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Li H, Wu J, Song L, Shao S, Chen Z, Wang J, Gao B, Huo L. The efficacy of bracing in the treatment of progressive early-onset scoliosis. Sci Rep 2024; 14:10208. [PMID: 38702519 PMCID: PMC11068787 DOI: 10.1038/s41598-024-61030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/30/2024] [Indexed: 05/06/2024] Open
Abstract
Serial casting as one of the applications to treat early-onset scoliosis has been reported efficiently to improve deformity, but no report has focused on the efficacy of braces in the treatment of congenital early-onset scoliosis and comparison with progressive idiopathic early-onset scoliosis. Patients with progressive EOS treated with braces in our institution with a minimum of 4 years follow-up were reviewed. Two groups according to the etiological diagnosis were analyzed and compared: the congenital scoliosis (CS) group and idiopathic scoliosis (IS) group. The success cases and the failure cases were also compared. 27 patients with an average main Cobb angle of 38.19° (20-55) underwent initial bracing at an average age of 55.7 months (24-108), the average follow-up time was 76.19 months (49-117). In IS group the main Cobb angle was corrected to 18.69 ± 12.06° (48.61%) following the first bracing; the final Cobb angle was 23.08 ± 22.15°(38.76%) after brace removal. In CS group the main Cobb angle was corrected to 33.93 ± 10.31°(17.1%) following the first bracing and 37.93 ± 14.74°(3.53%) after brace removal. Both coronal chest width and T1-T12 height increased dramatically from pre-bracing to the last follow-up. Patients diagnosed as IS tended to have a better result in main Cobb angle correction than that of CS (P = 0.049). By the time of last follow-up, 8 patients had undergone surgery, and the operation time was postponed by 68.88 ± 26.43 months. For patients with progressive early-onset scoliosis, bracing is an efficient nonsurgical alternative to casting, and some of them can be cured; if not, eventual surgical intervention can be delayed for a period of time without restrictions on the thoracic cavity.
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Affiliation(s)
- Haixia Li
- Department of Spine Surgery, Strategic Support Force Medical Center, Beijing, 100101, China
| | - Jigong Wu
- Department of Spine Surgery, Strategic Support Force Medical Center, Beijing, 100101, China.
| | - Lizhi Song
- Beijing Lizhi Rehabilitation Aids Center, Beijing, 102208, China
| | - Shuilin Shao
- Department of Spine Surgery, Strategic Support Force Medical Center, Beijing, 100101, China
| | - Zhiming Chen
- Department of Spine Surgery, Strategic Support Force Medical Center, Beijing, 100101, China.
| | - Jiaxu Wang
- Department of Spine Surgery, Strategic Support Force Medical Center, Beijing, 100101, China
| | - Bo Gao
- Department of Spine Surgery, Strategic Support Force Medical Center, Beijing, 100101, China
| | - Litao Huo
- Department of Spine Surgery, Strategic Support Force Medical Center, Beijing, 100101, China
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Deng J, Chen XK, Guo FZ, Huang W, Zhu FX, Wang TB, Jiang BG. Respiratory Function Tolerance of Rats with Vaying Degrees of Thoracic Volume Reduction. Orthop Surg 2023; 15:1144-1152. [PMID: 36855908 PMCID: PMC10102318 DOI: 10.1111/os.13630] [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: 12/16/2020] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE To compare the effects of respiratory function on different degrees of reduced thoracic volume and evaluate the tolerance of rats with reduced thoracic volume, and to assess the feasibility of thoracic volume as a measure of the severity of rib fractures. METHODS A total of 24 10-week-old female Sprague-Dawley (SD) rats were randomly divided into four groups (n = 6 in each group) according to the displacement degree of bilateral rib fractures (2, 4, 6, and 8 mm). The respiratory function of the rats(Tidal volume, Inspiration time, Expiration time, Breath rate, Minute volume, Peak inspiration flow) measured via whole-body barometric plethysmography before and after operation for 14 consecutive days. Respiratory function parameters of each group were analyzed. Chest CT scans were performed before and 14 days after operation, after that we reconstructed three-dimensional of the thoracic and lung and measured their volumes by computer software. We calculated the percentage of thoracic and lung volume reduction after operation. RESULTS At the 14th day after the operation, the decline of thoracic volume rates of in the 2, 4, 6, and 8 mm groups were 5.20%, 9.01%, 16.67%, and 20.74%, respectively. The 8 mm group showed a significant reduction in lung volume. The postoperative tidal volumes were lower in each of the groups than the baseline values before the operation. The tidal volume of the 2 mm group gradually recovered after the operation and returned to a normal level (1.54 ± 0.07 mL) at 14th day after the operation. The tidal volume of the 4, 6, and 8 mm groups recovered gradually after the operation, but did not return to baseline level at the 14th day. In particular, the tidal volume of the 8 mm group was significantly lower than that of the other groups during the 14 days (1.23 ± 0.12 mL, p < 0.05). There were no significant changes in the inspiratory and expiratory times, peak inspiratory and expiratory flows, respiratory rate, and minute ventilation during the 14 days after the operation in each group. CONCLUSIONS Displaced rib fractures lead to thoracic collapse and reduced thoracic volume, which can affect tidal volume in rats. The greater the decrease of thoracic volume, the more obvious the decrease of early tidal volume. The thoracic volume can be used as an objective parameter to evaluate the severity of multiple rib fractures. Early operation to restore thoracic volume may improve early respiratory function. Decreased thoracic volume affected respiratory function and can be compensated and recovered in the long term.
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Affiliation(s)
- Jiuxu Deng
- National Center for Trauma Medicine, Trauma Medicine Center, Ministry of Education Key Laboratory of Trauma and Neuroregeneration, Peking University People's Hospital, Beijing, China
| | - Xiao-Kun Chen
- National Center for Trauma Medicine, Trauma Medicine Center, Ministry of Education Key Laboratory of Trauma and Neuroregeneration, Peking University People's Hospital, Beijing, China
| | - Fu-Zheng Guo
- National Center for Trauma Medicine, Trauma Medicine Center, Ministry of Education Key Laboratory of Trauma and Neuroregeneration, Peking University People's Hospital, Beijing, China
| | - Wei Huang
- National Center for Trauma Medicine, Trauma Medicine Center, Ministry of Education Key Laboratory of Trauma and Neuroregeneration, Peking University People's Hospital, Beijing, China
| | - Feng-Xue Zhu
- National Center for Trauma Medicine, Trauma Medicine Center, Ministry of Education Key Laboratory of Trauma and Neuroregeneration, Peking University People's Hospital, Beijing, China
| | - Tian-Bing Wang
- National Center for Trauma Medicine, Trauma Medicine Center, Ministry of Education Key Laboratory of Trauma and Neuroregeneration, Peking University People's Hospital, Beijing, China
| | - Bao-Guo Jiang
- National Center for Trauma Medicine, Trauma Medicine Center, Ministry of Education Key Laboratory of Trauma and Neuroregeneration, Peking University People's Hospital, Beijing, China
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Efficacy of distal pedicle screw fixation as a caudal foundation in VEPTR growing rod constructs for early onset scoliosis. Spine Deform 2021; 9:1169-1174. [PMID: 33523456 DOI: 10.1007/s43390-021-00295-6] [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: 04/27/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Surgical treatment of Early Onset Scoliosis (EOS) is challenging. Stable and robust foundations are vital. We have assessed a small cohort of patients with a rib-based proximal fixation and a pedicle screw-based distal foundation for a distraction based growing rod system. METHOD This is a single center study in a tertiary spinal deformity unit with a catchment population of over 6 million. We performed a retrospective radiographic evaluation of 15 patients with EOS treated with Vertical Expandable Titanium Prosthetic Rib (VEPTR) implant between 2007 and 2017. The review of medical records and imaging data was performed to identify growth of the spine and complications with pedicle screws. RESULTS There were ten male and five female patients with an average age at index surgery of 4yrs 11 months. Mean length of follow-up was 6 yrs 9 months. Serial radiographs revealed improvements in mean Cobb angle of 12 degrees, T1-T12 height of 29 mm and T1-S1 height of 48 mm with no deterioration in distal LIV tilt angle. We report that none of these patients had any complications related to their pedicle screws including cut-out. CONCLUSION We report a technique which is efficacious and provides a mechanically robust distal fixation for VEPTR lengthening in early onset scoliosis.
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Chen XK, Liu YJ, Guo FZ, Deng JX, Xiong J, Wang TB, Jiang BG. Assessment of thoracic volume changes after the collapse of lateral rib fractures based on chest computed tomography data: computer simulation and a multiple variable linear regression analysis. J Cardiothorac Surg 2020; 15:167. [PMID: 32646474 PMCID: PMC7346514 DOI: 10.1186/s13019-020-01213-z] [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: 02/11/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background Chest blunt trauma (CBT) and the resultant rib fractures often lead to thoracic collapse. The purpose of this study was to explore the effect of displacement of the rib fracture and thoracic collapse on the thoracic volume by using normal chest CT data. Methods In this retrospective study, seven consecutive normal participants were selected from our hospital between June and July 2018. Normal thoracic models were reconstructed, followed by simulation of lateral fractures through the 4th to 9th ribs under three collapse modes with 1–5 cm of collapse. The thoracic collapse models (n = 630) were reconstructed using 3Dmax 2014. We calculated the thoracic volume and reduction percentage for each thoracic collapse model. Linear regression-based comparisons of thoracic volume reductions were performed. Results In all three collapse modes, the degree of the collapse was linearly correlated with the mean thoracic volume reduction. The reduction percentage in the posterior collapse mode was higher than that in the anterior collapse mode (P < 0.001). The largest volume reductions in the anterior, posterior, and simultaneous collapse models were in the 6th rib fracture model (P < 0.001), 8th rib fracture model (P < 0.001), and 7th rib fracture model (P < 0.001), respectively. Conclusions The influences of rib fracture displacement and collapse on the thoracic volume in the 6th through 8th ribs are critical in lateral rib fractures. For patients with 6th to 8th rib fractures and posterior rib collapse, surgical intervention to restore thoracic volume may be more essential.
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Affiliation(s)
- Xiao-Kun Chen
- Department of Orthopedic Trauma, Peking University People Hospital, No. 11 Xizhimen South Road, Beijing, 100044, P. R. China
| | - Yi-Jun Liu
- Department of Orthopedic Trauma, Peking University People Hospital, No. 11 Xizhimen South Road, Beijing, 100044, P. R. China
| | - Fu-Zheng Guo
- National Center for Trauma Medicine, Beijing, 100044, P. R. China
| | - Jiu-Xu Deng
- National Center for Trauma Medicine, Beijing, 100044, P. R. China
| | - Jian Xiong
- Department of Orthopedic Trauma, Peking University People Hospital, No. 11 Xizhimen South Road, Beijing, 100044, P. R. China
| | - Tian-Bing Wang
- Department of Orthopedic Trauma, Peking University People Hospital, No. 11 Xizhimen South Road, Beijing, 100044, P. R. China. .,National Center for Trauma Medicine, Beijing, 100044, P. R. China.
| | - Bao-Guo Jiang
- Department of Orthopedic Trauma, Peking University People Hospital, No. 11 Xizhimen South Road, Beijing, 100044, P. R. China. .,National Center for Trauma Medicine, Beijing, 100044, P. R. China.
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Glotzbecker M, Miller P, Vitale M, DeWitt L, Grzywna A, Sawyer J, Pahys J, Cahill P, Emans J. Hemoglobin Levels Pre- and Posttreatment as a Surrogate for Disease Severity in Early-Onset Scoliosis. Spine Deform 2019; 7:641-646. [PMID: 31202383 DOI: 10.1016/j.jspd.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 10/30/2018] [Accepted: 11/03/2018] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN Prospective cohort. OBJECTIVE To compare preoperative hemoglobin levels to postoperative hemoglobin levels in patients with early-onset scoliosis (EOS). SUMMARY OF BACKGROUND DATA Elevated hemoglobin (Hgb) may be a marker for preoperative hypoxia in patients with EOS and thoracic insufficiency syndrome (TIS). The changes in Hgb level after treatment may be a surrogate marker for improved oxygenation. METHODS Because normal levels of Hgb vary with patient age, Hgb z scores were calculated by dividing age-adjusted mean Hgb levels by the age-adjusted standard deviation. Elevated Hgb was defined by a hemoglobin z score >1. Patients with a baseline Hgb value measured before initial implantation with at least one follow-up measurement, at 6, 12, or 18 months, were included in longitudinal analysis. Change in Hgb z score as well as change in curve magnitude over time was assessed using piecewise linear mixed modeling for patients with elevated Hgb and those without. RESULTS Two hundred sixty-seven patients with EOS were treated surgically over the study period. Average age at initial implantation was 6.8 years. Forty-eight (18%; 95% confidence interval = 13.7%, 23.2%) subjects had an elevated Hgb (z score > 1) level before implantation procedure. Hgb levels decreased in subjects with elevated Hgb from implantation to 6 months (p < .001) with no change in Hgb from 6 to 12 months (p = .46) or from 12 to 18 months (p = .59), but an overall decrease from preoperative to 18 months (p < .001). There was no change in Hgb levels for subjects without elevated Hgb from implantation to 6 months (p = .94), from 6 to 12 months (p = .61), or from 12 to 18 months (p = .78). CONCLUSIONS In some patients with EOS and TIS, there appears to be significant positive impact on oxygenation from distraction instrumentation as evidenced by a meaningful proxy measurement: improvement in abnormal preoperative Hgb levels after surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michael Glotzbecker
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Patricia Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Michael Vitale
- Department of Orthopaedic Surgery, Morgan Stanley Hospital, 3959 Broadway, New York, NY 10032, USA
| | - Leah DeWitt
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Alexandra Grzywna
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Jeffrey Sawyer
- Department of Orthopaedic Surgery, Campbell Clinic Orthopaedics, 1211 Union Ave Suite 500, Memphis, TN 38104, USA
| | - Joshua Pahys
- Department of Orthopaedic Surgery, Shriners Hospital for Children, 3551 N Broad St, Philadelphia, PA 19140, USA
| | - Patrick Cahill
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - John Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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Johnston CE, Tran DP, McClung A. Functional and Radiographic Outcomes Following Growth-Sparing Management of Early-Onset Scoliosis. J Bone Joint Surg Am 2017. [PMID: 28632593 DOI: 10.2106/jbjs.16.00796] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In this study, we sought to evaluate radiographic, functional, and quality-of-life outcomes of patients who have completed growth-sparing management of early-onset scoliosis. METHODS This prospective study involved patients with early-onset scoliosis who underwent growth-sparing treatment and either "final" fusion or observation for ≥2 years since the last lengthening procedure. Demographics, radiographic parameters, pulmonary function test (PFT) values, and scores of patient-reported assessments (Early-Onset Scoliosis Questionnaire [EOSQ] and Scoliosis Research Society [SRS]-30) were obtained. At the most recent follow-up, patients performed 2 additional functional outcome tests: step-activity monitoring and a treadmill exercise-tolerance test. RESULTS Twelve patients were evaluated as "graduates" of growth-sparing management of early-onset scoliosis (mean of 37 months since the most recent surgery). The major scoliosis curve measurement averaged 88° before treatment and 47° at the most recent follow-up. T1-S1 height increased from a mean of 22.3 cm to 34.7 cm and T1-T12 height, from 13.3 to 22.3 cm. At the most recent follow-up, the mean forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) as a percentage of the predicted volume were 52.1% and 55.3%, respectively, and were essentially unchanged from the earliest PFT that patients could perform (FEV1 = 53.8% of predicted and FVC = 53.5% of predicted). There was no difference between graduates and controls with respect to activity time or total steps in step-activity monitoring, and in the exercise-tolerance test, graduates walked at the same speed but at a higher heart rate and at a significantly higher (p <0.001) VO2 cost (rate of oxygen consumed per distance traveled). The EOSQ mean score was 102.2 of a possible 120 points, and the SRS mean score was 4.1 of a possible 5 points. CONCLUSIONS A realistic long-term goal for the management of early-onset scoliosis appears to be spine elongation and maintenance of pulmonary function at a level that is no less than the percentage of normal at initial presentation. Functional testing and patient-reported outcomes at a mean of 3 years from the last surgery suggest that activity levels were generally equal to those of controls but required greater physiologic demand. General health and physical function outcomes revealed continued impairment in these domains. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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