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Larrieu D, Baroncini A, Assi A, Roscop C, Boissiere L, Obeid I. Validation of a new method for the radiological measurement of rod curvature in patients with spine deformity. Spine Deform 2024:10.1007/s43390-024-00905-z. [PMID: 38814381 DOI: 10.1007/s43390-024-00905-z] [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: 04/04/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE The relationship between rod curvature and postoperative radiographic results is a debated topic. One of the reasons of the heterogeneity of the observed results might reside in the lack of a validated and widely employed method to measure the curvature of the rods. Aim of this study was to present and validate a novel method for rod measurement, which is based on routine X-rays and utilizes a regression algorithm that limits manual measurements and the related errors. METHODS Data from 20 adolescent idiopathic scoliosis/Scheuermann kyphosis (AIS/SK) patients and 35 adult spine deformity (ASD) patients for analysis, with 112 rods in total. An orthogonal reference grid was overlaid on the lateral X-ray; seven points were then marked along each rod and their coordinates recorded in a table. Using these coordinates, a third-order polynomial regression was applied to obtain the rod curvature equation (correlation coefficients > 0.97). Three observers (one surgeon, one experienced and one inexperienced observer) independently applied the developed method to measure the rod angulation of the included patients and performed the measurements twice. The reliability of the method was evaluated in terms of intraclass correlation coefficient (ICC), Bland-Altmann plot and 2SR. RESULTS The intra-observer ICCs for all measurements exceed 0.85, indicating an excellent correlation. For the AIS/SK group, the surgeon showed a slightly lower reliability compared to the other two evaluators (0.93 vs 0.98 and 0.98). However, the surgeon showed a higher reliability in measurements of the rods at the lumbar level, both for L1-S1 and L4-S1 (0.98 vs 0.96 and 0.89; 0.97 vs. 0.85 and 0.91, respectively). The variability also showed excellent results, with a mean variability ranging from 1.09° to 3.76°. The inter-observer ICCs for the three measurement groups showed an excellent reliability for the AIS/SK group (0.98). The reliability was slightly lower but still excellent for the lumbar measurements in ASD patients at L1-S1 (0.89) and L4-S1 (0.83). The results of the 2SR for each measured segment were 4.4° for T5-T11, 5.4° for L1-S1 and 5.5° for L4-S1. CONCLUSION The described method represents a reliable and reproducible way to measure rod curvature. This method is based on routine X-rays and utilizes a regression algorithm that limits manual measurements and the related errors.
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Affiliation(s)
- Daniel Larrieu
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Brugge Cedex, France
| | | | - Ayman Assi
- Saint Joseph University of Beirut, Beirut, Lebanon
| | - Cecile Roscop
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Brugge Cedex, France
| | - Louis Boissiere
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Brugge Cedex, France
| | - Ibrahim Obeid
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Brugge Cedex, France
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Essex R, Dibley L. Adolescent idiopathic scoliosis: treatment outcomes, quality of life and implications for practice. Nurs Child Young People 2024:e1510. [PMID: 38764402 DOI: 10.7748/ncyp.2024.e1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 05/21/2024]
Abstract
Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder among children and adolescents, with most cases being diagnosed around puberty. While the majority of people with AIS do not undergo treatment, a small but significant number are treated, depending on the extent of their spinal curvature. Treatment typically involves bracing, which requires substantial adherence, and/or surgery, which is invasive and permanent. Furthermore, decisions about treatment often need to be made at a critical stage of the person's development. This article examines the evidence on AIS and its treatment, synthesising the current literature and drawing from the authors' empirical work to explore the clinical outcomes of bracing and surgery, as well as the longer-term effects on people's quality of life. Drawing from this evidence, the authors provide guidance for nurses and healthcare professionals who care for people with AIS.
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Affiliation(s)
- Ryan Essex
- Institute for Lifecourse Development, University of Greenwich, London, England
| | - Lesley Dibley
- Institute for Lifecourse Development, University of Greenwich, London, England
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Garg B, Bansal T, Mehta N, Mehta J. Is the morphology of the apical pedicles influenced by apical rotation or the coronal curve magnitude in adolescent idiopathic scoliosis?: a radiographic assessment. Spine Deform 2024; 12:341-348. [PMID: 37875662 DOI: 10.1007/s43390-023-00773-z] [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: 07/04/2023] [Accepted: 09/30/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Asymmetry in pedicle anatomy is most distinctly noted around the apex of the curve. The correlation of pedicle dysmorphia with apical vertebral rotation (AVR) and coronal Cobb angle (CCA) has not been studied. OBJECTIVE To establish whether pedicle dysmorphism is linked to curve magnitude CCA and the AVR in adolescent idiopathic scoliosis (AIS). METHODOLOGY Preoperative plain whole spine standing radiographs and non-contrast computed tomography (CT) scans of 25 AIS patients that were operated at a single centre from 2013 to 2019 were retrospectively reviewed by 3 independent co-investigators. CCA was noted on the standing radiograph, whereas the AVR was measured on the axial cuts of CT scan. Pedicle morphometric measurements were performed for apical and periapical pedicles. These included apical vertebra (when present), 2 vertebrae above (U1 and U2) and below (B1 and B2) the apex vertebra/disc. The pedicle morphometric measurements were performed on CT scans. We assessed the transverse pedicle diameter, transverse cancellous channel diameter, sagittal pedicle diameter, pedicle length and pedicle axis length. Correlation tests between various pedicle morphometric measurements, AVR and the curve magnitude (Cobb angle) was performed by the Pearson correlation test. RESULTS The apex of the major curve was in the thoracic spine in 20 patients, thoracolumbar in three patients and in the lumbar spine in two patients. The mean Cobb angle was 61.5 ± 9.3° and the mean AVR was 28.4 ± 17.8°. A positive correlation was noted with the AVR for U1 concave pedicle length (r = 0.45, p = 0.03), pedicle axis length of the U2 concave pedicle (r = 0.6, p = 0.04), transverse pedicle diameter of the convex apical vertebrae (r = 0.82, p = 0.00009) and the convex apical transverse pedicle diameter (r = 0.80, p = 0.002). A negative correlation with the AVR was noted for U2 convex pedicle length (r = - 0.51, p = 0009), transverse cancellous channel diameter of the U2 concave pedicle (r = - 0.42, p = 0.04) and apical concave pedicle (r = - 0.78, p = 0.002) and the sagittal pedicle diameter for the convex pedicle of U2 (r = - 0.45, p = 0.03) and apex(r = - 0.59, p = 0.04). The Cobb angle did not show a significant correlation with any of the pedicle measurements at any of the levels on the convex and the concave sides. CONCLUSION Pedicle asymmetry and dysmorphism demonstrate a morphometric association with the apical vertebral rotation than the curve magnitude. The pedicle length and the pedicle axis length increase on the concave apical and periapical region with increase in AVR. The transverse cancellous channel diameter significantly decreases on the concave apical region with the increase in AVR. The sagittal pedicle diameter decreases on the convex side with the increase in AVR.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Tungish Bansal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Nishank Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Boissiere L, Bourghli A, Guevara-Villazon F, Pellisé F, Alanay A, Kleinstück F, Pizones J, Roscop C, Larrieu D, Obeid I. Rod Angulation Relationship with Thoracic Kyphosis after Adolescent Idiopathic Scoliosis Posterior Instrumentation. CHILDREN (BASEL, SWITZERLAND) 2023; 11:29. [PMID: 38255344 PMCID: PMC10813855 DOI: 10.3390/children11010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Surgery to correct spinal deformities in scoliosis involves the use of contoured rods to reshape the spine and correct its curvatures. It is crucial to bend these rods appropriately to achieve the best possible correction. However, there is limited research on how the rod bending process relates to spinal shape in adolescent idiopathic scoliosis surgery. METHODS A retrospective study was conducted using a prospective multicenter scoliosis database. This study included adolescent idiopathic scoliosis patients from the database who underwent surgery with posterior instrumentation covering the T4 to T12 segments. Standing global spine X-rays were used in the analysis. The sagittal Cobb angles between T5 and T11 were measured on the spine. Additionally, the curvature of the rods between T5 and T11 was measured using the tangent method. To assess the relationship between these measurements, the difference between the dorsal kyphosis (TK) and the rod kyphosis (RK) was calculated (ΔK = TK - RK). This study aimed to analyze the correlation between ΔK and various patient characteristics. Both descriptive and statistical analyses were performed to achieve this goal. RESULTS This study encompassed a cohort of 99 patients, resulting in a total of 198 ΔK measurements for analysis. A linear regression analysis was conducted, revealing a statistically significant positive correlation between the kyphosis of the rods and that of the spine (r = 0.77, p = 0.0001). On average, the disparity between spinal and rod kyphosis averaged 5.5°. However, it is noteworthy that despite this modest mean difference, there was considerable variability among the patients. In particular, in 84% of cases, the concave rod exhibited less kyphosis than the spine, whereas the convex rod displayed greater kyphosis than the spine in 64% of cases. It was determined that the primary factor contributing to the flattening of the left rod was the magnitude of the coronal Cobb angle, both before and after the surgical procedure. These findings emphasize the importance of considering individual patient characteristics when performing rod bending procedures, aiming to achieve the most favorable outcomes in corrective surgery. CONCLUSIONS Although there is a notable and consistent correlation between the curvature of the spine and the curvature of the rods, it is important to acknowledge the substantial heterogeneity observed in this study. This heterogeneity suggests that individual patient factors play a significant role in shaping the outcome of spinal corrective surgery. Furthermore, this study highlights that more severe spinal curvatures in the frontal plane have an adverse impact on the shape of the rods in the sagittal plane. In other words, when the scoliosis curve is more pronounced in the frontal plane, it tends to influence the way the rods are shaped in the sagittal plane. This underscores the complexity of spinal deformities and the need for a tailored approach in surgical interventions to account for these variations among patients.
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Affiliation(s)
- Louis Boissiere
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, 33520 Bruges, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, 08035 Barcelona, Spain
| | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Istanbul 34750, Turkey
| | - Frank Kleinstück
- Research and Development, Schulthess Klinik, 8008 Zurich, Switzerland
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Cécile Roscop
- Spine Surgery Unit, CHU Pellegrin, 33076 Bordeaux, France
| | - Daniel Larrieu
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, 33520 Bruges, France
| | - Ibrahim Obeid
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, 33520 Bruges, France
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Zhang HQ, Deng A, Guo CF, Sun Y, Li MJ. Multi-rod posterior correction only with halo-femoral traction for the management of adult neuromuscular scoliosis (> 100°) with severe pelvic obliquity: a minimum 5-year follow-up. J Orthop Surg Res 2023; 18:786. [PMID: 37858229 PMCID: PMC10585782 DOI: 10.1186/s13018-023-04285-4] [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: 09/08/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Many patients with neuromuscular scoliosis (NMS) experience a variety of difficult medical problems that aggravate the development effects of progressive scoliosis and pelvic obliquity (PO). The objective of the current study was to assess the safety and effectiveness of multi-rod posterior correction only (MRPCO) with halo-femoral traction (HFT) for the management of adult NMS (> 100°) with severe PO. METHODS From 2012 to 2017, 13 adult patients who suffered from NMS (> 100°) with severe PO underwent MRPCO with HFT. The radiography parameters in a sitting position, such as the coronal Cobb angle of the main curve, the PO and the trunk shift (TS), were measured at the preoperative, postoperative and final follow-up stages. The preoperative and final follow-up assessment of the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) was taken. RESULTS The average follow-up span was 68.15 ± 6.78 months. There was decreased postoperative coronal Cobb angle with an average mean of 125.24° ± 11.78° to 47.55° ± 12.10°, with a correction rate of 62.43%; the PO was reduced to 6.25° ± 1.63° from 36.93° ± 4.25° with a correction rate of 83.07%; the TS was reduced to 2.41 cm ± 1.40 cm from 9.19 cm ± 3.07 cm. There was significant improvement in all parameters compared to the preoperative data. The VAS score reduced from 4.77 ± 0.93 to 0.69 ± 0.75, and the ODI score reduced from 65.38 ± 16.80 to 28.62 ± 12.29 at the final follow-up. CONCLUSIONS Treatment of adult NMS (> 100°) with severe PO could be safe and effective with MRPCO with HFT. In order to obtain the optimum sitting balance, this could reduce the prevalence of complications and rectify the curvature and the correction of PO.
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Affiliation(s)
- Hong-Qi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
| | - Ang Deng
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China.
| | - Chao-Feng Guo
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
| | - Yang Sun
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
| | - Meng-Jun Li
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
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Jia R, Long Y. Risk factors for distal junctional kyphosis after posterior spinal surgery in adolescent idiopathic scoliosis: a meta-analysis. Front Surg 2023; 10:1263655. [PMID: 37920534 PMCID: PMC10619151 DOI: 10.3389/fsurg.2023.1263655] [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: 07/20/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Distal junctional kyphosis (DJK) is a serious complication after posterior spinal surgery in managing adolescent idiopathic scoliosis (AIS). Our study aims to investigate the predictors of DJK in AIS patients. Methods We searched the English databases of PubMed, Embase, and the Cochrane Library for clinical research studies on AIS. To identify the risk factors for DJK, we collected demographic data, such as age, gender, and body mass index (BMI), and sagittal parameters, including preoperative pelvic tilt (PT), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), distal junctional angle (DJA), lowest instrumented vertebrae (LIV) relative to sagittal stable vertebrae (SSV), and postoperative DJA. Data were analyzed by RevMan (5.3 version) and STATA (12.0 version). Results Finally, six included articles (1,240 patients) showed 9% (98 of 1,240 patients) of patients suffering from DJK. Our findings indicated that preoperative TK [p = 0.007, OR = 0.35, 95% CI (0.10, 0.61)], TLK [p < 0.0001, OR = 5.99, 95% CI (3.33, 8.65)], and postoperative DJA [p = 0.002, OR = 0.56, 95% CI (0.21, 0.91)] in the DJK group were markedly higher than those in the non-DJK group. Moreover, patients with LIV above SSV [p < 0.0001, OR = 7.95, 95% CI (4.16, 15.22)] were more likely to develop DJK. No discernible difference was found in age, sex, BMI, preoperative PT, SVA, LL, or DJA between the two groups. Conclusions Regarding the AIS patients, factors such as higher preoperative TK and TLK, higher postoperative DJA, and LIV above the SSV were related to an increased rate of DJK.
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Affiliation(s)
- Ruili Jia
- Department of Nephrology, The First Central Hospital of Baoding, Baoding, China
| | - Yubin Long
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, China
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Verde SRL, Lima-Verde EC, Dias Junior CPP, Teixeira GFD, Prado Filho CS, De Andrade CLA. Comparative Analysis Between Isolated Posterior and Anteroposterior Approaches for Severe Scoliosis Treatment. Rev Bras Ortop 2023; 58:e712-e718. [PMID: 37908537 PMCID: PMC10615597 DOI: 10.1055/s-0043-1768622] [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: 08/21/2022] [Accepted: 10/18/2022] [Indexed: 11/02/2023] Open
Abstract
Objective To comparatively analyze isolated posterior and double surgical approaches for the treatment of severe scoliosis. Methods We retrospectively analyzed medical records of 32 patients with scoliosis angular value > 70° submitted to surgical treatment in a tertiary hospital between 2009 and 2019. These patients were divided into two groups: PV group with 17 patients submitted to arthrodesis by isolated posterior route (PV) and APV group with 15 patients approached anteriorly and posteriorly (APV). In the PV group, there were 16 female patients and 1 male, with a mean age of 16.86 years old. In the APV group, there were 10 female patients and 5 males, with a mean age of 17.71 years old. Cobb angles were measured by a single spinal surgeon manually on panoramic radiographs, orthostasis before and after surgery. Weight, pre- and postoperative height, and duration of the procedure were also evaluated. Results In the PV group, preoperative and postoperative Cobb angles, verified in the main curve, were 96.06 ± 8.45° and 52.27 ± 15.18°, with an average correction rate of 0.54 ± 0.16, respectively. In the APV group, these values were 83.12 ± 11.60° for preoperative Cobb angle, and 48.53 ± 10.76° postoperatively, with correction rate of the main curve of 0.58 ± 0.11. Conclusion The two forms of surgical approach for the treatment of severe scoliosis were astowed as to the rate of correction of the deformity. Therefore, isolated posterior access has an advantage over the double approach, based on shorter surgical time, shorter hospital stay, and less risk of complications.
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Affiliation(s)
- Saulo Rabelo Lima Verde
- Médico ortopedista e traumatologista do Departamento de Ortopedia do Hospital Geral de Fortaleza, Fortaleza, CE, Brasil
| | | | | | | | - Cláudio Sousa Prado Filho
- Médico ortopedista e traumatologista do Departamento de Ortopedia do Hospital Geral de Fortaleza, Fortaleza, CE, Brasil
| | - Caio Lúcio Alencar De Andrade
- Médico ortopedista e traumatologista do Departamento de Ortopedia do Hospital Geral de Fortaleza, Fortaleza, CE, Brasil
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Zhang H, Yang G, Li J, Xiao L, Guo C, Wang Y. Impaired autophagy activity-induced abnormal differentiation of bone marrow stem cells is related to adolescent idiopathic scoliosis osteopenia. Chin Med J (Engl) 2023; 136:2077-2085. [PMID: 36728938 PMCID: PMC10476821 DOI: 10.1097/cm9.0000000000002165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Osteopenia has been well documented in adolescent idiopathic scoliosis (AIS). Bone marrow stem cells (BMSCs) are a crucial regulator of bone homeostasis. Our previous study revealed a decreased osteogenic ability of BMSCs in AIS-related osteopenia, but the underlying mechanism of this phenomenon remains unclear. METHODS A total of 22 AIS patients and 18 age-matched controls were recruited for this study. Anthropometry and bone mass were measured in all participants. Bone marrow blood was collected for BMSC isolation and culture. Osteogenic and adipogenic induction were performed to observe the differences in the differentiation of BMSCs between the AIS-related osteopenia group and the control group. Furthermore, a total RNA was extracted from isolated BMSCs to perform RNA sequencing and subsequent analysis. RESULTS A lower osteogenic capacity and increased adipogenic capacity of BMSCs in AIS-related osteopenia were revealed. Differences in mRNA expression levels between the AIS-related osteopenia group and the control group were identified, including differences in the expression of LRRC17 , DCLK1 , PCDH7 , TSPAN5 , NHSL2 , and CPT1B . Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed several biological processes involved in the regulation of autophagy and mitophagy. The Western blotting results of autophagy markers in BMSCs suggested impaired autophagic activity in BMSCs in the AIS-related osteopenia group. CONCLUSION Our study revealed that BMSCs from AIS-related osteopenia patients have lower autophagic activity, which may be related to the lower osteogenic capacity and higher adipogenic capacity of BMSCs and consequently lead to the lower bone mass in AIS patients.
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Affiliation(s)
- Hongqi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
| | - Guanteng Yang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
| | - Jiong Li
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
| | - Lige Xiao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
| | - Chaofeng Guo
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
| | - Yuxiang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
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Ishikawa Y, Kanai S, Ura K, Kokabu T, Yamada K, Abe Y, Tachi H, Suzuki H, Ohnishi T, Endo T, Ukeba D, Takahata M, Iwasaki N, Sudo H. Development of Notch-Free, Pre-Bent Rod Applicable for Posterior Corrective Surgery of Thoracolumbar/Lumbar Adolescent Idiopathic Scoliosis. J Clin Med 2023; 12:5750. [PMID: 37685817 PMCID: PMC10488454 DOI: 10.3390/jcm12175750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS), the most common pediatric musculoskeletal disorder, causes a three-dimensional spine deformity. Lenke type 5 AIS is defined as a structural thoracolumbar/lumbar curve with nonstructural thoracic curves. Although a rod curvature will affect clinical outcomes, intraoperative contouring of the straight rod depends on the surgeon's knowledge and experience. This study aimed to determine the optimum rod geometries to provide a pre-bent rod system for posterior spinal surgery in patients with Lenke type 5 AIS. These pre-bent rods will be beneficial for achieving proper postoperative outcomes without rod contouring based on surgeon experience. We investigated 20 rod geometries traced in posterior spinal reconstruction in patients with Lenke type 5 AIS. The differences between the center point clouds in each cluster were evaluated using the iterative closest point (ICP) method with modification. Before the evaluation using the ICP method, the point clouds were divided into four clusters based on the rod length using a hierarchical cluster analysis. Because the differences in the values derived from the ICP method were <5 mm for each length-based cluster, four representative rod shapes were generated from the length-based clusters. We identified four optimized rod shapes that will reduce operation time, leading to a decreased patient and surgeon burden.
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Affiliation(s)
- Yoko Ishikawa
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
- Department of Orthopaedic Surgery, Eniwa Hospital, 2-1-1 Kogane-Chuo, Eniwa 061-1449, Hokkaido, Japan;
| | - Satoshi Kanai
- Division of Systems Science and Informatics, Hokkaido University Graduate School of Information Science and Technology, N14W9, Sapporo 060-0814, Hokkaido, Japan
| | - Katsuro Ura
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Terufumi Kokabu
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
- Department of Orthopaedic Surgery, Eniwa Hospital, 2-1-1 Kogane-Chuo, Eniwa 061-1449, Hokkaido, Japan;
| | - Katsuhisa Yamada
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Yuichiro Abe
- Department of Orthopaedic Surgery, Eniwa Hospital, 2-1-1 Kogane-Chuo, Eniwa 061-1449, Hokkaido, Japan;
| | - Hiroyuki Tachi
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
- Department of Orthopaedic Surgery, Eniwa Hospital, 2-1-1 Kogane-Chuo, Eniwa 061-1449, Hokkaido, Japan;
| | - Hisataka Suzuki
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
- Department of Orthopaedic Surgery, Eniwa Hospital, 2-1-1 Kogane-Chuo, Eniwa 061-1449, Hokkaido, Japan;
| | - Takashi Ohnishi
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Tsutomu Endo
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Daisuke Ukeba
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Hideki Sudo
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N15W7, Sapporo 060-8638, Hokkaido, Japan
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Burrows KR, Henzell IS, Martin G, Chisholm CV, Carstens A, Hodgson BF. Long-term adjacent segment degeneration at average 21-year follow-up of posterior instrumented fusion for adolescent idiopathic scoliosis. Spine Deform 2023; 11:933-941. [PMID: 36807104 DOI: 10.1007/s43390-023-00652-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/21/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Posterior instrumented fusion for progressive adolescent idiopathic scoliosis (AIS) is generally considered to have good outcomes, but very long-term reviews are rare. Data on adjacent segment degeneration (ASD) following posterior instrumented thoracic fusion for AIS are lacking. The primary aim was to assess the incidence of ASD and to correlate this with radiographic measures and patient-reported outcome measures (PROMs). The secondary aim was to assess maintenance of curve correction at very long-term follow-up. METHODS This single-surgeon consecutive case series of 47 AIS patients was identified from a prospectively collated dataset. As the primary outcome, ASD was assessed radiographically using the Mimura grading system. Pulmonary function tests and PROMs were assessed along with secondary radiographic outcome measures. RESULTS Radiographic follow-up was achieved in 77% (36/47) of patients at an average of 21 years (range, 16.5-26.5 years) after surgery. Radiographic evidence of ASD was seen in 64%. PROMs showed a mean Oswestry disability index of 12.1% with an overall Scoliosis Research Society 22 score averaging at 3.7 out of 5. The Coronal Cobb Angle was corrected from an average of 57° preoperatively to 19° immediately postoperatively, deteriorating to 22° at final review, maintaining a 61% curve correction. CONCLUSIONS Radiographic evidence of ASD was found in 64% of the cohort. The patient-reported outcome measures were good, with few limitations to activities.
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Affiliation(s)
- Kenan R Burrows
- Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand.
| | - Isobella S Henzell
- Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
| | - Ginny Martin
- Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
| | - Carl V Chisholm
- Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
| | - Alan Carstens
- Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
- Mercy Hospital, 72 Newington Avenue, Maori Hill, Dunedin, 9010, New Zealand
| | - Bruce F Hodgson
- Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
- Mercy Hospital, 72 Newington Avenue, Maori Hill, Dunedin, 9010, New Zealand
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Dwarakanath LV, Sewell MD, Leung E, Knight T, Jones M, McKay G, Newton-Ede M, Marks D, Spilsbury J, Mehta J, Gardner A. Systematic Review and Meta-analysis: Does Anterior-Posterior Spinal Fusion Still have a Role in Severe Thoracic Adolescent Idiopathic Scoliosis? Indian J Orthop 2023; 57:167-176. [PMID: 36777133 PMCID: PMC9880087 DOI: 10.1007/s43465-022-00747-9] [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: 03/03/2022] [Accepted: 09/06/2022] [Indexed: 02/14/2023]
Abstract
Background Debate exists as to whether anterior-posterior spinal fusion (APSF), rather than posterior-only spinal fusion (PSF), provides benefit for treating severe thoracic adolescent idiopathic scoliosis (AIS). This systematic review and meta-analysis compare (1) Cobb angle correction, (2) complication and reoperation rate, (3) pulmonary function, (4) number of fused segments, and 5) patient-reported outcome measures (PROMs) in both groups. Methods Electronic databases were searched to identify studies that met the following inclusion criteria: comparative studies (level 3 or above), severe thoracic curves (≥ 70°), age ≤ 16, AIS aetiology, Lenke 1-4 curves and follow-up ≥ 1 year for ≥ 95% of patient population. Literature was graded for quality and bias using GRADE and MINORS criteria. Results Eight studies were included, defined by GRADE as low or moderate level evidence. Three studies showed superior curve correction in the APSF group; however, the meta-analysis showed no significant difference in curve correction between groups (95% CI - 3.45-12.96, P = 0.26). There were more complications in the APSF group, without statistical significance (95% CI 0.53-3.39, P = 0.54; I 2 = 0%, P = 0.78). There were no re-operations in either group. Two studies reported pulmonary function; one showed better function in the APSF group, the other better function in the PSF group. One study showed fewer fused segments in the APSF group, however, no significance was observed in the meta-analysis (95%CI - 1.65-0.31, P = 0.18). Three studies reported PROMs with no differences reported between groups. Conclusions APSF and PSF have been found to have comparable results. The present evidence cannot support recommendations for guidelines on future practice with regards to effect on curve correction, complications, re-operations, pulmonary function or PROMs. Level of evidence Level III, Systematic review of Level-III studies.
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Affiliation(s)
| | | | - Enid Leung
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
| | - Timothy Knight
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
| | - Morgan Jones
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
| | - George McKay
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
| | | | - David Marks
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
| | | | - Jwalant Mehta
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
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Zhu F, Zhang Y, Wang G, Ning Y, Leng X, Huang B. Posterior Multisegment Apical Convex plus Concave Intervertebral Release Combined with Posterior Column Osteotomy for the Treatment of Rigid Thoracic/Thoracolumbar Scoliosis. World Neurosurg 2023; 170:43-53. [PMID: 36442784 DOI: 10.1016/j.wneu.2022.11.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intervertebral release (IVR) in the apical region is critical for full release of a rigid spine. Previous studies have mainly reported IVR techniques using an anterior approach or posterior apical convex IVR. We first report the surgical procedure of posterior multisegment apical convex plus concave IVR combined with posterior column osteotomy (PCO) for treating rigid thoracic/thoracolumbar scoliosis. METHODS This study retrospectively analyzed clinical, radiologic outcomes and technique notes of 18 patients with rigid scoliosis treated with posterior multisegment convex plus concave IVR combined with PCO. RESULTS The preoperative, postoperative, and final follow-up mean sagittal Cobb angles of the main curve were 75.2° (58.7°-110.2°), 18.4° (9°-35.1°), and 19.0° (8.2°-36.3°), respectively. The mean correction rate was 75.3% (66.7%-86.7%). In cases of thoracolumbar kyphosis, the preoperative, postoperative, and final follow-up mean sagittal Cobb angles were 45.7° (40.5°-52.6°), 18.8° (10.2°-27.5°), and 19.8° (11.1°-29°), respectively. The mean correction rate was 57% (42.1%-72.6%). The mean axial vertebral rotation (AVR) in the IVR region was 24.4° (14.3°-46.3°) preoperatively and was corrected to 10.9° (10.9°-26.6°) postoperatively. The mean correction rate for AVR was 55.9% (41.1%-78.6%). The coronal and sagittal Cobb angles and AVR postoperatively were significantly lower than those preoperatively (P < 0.001). This case series reported 2 cases of pleural effusion and 1 case of wound infection. CONCLUSIONS Single posterior multilevel apical convex plus concave IVR combined with PCO is a safe and effective surgical method for treating rigid thoracic/thoracolumbar scoliosis that does not need 3-column osteotomy.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Guanzhong Wang
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China.
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13
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Jiao Y, Tan H, Feng E, Wang Z, Lin Y, Zhao J, Shen J. Apical region correction and global balance: a 3-rods surgical strategy for the treatment of severe and rigid scoliosis. BMC Musculoskelet Disord 2022; 23:775. [PMID: 35964038 PMCID: PMC9375359 DOI: 10.1186/s12891-022-05732-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background The treatment of severe and rigid scoliosis is challenging. We developed a surgical strategy for severe and rigid scoliosis since 2014. This study aimed to retrospectively analyze the safety and efficacy of apical region correction and global balance with 3 rods as a surgical strategy for the treatment of severe and rigid scoliosis. Methods A retrospective study was performed for patients with severe and rigid scoliosis who underwent one-stage posterior corrective operation using the apical region correction and global balance with 3 rods surgical strategy between February 2014 and April 2020. The inclusion criteria were as follows: [1] Cobb angle > 90°; [2] flexibility < 30%; [3] a minimum 2-year follow-up. Patients were excluded if they had a history of traction or spinal surgery. Coronal and sagittal parameters, including Cobb angle, flexibility, apex vertebra translation, trunk shift (TS), thoracic kyphosis, lumbar lordosis, and sagittal vertical axis (SVA) were measured preoperatively, postoperatively and at the final follow-up. The Scoliosis Research Society 22-item questionnaire was administered preoperatively and at the final follow-up. During the operation, one slightly-bent short rod was placed into the concave side of apical region and correction was achieved by rod-rotation and distraction. Two pre-bent long rods were placed into both sides of the scoliosis and global balance was improved by leveling the proximal thoracic vertebrae and distal lumbar vertebrae. Results A total of 41 patients were included, with an average age of 20 years (range, 12–49 years) and follow-up of 34 months (range, 24–58 months). Postoperative correction rate was 53% for scoliosis. There were 14 patients with normal kyphosis before surgery, and 28 patients with normal kyphosis at the last follow-up. 88% of the patients (23/26) with preoperative coronal imbalance (TS > 20 mm) restored coronal balance at the final follow-up. 87% of the patients (14/16) with preoperative sagittal imbalance (SVA > 40 mm) restored sagittal balance at the final follow-up. The mean operation time and blood loss were 286 min and 941 mL, respectively. No patients had neurological complications or implant failure. Conclusion The surgical strategy of apical region correction and global balance with 3 rods is a safe and effective alternative for the surgical treatment of severe and rigid scoliosis.
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Affiliation(s)
- Yang Jiao
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Haining Tan
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Erwei Feng
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Zhen Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Youxi Lin
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Junduo Zhao
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Jianxiong Shen
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China.
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Zhang HQ, Deng A, Guo CF, Tang MX, Alonge E. Posterior-only surgical correction with heavy halo-femoral traction for the treatment of extremely severe and rigid adolescent idiopathic scoliosis (> 130°). Arch Orthop Trauma Surg 2022; 142:1317-1324. [PMID: 33484310 DOI: 10.1007/s00402-020-03720-z] [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: 07/09/2020] [Accepted: 12/06/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The treatment of extremely severe and rigid spinal deformities was a great surgical challenge. Pulmonary impairment often occurred, which increased the challenges to already daunting surgical approaches. The present study was performed to evaluate the safety and efficacy of posterior-only surgical correction with heavy halo-femoral traction (HFT) for the treatment of extremely severe and rigid adolescent idiopathic scoliosis (AIS) of more than 130°. MATERIALS AND METHODS From 2010 to 2017, 11 patients suffered from extremely severe and rigid AIS of more than 130° underwent posterior-only surgical correction with HFT. The preoperative mean coronal Cobb angle of major curve was 139.01° ± 5.83°, and the mean flexibility was 17.21% ± 3.33%; the mean angle of thoracic kyphosis (TK) and lumbar lordosis (LL) were 65.02° ± 7.21° and 39.05° ± 4.08°, respectively; the mean trunk shift (TS) and sagittal vertical axis (SVA) were 3.3 ± 0.97 cm and 3.97 ± 1.16 cm, respectively; moreover, the percent forced vital capacity (FVC%) and percent forced expiratory volume in 1 s (FEV1%) were 50.08% ± 6.07% and 53.46% ± 5.96%, respectively; the mean body height and weight were 140.09 ± 4.95 cm and 37 ± 4.34 kg, respectively. RESULTS The mean duration of surgery was 335.91 ± 48.31 min and blood loss was 1590 ± 520.1 ml. The average period of follow-up was 32.18 ± 8.17 months. After heavy HFT, the mean coronal Cobb angle of major curve was reduced to 82.98° ± 6.91° with correction rate of 40.39%. After posterior-only surgical correction, the mean coronal Cobb angle was further reduced to 51.17° ± 5.4° with correction rate of 63.27%. The postoperative mean TK, LL, TS and SVA were improved to 23.85° ± 5.14°, 44.95° ± 2.26°, 1.32 ± 0.72 cm and 1.42 ± 0.83 cm, respectively. At the final follow-up, the corrective loss rate of Cobb angle was only 0.72%; moreover, the mean FVC% and FEV1% were increased to 65.45% ± 5.29% and 69.08% ± 5.32% with improvement of 15.36% and 15.62%, respectively; the mean body height and weight were increased to 154.45 ± 5.32 cm and 45 ± 4.02 kg with improvement of 14.36 cm and 8 kg, respectively. The spinal cord function was stable, and there were no new neurological symptoms after correction. CONCLUSIONS Posterior-only surgical correction with heavy HFT could be safe and effective for the treatment of extremely severe and rigid AIS of more than 130° in reducing the incidence of complications and greatly improving curve correction.
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Affiliation(s)
- Hong-Qi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China
| | - Ang Deng
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China.
| | - Chao-Feng Guo
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China
| | - Ming-Xing Tang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China
| | - Emmanuel Alonge
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China
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15
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Boachie-Adjei O, Duah HO, Sackeyfio A, Yankey KP, Lenke LG, Sponseller PD, Samdani AF, Sucato DJ, Sides BA, Newton PO, Shah SA, Akoto H, Gupta MC. Surgical outcomes of severe spinal deformities exceeding 100° or treated by vertebral column resection (VCR). Does implant density matter?: an observational study of deformity groupings. Spine Deform 2022; 10:595-606. [PMID: 35305251 DOI: 10.1007/s43390-021-00460-x] [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: 10/12/2020] [Accepted: 12/11/2021] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Prospective multicenter international observational study. OBJECTIVE To investigate the effect of implant density on clinical outcomes in complex pediatric spine reconstruction. Implant density in spine deformity surgery has been a subject of much debate with some authors advocating higher density for better correction. Few studies have looked at the effect of implant density on severe curves > 100 deg or treated with vertebral column resection (VCR). METHODS 250/311 pts with 2-year f/u enrolled in the FOX pediatric database from 17 international sites were queried for the impact of implant density and surgical outcomes. Patients were grouped into three implant density categories for comparative analysis Group 1 (density ≤ 1), Group 2 (1 < density < 1.5) and Group 3 (density; 1.5-2). RESULTS 250 pts: 47 (Grp1)/99 (Grp2) /104 (Grp3); Pre-op age and etiology and curve types were similar in all groups, but body mass index (BMI) was higher in Grp3. Grps 1 and 2 had significantly higher sagittal deformity angular ratio (S-DAR) compared to Grp 3 (p < 0.001). Pre-op Halo Gravity Traction (HGT) was used in 55.3%/44.4%/31.7%, p = 0.017; Grp1/Grp2/Grp3, respectively. Average duration of surgery (min) was higher in Grp3 relative to Grp1 only: 352.5/456.5/515.0, p = 0.0029. Blood loss was similar in all Grps. Rate of VCR, PSO and SPO was similar in all Grps. Pre-op Coronal Cobb avg 96.1/83.6/88.6, p = 0.2342, attained similar correction after HGT (24.6%/27.2%/23.2%, p = 0.4864. Coronal Cobb corrections at 2-year follow-up (FU) were (37.1%/40.3%/53.5%, p = 0.0004). Pre-op sagittal Cobb was (105.4/101.9/75.9, p < 0.01.), achieved similar %correction in HGT (19.1%/22.3%/22.5%, p = 0.6851) and at 2-year FU (39.6%/41.4%/29.8%, p = 0.1916). After adjusting for C-DAR, S-DAR, pre-op coronal and sagittal Cobb, etiology, curve types, age, BMI and number of rods in multivariate analysis, the odds of developing post-operative implant complication was 11 times greater in group 1 compared to group 3 (OR = 11.17,95% CI 2.34-53.32). There was significant improvement in SRS scores in all Grps at 2-year FU. CONCLUSION Although higher implant density was observed to be associated with greater curve correction and lower rates of post-operative implant-related complication and revision in heterogeneous case groups, the results may not imply causality of implant density on the outcomes in severe pediatric spine reconstruction.
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Affiliation(s)
| | - Henry Ofori Duah
- FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana
| | - Arthur Sackeyfio
- FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana
| | | | | | | | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, Philadelphia, PA, USA
| | | | - Brenda A Sides
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Suken A Shah
- Spine and Scoliosis Center, Nemours/Alfred I. du Pont Pediatrics, Wilmington, DE, USA
| | | | - Munish C Gupta
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA
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Abstract
Scoliosis is an abnormal curvature of the spine, which generally develops during childhood or adolescence. It affects 2–4 percent of the global population and is more prevalent among girls. Scoliosis is classified by its etiology: idiopathic, congenital, or neuromuscular. Among these, the former is the most common. Treatment options for scoliosis vary depending on the severity of the curve. Most scoliosis diagnoses tend to be mild and only require monitoring. However, curves between 20 and 40 degrees require bracing, while 40 degrees and above require surgery. There are various bracings available, such as Boston, Charleston, and Milwaukee. In severe cases of scoliosis, either fusion or fusionless surgery may be required. This review aims to discuss etiologies and different treatment interventions for scoliosis.
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Chung WH, Lee YJ, Chiu CK, Hasan MS, Chan CYW, Kwan MK. Severe Lenke 1 and 2 adolescent idiopathic scoliosis had poorer perioperative outcome, higher complication rate, longer fusion and higher operative cost compared to non-severe 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 2022; 31:1051-1059. [PMID: 35066683 DOI: 10.1007/s00586-022-07118-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 12/09/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the perioperative outcome and operative cost of posterior spinal fusion (PSF) surgery between severe and non-severe Lenke 1 and 2 adolescent idiopathic scoliosis (AIS) patients. METHODS A total of 509 AIS patients who underwent single-staged PSF between 2013 and 2020 were reviewed. Fifty-four severe scoliosis patients (Cobb angle ≥ 90°) were categorized into Gp1, and 455 non-severe scoliosis (Cobb angle < 90°) patients into Gp2. Propensity score matching (PSM) analysis using one-to-one nearest neighbor matching and match tolerance of 0.001 were performed. Outcome measures were operative time, intraoperative blood loss (IBL), allogeneic transfusion rate, perioperative complication, length of stay, fusion level, number of screws used, postoperative Cobb angle, correction rate (CR), side bending correction index (SBCI) and operative cost. RESULTS From the PSM analysis, 35 patients from each group were matched. The operative time was 155.9 ± 41.4 and 130.0 ± 30.3 min for Gp1 and Gp2, respectively (p = 0.004). The IBL was 1349.2 ± 1019.0 and 781.9 ± 325.1 mLs for Gp1 and Gp2, respectively (p = 0.003). Fusion level (12.5 ± 0.8 vs. 11.2 ± 1.3, p < 0.001) and number of screws used (16.4 ± 1.6 vs. 14.6 ± 1.4, p < 0.001) were higher in Gp1. Four perioperative complications were observed in Gp1 compared to none in Gp2 (p < 0.039). Gp1 had larger postoperative Cobb angle (p < 0.001), lower CR (p = 0.005) and higher SBCI (p < 0.001). The operative cost was higher in Gp1 (p < 0.001). CONCLUSIONS Severe Lenke 1 and 2 AIS patients had poorer perioperative outcome, higher complication rate, longer fusion and higher operative cost than non-severe AIS.
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Affiliation(s)
- Weng Hong Chung
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yu Jie Lee
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Iwamae M, Matsumura A, Namikawa T, Hoshino M, Hori Y, Nakamura H. Staged Corrective Surgery for a Patient With Sagittal Malalignment Related to Noonan Syndrome: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00010. [PMID: 35020628 DOI: 10.2106/jbjs.cc.21.00559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 20-year-old man with Noonan syndrome had rigid cervical kyphosis caused by cervical myelopathy and thoracic lordosis caused by pulmonary disfunction. Two-staged corrective surgery, which involved initial posterior spinal fusion (PSF) in T2-L2 followed by PSF in C3-T2, had been performed without any complications. The radiographs before surgery and 2 years after surgery showed that cervical lordosis (C2-7) changed form -56° to -29°, and thoracic kyphosis (T5-12) improved from -49° to 10°. CONCLUSION Initial realignment surgery in the caudal lesion should be better for improving global spinal alignment in patients with rigid spinal deformities at different locations.
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Affiliation(s)
- Masayoshi Iwamae
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akira Matsumura
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Takashi Namikawa
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Garg B, Bansal T, Mehta N. Clinical, radiological, and functional outcomes of posterior-only three-column osteotomy in congenital kyphosis : a minimum of two years' follow-up. Bone Joint J 2021; 103-B:1309-1316. [PMID: 34192927 DOI: 10.1302/0301-620x.103b7.bjj-2020-2162.r1] [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] [Indexed: 11/05/2022]
Abstract
AIMS To describe the clinical, radiological, and functional outcomes in patients with isolated congenital thoracolumbar kyphosis who were treated with three-column osteotomy by posterior-only approach. METHODS Hospital records of 27 patients with isolated congenital thoracolumbar kyphosis undergoing surgery at a single centre were retrospectively analyzed. All patients underwent deformity correction which involved a three-column osteotomy by single-stage posterior-only approach. Radiological parameters (local kyphosis angle (KA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), C7 sagittal vertical axis (C7 SVA), T1 slope, and pelvic incidence minus lumbar lordosis (PI-LL)), functional scores, and clinical details of complications were recorded. RESULTS The mean age of the study population was 13.9 years (SD 6.4). The apex of deformity was in thoracic, thoracolumbar, and lumbar spine in five, 14, and eight patients, respectively. The mean operating time was 178.4 minutes (SD 38.5) and the mean operative blood loss was 701.8 ml (SD 194.4). KA (preoperative mean 70.8° (SD 21.6°) vs final follow-up mean 24.7° (SD 18.9°); p < 0.001) and TK (preoperative mean -1.48° (SD 41.23°) vs final follow-up mean 24.28° (SD 17.29°); p = 0.005) underwent a significant change with surgery. Mean Scoliosis Research Society (SRS-22r) score improved after surgical correction (preoperative mean 3.24 (SD 0.37) vs final follow-up mean 4.28 (SD 0.47); p < 0.001) with maximum improvement in self-image and mental health domains. The overall complication rate was 26%, including two neurological and five non-neurological complications. Permanent neurological deficit was noted in one patient. CONCLUSION Deformity correction employing three-column osteotomies by a single-stage posterior-only approach is safe and effective in treating isolated congenital thoracolumbar kyphosis. Cite this article: Bone Joint J 2021;103-B(7):1309-1316.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Tungish Bansal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Nishank Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Li Y, Shi B, Liu D, Liu Z, Sun X, Qiu Y, Zhu Z. Sequential correction using satellite rod for severe thoracic idiopathic scoliosis: an effective method to optimize deformity correction. J Neurosurg Spine 2021:1-7. [PMID: 33799305 DOI: 10.3171/2020.9.spine201168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/11/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this paper was to compare the radiographic and clinical outcomes between the sequential correction (SC) technique and the traditional 2-rod correction (TC) technique in patients with severe thoracic idiopathic scoliosis (STIS) undergoing posterior-only correction surgery. METHODS Records of a consecutive series of STIS patients undergoing posterior-only correction surgery between October 2013 and October 2017 with more than 2 years of follow-up were reviewed. The radiographic parameters were assessed preoperatively, postoperatively, and at the last follow-up. Radiographic parameters, operative time, blood loss, and complications were compared between the two groups. RESULTS A total of 33 patients were included in the SC group, and 21 patients were included in the TC group. There was no significant difference in age, sex, or deformity magnitude (93.6° ± 7.8° vs 89.8° ± 6.6°, p = 0.070) preoperatively between groups. The operation time was shorter in the SC group than in the TC group (251.5 ± 42.8 minutes vs 275.4 ± 39.8 minutes, p = 0.020), while both blood loss (1284.6 ± 483.3 vs 1398.0 ± 558.4 ml, p = 0.432) and number of fused levels (13.1 ± 2.8 vs 13.6 ± 2.4, p = 0.503) were similar between the groups. Compared with the TC group, patients in the SC group had a higher correction rate (55.8% ± 9.2% vs 45.7% ± 8.8%, p < 0.001), less coronal (1.1° ± 0.81° vs 2.9° ± 0.93°, p < 0.001) and sagittal (1.5° ± 0.96° vs 2.1° ± 0.64°, p = 0.015) correction loss at the 2-year follow-up, and a lower incidence of intraoperative pedicle screw pullout (14.3% vs 23.8%, p = 0.026). CONCLUSIONS The SC technique could significantly and practically reduce the difficulty of rod installation with better deformity correction outcomes than the traditional TC technique. The SC technique was an effective alternative for patients with STIS.
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21
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Long-term experience with simultaneous prone video-assisted thoracoscopic anterior spinal release and posterior spinal fusion in severe rigid pediatric spinal deformities. 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; 30:724-732. [PMID: 33417038 DOI: 10.1007/s00586-020-06711-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/27/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE While posterior-alone techniques have been successful for most pediatric spinal deformities, anterior spinal release may be useful for severe rigid deformities. Traditional lateral-positioned video-assisted thoracoscopic surgical release (VATSR) followed by prone posterior spinal fusion (PSF) has been criticized for adding extensive operative morbidity. We aimed to reduce its disadvantages by performing prone VATSR and PSF simultaneously and evaluate its long-term outcomes. METHODS All consecutive patients from 1991 to 2012 undergoing VATSR and PSF at one institution were retrospectively reviewed. The inclusion criteria comprised severe rigid thoracic scoliosis (> 70°, bending correction > 45°) or kyphosis (> 75°, bolster correction > 45°), and a minimum 2 year follow-up. Demographics, operative data, hospital stay, and radiographic correction data were compared between patients who had undergone sequential VATSR followed by PSF and those who had undergone these procedures simultaneously. RESULTS Of 153 patients who had undergone VATSR and PSF, 53 met the inclusion criteria (31 sequential, 22 simultaneous; average follow-up, 50 [range, 24-86] months). Age, preoperative measurements and flexibility, and perioperative complications did not differ significantly. The simultaneous group showed significantly lower operative time (449 vs. 618 min), blood loss (1039 vs. 1906 cc), and hospital stay (6.3 vs. 8.5 days) (all, p < 0.05). Postoperative radiographic correction and maintenance at the final follow-up showed a non-significant trend favoring the simultaneous group. CONCLUSION Our simultaneous prone VATSR and PSF technique showed significantly lower operative time, blood loss, and hospital stay compared with the traditional sequential VATSR and PSF method, suggesting its value in treating rigid deformities.
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Lee CH, Won YI, San Ko Y, Yang SH, Kim CH, Park SB, Chung CK. Posterior-only versus combined anterior-posterior fusion in Scheuermann disease: a systematic review and meta-analysis. J Neurosurg Spine 2020; 34:608-616. [PMID: 33361485 DOI: 10.3171/2020.7.spine201062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Combined anterior-posterior (AP) surgery is considered the gold standard for surgical treatment of Scheuermann kyphosis. There are trends toward posterior-only (PO) surgery for correcting this deformity because of the availability of multisegmental compression instruments and posterior shortening osteotomy. To date, surgical strategies for Scheuermann kyphosis remain controversial. The purpose of this study was to compare various surgical approaches for the treatment of Scheuermann kyphosis, including radiological correction and intraoperative outcomes, using a systematic review and meta-analysis. METHODS A comprehensive database search of PubMed, EMBASE, Web of Science, and Cochrane Library was performed to identify studies concerning Scheuermann kyphosis. The inclusion criteria were direct comparisons between AP and PO surgeries for Scheuermann kyphosis and assessment of the angle of thoracic kyphosis preoperatively and postoperatively. The authors used the principles of a cumulative meta-analysis by updating the pooled estimate of the treatment effect. RESULTS Data from 13 studies involving 1147 participants (542 patients in the AP group and 605 patients in the PO group) were included. The average age was 18.2 years for the AP and 17.9 years for the PO group. The overall mean difference of changes in thoracic kyphosis angles between the AP and PO surgeries was 0.23° (95% CI -2.24° to 2.71°). In studies in which posterior shortening osteotomies were not performed, PO surgery resulted in a significantly low degree of correction of thoracic kyphosis, with a mean difference of 5.59° (95% CI 0.34°-10.83°). Studies in which osteotomies were performed revealed that the angle of correction for PO surgery was comparable to that of AP surgery. Regardless of fixation methods, PO surgical approaches achieved comparable angles. CONCLUSIONS PO surgery using posterior osteotomies can achieve correction of Scheuermann kyphosis as successfully as AP surgery does. Reflecting the advancement of surgical technology, large prospective studies are necessary to identify the proper treatments for Scheuermann kyphosis.
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Affiliation(s)
- Chang-Hyun Lee
- 1Department of Neurosurgery, Seoul National University Hospital.,2Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital
| | - Young Ii Won
- 1Department of Neurosurgery, Seoul National University Hospital
| | - Young San Ko
- 1Department of Neurosurgery, Seoul National University Hospital
| | - Seung Heon Yang
- 1Department of Neurosurgery, Seoul National University Hospital
| | - Chi Heon Kim
- 1Department of Neurosurgery, Seoul National University Hospital.,3Department of Neurosurgery, Seoul National University College of Medicine
| | - Sung Bae Park
- 4Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center; and
| | - Chun Kee Chung
- 1Department of Neurosurgery, Seoul National University Hospital.,3Department of Neurosurgery, Seoul National University College of Medicine.,5Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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23
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Chen L, Sun Z, He J, Xu Y, Li Z, Zou Q, Li B. Effectiveness and safety of surgical interventions for treating adolescent idiopathic scoliosis: a Bayesian meta-analysis. BMC Musculoskelet Disord 2020; 21:427. [PMID: 32615956 PMCID: PMC7333422 DOI: 10.1186/s12891-020-03233-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/24/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity in children and adolescents which presents as complex three-dimensional (3D) deformity of the spine and rib cage. This study aimed to estimate the effectiveness and safety of surgical interventions for AIS using Bayesian meta-analysis. METHODS The PubMed, EMBASE, and Cochrane Controlled Register of Trials were searched through Oct 1, 2019, without language restrictions. Relevant studies evaluating combined effectiveness and safety of surgical interventions for AIS were included according to eligibility criteria. The primary outcome measures included pulmonary function (change of absolute forced vital capacity and forced expiratory volume in 1 second from pre-operation to post-operation) and incidence of complications. The secondary outcome measure was change of Cobb angle from pre-operation to post-operation. Data was pooled using a random effects model in pairwise meta-analysis. Bayesian meta-analysis combined direct and indirect evidence using a Bayesian framework. RESULTS Twenty-eight case-controlled studies with totally 1970 participants were included. This Bayesian meta-analysis combining direct and indirect evidences indicated that posterior fusion with instrumentation without thoracoplasty (PSF) had the highest probability to achieve better pulmonary function and lower complication rate; video assisted anterior fusion with instrumentation without thoracoplasty (VAT) had the highest probability to obtain better Cobb angle correction based on analysis of rank probability. CONCLUSION This Bayesian meta-analysis demonstrated that PSF had the highest probability to achieve better post-surgical pulmonary function and lower complication rate, which gives a practical recommendation of PSF as a primary surgical treatment for AIS. The results also support statistics that current surgeries adopted more PSF but less open anterior approach surgery and thoracoplasty. More research work is required to address the effectiveness and safety of VAT for treating AIS more convincingly.
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Affiliation(s)
- Long Chen
- Department of Orthopedics, Guizhou Provincial People's Hospital, No.83 Zhongshan East Road, Guiyang, 550000, Guizhou, China
| | - Zeyu Sun
- Department of Orthopedics, Guizhou Provincial People's Hospital, No.83 Zhongshan East Road, Guiyang, 550000, Guizhou, China
| | - Jingming He
- Department of Orthopedics, Guizhou Provincial People's Hospital, No.83 Zhongshan East Road, Guiyang, 550000, Guizhou, China
| | - Yunwen Xu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Zhuhai Li
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Qian Zou
- Department of Orthopedics, Guizhou Provincial People's Hospital, No.83 Zhongshan East Road, Guiyang, 550000, Guizhou, China
| | - Bo Li
- Department of Orthopedics, Guizhou Provincial People's Hospital, No.83 Zhongshan East Road, Guiyang, 550000, Guizhou, China.
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Addai D, Zarkos J, Bowey AJ. Current concepts in the diagnosis and management of adolescent idiopathic scoliosis. Childs Nerv Syst 2020; 36:1111-1119. [PMID: 32314025 PMCID: PMC7250959 DOI: 10.1007/s00381-020-04608-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Adolescent Idiopathic Scoliosis (AIS) is a complex 3D structural disorder of the spine that has a significant impact on a person's physical and emotionalstatus. Thus, efforts have been made to identify the cause of the curvature and improve management outcomes. AIM This comprehensive review looks at the relevant literature surrounding the possible aetio-pathogenesis of AIS, its clinical features, investigations, surgicalmanagement options, and reported surgical outcomes in anterior spinal fusion, posterior spinal fusion or combined approach in the treatment of AIS.
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Affiliation(s)
- Daniel Addai
- Department of Orthopaedic Spine Surgery, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, England
| | - Jacqueline Zarkos
- Department of Orthopaedic Spine Surgery, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, England
| | - Andrew James Bowey
- Department of Orthopaedic Spine Surgery, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, England.
- Newcastle University, Newcastle upon Tyne, UK.
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Xiao L, Zhang H, Wang Y, Li J, Yang G, Wang L, Liang Z. Dysregulation of the ghrelin/RANKL/OPG pathway in bone mass is related to AIS osteopenia. Bone 2020; 134:115291. [PMID: 32087335 DOI: 10.1016/j.bone.2020.115291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/15/2020] [Accepted: 02/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Osteopenia has been well documented in adolescent idiopathic scoliosis (AIS), and ghrelin has been shown to have a positive effect on bone metabolism. However, the circulating level of ghrelin is increased in AIS osteopenia, and the relationship between ghrelin and low bone mass in AIS osteopenia remains unclear. METHOD A total of 563 AIS and 281 age-matched controls were recruited for this study. Anthropometry and bone mass were measured in all participants. Plasma ghrelin levels were determined by enzyme-linked immunosorbent assay (ELISA) in both AIS and control groups. An improved multiplex ligation detection reaction was performed to analyze single-nucleotide polymorphisms (SNPs). Facet joints were collected and subjected to immunohistochemistry; osteogenic gene and protein expression was also measured. Furthermore, primary cells were extracted from facet joints and bone marrow to observe the response to ghrelin stimulation. RESULTS The body mass index was lower and circulating ghrelin was markedly higher in the AIS osteopenia group than in the control group. No significant difference was observed in four ghrelin level-related SNPs between the AIS osteopenia and control groups. RNA and protein analyses revealed higher RANKL/OPG and lower runx2 levels in AIS cancellous bone. Compared with normal primary osteoblasts and BMSCs, AIS osteopenia primary cells were insensitive to the same ghrelin concentration gradient and showed lower osteogenic ability, increases in OPG and decreases in RANKL. CONCLUSION Our results indicate that high circulating ghrelin levels may not result from gene variations in AIS osteopenia. Dysregulation of the ghrelin/RANKL/OPG pathway may lead to decreased osteogenic ability of osteoblasts and BMSCs, which may be related to lower bone mass in AIS osteopenia.
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Affiliation(s)
- Lige Xiao
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China
| | - Hongqi Zhang
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China
| | - Yunjia Wang
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China.
| | - Jiong Li
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China
| | - Guanteng Yang
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China
| | - Longjie Wang
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China
| | - Zhuotao Liang
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China
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High density all-pedicle screw technique in correction of high-degree (≥70 degrees) scoliosis with sequential derotation without osteotomies. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mirzashahi B, Moosavi M, Rostami M. Outcome of Posterior-Only Approach for Severe Rigid Scoliosis: A Retrospective Report. Int J Spine Surg 2020; 14:232-238. [PMID: 32355631 PMCID: PMC7188093 DOI: 10.14444/7032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The management of severe scoliosis may lead to significant complications, and adequate mobilization is a key step to achieve maximal correction, usually requiring extensive approaches. There is still no consensus on the management of these severe and rigid curves. In this study we evaluated the clinical and radiologic outcome of a posterior-only approach with multilevel asymmetric Ponte osteotomy with a minimum of 2 years' follow-up. METHODS In this retrospective study, 23 patients with severe and rigid adolescent idiopathic scoliosis who underwent surgery with a single-staged posterior-only approach were included. The surgical procedures in these patients were excision of posterior ligaments and spinous process, partial laminectomy in caudal part of lamina, excision of the ligamentum flavum, facetectomies, and multilevel asymmetric posterior column osteotomies (Ponte) followed by instrumented fusion. Clinical records-including demographic data; operating time; hospitalization time; blood loss; number of segments instrumented, fused, and osteotomized; functional improvement; follow-up duration; and complications-were recorded. RESULTS The mean preoperative Cobb angle of major curve in coronal plan was 97.5° (range, 82°-131°) with the mean flexibility of 21.4° (range, 10°-25°) on bending radiography. The mean immediate postoperative Cobb angle of major curve was 34.8° (range, 17°-61°), showing a 64.2% correction. The mean preoperative coronal and sagittal imbalances of 3.8 and 4.2 cm were improved to 1.0 and 1.3 cm at postoperative measurements, respectively. A mean of 6.1 (range, 5-9) vertebral segments were osteotomized. We experienced no major complications. CONCLUSIONS We found that a posterior-only procedure in patients with severe and rigid adolescent idiopathic scoliosis could provide correction rate, coronal and sagittal balance, and clinical outcomes comparable with other procedures. Using this technique can eliminate the need for the anterior release, with the associated complications related to anterior surgery, in the treatment of severe rigid scoliosis.
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Affiliation(s)
- Babak Mirzashahi
- Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mersad Moosavi
- Department of Orthopedic Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Rostami
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran
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Malik AT, Yu E, Kim J, Khan SN. Intensive Care Unit Admission Following Surgery for Pediatric Spinal Deformity: An Analysis of the ACS-NSQIP Pediatric Spinal Fusion Procedure Targeted Dataset. Global Spine J 2020; 10:177-182. [PMID: 32206517 PMCID: PMC7076600 DOI: 10.1177/2192568219841367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To understand which patient and surgical factors are predictive of an increased odds of undergoing an admission and a prolonged stay >2 days in an intensive care unit (ICU) following corrective surgery for pediatric deformity. METHODS The 2016 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric Spinal Fusion Procedure Targeted database records, merged with original 2016 ACS-NSQIP Pediatric file variables, were used for this study. Univariate and multivariate analyses were used to identify independent risk factors associated with admission, as well as a prolonged length of stay in the ICU following surgery. RESULTS A total of 1398 (39.5%) patients required an ICU admission following the procedure-out of whom 416 (29.8%) stayed for more than 2 days. Following adjusted analysis, patient and surgical factors independently associated with an ICU admission were black/African American versus white race, anterior fusion, combined fusion, nonidiopathic scoliosis, preoperative ventilator dependence, asthma, having structural pulmonary abnormality, developmental delay, having a neuromuscular disorder, requiring nutritional support and a total operative time >270 minutes. The only significant factors associated with a prolonged length of ICU stay >2 days were preoperative ventilator dependence, nutritional support requirement, and undergoing anterior or combined fusion. CONCLUSIONS This study is the first of its kind to identify significant patient- and procedure-level factors associated with an ICU admission, and also explores predictors for a prolonged stay in the ICU. Surgeons can use this data to preoperatively counsel families and ensure postoperative course of care is appropriately planned ahead of time.
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Affiliation(s)
| | - Elizabeth Yu
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Jeffery Kim
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Safdar N. Khan
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA,Safdar N. Khan, Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, OH 43210, USA.
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Patient-reported Outcomes Following Surgical Intervention for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. Clin Spine Surg 2020; 33:24-34. [PMID: 30925497 DOI: 10.1097/bsd.0000000000000822] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a systematic review and meta-analysis. OBJECTIVE This study aims to perform a systematic review and quantitative meta-analysis of patient-reported outcome measures after spinal fusion for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Radiographic correction of scoliosis is extensively reported in the literature but there is a need to study the impact of spinal fusion on patient-reported outcome measures. Prior reviews lacked homogeneity in outcome measures, did not perform quantitative meta-analysis of pooled effect size, or interpret the results in light of minimally clinically important difference thresholds. MATERIALS AND METHODS A systematic review of medical databases identified all studies that prospectively reported Scoliosis Research Society (SRS)-22 questionnaire data after spinal fusion for AIS. We screened 2314 studies for eligibility. Studies were included that reported preoperative and postoperative data at 24- or >60-month follow-up. Studies were excluded that failed to report means and SDs which were needed to calculate Cohen d effect sizes and 95% confidence intervals in estimating the magnitude and precision of the effect. RESULTS A total of 7 studies met eligibility criteria for inclusion in quantitative meta-analysis of effect sizes and 95% confidence intervals. Patients report large improvements in total score, self-image, and satisfaction; and moderate improvements in pain, function and mental health at 2 and 5 years after spinal fusion for AIS. All domains showed statistically significant improvement at all times except function at >60 months. All domains surpassed the minimally clinically important difference at all times except mental health. CONCLUSIONS Moderate evidence suggests that spinal fusion improves quality of life for adolescents with idiopathic scoliosis in medium and long-term follow-up. Our results may help inform patient expectations regarding surgery. OCEMB LEVEL OF EVIDENCE Level I-systematic review and meta-analysis of prospective studies.
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Liu PY, Lai PL, Lin CL. A biomechanical investigation of the retentive force of pedicle screw structures for different screw tulip designs. Clin Biomech (Bristol, Avon) 2019; 70:23-30. [PMID: 31382200 DOI: 10.1016/j.clinbiomech.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pedicle screw based spinal fixation systems have been widely used for treating a variety of spinal diseases. The retentive force is an important factor that determines structural stability. The screw tulip design and the magnitude of nut tightening torque influence the retentive force. This study investigated the influences of varied tilt angles between the shaft-rod interface and varied nut tightening torques on the retentive force of the monoaxial, polyaxial, and uniplanar screws. METHODS Three types of tulip constructs were biomechanically tested. Two parameters that affect the retentive force include the tilt angle and the nut tightening torque. The retentive force was investigated by an axial gripping capacity test and axial torque gripping capacity test. FINDING Among all combinations of screw designs and tilt angles, the 12 Nm nut tightening torque offered a greater retentive force than the 8 Nm, except for monoaxial screws with a 0 degree tilt angle. For monoaxial screws, the retentive force was negatively correlated with increasing tilt angles. For polyaxial and uniplanar screws, the retentive forces remained constant with increasing tilt angles. INTERPRETATION In monoaxial screws, when the axis of the shaft isn't perpendicular to the axis of the rod, a gap is formed between the tulip-rod interface. This results in a decreased retentive force. In polyaxial and uniplanar screws, the contact surfaces were the same in different tilt angles, therefore, the retentive force remained constant, which was attributed to the adjustable tulips always being perpendicular to the axis of the rods.
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Affiliation(s)
- Po-Yi Liu
- Department of Biomedical Engineering, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist., Taipei City 11221, Taiwan; Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan
| | - Po-Liang Lai
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan.
| | - Chun-Li Lin
- Department of Biomedical Engineering, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist., Taipei City 11221, Taiwan.
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Rüwald JM, Eymael RL, Upenieks J, Zhang L, Jacobs C, Pflugmacher R, Schildberg FA. An Overview of the Current State of Pediatric Scoliosis Management. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 158:508-516. [PMID: 31416110 DOI: 10.1055/a-0965-7760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Historically pediatric scoliosis represents a condition deeply rooted within the origins of orthopedic surgery. Today only a few subspecialized surgeons treat pediatric scoliosis patients. In severe cases surgery can hold progression of and correct pathologic spinal curvature. The goal of this article is to provide an overview of the current state of pediatric scoliosis management. It aims to increase the attention of general physicians and orthopedic surgeons to a niched but rather frequently encountered pediatric pathology to facilitate early recognition and diagnosis. A thorough research of literature was conducted to summarize the different scoliosis types, their etiology and presentation. Classification, normal human growth phases and curve progression risk have been further elaborated. Finally, current treatment options with their benefits, shortcomings and complications were laid out and discussed. Among the etiological groups a focus was put on idiopathic scoliosis, in particular adolescent idiopathic scoliosis as the most frequently encountered subtype.
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Affiliation(s)
- Julian M Rüwald
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn
| | | | - Janis Upenieks
- Department of Pediatric Surgery, University Children's Hospital, Riga, Latvia
| | - Li Zhang
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn
| | - Cornelius Jacobs
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn
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Cinnella P, Rava A, Mahagna AA, Fusini F, Masse A, Girardo M. Over 70° thoracic idiopathic scoliosis: Results with screws or hybrid constructs. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2019; 10:108-113. [PMID: 31404131 PMCID: PMC6652256 DOI: 10.4103/jcvjs.jcvjs_39_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis is the most common type of scoliosis. High degrees curve can be treated with the anterior, posterior, or combined anterior-posterior approach. Contrarily to the anterior approach, the posterior one is widely used nowadays for its good correction outcomes and relatively low-complication rate. MATERIALS AND METHODS We evaluated retrospectively 27 patients, treated with posterior approach. Patients were divided into two groups, namely pedicle screws group (PSG) and hybrid group (pedicle screws + sublaminar bands). Radiographic measurements, including thoracic and lumbar Cobb° measurements of primary and secondary curves, coronal balance and sagittal balance, kyphosis and lordosis, curve flexibility, first and last vertebra included in the arthrodesis, and implant density were evaluated. Clinical patients' satisfaction was also evaluated with Scoliosis Research Society (SRS) 24 questionnaire. RESULTS Considering both groups, on preoperative X-rays, the average primary scoliotic curve angle was 83.56° ± 10.96° (range 70°-112°), whereas the global flexibility was 64° ± 7.63 (range 46°-72°). The curves were classified following the Lenke classification: 17 Type 1, 2 Type 2, and 8 Type 3. The primary curve resulted to be well corrected in both groups. In T0, the groups were homogeneous, but in T1 and follow-up, PSG stated a better mean value. No other significative differences can be found between groups for all other items (P > 0.05). Clinical results of SRS 24 were excellent in both groups. CONCLUSIONS The posterior approach proved to be an excellent technique for obtaining good clinical and radiographic results if the surgeon adopts the third-generation high-density implants. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pasquale Cinnella
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Alessandro Rava
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Abed Mahagna
- Department of Orthopaedic and Traumatology, IRCCS Foundation, S. Matteo Hospital Institute, University of Pavia, Pavia, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Alessandro Masse
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Massimo Girardo
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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Johans SJ, Hofler RC, Nockels RP. Management of Adolescent Idiopathic Scoliosis: Institutional Experience, Integration into Neurosurgical Practice, and Impact on Resident Training. World Neurosurg 2019; 126:e181-e189. [PMID: 30797921 DOI: 10.1016/j.wneu.2019.01.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Management of adolescent idiopathic scoliosis (AIS) in neurosurgery residency training may have a significant impact on resident experience, even though few trainees are likely to pursue careers in the field of AIS. The impact of this exposure on resident knowledge in adult spinal disease management is the subject of our retrospective analysis. METHODS An analysis was performed of all adolescent patients undergoing surgical correction of spinal deformity between 2006 and 2016. Patient characteristics, including age at operation, Cobb angles, length of stay, operative time, blood loss, and complications, were collected. Objective benchmarks were created for resident education in the management of AIS. A survey was sent to the last 7 years of graduates to assess the impact of exposure to AIS during neurosurgery training on their current practice. RESULTS Nine male and 37 female patients ages 11 to 22 years were identified. Neurosurgical residents assisted in all procedures without fellows or surgical assistants. Average operative time was 336 minutes (range, 215-575 minutes), and blood loss per procedure was 603 mL (range, 200-4000 mL). The average Cobb angle correction was 72.2% (range, 35.3%-90.9%). Zero of the past 7 graduates currently treat AIS surgically. All 7 graduates agreed that exposure to AIS during residency enhanced their knowledge of adult spinal disease management. CONCLUSIONS Treatment of AIS by surgeons with specialized training can be effective and safe. Resident exposure to these patients enhances their understanding of spinal biomechanics and deformity correction, which is applicable to treating AIS and adult spinal deformity.
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Affiliation(s)
- Stephen J Johans
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Ryan C Hofler
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Russ P Nockels
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
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Sze CH, Smith JC, Luhmann SJ. Complications of Posterior Column Osteotomies in the Pediatric Spinal Deformity Patient. Spine Deform 2019; 6:656-661. [PMID: 30348340 DOI: 10.1016/j.jspd.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/15/2018] [Accepted: 03/03/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND In spinal deformity surgery, posterior column osteotomies (PCOs) are used to increase spinal flexibility and permit greater deformity correction, while avoiding the morbidity of anterior column surgery. Complications related to use of PCOs have been well characterized in adults; however, there is a paucity of information in the pediatric population. METHODS A single-surgeon retrospective analysis was completed of 484 PCOs in 142 patients (average age: 14.5 years) undergoing spinal deformity surgery. All surgeries were completed by a standard posterior approach using a midline incision and dual-rod, pedicle screw constructs. PCO-related complications were recorded (intraoperative monitoring alerts, postoperative neurologic deficit, dural tear/violations, cerebrospinal fluid [CSF] leak, pseudarthrosis, etc.) and analyzed by diagnosis (idiopathic, congenital, neuromuscular, syndromic). RESULTS The diagnoses for the 142 patients were idiopathic (103 patients), neuromuscular (23 patients), syndromic (14 patients), and congenital (2 patients). In a subset of 87 patients with 2-year radiographic follow-up, the preoperative major coronal Cobb measurement was 75.5° ± 17.6°, which corrected to 34.9° ± 17.5° postoperatively and 37.8° ± 17.9° at last follow-up (p < .0001, p < .0001). Complications evaluated were postoperative neurologic deficit (0% of patients, 0/142), dural tears/violations at site of PCO (0.4% of PCOs, 2/484), CSF leak (0% of patients, 0/142), and pseudoarthrosis at site of PCO (0% of PCOs, 0/290). CONCLUSION The overall frequency of complications related to PCOs was 0.4% (0.4% dural tears/violations) with 0% postoperative neurologic deficit, CSF leak, or pseudarthrosis. Based on these data, PCOs appear to be a safe technique in pediatric spine deformity surgery, with a low rate of technique-related complications. STUDY DESIGN Retrospective case series. OBJECTIVES To report the frequency of posterior column osteotomy complications (neurologic deficit, dural tear, cerebrospinal fluid leak, and pseudarthrosis) in pediatric patients undergoing spinal deformity surgery. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Chia-Hung Sze
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA
| | - June C Smith
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA
| | - Scott J Luhmann
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA.
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Thoracoscopic Anterior Instrumentation and Fusion as a Treatment for Adolescent Idiopathic Scoliosis: A Systematic Review of the Literature. Spine Deform 2019; 6:384-390. [PMID: 29886908 DOI: 10.1016/j.jspd.2017.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/24/2017] [Accepted: 12/25/2017] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN A systematic review and meta-analysis on thoracoscopic anterior instrumentation and fusion as a treatment for adolescent idiopathic scoliosis (AIS). OBJECTIVE The goal of this study is to determine the current status of thoracoscopic instrumentation and fusion as a treatment for AIS. SUMMARY OF BACKGROUND DATA Traditional surgical techniques for AIS have been open anterior thoracotomy with instrumentation and posterior spinal fusion and instrumentation. With the growing clinical interest in growth modulation surgeries, such as vertebral body tethering, there is a resurgence of interest in a thoracoscopic technique. METHODS The most commonly used medical databases (PubMed, Medline, EMBASE, CINAHL, and the Cochrane library) were searched up to November 2016 using the search terms VATS, thoracoscopic scoliosis, and thoracoscopic scoliosis instrumentation. RESULTS Thirteen studies met the strict inclusion criteria. Five hundred thirty patients were reported: 81.7% females, with the majority diagnosed as AIS. The mean operative time was 371.5 minutes, mean blood loss of 502.85 mL, and mean hospital stay of 5.9 days. Mean preoperative curve magnitude was 52.9°; postoperative curve magnitude was 17.9°, with a correction of 62.7%. Number of levels instrumented was 6.3, pulmonary function tests returned to preoperative values by 2 years postoperation, and the complication rate was 21.3%. Compared to thoracotomy, VATS had similar complication rates, blood loss, operation theater time, curve correction, and number of fused levels. Compared to posterior fusion, VATS has higher complication rates and operation theater time. Blood loss and percentage correction were similar. VATS had a smaller number of fused segments. CONCLUSIONS Advantages include less invasive, excellent curve correction, few levels fused, good satisfaction, and no long-term effect on pulmonary function. Drawbacks are increased operative time and incidence of pulmonary complications. With appropriate surgeon training and careful patient selection, this technique offers an acceptable alternative to the more traditional procedures. LEVEL OF EVIDENCE Level II.
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Analysis of Shoulder Complex Function After Posterior Spinal Fusion in Adolescents With Idiopathic Scoliosis. J Pediatr Orthop 2019; 39:e32-e38. [PMID: 30312252 DOI: 10.1097/bpo.0000000000001267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nonsurgically treated patients with AIS demonstrate altered scapular kinematics and decreased patient-reported shoulder function compared with typically developing adolescents. It is unknown whether surgical correction of the spine deformity has beneficial or detrimental effects on scapulothoracic joint function, as previous assessments of shoulder function following surgery have only focused on humerothoracic motion. The objective of this study was to perform a comprehensive analysis of scapular kinematics before and after PSF and compare postoperative scapular kinematics in AIS to those of a typically developing cohort. METHODS Typically developing adolescents (n=33) and patients with AIS (n=20) with a planned PSF surgery were recruited. Motion capture was used to analyze scapular kinematics at rest and in full abduction. AIS subjects were evaluated before surgery and at a 6-month follow-up. Individual changes following surgery were assessed, and postoperative scapular kinematics were compared with the typically developing subjects. RESULTS Patients with AIS patients in this study demonstrated significant losses of scapulothoracic range of motion for the convex side shoulder and gains of scapulothoracic range of motion for the concave side shoulder following PSF. When compared with typically developing adolescents, the resting scapular position of the postoperative AIS group seemed normalized, but the AIS group still exhibited altered scapular motion, particularly along the upward rotation and tilt axes. CONCLUSIONS Patients with AIS demonstrated significant changes at the scapulothoracic joint following PSF. Compared with typically developing adolescents, scapular resting position normalized, but the AIS group still demonstrated altered scapular kinematics, including patterns associated with shoulder pathology. The results of this study will inform the course of short-term postoperative rehabilitation by addressing the upper extremity implications of PSF for individuals with AIS. LEVEL OF EVIDENCE Level III.
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Bao H, Shu S, Yan P, Liu S, Liu Z, Zhu Z, Qian B, Qiu Y. Fifteen Years and 2530 Patients: The Evolution of Instrumentation, Surgical Strategies, and Outcomes in Adolescent Idiopathic Scoliosis in a Single Institution. World Neurosurg 2018; 120:e24-e32. [DOI: 10.1016/j.wneu.2018.07.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
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Solla F, Clément JL, Doria C, Bertoncelli C, Rosello O, Rampal V. Adolescent idiopathic scoliosis exceeding 70°: a single unit surgical experience. ACTA ACUST UNITED AC 2018. [DOI: 10.23736/s0394-3410.18.03881-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ulusoy A, Demiroz S, Erdem S. How accurate is visual estimation of perioperative blood loss in adolescent idiopathic scoliosis surgery? ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:267-271. [PMID: 29705298 PMCID: PMC6146011 DOI: 10.1016/j.aott.2018.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 02/22/2018] [Accepted: 03/19/2018] [Indexed: 11/10/2022]
Abstract
Objective The aim of this study was to assess whether the visual estimation method for perioperative blood loss is accurate in adolescent idiopathic scoliosis surgery. Methods Sixty-five consecutive patients, who were operated on from 2012 to 2015 and had a diagnosis of AIS, were included into the study. Gender, age, preoperative weight and height, preoperative major curve magnitude and T5‒T12 kyphosis angles, the fusion level, and the time of surgery were recorded. Perioperative blood loss was estimated by the same anesthesiologist for all patients. Then, an experienced surgeon estimated the perioperative blood loss by a gravimetric method, and the results were compared. Results Seventeen (26.2%) of the patients were male and 48 (73.8%) were female. The mean age was 15.8 ± 1.9. The mean height of the patients was 162.1 ± 8.9 cm and the mean weight was 52.6 ± 8.9 kg. The mean preoperative major curve magnitude and kyphosis angles were 49.5 ± 9.2 and 47.1 ± 12.7 respectively. The mean estimate of the surgeon was 1009 ± 404.5 ml and the mean estimate of the anesthesiologist was 434 ± 217.6 ml and the difference was statistically significant (p < 0.05). Moreover, if blood loss was high during the operation, the difference between the estimates of the surgeon and anesthesiologist was also higher. Conclusions Even in operations where most of the blood goes into a suction canister, such as for AIS, a visual estimation method is not accurate. A short training regarding optimizing the amount of blood contained in sponges that are not fully soaked may be sufficient to improve this method.
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Cheng MF, Ma HL, Lin HH, Chou PH, Wang ST, Liu CL, Chang MC. Anterior release may not be necessary for idiopathic scoliosis with a large curve of more than 75° and a flexibility of less than 25. Spine J 2018; 18:769-775. [PMID: 28939170 DOI: 10.1016/j.spinee.2017.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 08/28/2017] [Accepted: 09/11/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT To improve correction and fusion rates, an anterior release is often needed for the treatment of idiopathic scoliosis with a curve of more than 75° before posterior correction, instrumentation, and fusion. However, there are disadvantages to anterior release, and we are concerned about whether it is necessary for anterior-posterior spinal fusion in these patients. PURPOSE The objective of this study was to compare the surgical results for idiopathic scoliosis with a curve of more than 75° and a flexibility of less than 25% between using posterior-only approach and combined anterior release followed by posterior correction with a hybrid construct (hooks and pedicle screws) and spinal fusion. STUDY DESIGN/SETTING This was a retrospective cohort study. PATIENT SAMPLE From 2000 to 2014, 388 consecutive patients with idiopathic scoliosis were treated surgically at our hospital. Of these patients, 53 whose primary curves were more than 75° with a flexibility of less than 25%, at an incidence of 13.6%, were included and divided into two groups. Thirty-one patients (mean age: 16.3 years old) who underwent anterior release followed by posterior correction, instrumentation, and fusion were included in the A+P group, and the remaining 22 patients (mean age: 17.3 years old) were designated as the P group for posterior procedure alone. OUTCOME MEASURES The clinical outcomes were analyzed in terms of correction and loss of correction and by the Scoliosis Patient Questionnaire: Version 30 functional questionnaire. MATERIALS AND METHODS In the A+P group, halo-femoral traction was applied for 1 week between the anterior release and the posterior procedure. Posterior instrumentation with a hybrid construct with hooks and pedicle screws was used for both groups. The radiological and functional outcomes were compared between the two groups. RESULTS The average preoperative Cobb angle was 85.3° for the A+P group, with an average 17.4% flexibility, and 80° for the P group, with 15.3% flexibility. The postoperative Cobb angle was 53.1° for the A+P group and 45.6° for the P group. The Cobb angle at the final follow-up for the A+P group was 55.2° and that for the P group was 48°. The average correction rates of the A+P and P groups were 37% and 43.4%, respectively. There were no statistically significant differences between the groups in gender, age, number of levels fused, and flexibility of coronal curve. With a minimum 2-year follow-up, similar results were found between these two groups in terms of correction rate, loss of correction, and functional outcome. CONCLUSIONS In this study, we found that a posterior-only approach with hybrid construct (hooks and pedicle screws) could provide a correction similar to that of an anterior-posterior approach. Also, the disadvantages of anterior release could be avoided by the posterior-only approach.
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Affiliation(s)
- Ming Fai Cheng
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan
| | - Hsiao-Li Ma
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan
| | - Hsi-Hsien Lin
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan
| | - Po-Hsin Chou
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan
| | - Shih-Tien Wang
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong St, Beitou District, Taipei 11221, Taiwan; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan.
| | - Chien-Lin Liu
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan
| | - Ming-Chou Chang
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong St, Beitou District, Taipei 11221, Taiwan; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan
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De la Garza Ramos R, Goodwin CR, Abu-Bonsrah N, Jain A, Miller EK, Huang N, Kebaish KM, Sponseller PD, Sciubba DM. Patient and operative factors associated with complications following adolescent idiopathic scoliosis surgery: an analysis of 36,335 patients from the Nationwide Inpatient Sample. J Neurosurg Pediatr 2016; 25:730-736. [PMID: 27564784 DOI: 10.3171/2016.6.peds16200] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the incidence of and factors associated with complications following idiopathic scoliosis surgery in adolescents. METHODS The Nationwide Inpatient Sample database was used to identify patients 10-18 years of age who had undergone spinal fusion for adolescent idiopathic scoliosis (AIS) from 2002 to 2011. Twenty-three unique in-hospital postoperative complications, including death, were examined. A series of logistic regressions was used to determine if any demographic, comorbid, or surgical parameter was associated with complication development. Results of multiple logistic regression analyses were reported as odds ratios with 95% confidence intervals. All analyses were performed after the application of discharge weights to produce national estimates. RESULTS A total of 36,335 patients met the study inclusion criteria, 7.6% of whom (95% CI 6.3%-8.9%) developed at least one in-hospital complication. The 3 most common complications were respiratory failure (3.47%), reintubation (1.27%), and implant related (1.14%). Major complications such as death, pancreatitis, disseminated intravascular coagulation, visual loss, spinal cord injury, cardiac arrest, sepsis, nerve root injury, deep vein thrombosis, pulmonary embolism, shock, malignant hyperthermia, myocardial infarction, and iatrogenic stroke each had an incidence ≤ 0.2%. On multiple logistic regression analysis, an increasing age (OR 0.80) was associated with significantly lower odds of complication development; patients who were male (OR 1.80) or who had anemia (OR 2.10), hypertension (OR 2.51), or hypothyroidism (OR 2.27) or underwent revision procedures (OR 5.55) were at a significantly increased risk for complication development. The rates of postoperative complications for posterior, anterior, and combined approaches were 6.7%, 10.0%, and 19.8%, respectively (p < 0.001). Length of fusion (< 8 vs ≥ 8 levels) was not associated with complication development (p = 0.311). CONCLUSIONS Analysis of 36,335 patients who had undergone surgery for AIS revealed that younger patients, male patients, patients with a history of anemia, hypertension, or hypothyroidism, as well as those undergoing revision or anterior or combined approaches may have higher rates of postoperative complications. However, the overall complication rate was low (7.6%), and major complications had a rate ≤ 0.2% for each event. These findings suggest that surgery for AIS remains relatively safe, and future prospective investigations may further help to decrease the postoperative morbidity rate.
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Affiliation(s)
| | | | | | - Amit Jain
- Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily K Miller
- Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Khaled M Kebaish
- Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul D Sponseller
- Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Huang D, Du X, Liang H, Hu W, Hu H, Cheng X. Anterior corpectomy versus posterior laminoplasty for the treatment of multilevel cervical myelopathy: A meta-analysis. Int J Surg 2016; 35:21-27. [DOI: 10.1016/j.ijsu.2016.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/06/2016] [Indexed: 11/25/2022]
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Chen Z, Rong L. Answer to the Letter to the Editor of A. Gardner concerning "Comparison of combined anterior-posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis" by Chen Z, Rong L (2016) Eur Spine J;25(2):363-371. 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 2016; 25:3766-3767. [PMID: 27535286 DOI: 10.1007/s00586-016-4734-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Zihao Chen
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - Limin Rong
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, China.
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Single vs two attending senior surgeons: assessment of intra-operative blood loss at different surgical stages of posterior spinal fusion surgery in Lenke 1 and 2 adolescent idiopathic 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 2016; 26:155-161. [DOI: 10.1007/s00586-016-4803-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/06/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
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Novikov VV, Vasyura AS, Lebedeva MN, Mikhaylovskiy MV, Sadovoy MA. Surgical management of neurologically complicated kyphoscoliosis using transposition of the spinal cord: Case report. Int J Surg Case Rep 2016; 27:13-17. [PMID: 27521778 PMCID: PMC4983149 DOI: 10.1016/j.ijscr.2016.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/18/2016] [Accepted: 07/23/2016] [Indexed: 11/19/2022] Open
Abstract
Case of patient with single-stage correction of severe congenital kyphoscoliotic spinal deformities is provided. Combined anterior-posterior approach was applied. Transposition of the spinal cord followed by correction using vertebral instrumentation made it possible to improve trunk balance and stop deformity progression.
Background Transposition of the spinal cord made it possible to achieve mobilization of the fixed kyphoscoliosis, significantly increase spinal canal volume and improve spinal canal shape. This helped to eliminate spinal cord compression and achieve complete regression of the existing neurological symptoms. Methods and results We report the clinical case of surgical management of neurologically complicated kyphoscoliotic deformity of the thoracic spine by transposition of the spinal cord and correction using posterior segmental spinal instrumentation. Conclusions The required correction of severe kyphoscoliosis was performed; the risks of trunk imbalance, deformity progression, and instrumentation failure in the long-term postoperative period were reduced. Level of evidence Level IV – 1 case.
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Affiliation(s)
- V V Novikov
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Russia.
| | - A S Vasyura
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Russia.
| | - M N Lebedeva
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Russia.
| | - M V Mikhaylovskiy
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Russia.
| | - M A Sadovoy
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Russia.
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