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Photopoulos G, Hurry J, Bansal A, Miyanji F, Parent S, Murphy J, El-Hawary R. Differential vertebral body growth is maintained after vertebral body tethering surgery for idiopathic scoliosis: 4-year follow-up on 888 peri-apical vertebrae and 592 intervertebral discs. Spine Deform 2024:10.1007/s43390-024-00874-3. [PMID: 38634997 DOI: 10.1007/s43390-024-00874-3] [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: 04/16/2023] [Accepted: 03/30/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To radiographically evaluate if vertebral body tethering (VBT) can maintain differential peri-apical vertebral growth at medium-term follow-up of 4 years. METHODS A prospective, international, multicenter database was queried to identify idiopathic scoliosis patients treated with thoracic VBT. Concave vs. convex vertebral body height, vertebral wedging, and disc wedging of the 3 peri-apical vertebrae were measured by two independent observers at 5 timepoints (pre-operative to 4-year follow-up). RESULTS 65 skeletally immature patients (60 female, mean 12.8 years old, 21 with open triradiate cartilages) met inclusion criteria. Mean pre-operative maximum scoliosis of 50 ± 8° decreased significantly post-operatively to 27 ± 9° (p < 0.001), which remained stable at 4-year follow-up 30 ± 17° (p = 0.38 vs. post-operative). Mean instrumented scoliosis was 21 ± 14° at 4-year follow-up, which was significantly different than 4-year maximum scoliosis (p < 0.001). Mean pre-operative kyphosis of 30 ± 12° did not significantly change post-operatively (p = 1.0) and remained stable at 4-year follow-up (35 ± 18°; p = 0.05). Mean individual convex vertebral height increased from 17.7 ± 1.9 mm to 19.8 ± 1.5 mm (p < 0.001), while mean individual concave height increased from 14.8 ± 1.9 mm to 17.6 ± 1.6 mm (p < 0.001). Summing the peri-apical heights, the difference in height from pre-operative to 4-year follow-up was greater on the concave (8.3 ± 4.7 mm) than on the convex side (6.2 ± 4.7 mm) (p < 0.001). Mean individual vertebral wedging decreased from 6 ± 2° at pre-operative to 4 ± 2° at 4-year follow-up (p < 0.001). Mean total vertebral and disc wedging started at 29 ± 7° pre-operatively, decreased to 16 ± 6° at post-operative (p < 0.001), then further decreased to 14 ± 8° at 4-year follow-up (p < 0.001). Patients with open triradiate cartilages at the time of surgery had a larger height change over the 4 years compared to those with closed triradiate cartilages (p < 0.001). CONCLUSION Patients with idiopathic scoliosis treated with VBT demonstrated differential vertebral growth which was maintained at minimum 4-year follow-up. This effect was more pronounced in patients whose triradiate cartilages were open at the time of surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gregory Photopoulos
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Orthopedic Surgery, IWK Health Centre, Orthopaedic Clinic, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - Jennifer Hurry
- Division of Orthopedic Surgery, IWK Health Centre, Orthopaedic Clinic, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - Ankita Bansal
- Division of Orthopedic Surgery, IWK Health Centre, Orthopaedic Clinic, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - Firoz Miyanji
- Orthopaedics Research Department, BC Children's Hospital, Vancouver, BC, Canada
| | - Stefan Parent
- Department of Orthopaedics, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Joshua Murphy
- Department of Orthopaedic Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ron El-Hawary
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
- Division of Orthopedic Surgery, IWK Health Centre, Orthopaedic Clinic, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada.
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Pahys JM. In Search of Bracing's New Crystal Ball: Commentary on an article by Prudence Wing Hang Cheung, BDSc(Hons), PhD, et al.: "Using the Proximal Femur Maturity Index at Brace Initiation for Adolescent Idiopathic Scoliosis Predicts Curve Progression Risk". J Bone Joint Surg Am 2024; 106:e17. [PMID: 38506724 DOI: 10.2106/jbjs.23.01399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Joshua M Pahys
- Shriners Children's Philadelphia, Philadelphia, Pennsylvania
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Guo H, Zhou X, Li Y, Yang Y, Yu H, Li X, Yuan H, Chen Y, Feng Y, Huang J, Du Q. Application of the six-minute Walk Test in Assessment of the Cardiopulmonary Function of Children with Idiopathic Scoliosis. Spine (Phila Pa 1976) 2023; 49:00007632-990000000-00545. [PMID: 38158748 PMCID: PMC11132092 DOI: 10.1097/brs.0000000000004913] [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: 05/10/2022] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
STUDY DESIGN A retrospective observational study. OBSJECTIVE To assess whether the 6-minute walk test (6MWT) can predict cardiopulmonary function in children with idiopathic scoliosis (IS) as an alternative to the cardiopulmonary exercise test (CPET). SUMMARY OF BACKGROUND DATA Cardiopulmonary functional impairment in the setting of IS is a common health problem. A simple and convenient assessment method is needed. METHODS We recruited 65 children (eight male, 57 female) aged 10.70-14.84 years old with IS. Radiographic characteristics of the cohort were measured, including Risser's sign and Cobb angle. We measured cardiopulmonary exercise tolerance using both the 6MWT and CPET and their corresponding indicators, including six-minute walking distance (6MWD) and peak oxygen uptake (peak VO2), respectively. Pearson correlation analysis was used to determine the relationship between 6MWT indicators and IS parameters. Linear regression models were used to explore the relationship between 6MWT and CPET response indicators. RESULTS Over a third of the cohort (35.4%) had a Risser's sign grade of 0, with 21.5% in grade 2 and 3, respectively. The cohort's mean Cobb angle was 26.02 degrees. 6MWD was significantly positively correlated with Risser's sign (R=0.258; P=0.038) and change in respiratory rate (△RR) positively correlated with vertebral rotation (R=0.264; P=0.034). 6MWD positively correlated with peak VO2, peak VO2/heart rate (HR) and metabolic equivalents (METs), and negatively correlated with ventilation equivalent of carbon dioxide slope (VE/VCO2 slope) (P<0.05). These four CPET indicators were found to be predicted from 6MWD in the linear regression model (P<0.05). CONCLUSION CPET response indicators, especially peak VO2, can be predicted using 6MWD among other factors. The 6MWT can therefore be used to rapidly and efficiently predict the cardiorespiratory tolerance of children with IS. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Haibin Guo
- Department of Rehabilitation Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan Zhou
- Department of Rehabilitation Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanyan Li
- Department of Rehabilitation Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqi Yang
- College of Global Public Health, New York University, New York, NY
| | - Hong Yu
- Department of Rehabilitation Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Li
- Department of Rehabilitation Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Yuan
- Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yushan Chen
- Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yufei Feng
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Du
- Department of Rehabilitation Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Santos F, Argente J. Is collagen X marker (CXM) a useful index of growth velocity in children with chronic kidney disease? Pediatr Nephrol 2023; 38:3871-3873. [PMID: 37495740 DOI: 10.1007/s00467-023-06105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Fernando Santos
- Hospital Universitario Central de Asturias & Universidad de Oviedo, Oviedo, Asturias, Spain.
| | - Jesús Argente
- Hospital Universitario Niño Jesús & Universidad Autonoma de Madrid, Madrid, Spain
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Patient-specific finite element modeling of scoliotic curve progression using region-specific stress-modulated vertebral growth. Spine Deform 2023; 11:525-534. [PMID: 36593421 PMCID: PMC10147794 DOI: 10.1007/s43390-022-00636-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: 05/28/2022] [Accepted: 12/17/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE This study describes the creation of patient-specific (PS) osteo-ligamentous finite element (FE) models of the spine, ribcage, and pelvis, simulation of up to three years of region-specific, stress-modulated growth, and validation of simulated curve progression with patient clinical angle measurements. RESEARCH QUESTION Does the inclusion of region-specific, stress-modulated vertebral growth, in addition to scaling based on age, weight, skeletal maturity, and spine flexibility allow for clinically accurate scoliotic curve progression prediction in patient-specific FE models of the spine, ribcage, and pelvis? METHODS Frontal, lateral, and lateral bending X-Rays of five AIS patients were obtained for approximately three-year timespans. PS-FE models were generated by morphing a normative template FE model with landmark points obtained from patient X-rays at the initial X-ray timepoint. Vertebral growth behavior and response to stress, as well as model material properties were made patient-specific based on several prognostic factors. Spine curvature angles from the PS-FE models were compared to the corresponding X-ray measurements. RESULTS Average FE model errors were 6.3 ± 4.6°, 12.2 ± 6.6°, 8.9 ± 7.7°, and 5.3 ± 3.4° for thoracic Cobb, lumbar Cobb, kyphosis, and lordosis angles, respectively. Average error in prediction of vertebral wedging at the apex and adjacent levels was 3.2 ± 2.2°. Vertebral column stress ranged from 0.11 MPa in tension to 0.79 MPa in compression. CONCLUSION Integration of region-specific stress-modulated growth, as well as adjustment of growth and material properties based on patient-specific data yielded clinically useful prediction accuracy while maintaining physiological stress magnitudes. This framework can be further developed for PS surgical simulation.
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Hauta-Alus HH, Holmlund-Suila EM, Valkama SM, Enlund-Cerullo M, Rosendahl J, Coghlan RF, Andersson S, Mäkitie O. Collagen X Biomarker (CXM), Linear Growth, and Bone Development in a Vitamin D Intervention Study in Infants. J Bone Miner Res 2022; 37:1653-1664. [PMID: 35838180 PMCID: PMC9544705 DOI: 10.1002/jbmr.4650] [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: 04/06/2022] [Revised: 06/23/2022] [Accepted: 07/12/2022] [Indexed: 11/05/2022]
Abstract
Collagen X biomarker (CXM) is suggested to be a biomarker of linear growth velocity. However, early childhood data are limited. This study examines the relationship of CXM to the linear growth rate and bone development, including the possible modifying effects of vitamin D supplementation. We analyzed a cohort of 276 term-born children participating in the Vitamin D Intervention in Infants (VIDI) study. Infants received 10 μg/d (group-10) or 30 μg/d (group-30) vitamin D3 supplementation for the first 2 years of life. CXM and length were measured at 12 and 24 months of age. Tibial bone mineral content (BMC), volumetric bone mineral density (vBMD), cross-sectional area (CSA), polar moment of inertia (PMI), and periosteal circumference (PsC) were measured using peripheral quantitative computed tomography (pQCT) at 12 and 24 months. We calculated linear growth as length velocity (cm/year) and the growth rate in length (SD unit). The mean (SD) CXM values were 40.2 (17.4) ng/mL at 12 months and 38.1 (12.0) ng/mL at 24 months of age (p = 0.12). CXM associated with linear growth during the 2-year follow-up (p = 0.041) but not with bone (p = 0.53). Infants in group-30 in the highest tertile of CXM exhibited an accelerated mean growth rate in length compared with the intermediate tertile (mean difference [95% CI] -0.50 [-0.98, -0.01] SD unit, p = 0.044) but not in the group-10 (p = 0.062) at 12 months. Linear association of CXM and growth rate until 12 months was weak, but at 24 months CXM associated with both length velocity (B for 1 increment of √CXM [95% CI] 0.32 [0.12, 0.52] cm/yr, p = 0.002) and growth rate in length (0.20 [0.08, 0.32] SD unit, p = 0.002). To conclude, CXM may not reliably reflect linear growth from birth to 12 months of age, but its correlation with growth velocity improves during the second year of life. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Helena H Hauta-Alus
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism (CAMM), Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Population Health Unit, National Institute for Health and Welfare (THL), Helsinki, Finland.,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Elisa M Holmlund-Suila
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism (CAMM), Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Saara M Valkama
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism (CAMM), Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Maria Enlund-Cerullo
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism (CAMM), Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jenni Rosendahl
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism (CAMM), Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Sture Andersson
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Outi Mäkitie
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden.,Folkhälsan Institute of Genetics, Helsinki, Finland
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