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Shea GKH, Ng SYL, Zhang C, Wang G. Prognosticating accelerated deterioration in skeletally mature adolescent idiopathic scoliosis curves of 40-50° using uniplanar radiographic measures of axial rotation. Spine Deform 2024:10.1007/s43390-024-00949-1. [PMID: 39145791 DOI: 10.1007/s43390-024-00949-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 07/15/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE The management of adolescent idiopathic scoliosis (AIS) curves between 40 and 50° is controversial. Here, we investigated the prognostic significance of simple radiographic rotational parameters to identify curves of this magnitude with accelerated deterioration following skeletal maturity. METHODS Seventy-three patients were identified with AIS and Cobb angles of the major curve between 40 and 50° at skeletal maturity. We defined fast progressive curves as those increasing by ≥ 2° per year after skeletal maturity. From the apical vertebra of the major curve upon presentation and skeletal maturity, we determined the modified Nash-Moe index (×100), and from thoracic major curves, the Rib Index. T tests were performed to compare fast-progressive curves with those that deteriorated by < 2° per year. Receiver operator characteristic (ROC) curves were plotted to establish optimal cutoffs, sensitivity, and specificity measures for rotational parameters. RESULTS The average duration of follow-up post was 11.8 ± 7.3 years. Thirteen out of seventy-three patients were fast progressors. The modified Nash-Moe index was similar between groups at presentation (p = 0.477) but significantly higher in fast progressors than non-fast progressors at maturity for major thoracic curves (25.40 ± 6.60 vs. 19.20 ± 4.40, p < 0.001). Rib Index values were also higher among fast progressors at skeletal maturity (2.50 ± 0.90 vs. 1.80 ± 0.60, p = 0.026). An ROC curve for a modified Nash-Moe index of 0.235 for thoracic curves achieved an area under the curve (AUC) of 0.76 for discriminating fast progressors. A threshold of 1.915 for Rib Index at maturity achieved an AUC of 0.72 for discriminating fast progressors. In combining both rotational parameters, an AUC of 0.81 was achieved. CONCLUSION These simple rotational parameters may be useful to predict fast progression in 40-50° AIS curves following skeletal maturity indicated for early fusion, but further validation upon larger cohorts and non-thoracic major curves is required.
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Affiliation(s)
- Graham Ka-Hon Shea
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.
| | - Samuel Yan-Lik Ng
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Changmeng Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Guodong Wang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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2
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Costa L, van Lange A, Seevinck PR, Chu W, Vavruch L, Kruyt MC, Castelein RM, Schlosser TPC. Maturation of the vertebral ring apophysis is delayed in girls with adolescent idiopathic scoliosis compared to the normal population. Spine Deform 2024:10.1007/s43390-024-00908-w. [PMID: 38849690 DOI: 10.1007/s43390-024-00908-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/24/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The ring apophysis is a secondary ossification center on both sides of each vertebral body, to which the annulus of the intervertebral disc inserts. Recently, its pattern of ossification and fusion to the vertebral body was described for the normal growing spine. The aim of the present study was to investigate the ossification and fusion of the ring apophysis in patients with adolescent idiopathic scoliosis (AIS) and compare it to the normal growing population. METHODS Ring apophysis maturation along the entire thoracic and lumbar spine was analyzed on CT scans of 99 female, pre-operative AIS patients and compared to 134 CT scans of non-scoliotic girls, aged 12 to 20. RESULTS The ring apophysis maturation in AIS patients was delayed at all spinal levels in AIS patients compared to non-scoliotic controls. Ossification starts at T4-T11 at age 12, followed by T1-T5 and L3-S1 at age 15. The fusion process in AIS patients continues longer in the midthoracic region as compared to the other regions and as compared to non-scoliotic controls, with many incomplete fusions still at age 20. CONCLUSION The ring apophysis maturation in AIS is delayed compared to that in the normal population and lasts longer in the mid/low thoracic spine. Delayed maturation of the spine's most important stabilizer, while the body's dimensions continue to increase, could be part of the patho-mechanism of AIS.
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Affiliation(s)
- Lorenzo Costa
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, 3508 GA, P.O. Box 85500, Utrecht, The Netherlands
| | - Agnes van Lange
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, 3508 GA, P.O. Box 85500, Utrecht, The Netherlands
| | - Peter R Seevinck
- Department of Imaging, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Winnie Chu
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong at The Prince of Wales Hospital, Sha Tin, China
| | - Ludvig Vavruch
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Moyo C Kruyt
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, 3508 GA, P.O. Box 85500, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, 3508 GA, P.O. Box 85500, Utrecht, The Netherlands
| | - Tom P C Schlosser
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, 3508 GA, P.O. Box 85500, Utrecht, The Netherlands.
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Chen C, Tang Y, Yang S, Dai W, Tan J, Yu X, Zhang C, Luo F. Relationship between paravertebral muscle function, pelvic incidence, and health-related quality of life in patients with degenerative spinal deformity. J Orthop Surg Res 2024; 19:102. [PMID: 38297329 PMCID: PMC10832213 DOI: 10.1186/s13018-024-04593-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/28/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Patients with degenerative spinal deformity often experience symptoms that seriously affect their quality of life, such as low back pain and dysfunction. This study aimed to investigate the relationship between paravertebral muscle function and pelvic incidence (PI) and their effect on health-related quality of life (HRQL) in patients with degenerative spinal deformity. METHODS A total of 112 patients with degenerative spinal deformity in Southwest Hospital (Chongqing, China) were enrolled. They were divided into groups according to PI angle: high (PI > 60°, n = 37), normal (PI 50°-60°, n = 31), and low (PI < 50°, n = 44). Paravertebral muscle strength and endurance were assessed using the prone external fixation test frame. The sagittal vertical axis (SVA) was measured on X-rays of the spine in an anterolateral position, and all subjects were assessed with the Oswestry Disability Index (ODI), Roland-Morris questionnaire (RMQ), and 36-Item Short Form Health Survey (SF-36). Pearson or Spearman coefficients were used to assess the relationship of paravertebral muscle function with SVA, PI, and health-related quality of life. RESULTS Maximal voluntary exercise (MVE) in the high-PI group was significantly lower than the MVE of both the normal- and low-PI groups (p < 0.05). There was no significant difference in MVE between the normal- and low-PI groups (p > 0.05). There was no significant difference in endurance time, SVA, ODI, RMQ, and SF-36 among the three groups. Paravertebral muscle MVE was negatively correlated with PI, SVA, ODI, and RMQ (r = - 0.193, - 0.210, - 0.283, - 0.277, p < 0.05). Endurance time of paravertebral muscle was also negatively correlated with SVA, ODI, and RMQ (r = - 0.200, - 0.420, - 0.348, p < 0.05) and positively correlated with SF-36 (r = 0.245, p < 0.05). In addition, paravertebral muscle MVE was positively correlated with the physical functioning score of the SF-36 (r = 0.251, p < 0.05), and the endurance time of paravertebral muscle was positively correlated with the physical functioning, physical role, bodily pain, and social function scores of the SF-36 (r = 0.342, 0.230, 0.209, 0.256, p < 0.05). CONCLUSIONS High PI may serve as a risk factor for decreased paraspinal muscle strength in patients with degenerative spinal deformities. Early and targeted exercises focusing on paraspinal muscle strength and endurance could potentially be of positive significance in slowing down the progression of sagittal imbalance, alleviating functional disorders, and increasing health-related quality of life in patients with degenerative spinal deformity.
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Affiliation(s)
- Can Chen
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, People's Republic of China
- Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University (Third Military Medical University), Chongqing, 400038, People's Republic of China
| | - Yong Tang
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, People's Republic of China
- Department of Orthopaedics, The 72nd Group Army Hospital, Huzhou University, Huzhou, 313000, Zhejiang, People's Republic of China
| | - Sen Yang
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, People's Republic of China
| | - Wei Dai
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, People's Republic of China
| | - Jiulin Tan
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, People's Republic of China
| | - Xueke Yu
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, People's Republic of China
| | - Chengmin Zhang
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, People's Republic of China.
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, People's Republic of China.
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Yu H, Khanshour AM, Ushiki A, Otomo N, Koike Y, Einarsdottir E, Fan Y, Antunes L, Kidane YH, Cornelia R, Sheng RR, Zhang Y, Pei J, Grishin NV, Evers BM, Cheung JPY, Herring JA, Terao C, Song YQ, Gurnett CA, Gerdhem P, Ikegawa S, Rios JJ, Ahituv N, Wise CA. Association of genetic variation in COL11A1 with adolescent idiopathic scoliosis. eLife 2024; 12:RP89762. [PMID: 38277211 PMCID: PMC10945706 DOI: 10.7554/elife.89762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a common and progressive spinal deformity in children that exhibits striking sexual dimorphism, with girls at more than fivefold greater risk of severe disease compared to boys. Despite its medical impact, the molecular mechanisms that drive AIS are largely unknown. We previously defined a female-specific AIS genetic risk locus in an enhancer near the PAX1 gene. Here, we sought to define the roles of PAX1 and newly identified AIS-associated genes in the developmental mechanism of AIS. In a genetic study of 10,519 individuals with AIS and 93,238 unaffected controls, significant association was identified with a variant in COL11A1 encoding collagen (α1) XI (rs3753841; NM_080629.2_c.4004C>T; p.(Pro1335Leu); p=7.07E-11, OR = 1.118). Using CRISPR mutagenesis we generated Pax1 knockout mice (Pax1-/-). In postnatal spines we found that PAX1 and collagen (α1) XI protein both localize within the intervertebral disc-vertebral junction region encompassing the growth plate, with less collagen (α1) XI detected in Pax1-/- spines compared to wild-type. By genetic targeting we found that wild-type Col11a1 expression in costal chondrocytes suppresses expression of Pax1 and of Mmp3, encoding the matrix metalloproteinase 3 enzyme implicated in matrix remodeling. However, the latter suppression was abrogated in the presence of the AIS-associated COL11A1P1335L mutant. Further, we found that either knockdown of the estrogen receptor gene Esr2 or tamoxifen treatment significantly altered Col11a1 and Mmp3 expression in chondrocytes. We propose a new molecular model of AIS pathogenesis wherein genetic variation and estrogen signaling increase disease susceptibility by altering a PAX1-COL11a1-MMP3 signaling axis in spinal chondrocytes.
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Affiliation(s)
- Hao Yu
- Center for Translational Research, Scottish Rite for ChildrenDallasUnited States
| | - Anas M Khanshour
- Center for Translational Research, Scottish Rite for ChildrenDallasUnited States
| | - Aki Ushiki
- Department of Bioengineering and Therapeutic Sciences, University of California, San FranciscoSan FranciscoUnited States
- Institute for Human Genetics, University of California, San FranciscoSan FranciscoUnited States
| | - Nao Otomo
- Laboratory of Bone and Joint Diseases, RIKEN Center for Integrative Medical SciencesTokyoJapan
| | - Yoshinao Koike
- Laboratory of Bone and Joint Diseases, RIKEN Center for Integrative Medical SciencesTokyoJapan
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical SciencesYokohamaJapan
| | - Elisabet Einarsdottir
- Science for Life Laboratory, Department of Gene Technology, KTH-Royal Institute of TechnologySolnaSweden
| | - Yanhui Fan
- School of Biomedical Sciences, The University of Hong KongHong Kong SARChina
| | - Lilian Antunes
- Department of Neurology, Washington University in St. LouisSt. LouisUnited States
| | - Yared H Kidane
- Center for Translational Research, Scottish Rite for ChildrenDallasUnited States
| | - Reuel Cornelia
- Center for Translational Research, Scottish Rite for ChildrenDallasUnited States
| | - Rory R Sheng
- Department of Bioengineering and Therapeutic Sciences, University of California, San FranciscoSan FranciscoUnited States
- Institute for Human Genetics, University of California, San FranciscoSan FranciscoUnited States
| | - Yichi Zhang
- Department of Bioengineering and Therapeutic Sciences, University of California, San FranciscoSan FranciscoUnited States
- Institute for Human Genetics, University of California, San FranciscoSan FranciscoUnited States
- School of Pharmaceutical Sciences, Tsinghua UniversityBeijingChina
| | - Jimin Pei
- Department of Biophysics, University of Texas Southwestern Medical CenterDallasUnited States
| | - Nick V Grishin
- Department of Biophysics, University of Texas Southwestern Medical CenterDallasUnited States
| | - Bret M Evers
- Department of Pathology, University of Texas Southwestern Medical CenterDallasUnited States
- Department of Ophthalmology, University of Texas Southwestern Medical CenterDallasUnited States
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology LKS Faculty of Medicine, The University of Hong KongHong Kong SARChina
| | - John A Herring
- Department of Orthopedic Surgery, Scottish Rite for ChildrenDallasUnited States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical CenterDallasUnited States
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical SciencesYokohamaJapan
| | - You-qiang Song
- School of Biomedical Sciences, The University of Hong KongHong Kong SARChina
| | - Christina A Gurnett
- Department of Neurology, Washington University in St. LouisSt. LouisUnited States
| | - Paul Gerdhem
- Department of Surgical Sciences, Uppsala UniversityUppsalaSweden
- Department of Orthopaedics and Hand Surgery, Uppsala University HospitalUppsalaSweden
- Department of Clinical Science, Intervention & Technology (CLINTEC), Karolinska Institutet, Stockholm, Uppsala UniversityUppsalaSweden
| | - Shiro Ikegawa
- Laboratory of Bone and Joint Diseases, RIKEN Center for Integrative Medical SciencesTokyoJapan
| | - Jonathan J Rios
- Center for Translational Research, Scottish Rite for ChildrenDallasUnited States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical CenterDallasUnited States
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical CenterDallasUnited States
- Department of Pediatrics, University of Texas Southwestern Medical CenterDallasUnited States
| | - Nadav Ahituv
- Department of Bioengineering and Therapeutic Sciences, University of California, San FranciscoSan FranciscoUnited States
- Institute for Human Genetics, University of California, San FranciscoSan FranciscoUnited States
| | - Carol A Wise
- Center for Translational Research, Scottish Rite for ChildrenDallasUnited States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical CenterDallasUnited States
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical CenterDallasUnited States
- Department of Pediatrics, University of Texas Southwestern Medical CenterDallasUnited States
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5
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Yu H, Khanshour AM, Ushiki A, Otomo N, Koike Y, Einarsdottir E, Fan Y, Antunes L, Kidane YH, Cornelia R, Sheng R, Zhang Y, Pei J, Grishin NV, Evers BM, Cheung JPY, Herring JA, Terao C, Song YQ, Gurnett CA, Gerdhem P, Ikegawa S, Rios JJ, Ahituv N, Wise CA. Association of genetic variation in COL11A1 with adolescent idiopathic scoliosis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.26.542293. [PMID: 37292598 PMCID: PMC10245954 DOI: 10.1101/2023.05.26.542293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Adolescent idiopathic scoliosis (AIS) is a common and progressive spinal deformity in children that exhibits striking sexual dimorphism, with girls at more than five-fold greater risk of severe disease compared to boys. Despite its medical impact, the molecular mechanisms that drive AIS are largely unknown. We previously defined a female-specific AIS genetic risk locus in an enhancer near the PAX1 gene. Here we sought to define the roles of PAX1 and newly-identified AIS-associated genes in the developmental mechanism of AIS. In a genetic study of 10,519 individuals with AIS and 93,238 unaffected controls, significant association was identified with a variant in COL11A1 encoding collagen (α1) XI (rs3753841; NM_080629.2_c.4004C>T; p.(Pro1335Leu); P=7.07e-11, OR=1.118). Using CRISPR mutagenesis we generated Pax1 knockout mice (Pax1-/-). In postnatal spines we found that PAX1 and collagen (α1) XI protein both localize within the intervertebral disc (IVD)-vertebral junction region encompassing the growth plate, with less collagen (α1) XI detected in Pax1-/- spines compared to wildtype. By genetic targeting we found that wildtype Col11a1 expression in costal chondrocytes suppresses expression of Pax1 and of Mmp3, encoding the matrix metalloproteinase 3 enzyme implicated in matrix remodeling. However, this suppression was abrogated in the presence of the AIS-associated COL11A1P1335L mutant. Further, we found that either knockdown of the estrogen receptor gene Esr2, or tamoxifen treatment, significantly altered Col11a1 and Mmp3 expression in chondrocytes. We propose a new molecular model of AIS pathogenesis wherein genetic variation and estrogen signaling increase disease susceptibility by altering a Pax1-Col11a1-Mmp3 signaling axis in spinal chondrocytes.
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Affiliation(s)
- Hao Yu
- Center for Pediatric Bone Biology and Translational Research, Scottish Rite for Children, Dallas, TX, USA
| | - Anas M Khanshour
- Center for Pediatric Bone Biology and Translational Research, Scottish Rite for Children, Dallas, TX, USA
| | - Aki Ushiki
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Nao Otomo
- Laboratory of Bone and Joint Diseases, RIKEN Center for Integrative Medical Sciences, Tokyo, JP
| | - Yoshinao Koike
- Laboratory of Bone and Joint Diseases, RIKEN Center for Integrative Medical Sciences, Tokyo, JP
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, JP
| | - Elisabet Einarsdottir
- Science for Life Laboratory, Department of Gene Technology, KTH-Royal Institute of Technology, Solna, SE
| | - Yanhui Fan
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, CN
| | - Lilian Antunes
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Yared H Kidane
- Center for Pediatric Bone Biology and Translational Research, Scottish Rite for Children, Dallas, TX, USA
| | - Reuel Cornelia
- Center for Pediatric Bone Biology and Translational Research, Scottish Rite for Children, Dallas, TX, USA
| | - Rory Sheng
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Yichi Zhang
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, CN
| | - Jimin Pei
- Department of Biophysics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nick V Grishin
- Department of Biophysics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bret M Evers
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, CN
| | - John A Herring
- Department of Orthopedic Surgery, Scottish Rite for Children, Dallas, TX, USA
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, JP
| | - You-Qiang Song
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, CN
| | - Christina A Gurnett
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Paul Gerdhem
- Department of Clinical Science, Intervention & Technology (CLINTEC), Karolinska Institutet, Stockholm, Uppsala University, Uppsala, SE
- Department of Surgical Sciences, Uppsala University and
- Department of Orthopaedics and Hand Surgery, Uppsala University Hospital, Uppsala, SE
| | - Shiro Ikegawa
- Laboratory of Bone and Joint Diseases, RIKEN Center for Integrative Medical Sciences, Tokyo, JP
| | - Jonathan J Rios
- Center for Pediatric Bone Biology and Translational Research, Scottish Rite for Children, Dallas, TX, USA
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nadav Ahituv
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Carol A Wise
- Center for Pediatric Bone Biology and Translational Research, Scottish Rite for Children, Dallas, TX, USA
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Langlais T, Bouy A, Eloy G, Mainard N, Skalli W, Vergari C, Vialle R. Sagittal plane assessment of manual concave rod bending for posterior correction in adolescents with idiopathic thoracic scoliosis (Lenke 1 and 3). Orthop Traumatol Surg Res 2023; 109:103654. [PMID: 37399990 DOI: 10.1016/j.otsr.2023.103654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 07/05/2023]
Abstract
OBJECTIVES The objectives of this study were to evaluate the repeatability and reproducibility of a method for measuring freehand rod bending and to analyze the relationship between the rod's bend and the resulting sagittal correction. MATERIALS AND METHODS All the children who underwent correction by posterior translation using pedicle screws at all levels were included prospectively in 2018 and 2019. The rod's sagittal parameters were measured retrospectively by three independent surgeons on two separate occasions using the same protocol. After the rods were bent but before they were inserted, the surgeon traced the contours of the rods on a sheet of paper that was later scanned and analyzed semiautomatically. The spinal parameters were calculated based on biplanar radiographs taken preoperatively, postoperatively and at the final follow-up visit. Patients who had less than 10° thoracic kyphosis (T5-T12) made up the "Lenke N-" subgroup. RESULTS Thirty patients were included (14 of whom were Lenke N-) who had a Cobb angle of 59.2±11.3° preoperatively and 13.3±8.4° postoperatively (p<0.00001). The inter- and intrarater ICC for the rod measurements were>0.9 (excellent). The mean kyphosis of the concave rod was 48.4±5.7° (38.3-60.9°). The mean change in T5-T12 kyphosis was 9.7±10.8° (-14.3-30.8°) (p<0.0001) in the entire population, while it was 17.7±7.1° (5.5-30.8°) (p<0.0001) in the Lenke N- subgroup. The change in thoracic kyphosis was positively correlated with the kyphosis of the concave rod (rho=0.52; p=0.003). CONCLUSION This study found excellent reproducibility and repeatability of measuring freehand rod bending. The kyphosis applied to the concave rod is positively correlated to the change in the resulting kyphosis and made it possible to restore satisfactory thoracic kyphosis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tristan Langlais
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France; Institut de Biomécanique Humaine Georges Charpak-IBHGC, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, HESAM Université, 75013 Paris, France; Service d'orthopédie pédiatrique, hôpital des Enfants, Purpan, Toulouse université, Toulouse, France.
| | - Alois Bouy
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Gauthier Eloy
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Nicolas Mainard
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak-IBHGC, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, HESAM Université, 75013 Paris, France
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak-IBHGC, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, HESAM Université, 75013 Paris, France
| | - Raphaël Vialle
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
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Liu Z, Li H, Tang Y, Liu H, Zhang J, Zou J, Zhang K, Chen K. Comparison of unilateral and bilateral percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures associated with scoliosis. Exp Ther Med 2023; 26:335. [PMID: 37383374 PMCID: PMC10294595 DOI: 10.3892/etm.2023.12034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/27/2023] [Indexed: 06/30/2023] Open
Abstract
To assess the clinical and radiographic effectiveness of unilateral and bilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF) associated with scoliosis, 52 patients with OVCF associated with scoliosis who underwent PKP were retrospectively analysed. The patients were divided into the unilateral PKP group (n=26) and the bilateral PKP group (n=26). The operation time, bone cement injection volume and frequency of intraoperative fluoroscopy were recorded and compared between the groups. Additionally, visual analogue scale (VAS) and Oswestry disability index (ODI) scores, as well as postoperative complications, including bone cement leakage and adjacent vertebral fractures, were also assessed. The operation time, bone cement injection volume and intraoperative fluoroscopy frequency were significantly lower in the unilateral compared with the bilateral group (P<0.001). The VAS score, ODI score, average vertebral body height and kyphotic angle (KA) were improved after surgery in each group with no difference in these clinical parameters between the two groups both before and after surgery. Furthermore, the proportion of cases with bone cement leakage in the unilateral group was significantly lower compared with that in the bilateral group (P<0.05). During the follow-up, there were three cases (11.5%) in the unilateral group and two cases (7.7%) in the bilateral group who suffered adjacent vertebral fractures, but there was no statistically significant difference between the two groups (P>0.05). For treating patients with OVCF accompanied by scoliosis, both unilateral and bilateral PKP could effectively relieve the acute back pain and correct the KA. However, unilateral PKP presents more advantages, such as a short operation duration and reduced intraoperative fluoroscopy frequency and bone cement leakage.
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Affiliation(s)
- Zixiang Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Hanwen Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Yingchuang Tang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Hao Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Junxin Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jun Zou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Kai Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Kangwu Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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Trobisch PD, Castelein R, Da Paz S. Radiographic outcome after vertebral body tethering of the lumbar spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023:10.1007/s00586-023-07740-2. [PMID: 37133761 DOI: 10.1007/s00586-023-07740-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/21/2023] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Multiple studies have analyzed the outcome after thoracic Vertebral Body Tethering (VBT). The results seem reproducible with most studies reporting coronal correction rates around 50% and a tether breakage rate near 20% at two years follow-up. There is a paucity of data on lumbar VBT, and no study has yet analyzed the radiographic outcome after lumbar VBT in a double tether technique at two years follow-up, which was the aim of this study. METHODS This is a retrospective, single surgeons' data analysis of all consecutive immature patients who have had VBT of the lumbar spine (to L3 or L4) between January 2019 and September 2020. Primary interest focused on coronal curve correction at two years post-operatively. Suspected tether breakages were analyzed separately and defined as an angular change of more than 5° between two adjacent screws. RESULTS Forty-one patients were eligible for this study and 35 (85%) had complete two-year follow-up data. Average age at surgery was 14.3 years. All patients had a Sanders stage of 7 or below. Average curve correction for thoracolumbar/lumbar curves at two years follow-up was 50%. 90% of patients had at least one level with a suspected tether breakage. No patient required a revision surgery within two years from surgery but two patients were surgically revised after two years. CONCLUSION VBT in the lumbar spine resulted in 50% coronal curve correction two years post-operatively despite a tether breakage in 90% of patients.
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Affiliation(s)
- Per D Trobisch
- Eifelklinik St. Brigida, Spine Surgery, Kammerbruchstr. 8, 52152, Simmerath, Germany.
| | - Rene Castelein
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CZ, Utrecht, The Netherlands
| | - Stephanie Da Paz
- Eifelklinik St. Brigida, Spine Surgery, Kammerbruchstr. 8, 52152, Simmerath, Germany
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Lemans JVC, Wijdicks SPJ, Overweg G, Hekman EEG, Schlösser TPC, Castelein RM, Verkerke GJ, Kruyt MC. Three-dimensional correction of scoliosis by a double spring reduction system as a dynamic internal brace: a pre-clinical study in Göttingen minipigs. Spine J 2023; 23:599-608. [PMID: 36343914 DOI: 10.1016/j.spinee.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/07/2022] [Accepted: 10/26/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND CONTEXT Adolescent idiopathic scoliosis (AIS) is a major skeletal deformity that is characterized by a combination of apical rotation, lateral bending and apical lordosis. To provide full 3D correction, all these deformations should be addressed. We developed the Double Spring Reduction (DSR) system, a (growth-friendly) concept that continuously corrects the deformity through two different elements: A posterior convex Torsional Spring Implant (TSI) that provides a derotational torque at the apex, and a concave Spring Distraction System (SDS), which provides posterior, concave distraction to restore thoracic kyphosis. PURPOSE To determine whether the DSR components are able to correct an induced idiopathic-like scoliosis and to compare correction realized by the TSI alone to correction enforced by the complete DSR implant. STUDY DESIGN/SETTING Preclinical randomized animal cohort study. PATIENT SAMPLE Twelve growing Göttingen minipigs. OUTCOME MEASURES Coronal Cobb angle, T10-L3 lordosis/kyphosis, apical axial rotation, relative anterior lengthening. METHODS All mini-pigs received the TSI with a contralateral tether to induce an idiopathic-like scoliosis with apical rotation (mean Cobb: 20.4°; mean axial apical rotation: 13.1°, mean lordosis: 4.9°). After induction, the animals were divided into two groups: One group (N=6) was corrected by TSI only (TSI only-group), another group (N=6) was corrected by a combination of TSI and SDS (DSR-group). 3D spinal morphology on CT was compared between groups over time. After 2 months of correction, animals were euthanized. RESULTS Both intervention groups showed excellent apical derotation (TSI only-group: 15.0° to 5.4°; DSR-group: 11.2° to 3.5°). The TSI only-group showed coronal Cobb improvement from 22.5° to 6.0°, while the DSR-group overcorrected the 18.3° Cobb to -9.2°. Lordosis was converted to kyphosis in both groups (TSI only-group: -4.6° to 4.3°; DSR-group: -5.2° to 25.0°) which was significantly larger in the DSR-group (p<.001). CONCLUSIONS The TSI alone realized strong apical derotation and moderate correction in the coronal and sagittal plane. The addition of distraction on the posterior concavity resulted in more coronal correction and reversal of induced lordosis into physiological kyphosis. CLINICAL SIGNIFICANCE This study shows that dynamic spring forces could be a viable method to guide the spine towards healthy alignment, without fusing it or inhibiting its growth.
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Affiliation(s)
- Justin V C Lemans
- University Medical Center Utrecht, Department of Orthopaedic Surgery, PO Box 85500, 3553 GA, Utrecht, The Netherlands.
| | - Sebastiaan P J Wijdicks
- University Medical Center Utrecht, Department of Orthopaedic Surgery, PO Box 85500, 3553 GA, Utrecht, The Netherlands
| | - Gerrit Overweg
- University of Twente, Department of Biomechanical Engineering, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Edsko E G Hekman
- University of Twente, Department of Biomechanical Engineering, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Tom P C Schlösser
- University Medical Center Utrecht, Department of Orthopaedic Surgery, PO Box 85500, 3553 GA, Utrecht, The Netherlands
| | - René M Castelein
- University Medical Center Utrecht, Department of Orthopaedic Surgery, PO Box 85500, 3553 GA, Utrecht, The Netherlands
| | - Gijsbertus J Verkerke
- University of Twente, Department of Biomechanical Engineering, PO Box 217, 7500 AE, Enschede, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Moyo C Kruyt
- University Medical Center Utrecht, Department of Orthopaedic Surgery, PO Box 85500, 3553 GA, Utrecht, The Netherlands; University of Twente, Department of Developmental BioEngineering, PO Box 217, 7500 AE, Enschede, The Netherlands
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10
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Bisson DG, Sheng K, Kocabas S, Ocay DD, Ferland CE, Saran N, Ouellet JA, Haglund L. Axial rotation and pain are associated with facet joint osteoarthritis in Adolescent Idiopathic Scoliosis. Osteoarthritis Cartilage 2023:S1063-4584(23)00729-X. [PMID: 36948383 DOI: 10.1016/j.joca.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE Facet joints are crucial for spinal stability and develop premature osteoarthritis in patients with adolescent idiopathic scoliosis (AIS). Here, we evaluated the association between facet joint cartilage and subchondral bone homeostasis, perceived back pain and 3-dimensional spinal deformity to understand better the role of facet joint degeneration in AIS progression and pain. METHOD Cartilage and bone osteoarthritic states of AIS facet joint surgical samples were characterized using histological OARSI scoring, visual morphological grading and μCT analysis, respectively. Back pain was self-reported using a numerical rating scale and expressed relative to the location on the patient's back. The scoliotic curves from our patient cohort were digitally reconstructed using biplanar radiographs and the eOS system (EOS imaging). The deformity was then reduced to 3 intervertebral angles (coronal, sagittal and axial) for each pair of bilateral facet joints. Statistical associations between the intervertebral angles, osteoarthritis parameters and pain intensity were performed using the Spearman method and Friedman test. RESULTS Facet joint cartilage degeneration was associated with decreased subchondral bone volume and quality. Most importantly, asymmetrical, and overall degeneration of facet joints was strongly correlated to intervertebral axial rotation. Additionally, kyphotic intervertebral segments in the sagittal plane were good predictors of increased facet joint degeneration and back pain. CONCLUSION Facet joint degeneration is associated with axial deformity, kyphotic intervertebral angle and back pain intensity in AIS. These results suggest that facet joints are important features to consider for rotational instability in AIS spines and related disease progression and perceived back pain.
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Affiliation(s)
- Daniel G Bisson
- Orthopaedic Research Laboratory, Shriners Hospital for Children, Montreal, Canada; Department of Experimental Surgery, McGill University, Montreal, Canada
| | - Kai Sheng
- Orthopaedic Research Laboratory, Shriners Hospital for Children, Montreal, Canada; Department of Experimental Surgery, McGill University, Montreal, Canada
| | - Semsi Kocabas
- Orthopaedic Research Laboratory, Shriners Hospital for Children, Montreal, Canada; Department of Experimental Surgery, McGill University, Montreal, Canada
| | - Don Daniel Ocay
- Department of Experimental Surgery, McGill University, Montreal, Canada
| | - Catherine E Ferland
- Department of Clinical Research, Shriner's Hospital for Children, Montreal, Canada; Department of Anesthesia, McGill University, Montreal, Canada
| | - Neil Saran
- Orthopaedic Research Laboratory, Shriners Hospital for Children, Montreal, Canada; Department of Experimental Surgery, McGill University, Montreal, Canada
| | - Jean A Ouellet
- Orthopaedic Research Laboratory, Shriners Hospital for Children, Montreal, Canada; Department of Experimental Surgery, McGill University, Montreal, Canada
| | - Lisbet Haglund
- Orthopaedic Research Laboratory, Shriners Hospital for Children, Montreal, Canada; Department of Experimental Surgery, McGill University, Montreal, Canada.
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Qi L, Luo L, Meng X, Zhang J, Yu T, Nie X, Liu Q. Risk factors for lumbar disc herniation in adolescents and young adults: A case-control study. Front Surg 2023; 9:1009568. [PMID: 36684299 PMCID: PMC9852704 DOI: 10.3389/fsurg.2022.1009568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/14/2022] [Indexed: 01/07/2023] Open
Abstract
Background There is a limited understanding of the risk factors for lumbar disc herniation (LDH) in younger people, even though the evidence suggests that LDH is more prevalent in this population. This study aimed to comprehensively analyze the risk factors for LDH in adolescents and young adults. Methods The medical records of all patients were retrospectively reviewed with inclusion criteria of being younger than 25 years. Magnetic resonance imaging (MRI) was used to confirm LDH from September 2016 to September 2021. Furthermore, 104 healthy people in the same age range were enrolled as the control group from physical examination centers. Gender, BMI, smoking, drinking, genetic history, sitting posture, daily sitting time, traumatic history of the lower back, scoliosis, and daily exercise time were examined for all enrolled people. These factors were statistically analyzed to determine the high-risk factors. Results A total of 208 young individuals were enrolled in the present study. The mean age of the study group and the control group was 21.06 ± 3.27 years (range: 11-25 years) and 21.26 ± 2.23 years (range: 15-25 years), respectively. The result of the chi-squared test demonstrated that there was a significant difference in BMI of more than 30 (p < 0.001), genetic history (p = 0.004), sitting posture (p < 0.001), daily sitting time of more than 6 h (p < 0.001), and the history of low back trauma (p = 0.002). Additionally, multivariate logistic regression showed that these were high-risk factors for LDH, particularly the duration of daily sitting time (more than 6 h). Conclusions BMI of more than 30, genetic history, sitting posture, daily sitting time of more than 6 h, and a history of low back trauma are the high-risk factors for adolescents and young adults with LDH. Therefore, providing them with the proper guidance and education, particularly about the protection of the lower back and the reduction of spinal load, could play a key role in preventing and reducing LDH.
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Affiliation(s)
- Le Qi
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Lijuan Luo
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Xianrong Meng
- Department of Nursing, The Second Hospital of Jilin University, Changchun, China
| | - Jun Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Tong Yu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Xinyu Nie
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Qinyi Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China,Correspondence: Qinyi Liu
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12
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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] [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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Vergari C, Skalli W, Abelin-Genevois K, Bernard JC, Hu Z, Cheng JCY, Chu WCW, Assi A, Karam M, Ghanem I, Bassani T, Galbusera F, Sconfienza LM, Brayda-Bruno M, Courtois I, Ebermeyer E, Vialle R, Langlais T, Dubousset J. Spine slenderness is not an early sign of progression in adolescent idiopathic scoliosis. Med Eng Phys 2022; 108:103879. [DOI: 10.1016/j.medengphy.2022.103879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 10/15/2022]
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Marya S, Tambe AD, Millner PA, Tsirikos AI. Adolescent idiopathic scoliosis : a review of aetiological theories of a multifactorial disease. Bone Joint J 2022; 104-B:915-921. [PMID: 35909373 DOI: 10.1302/0301-620x.104b8.bjj-2021-1638.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adolescent idiopathic scoliosis (AIS), defined by an age at presentation of 11 to 18 years, has a prevalence of 0.47% and accounts for approximately 90% of all cases of idiopathic scoliosis. Despite decades of research, the exact aetiology of AIS remains unknown. It is becoming evident that it is the result of a complex interplay of genetic, internal, and environmental factors. It has been hypothesized that genetic variants act as the initial trigger that allow epigenetic factors to propagate AIS, which could also explain the wide phenotypic variation in the presentation of the disorder. A better understanding of the underlying aetiological mechanisms could help to establish the diagnosis earlier and allow a more accurate prediction of deformity progression. This, in turn, would prompt imaging and therapeutic intervention at the appropriate time, thereby achieving the best clinical outcome for this group of patients. Cite this article: Bone Joint J 2022;104-B(8):915-921.
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Affiliation(s)
- Shivan Marya
- Royal Manchester Children's Hospital, Manchester, UK
| | | | | | - Athanasios I Tsirikos
- Scottish National Spine Deformity Centre, Royal Hospital for Children and Young People, Edinburgh, UK
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Asymmetrical thoracic-lumbar coordination during trunk rotation between adolescents with and without thoracic idiopathic scoliosis. Spine Deform 2022; 10:783-790. [PMID: 35175573 DOI: 10.1007/s43390-022-00483-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
STUDY DESIGN Cross-sectional comparative study. PURPOSE To compare thoracic-lumbar kinematic changes and coordination based on coupling angles (CAs) in two different directions of trunk rotation between adolescents with idiopathic scoliosis (AIS) and control subjects. Altered three-dimensional (3D) deviations are often apparent in AIS groups during functional activities, such as gait. However, there is a lack of consistent evidence on coordinated motions during different directions of trunk rotation. METHODS This study included 14 AIS and 17 age-matched control subjects who were all right limb dominant. A motion capture system was utilized to analyze the spinal segment motions. The outcome measures included range of motion (ROM) at the first thoracic (T1), seventh thoracic (T7), and first lumbar (L1) spinous processes as well as the sacral tubercle (S1). The CAs compared in-phase (rotation from right to left) and anti-phase (rotation from left to right) trunk rotations. RESULTS Although there was no significant association with the spinal segments in the control group, the Cobb angle demonstrated significant positive correlations with anti-phase at T7 and L1 as well as in-phase at L1. Regarding the CAs, the groups demonstrated a significant interaction with both phases (F = 4.7, p = 0.04). The AIS group demonstrated positive correlations with ROM during in-phase at L1 and anti-phase at T7 and L1. CONCLUSION The coordination based on the CAs of the lumbar spine relative to the thoracic spine significantly decreased during left to right trunk rotation in the AIS group. These results indicated that the AIS group demonstrated directional dissociation toward the dominant side of lumbar rotation. LEVEL OF EVIDENCE III.
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de Reuver S, Moens AJBWD, Kruyt MC, Nievelstein RAJ, Ito K, Castelein RM. Ultrasound Shear Wave Elastography of the Intervertebral Disc and Idiopathic Scoliosis: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:721-729. [PMID: 35232608 DOI: 10.1016/j.ultrasmedbio.2022.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 06/14/2023]
Abstract
Ultrasound shear wave elastography is a radiation-free and low-cost technique for evaluating the mechanical properties of different tissues. This study systematically reviewed all relevant literature on shear wave elastography of the intervertebral disc. The purpose was twofold: first, to determine the validity of the elastography method, that is, the correlation between elastographically measured shear wave speed and disc mechanical properties, and inter-/intra-operator reliability; and second, to explore if disc elastography is potentially useful in identifying children at risk for idiopathic scoliosis. This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A comprehensive search was performed in PubMed and Embase, and study quality was assessed using the AXIS (Appraisal Tool for Cross-sectional Studies) critical appraisal instrument. Seven articles were included. Three animal ex vivo studies reported moderate-to-good correlations between shear wave speed and disc mechanical properties (r = 0.45-0.81). Three studies reported high intra-operator repeatability (intra-class correlation coefficient [ICC] 0.94-0.99) and inter-operator reproducibility (ICC 0.97-0.98). Four clinical studies measured shear wave speed in asymptomatic children. Two studies reported significantly higher shear wave speeds in scoliosis patients compared with healthy controls, measured in discs both inside and outside the scoliotic curve. In conclusion, shear wave elastography appears reliable in assessing intervertebral disc mechanical characteristics. Despite its promising capabilities to distinguish patients with asymptomatic from those with pathological discs, the exact correlation between disc mechanical properties and shear wave speed remains unclear.
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Affiliation(s)
- Steven de Reuver
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aaron J B W D Moens
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Moyo C Kruyt
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Keita Ito
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
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22q11.2 Deletion Syndrome as a Human Model for Idiopathic Scoliosis. J Clin Med 2021; 10:jcm10214823. [PMID: 34768342 PMCID: PMC8584329 DOI: 10.3390/jcm10214823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Abstract
To better understand the etiology of idiopathic scoliosis, prospective research into the pre-scoliotic state is required, but this research is practically impossible to carry out in the general population. The use of ‘models’, such as idiopathic-like scoliosis established in genetically modified animals, may elucidate certain elements, but their translatability to the human situation is questionable. The 22q11.2 deletion syndrome (22q11.2DS), with a 20-fold increased risk of developing scoliosis, may be a valuable and more relevant alternative and serve as a human ‘model’ for idiopathic scoliosis. This multicenter study investigates the morphology, dynamic behavior, and presence of intraspinal anomalies in patients with 22q11.2DS and scoliosis compared to idiopathic scoliosis. Scoliosis patients with 22q11.2DS and spinal radiography (n = 185) or MRI (n = 38) were included (mean age 11.6 ± 4.2; median Cobb angle 16°) and compared to idiopathic scoliosis patients from recent literature. Radiographic analysis revealed that 98.4% of 22q11.2DS patients with scoliosis had a curve morphology following predefined criteria for idiopathic curves: eight or fewer vertebrae, an S-shape and no inclusion of the lowest lumbar vertebrae. Furthermore, curve progression was present in 54.2%, with a mean progression rate of 2.5°/year, similar to reports on idiopathic scoliosis with 49% and 2.2–9.6°/year. The prevalence of intraspinal anomalies on MRI was 10.5% in 22q11.2DS, which is also comparable to 11.4% reported for idiopathic scoliosis. This indicates that 22q11.2DS may be a good model for prospective studies to better understand the etiology of idiopathic scoliosis.
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Idiopathic scoliosis: general characteristics and analysis of etiological theories (literature review). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Idiopathic scoliosis is a severe pathology of the musculoskeletal system that affects children and adolescents all over the world. The disease occurs in approximately 0.2-0.6% of the general population, and is the largest subgroup of spinal curvature in humans (70-90% of all known scoliosis cases). In idiopathic scoliosis, a threedimensional deformation of the vertebral column is formed, leading to the formation of a rib hump, curvature of the ribs and chest, asymmetry of the pelvis and impaired development of internal organs. The main feature of the disease is the spontaneous development of deformity during the growth of the child and the tendency to progress. Scoliosis is not only an orthopedic disease, but also a ignificant cosmetic, and, consequently, a psychological and social problem. The standard of treatment for scoliotic disease remains unchanged for a long time: observation, corset treatment and surgical correction. The prognosis for the development of pathology varies depending on the degree of deformation. The corset-therapy, hospitalization, surgery and treatment of chronic back pain have a negative impact on the psychoemotional state of children and adolescents. Despite significant advances in the methods of diagnosis of deformity, improvement of surgical treatment methods and in the study of pathogenesis, the etiological factor of pathology is still unknown. The search for the causes of idiopathic scoliosis covers almost all aspects of its possible origin: genetic, environmental, hormonal, metabolic, biochemical, neurological, and others. In recent decades, relevant theories of the development of scoliosis have been formulated, but none of the theories reveals the essence of the pathological process and has no clear justification. The greatest number of supporters is the genetic theory: genetic factors play a key role in the occurrence and development of idiopathic scoliosis. Understanding the underlying factors of the disease will enable prevention, early diagnosis, and identification of the risk groups of the patients in question.
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de Reuver S, van der Linden PP, Kruyt MC, Schlösser TPC, Castelein RM. The role of sagittal pelvic morphology in the development of adult degenerative scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2467-2472. [PMID: 34292371 DOI: 10.1007/s00586-021-06924-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/15/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Pelvic morphology dictates the alignment and biomechanics of the spine. Recent observations in different types of adolescent idiopathic scoliosis indicate that individual pelvic morphology is related to the spinal levels in which scoliosis develops: primary lumbar adolescent scoliosis is associated with a higher pelvic incidence (PI) than thoracic scoliosis and non-scoliotic controls. We hypothesize that adult degenerative scoliosis (ADS) of the lumbar spine follows the same mechanical principles and is associated with a high PI. METHODS This study used an existing CT-scan database, 101 ADS patients were sex and age matched to 101 controls. The PI was measured by two observers with multi-planar reconstruction, perpendicular to the hip-axis according to a previously validated technique. RESULTS The PI was 54.1° ± 10.8° in ADS patients and 47.7° ± 10.8° in non-scoliotic controls (p < 0.001). The median ADS curve apex was the disc L2-3 and median curve length was 4 vertebral levels. The mean supine Cobb angle was 21° ± 8° (ranged 10°-47°). There was no significant correlation between PI and the apex level (p = 0.883), the curve length (p = 0.418) or the Cobb angle (p = 0.518). CONCLUSIONS ADS normally develops de novo in the lumbar spine of patients with a higher PI than controls, similar to primary lumbar adolescent idiopathic scoliosis. This suggests a shared mechanical basis of both deformities. Pelvic morphology dictates spinal sagittal alignment, which determines the segments of the spine that are prone to develop scoliosis.
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Affiliation(s)
- Steven de Reuver
- Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Philip P van der Linden
- Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Moyo C Kruyt
- Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Tom P C Schlösser
- Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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Ossification and Fusion of the Vertebral Ring Apophysis as an Important Part of Spinal Maturation. J Clin Med 2021; 10:jcm10153217. [PMID: 34362001 PMCID: PMC8347734 DOI: 10.3390/jcm10153217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/22/2022] Open
Abstract
In scoliosis, most of the deformity is in the disc and occurs during the period of rapid growth. The ring apophyses form the insertion of the disc into the vertebral body, they then ossify and fuse to the vertebrae during that same crucial period. Although this must have important implications for the mechanical properties of the spine, relatively little is known of how this process takes place. This study describes the maturation pattern of the ring apophyses in the thoracic and lumbar spine during normal growth. High-resolution CT scans of the spine for indications not related to this study were included. Ossification and fusion of each ring apophysis from T1 to the sacrum was classified on midsagittal and midcoronal images (4 points per ring) by two observers. The ring apophysis maturation (RAM) was compared between different ages, sexes, and spinal levels. The RAM strongly correlated with age (R = 0.892, p < 0.001). Maturation differed in different regions of the spine and between sexes. High thoracic and low lumbar levels fused earlier in both groups, but, around the peak of the growth spurt, in girls the mid-thoracic levels were less mature than in boys, which may have implications for the development of scoliosis.
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Pasha S, de Reuver S, Homans JF, Castelein RM. Sagittal curvature of the spine as a predictor of the pediatric spinal deformity development. Spine Deform 2021; 9:923-932. [PMID: 33449344 DOI: 10.1007/s43390-020-00279-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The sagittal curvature of the spine is hypothesized to play an important role in induction of spinal deformities in adolescent idiopathic scoliosis. We previously showed an S shaped flexible rod, with the same curvature as the pediatric sagittal spinal curve, produces scoliotic-like deformities under physiologic loading. Yet, detailed characteristics of the pediatric sagittal spinal curves associated with higher risk of scoliosis are not well defined. METHODS A total of 32 patients in a population with a high prevalence of idiopathic-like scoliosis, 22q11.2 deletion syndrome (22q), were included and followed up for at least two-years. We developed a reduced order finite element model (FEM) of the sagittal profile of these 32 patients where the spine was modeled as an S shaped elastic rod. We related the geometrical parameters of the sagittal curves and the deformed FEM of the corresponding S shaped rods to the risk of scoliosis development at two-year follow-up in this cohort. RESULTS Variations in the sagittal curvature in the cohort of 22q patients resulted in five different deformity patterns shown by finite element analyses. Two sagittal plane deformity pattern groups had high rate of scoliosis development (86% and 100%) whereas the other 3 groups had less than 50% rate of scoliosis development (40%, 33%, and 0%). The pre-scoliotic position of the inflection point (where lordosis turns into kyphosis), the ratio of the spinal curvatures above and below the inflection point, and the length of the spinal curve above and below the inflection point were significantly different between the five deformity patterns groups, p < 0.05. CONCLUSION Combination of geometrical parameters of the sagittal profile prior to onset of scoliosis can relate to the development of spinal deformity in pediatric population.
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Affiliation(s)
- Saba Pasha
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Steven de Reuver
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelle F Homans
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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de Reuver S, IJsseldijk LL, Homans JF, Willems DS, Veraa S, van Stralen M, Kik MJL, Kruyt MC, Gröne A, Castelein RM. What a stranded whale with scoliosis can teach us about human idiopathic scoliosis. Sci Rep 2021; 11:7218. [PMID: 33785866 PMCID: PMC8009909 DOI: 10.1038/s41598-021-86709-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/19/2021] [Indexed: 02/01/2023] Open
Abstract
Scoliosis is a deformation of the spine that may have several known causes, but humans are the only mammal known to develop scoliosis without any obvious underlying cause. This is called 'idiopathic' scoliosis and is the most common type. Recent observations showed that human scoliosis, regardless of its cause, has a relatively uniform three-dimensional anatomy. We hypothesize that scoliosis is a universal compensatory mechanism of the spine, independent of cause and/or species. We had the opportunity to study the rare occurrence of scoliosis in a whale (Balaenoptera acutorostrata) that stranded in July 2019 in the Netherlands. A multidisciplinary team of biologists, pathologists, veterinarians, taxidermists, radiologists and orthopaedic surgeons conducted necropsy and imaging analysis. Blunt traumatic injury to two vertebrae caused an acute lateral deviation of the spine, which had initiated the development of compensatory curves in regions of the spine without anatomical abnormalities. Three-dimensional analysis of these compensatory curves showed strong resemblance with different types of human scoliosis, amongst which idiopathic. This suggests that any decompensation of spinal equilibrium can lead to a rather uniform response. The unique biomechanics of the upright human spine, with significantly decreased rotational stability, may explain why only in humans this mechanism can be induced relatively easily, without an obvious cause, and is therefore still called 'idiopathic'.
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Affiliation(s)
- Steven de Reuver
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lonneke L IJsseldijk
- Division of Pathology, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
| | - Jelle F Homans
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dorien S Willems
- Division of Diagnostic Imaging, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Stefanie Veraa
- Division of Diagnostic Imaging, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Marijn van Stralen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marja J L Kik
- Division of Pathology, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Moyo C Kruyt
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrea Gröne
- Division of Pathology, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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