95% CI 0.14-0.97, p = 0.0427]. Conditioning and flexibility were the most common barriers to return to sport. CONCLUSIONS When released to unrestricted activity at 4-8 weeks, athletes rapidly return to baseline levels of sports performance, with over half achieving this metric by 3 months.
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Affiliation(s)
- Tyler Tetreault
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hannah Darland
- Department of Pediatric Orthopedics, Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO, 80045, USA
| | - Angela Vu
- Department of Pediatric Orthopedics, Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO, 80045, USA
| | - Patrick Carry
- Department of Pediatric Orthopedics, Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO, 80045, USA
| | - Sumeet Garg
- Department of Pediatric Orthopedics, Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO, 80045, USA.
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162
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Berlin C, Quante M, Halm H. Influence of posterior instrumented correction with pedicle screw dual rod systems on thoracic kyphosis in Lenke 1 and 2 curves: minimum 2 years follow-up. Eur Spine J 2023; 32:1187-1195. [PMID: 36856867 DOI: 10.1007/s00586-023-07617-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/13/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) often correspond with hypo thoracic kyphosis (TK) or even lordosis. The aim of this study was to analyze the influence of posterior instrumentation in thoracic AIS. METHODS Analysis of prospectively collected AIS-data with structural thoracic curves (Lenke type 1 & 2), operated 2010-2019 with pedicle screw dual rod systems in one scoliosis center. Follow-up (FU) minimum 24 months. Coronal and sagittal angles measured based on standing long-cassette-X-rays: thoracic major (MC), proximal thoracic (PC) and lumbar curve (LC), TK, lumbar lordosis (LL). STATISTICAL ANALYSIS values as mean ± SD, differences by student's t-test (significancy a = 0.05), Pearson's correlation, sub-analysis with sagittal modifier (-, N, +). RESULTS A total of 127 AIS could be identified (63% type 1, 37% type 2). Mean FU 32.2 ± 16.6 months, mean age 14 ± 1.5 years. Mean Correction of MC 73 ± 12%, PC 51 ± 17%, LC 69 ± 21% with a significantly better correction of PC in Lenke 2 curves(p < 0.05). On average, TK (FU-preop) decreased by -2.1 ± 12.1°(p < 0.05) in all AIS. Whereas TK in type 1 was unchanged (p = 0.9), TK significantly decreased by - 6.0 ± 12.7°(p < 0.05) in type 2. No significant difference in LL. TK in hypokyphotic cases increased by 9.5 ± 5.5°(p < 0.05), stayed almost unchanged (- 1.4 ± 9.1°,p = 0.2) in normokyphotic, decreased by - 17.2 ± 14.2°(p < 0.05) in hyperkyphotic cases. Only hypokyphotic cases had a moderately strong correlation between correction of LC (r = 0.6) and PC (r = - 0.4) (frontal plane) and change from pre- to postoperative TK (sagittal plane) (r = 0.6). No relevant correlations for normo- and hyperkyphotic AIS. Postoperative hypokyphosis was significantly more often in Lenke 2 (16.3% vs. 2.6%, p < 0.05). Rod diameter (5,5 mm versus 6 mm) had no significant influence. CONCLUSION Significant correction of hypo- and hyperkyphosis can be achieved with posterior spinal fusion (pedicle screw dual rod systems), whereas normokyphotic spines stay unchanged. However, Lenke 2 curves have a significantly higher risk for a postoperative thoracic hypokyphosis.
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Affiliation(s)
- Clara Berlin
- Spine Surgery with Scoliosis Center, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany.
| | - Markus Quante
- Spine Surgery with Scoliosis Center, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany
| | - Henry Halm
- Spine Surgery with Scoliosis Center, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany
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163
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Joarder I, Taniguchi S, Mendoza A, Snow ME. Defining "successful" treatment outcomes in adolescent idiopathic scoliosis: a scoping review. Eur Spine J 2023; 32:1204-1244. [PMID: 36847911 DOI: 10.1007/s00586-023-07592-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/07/2023] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis that affects children aged 10-18 years old, manifesting in a three-dimensional spinal deformity. This study aimed to explore outcome measures used in defining AIS treatment success. Particularly, analyzing the extent of qualitative and quantitative (radiographic and quality of life domains) measures to evaluate AIS and whether AIS treatment approaches (surgical, bracing and physiotherapy) influences outcomes used as proxies of treatment success. METHODS EMBASE and MEDLINE databases were used to conduct a systematic scoping review with 654 search queries. 158 papers met the inclusion criteria and were screened for data extraction. Extractable variables included: study characteristics, study participant characteristics, type of study, type of intervention approach and outcome measures. RESULTS All 158 studies measured quantitative outcomes. 61.38% of papers used radiographic outcomes whilst 38.62% of papers used quantitative quality of life outcomes to evaluate treatment success. Irrespective of treatment intervention utilized, the type of quantitative outcome measure recorded were similar in proportion. Moreover, of the radiographic outcome measures, the subcategory Cobb angle was predominantly used across all intervention approaches. For quantitative quality of life measures, questionnaires investigating multiple domains such as SRS were primarily used as proxies of AIS treatment success across all intervention approaches. CONCLUSION This study identified that no articles employed qualitative measures of describing the psychosocial implications of AIS in defining treatment success. Although quantitative measures have merit in clinical diagnoses and management, there is increasing value in using qualitative methods such as thematic analysis in guiding clinicians to develop a biopsychosocial approach for patient care.
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Affiliation(s)
- Ishraq Joarder
- Faculty of Medicine, University of British Columbia, #908 - 2233 Allison Road, Vancouver, BC, V6T 1T7, Canada.
| | - Seika Taniguchi
- Faculty of Medicine, University of British Columbia, #908 - 2233 Allison Road, Vancouver, BC, V6T 1T7, Canada
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Erşen Ö, Yüzügüldü U, Başak AM, Güveli R, Ege T. Effect of clinical and radiological parameters on the quality of life in adult patients with untreated adolescent idiopathic scoliosis: a cross-sectional study. Eur Spine J 2023; 32:1196-1203. [PMID: 36797417 DOI: 10.1007/s00586-023-07571-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE The aim of this study is to evaluate the factors that affect health-related quality of life (HRQoL) in untreated adolescent idiopathic scoliosis (AIS) patients in adulthood. We investigate the effect of clinical and radiological parameters on the SRS-22 results. METHODS A total of 286 untreated adolescent idiopathic scoliosis patients at adult age between April 2021 and April 2022 who were admitted to our clinic were included in the study. Rotational deformities were evaluated with a scoliometer. Cobb angles, coronal balance, clavicle angle, coronal pelvic tilt, trunk shift, and apical vertebral translation were measured in standing anteroposterior X-rays. The effect of each clinical and radiological parameter on SRS-22 results was evaluated. RESULTS No correlation was found between gender, age, curve type, presence of gibbosity or diagnosis time, and SRS-22 scores. A negative correlation was found between the BMI of the patients and the self-image scores (r = - 0.246, p < 0.01) and function scores (r = - 0.193, p < 0.05). Main thoracic (MT) gibbosity negatively correlates with self-image and total SRS-22 scores. Also, negative correlations were found between lumbar/thoracolumbar (LTL) gibbosity, function, and pain scores. MT Cobb angle magnitude was negatively correlated with self-image, mental health, and total SRS-22 scores. There were negative correlations between clavicle angle and mental health score, coronal pelvic tilt and self-image score, and apical vertebral translation and pain score. CONCLUSION BMI, MT gibbosity, LTL gibbosity, MT Cobb angle, clavicle angle, coronal pelvic tilt, and apical vertebral translation were negatively correlated with SRS-22 domains in untreated AIS patients in adulthood.
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Affiliation(s)
- Ömer Erşen
- Department of Orthopedics, Gülhane School of Medicine, Health Sciences University, Ankara, Turkey.
| | - Uğur Yüzügüldü
- Department of Orthopedics, Gülhane School of Medicine, Health Sciences University, Ankara, Turkey
| | - Ali Murat Başak
- Department of Orthopedics, Gülhane School of Medicine, Health Sciences University, Ankara, Turkey
| | - Rıfat Güveli
- Department of Public Health, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Tolga Ege
- Department of Orthopedics, Gülhane School of Medicine, Health Sciences University, Ankara, Turkey
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165
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Zhang M, Chen W, Wang S, Du Y, Zhang J, Pu F. Correlation between supine flexibility and postoperative correction in adolescent idiopathic scoliosis. BMC Musculoskelet Disord 2023; 24:126. [PMID: 36793065 PMCID: PMC9930213 DOI: 10.1186/s12891-023-06227-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The preoperative flexibility of the scoliotic spine is a key aspect of surgical planning, as it provides information on the rigidity of the curve, the extent of structural changes, the levels to be fused and the amount of correction. The purpose of this study was to assess whether supine flexibility can be used to predict postoperative correction in patients with adolescent idiopathic scoliosis (AIS) by determining the correlation between these two characteristics. METHODS A total of 41 AIS patients who underwent surgical treatment between 2018 and 2020 were retrospectively enrolled for analysis. Preoperative and postoperative standing radiographs and preoperative CT images of the entire spine were collected and used to measure supine flexibility and the postoperative correction rate. T tests were used to analyse the differences in supine flexibility and postoperative correction rate between groups. Pearson's product-moment correlation analysis was performed, and regression models were established to determine the correlation between supine flexibility and postoperative correction. Thoracic curves and lumbar curves were analysed independently. RESULTS Supine flexibility was found to be significantly lower than the correction rate but showed a strong correlation with the postoperative correction rate, with r values of 0.68 for the thoracic curve group and 0.76 for the lumbar curve group. The relationship between supine flexibility and postoperative correction rate could be expressed by linear regression models. CONCLUSION Supine flexibility can be used to predict postoperative correction in AIS patients. In clinical practice, supine radiographs may be used in place of existing flexibility test techniques.
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Affiliation(s)
- Mingzheng Zhang
- grid.64939.310000 0000 9999 1211Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China ,grid.490276.eBeijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Neuro-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Wenxuan Chen
- grid.64939.310000 0000 9999 1211Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shengru Wang
- grid.506261.60000 0001 0706 7839The Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - You Du
- grid.506261.60000 0001 0706 7839The Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jianguo Zhang
- The Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Fang Pu
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
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González-Ruiz JM, Bastir M, Pizones J, Palancar CA, Toro-Ibacache V, García Alfaro MD, Moreno Manzanaro L, Sánchez Márquez JM, Pérez Núñez MI. Vitamin D and adolescent idiopathic scoliosis, should we stop the hype? A cross-sectional observational prospective study based on a geometric morphometrics approach. Eur Spine J 2023;:1-8. [PMID: 36764946 DOI: 10.1007/s00586-023-07566-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/26/2022] [Accepted: 01/25/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE There is strong evidence supporting the presence of fluctuating asymmetry (FA) in Adolescents with Idiopathic Scoliosis (AIS). Additionally, recent research investigating the relationship between vitamin D and AIS found a relation between them. We hypothesize a negative correlation between FA and vitamin D. METHODS We performed a surface scan of the torso of 53 AIS patients, a blood test to measure vitamin D and the radiographic Cobb angle. A correlation analysis between vitamin D and FA was carried out to test our hypothesis, and a regression of vitamin D on 3D shape was performed to observe shape differences between the vitamin D deficiency and insufficiency groups. RESULTS There was no correlation between vitamin D and FA. We found a strong negative correlation between vitamin D and the Cobb angle only in the premenarche group (n = 7; r = - 0.92). Differences in shape were observed between the deficiency and insufficiency groups, and that differences were related to the width of the torso, but not the rotation or lateral flexion. CONCLUSIONS Our results do not support the massive screening of vitamin D in AIS. Shape analysis revealed differences between the shape of the deficiency and insufficiency groups related to robustness. However, this finding had no relation with the scoliosis characteristics, it just reflected different body composition, and its importance should be explored in future.
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167
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Sakti YM, Lanodiyu ZA, Ichsantyaridha M, Wijanarko S, Filza MR, Taufan T, Susanto DB, Tampubolon YO, Baskara AANN, Nurshal AA, Mustofa FD, Rosfadilla A, Magetsari R, Rukmoyo T. Pedicle morphometry analysis of main thoracic apex adolescent idiopathic scoliosis. BMC Surg 2023; 23:34. [PMID: 36759804 PMCID: PMC9912543 DOI: 10.1186/s12893-022-01877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/05/2022] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Screw insertion during scoliosis surgery uses free-hand pedicle screw insertion methods. However, there is a wide variation in pedicle shapes, sizes, and morphometry, especially in scoliosis patients. CT scan pedicle measurements in main thoracic Lenke type 1 adolescent idiopathic scoliosis can help visualize this diversity. This study aimed to highlight the features of pedicle morphometry on the concave and convex sides, including pedicle diameter (width in axial and height in the sagittal plane), the depth to the anterior cortex, and Watanabe Pedicle classification in patients with main thoracic apex adolescent idiopathic scoliosis. MATERIALS AND METHODS This study was a cross-sectional observational study of Adolescent Idiopathic Scoliosis (AIS) patients whose apex in the main thoracic patient underwent deformity correction procedures. We used a three-dimensional CT scan to evaluate pedicle morphometry on the apex vertebrae, three consecutive vertebrae above and below the apex. RESULTS A total of 6 patients with apex main thoracic AIS with 84 pedicles consisting of 42 pedicles from each concave and convex curve were analyzed. All of the samples were female, with the mean age at the procedure being 21.2 ± 5.56. The mean cobb angle was 62° ± 23°, with the main apex between VT8-VT10. The size of the pedicle was bigger from upper to lower vertebrae. The mean pedicle depth, pedicle width, and pedicle height for the concave side were 36.06 ± 4.31 mm, 3.91 ± 0.66 mm, and 9.16 ± 1.52 mm, respectively. Meanwhile, the convex side is 37.52 ± 1.84 mm, 5.20 ± 0.55 mm, and 11.05 ± 0.70 mm, respectively. We found a significant difference between the concave and convex sides for the pedicle width and height. The concave and convex sides were mainly classified as type C (38%) and type A (50%) Watanabe pedicle. CONCLUSION Pedicle width and pedicle height are significantly different between the concave and the convex side with convex side has better Watanabe pedicle classification. Pre-operative CT evaluation is essential for planning proper pedicle screw placement in AIS patients.
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Affiliation(s)
- Yudha Mathan Sakti
- Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia.
| | - Zikrina Abyanti Lanodiyu
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Mahardhika Ichsantyaridha
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Sonny Wijanarko
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Muhammad Riyad Filza
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Taufan Taufan
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Dwi Budhi Susanto
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Yunus Oksikimbawan Tampubolon
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Anak Agung Ngurah Nata Baskara
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Aidil Akbar Nurshal
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Fuad Dheni Mustofa
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Annissa Rosfadilla
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Rahadyan Magetsari
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Tedjo Rukmoyo
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
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Wu C, Ou W, Gao M, Li J, Liu Q, Kang Z, Wang H, Li Z, Wang X, Zhang S, Zhang Y, Jin F, Zhang K, Li X. Digital measurement and correlation analysis of coronal and sagittal anatomic parameters in the radiographs of adolescent patients with idiopathic scoliosis. Eur Spine J 2023; 32:1161-1172. [PMID: 36745261 DOI: 10.1007/s00586-023-07527-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/06/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To use digital software to measure the morphologic and anatomic parameters of adolescent idiopathic scoliosis (AIS). Differences and correlations among different parameters were compared to provide an anatomic basis for the selection of treatment methods and preoperative evaluation of AIS. METHODS Spinal radiographs were taken from 300 boys and girls (age, 10-18 years) suffering from idiopathic scoliosis in four grade-A hospitals in Inner Mongolia. After screening, 120 cases with complete imaging data were assessed. Imaging data were transferred to a work station (Dr Wise™). The anatomic indices of the Cobb Angle, CVA, AVT, TS, CA, CPT, CSI, FPT, CCA, TK, LL, SS, PT, and PI were measured. RESULTS There were significant differences in AVT between different grades and types of scoliosis (F = 34.079, P = 0.000; χ2 = 23.379, P = 0.000). AVT was a protective factor, and the smaller the AVT, the less severe was the scoliosis. Compared with adolescents with mild or moderate scoliosis, the Cobb angle of adolescents with severe scoliosis was negatively correlated with CCA, LL, and SS (r = - 0.641, p < 0.05; r = - 0.695, p < 0.01; r = - 0.814, p < 0.01). CONCLUSIONS Some of the anatomic parameters in the coronal and sagittal planes of adolescents with idiopathic scoliosis were significantly different according to the severity and type of scoliosis. Significant correlations were found between more anatomic indices in adolescents with severe scoliosis than in adolescents suffering from mild or moderate scoliosis.
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Affiliation(s)
- Chao Wu
- Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia, China
- Baotou Central Hospital, Baotou, 014040, Inner Mongolia, China
| | - Wenjing Ou
- Baotou Central Hospital, Baotou, 014040, Inner Mongolia, China
| | - Mingjie Gao
- Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia, China
| | - Jiawei Li
- Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia, China
| | - Qinghua Liu
- Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia, China
| | - Zhijie Kang
- Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia, China
| | - Haiyan Wang
- Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia, China
| | - Zhijun Li
- Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia, China
| | - Xing Wang
- Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia, China
| | - Shaojie Zhang
- Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia, China
| | - Yunfeng Zhang
- Department of Radiology, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010010, Inner Mongolia, China
| | - Feng Jin
- Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010010, Inner Mongolia, China
| | - Kai Zhang
- Department of Orthopedics, Ulanqab Second Hospital, Ulanqab, 011800, Inner Mongolia, China
| | - Xiaohe Li
- Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia, China.
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Akazawa T, Torii Y, Ueno J, Umehara T, Iinuma M, Yoshida A, Tomochika K, Ohtori S, Niki H. Accuracy of computer-assisted pedicle screw placement for adolescent idiopathic scoliosis: a comparison between robotics and navigation. Eur Spine J 2023; 32:651-658. [PMID: 36567341 DOI: 10.1007/s00586-022-07502-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare the accuracy of pedicle screw placement in adolescent idiopathic scoliosis (AIS) between robotics and navigation and clarify the factors that cause screw deviation when robotics is used. METHODS Fifty consecutive patients who underwent posterior spinal fusions with computer-assisted pedicle screw placement including robotics and navigation for AIS were included. A total of 741 pedicle screws (250: Robot group, 491: Navi group) were evaluated on postoperative CT images. A rate of penetration of ≥ 2 mm was calculated as the deviation rate. After propensity score matching, we examined vertebral levels, the distance from the reference frame (RF), and the pedicle channel grade as factors for deviation. RESULTS The deviation rate was significantly lower in the Robot group than in the Navi group (Robot group: 1.6%, Navi group: 7.5%). After propensity score matching, 22 cases were extracted. At T5-T8, the deviation rate of the Robot group was significantly lower than that of the Navi group. In the Robot group, the T2-T4 deviation rate was significantly higher than at the other vertebral levels. The distance from the RF didn't affect the deviation rate. The deviation rate of pedicle channel Grade 4 (inner diameter of less than 1 mm) was significantly higher than for the other grades. CONCLUSION The deviation rate of robotics was 1.6%, lower than that of navigation. The narrow pedicles with an inner diameter of less than 1 mm (deviation rate: 22.2%) and the upper thoracic level (deviation rate: 14.3%) were factors related to screw deviation even when using robotics.
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Affiliation(s)
- Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan. .,Spine Center, St. Marianna University Hospital, Kawasaki, Japan.
| | - Yoshiaki Torii
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.,Spine Center, St. Marianna University Hospital, Kawasaki, Japan
| | - Jun Ueno
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.,Spine Center, St. Marianna University Hospital, Kawasaki, Japan
| | - Tasuku Umehara
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.,Spine Center, St. Marianna University Hospital, Kawasaki, Japan
| | - Masahiro Iinuma
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.,Spine Center, St. Marianna University Hospital, Kawasaki, Japan
| | - Atsuhiro Yoshida
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.,Spine Center, St. Marianna University Hospital, Kawasaki, Japan
| | - Ken Tomochika
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.,Spine Center, St. Marianna University Hospital, Kawasaki, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisateru Niki
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
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Da Paz S, Trobisch P, Baroncini A. The use of electronic conductivity devices can effectively reduce radiation exposure in vertebral body tethering. Eur Spine J 2023; 32:634-8. [PMID: 36520213 DOI: 10.1007/s00586-022-07489-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 11/15/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Vertebral body tethering (VBT) presents new challenges in respect to radiation exposure, as screws cannot be placed free-hand and the lateral positioning of the patients increases scattered radiation. To reduce radiation exposure, we introduced the use of electronic conductivity device (ECD). These are drilling probes send an audio signal when cortical bone is breached. Thus, anterior, bicortical screws can be placed without multiple fluoroscopic controls. ECD has been used for all VBT procedures at our institution starting April 2020. The aim of this study was to test the safety of ECD and its efficacy in radiation reduction in comparison with the current standard, the fluoroscopic guidance. MATERIALS AND METHODS All patients who underwent VBT between August 2019 and December 2020 were retrospectively reviewed and divided into two groups according to whether ECD had been used or not. The radiation exposure per procedure and per screw was compared among the two groups, overall and separately for thoracic, lumbar and bilateral procedures. The rate of misplaced screws was calculated. RESULTS Data from 62 patients and 825 screws were obtained (397 with ECD). No screw misplacement was observed. Radiation reduction with ECD reached up to 41%. A significant reduction was observed in the radiation per procedure in bilateral instrumentation (from 9.16 to 5.52 mGy*m2), and in the analysis per screw overall (from 9.16 to 5.52 mGy*m2) and for lumbar curves (from 0.54 to 0.32 mGy*m2). CONCLUSION ECD can safely and effectively reduce the radiation exposure for VBT procedures.
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171
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Oba H, Uehara M, Ikegami S, Hatakenaka T, Kamanaka T, Miyaoka Y, Kurogouchi D, Fukuzawa T, Mimura T, Tanikawa Y, Koseki M, Ohba T, Takahashi J. Tips and pitfalls to improve accuracy and reduce radiation exposure in intraoperative CT navigation for pediatric scoliosis: a systematic review. Spine J 2023; 23:183-196. [PMID: 36174926 DOI: 10.1016/j.spinee.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/03/2022] [Accepted: 09/15/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT An increasing number of medical centers are adopting an intraoperative computed tomography (iCT) navigation system (iCT-Navi) to provide three-dimensional navigation for pediatric scoliosis surgery. While iCT-Navi has been reported to provide higher pedicle screw (PS) insertion accuracy, it may also result in higher radiation exposure to the patient. What innovations and studies have been introduced to reduce radiation exposure and further improve PS insertion? PURPOSE Evaluate the level of evidence and quality of papers while categorizing the tips and pitfalls regarding pediatric scoliosis surgery using iCT-Navi. Compare iCT-Navi with other methods, including preoperative CT navigation. STUDY DESIGN Systematic review. PATIENT SAMPLE Articles on pediatric scoliosis surgery with iCT-Navi published through to June 2022. OUTCOME MEASURES PS perforation rate and patient intraoperative radiation dose. METHODS Following PRISMA guidelines, the Cochrane Library, Google Scholar, and PubMed databases were searched for articles satisfying the criteria of iCT-Navi use and pediatric scoliosis surgery. The level of evidence and quality of the articles meeting the criteria were evaluated according to the guidelines of the North American Spine Society and American Academy of Orthopedic Surgeons, respectively. The articles were also categorized by theme and summarized in terms of PS insertion accuracy and intraoperative radiation dose. The origins and characteristics of five major classification methods of PS perforation grade were summarized as well. RESULTS The literature search identified 811 studies, of which 20 papers were included in this review. Overall, 513 pediatric scoliosis patients (381 idiopathic, 44 neuromuscular, 39 neurofibromatosis type 1, 28 congenital, 14 syndromic, seven other) were evaluated for PS perforations among 6,209 iCT-Navi insertions. We found that 232 (3.7%) screws were judged as major perforations (G2 or G3), 55 (0.9%) screws were judged as dangerous deviations (G3), and seven (0.1%) screws were removed. There were no reports of neurovascular injury caused by PSs. The risk factors for PS perforation included more than six vertebrae distance from the reference frame, more than nine consecutive insertions, upper thoracic level, thinner pedicle, upper instrumented vertebra proximity, short stature, and female. The accuracy of PS insertion did not remarkably decrease when the radiation dose was reduced to 1/5 or 1/10 by altering the iCT-Navi protocol. CONCLUSIONS iCT-Navi has the potential to reduce PS perforation rates compared with other methods. The use of low-dose radiation protocols may not significantly affect PS perforation rates. Although several risk factors for PS perforation and measures to reduce radiation dose have been reported, the current evidence is limited by a lack of consistency in classifying PS perforation and evaluating patient radiation dose among studies. The standardization of several outcome definitions is recommended in this rapidly developing field.
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Affiliation(s)
- Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Terue Hatakenaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takayuki Kamanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yoshinari Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Daisuke Kurogouchi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takuma Fukuzawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Tetsuhiko Mimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yusuke Tanikawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Michihiko Koseki
- Faculty of Textile Science and Technology, Shinshu University, 3-15-1 Tokida, Ueda, Nagano 386-8567, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi School of Medicine, School of Medicine, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Banno T, Yamato Y, Hasegawa T, Yoshida G, Arima H, Oe S, Mihara Y, Ide K, Watanabe Y, Kurosu K, Nakai K, Matsuyama Y. Preoperative Less Right Shoulder Elevation Had a Higher Risk of Postoperative Shoulder Imbalance When Main Thoracic Curve Shows Higher Correction Regardless of the Upper Instrumented Vertebra Level for Patients with Adolescent Idiopathic Scoliosis Lenke Type 1. Asian Spine J 2023; 17:166-175. [PMID: 36138576 PMCID: PMC9977976 DOI: 10.31616/asj.2022.0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This is a retrospective study. PURPOSE This study aimed to investigate the incidence of and risk factors for postoperative shoulder imbalance (PSI) in patients with Lenke type 1. OVERVIEW OF LITERATURE PSI is a complication resulting in poor self-image and satisfaction in adolescent idiopathic scoliosis (AIS) patients. METHODS We examined the data of AIS patients with Lenke type 1 curves who underwent posterior fusion surgery in a retrospective manner. PSI was defined as a 2-year postoperative absolute radiographic shoulder height (RSH) of ≥2 cm. Patients were divided into two groups based on the presence of PSI and the level of their upper instrumented vertebra (UIV) (UIV at T2 or T3 [U-UIV] or UIV below T3 [L-UIV]). The radiographic parameters and clinical outcomes were compared, and the cutoff values of risk factors were identified by multivariate analysis. RESULTS Of 104 patients, 21 (20.2%) had left shoulder elevation PSI. The PSI group had a significantly greater preoperative RSH (-5.1 mm vs. -14.3 mm) and main thoracic (MT) curve correction rate (77.3% vs. 69.1%) than the non-PSI group. The PSI incidence did not differ between the U-UIV and L-UIV groups. Multivariate analysis identified preoperative RSH and the MT curve correction rate as independent risk factors for PSI. The receiver operating characteristic curve analysis identified the preoperative RSH cutoff value as -6.5 mm and MT curve correction rate cutoff value as 76.9%. CONCLUSIONS Even in AIS patients with Lenke type 1 curves, the incidence of PSI was relatively high (20.2%). Patients with preoperative lower right shoulder elevation (i.e., RSH >-6.5 mm) had a higher risk of PSI regardless of UIV level when the MT curve showed a higher correction rate (i.e., correction rate >76.9%).
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Affiliation(s)
- Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuki Mihara
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuh Watanabe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kenta Kurosu
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keiichi Nakai
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Abstract
AIMS Only a few studies have investigated the long-term health-related quality of life (HRQoL) in patients with an idiopathic scoliosis. The aim of this study was to investigate the overall HRQoL and employment status of patients with an idiopathic scoliosis 40 years after diagnosis, to compare it with that of the normal population, and to identify possible predictors for a better long-term HRQoL. METHODS We reviewed the full medical records and radiological reports of patients referred to our hospital with a scoliosis of childhood between April 1972 and April 1982. Of 129 eligible patients with a juvenile or adolescent idiopathic scoliosis, 91 took part in the study (71%). They were evaluated with full-spine radiographs and HRQoL questionnaires and compared with normative data. We compared the HRQoL between observation (n = 27), bracing (n = 46), and surgical treatment (n = 18), and between thoracic and thoracolumbar/lumbar (TL/L) curves. RESULTS The mean time to follow-up was 40.8 years (SD 2.6) and the mean age of patients was 54.0 years (SD 2.7). Of the 91 patients, 86 were female (95%) and 51 had a main thoracic curve (53%). We found a significantly lower HRQoL measured on all the Scoliosis Research Society 22r instrument (SRS-22r) subdomains (p < 0.001) with the exception of mental health, than in an age-matched normal population. Incapacity to work was more prevalent in scoliosis patients (21%) than in the normal population (11%). The median SRS-22r subscore was 4.0 (interquartile range (IQR) 3.3 to 4.4) for TL/L curves and 4.1 (IQR 3.8 to 4.4) for thoracic curves (p = 0.300). We found a significantly lower self-image score for braced (median 3.6 (IQR 3.0 to 4.0)) and surgically treated patients (median 3.6 (IQR 3.2 to 4.3)) than for those treated by observation (median 4.0 (IQR 4.1 to 4.8); p = 0.010), but no statistically significant differences were found for the remaining subdomains. CONCLUSION In this long-term follow-up study, we found a significantly decreased HRQoL and capacity to work in patients with an idiopathic scoliosis 40 years after diagnosis.Cite this article: Bone Joint J 2023;105-B(2):166-171.
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Affiliation(s)
- Lærke C Ragborg
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Casper Dragsted
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Ohrt-Nissen
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Andersen
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Martin Gehrchen
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Benny Dahl
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Eun IS, Goh TS, Kim DS, Choi M, Lee JS. Comparison of Korean Body Image Questionnaires in Adolescent Idiopathic Scoliosis. Asian Spine J 2023; 17:47-60. [PMID: 35527533 PMCID: PMC9977971 DOI: 10.31616/asj.2021.0460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/08/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN A prospective study. PURPOSE To obtain the results of four body image questionnaires analyzed for validity in Korean and compare them to radiographic findings and quality of life scores. OVERVIEW OF LITERATURE Each of the four body image questionnaires has been studied, but comparative studies of each other are rare. METHODS Adolescent idiopathic scoliosis (AIS) patients ages 10 to 19 years completed the Korean version of the Quality of Life Profile for Spinal Deformities (K-QLPSD), the Scoliosis Research Society-22 self-image subscale (K-SRS-22-si), Korean version of the Spinal Appearance Questionnaire (K-SAQ), Korean version of the Body Image Disturbance Questionnaire-Scoliosis (K-BIDQ-S), and Korean version of the Italian Spine Youth Quality of Life (K-ISYQOL). Four body image questionnaires were compared with K-ISYQOL and radiographic major curve magnitude, coronal balance, and sagittal balance. Spearman's correlation was performed to compare the four body image questionnaires. RESULTS The study included 84 AIS patients, with a mean age of 12.6 years and a major Cobb angle of 29.4°. The four surveys were correlated with major curve magnitude and K-ISYQOL. K-SAQ and K-BIDQ-S were correlated better than K-QLPSD, and K-SRS-22-si was correlated with K-ISYQOL. The four surveys were moderately correlated with major curve magnitude, but there was no correlation with age, coronal balance, and sagittal balance. CONCLUSIONS K-SAQ and K-BIDQ-S correlate better with K-ISYQOL than K-QLPSD and K-SRS-22-si.
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Affiliation(s)
- Il-Soo Eun
- Department of Orthopaedic Surgery, Good Samsun Hospital, Busan,
Korea
| | - Tae Sik Goh
- Department of Orthopaedic Surgery, Biomedical Research Institute, Busan National University Hospital, Busan National University School of Medicine, Busan,
Korea
| | - Dong Suk Kim
- Department of Orthopaedic Surgery, Biomedical Research Institute, Busan National University Hospital, Busan National University School of Medicine, Busan,
Korea
| | - Minjun Choi
- Department of Orthopaedic Surgery, Biomedical Research Institute, Busan National University Hospital, Busan National University School of Medicine, Busan,
Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, Biomedical Research Institute, Busan National University Hospital, Busan National University School of Medicine, Busan,
Korea
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Azzam MM, Guiroy AJ, Galgano MA. Surgical Correction of Distal Junctional Kyphosis. World Neurosurg 2023; 170:157. [PMID: 36400358 DOI: 10.1016/j.wneu.2022.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022]
Abstract
Distal junctional kyphosis (DJK) is defined as the development of a kyphotic angulation over 10 degrees below a fusion construct and has been described as a complication of the treatment of adolescent idiopathic scoliosis, Scheuermann kyphosis, adult spinal deformity, and cervical deformity. There are some inherent risk factors to DJK: multilevel fusions, damage to the midline soft tissues including interspinous/supraspinous ligaments, T5-T12 thoracic kyphosis, T11-L2 thoracolumbar kyphosis, and increased mismatch between cervical lordosis and T1 slope. A 53-year-old male presented with cervicalgia, inability to sustain horizontal gaze, and kyphosis-enabled forward head posture. He underwent C3-T1 posterior decompression and fusion as treatment for cervical myelopathy 18 months prior. Neurologic examination was normal, with appreciable protrusion of the T1 vertebral spinous process. Surgery was initiated through subperiosteal exposure of C2-T6, followed by removal of previously set instrumentation, placement of new screws, and posterior column osteotomies of selected segments. Final steps involved compression across excised portions, locking pedicle screws, and a multirod insertion after closure of the posterior column osteotomies by compression maneuvers. Correction for DJK encompasses sagittal alignment restoration, a stable construct, and a good biological environment for healing. Failure of DJK realignment can occur if the patient's ligaments deteriorate distal to the construct or fractures develop in vertebral bodies at the lowest instrumented vertebra or lowest instrumented vertebra +1. One year after surgery, the patient's condition improved, evidenced from both patient self-report and a standing posture radiograph.
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Affiliation(s)
- Moatasem M Azzam
- School of Medicine, St. George's University, Grenada, West Indies.
| | - Alfredo J Guiroy
- Spinal Pathology Unit, Spanish Hospital of Mendoza, Mendoza, Argentina
| | - Michael A Galgano
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Boeyer ME, Groneck A, Alanay A, Neal KM, Larson AN, Parent S, Newton P, Miyanji F, Haber L, Hoernschemeyer DG; Harms Study Group. Operative differences for posterior spinal fusion after vertebral body tethering: Are we fusing more levels in the end? Eur Spine J 2023; 32:625-33. [PMID: 36542164 DOI: 10.1007/s00586-022-07450-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/09/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Little is known about the perioperative characteristics associated with a posterior spinal fusion (PSF) in adolescent idiopathic scoliosis patients previously treated with vertebral body tethering (VBT). We aimed to determine if operative time, estimated blood loss, postoperative length of stay, instrumentation type, and implant density differed in patients that received a PSF (i.e., PSF-Only) or a PSF following a failed VBT (i.e., PSF-VBT). METHODS We retrospectively assessed matched cohort data (PSF-VBT = 22; PSF-Only = 22) from two multi-center registries. We obtained: (1) operative time, (2) estimated blood loss, (3) postoperative length of stay, (4) instrumentation type, and (5) implant density. Theoretical fusion levels prior to the index procedure were obtained for PSF-VBT and compared to the actual levels fused. RESULTS We observed no difference in operative time, estimated blood loss, or postoperative length of stay. Instrumentation type was all-screw in PSF-Only and varied in PSF-VBT with nearly 25% of patients exhibiting a hybrid construct. There was no added benefit to removing anterior instrumentation prior to fusion; however, implant density was higher in PSF-Only (1.9 ± 0.2) than when compared to PSF-VBT (1.7 ± 0.3). An additional two levels were fused in 50% of PSF-VBT patients, most of which were added to the distal end of the construct. CONCLUSIONS We found that operative time, estimated blood loss, and postoperative length of stay were similar in both cohorts; however, the length of the fusion construct in PSF-VBT is likely to be two levels longer when a failed VBT is converted to a PSF.
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Babaee T, Moradi V, Hashemi H, Shariat A, Anastasio AT, Khosravi M, Bagheripour B. Does Bracing Control the Progression of Adolescent Idiopathic Scoliosis in Curves Higher Than 40°? A Systematic Review and Meta-analysis. Asian Spine J 2023; 17:203-212. [PMID: 36382367 PMCID: PMC9977970 DOI: 10.31616/asj.2022.0162] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022] Open
Abstract
Routinely, adolescent idiopathic scoliosis (AIS) curves that progress beyond 40° in skeletally immature adolescents require surgery. However, some adolescents with AIS and their parents utterly refuse surgery and insist on wearing a brace. Debate continues regarding the appropriateness of bracing for AIS curves exceeding 40° in patients who have rejected surgical intervention. This systematic review and meta-analysis was conducted to review the literature on the effectiveness of bracing and its predictive factors in largermagnitude AIS curves ≥40°. This study replicated the search strategy used by the PICOS system for formulating study questions, which include consideration of the patient/population (P), intervention (I), comparison (C), outcome (O), and study design (S). The search was conducted up to January 2022 in the following bibliographic online databases only in the English language: PubMed, Google Scholar, Scopus, and Web of Science. Two assessors reviewed the articles for qualification. Eligible studies were assessed for risk of bias at the study level using the Newcastle-Ottawa Scale. The effect size across the studies was determined using standardized mean differences (Cohen's d) and 95% confidence intervals for the meta-analysis. Among the eight included moderate quality studies, evidence of potential publication bias (p <0.05) for the trials included was found in the Cobb angle outcome. Results obtained through meta-analysis indicated that the effectiveness of bracing in controlling Cobb angle progression in curves ≥40° is significantly positive. Additionally, initial curve severity, Risser stage, in-brace curve correction, curve type, and apical vertebral rotation were considered risk factors associated with brace effectiveness. This systematic review revealed that bracing could alter the normal course of AIS curves ≥40° in patients refusing posterior spinal fusion (PSF). However, the suggested course for patients refusing PSF remains unclear because of the significant heterogeneity in the risk factors associated with bracing failure.
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Affiliation(s)
- Taher Babaee
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran,
Iran
| | - Vahideh Moradi
- Iran-Helal Institute of Applied Science and Technology, Tehran,
Iran
| | - Hoda Hashemi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran,
Iran
| | - Ardalan Shariat
- Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran,
Iran
| | | | - Mobina Khosravi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran,
Iran
| | - Batoul Bagheripour
- Department of Orthotics and Prosthetics, Sahlgrenska University Hospital, Gothenburg,
Sweden
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Luhmann S, Zaaroor-Regev D, Upasani VV, Shufflebarger H. The natural history of curve behavior after brace removal in adolescent idiopathic scoliosis: a literature review. Spine Deform 2023. [PMID: 36715866 DOI: 10.1007/s43390-022-00638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 12/26/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Brace treatment is the most common nonoperative treatment to prevent curve progression in adolescent idiopathic scoliosis (AIS). The goal of this review and analysis is to characterize curve behavior after completion of brace treatment and to identify factors that may facilitate the estimation of long-term curve progression. METHOD A review of the English language literature was completed using the MEDLINE (PUBMED) database of publications after 1990 until September 2020. Studies were included if they detailed a minimum of 1 year post-brace removal follow-up of AIS patients. Data retrieved from the articles included Cobb angle measurements of the major curves at "in-brace," weaning, and follow-up visit(s) for all patients described and for subset populations. RESULTS From 75 articles, 18 relevant studies describing a follow-up period of 1-25 years following brace removal were included in the analyses. The reviewed literature demonstrates that curves continue to progress after brace treatment is completed with three main phases of progression: (i) immediate (upon brace removal) where a mean curve progression of 7° occurs; (ii) short term (within five years of brace removal) where a relatively high progression rate is evident (0.8°/year); and (iii) long term (more than five years after brace removal) where the progression rate slows (0.2°/year). The magnitude and rate of curve progression is mainly dependent on the degree of curve at weaning as curves weaned at < 25° progress substantially less than curves weaned at ≥ 25° at 25 years. CONCLUSION Curves continue to progress after brace removal and the rate and magnitude of progression are associated with the curve size at weaning, with larger curves typically exhibiting more rapid and severe progression. This analysis provides physicians and patients the ability to estimate long-term curve size based on the curve size at the time of weaning. LEVEL OF EVIDENCE IV.
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Pan X, Qiao J, Liu Z, Shi B, Mao S, Li S, Sun X, Zhu Z, Qiu Y. Posterior-only correction surgery for idiopathic scoliosis Lenke type 5c: differences of strategies and outcomes between adult patients and adolescent patients. Spine Deform 2023; 11:665-670. [PMID: 36709465 PMCID: PMC10147739 DOI: 10.1007/s43390-023-00647-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 01/15/2023] [Indexed: 01/30/2023]
Abstract
PURPOSE To compare radiographic parameters, and functional and surgical outcomes between lumbar adolescent idiopathic scoliosis (AIS) and lumbar adult idiopathic scoliosis (AdIS). METHODS A retrospective study was performed to identify Lenke 5c type AIS and AdIS patients from our scoliosis database who had undergone posterior surgical treatment for scoliosis. Preoperative and postoperative radiographic and clinical outcomes were compared between the two groups. RESULTS A total of 22 patients were included in AdIS group, and 44 matched patients in AIS group. AdIS group had significantly larger L3 and L4 tilt and translation than AIS group (P < 0.05). AdIS group had larger T10-L2 angle and smaller T5-T12 angle (P < 0.05). AdIS group had higher VAS scores (P < 0.05) and pain domain of SRS-22 scores (P < 0.05) as compared to AIS group. Correlation analysis demonstrated positive relationship between VAS scores and T10-L2 angle (r = 0.492, P < 0.05). AdIS group was fused longer than AIS group (P < 0.05). Cobb angle of TL/L curve was larger and correction ratio was smaller at AdIS group (P < 0.05). AdIS group still had significantly larger L3 and L4 tilt and translation than AIS group (P < 0.05). CT measurements demonstrated larger postoperative vertebral body rotation at apical vertebrae and LIV at AdIS group (P < 0.05). Vertebral correction ratio was smaller at AdIS group (P < 0.05). CONCLUSION Lenke 5c AdIS patients had greater preoperative and postoperative L3 and L4 tilt and translation, as well as less correction of major curve and vertebral body derotation than AIS patients. However, the incidence of adding-on was similar between the two groups.
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Affiliation(s)
- Xiyu Pan
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Jun Qiao
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Benlong Shi
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Saihu Mao
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Song Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
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Ohashi M, Watanabe K, Hirano T, Hasegawa K, Katsumi K, Tashi H, Shibuya Y, Makino T, Kawashima H. Marriage and childbirth of patients who were surgically and non-surgically treated for adolescent idiopathic scoliosis: a survey at the age of 30 years or older. Spine Deform 2023; 11:597-603. [PMID: 36709464 DOI: 10.1007/s43390-023-00648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/14/2023] [Indexed: 01/30/2023]
Abstract
PURPOSE We aimed to investigate the marital status and childbirth in adolescent idiopathic scoliosis (AIS) patients. METHODS This study included women who were treated surgically or non-surgically for AIS with a scoliosis magnitude ≥ 30° before surgery or at skeletal maturity and were followed up until age 30 years or older. Patients were divided into surgically treated (S-AIS, n = 55) and non-surgically treated AIS groups (N-AIS, n = 86). Data from the national fertility survey were used as control values. RESULTS There were no significant differences in age at the final follow-up between the S- (40.7 years) and N-AIS (42.1 years) groups. The unmarried rate among all women and the nulliparous rate among married women in the S-AIS group (29.1% and 18.4%, respectively) were similar to those in the N-AIS group (26.7% and 16.1%, respectively). The mean number of children per married woman also did not differ between the S- and N-AIS groups (1.5 vs 1.4). Compared to the control group, after adjusting for age, the common odds ratio in the AIS group was 1.56 (p = 0.031) for unmarried status and 1.88 (p = 0.026) for nulliparity among married women. Moreover, the mean number of children per married woman was significantly lower in the AIS group than in the control group (1.3 vs 1.7, p < 0.001). CONCLUSION Surgically and non-surgically treated women with AIS had a similar status with regard to marriage and childbirth, while women with AIS were more likely to be unmarried and nulliparous and to have fewer children compared to the nationwide population.
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Affiliation(s)
- Masayuki Ohashi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan.
| | - Kei Watanabe
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Toru Hirano
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Japan
| | | | - Keiichi Katsumi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, Niigata, Japan
| | - Hideki Tashi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Yohei Shibuya
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Tatsuo Makino
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan
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Yang JH, Kim HJ, Chang DG, Suh SW. Fusion rates based on type of bone graft substitute using minimally invasive scoliosis surgery for adolescent idiopathic scoliosis. BMC Musculoskelet Disord 2023; 24:30. [PMID: 36639795 PMCID: PMC9840254 DOI: 10.1186/s12891-023-06134-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Minimally invasive scoliosis surgery (MISS) is currently introduced on novel technique for surgical treatment of adolescent idiopathic scoliosis (AIS). This study is aimed to evaluate the efficacy of facet fusion in MISS compared to posterior fusion in conventional open scoliosis surgery (COSS) and compare facet fusion rates based on three bone graft substitutes in MISS for adolescent idiopathic scoliosis (AIS). METHODS Eighty six AIS patients who underwent scoliosis surgery were divided into two groups: the COSS group and the MISS group. COSS was performed through posterior fusion with allograft. MISS was applied via facet fusion with three bone graft substitutes. The MISS group was further divided into three subgroups based on graft substitute: Group A (allograft), Group B (demineralized bone matrix [DBM]), and group C (demineralized cancellous bone chips). Fusion rate was measured using conventional radiographs to visualize loss of correction > 10°, presence of lysis around implants, breaks in fusion mass, and abnormal mobility of the fused segment. RESULTS The fusion rates showed no significant difference in COSS and MISS groups (p = 0.070). In the MISS group, the fusion rates were 85, 100, and 100% in groups A, B, and C, respectively, with no significant difference (p = 0.221). There were no statistical differences between groups A, B, and C in terms of correction rate, fusion rate, and SRS-22 scores (p > 0.05). CONCLUSIONS The facet fusion in MISS showed comparable to posterior fusion in COSS with regard to radiological and clinical outcomes. Furthermore, the type of graft substitute among allograft, DBM, and demineralized cancellous bone chips did not affect facet fusion rate or clinical outcomes in MISS. Therefore, MISS showed comparable fusion rate (with no influences on the type of graft substitute) and clinical outcomes to those of COSS in the surgical treatment of AIS.
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Affiliation(s)
- Jae Hyuk Yang
- grid.222754.40000 0001 0840 2678Department of Orthopedic Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Hong Jin Kim
- grid.411612.10000 0004 0470 5112Spine Center and Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 1342, Dongil-Ro, Nowon-Gu, Seoul, 01757 Republic of Korea
| | - Dong-Gune Chang
- grid.411612.10000 0004 0470 5112Spine Center and Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 1342, Dongil-Ro, Nowon-Gu, Seoul, 01757 Republic of Korea
| | - Seung Woo Suh
- grid.222754.40000 0001 0840 2678Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
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Ghorbani F, Ranjbar H, Kamyab M, Babaee T, Kamali M, Razavi H, Sharifi P, Janani L. Effect of Brace Treatment on Craniovertebral to Lumbopelvic Sagittal Parameters in Adolescents with Idiopathic Scoliosis: A Systematic Review. Asian Spine J 2023; 17:401-417. [PMID: 36625021 PMCID: PMC10151630 DOI: 10.31616/asj.2022.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/17/2022] [Indexed: 01/11/2023] Open
Abstract
The current study was carried out systematically by conducting a review of the literature. The purpose of this study was to conduct a systematic review of the literature to determine the effects of brace wearing on sagittal parameters in adolescents with idiopathic scoliosis (AIS). In this study, PubMed/MEDLINE (National Library of Medicine), Scopus, Ovid, CINAHL, PEDro, Google Scholar, and the Cochrane Library were accessed and searched using the patient, intervention, comparison, outcome, and study design model. We included studies that looked at the effects of brace treatment on sagittal spinopelvic parameters in AIS patients over the age of 18. The studies were chosen for their cross-sectional, retrospective, or prospective observational designs, and they were published in English. Review articles, case reports, case study designs, and conference abstracts were excluded from consideration. The methodological quality of the remaining articles was assessed using the Newcastle Ottawa Scale. A total of 12 studies were chosen, and 995 participants were evaluated, with 3 (25%) and 9 (75%) having high and moderate quality, respectively. The studies were classified based on the length of follow-up. Long-term, short-term, and immediate effects of brace wearing on sagittal spinopelvic parameters were reported in four, five, and three studies, respectively. The results of nine studies showed a significant decrease in Cobb angle after wearing the brace, which contradicted the findings of the other two. The cervical and sagittal pelvic parameters, thoracic kyphosis (TK), lumbar lordosis (LL), spinopelvic parameters, and sagittal balance were all evaluated in the intended studies, yielding varying results. According to the available literature, wearing a brace flattens the TK and LL. According to this systematic review, brace treatment may affect sagittal spinopelvic parameters in adolescents with AIS, particularly in TK and LL. The cervical and pelvic parameters yielded inconclusive results. This study backs up the idea that brace design and structure can influence sagittal parameter changes. The limitations of this study include different methods of parameter measurement, variations in the brace types and wear time, varying follow-up duration, and differences in participant characteristics.
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Affiliation(s)
- Faezeh Ghorbani
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, California State University Dominguez Hills, Carson, CA, USA
| | - Taher Babaee
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kamali
- Department of Rehabilitation Basic Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hiva Razavi
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Pouya Sharifi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Imperial Clinical Trials Unit, Imperial College London, London, UK
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Zhang DA, Brenn B, Cho R, Samdani A, Poon SC. Effect of gabapentin on length of stay, opioid use, and pain scores in posterior spinal fusion for adolescent idiopathic scoliosis: a retrospective review across a multi-hospital system. BMC Anesthesiol 2023; 23:10. [PMID: 36609230 PMCID: PMC9824993 DOI: 10.1186/s12871-022-01965-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Gabapentin has been adopted in Enhanced Recovery After Surgery protocols as a means to reduce opioid consumption while maintaining adequate post-operative analgesia. The purpose of our study was to review and compare changes in length of stay, opioid use, and patient reported pain scores after the addition of gabapentin into five, distinct pain protocols for posterior spinal fusion in adolescent idiopathic scoliosis. METHODS A retrospective review was completed using a database of electronic medical data from a single pediatric orthopedic healthcare system that was queried for patients with adolescent idiopathic scoliosis who underwent first-time posterior spinal fusion. Perioperative data including demographics, hospital length of stay, surgical details, opioid use, patient reported pain scores, and non-opioid analgesic use were collected. RESULTS From December 2012 to February 2019, 682 hospitalizations for posterior spinal fusion in adolescent idiopathic scoliosis were identified with complete inpatient data; 49% were administered gabapentin. For the gabapentin cohort, the system saw no statistically significant effect on length of stay or pain averaged over POD#0-3. Opioid use was statistically lower averaged over POD#0-3. Individual sites saw variation on length of stay and opioid use compared to the system. CONCLUSION In conclusion, system-wide data showed gabapentin containing protocols reduced opioid use while maintaining clinically equivalent analgesia. However, variations of individual site results make it difficult to conclude the degree to which gabapentin were responsible for this effect.
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Affiliation(s)
- De-An Zhang
- Shriners Children’s Southern California, 909 S Fair Oaks Ave, Pasadena, CA 91105 USA
| | - Bruce Brenn
- Shriners Children’s Philadelphia, 3551 N Broad St, Philadelphia, PA 19140 USA
| | - Robert Cho
- Shriners Children’s Southern California, 909 S Fair Oaks Ave, Pasadena, CA 91105 USA
| | - Amer Samdani
- Shriners Children’s Philadelphia, 3551 N Broad St, Philadelphia, PA 19140 USA
| | | | - Selina C. Poon
- Shriners Children’s Southern California, 909 S Fair Oaks Ave, Pasadena, CA 91105 USA
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D'Andrea CR, Samdani AF, Balasubramanian S. Patient-specific finite element modeling of scoliotic curve progression using region-specific stress-modulated vertebral growth. Spine Deform 2023. [PMID: 36593421 DOI: 10.1007/s43390-022-00636-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 12/17/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE This study describes the creation of patient-specific (PS) osteo-ligamentous finite element (FE) models of the spine, ribcage, and pelvis, simulation of up to three years of region-specific, stress-modulated growth, and validation of simulated curve progression with patient clinical angle measurements. RESEARCH QUESTION Does the inclusion of region-specific, stress-modulated vertebral growth, in addition to scaling based on age, weight, skeletal maturity, and spine flexibility allow for clinically accurate scoliotic curve progression prediction in patient-specific FE models of the spine, ribcage, and pelvis? METHODS Frontal, lateral, and lateral bending X-Rays of five AIS patients were obtained for approximately three-year timespans. PS-FE models were generated by morphing a normative template FE model with landmark points obtained from patient X-rays at the initial X-ray timepoint. Vertebral growth behavior and response to stress, as well as model material properties were made patient-specific based on several prognostic factors. Spine curvature angles from the PS-FE models were compared to the corresponding X-ray measurements. RESULTS Average FE model errors were 6.3 ± 4.6°, 12.2 ± 6.6°, 8.9 ± 7.7°, and 5.3 ± 3.4° for thoracic Cobb, lumbar Cobb, kyphosis, and lordosis angles, respectively. Average error in prediction of vertebral wedging at the apex and adjacent levels was 3.2 ± 2.2°. Vertebral column stress ranged from 0.11 MPa in tension to 0.79 MPa in compression. CONCLUSION Integration of region-specific stress-modulated growth, as well as adjustment of growth and material properties based on patient-specific data yielded clinically useful prediction accuracy while maintaining physiological stress magnitudes. This framework can be further developed for PS surgical simulation.
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de Reuver S, de Block N, Brink RC, Chu WCW, Cheng JCY, Kruyt MC, Castelein RM, Schlösser TPC. Convex-concave and anterior-posterior spinal length discrepancies in adolescent idiopathic scoliosis with major right thoracic curves versus matched controls. Spine Deform 2023; 11:87-93. [PMID: 36098947 PMCID: PMC9767993 DOI: 10.1007/s43390-022-00566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/30/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The apical deformation in adolescent idiopathic scoliosis (AIS) is a combination of rotation, coronal deviation and passive anterior lengthening of the spine. In AIS surgery, posterior-concave lengthening or anterior-convex shortening can be part of the corrective maneuver, as determined by the individual surgeon's technique. The magnitude of convex-concave and anterior-posterior length discrepancies, and how this needs to be modified to restore optimal spinal harmony, remains unknown. METHODS CT-scans of 80 pre-operative AIS patients with right convex primary thoracic curves were sex- and age-matched to 80 healthy controls. The spinal length parameters of the main thoracic curves were compared to corresponding levels in controls. Vertebral body endplates and posterior elements were semi-automatically segmented to determine the length of the concave and convex side of the anterior column and along the posterior pedicle screw entry points while taking the 3D-orientation of each individual vertebra into account. RESULTS The main thoracic curves showed anterior lengthening with a mean anterior-posterior length discrepancy of + 3 ± 6%, compared to a kyphosis of - 6 ± 3% in controls (p < 0.01). In AIS, the convex side was 20 ± 7% longer than concave (0 ± 1% in controls; p < 0.01). The anterior and posterior concavity were 7 and 22 mm shorter, respectively, while the anterior and posterior convexity were 21 and 8 mm longer compared to the controls. CONCLUSIONS In thoracic AIS, the concave shortening is more excessive than the convex lengthening. To restore spinal harmony, the posterior concavity should be elongated while allowing for some shortening of the posterior convexity.
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Affiliation(s)
- Steven de Reuver
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Nick de Block
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Rob C. Brink
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jack C. Y. Cheng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Moyo C. Kruyt
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - René M. Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Tom P. C. Schlösser
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Catanzano AA, Sponseller PD, Newton PO, Bastrom TP, Bartley CE, Shah SA, Cahill PJ, Group HS, Yaszay B. Beware of open triradiate cartilage: 1 in 4 patients will lose > 10° of correction following posterior only fusion. Spine Deform 2023; 11:133-138. [PMID: 35978156 DOI: 10.1007/s43390-022-00565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE As 2-year follow-up may not be sufficient to assess the risk of curve progression following fusion in immature patients with adolescent idiopathic scoliosis (AIS), this study reports on 5-year outcomes of AIS patients, factoring in maturity and surgical approach, to determine whether immature patients are at risk of continued curve progression beyond 2 years. METHODS A multicenter database was reviewed for AIS patients who underwent spinal fusion with pedicle screw fixation and who had both 2 and 5-year follow-up. Radiographic and SRS-22 scores were compared between three groups: open triradiate cartilage-posterior fusion (OTRC-P), OTRC-combined anterior/posterior fusion (OTRC-APSF), and closed TRC (CTRC, matched to OTRC-P group). RESULTS 142 subjects were included (67 OTRC-P, 8 OTRC-APSF, 67 CTRC). Main curve type (p = 0.592) and size (p = 0.117) were not different between groups at all timepoints. Compensatory curve size was similar at all timepoints for OTRC-P and CTRC, with a slight increase for OTRC-APSF from immediate postoperative to 5 years. At 5 years, OTRC-P had > 10° loss of correction in 25% of patients, which was greater than in the CTRC (6%) and OTRC-APSF (0%) groups (p = 0.002). No significant differences were found in loss of correction of the compensatory curve or in SRS-22 scores between groups. CONCLUSIONS Compared to those with CTRC and those treated with anterior/posterior fusion, patients with OTRC treated with posterior fusion had an increased risk of main curve progression greater than 10°, with some continued loss of correction after 2 years. This did not appear to affect patient-reported outcomes.
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Affiliation(s)
- Anthony A Catanzano
- Department of Orthopedics, Duke Children's Hospital and Health Center, Durham, NC, USA
| | - Paul D Sponseller
- Department of Orthopedics, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - Peter O Newton
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA.,Department of Orthopedics, University of California, San Diego, CA, USA
| | - Tracey P Bastrom
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA
| | - Carrie E Bartley
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA
| | - Suken A Shah
- Department of Orthopedics, Nemours Children's Hospital, Wilmington, DE, USA
| | - Patrick J Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Burt Yaszay
- Division of Orthopedics and Sports Medicine, Seattle Children's Hospital, M/S OA.9.120, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.
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Zhu L, Ru S, Wang W, Dou Q, Li Y, Guo L, Chen X, Wang W, Li W, Zhu Z, Yang L, Lu C, Yan B. Associations of physical activity and screen time with adolescent idiopathic scoliosis. Environ Health Prev Med 2023; 28:55. [PMID: 37766541 PMCID: PMC10569969 DOI: 10.1265/ehpm.23-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/28/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is the most common type of idiopathic scoliosis, affecting approximately 0.61%-6.15% adolescents worldwide. To date, the results on the relationship between moderate-to-vigorous physical activity (MVPA) and AIS were inconsistent, and the association between screen time (ST) and AIS remained unclear. This study aimed to describe MVPA and ST among adolescents, and to explore the independent and joint associations between PA, ST, and AIS. METHODS A frequency-matched case-control study based on the 2021 Chinese School-based Scoliosis Screening Program in Shenzhen city, south China, was conducted. The research involved 494 AIS patients (aged 9-17 years) and 994 sex- and age-matched healthy controls. MVPA and ST were measured using a self-administered questionnaire. Logistic regression models estimated associations between PA, ST, and AIS. RESULTS Compared to subjects meeting the recommended 60-min daily of MVPA, adolescents reporting daily MVPA time less than 60 min had 1.76 times higher odds of experiencing AIS (95% CI: 1.32-2.35) and adolescents reporting daily MVPA in inactive status had 2.14 times higher odds of experiencing AIS (95% CI: 1.51-3.03). Moreover, participants reporting ST for 2 hours or more had 3.40 times higher odds of AIS compared with those reporting ST less than 2 hours (95% CI: 2.35-4.93). When compared with the adolescents reporting both ST and MVPA meeting the guidelines recommended times (ST < 2 h and MVPA ≥ 60 min/day), those reporting both ST ≥ 2 h and MVPA in inactive status are 8.84 times more likely to develop AIS (95% CI: 3.99-19.61). CONCLUSIONS This study reported that the insufficient MVPA, especially MVPA in inactive status, and excessive ST were risk factors for AIS. Additionally, the joint effects of insufficient MVPA and excessive ST probably increase the risk of AIS.
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Affiliation(s)
- Liwan Zhu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shouhang Ru
- Department of Spine Surgery, the First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Spine Surgery, the Shenzhen Second People’s Hospital, Shenzhen, China
- Shenzhen Youth Spine Health Center, Shenzhen, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qiufen Dou
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaosheng Chen
- Department of Spine Surgery, the First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Spine Surgery, the Shenzhen Second People’s Hospital, Shenzhen, China
- Shenzhen Youth Spine Health Center, Shenzhen, China
| | - Weijun Wang
- Department of Spine Surgery, the First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Spine Surgery, the Shenzhen Second People’s Hospital, Shenzhen, China
- Shenzhen Youth Spine Health Center, Shenzhen, China
| | - Wenyan Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhixiang Zhu
- Department of Spine Surgery, the First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Spine Surgery, the Shenzhen Second People’s Hospital, Shenzhen, China
- Shenzhen Youth Spine Health Center, Shenzhen, China
| | - Lei Yang
- Department of Spine Surgery, the First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Spine Surgery, the Shenzhen Second People’s Hospital, Shenzhen, China
- Shenzhen Youth Spine Health Center, Shenzhen, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bin Yan
- Department of Spine Surgery, the First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Spine Surgery, the Shenzhen Second People’s Hospital, Shenzhen, China
- Shenzhen Youth Spine Health Center, Shenzhen, China
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Cheung MC, Yip J, Law D, Cheung JPY. Surface electromyography (sEMG) biofeedback posture training improves the physical and mental health of early adolescents with mild scoliosis: A qualitative study. Digit Health 2023; 9:20552076231203820. [PMID: 37766906 PMCID: PMC10521269 DOI: 10.1177/20552076231203820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Asymmetry in paraspinal muscle activities is observed in adolescent idiopathic scoliosis and may be of value for predicting curve progression. We have reported the effects of the surface electromyography biofeedback posture training program in improving the symmetry of paraspinal muscle activities and reducing the curve progression of early adolescents with mild scoliosis. This study further explored their subjective experience of the training program on posture correction and health-related quality of life. Methods Using purposive sampling, 13 early adolescents aged between 11 and 13 years with mild scoliosis participated in semi-structured in-depth interviews after completing 30 sessions of training. The data were recorded, transcribed, and coded using thematic analysis with NVivo 10. Significant statements and phrases were categorized into themes and subthemes. Results As assessed by X-ray, five early adolescents showed at least a 5° Cobb angle reduction in spinal curvature, while eight showed no significant curve progression (a Cobb angle change under 5°). Several subthemes related to the benefits of the training program on the health-related quality of life were generated, namely (a) posture correction, (b) improvement in body appearance, (c) restoration of muscle relaxation, (d) reduction in bodily pain and fatigue, (e) enhancement of self-confidence/self-image, and (f) improvement in social functioning. Conclusions Given its positive effects, the sEMG biofeedback posture training program has the potential to be an alternative early intervention for early adolescents with mild scoliosis. Further empirical studies need to be carried out to substantiate its effectiveness and evaluate the sustainability of its benefits over time.
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Affiliation(s)
- Mei-Chun Cheung
- Department of Social Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Research Center for Neuropsychological Well-Being, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Joanne Yip
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Derry Law
- Department of Design, Caritas Institute of Higher Education and Caritas Bianchi College of Careers, Tseung Kwan O, New Territories, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Abul K, Özmen BB, Yücekul A, Zulemyan T, Yılgör Ç, Alanay A. If you look this way, you will see it: cranial shift in adolescent idiopathic scoliosis. Spine Deform 2023; 11:105-114. [PMID: 35921040 DOI: 10.1007/s43390-022-00560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Anatomical variations in the spine can be seen in each transitional border, either toward the skull as 'cranial shifts' or away as caudal shifts. Cranial shifting (CS) occurs when there is presence of occipitalization, C7 cervical costae or prominent transverse processes, thoracolumbar transitional vertebrae (TLTV) at T12 level, L5 sacralization, and sacrococcygeal fusion. We termed the coexistence of sacralization of L5 and absence or remarkable reduction of T12 rib size in AIS as Abul cranial shift (ACS). In this descriptive clinical study, primary aim was to investigate the incidence of ACS in AIS. METHODS Retrospective analysis of 187 surgically treated AIS cases was performed. Demographic data were recorded. The incidence of the specific set of anatomic variations including lumbosacral transitional vertebrae, TLTV, transverse process changes in C7 vertebrae, and posterior lumbosacral neural arch cleft formations (NACf) were evaluated in the radiological images. RESULTS 36 (19%) of 187 cases had ACS. ACS was detected in only 1 of 19 male cases (5%), while in 35 of 168 female cases (21%). Forty-one cases had sacralization of L5 (22%). There were only eleven pair of ribs in 14 (7%) of 187 cases and 10 (28%) of 36 ACS cases. Forty cases had NACf (21%). ACS and NACf coexistence were observed in 8 (22%) of 36 ACS cases. CONCLUSION Accurate spinal column assessment is critical in adolescent idiopathic scoliosis (AIS). ACS may be observed in up to one in five AIS cases and its presence should not be neglected to avoid wrong level surgery.
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Affiliation(s)
- Kadir Abul
- Department of Orthopedics and Traumatology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey.
| | - Berk Barış Özmen
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Altuğ Yücekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Tais Zulemyan
- Comprehensive Spine Center, Acibadem University Maslak Hospital, Istanbul, Turkey
| | - Çağlar Yılgör
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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Yang KG, Goff E, Cheng KL, Kuhn GA, Wang Y, Cheng JCY, Qiu Y, Müller R, Lee WYW. Abnormal morphological features of osteocyte lacunae in adolescent idiopathic scoliosis: A large-scale assessment by ultra-high-resolution micro-computed tomography. Bone 2023; 166:116594. [PMID: 36341948 DOI: 10.1016/j.bone.2022.116594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022]
Abstract
AIM Abnormal osteocyte lacunar morphology in adolescent idiopathic scoliosis (AIS) has been reported while the results were limited by the number of osteocyte lacunae being quantified. The present study aimed to validate previous findings through (a) comparing morphological features of osteocyte lacunae between AIS patients and controls in spine and ilium using a large-scale assessment, and (b) investigating whether there is an association between the acquired morphological features of osteocyte lacunae and disease severity in AIS. METHOD Trabecular bone tissue of the facet joint of human vertebrae on both concave and convex sides at the apex of the scoliotic curve were collected from 4 AIS and 5 congenital scoliosis (CS) patients, and also at the same anatomic site from 3 non-scoliosis (NS) subjects intraoperatively. Trabecular bone tissue from ilium was obtained from 12 AIS vs 9 NS subjects during surgery. Osteocyte lacunae were assessed using ultra-high-resolution micro-computed tomography. Clinical information such as age, body mass index (BMI) and radiological Cobb angle of the major curve were collected. RESULTS There was no significant difference between density of osteocyte lacuna and bone volume fraction (BV/TV) between groups. A total of 230,076 and 78,758 osteocyte lacunae from facet joints of apical vertebra of scoliotic curve and iliac bone were included in the analysis, respectively. In facet joint bone biopsies, lacunar stretch (Lc.St) was higher, and lacunar equancy (Lc.Eq), lacunar oblateness (Lc.Ob), and lacunar sphericity (Lc.Sr) were lower in AIS and CS groups when compared with NS group. CA side was associated with higher Lc.St when compared with CX side. In iliac bone biopsies, Lc.Ob was higher and lacunar surface area (Lc.S) was lower in AIS group than NS group. Median values of Lc.St, Lc.Eq and Lc.Sr were significantly associated with radiological Cobb angle with adjustment for age and BMI (R-squared: 0.576, 0.558 and 0.543, respectively). CONCLUSIONS This large-scale assessment of osteocyte lacunae confirms that AIS osteocyte lacunae are more oblate in iliac bone that is less influenced by asymmetric loading of the deformed spine than the vertebrae. Shape of osteocyte lacunae in iliac bone is associated with radiological Cobb angle of the major curve in AIS patients, suggesting the likelihood of systemic abnormal osteocyte morphology in AIS. Osteocyte lacunae from concave side of scoliotic curves were more stretched in both AIS and CS groups, which is likely secondary to asymmetric mechanical loading.
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Affiliation(s)
- Kenneth Guangpu Yang
- SH Ho Scoliosis Research Laboratory, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Elliott Goff
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Ka-Lo Cheng
- SH Ho Scoliosis Research Laboratory, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Gisela A Kuhn
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Yujia Wang
- SH Ho Scoliosis Research Laboratory, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jack Chun-Yiu Cheng
- SH Ho Scoliosis Research Laboratory, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yong Qiu
- SH Ho Scoliosis Research Laboratory, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China; Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
| | - Wayne Yuk-Wai Lee
- SH Ho Scoliosis Research Laboratory, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
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191
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Ghandhari H, Ameri E, Nikouei F, Mahdavi SM, Chehrassan M, Motalebi M. Selective Thoracolumbar/Lumbar Fusion in Adolescent Idiopathic Scoliosis: A Comprehensive Review of the Literature. Arch Bone Jt Surg 2023; 11:313-320. [PMID: 37265523 PMCID: PMC10231918 DOI: 10.22038/abjs.2022.61439.3014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/05/2022] [Indexed: 06/03/2023]
Abstract
In Adolescent Idiopathic Scoliosis (AIS), correction surgery can correct the maximum movement and balance of the spine. Under certain conditions for two simultaneous curvatures, the procedure, in which correcting one of the curvatures can result in the automatic correction of another curvature, is called selective fusion, attracting spine surgeons' interest because of more movement in the spine. However, the majority of surgeons have not used this technique due to the lack of sufficient information. The current study aimed to totally investigate selective thoracolumbar/lumbar fusion and to provide accurate information on outcomes and complications of surgery for spinal surgeons. This technique can also help spinal surgeons have a better selection of patients' surgical procedures.
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Affiliation(s)
- Hasan Ghandhari
- Bone and Joint reconstruction research center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Ameri
- Bone and Joint reconstruction research center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Nikouei
- Bone and Joint reconstruction research center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mani Mahdavi
- Orthopedic Spine Surgery Department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mohammadreza Chehrassan
- Bone and Joint reconstruction research center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Motalebi
- Bone and Joint reconstruction research center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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192
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Dou Q, Zhu Z, Zhu L, Wang W, Guo L, Ru S, Chen X, Yang L, Lu C, Yan B. Academic-related factors and daily lifestyle habits associated with adolescent idiopathic scoliosis: a case-control study. Environ Health Prev Med 2023; 28:23. [PMID: 37045748 PMCID: PMC10106331 DOI: 10.1265/ehpm.22-00243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is the most prevalent spinal deformity, which may have long-term negative consequences on adolescents. The research on the etiology is of great importance for identifying high-risk population and formulate tailored prevention. This study aimed to evaluate the association between academic-related factors and daily lifestyle habits and AIS. METHODS In this population-based case-control study, 491 AIS cases and 1,346 healthy controls that frequency-matched by age and sex were recruited in Shenzhen, Southern China. AIS was diagnosed as a Cobb angle ≥ 10° on standing posteroanterior radiographs of the whole spine. The academic-related factors (e.g., reading and writing posture) and daily lifestyle habits (e.g., intake of milk and dairy products) were collected by a self-reported questionnaire. The logistic regression analysis was performed. RESULTS After adjusting for potential confounding factors, multivariable logistic regression models demonstrated that academic-related factors were associated with AIS. Individuals with poor reading and writing posture were more likely to have AIS (AOR: 2.06, 95%CI: 1.58-2.68). Moreover, there was a significant association between heavy school bags and AIS (AOR: 2.22, 95%CI: 1.50-3.31). Additionally, adolescents who reported daily screen time on weekdays over 2 hours were more likely to develop AIS (P < 0.001). Regarding daily lifestyle habits, individuals without the habit of taking milk and dairy products had a higher risk of developing AIS (AOR: 1.87, 95%CI: 1.29-2.71). CONCLUSIONS Academic-related factors and daily lifestyle habits were associated with AIS among Chinese adolescents. Schools, families, and related facilities are recommended to take actions on developing effective prevention and management strategies that integrates "Student-Family-School-Education-Health-Sports" for AIS.
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Affiliation(s)
- Qiufen Dou
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University
| | - Zhixiang Zhu
- The First Affiliated Hospital of Shenzhen University
- Department of Spine Surgery, The Shenzhen Second People's Hospital
- Shenzhen Youth Spine Health Center
| | - Liwan Zhu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University
| | - Shouhang Ru
- The First Affiliated Hospital of Shenzhen University
- Department of Spine Surgery, The Shenzhen Second People's Hospital
- Shenzhen Youth Spine Health Center
| | - Xiaosheng Chen
- The First Affiliated Hospital of Shenzhen University
- Department of Spine Surgery, The Shenzhen Second People's Hospital
- Shenzhen Youth Spine Health Center
| | - Lei Yang
- The First Affiliated Hospital of Shenzhen University
- Department of Spine Surgery, The Shenzhen Second People's Hospital
- Shenzhen Youth Spine Health Center
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University
| | - Bin Yan
- The First Affiliated Hospital of Shenzhen University
- Department of Spine Surgery, The Shenzhen Second People's Hospital
- Shenzhen Youth Spine Health Center
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Jia S, Lin L, Yang H, Xie J, Liu Z, Zhang T, Fan J, Han L. Biodynamic responses of adolescent idiopathic scoliosis exposed to vibration. Med Biol Eng Comput 2023; 61:271-284. [PMID: 36385615 DOI: 10.1007/s11517-022-02710-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
Patients with adolescent idiopathic scoliosis suffer severe health issues. The unclear dynamic biomechanical characteristics of scoliosis were needed to be explored to improve the prevention and treatment in clinics. Validated 3D finite element (FE) models of thoracolumbosacral spine (T1-S1) both with and without scoliosis were developed from computed tomography (CT) images. Modal and harmonic analyses were performed to investigate the biomechanical responses of the spinal models to vibration. Resonant frequencies of the scoliotic model were lower than those of the model without scoliosis. Peak amplitudes occurred at vibrational frequencies close to the modal resonant frequencies, which caused the deformed thoracic segment in scoliosis suffered the maximum amplitude. The stresses on vertebrae and intervertebral discs in the scoliotic model derived from vibrations were significantly larger than those in the non-scoliosis model, and heterogeneously concentrated on the scoliotic thoracic segment. In conclusion, the scoliotic spine in the patients with Lenke 1BN scoliosis is more prone to injuries than the non-scoliotic spine while vibrating. Scoliotic thoracic segments in patients with Lenke 1BN scoliosis were the more vulnerable and sensitive component of the T1-S1 spine to vibration than lumbar spines. This study suggested that vibration would impair the scoliotic spines, and patients with Lenke 1BN scoliosis should avoid exposure to vibration, especially the low-frequency vibration.
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Affiliation(s)
- Shaowei Jia
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Mechanical Engineering, Hebei University of Technology, Tianjin, China
| | - Liying Lin
- School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Hufei Yang
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, China
| | - Junde Xie
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, China
| | - Zefeng Liu
- School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Tianyou Zhang
- School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Jie Fan
- School of Foreign Languages, Hebei University of Technology, Tianjin, China
| | - Li Han
- School of Medical Imaging, Tianjin Medical University, Tianjin, China. .,Medical College, University of Michigan, Ann Arbor, MI, USA.
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Gallazzi E, Pallotta LM, La Maida GA, Luca A, Bassani T, Brayda-Bruno M. Is posteromedial translation with sublaminar bands effective in correcting axial rotation in adolescent idiopathic scoliosis surgery? A 3D reconstruction study. Eur Spine J 2023; 32:202-209. [PMID: 36372841 DOI: 10.1007/s00586-022-07449-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 11/14/2022]
Abstract
PURPOSE Hybrid constructs with sublaminar bands have recently regained popularity as an alternative to all-screw construct for correction of adolescent idiopathic scoliosis (AIS). The aim of this study is to evaluate the ability of hybrid constructs with sublaminar bands to achieve a tridimensional correction of the scoliotic deformity. Our hypothesis is that hybrid construct with sublaminar bands are able to achieve a substantial derotation of the apical vertebrae, while preserving the thoracic kyphosis. METHODS A prospective evaluation of 50 consecutive cases (41 F, 9 M, mean age 14.7 ± 2 years) of AIS correction with hybrid construct was performed. In all cases, sublaminar bands were used at the apex of the main curve on concave side. All patients underwent pre and postoperative X-rays with EOS System, with full 3D reconstruction. Spinopelvic parameters and axial rotation of the vertebrae were measured pre and postoperatively. RESULTS 2.7 ± 0.9 mean sublaminar bands were used per patient. Mean correction of deformity was 50 ± 9.5%. on the coronal plane. The mean axial rotation of the apical vertebra went from 18° ± 11.5° preoperatively to 9.4° ± 7.2° postoperatively (p < 0.001) with a mean derotation of 47.7%. Thoracic kyphosis went from 32.1° ± 18° preoperatively to 37.3° ± 13.1° postoperatively (p < 0.05). No intraoperative complications due to sublaminar bands were recorded. CONCLUSIONS Hybrid construct with sublaminar band have been showed to be safe and effective in deformity correction and in maintaining or restoring thoracic kyphosis. This study showed that with sublaminar bands applied at the curve apex a substantial derotation of the apical vertebrae can be achieved.
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Affiliation(s)
- Enrico Gallazzi
- U.O. Ortopedia e Traumatologia per le Patologie della Colonna Vertebrale, ASST Gaetano Pini - CTO, Milan, Italy.
| | - Ludovica Maria Pallotta
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi Di Milano, Milan, Italy
| | - Giovanni Andrea La Maida
- U.O. Ortopedia e Traumatologia per le Patologie della Colonna Vertebrale, ASST Gaetano Pini - CTO, Milan, Italy
| | - Andrea Luca
- U.O. Chirurgia Vertebrale III - Scoliosi, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Tito Bassani
- LABS-Laboratory of Biological Structures Mechanics, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Marco Brayda-Bruno
- U.O. Chirurgia Vertebrale III - Scoliosi, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
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Shen X, Yang Z, Zhang P, Xu Y, Wang J. Effects of balance training combined with Schroth therapy on adolescents with mild idiopathic scoliosis: A six-week randomized controlled trial. J Back Musculoskelet Rehabil 2023; 36:1365-1373. [PMID: 37458026 DOI: 10.3233/bmr-220383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) has a great negative impact on the physical and mental health of patients; thus, a range of effective, timely interventions are urgently needed. Currently, there is a lack of evidence to illustrate the effect of balance training in patients with AIS, and the traditional AIS therapy often ignores the recovery in balance function of patients with AIS. OBJECTIVE To investigate the effect of balance training combined with Schroth therapy among adolescent with mild idiopathic scoliosis. METHODS 59 adolescents (aged 10 to 18, 35.59% male) with idiopathic scoliosis were selected and divided into an intervention group (n= 30) and a control group (n= 29). Participants in both groups received routine rehabilitation treatment based on Schroth therapy, and balance training was added in the intervention group. The duration of treatment for both groups was 6 weeks. The Trunk Rotation Angle (ATR), Cobb angle, Scoliosis Research Society 22 (SRS-22) scale and balance function of the two groups were evaluated at baseline and after the intervention. RESULTS No significant difference of outcomes were observed between groups at baseline (P> 0.05). After 6 weeks of intervention, the ATR, Cobb angle, SRS-22 and balance function of the two groups improved significantly compared with those before treatment (P< 0.05), and the intervention group had a significant improvement than the control group (P< 0.05). CONCLUSION Balance training combined with Schroth therapy for adolescents with mild idiopathic scoliosis can significantly improve ATR, Cobb angle and quality of life, as well as overall balance function.
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Affiliation(s)
- Xiangyu Shen
- School of Physical Education and Sports, Soochow University, Suzhou, Jiangsu, China
| | - Zhen Yang
- Department of Movement Science, KU Leuven, Leuven, Belgium
| | - Peng Zhang
- Department of Rehabilitation Medicine, Suzhou Science and Technology Town Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yingye Xu
- School of Physical Education and Sports, Soochow University, Suzhou, Jiangsu, China
| | - Jielong Wang
- School of Physical Education and Sports, Soochow University, Suzhou, Jiangsu, China
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Lin A, Guo X, Lai G, Kang J, Wang Z, Chen H, Liu W, Kang X. Evaluation of Chêneau brace in the treatment of thoracic and lumbar adolescent idiopathic scoliosis with apical vertebral rotation. J Back Musculoskelet Rehabil 2023; 36:1345-1354. [PMID: 37458019 DOI: 10.3233/bmr-220363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is a common structural disorder of the spine in adolescents, often associated with structural deformities in both coronal and axial positions. Apical vertex rotation (AVR) is one of the main indicators of axial deformity in patients with scoliosis. Currently, there are few studies on the impact of AVR in the treatment of AIS. OBJECTIVE This study examined the influence of different AVR on AIS after brace treatment. METHODS Data were collected from 106 AIS participants aged 11-16 years from the orthopedic outpatient clinic of the Second Hospital of Lanzhou University. Two orthopaedic professionals measured the Cobb angle, AVR and spinal mid-line offset before and after brace treatment, and descriptive and linear correlation analyses were used to determine the correlation between AVR and AIS measured parameters. RESULTS (1) In AIS volunteers with the same AVR, the treatment effect of AIS with lumbar predominant curvature was higher than that of AIS with thoracic predominant curvature. The treatment effect tended to decrease with increasing AVR. (2) Spinal mid-line deviation was associated with AVR. For patients with AIS with I and II degrees of AVR, the treatment effect of spinal mid-line offset after bracing is better. For AIS patients with AVR III degrees and above, the degree of correction of spinal mid-line offset decreases with the continuous correction of Cobb angle. CONCLUSIONS The efficacy of AIS was found to be related to the severity of AVR. The efficacy of AIS with predominantly lumbar curvature was significantly higher than that of AIS with predominantly thoracic curvature. The efficacy of treatment of mid-line spinal deviation also decreased with increasing AVR.
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Affiliation(s)
- Aixin Lin
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- The Second Clinical Medical College, Lanzhou Unversity, Lanzhou, Gansu, China
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xudong Guo
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- The Second Clinical Medical College, Lanzhou Unversity, Lanzhou, Gansu, China
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Guilin Lai
- Gansu Printer Science and Technology Co. Ltd., Lanzhou, Gansu, China
| | - Jihe Kang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- The Second Clinical Medical College, Lanzhou Unversity, Lanzhou, Gansu, China
| | - Zhaoheng Wang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- The Second Clinical Medical College, Lanzhou Unversity, Lanzhou, Gansu, China
| | - Haiwei Chen
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- The Second Clinical Medical College, Lanzhou Unversity, Lanzhou, Gansu, China
| | - Wenzhao Liu
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- The Second Clinical Medical College, Lanzhou Unversity, Lanzhou, Gansu, China
| | - Xuewen Kang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- The Second Clinical Medical College, Lanzhou Unversity, Lanzhou, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- The International Cooperation Base of Gansu Province for The Pain Research in Spinal Disorders, Lanzhou, Gansu, China
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197
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Thomas ES, Boyer N, Meyers A, Aziz H, Aminian A. Restoration of thoracic kyphosis in adolescent idiopathic scoliosis with patient-specific rods: did the preoperative plan match postoperative sagittal alignment? Eur Spine J 2023; 32:190-201. [PMID: 36357540 DOI: 10.1007/s00586-022-07437-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/17/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE To determine if the planned sagittal profile for thoracic kyphosis (TK) restoration was achieved after adolescent idiopathic scoliosis (AIS) surgery using a novel hybrid construct with apical double bands and precontoured patient-specific rods (PSR) made according to the detailed surgical plan for the desired sagittal plane. METHODS AIS patients with a Lenke type 1-4 primary right thoracic curve who underwent corrective surgery by a single surgeon and had minimum 24-month follow-up were analyzed retrospectively from a prospective database. All patients underwent simultaneous translation on two rods with apical double bands and PSR. Clinical outcomes in terms of sagittal 2D TK (T4-T12), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), PI-LL mismatch, rod angle, and rod deflection were compared between preoperative, planned, and 24-month data, while 3D apical rotation, 3D TK (T5-T12), sagittal thoracolumbar angle, degree of curvature at L1-L4 and L4-S1, proximal junctional angle, and distal junctional angle were compared at baseline and at 6 and 24 months postoperatively. SRS-22 questionnaire scores were obtained at baseline and 24 months postoperatively. RESULTS Forty-eight patients were included. Study patients had a median coronal thoracic curve of 62.7° preoperatively and 22.4° at 24-month follow-up (p < 0.001). Median TK gain was 6.5° for the entire cohort (n = 48) and 19.1° in the Lenke type 1 and 2 hypokyphotic subgroup (n = 14). Both groups had no significant changes between planned and 24-month TK (p = 0.068 and p = 0.943, respectively), rod angle (p = 0.776 and p = 0.548, respectively), or rod deflection (p = 0.661 and p = 0.850, respectively). For the overall study cohort, median LL gain was 7.0° (p < 0.001), 3D apical derotation was 10.7° (p < 0.001), and change in 3D TK was 36° (p < 0.001). No instance of proximal junctional kyphosis was observed. SRS-22 scores for pain, self-image, and satisfaction differed significantly between the preoperative and 24-month follow-up time-points. CONCLUSIONS With sagittal plane planning, desired TK, improved reciprocal changes in LL, and minimal changes in rod shape can be achieved in patients with AIS.
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Affiliation(s)
- Evelyn S Thomas
- Department of Orthopedic Surgery, Children's Hospital of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA. .,Department of Orthopedic Surgery, Kettering Health Dayton, Dayton, OH, USA.
| | - Noah Boyer
- Department of Orthopedic Surgery, Children's Hospital of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
| | - Andrew Meyers
- Department of Orthopedic Surgery, Community Memorial Hospital, Ventura, CA, USA
| | - Hossein Aziz
- Department of Orthopedic Surgery, Children's Hospital of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA.,Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Afshin Aminian
- Department of Orthopedic Surgery, Children's Hospital of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
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Kan MMP, Negrini S, Di Felice F, Cheung JPY, Donzelli S, Zaina F, Samartzis D, Cheung ETC, Wong AYL. Is impaired lung function related to spinal deformities in patients with adolescent idiopathic scoliosis? A systematic review and meta-analysis-SOSORT 2019 award paper. Eur Spine J 2023; 32:118-39. [PMID: 36509885 DOI: 10.1007/s00586-022-07371-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/08/2022] [Accepted: 08/27/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Some teenagers with adolescent idiopathic scoliosis (AIS) display compromised lung function. However, the evidence regarding the relations between pulmonary impairments and various spinal deformity parameters in these patients remains unclear, which affects clinical management. This systematic review and meta-analysis aimed to summarize the associations between various lung function parameters and radiographic features in teenagers with AIS. METHODS A search of PubMed, Embase, PEDro, SPORTDiscus, CINAHL, Cochrane Library, and PsycINFO (from inception to March 14, 2022) without language restriction. Original studies reporting the associations between lung function and spinal deformity in patients with AIS were selected. Independent reviewers extracted data and evaluated the methodological quality of the included studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pearson correlation and 95% confidence intervals were calculated using random-effects meta-analysis. RESULTS Twenty-seven studies involving 3162 participants were included. Limited-quality evidence supported that several spinal parameters were significantly related to lung function parameters (e.g., absolute value and percent of the predicted forced vital capacity (FVC; %FVC), forced expiratory volume in one second (FEV1; %FEV1), and total lung capacity (TLC; %TLC)) in AIS patients. Specifically, meta-analyses showed that main thoracic Cobb angles in the coronal plane were significantly and negatively related to FVC (r = - 0.245), %FVC (r = - 0.302), FEV1 (r = - 0.232), %FEV1 (r = - 0.348), FEV1/FVC ratio (r = - 0.166), TLC (r = - 0.302), %TLC (r = - 0.183), and percent predicted vital capacity (r = - 0.272) (p < 0.001). Similarly, thoracic apical vertebral rotation was negatively associated with %FVC (r = - 0.215) and %TLC (r = - 0.126) (p < 0.05). Conversely, thoracic kyphosis angles were positively related to %FVC (r = 0.180) and %FEV1 (r = 0.193) (p < 0.05). CONCLUSION Larger thoracic Cobb angles, greater apical vertebral rotation angle, or hypokyphosis were significantly associated with greater pulmonary impairments in patients with AIS, although the evidence was limited. From a clinical perspective, the results highlight the importance of minimizing the three-dimensional spinal deformity in preserving lung function in these patients. More research is warranted to confirm these results.
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Shakeri M, Mahdavi SM, Nikouei F, Ameri E, Eslami A, Habibollahzadeh A, Ghandhari H. Reliability and Validity of the Persian Version of the Body Image Disturbance Questionnaire-Scoliosis in Patients with Adolescent Idiopathic Scoliosis Who Did Not Have Surgical Indication. Arch Bone Jt Surg 2023; 11:130-135. [PMID: 37168827 PMCID: PMC10165678 DOI: 10.22038/abjs.2022.66298.3170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/22/2022] [Indexed: 05/13/2023]
Abstract
Background Adolescent Idiopathic Scoliosis (AIS) is the most common spinal deformity disorder associated with bad posture and reduced quality of life. The Body Image Disturbance Questionnaire-Scoliosis (BIDQ-S) is a self-report instrument that assesses the concerns of scoliotic patients. This study aimed to translate and evaluate the reproducibility and internal consistency of the BIDQ-S in the Persian-speaking population worldwide suffering from AIS. Methods The BIDQ-S was translated into Persian by two native-speaking Iranian translators and back-translated into English by two native-English translators. The resulting back-translated English BIDQ-S was then sent to the authors of the English BIDQ-S questionnaire for validation. After translation, it was provided for 41 AIS patients from those who referred to the outpatient clinics of Shafa Yahyaian Hospital from January 2020 to January 2021. Patients were asked to complete the Persian BIDQ-S and Persian Scoliosis Research Society-22 (SRS-22) inventories. Internal consistency and reproducibility were assessed using Cronbach's alpha and interclass correlation coefficients (ICC), respectively. The validity of the questionnaire was evaluated by comparing the scores obtained on the Persian BIDQ-S (P-BIDQ-S) inventory with those obtained on the SRS-22 subscales. Results The consistency and reliability of the P- BIDQ-S inventory were confirmed by Cronbach's alpha of 0.856 and interclass correlation coefficients of 0.882. The P-BIDQ-S scores directly correlated with the level of education of patients (r=0.21, P=0.041). The correlation coefficient between the P-BIDQ-S inventory and the SRS-22 questionnaire was -0.56 (P=0.001). A significant correlation was also observed between the P-BIDQ-S items and all of the SRS-22 subscales (P<0.05). Conclusion The P-BIDQ-S inventory maintains adequate reliability, internal consistency, and reproducibility for the evaluation of Persian-speaking AIS patients.
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Affiliation(s)
- Mohammadreza Shakeri
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mani Mahdavi
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Nikouei
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Ameri
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Arvin Eslami
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Habibollahzadeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Ghandhari
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Quarto E, Bourret S, Rebollar Y, Mannem A, Cloche T, Balabaud L, Boue L, Thompson W, Le Huec JC. Team management in complex posterior spinal surgery allows blood loss limitation. Int Orthop 2023; 47:225-31. [PMID: 36194284 DOI: 10.1007/s00264-022-05586-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/18/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE The objective is to analyse peri-operative blood loss (BL) and hidden blood loss (HBL) rates in spinal deformity complex cases surgery, with a focus on the strategies to prevent major bleeding. METHODS We retrospectively analysed surgical and anaesthesiologic data of patients who had been operated for adolescent idiopathic scoliosis (AIS) or adult spinal deformities (ASD) with a minimum of five levels fused. A statistical comparison among AIS, ASD without a pedicle subtraction osteotomy (PSO) (ASD-PSO( -)) and ASD with PSO (ASD-PSO( +)) procedures was performed with a view to identifying patient- and/or surgical-related factors affecting peri-operative BL and HBL. RESULTS One-hundred patients were included with a mean 9.9 ± 2.8 fused vertebrae and a mean 264.2 ± 68.3 minutes operative time (OT) (28.3 ± 9 min per level). The mean perioperative BL was 641.2 ± 313.8 ml (68.9 ± 39.5 ml per level) and the mean HBL was 556.6 ± 381.8 ml (60.6 ± 42.8 ml per level), with the latter accounting for 51.5% of the estimated blood loss (EBL). On multivariate regression analysis, a longer OT (p < 0.05; OR 3.38) and performing a PSO (p < 0.05; OR 3.37) were related to higher peri-operative BL, while older age (p < 0.05; OR 2.48) and higher BMI (p < 0.05; OR 2.15) were associated to a more significant post-operative HBL. CONCLUSION With the correct use of modern technologies and patient management, BL in major spinal deformity surgery can be dramatically reduced. Nevertheless, it should be kept in mind that 50% of patients estimated losses are hidden and not directly controllable. Knowing the per-level BL allows anticipating global losses and, possibly, the need of allogenic transfusions.
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