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Borselle D, Grochowski K, Gerus S, Międzybrodzki K, Kołtowski K, Jasińska A, Kamiński A, Patkowski D. Thoracic Musculoskeletal Deformities Following Surgical Treatment of Esophageal Atresia - Thoracoscopic Versus Open Approach: A Retrospective Two Centers Cohort Study. J Pediatr Surg 2024; 59:1719-1724. [PMID: 38594136 DOI: 10.1016/j.jpedsurg.2024.03.023] [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: 11/02/2023] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Thoracic musculoskeletal deformities are significant complications following open correction of esophageal atresia (EA) during long-term follow-up. We aimed to compare the frequency and severity of thoracic musculoskeletal deformities after open and thoracoscopic repair of EA. We hypothesized that fewer deformities would occur following the less invasive thoracoscopic approach. METHODS This retrospective study analyzed patients treated at two pediatric surgery departments in Poland between 2005 and 2021. The patient groups differed in surgical approach, operative techniques, indications for multi-staged surgery, and postoperative complications. The study encompassed all types of EA/TEF. The first group comprised 68 patients who underwent thoracoscopic esophageal atresia repair (Wroclaw), while the second group involved 44 patients who underwent open repair (Warsaw). Clinical data were retrospectively reviewed, with results considered significant at p < 0.05. RESULTS The median age at examination was 6 years in the thoracoscopy group and 5.5 years in the thoracotomy group. In the thoracoscopy group, 53 out of 68 patients (77.9%) and in the thoracotomy group - 35 out of 44 patients (79.5%) were treated in one stage. The incidence of thoracic musculoskeletal deformities was significantly lower in the thoracoscopy group (1.5%) compared to the thoracotomy group (34.1%, p < 0.001). Scoliosis occurred significantly more often after thoracotomy (13.6% vs 1.5%, p = 0.016). There was no rib fusion (0% vs 37.1%, p < 0.001) and no scoliosis of =>20° (0% vs 6.8%, p = 0.058) after thoracoscopy. The coincidence of rib fusion and scoliosis was significant (9.1%, p = 0.022) for the open approach. In the thoracotomy group, multi-staged surgery and more frequent reoperations due to major complications were significantly associated with an increased occurrence of deformities. None of the patients after thoracoscopic multi-stage or complicated EA/TEF repair developed scoliosis. CONCLUSIONS The frequency and severity of thoracic musculoskeletal deformities were significantly lower after the thoracoscopic approach. Thoracoscopy may be a more advantageous and preferred surgical approach for the EA/TEF treatment, although further randomized, controlled studies are necessary. Post-thoracotomy scoliosis may progress to a severity requiring surgery.
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Affiliation(s)
- Dominika Borselle
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland.
| | - Konrad Grochowski
- Department of Pediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Sylwester Gerus
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Krzysztof Kołtowski
- Department of Pediatric Orthopedics and Traumatology, University Hospital of Jan Mikulicz-Radecki, Wroclaw, Poland
| | - Aleksandra Jasińska
- Department of Pediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Kamiński
- Department of Pediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
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Kato S, Maeda Y, Nagura T, Nakamura M, Watanabe K. Comparison of three artificial intelligence algorithms for automatic cobb angle measurement using teaching data specific to three disease groups. Sci Rep 2024; 14:17989. [PMID: 39097613 PMCID: PMC11297987 DOI: 10.1038/s41598-024-68937-z] [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: 04/09/2024] [Accepted: 07/30/2024] [Indexed: 08/05/2024] Open
Abstract
Spinal deformities, including adolescent idiopathic scoliosis (AIS) and adult spinal deformity (ASD), affect many patients. The measurement of the Cobb angle on coronal radiographs is essential for their diagnosis and treatment planning. To enhance the precision of Cobb angle measurements for both AIS and ASD, we developed three distinct artificial intelligence (AI) algorithms: AIS/ASD-trained AI (trained with both AIS and ASD cases); AIS-trained AI (trained solely on AIS cases); ASD-trained AI (trained solely on ASD cases). We used 1612 whole-spine radiographs, including 1029 AIS and 583 ASD cases with variable postures, as teaching data. We measured the major and two minor curves. To assess the accuracy, we used 285 radiographs (159 AIS and 126 ASD) as a test set and calculated the mean absolute error (MAE) and intraclass correlation coefficient (ICC) between each AI algorithm and the average of manual measurements by four spine experts. The AIS/ASD-trained AI showed the highest accuracy among the three AI algorithms. This result suggested that learning across multiple diseases rather than disease-specific training may be an efficient AI learning method. The presented AI algorithm has the potential to reduce errors in Cobb angle measurements and improve the quality of clinical practice.
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Affiliation(s)
- Shuzo Kato
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku, Tokyo, 160-8582, Japan
| | - Yoshihiro Maeda
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku, Tokyo, 160-8582, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku, Tokyo, 160-8582, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku, Tokyo, 160-8582, Japan.
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Tingsheng L, Chunshan L, Shudan Y, Xingwei P, Qiling C, Minglu Y, Lu C, Lihang W. Validation of Artificial Intelligence in the Classification of Adolescent Idiopathic Scoliosis and the Compairment to Clinical Manual Handling. Orthop Surg 2024; 16:2040-2051. [PMID: 38961674 PMCID: PMC11293916 DOI: 10.1111/os.14144] [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: 03/14/2024] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE The accurate measurement of Cobb angles is crucial for the effective clinical management of patients with adolescent idiopathic scoliosis (AIS). The Lenke classification system plays a pivotal role in determining the appropriate fusion levels for treatment planning. However, the presence of interobserver variability and time-intensive procedures presents challenges for clinicians. The purpose of this study is to compare the measurement accuracy of our developed artificial intelligence measurement system for Cobb angles and Lenke classification in AIS patients with manual measurements to validate its feasibility. METHODS An artificial intelligence (AI) system measured the Cobb angle of AIS patients using convolutional neural networks, which identified the vertebral boundaries and sequences, recognized the upper and lower end vertebras, and estimated the Cobb angles of the proximal thoracic, main thoracic, and thoracolumbar/lumbar curves sequentially. Accordingly, the Lenke classifications of scoliosis were divided by oscillogram and defined by the AI system. Furthermore, a man-machine comparison (n = 300) was conducted for senior spine surgeons (n = 2), junior spine surgeons (n = 2), and the AI system for the image measurements of proximal thoracic (PT), main thoracic (MT), thoracolumbar/lumbar (TL/L), thoracic sagittal profile T5-T12, bending views PT, bending views MT, bending views TL/L, the Lenke classification system, the lumbar modifier, and sagittal thoracic alignment. RESULTS In the AI system, the calculation time for each patient's data was 0.2 s, while the measurement time for each surgeon was 23.6 min. The AI system showed high accuracy in the recognition of the Lenke classification and had high reliability compared to senior doctors (ICC 0.962). CONCLUSION The AI system has high reliability for the Lenke classification and is a potential auxiliary tool for spinal surgeons.
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Affiliation(s)
- Lu Tingsheng
- Department of Spine SurgeryBeijing Jishuitan Hospital Guizhou HospitalGuiyangChina
| | - Luo Chunshan
- Department of Spine SurgeryBeijing Jishuitan Hospital Guizhou HospitalGuiyangChina
| | - Yao Shudan
- Department of Spine SurgeryBeijing Jishuitan Hospital Guizhou HospitalGuiyangChina
| | - Pu Xingwei
- Department of Spine SurgeryBeijing Jishuitan Hospital Guizhou HospitalGuiyangChina
| | - Chen Qiling
- Department of Spine SurgeryBeijing Jishuitan Hospital Guizhou HospitalGuiyangChina
| | - Yang Minglu
- Department of Spine SurgeryBeijing Jishuitan Hospital Guizhou HospitalGuiyangChina
| | - Chen Lu
- Department of Spine SurgeryBeijing Jishuitan Hospital Guizhou HospitalGuiyangChina
| | - Wang Lihang
- Department of Spine SurgeryBeijing Jishuitan Hospital Guizhou HospitalGuiyangChina
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Shcherbakova YM, Lafranca PPG, Foppen W, van der Velden TA, Nievelstein RAJ, Castelein RM, Ito K, Seevinck PR, Schlosser TPC. A multipurpose, adolescent idiopathic scoliosis-specific, short MRI protocol: A feasibility study in volunteers. Eur J Radiol 2024; 177:111542. [PMID: 38861906 DOI: 10.1016/j.ejrad.2024.111542] [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: 03/20/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Visualization of scoliosis typically requires ionizing radiation (radiography and CT) to visualize bony anatomy. MRI is often additionally performed to screen for neural axis abnormalities. We propose a 14-minutes radiation-free scoliosis-specific MRI protocol, which combines MRI and MRI-based synthetic CT images to visualize soft and osseous structures in one examination. We assess the ability of the protocol to visualize landmarks needed to detect 3D patho-anatomical changes, screen for neural axis abnormalities, and perform surgical planning and navigation. METHODS 18 adult volunteers were scanned on 1.5 T MR-scanner using 3D T2-weighted and synthetic CT sequences. A predefined checklist of relevant landmarks was used for the parameter assessment by three readers. Parameters included Cobb angles, rotation, torsion, segmental height, area and centroids of Nucleus Pulposus and Intervertebral Disc. Precision, reliability and agreement between the readers measurements were evaluated. RESULTS 91 % of Likert-based questions scored ≥ 4, indicating moderate to high confidence. Precision of 3D dot positioning was 1.0 mm. Precision of angle measurement was 0.6° (ICC 0.98). Precision of vertebral and IVD height measurements was 0.4 mm (ICC 0.99). Precision of area measurement for NP was 8 mm2 (ICC 0.55) and for IVD 18 mm2 (ICC 0.62) for IVD. Precision of centroid measurement for NP was 1.3 mm (ICC 0.88-0.92) and for IVD 1.1 mm (ICC 0.88-91). CONCLUSIONS The proposed MRI protocol with synthetic CT reconstructions, has high precision, reliability and agreement between the readers for multiple scoliosis-specific measurements. It can be used to study scoliosis etiopathogenesis and to assess 3D spinal morphology.
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Affiliation(s)
- Yulia M Shcherbakova
- Department of Radiology, Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands.
| | | | - Wouter Foppen
- Department of Radiology & Nuclear Medicine, Division Imaging & Oncology, UMC Utrecht, Utrecht, Netherlands
| | - Tijl A van der Velden
- Department of Radiology, Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands; MRIguidance B.V., Utrecht, Netherlands
| | - Rutger A J Nievelstein
- Department of Radiology & Nuclear Medicine, Division Imaging & Oncology, UMC Utrecht, Utrecht, Netherlands
| | - Rene M Castelein
- Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, Netherlands
| | - Keita Ito
- Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Peter R Seevinck
- Department of Radiology, Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands; MRIguidance B.V., Utrecht, Netherlands
| | - Tom P C Schlosser
- Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, Netherlands
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Zhang Y, Chai T, Weng H, Liu Y. Pelvic rotation correction combined with Schroth exercises for pelvic and spinal deformities in mild adolescent idiopathic scoliosis: A randomized controlled trial. PLoS One 2024; 19:e0307955. [PMID: 39078854 PMCID: PMC11288462 DOI: 10.1371/journal.pone.0307955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 07/09/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Individualized treatment of spinal deformity is needed for adolescent idiopathic scoliosis (AIS), and the integration of pelvic rotation correction based on proprioceptive neuromuscular facilitation (PNF) into regular physiotherapy may be a promising approach. However, few high-quality studies have investigated its effects. This study aimed to evaluate the efficacy of pelvic rotation correction combined with Schroth exercises in the treatment of mild AIS. METHODS This was a randomized controlled trial. Forty-two AIS patients were randomly divided into experimental and control groups. Both groups underwent 20 therapeutic sessions over 24 weeks. All patients (n = 42) performed Schroth exercises at each session. In addition, the experimental group (n = 21) also participated in a pelvic rotation correction program based on PNF at each session. The primary outcome was the concave/convex ratio of hipbone widths, and the secondary outcomes included the Cobb angle, trunk rotation angle, self-perception, apical vertebral translation, and apical vertebral rotation. Patients were evaluated before and after 24 weeks of intervention. RESULTS There was a significant between-group difference in the change from baseline between the experimental and control groups for the following parameters: concave/convex ratio 2.89% (95% confidence interval [CI], 1.58 to 4.20, P<0.001), trunk rotation angle -1.26° (95% CI, -2.20 to -0.32; P = 0.01), and apical vertebral rotation improved by at least one class from baseline in 3 patients (14.3%) in the control group and 9 patients (42.9%) in the experimental group (P = 0.04). While Cobb angle -1.60° (95% CI, -7.75 to 0.54; P = 0.14), self-image 0.149 (95% CI, 0.001 to 0.297; P = 0.049), apical vertebral translation -0.58 mm (95% CI, -3.83 to 2.67; P = 0.72), and pelvic obliquity 0.10° (95% CI, -0.21 to 0.41; P = 0.52) did not differ significantly. CONCLUSIONS Pelvic rotation correction combined with Schroth exercises more effectively improved pelvic axial rotation and other spinal deformities, including trunk rotation and apical vertebral rotation, than Schroth exercises alone in the treatment of mild AIS.
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Affiliation(s)
- Yafei Zhang
- Department of Rehabilitation Medicine, Aerospace Center Hospital, Beijing, China
| | - Tingting Chai
- Department of Rehabilitation Medicine, Aerospace Center Hospital, Beijing, China
| | - Hao Weng
- Department of Rehabilitation Medicine, Aerospace Center Hospital, Beijing, China
| | - Yang Liu
- Department of Rehabilitation Medicine, Aerospace Center Hospital, Beijing, China
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Kim DJ, Dermott JA, Mitani AA, Doria AS, Howard AW, Lebel DE. The diagnostic accuracy of community spine radiology for adolescent idiopathic scoliosis brace candidates. 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 2024:10.1007/s00586-024-08389-1. [PMID: 39014076 DOI: 10.1007/s00586-024-08389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 03/19/2024] [Accepted: 06/29/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE The study aims to establish the diagnostic accuracy of community spine x-rays for brace candidates. METHODS A review of adolescent idiopathic scoliosis patients seen for initial visit at a tertiary care pediatric hospital was conducted (n = 170). The index test was the pre-referral community spine x-ray interpreted by a community radiologist. Measures of diagnostic accuracy for the index test were determined against the reference standard if images were obtained within 90 days (n = 111). The reference standard was the 3-foot standing EOS spine x-ray evaluated by spine specialists. Diagnostic criterion for a brace candidate was dichotomized by Cobb angle range (25-40°) according to Scoliosis Research Society criteria. Risser stage was not included given significant missing data in index reports. To mitigate the uncertainty around true progression, sensitivity analyses were conducted on a sub-sample of data when index test was within 60 days of the reference standard (n = 67). RESULTS Accuracy of the community spine x-ray to detect a brace candidate was 65.8% (95% CI 56.2-74.5). Sensitivity of the index test was 65.4% with a false negative rate of 34.6%. Specificity was 66.1% with a false positive rate of 33.9%. Positive and negative predictive values were 63.0% and 68.4%, respectively. Of the total number of brace candidates (n = 52), 32.7% were missed because of underestimation in Cobb angle (95% CI 21.5-46.2). The proportion of missed brace candidates because of underestimation was unchanged with 60-day data (p = 0.37). CONCLUSIONS Inaccuracies in community spine radiology may lead to missed opportunities for non-operative treatment.
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Affiliation(s)
- Dorothy J Kim
- Hospital for Sick Children, 555 University Avenue, Room S229, Toronto, ON M5G 1X8, Canada.
| | - Jennifer A Dermott
- Hospital for Sick Children, 555 University Avenue, Room S229, Toronto, ON M5G 1X8, Canada
| | - Aya A Mitani
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Andrea S Doria
- Hospital for Sick Children, 555 University Avenue, Room S229, Toronto, ON M5G 1X8, Canada
| | - Andrew W Howard
- Hospital for Sick Children, 555 University Avenue, Room S229, Toronto, ON M5G 1X8, Canada
| | - David E Lebel
- Hospital for Sick Children, 555 University Avenue, Room S229, Toronto, ON M5G 1X8, Canada
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Chen K, Stotter C, Klestil T, Mitterer JA, Lepenik C, Nehrer S. Fully Automated Measurement of Cobb Angles in Coronal Plane Spine Radiographs. J Clin Med 2024; 13:4122. [PMID: 39064162 PMCID: PMC11278017 DOI: 10.3390/jcm13144122] [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: 05/07/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: scoliosis is a three-dimensional structural deformity characterized by lateral and rotational curvature of the spine. The current gold-standard method to assess scoliosis is the measurement of lateral curvature of the spine using the Cobb angle in coronal plane radiographs. The interrater variability for Cobb angle measurements reaches up to 10°. The purpose of this study was to describe and assess the performance of a fully automated method for measuring Cobb angles using a commercially available artificial intelligence (AI) model trained on over 17,000 images, and investigate its interrater/intrarater agreement with a reference standard. Methods: in total, 196 AP/PA full-spine radiographs were included in this study. A reference standard was established by four radiologists, defined as the median of their Cobb angle measurements. Independently, an AI-based software, IB Lab SQUIRREL (version 1.0), also performed Cobb angle measurements on the same radiographs. Results: after comparing the readers' Cobb angle end vertebrae selection to the AI's outputs, 194 curvatures were considered valid for performance assessment, displaying an accuracy of 88.58% in end vertebrae selection. The AI's performance showed very low absolute bias, with a mean difference and standard deviation of differences from the reference standard of 0.16° ± 0.35° in the Cobb angle measurements. The ICC comparing the reference standard and the AI's measurements was 0.97. Conclusions: the AI model demonstrated good results in the determination of end vertebrae and excellent results in automated Cobb angle measurements compared to radiologists and could serve as a reliable tool in clinical practice and research.
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Affiliation(s)
- Kenneth Chen
- Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, 3500 Krems, Austria; (K.C.); (C.S.); (T.K.); (C.L.)
- Department for Orthopedics and Traumatology, Landesklinikum Waidhofen/Ybbs, 3340 Waidhofen an der Ybbs, Austria
| | - Christoph Stotter
- Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, 3500 Krems, Austria; (K.C.); (C.S.); (T.K.); (C.L.)
- Department for Orthopedics and Traumatology, Landesklinikum Baden-Mödling, 2340 Mödling, Austria
| | - Thomas Klestil
- Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, 3500 Krems, Austria; (K.C.); (C.S.); (T.K.); (C.L.)
- Department for Orthopedics and Traumatology, Landesklinikum Baden-Mödling, 2340 Mödling, Austria
| | - Jennyfer A. Mitterer
- Michael-Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, 1130 Vienna, Austria;
- II. Department of Pediatric Orthopaedics, Orthopaedic Hospital Vienna-Speising, 1130 Vienna, Austria
| | - Christopher Lepenik
- Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, 3500 Krems, Austria; (K.C.); (C.S.); (T.K.); (C.L.)
| | - Stefan Nehrer
- Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, 3500 Krems, Austria; (K.C.); (C.S.); (T.K.); (C.L.)
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Kim YG, Kim S, Park JH, Yang S, Jang M, Yun YJ, Cho JS, You S, Jang SH. Explainable Deep-Learning-Based Gait Analysis of Hip-Knee Cyclogram for the Prediction of Adolescent Idiopathic Scoliosis Progression. SENSORS (BASEL, SWITZERLAND) 2024; 24:4504. [PMID: 39065902 PMCID: PMC11280687 DOI: 10.3390/s24144504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/12/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024]
Abstract
Accurate prediction of scoliotic curve progression is crucial for guiding treatment decisions in adolescent idiopathic scoliosis (AIS). Traditional methods of assessing the likelihood of AIS progression are limited by variability and rely on static measurements. This study developed and validated machine learning models for classifying progressive and non-progressive scoliotic curves based on gait analysis using wearable inertial sensors. Gait data from 38 AIS patients were collected using seven inertial measurement unit (IMU) sensors, and hip-knee (HK) cyclograms representing inter-joint coordination were generated. Various machine learning algorithms, including support vector machine (SVM), random forest (RF), and novel deep convolutional neural network (DCNN) models utilizing multi-plane HK cyclograms, were developed and evaluated using 10-fold cross-validation. The DCNN model incorporating multi-plane HK cyclograms and clinical factors achieved an accuracy of 92% in predicting curve progression, outperforming SVM (55% accuracy) and RF (52% accuracy) models using handcrafted gait features. Gradient-based class activation mapping revealed that the DCNN model focused on the swing phase of the gait cycle to make predictions. This study demonstrates the potential of deep learning techniques, and DCNNs in particular, in accurately classifying scoliotic curve progression using gait data from wearable IMU sensors.
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Affiliation(s)
- Yong-Gyun Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul 04763, Republic of Korea; (Y.-G.K.); (S.K.); (J.H.P.)
| | - Sungjoon Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul 04763, Republic of Korea; (Y.-G.K.); (S.K.); (J.H.P.)
| | - Jae Hyeon Park
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul 04763, Republic of Korea; (Y.-G.K.); (S.K.); (J.H.P.)
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea;
| | - Seung Yang
- Department of Pediatrics, Hanyang University College of Medicine, Seoul 04763, Republic of Korea;
| | - Minkyu Jang
- Department of Computer Science, Hanyang University College of Engineering, Seoul 04763, Republic of Korea;
| | - Yeo Joon Yun
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea;
| | - Jae-sung Cho
- Robotics Lab, Research and Development Division of Hyundai Motor Company, Uiwang 16082, Republic of Korea;
| | - Sungmin You
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Seong-Ho Jang
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul 04763, Republic of Korea; (Y.-G.K.); (S.K.); (J.H.P.)
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea;
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Wong J, Reformat M, Parent E, Lou E. Validity and accuracy of automatic cobb angle measurement on 3D spinal ultrasonographs for children with adolescent idiopathic scoliosis: SOSORT 2024 award winner. 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 2024:10.1007/s00586-024-08376-6. [PMID: 38987512 DOI: 10.1007/s00586-024-08376-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 06/15/2024] [Accepted: 06/15/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Ultrasonography for scoliosis is a novel imaging method that does not expose children with adolescent idiopathic scoliosis (AIS) to radiation. A single ultrasound scan provides 3D spinal views directly. However, measuring ultrasonograph parameters is challenging, time-consuming, and requires considerable training. This study aimed to validate a machine learning method to measure the coronal curve angle on ultrasonographs automatically. METHODS A total of 144 3D spinal ultrasonographs were extracted to train and validate a machine learning model. Among the 144 images, 70 were used for training, and 74 consisted of 144 curves for testing. Automatic coronal curve angle measurements were validated by comparing them with manual measurements performed by an experienced rater. The inter-method intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), and percentage of measurements within clinical acceptance (≤ 5°) were analyzed. RESULTS The automatic method detected 125/144 manually measured curves. The averages of the 125 manual and automatic coronal curve angle measurements were 22.4 ± 8.0° and 22.9 ± 8.7°, respectively. Good reliability was achieved with ICC2,1 = 0.81 and SEM = 1.4°. A total of 75% (94/125) of the measurements were within clinical acceptance. The average measurement time per ultrasonograph was 36 ± 7 s. Additionally, the algorithm displayed the predicted centers of laminae to illustrate the measurement. CONCLUSION The automatic algorithm measured the coronal curve angle with moderate accuracy but good reliability. The algorithm's quick measurement time and interpretability can make ultrasound a more accessible imaging method for children with AIS. However, further improvements are needed to bring the method to clinical use.
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Affiliation(s)
- Jason Wong
- Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-263, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada
| | - Marek Reformat
- Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-263, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada
| | - Eric Parent
- Department of Physical Therapy, University of Alberta, Edmonton, AB, T6G 2G4, Canada
| | - Edmond Lou
- Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-263, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada.
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Kluszczyński M, Zaborowska-Sapeta K, Kowalski I, Karpiel IS. An Innovative Method for the Conservative Treatment of Idiopathic Scoliosis Using the GraviSpine Device According to the Concept of Spinal Reflex Balance. J Clin Med 2024; 13:4044. [PMID: 39064083 PMCID: PMC11277943 DOI: 10.3390/jcm13144044] [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: 04/17/2024] [Revised: 07/04/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Objectives: Conservative treatment of idiopathic scoliosis is more effective as a result of early diagnosis in conjunction with the use of specific physiotherapy and bracing techniques. Our aim was to investigate the effectiveness of specific physiotherapy developed according to the concept of spinal reflex balance using the GraviSpine device. This study is a retrospective analysis of prospectively collected data. Methods: A total of 199 patients aged 6-17 years, with a mean age of 11.26 ± 3.35 years, including 168 girls (84.4%) and 31 boys (15.6%), out of a total of 830 patients treated for IS at the Scoliosis Treatment Center in 2014-2019 were included in the assessment, which was conducted according to the inclusion and exclusion criteria. The study group was divided into three age groups. Group A subjects were 6-9 years old; group B, 10-12 years old; and group C, 13-17 years old. The mean follow-up time was 28.71 ± 10.98 months. Treatment outcomes were compared, based on changes in the Cobb angle and the angle of trunk rotation before and after treatment, both within the groups and with respect to sex and curvature location, using the Wilcoxon signed-rank test. Cobb angle changes in patients were classified as improvements, stabilizations, or deteriorations according to the SOSORT criteria. Results: A majority of patients improved or stabilized after treatment, with 67%, 71%, and 90% of subjects in groups A, B, and C, respectively, achieving these results. In group C (the oldest children), a statistically significant reduction of -1.84° ± 6.88° (6.31%) in the mean Cobb angle was achieved after treatment. With regard to sex, improvements and stabilizations accounted for 81% of cases in girls and 61% in boys, respectively. With respect to location, statistically significant reductions in the Cobb angle were noted for thoracic and thoracolumbar spines of -2.2° ± 7.54° (10.17%) p = 0.022 and -2.2° ± 6.58° (6.36%) p = 0.049, respectively. A significant reduction in the mean angle of trunk rotation was obtained in the group and in three curvature locations. Conclusions: Based on the presented research findings, the utilization of the GraviSpine device as an adjunct to specific PSSE (physiotherapeutic scoliosis-specific exercises) physiotherapy and bracing in the management of pediatric patients with mild to moderate scoliosis appears to enhance treatment efficacy.
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Affiliation(s)
- Marek Kluszczyński
- Department of Health Sciences, Jan Dlugosz University, 4/8 Waszyngtona, 42-200 Częstochowa, Poland
| | - Katarzyna Zaborowska-Sapeta
- Department of Rehabilitation and Orthopedics, School of Medicine, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland; (K.Z.-S.); (I.K.)
- Regional Specialized Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Ireneusz Kowalski
- Department of Rehabilitation and Orthopedics, School of Medicine, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland; (K.Z.-S.); (I.K.)
- Regional Specialized Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Ilona Sylwia Karpiel
- Łukasiewicz Research Network—Krakow Institute of Technology, The Centre for Biomedical Engineering, Zakopiańska Str. 73, 30-418 Kraków, Poland
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Meyers J, Eaker L, Samdani A, Miyanji F, Herrera M, Wilczek A, Alanay A, Yilgor C, Hoernschemeyer D, Shah S, Newton P, Lonner B. Anterior vertebral body tethering shows clinically comparable shoulder balance outcomes to posterior spinal fusion. Spine Deform 2024; 12:1033-1042. [PMID: 38517667 DOI: 10.1007/s43390-024-00847-6] [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: 09/19/2023] [Accepted: 02/14/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE Posterior spinal fusion (PSF) is the current gold standard in surgical treatment for adolescent idiopathic scoliosis. Vertebral body tethering (VBT) is a fusionless alternative. Shoulder balance is an important metric for outcomes and patient satisfaction. Here we compare shoulder balance outcomes between PSF and VBT. METHODS In this retrospective review, the pre-operative and post-operative absolute radiographic shoulder height (|RSH|) of 45 PSF patients were compared to 46 VBT patients. Mean values were compared and then collapsed into discrete groups (|RSH| GROUP) and compared. Patients were propensity score matched. Regression models based on pretest-posttest designs were used to compare procedure type on post-operative outcomes. RESULTS Pre-operatively there were no differences in |RSH| between PSF and VBT, however, at latest post-operative follow-up PSF maintained a larger |RSH| imbalance compared to VBT (0.91 cm vs 0.63 cm, p = 0.021). In an ANCOVA regression, PSF was associated with a larger |RSH| imbalance compared to VBT, F(1, 88) = 5.76, p = 0.019. An ordinal logistic regression found that the odds ratio of being in a worse |RSH| GROUP for PSF vs VBT is 2.788 (95% CI = 1.099 to 7.075), a statistically significant effect χ2(1) = 4.658, p = 0.031. Results were similar in subgroup analyses of Lenke 1 and Lenke 2 patients, though to less statistical significance. CONCLUSION While PSF was found to be associated with worse |RSH| outcomes, the actual numbers (2-3 mm) are unlikely to be clinically meaningful. Thus, in this analysis, VBT can be said to show comparable shoulder balance outcomes to PSF.
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Affiliation(s)
- James Meyers
- Department of Orthopaedics, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th St., 4th Floor, New York, NY, 10029, USA
| | - Lily Eaker
- Department of Orthopaedics, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th St., 4th Floor, New York, NY, 10029, USA
| | - Amer Samdani
- Department of Neurosurgery, Shriners Hospital-Philadelphia, Philadelphia, PA, USA
| | - Firoz Miyanji
- Department of Orthopedics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Michael Herrera
- Department of Orthopaedics, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th St., 4th Floor, New York, NY, 10029, USA
| | - Ashley Wilczek
- Department of Orthopaedics, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th St., 4th Floor, New York, NY, 10029, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Suken Shah
- Department of Orthopaedics, Nemours Children's Hospital, Wilmington, DE, USA
| | - Peter Newton
- Department of Orthopaedics, Rady Children's Hospital, San Diego, CA, USA
| | - Baron Lonner
- Department of Orthopaedics, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th St., 4th Floor, New York, NY, 10029, USA.
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12
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Hershkovich O, Gordon B, Derazne E, Tzur D, Afek A, Lotan R. Hypermobility Among Adolescents and the Association With Spinal Deformities: A Large Cross-Sectional Study. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202407000-00007. [PMID: 38996221 PMCID: PMC11239161 DOI: 10.5435/jaaosglobal-d-24-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/24/2024] [Indexed: 07/14/2024]
Abstract
INTRODUCTION Adolescent idiopathic scoliosis and Scheuermann kyphosis are common spinal deformities (SD) among adolescents. The potential link between hypermobility and SD is a topic of debate. We aimed to investigate the prevalence of hypermobility and its association with SD. METHODS A cross-sectional analysis of records of 17-year-old subjects who were recruited into mandatory military service was conducted. Study population comprised 1,220,073 subjects. Prevalence rates were calculated for hypermobility and different categories of SD by severity, studying the strength of the association between hypermobility and SD. RESULTS Of 1,220,073 subjects, 0.0111% exhibited hypermobility. Spinal deformities were identified in 10.5% of subjects. Specifically, 7.9% had mild SD, 2.4% had moderate SD, and 0.1% had severe SD. The overall association between hypermobility and SD showed an odds ratio of 2.31 (P < 0.001). Subgroup analyses revealed ORs of 1.226 (P = 0.041) for mild deformities, 5.783 (P < 0.001) for moderate deformities, and 4.01 (P = 0.002) for severe deformities. The association was stronger for moderate and severe SD. CONCLUSIONS This study establishes a notable association between hypermobility and SD among adolescents. The findings highlight the importance of understanding this relationship, which could contribute to advancements in comprehending SD development. Additional research is warranted to expand upon these findings.
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Affiliation(s)
- Oded Hershkovich
- From the Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel (Dr. Hershkovich and Dr. Lotan); the Medical Corps, Israeli Defense Forces, Israel (Dr. Gordon, Derazne, and Tzur); the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Hershkovich, Dr. Afek, and Dr. Lotan); and the Chaim Sheba Medical Center, Tel Hashomer, Israel (Dr. Afek)
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13
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Gilbertson LE, Muhly WT, Montana MC, Chidambaran V, DiCindio S, Sadacharam K, Wilder RT, Whyte SD, Hifko A, Sponseller PD, Frankville DD. A survey of practice in the anesthetic management of adolescent idiopathic scoliosis spine fusion by the North American Pediatric Spine Anesthesiologists Collaborative. Paediatr Anaesth 2024; 34:645-653. [PMID: 38578166 DOI: 10.1111/pan.14895] [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: 11/16/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Adolescent Idiopathic Scoliosis (AIS) affects 2%-4% of the general pediatric population. While surgical correction remains one of the most common orthopedic procedures performed in pediatrics, limited consensus exists on the perioperative anesthetic management. AIMS To examine the current state of anesthetic management of typical AIS spine fusions at institutions which have a dedicated pediatric orthopedic spine surgeon. METHODS A web-based survey was sent to all members of the North American Pediatric Spine Anesthesiologists (NAPSA) Collaborative. This group included 34 anesthesiologists at 19 different institutions, each of whom has a Harms Study Group surgeon performing spine fusions at their hospital. RESULTS Thirty-one of 34 (91.2%) anesthesiologists completed the survey, with a missing response rate from 0% to 16.1% depending on the question. Most anesthesia practices (77.4%; 95% confidence interval [CI], 67.7-93.4) do not have patients come for a preoperative visit prior to the day of surgery. Intravenous induction was the preferred method (74.2%; 95% CI 61.3-89.9), with the majority utilizing two peripheral IVs (93.5%; 95% CI 90.3-100) and an arterial line (100%; 95% CI 88.8-100). Paralytic administration for intubation and/or exposure was divided (51.6% rocuronium/vecuronium, 45.2% no paralytic, and 3.2% succinylcholine) amongst respondents. While tranexamic acid was consistently utilized for reducing blood loss, dosing regimens varied. When faced with neuromonitoring signal issues, 67.7% employ a formal protocol. Most anesthesiologists (93.5%; 95% CI 78.6-99.2) extubate immediately postoperatively with patients admitted to an inpatient floor bed (77.4%; 95% CI 67.7-93.3). CONCLUSION Most anesthesiologists (87.1%; 95% CI 80.6-99.9) report the use of some form of an anesthesia-based protocol for AIS fusions, but our survey results show there is considerable variation in all aspects of perioperative care. Areas of agreement on management comprise the typical vascular access required, utilization of tranexamic acid, immediate extubation, and disposition to a floor bed. By recognizing the diversity of anesthetic care, we can develop areas of research and improve the perioperative management of AIS.
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Affiliation(s)
- Laura E Gilbertson
- Department of Anesthesiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wallis T Muhly
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael C Montana
- Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Vidya Chidambaran
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sabina DiCindio
- Department of Anesthesiology, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Kesavan Sadacharam
- Department of Anesthesiology, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Robert T Wilder
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Simon D Whyte
- Department of Anesthesiology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Alan Hifko
- Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Paul D Sponseller
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - David D Frankville
- Anesthesia Services Medical Group, Rady Children's Hospital of San Diego, San Diego, California, USA
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14
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Hengartner AC, Elsamadicy AA, Jonnalagadda A, Craft S, Sherman JJZ, Reeves BC, Fernandez T, Hobbs J, Koo AB, DiLuna M, Tuason DA. Impact of a quality improvement initiative and monthly multidisciplinary meetings on outcomes after posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 2024; 12:1043-1051. [PMID: 38493442 DOI: 10.1007/s43390-024-00859-2] [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: 08/21/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Several studies have demonstrated the benefits of enhanced recovery after surgery (ERAS) protocols for patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal instrumented fusion (PSIF). However, there are relatively few studies investigating the effect of regular multidisciplinary team meetings on level selection, surgical performance parameters, and patient outcomes after PSIF for AIS. The aim of this study was to assess changes in intra- and postoperative outcomes following multidisciplinary team meeting implementation for patients undergoing PSIF for AIS. METHODS The medical records of 96 adolescents (10 to 18 years old) diagnosed with AIS and undergoing PSIF at a major academic institution from 2017 to 2022 were retrospectively reviewed. A quality improvement (QI) initiative was implemented in February 2020, including institution of monthly multidisciplinary conferences focusing on preoperative indications, level selection, postoperative review of surgical performance parameters for previous cases, and discussion and optimization of postoperative ambulation and pain control protocols. Patients were placed into "Pre-QI" (treated pre-February 2020) and "Post-QI" (treated post-February 2020) cohorts. Patient demographics, comorbidities, deformity characteristics, intraoperative variables, ambulation status, postoperative complications, length of stay (LOS), and unplanned readmission rates were assessed. RESULTS Of the 96 study patients, 44 (45.8%) were in the Pre-QI cohort, and 52 (54.2%) were in the Post-QI cohort. Mean major curve was not significantly different between the two cohorts (Pre-QI: 58.0 ± 7.3° vs Post-QI: 57.9 ± 14.5°, p = 0.169). The Pre-QI cohort had a greater mean minor curve degree (Pre-QI: 42.7 ± 11.8° vs Post-QI: 36.8 ± 12.4, p = 0.008). The Pre-QI cohort had significantly greater mean spinal levels fused (Pre-QI: 11.7 ± 1.7 vs Post-QI: 10.4 ± 2.6, p = 0.009), significantly greater mean estimated blood loss (Pre-QI: 1063.6 ± 631.5 ml vs. Post-QI: 415.8 ± 189.9 ml, p < 0.001), significantly greater mean operative time normalized to levels fused (Pre-QI: 0.6 ± 0.1 h/level fused vs Post-QI: 0.4 ± 0.1 h/level fused, p < 0.001), and a significantly greater proportion of patients with intraoperative drain placement (Pre-QI: 93.2% vs Post-QI: 5.8%, p < 0.001). The Post-QI cohort had significantly shorter time to postoperative ambulation (Pre-QI: 2.1 ± 0.9 days vs Post-QI: 1.3 ± 0.5 days, p < 0.001). A significantly greater proportion of patients in the Pre-QI cohort developed any postoperative complication (Pre-QI: 72.7% vs Post-QI: 34.6%, p < 0.001), and mean LOS was significantly greater among Pre-QI patients (Pre-QI: 4.5 ± 1.1 days vs Post-QI: 3.2 ± 0.8 days, p < 0.001). Discharge disposition (p = 0.758) and 30-day unplanned readmissions (p = 0.207) were similar between the cohorts. CONCLUSIONS Our findings suggest that monthly multidisciplinary pediatric spine team meetings may improve patient care. Further studies exploring the incorporation of QI implementation with frequent multidisciplinary team meetings into existing ERAS protocols are merited.
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Affiliation(s)
- Astrid C Hengartner
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Anshu Jonnalagadda
- Department of Orthopedics, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Josiah J Z Sherman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Tiana Fernandez
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Joshua Hobbs
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Michael DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Dominick A Tuason
- Department of Orthopedics, Yale University School of Medicine, New Haven, CT, 06520, USA.
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Grabala P, Kowalski P, Grabala M. From Rib Hump to Baby Hump-Common Questions of Patients Suffering from and Undergoing Treatment for Scoliosis-A Comprehensive Literature Review. J Clin Med 2024; 13:3814. [PMID: 38999380 PMCID: PMC11242321 DOI: 10.3390/jcm13133814] [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: 05/04/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Scoliosis, the most prevalent spinal deformity in children, is often associated with adolescent idiopathic scoliosis (AIS). Curves surpassing 50 degrees can deteriorate, especially thoracic curves, leading to pulmonary limitations. Surgical intervention is usually advised for curvatures exceeding 50 degrees to halt further progression. Severe AIS is notably more frequent in females, yet knowledge regarding subsequent pregnancies and associated risks is scarce. Female patients often inquire about conception, pregnancy, labor, and future back pain (BP) concerns. Reports on the long-term outcomes after pediatric AIS treatment and pregnancy consequences remain limited. Uncertainty looms over the likelihood of increased back pain (BP), cesarean sections (CSs), or other pregnancy-related issues following surgical AIS management. In this investigation, an attempt was made to scrutinize the existing research on individuals afflicted with scoliosis who received either conservative or surgical treatment, with the aim of delineating crucial and pragmatic findings that can serve as a compass for spine surgeons when counseling young patients with adolescent idiopathic scoliosis regarding the ailment, its repercussions, the available treatment modalities, and the associated outcomes. A comprehensive analysis pinpointed the optimal data at hand. Consequently, the primary objective of this investigation was to assess the patient-reported and clinical consequences in scoliosis patients who have undergone segmental posterior fusion and subsequently conceived. Conclusions: While the majority of individuals with AIS are capable of conceiving and bearing children, they may encounter greater challenges in fertility than healthy women unaffected by AIS. Pregnant women with a prior history of spinal fusion for AIS can undergo pregnancy and childbirth with no significant escalation in perinatal complications. Women who have undergone surgical procedures for AIS have been observed to exhibit a prevalence of back pain comparable with that of healthy pregnant women; however, a higher incidence of low back pain is evident when spinal fusion is extended to the L3 or L4 vertebra. Although back pain is a common occurrence in pregnant women with AIS, the spinal alterations induced by pregnancy are typically minor and transient. In comparison with healthy women, individuals with a history of spinal fusion necessitate cesarean sections more frequently. The degree of correction loss during pregnancy is lower in previous reports involving pedicle screw instrumentation than in previous reports involving Harrington or hybrid segmental instrumentation.
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Affiliation(s)
- Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, University Children’s Hospital, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland
| | - Piotr Kowalski
- Department of Neurosurgery, Regional Specialized Hospital, ul. Dekerta 1, 66-400 Gorzow Wielkopolski, Poland;
| | - Michal Grabala
- 2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok, ul. M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland;
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Chen W, Khodaei M, Reformat M, Lou E. Validity of a fast automated 3d spine reconstruction measurements for biplanar radiographs: SOSORT 2024 award winner. 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 2024:10.1007/s00586-024-08375-7. [PMID: 38926172 DOI: 10.1007/s00586-024-08375-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To validate a fast 3D biplanar spinal radiograph reconstruction method with automatic extract curvature parameters using artificial intelligence (AI). METHODS Three-hundred eighty paired, posteroanterior and lateral, radiographs from the EOS X-ray system of children with adolescent idiopathic scoliosis were randomly selected from the database. For the AI model development, 304 paired images were used for training; 76 pairs were employed for testing. The validation was evaluated by comparing curvature parameters, including Cobb angles (CA), apical axial vertebral rotation (AVR), kyphotic angle (T1-T12 KA), and lordotic angle (L1-L5 LA), to manual measurements from a rater with 8 years of scoliosis experience. The mean absolute differences ± standard deviation (MAD ± SD), the percentage of measurements within the clinically acceptable errors, the standard error of measurement (SEM), and the inter-method intraclass correlation coefficient ICC[2,1] were calculated. The average reconstruction speed of the 76 test images was recorded. RESULTS Among the 76 test images, 134 and 128 CA were exported automatically and measured manually, respectively. The MAD ± SD for CA, AVR at apex, KA, and LA were 3.3° ± 3.5°, 1.5° ± 1.5°, 3.3° ± 2.6° and 3.5° ± 2.5°, respectively, and 98% of these measurements were within the clinical acceptance errors. The SEMs and the ICC[2,1] for the compared parameters were all less than 0.7° and > 0.94, respectively. The average time to display the 3D spine and report the measurements was 5.2 ± 1.3 s. CONCLUSION The developed AI algorithm could reconstruct a 3D scoliotic spine within 6 s, and the automatic curvature parameters were accurately and reliably extracted from the reconstructed images.
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Affiliation(s)
- Weiying Chen
- Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-263, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada
| | - Mahdieh Khodaei
- Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-263, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada
| | - Marek Reformat
- Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-263, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada
| | - Edmond Lou
- Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-263, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada.
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17
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Baetsen JTF, Hooff ML, Bisseling P, Van Dongen JM, Van de Fliert DG, Hoebink E, Kempen DHR, Rutges JPHJ, Schlösser TPC, Van West HM, Van der Wees PJ, Willems PC, De Kleuver M. The effectiveness of a protocol without routine radiographs for follow-up of adolescent idiopathic scoliosis patients (CURVE): a study protocol. Acta Orthop 2024; 95:298-306. [PMID: 38888063 PMCID: PMC11181918 DOI: 10.2340/17453674.2024.40904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/03/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND AND PURPOSE Current follow-up protocols for adolescent idiopathic scoliosis (AIS) are based on consensus and consist of regular full-spine radiographs to monitor curve progression and surgical complications. Consensus exists to avoid inappropriate use of radiographs in children. It is unknown whether a standard radiologic follow-up (S-FU) approach is necessary or if a patient-empowered follow-up (PE-FU) approach can reduce the number of radiographs without treatment consequences. METHODS AND ANALYSES A nationwide multicenter pragmatic randomized preference trial was designed for 3 follow-up subgroups (pre-treatment, post-brace, post-surgery) to compare PE-FU and S-FU. 812 patients with AIS (age 10-18 years) will be included in the randomized trial or preference cohorts. Primary outcome is the proportion of radiographs with a treatment consequence for each subgroup. Secondary outcomes consist of the proportion of patients with delayed initiation of treatment due to non-routine radiographic follow-up, radiation exposure, societal costs, positive predictive value, and interrelation of clinical assessment, quality of life, and parameters for initiation of treatment during follow-up. Outcomes will be analyzed using linear mixed-effects models, adjusted for relevant baseline covariates, and are based on intention-to-treat principle. Study summary: (i) a national, multicenter pragmatic randomized trial addressing the optimal frequency of radiographic follow-up in patients with AIS; (ii) first study that includes patient-empowered follow-up; (iii) an inclusive study with 3 follow-up subgroups and few exclusion criteria representative for clinical reality; (iv) preference cohorts alongside to amplify generalizability; (v) first study conducting an economic evaluation comparing both follow-up approaches.
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Affiliation(s)
- Jurre T F Baetsen
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen.
| | - Miranda L Hooff
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen; Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen
| | - Pepijn Bisseling
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen
| | - Johanna M Van Dongen
- Vrije Universiteit Amsterdam, Department of Health Sciences, Faculty of Science, Amsterdam Movement Science Research Institute, Amsterdam; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam
| | | | | | | | | | - Tom P C Schlösser
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht
| | | | - Philip J Van der Wees
- IQ Healthcare and Department of Rehabilitation, Radboud University Medical Center, Nijmegen
| | - Paul C Willems
- Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marinus De Kleuver
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen; Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen
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Chui CS(E, He Z, Lam TP, Mak KK(K, Ng HT(R, Fung CH(E, Chan MS, Law SW, Lee YW(W, Hung LH(A, Chu CW(W, Mak SY(S, Yau WF(E, Liu Z, Li WJ, Zhu Z, Wong MY(R, Cheng CY(J, Qiu Y, Yung SH(P. Deep Learning-Based Prediction Model for the Cobb Angle in Adolescent Idiopathic Scoliosis Patients. Diagnostics (Basel) 2024; 14:1263. [PMID: 38928678 PMCID: PMC11203267 DOI: 10.3390/diagnostics14121263] [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: 04/18/2024] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Scoliosis, characterized by spine deformity, is most common in adolescent idiopathic scoliosis (AIS). Manual Cobb angle measurement limitations underscore the need for automated tools. This study employed a vertebral landmark extraction method and Feedforward Neural Network (FNN) to predict scoliosis progression in 79 AIS patients. The novel intervertebral angles matrix format showcased results. The mean absolute error for the intervertebral angle progression was 1.5 degrees, while the Pearson correlation of the predicted Cobb angles was 0.86. The accuracy in classifying Cobb angles (<15°, 15-25°, 25-35°, 35-45°, >45°) was 0.85, with 0.65 sensitivity and 0.91 specificity. The FNN demonstrated superior accuracy, sensitivity, and specificity, aiding in tailored treatments for potential scoliosis progression. Addressing FNNs' over-fitting issue through strategies like "dropout" or regularization could further enhance their performance. This study presents a promising step towards automated scoliosis diagnosis and prognosis.
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Affiliation(s)
- Chun-Sing (Elvis) Chui
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Zhong He
- Division of Spine Surgery, Department of Orthopedic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China; (Z.H.); (Z.L.); (Z.Z.)
| | - Tsz-Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Ka-Kwan (Kyle) Mak
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Hin-Ting (Randy) Ng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Chun-Hai (Ericsson) Fung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Mei-Shuen Chan
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Sheung-Wai Law
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Yuk-Wai (Wayne) Lee
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Lik-Hang (Alec) Hung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong, China;
| | - Chiu-Wing (Winnie) Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China;
| | - Sze-Yi (Sibyl) Mak
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China;
| | | | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China; (Z.H.); (Z.L.); (Z.Z.)
| | - Wu-Jun Li
- National Institute of Healthcare Data Science, Nanjing University, Nanjing 210023, China;
- National Key Laboratory for Novel Software Technology, Department of Computer Science and Technology, Nanjing University, Nanjing 210023, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China; (Z.H.); (Z.L.); (Z.Z.)
| | - Man Yeung (Ronald) Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Chun-Yiu (Jack) Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China; (Z.H.); (Z.L.); (Z.Z.)
| | - Shu-Hang (Patrick) Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
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Wang L, Xia Q, Ni W, Zhuang D, Tong X, Jiang L, Mao Y. Predicting delayed extubation and transfer to the intensive care unit in children undergoing posterior fusion surgery for scoliosis : A retrospective observational study. DIE ANAESTHESIOLOGIE 2024; 73:398-407. [PMID: 38575771 DOI: 10.1007/s00101-024-01391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/22/2023] [Accepted: 01/02/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Delayed extubation and transfer to the intensive care unit (ICU) in children undergoing major scoliosis surgery may increase postoperative complications, prolong hospital stay, and increase medical expenses; however, whether a child will require delayed extubation or transfer to the ICU after scoliosis orthopedic surgery is not fully understood. In this study, we reviewed the risk factors for delayed extubation and transfer to the ICU after scoliosis orthopedic surgery in children. METHOD The electronic medical records of pediatric patients (≤ 18 years) who underwent posterior spinal fusion surgery between January 2018 and November 2021 were reviewed and analyzed. Patient characteristics (age, sex, body mass index, American Society of Anesthesiologists, ASA, grade, preoperative lung function, and congenital heart disease), preoperative Cobb angle, scoliosis type, correction rate, vertebral fusion segments, pedicle screws, surgical osteotomy, intraoperative bleeding, intraoperative allogeneic transfusion, intraoperative hemoglobin changes, intraoperative mean arterial pressure changes, intraoperative tidal volume (ml/kg predicted body weight), surgical time, postoperative extubation, and transfer to the ICU were collected. The primary outcomes were delayed extubation and transfer to the ICU. Multivariate logistic regression models were used to determine the risk factors for delayed extubation and ICU transfer. RESULTS A total of 246 children who satisfied the inclusion criteria were enrolled in this study, of whom 23 (9.3%) had delayed extubation and 81 (32.9%) were transferred to the ICU after surgery. High ASA grade (odds ratio [OR] 5.42; 95% confidence interval [CI] 1.49-19.78; p = 0.010), high Cobb angle (OR 1.04; 95% CI 1.02-1.07; p < 0.001), moderate to severe pulmonary dysfunction (OR 10.9; 95% CI 2.00-59.08; p = 0.006) and prolonged surgical time (OR 1.01; 95% CI 1.00-1.03; p = 0.040) were risk factors for delayed extubation. A high Cobb angle (OR 1.02; 95% CI 1.01-1.04; p = 0.004), high intraoperative bleeding volume (OR 1.06; 95% CI 1.03-1.10; p = 0.001), allogeneic transfusion (OR 3.30; 95% CI 1.24-8.83; p = 0.017) and neuromuscular scoliosis (OR 5.38; 95% CI 1.59-18.25; p = 0.007) were risk factors for transfer to the ICU. A high Cobb angle was a risk factor for both delayed extubation and ICU transfer. Age, sex, body mass index, number of vertebral fusion segments, correction rate, and intraoperative tidal volume were not associated with delayed postoperative extubation and ICU transfer. CONCLUSION The most common risk factor for delayed extubation and ICU transfer in pediatric patients who underwent posterior spinal fusion was a high Cobb angle. Determining risk factors for a poor prognosis may help optimize perioperative respiratory management strategies and planning of postoperative care for children undergoing complicated spinal surgery.
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Affiliation(s)
- Lai Wang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Qin Xia
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Wenwen Ni
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, 200031, Shanghai, China
| | - Di Zhuang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Xianya Tong
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Lai Jiang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China.
| | - Yanfei Mao
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China.
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Zhang B, Chen K, Yuan H, Liao Z, Zhou T, Guo W, Zhao S, Wang R, Su P. Automatic Lenke classification of adolescent idiopathic scoliosis with deep learning. JOR Spine 2024; 7:e1327. [PMID: 38690524 PMCID: PMC11058480 DOI: 10.1002/jsp2.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/26/2024] [Accepted: 03/10/2024] [Indexed: 05/02/2024] Open
Abstract
Purpose The Lenke classification system is widely utilized as the preoperative evaluation protocol for adolescent idiopathic scoliosis (AIS). However, manual measurement is susceptible to observer-induced variability, which consequently impacts the evaluation of progression. The goal of this investigation was to develop an automated Lenke classification system utilizing innovative deep learning algorithms. Methods Using the database from the First Affiliated Hospital of Sun Yat-sen University, the whole spinal x-rays images were retrospectively collected. Specifically, images collection was divided into AIS and control group. The control group consisted of individuals who underwent routine health checks and did not have scoliosis. Afterwards, relative features of all images were annotated. Deep learning was implemented through the utilization of the key-point based detection method to realize the vertebral detection, and Cobb angle measurement and scoliosis classification were performed based on relevant standards. Besides, the segmentation method was employed to achieve the recognition of lumbar vertebral pedicle to determine the type of lumbar spine modifier. Finally, the model performance was further quantitatively analyzed. Results In the study, a total of 2082 spinal x-ray images were collected from 407 AIS patients and 227 individuals in the control group. The model for vertebral detection achieved an F1-score of 0.809 for curve type evaluation and an F1-score of 0.901 for thoracic sagittal profile. The intraclass correlation efficient (ICC) of the Cobb angle measurement was 0.925. In the analysis of performance for vertebra pedicle segmentation model, the F1-score of lumbar modification profile was 0.942, the intersection over union (IOU) of the target pixels was 0.827, and the Hausdorff distance (HD) was 6.565 ± 2.583 mm. Specifically, the F1-score for ultimate Lenke type classifier was 0.885. Conclusions This study has constructed an automated Lenke classification system by employing the deep learning networks to achieve the recognition pattern and feature extraction. Our models require further validation in additional cases in the future.
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Affiliation(s)
- Baolin Zhang
- Department of Orthopaedic SurgeryFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Kanghao Chen
- School of Computer Science and EngineeringSun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Haodong Yuan
- Department of Orthopaedic SurgeryFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Graduate School of Biomedical EngineeringUNSW SydneySydneyNew South WalesAustralia
| | - Zhiheng Liao
- Department of Orthopaedic SurgeryFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Taifeng Zhou
- Department of Orthopaedic SurgeryFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Weiming Guo
- Department of Orthopaedic SurgeryFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Shen Zhao
- School of Intelligent Systems EngineeringSun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Ruixuan Wang
- School of Computer Science and EngineeringSun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Peiqiang Su
- Department of Orthopaedic SurgeryFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyFirst Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
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21
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Peng C, Li D, Guo T, Li S, Chen Y, Zhao L, Mi J. Efficacy of Different Exercises on Mild to Moderate Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2024; 103:494-501. [PMID: 38113028 DOI: 10.1097/phm.0000000000002389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE The aims of this study are to evaluate the effectiveness of different exercise interventions on patients with adolescent idiopathic scoliosis and to provide evidence-based exercise prescriptions for this population. METHODS The PubMed, Embase, Cochrane Library, Web of Science, CNKI, Chinese Biomedical Literature Database (CBM), VIP, and Wanfang Data Knowledge Service Platform were searched until January 2023. The data were pooled and a meta-analysis was conducted. RESULTS A total of 19 studies were conducted with 778 participants. The Schroth exercises group (mean difference = -3.48, 95% confidence interval = -4.73 to -2.23, P < 0.00001) and strength training group (mean difference = -3.43, 95% confidence interval = -4.06 to -2.80, P < 0.00001) had better recovery of the Cobb angle than the other groups. The Cobb angle rehabilitation effect was good in the time of less than 60-min group. In addition, there was no significant difference found between the different intervention periods groups ( P > 0.05). CONCLUSIONS Schroth exercise and strength training significantly improved Cobb angle of adolescent idiopathic scoliosis patients; exercising for less than 60 mins is effective for Cobb angle rehabilitation, but prolonging exercise time cannot improve training effectiveness; 12 wks of exercise significantly improved Cobb angle, but prolonged training periods did not have a significant impact.
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Affiliation(s)
- Cheng Peng
- From the China Athletics College, Beijing Sport University, Beijing, China (CP); Physical Education College, Beijing Normal University, Beijing, China (DL); School of Competitive Sports, Beijing Sport University, Beijing, China (TG, SL, YC, JM); and Sport Science School, Beijing Sport University, Beijing, China (LZ)
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22
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Zheng S, Xu N, Jiang Y, Wu Y. A comprehensive therapeutic approach of traditional Chinese medicine for mild adolescent idiopathic scoliosis. Asian J Surg 2024; 47:2675-2676. [PMID: 38575498 DOI: 10.1016/j.asjsur.2024.03.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Affiliation(s)
- Shihui Zheng
- College of Acupuncture and Massage, Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu Province, China
| | - Na Xu
- College of Acupuncture and Massage, Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu Province, China
| | - Yongwei Jiang
- College of Acupuncture and Massage, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu Province, China.
| | - Yunchuan Wu
- College of Acupuncture and Massage, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu Province, China.
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Chen J, Xu T, Zhou J, Han B, Wu Q, Jin W, Zhang X. The Superiority of Schroth Exercise Combined Brace Treatment for Mild-to-Moderate Adolescent Idiopathic Scoliosis: A Systematic Review and Network Meta-Analysis. World Neurosurg 2024; 186:184-196.e9. [PMID: 38531472 DOI: 10.1016/j.wneu.2024.03.103] [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: 03/14/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The current study aimed to assess and rank the comparative efficacy of different nonoperative treatments on Cobb angle, angle of trunk rotation, and quality of life for mild-to-moderate adolescent idiopathic scoliosis. METHODS A comprehensive search of databases, including Medline, The Cochrane Library, PubMed, EMBASE, and Web of Science spanning all previous years up to January 1, 2024. The included studies were evaluated for literature quality according to Cochrane Handbook criteria, and a network meta-analysis was performed using STATA 14.0 statistical software. RESULTS Twenty randomized controlled trials met all inclusion criteria and were analyzed. Schroth exercise and scoliosis-specific exercise combined with brace treatments had a significant positive effect on Cobb angle and quality of life. For angle of trunk rotation, Schroth exercise and Schroth exercise combined with brace treatments prove more effective compared to the control group. On surface-under-the-cumulative-ranking-curve analysis, Schroth exercise combined with brace treatment had the highest likelihood for reducing Cobb angle (P-score = 0.899), angle of trunk rotation (0.82), and improving quality of life (0.828). CONCLUSIONS Although most conservative treatments had benefits for mild-to-moderate adolescent idiopathic scoliosis, the most optimal programs were those that included (1) at least 10 weeks of approximately 60-minute Schroth exercise sessions twice a week and (2) wearing the brace for 23 hours every day throughout the treatment period.
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Affiliation(s)
- Jiping Chen
- School of Physical Education, Shandong University, Jinan, China
| | - Tianwen Xu
- School of Physical Education, Shandong University, Jinan, China
| | - Jianfan Zhou
- School of Physical Education, Shandong University, Jinan, China
| | - Bing Han
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Qingxu Wu
- School of Physical Education, Shandong University, Jinan, China
| | - Wei Jin
- School of Physical Education, Shandong University, Jinan, China
| | - Xianliang Zhang
- School of Physical Education, Shandong University, Jinan, China.
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Neri S, Assirelli E, Manzetti M, Viroli G, Ialuna M, Traversari M, Ciaffi J, Ursini F, Faldini C, Ruffilli A. Identification of Epigenetic Biomarkers of Adolescent Idiopathic Scoliosis Progression: A Workflow to Assess Local Gene Expression. Int J Mol Sci 2024; 25:5329. [PMID: 38791368 PMCID: PMC11120692 DOI: 10.3390/ijms25105329] [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: 03/21/2024] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional structural deformity of the spine that affects 2-3% of adolescents under the age of 16. AIS etiopathogenesis is not completely understood; however, the disease phenotype is correlated to multiple genetic loci and results from genetic-environmental interactions. One of the primary, still unresolved issues is the implementation of reliable diagnostic and prognostic markers. For clinical management improvement, predictors of curve progression are particularly needed. Recently, an epigenetic contribution to AIS development and progression was proposed; nevertheless, validation of data obtained in peripheral tissues and identification of the specific mechanisms and genes under epigenetic control remain limited. In this study, we propose a methodological approach for the identification of epigenetic markers of AIS progression through an original workflow based on the preliminary characterization of local expression of candidate genes in tissues directly involved in the pathology. The feasibility of the proposed methodological protocol has been originally tested here in terms of identification of the putative epigenetic markers of AIS progression, collection of the different tissues, retrieval of an appropriate amount and quality of RNA and DNA, and identification of suitable reference genes.
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Affiliation(s)
- Simona Neri
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (J.C.); (F.U.)
| | - Elisa Assirelli
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (J.C.); (F.U.)
| | - Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.M.); (G.V.); (M.I.); (M.T.); (C.F.); (A.R.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Giovanni Viroli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.M.); (G.V.); (M.I.); (M.T.); (C.F.); (A.R.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Marco Ialuna
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.M.); (G.V.); (M.I.); (M.T.); (C.F.); (A.R.)
| | - Matteo Traversari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.M.); (G.V.); (M.I.); (M.T.); (C.F.); (A.R.)
| | - Jacopo Ciaffi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (J.C.); (F.U.)
| | - Francesco Ursini
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (J.C.); (F.U.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.M.); (G.V.); (M.I.); (M.T.); (C.F.); (A.R.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.M.); (G.V.); (M.I.); (M.T.); (C.F.); (A.R.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
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25
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Cai J, Zhou Y, Chen X, Huang X, Li L, Zhu Y, Cai Q, Huang J, Sun Z. Is refractive error a factor affecting scoliosis? PLoS One 2024; 19:e0303324. [PMID: 38739623 PMCID: PMC11090344 DOI: 10.1371/journal.pone.0303324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Scoliosis is one of the most common surgical disorders of the pediatric spine. Refractive errors are commonly associated with vision impairment worldwide. However, it is currently unclear whether refractive error correlates directly with the development of scoliosis. METHODS A cross-sectional study was performed in 2023, and a stratified cluster sampling technique was employed among school-aged students in Nantong City, China. Univariate and multivariate logistic regression analyses were used to investigate specific correlations between scoliosis and related parameters; various types of refractive errors were also included in the study. RESULTS The prevalence of scoliosis among school-aged students was 2.2% in Nantong city. Multiple logistic regression analyses showed that myopia, hyperopia, astigmatism, and anisometropia were not correlated with the development of scoliosis (all, p≥0.05). Lower body mass index (BMI) [adjusted odds ratio (aOR) = 0.92; 95% confidence interval (CI): 0.88-0.95; p<0.001], living in rural areas (aOR = 1.40; 95% CI: 1.05-1.86; p = 0.020), and older age (aOR = 1.32; 95% CI: 1.25-1.38; p<0.001) had significantly higher risks of scoliosis. CONCLUSIONS Refractive errors did not correlate with the development of scoliosis. However, BMI, living in rural areas and older age did correlate with the development of scoliosis.
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Affiliation(s)
- Jianru Cai
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Yue Zhou
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Xiaojuan Chen
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Xiaobo Huang
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Lele Li
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Yan Zhu
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Qi Cai
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Jianping Huang
- Nantong Center for Disease Control and Prevention in Jiangsu Province, Jiangsu Province, China
| | - ZhiMin Sun
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
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Rubega M, Passarotto E, Paramento M, Formaggio E, Masiero S. EEG Microstate as a Marker of Adolescent Idiopathic Scoliosis. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2024; 5:339-344. [PMID: 38899012 PMCID: PMC11186641 DOI: 10.1109/ojemb.2024.3399469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/22/2024] [Accepted: 05/07/2024] [Indexed: 06/21/2024] Open
Abstract
The pathophysiology of Adolescent Idiopathic Scoliosis (AIS) is not yet fully understood, but multifactorial hypotheses have been proposed that include defective central nervous system (CNS) control of posture, biomechanics, and body schema alterations. To deepen CNS control of posture in AIS, electroencephalographic (EEG) activity during a simple balance task in adolescents with and without AIS was parsed into EEG microstates. Microstates are quasi-stable spatial distributions of the electric potential of the brain that last tens of milliseconds. The spatial distribution of the EEG characterised by the orientation from left-frontal to right-posterior remains stable for a greater amount of time in AIS compared to controls. This spatial distribution of EEG, commonly named in the literature as class B, has been found to be correlated with the visual resting state network. Both vision and proprioception networks provide critical information in mapping the extrapersonal environment. This neurophysiological marker probably unveils an alteration in the postural control mechanism in AIS, suggesting a higher information processing load due to the increased postural demands caused by scoliosis.
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Affiliation(s)
- M. Rubega
- Department of NeuroscienceUniversity of Padova, Section of Rehabilitation35128PadovaItaly
| | - E. Passarotto
- Department of NeuroscienceUniversity of Padova, Section of Rehabilitation35128PadovaItaly
| | - M. Paramento
- Department of NeuroscienceUniversity of Padova, Section of Rehabilitation35128PadovaItaly
- Department of Information EngineeringUniversity of Padova35131PadovaItaly
| | - E. Formaggio
- Department of NeuroscienceUniversity of Padova, Section of Rehabilitation35128PadovaItaly
| | - S. Masiero
- Department of NeuroscienceUniversity of Padova, Section of Rehabilitation35128PadovaItaly
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You MJ, Lu ZY, Xu QY, Chen PB, Li B, Jiang SD, Jiang LS, Xia J, Zheng XF. Effectiveness of Physiotherapeutic Scoliosis-Specific Exercises on 3-Dimensional Spinal Deformities in Patients With Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00953-5. [PMID: 38719166 DOI: 10.1016/j.apmr.2024.04.011] [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: 09/24/2023] [Revised: 01/18/2024] [Accepted: 04/26/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE To investigate the effects of physiotherapeutic scoliosis-specific exercises (PSSE) on coronal, horizontal, and sagittal deformities of the spine in adolescent idiopathic scoliosis (AIS) as well as how curve severity, intervention duration, and intervention type could modify these effects. DATA SOURCES Data sources included PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases, which were searched from their inception to September 5, 2023. STUDY SELECTION Clinical controlled trials reporting the effects of PSSE on the Cobb angle, angle of trunk rotation (ATR), thoracic kyphosis (TK), or lumbar lordosis in patients with AIS aged 10-18 years. The experimental groups received PSSE; the control groups received standard care (observation or bracing) or conventional exercise such as core stabilization exercise, Pilates, proprioceptive neuromuscular facilitation, and other nonspecific exercises. DATA EXTRACTION Two researchers independently extracted key information from eligible studies. The quality of the studies was assessed using the Cochrane Handbook version 5.1.0 risk of bias assessment and the JBI Center for Evidence-Based Health Care (2016) of quasi-experimental research authenticity assessment tool. The level and certainty of evidence were rated according to the Grading of Recommendations, Assessment, Development, and Evaluation framework. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The protocol for this study was registered in PROSPERO (CRD42023404996). DATA SYNTHESIS Twelve randomized controlled trials (RCTs) and 5 non-RCTs were meta-analyzed separately. The results indicated that compared with other nonsurgical management, PSSE significantly improved the Cobb angle, ATR, and TK, whereas the lumbar lordosis improvement was not statistically significant. Additionally, the efficacy of PSSE on Cobb angle was not significant in patients with curve severity ≥30° compared with controls. Nevertheless, the pooled effect of PSSE on Cobb angle was not significantly modified by intervention duration and intervention type and that on ATR was not significantly modified by intervention duration. The overall quality of evidence according to Grading of Recommendations, Assessment, Development, and Evaluation was moderate to low for RCT and very low for non-RCT. CONCLUSIONS PSSE exhibited positive benefits on the Cobb angle, ATR, and TK in patients with AIS compared with other nonsurgical therapies. In addition, the effectiveness of PSSE may be independent of intervention duration and intervention type but may be influenced by the initial Cobb angle. However, more RCTs are needed in the future to validate the efficacy of PSSE in moderate AIS with a mean Cobb angle ≥30°. Current evidence is limited by inconsistent control group interventions and small sample size of the studies.
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Affiliation(s)
- Meng-Jia You
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Department of Medical Technology (Direction of Rehabilitation Therapy), School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Ze-Yu Lu
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Qing-Yin Xu
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Peng-Bo Chen
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Bo Li
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Sheng-Dan Jiang
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Department of Medical Technology (Direction of Rehabilitation Therapy), School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Lei-Sheng Jiang
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Department of Medical Technology (Direction of Rehabilitation Therapy), School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Jun Xia
- Department of Medical Technology (Direction of Rehabilitation Therapy), School of Exercise and Health, Shanghai University of Sport, Shanghai, China.
| | - Xin-Feng Zheng
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Department of Medical Technology (Direction of Rehabilitation Therapy), School of Exercise and Health, Shanghai University of Sport, Shanghai, China.
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Coraci D, Maccarone MC, Simioni G, Ragazzo L, Masiero S. Letter to the editor regarding "Associations between paraspinal muscle characteristics and spinal curvature in conservatively treated adolescent idiopathic scoliosis: a systematic review" by Chan et al. Spine J 2024; 24:919-921. [PMID: 38670787 DOI: 10.1016/j.spinee.2024.02.009] [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: 12/06/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, Padua, 35128 Italy
| | - Maria Chiara Maccarone
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, Padua, 35128 Italy.
| | - Giorgio Simioni
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, Padua, 35128 Italy
| | - Lisa Ragazzo
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, Padua, 35128 Italy
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, Padua, 35128 Italy
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Falade I, Park KM, Conkling N, Kim EA, Hansen SL, Hoffman W, Piper ML. Paraspinous Muscle Flaps in Complex Pediatric Spine Surgeries: A 12-Year Single Institution Experience. Ann Plast Surg 2024; 92:564-568. [PMID: 38563574 DOI: 10.1097/sap.0000000000003888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE The benefits of paraspinous flaps in adult complex spine surgery patients are established in the literature; however, their use in pediatric patients has not been well described. This study compares clinical outcomes with and without paraspinous muscle flap closure in pediatric patients who have undergone spine surgery. METHODS We conducted a retrospective review of all pediatric spine surgeries at the University of California, San Francisco from 2011 to 2022. Patients were divided into 2 cohorts based on whether the plastic surgery service closed or did not close the wound with paraspinous muscle flaps. We matched patients by age, American Society of Anesthesiology classification, prior spinal surgical history, and diagnosis. Surgical outcomes were compared between the 2 cohorts. RESULTS We identified 226 pediatric patients who underwent at least one spinal surgery, 14 of whom received paraspinous flap closure by plastic surgery. They were matched in a 1:4 ratio with controls (n = 56) that did not have plastic surgery closure. The most common indication for plastic surgery involvement was perceived complexity of disease by the spine surgeon with concern for inadequate healthy tissue coverage (78.6%), followed by infection (21.4%). Postoperative complications were similar between the two groups. The plastic surgery cohort had a higher rate of patients who were underweight (57.1% vs 14.3%, P < 0.01) and had positive preoperative wound cultures (28.6% vs 8.9%, P = 0.05), as well as a higher rate of postoperative antibiotic usage (78.6 vs 17.9%, P < 0.01). There was no difference in recorded postoperative outcomes. CONCLUSIONS Spine surgeons requested paraspinous flap closure for patients with more complex disease, preoperative infections, history of chemotherapy, or if they were underweight. Patients with paraspinous flap coverage did not have increased postoperative complications despite their elevated risk profile. Our findings suggest that paraspinous muscle flaps should be considered in high-risk pediatric patients who undergo spine surgery.
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Affiliation(s)
| | - Keon Min Park
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Nicole Conkling
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX
| | - Esther A Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Scott L Hansen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - William Hoffman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Merisa L Piper
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
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Vorhies JS, Hauth L, Garcia S, Roye BD, Poon S, Sturm PF, Glotzbecker M, Fletcher ND, Stone JD, Cahill PJ, Anari JB. A New Look at Vertebral Body Tethering (VBT): Through the Modified Clavien-Dindo-Sink (mCDS) Classification. J Pediatr Orthop 2024; 44:e389-e393. [PMID: 38454491 DOI: 10.1097/bpo.0000000000002653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Anterior vertebral body tethering (AVBT) is increasingly popular as an option for surgical treatment of idiopathic scoliosis (IS). While the technology remains new, it is important for families and patients to be able to compare it to the current standard of care, posterior spinal fusion (PSF). The purpose of this study is to describe the complication rate of AVBT in IS using the mCDS and to compare it to the recently reported complication rate of PSF in IS. METHODS A multicenter pediatric spine deformity database was queried for all idiopathic scoliosis patients who underwent vertebral body tethering. There were 171 patients with a minimum 9-month follow-up included in this study. Complications were retrospectively graded by 2 attending pediatric spine surgeons using the mCDS classification system. RESULTS Data from 171 patients with idiopathic scoliosis was available for analysis, with 156/171 (91%) of patients being female and an average age of 12.2 years old at surgery. There were 156 thoracic tethers (1 with an LIV below L2), 5 lumbar tethers, 9 staged double tethers, and only 1 patient with same-day double tether. Fifty-five (55) (32%) patients experienced a total of 69 complications. The most common complication type for VBT by mCDS was Grade IIIb, encompassing 29/69 (42%) of complications. The second most frequent complication grade was Grade I at 23/69 (33%). Thirty-four (34) out of 69 (49%) of the VBT complications reported required either procedural/surgical intervention or admission to the ICU. CONCLUSIONS This is the first study to directly compare the complication profile of VBT to PSF using the mCDS. Forty-nine percent (49%) of the VBT complications reported were at least Grade III, while only 7% of complications in the control PSF cohort from the literature were Grade III or higher. The mCDS complication classification brings light to the early learning experience of a new technique compared to the widely accepted standard of PSF for IS. LEVEL OF EVIDENCE III - Retrospective comparative study.
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Affiliation(s)
- John S Vorhies
- Department of Orthopaedics, Stanford Medicine Children's Health, Palo Alto, CA
| | - Lucas Hauth
- Department of Orthopaedics, The Children's Hospital of Philadelphia
| | - Samantha Garcia
- Department of Orthopaedics, The Children's Hospital of Philadelphia
| | - Benjamin D Roye
- Department of Orthopaedics, Columbia University, New York, NY
| | - Selina Poon
- Department of Orthopaedics, Shriners Children's Southern California, CA
| | - Peter F Sturm
- Department of Orthopaedics, Cincinnati Children's Hospital
- Department of Orthopaedic Surgery, The University of Cincinnati, Cincinnati
| | | | | | - Joseph D Stone
- Department of Orthopaedics, The University of North Carolina, Chapel Hill, NC
| | - Patrick J Cahill
- Department of Orthopaedics, The Children's Hospital of Philadelphia
- Department of Orthopaedic Surgery, The University of Pennsylvania, Philadelphia, PA
| | - Jason B Anari
- Department of Orthopaedics, The Children's Hospital of Philadelphia
- Department of Orthopaedic Surgery, The University of Pennsylvania, Philadelphia, PA
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Hori Y, Kaymaz B, da Silva LCA, Rogers KJ, Yorgova PK, Gabos PG, Shah SA. Differences in spine growth potential for Sanders maturation stages 7A and 7B have implications for treatment of idiopathic scoliosis. Spine Deform 2024; 12:621-628. [PMID: 38372941 PMCID: PMC11068661 DOI: 10.1007/s43390-024-00829-8] [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: 10/09/2023] [Accepted: 01/13/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE This study aimed to clarify the differences in spine and total body height growth and curve progression between Sanders maturation stage (SMS) 7A and 7B in patients with adolescent idiopathic scoliosis (AIS). METHODS This retrospective case-control study involving patients with AIS at SMS 7 evaluated the differential gains in the spine (T1-S1) and total body height and curve progression between SMS 7A and 7B. A validated formula was used to calculate the corrected height, accounting for height loss due to scoliosis. A multivariable non-linear and logistic regression model was applied to assess the distinct growth and curve progression patterns between the SMS 7 subtypes, adjusting for potential confounders. RESULTS A total of 231 AIS patients (83% girls, mean age 13.9 ± 1.2 years) were included, with follow-up averaging 3.0 years. Patients at SMS 7A exhibited larger gains in spine height (9.9 mm vs. 6.3 mm) and total body height (19.8 mm vs. 13.4 mm) compared with SMS 7B. These findings remained consistent even after adjustments for curve magnitude. Non-linear regression models showed continued spine and total body height increases plateauing after 2 years, significantly greater in SMS 7A. More SMS 7A patients had curve progression over 10°, with an adjusted odds ratio of 3.31. CONCLUSION This study revealed that patients staged SMS 7A exhibited more spine and total body growth and a greater incidence of substantial curve progression than those at 7B. These findings imply that delaying brace discontinuation until reaching 7B could be beneficial, particularly for those with larger curves. LEVEL OF EVIDENCE Level III (Case-control study).
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Affiliation(s)
- Yusuke Hori
- Department of Orthopaedic Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Burak Kaymaz
- Department of Orthopaedic Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | | | - Kenneth J Rogers
- Department of Orthopaedic Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Petya K Yorgova
- Department of Orthopaedic Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Peter G Gabos
- Department of Orthopaedic Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA.
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Yuan P, Wang ZH, Jiang H, Wang YH, Yang JY, Li LM, Wang WT, Chen J, Li DH, Long SY, Zhang W, He F, Wang WZ. Prevalence and plasma exosome-derive microRNA diagnostic biomarker screening of adolescent idiopathic scoliosis in Yunnan Province, China. Front Pediatr 2024; 12:1308931. [PMID: 38720947 PMCID: PMC11076730 DOI: 10.3389/fped.2024.1308931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
Background Idiopathic scoliosis significantly affects the physical and mental health of children and adolescents, with varying prevalence rates in different regions. The occurrence of idiopathic scoliosis is associated with genetic regulation and biochemical factors, but the changes in exosome-derived miRNA profiles among idiopathic scoliosis patients remain unclear. This study aimed to determine the prevalence of idiopathic scoliosis in Yunnan Province, China, and identify key exosome-derived miRNAs in idiopathic scoliosis through a cohort study. Methods From January 2018 to December 2020, a cross-sectional study on idiopathic scoliosis in children and adolescents was conducted in Yunnan Province. A total of 84,460 students from 13 cities and counties in Yunnan Province participated in a scoliosis screening program, with ages ranging from 7 to 19 years. After confirmation through screening and imaging results, patients with severe idiopathic scoliosis and normal control individuals were selected using propensity matching. Subsequently, plasma exosome-derived miRNA sequencing and RT-qPCR validation were performed separately. Based on the validation results, diagnostic performance analysis and target gene prediction were conducted for differential plasma exosome-derived miRNAs. Results The overall prevalence of idiopathic scoliosis in children and adolescents in Yunnan Province was 1.10%, with a prevalence of 0.87% in males and 1.32% in females. The peak prevalence was observed at age 13. Among patients diagnosed with idiopathic scoliosis, approximately 12.8% had severe cases, and there were more cases of double curvature than of single curvature, with thoracolumbar curvature being the most common in the single-curvature group. Sequencing of plasma exosome-derived miRNAs associated with idiopathic scoliosis revealed 56 upregulated and 153 downregulated miRNAs. Further validation analysis confirmed that hsa-miR-27a-5p, hsa-miR-539-5p, and hsa-miR-1246 have potential diagnostic value. Conclusions We gained insights into the epidemiological characteristics of idiopathic scoliosis in Yunnan Province and conducted further analysis of plasma exosome-derived miRNA changes in patients with severe idiopathic scoliosis. This study has provided new insights for the prevention and diagnosis of idiopathic scoliosis, paving the way for exploring clinical biomarkers and molecular regulatory mechanisms. However, further validation and elucidation of the detailed biological mechanisms underlying these findings will be required in the future.
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Affiliation(s)
- Ping Yuan
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
| | - Zhi-Hua Wang
- Trauma Medicine Centre, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hong Jiang
- Department of Medical Imaging, Kunming Children’s Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Yang-Hao Wang
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
- Department of Pathology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jian-Yi Yang
- Department of Orthopaedics, Kunming Guandu District People’s Hospital, Kunming, Yunnan, China
| | - Lu-Ming Li
- Department of Orthopedics, Yunnan Sino-German Orthopedic Hospital, Kunming, Yunnan, China
| | - Wen-Tong Wang
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
| | - Jing Chen
- Department of Pathology and Pathophysiology, Faculty of Basic Medical Science, Kunming Medical University, Kunming, Yunnan, China
| | - Deng-Hui Li
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
| | - Sheng-Yu Long
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
- Department of Orthopedic, Qujing Affiliated Hospital of Kunming Medical University, Qujing, Yunnan, China
| | - Wan Zhang
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
| | - Fei He
- Department of Orthopedic, Qujing Affiliated Hospital of Kunming Medical University, Qujing, Yunnan, China
| | - Wei-Zhou Wang
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
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Chen YS, Lin YH, Wu YC, Shih CM, Chen KH, Lee CH, Lu WH, Pan CC. Radiographic and clinical outcomes of robot-assisted pedicle screw instrumentation for adolescent idiopathic scoliosis. Front Surg 2024; 11:1344802. [PMID: 38712338 PMCID: PMC11070498 DOI: 10.3389/fsurg.2024.1344802] [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: 11/26/2023] [Accepted: 04/10/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction Pedicle screw instrumentation (PSI) serves as the widely accepted surgical treatment for adolescent idiopathic scoliosis (AIS). The accuracy of screw positioning has remarkably improved with robotic assistance. Nonetheless, its impact on radiographic and clinical outcomes remains unexplored. This study aimed to investigate the radiographic and clinical outcomes of robot-assisted PSI vs. conventional freehand method in AIS patients. Methods Data of AIS patients who underwent PSI with all pedicle screws between April 2013 and March 2022 were included and retrospectively analyzed; those with hybrid implants were excluded. Recruited individuals were divided into the Robot-assisted or Freehand group according to the technique used. Radiographic parameters and clinical outcome measures were documented. Results In total, 50 patients (19, Freehand group; 31, Robot-assisted group) were eligible, with an average age and follow-up period of 17.6 years and 60.2 months, respectively, and female predominance (40/50, 80.0%). The correction rates of Cobb's angles for both groups were significant postoperatively. Compared to freehand, the robot-assisted technique achieved a significantly reduced breech rate and provided better trunk shift and radiographic shoulder height correction with preserved lumbar lordosis, resulting in significantly improved visual analog scale scores for back pain from the third postoperative month. Conclusion Overall, robot-assisted PSI provides satisfactory radiographic and clinical outcomes in AIS patients.
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Affiliation(s)
- Yuan-Shao Chen
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Hsien Lin
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yun-Che Wu
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Min Shih
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan
| | - Kun-Huei Chen
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Office of Research and Development, National Chung Hsing University, Taichung, Taiwan
- Department of Computer Science and Information Engineering, Providence University, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan
| | - Wen-Hsien Lu
- Department of Orthopedic Surgery, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
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McCallum-Loudeac J, Moody E, Williams J, Johnstone G, Sircombe KJ, Clarkson AN, Wilson MJ. Deletion of a conserved genomic region associated with adolescent idiopathic scoliosis leads to vertebral rotation in mice. Hum Mol Genet 2024; 33:787-801. [PMID: 38280229 PMCID: PMC11031364 DOI: 10.1093/hmg/ddae011] [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: 06/22/2023] [Revised: 12/15/2023] [Accepted: 01/12/2024] [Indexed: 01/29/2024] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis, in which spinal curvature develops in adolescence, and 90% of patients are female. Scoliosis is a debilitating disease that often requires bracing or surgery in severe cases. AIS affects 2%-5.2% of the population; however, the biological origin of the disease remains poorly understood. In this study, we aimed to determine the function of a highly conserved genomic region previously linked to AIS using a mouse model generated by CRISPR-CAS9 gene editing to knockout this area of the genome to understand better its contribution to AIS, which we named AIS_CRMΔ. We also investigated the upstream factors that regulate the activity of this enhancer in vivo, whether the spatial expression of the LBX1 protein would change with the loss of AIS-CRM function, and whether any phenotype would arise after deletion of this region. We found a significant increase in mRNA expression in the developing neural tube at E10.5, and E12.5, for not only Lbx1 but also other neighboring genes. Adult knockout mice showed vertebral rotation and proprioceptive deficits, also observed in human AIS patients. In conclusion, our study sheds light on the elusive biological origins of AIS, by targeting and investigating a highly conserved genomic region linked to AIS in humans. These findings provide valuable insights into the function of the investigated region and contribute to our understanding of the underlying causes of this debilitating disease.
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Affiliation(s)
- Jeremy McCallum-Loudeac
- Department of Anatomy, School of Biomedical Sciences, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Edward Moody
- Department of Anatomy, School of Biomedical Sciences, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Jack Williams
- Department of Anatomy, School of Biomedical Sciences, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Georgia Johnstone
- Department of Anatomy, School of Biomedical Sciences, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Kathleen J Sircombe
- Department of Anatomy, School of Biomedical Sciences, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Andrew N Clarkson
- Department of Anatomy, School of Biomedical Sciences, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Megan J Wilson
- Department of Anatomy, School of Biomedical Sciences, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
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Lenke LG, Lee V, Hassan FM. Revision of Surgery for Adolescent Idiopathic Scoliosis: Reasons, Treatments, and Clinical Management with Case Examples. J Clin Med 2024; 13:2233. [PMID: 38673506 PMCID: PMC11051103 DOI: 10.3390/jcm13082233] [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: 03/22/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a curvature of the spine that develops in children ages 10-18 and can be attributed to unknown causes. The Lenke AIS classification system provides a template to classify these deformities by curve type paired with recommended operative treatments. Treatment of this patient population has been associated with low complication rates and overall surgical success. Nonetheless, a fraction of patients remain susceptible to revision surgery. This manuscript will focus on the aspects of AIS surgery, highlighting case examples, the different treatment approaches, complication rates, and primary reasons for revision surgery and associated outcomes.
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Affiliation(s)
- Lawrence G. Lenke
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA;
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Irving Medical Center, New York, NY 10034, USA
| | - Veronica Lee
- Roy and Diana Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA;
| | - Fthimnir M. Hassan
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA;
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Irving Medical Center, New York, NY 10034, USA
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Regan C, Transtrum MB, Jilakara B, Milbrandt TA, Larson AN. How Long Can You Delay? Curve Progression While Awaiting Vertebral Body Tethering Surgery. J Clin Med 2024; 13:2209. [PMID: 38673483 PMCID: PMC11050359 DOI: 10.3390/jcm13082209] [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: 02/01/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The implications of delaying surgical intervention for patients with adolescent idiopathic scoliosis (AIS) wishing to undergo vertebral body tethering (VBT) have not yet been explored. It is important to understand how these delays can impact surgical planning and patient outcomes. Methods: This was a retrospective review that analyzed all AIS patients treated between 2015 and 2021 at a single tertiary center. Time to surgery from initial surgical consultation and ultimate surgical plan were assessed. Patient characteristics, potential risk factors associated with increased curve progression, and reasons for delay were also analyzed. Results: 174 patients were evaluated and 95 were scheduled for VBT. Four patients later required a change to posterior spinal fusion (PSF) due to excessive curve progression. Patients requiring PSF were shown to have significantly longer delays than those who received VBT. Additionally, longer delays, younger age, greater curve progression, and lower skeletal maturity were correlated with significant curve progression (≥5 degrees). Conclusions: Surgical delays for AIS patients awaiting VBT may lead to significant curve progression and necessitate more invasive procedures. Patients with longer delays experienced an increased risk of needing PSF instead of VBT. Of those requiring PSF, the majority were due to insurance denials. Optimizing surgical timing and shared decision-making among patients, families, and healthcare providers are essential for achieving the best outcomes.
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Affiliation(s)
| | | | | | | | - A. Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA; (C.R.); (M.B.T.); (B.J.); (T.A.M.)
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Grabala P, Kowalski P, Grabala M. The Influence of Increased Pedicle Screw Diameter and Thicker Rods on Surgical Results in Adolescents Undergoing Posterior Spinal Fusion for Idiopathic Scoliosis. J Clin Med 2024; 13:2174. [PMID: 38673447 PMCID: PMC11051082 DOI: 10.3390/jcm13082174] [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: 03/22/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Modern surgical techniques allow for the correction of spinal deformity, stopping its progression and improving pain relief and social and physical functioning. These instruments have different implant designs, screws, and rod diameters and can be composed of different metal alloys with different hardnesses, which can have a significant impact on the effect of correcting spinal deformities. We designed a retrospective cohort study based on the same surgical technique and spine system using different implant sizes, and compared the results across them. Methods: This is a retrospective review of adolescent idiopathic scoliosis (AIS) patients who underwent posterior spinal fusion (PSF) between 2016 and 2022 with a minimum two-year follow-up (FU) using two spinal implant systems: 5.5 and 6.0 mm diameter screws with double 5.5 mm titanium rods (Group 1 (G1)), and 6.0 and 6.5 mm diameter pedicle screws with double 6.0 mm cobalt-chromium rods (Group 2 (G2)). The evaluated data were as follows: preoperative personal data, radiographic outcomes, complications, and health-related quality of life questionnaire (HRQoL). The parameters were reviewed preoperatively, after the final fusion, and during the FU. Results: The mean age of all 260 patients at surgery was 14.8 years. The average BMI was also similar in both groups and was noted as 21. The mean levels of fusion and screw density were similar in both groups. The mean preoperative major curves (MCs) were 57.6° and 62.5° in G1 and G2, respectively. The mean flexibility of the curves was noted as 35% in G1 and 33% in G2. After definitive surgery, the mean percentage correction of the MC was better in G2 vs. G1, with 74.5% vs. 69.8%, respectively (p < 0.001). At the final FU, the average loss of correction was 5.9° for G1 and 3.2° for G2 (p < 0.001). The mean preoperative (TK) thoracic kyphosis (T2-T5) was 12.2° in G1 and 10.8° in G2. It was corrected to 15.2° in G1 and to 13° in G2. At the FFU, we noted a significant difference in the TK (T2-T5) between the groups, with 16.7° vs. 9.6° for G1 vs. G2, respectively (p < 0.001). Statistical significance was observed between the preoperative sagittal balance and the final follow-up for both groups (p < 0.001). Conclusions: AIS patients surgically treated with screws with a larger diameter and thicker and stiffer rods showed greater correction and postoperative thoracic kyphosis without implant failure. The complication rates, implant density, and clinical outcomes remained similar. The radiographic benefits reported in this cohort study suggest that large-sized screws and stiffer rods for the correction of pediatric spinal deformities are safe and very effective.
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Affiliation(s)
- Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, Medical University of Bialystok and Medical University of Bialystok Children’s Clinical Hospital, ul. Waszyngtona 17, 15-274 Bialystok, Poland
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
- Department of Neurosurgery with Department of Interventional Neurology, Medical University of Bialystok and Medical University of Bialystok Clinical Hospital, ul. M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
| | - Piotr Kowalski
- Department of Neurosurgery, Regional Specialized Hospital, ul. Dekerta 1, 66-400 Gorzow, Poland;
| | - Michal Grabala
- 2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok and Medical University of Bialystok Clinical Hospital, ul. M. Skłodowskiej-Curie 24A, 15-276 Bialystok, Poland;
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Negrini F, Febbo F, Tessadri F, Zonta A, Tavernaro M, Donzelli S, Zaina F, Negrini S. The New Modular Sforzesco Brace (Modular Italian Brace) Is as Effective as the Classical One: A Retrospective Controlled Study from a Prospective Cohort. J Clin Med 2024; 13:2075. [PMID: 38610839 PMCID: PMC11012574 DOI: 10.3390/jcm13072075] [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: 01/29/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The Sforzesco brace is a very rigid push-up brace effective in adolescent idiopathic scoliosis (AIS). We recently developed a new Sforzesco brace based on modularity (the Modular Italian brace-MI brace) that could allow standardization, facilitating global expertise diffusion, increased modifiability and adaptability, and cost savings due to longer brace life. We aimed to compare the short-term results of the two braces. Methods: The retrospective study included 231 consecutive AIS treated with a MI brace (N = 53) or Sforzesco brace (N = 178). The main outcome was the first 6-month follow-up out-of-brace radiograph Cobb angle change. Secondary outcomes included the in-brace Cobb degrees and aesthetics (TRACE), prominence (angle of trunk rotation and mm), kyphosis, and lordosis changes. Results: The two groups were similar at baseline, apart from more immature patients in MI brace. Both braces reduced the Cobb angle (-6° out-of-brace; -16° in-brace) without differences between groups. All secondary outcomes improved, apart from a statistically and clinically insignificant 3° kyphosis reduction. The MI brace participants were 4.9 times more likely to improve the Cobb angle than the Sforzesco brace (OR = 4.92; 95%CI 1.91-12.64; p = 0.001). Conclusions: These findings suggest that the MI-brace can be safely used instead of the classical Sforzesco brace. However, further studies of different designs and longer follow-ups are needed to confirm these findings.
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Affiliation(s)
- Francesco Negrini
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy;
- Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy
| | - Francesca Febbo
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (A.Z.); (M.T.); (S.D.); (F.Z.)
| | | | - Andrea Zonta
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (A.Z.); (M.T.); (S.D.); (F.Z.)
| | - Marta Tavernaro
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (A.Z.); (M.T.); (S.D.); (F.Z.)
| | - Sabrina Donzelli
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (A.Z.); (M.T.); (S.D.); (F.Z.)
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (A.Z.); (M.T.); (S.D.); (F.Z.)
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University “La Statale”, 20122 Milan, Italy;
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
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Sha L, Zhang T, Sui W, Fan Q, Yang J, Deng Y, Huang Z, Yang J. Comparison of the efficacy of thoracolumbosacral and lumbosacral orthosis for adolescent idiopathic scoliosis in patients with major thoracolumbar or lumbar curves: a prospective controlled study. Front Pediatr 2024; 12:1368201. [PMID: 38628358 PMCID: PMC11018990 DOI: 10.3389/fped.2024.1368201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Thoracolumbosacral orthosis (TLSO) is the most commonly used type of brace for the conservative treatment of adolescent idiopathic scoliosis (AIS). Although lumbosacral orthosis (LSO) is designed to correct single thoracolumbar or lumbar (TL/L) curves, its effectiveness remains underexplored. This novel article aims to compare the effectiveness of LSO with TLSO in treating AIS with main TL/L curves. Methods This prospective controlled cohort study enrolled patients with AIS with main TL/L curves and minor thoracic curves who were treated with either TLSO or LSO. Demographic and radiographic data were compared between the two groups. Treatment outcomes were also assessed. Risk factors for minor curve progression were identified, and a cut-off value was determined within the LSO group. Results Overall, 82 patients were recruited, including 44 in the TLSO group and 38 in the LSO group. The initial TL/L curves showed no difference between both groups. However, the baseline thoracic curves were significantly larger in the TLSO group compared to the LSO group (25.98° ± 7.47° vs. 18.71° ± 5.95°, P < 0.001). At the last follow-up, LSO demonstrated similar effectiveness to TLSO in treating TL/L curves but was less effective for thoracic curves. The initial magnitude of thoracic curves was identified as a risk factor for minor curve outcomes in the LSO group. The ROC curve analysis determined a cut-off value of 21° for thoracic curves to predict treatment outcomes. Discussion In contrast to TLSO, LSO exhibits comparable effectiveness in treating main TL/L curves, making it a viable clinical option; however, it is less effective for thoracic minor curves. The initial magnitude of the minor thoracic curves may guide the selection of the appropriate brace type for patients with AIS with main TL/L curves.
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Affiliation(s)
- Lin Sha
- Department of Pediatric Orthopedics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyuan Zhang
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenyuan Sui
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Fan
- Department of Pediatric Orthopedics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingfan Yang
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaolong Deng
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zifang Huang
- Department of Spine Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Junlin Yang
- Department of Pediatric Orthopedics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Li J, Tseng C, Yuan Y, Jiang D, Qian Z, Hu Z, Zhu Z, Qiu Y, Liu Z. Determining the association between the radiographic parameters and the SRS-22 scores in Chinese female patients with adolescent idiopathic scoliosis: does curve pattern matter? Br J Neurosurg 2024; 38:349-355. [PMID: 33491493 DOI: 10.1080/02688697.2021.1875396] [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: 02/09/2020] [Revised: 06/16/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Background: The Scoliosis Research Society (SRS)-22 outcomes have been shown to be correlated with radiographic parameter of adolescent idiopathic scoliosis (AIS). A recent study suggested that curve patterns might play a role in assessing the influence of deformity on patient's reported outcomes. The aim of this study was to examine the relationship between radiographic parameters and SRS-22 questionnaire outcomes in female patients with adolescent AIS among the Chinese population based on five curve patterns.Patients and Methods: The radiographic data and SRS-22 questionnaires of 259 female AIS patients were reviewed. Radiographic measurements included: Cobb angle of the major curve, T1 tilt angle, apical vertebral rotation, apical vertebral translation (AVT), thoracic kyphosis, and lumbar lordosis. Curve patterns included single thoracic (T), single thoracolumbar/lumbar (TL), double thoracic (DT), double major (DM), and triple major (TM). The correlation between radiographic measurements and each domain in SRS-22 was determined by Pearson's correlation coefficient.Results: The curve magnitude and AVT of the major curve were found to be significantly correlated with the self-image domain in all cases (Cobb angle: r = -0.426, p = 0.002; AVT: r = -0.281, p=0.006) and in all curve patterns except for TM. Compared to other groups, the TM group had a significantly larger major curve than the DT group and TL group (p ≤ 0.004). In TM group, the self-image scores were lower than TL group (p =0.018), and the function scores were lower than that in T, TL (p < 0.001) and DM groups (p =0.013). In the DT group, the T1 tilt was significantly correlated with the self-image domain (r = -0.376, p =0.004). In the T group, coronal curve magnitude was significantly correlated with function domain (r = -0.397, p < 0.001).Conclusion: Our findings suggested curve patterns should be considered in evaluating the correlations between radiographic parameters and SRS-22 outcomes in patients with AIS.
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Affiliation(s)
- Jie Li
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Changchun Tseng
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yiwen Yuan
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Dengxu Jiang
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zhikai Qian
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zongshan Hu
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zhen Liu
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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Li J, Liu C, Xu Y, Ling C, Tang Z, Kiram A, Hu Z, Zhu Z, Qiu Y, Liu Z. Gut Microbiota Alterations in Adolescent Idiopathic Scoliosis Are Associated with Aberrant Bone Homeostasis. Orthop Surg 2024; 16:965-975. [PMID: 38389213 PMCID: PMC10984819 DOI: 10.1111/os.14019] [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: 08/26/2023] [Revised: 11/24/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE Low bone mineral density is the major prognostic factor for adolescent idiopathic scoliosis (AIS), but the underlying mechanisms remain unclear. Accumulating evidence suggests that gut microbiota (GM) have the potential to affect bone development, and the GM signatures are altered in AIS patients. However, the effect of GM alterations on aberrant bone homeostasis in AIS remains unclear. This study aims to investigate the GM profile in AIS patients with different bone mineral density (BMD) and explore the association between GM, osteopenia, and aberrant bone turnover. METHODS A total of 126 patients with AIS who received surgical treatment were retrospectively included in this study. We analyzed the composition of the GM by 16S rRNA sequencing and BMD by dual X-ray absorptiometry. Based on the BMD of the femur neck, the patients were divided into the osteopenia group (OPN) if the Z score < -1, and the normal (NOR) group if the Z score ≥ -1 SD compared to the healthy control. For the 16S rRNA sequencing, the raw reads were filtered to remove low-quality reads, and operational taxonomic units were identified with the Uparse program. Weighted UniFrac distance matrix for the beta-diversity metrics and principal coordinate analysis (PCoA) was performed, and the statistical comparisons were made with permutational multivariate analysis of variance (PERMANOVA) and analysis of similarity (ANONISM). Linear discriminant analysis effect size (LEfSe) was used to identify the enriched species in two groups. The "Random forest" was applied to determine the optimal biomarker for OPN according to the mean decrease in Gini value. The metabolic function was predicted by the Tax4Fun analysis. The Pearson correlation coefficient was used to evaluate the associations between GM species, bone turnover markers, and BMD. RESULTS The serum β-CTX was increased in the OPN group (n = 67) compared to the NOR group (n = 59). Patients in OPN groups showed significantly decreased α diversity indicated by the Shannon index. Principal coordinate analysis (PCoA) analysis showed significant clustering of GM between OPN and NOR groups. At genus level, the Escherichia-Shigella and Faecalibacterium were significantly enriched in the OPN group compared to that in the NOR group (p < 0.05), whereas the abundance of Prevotella was significantly decreased (p = 0.0012). The relative abundance of Megamonas and Prevotella was positively correlated with the femur BMD. The abundance of Escherichia-Shigella was negatively correlated with femur BMD and positively correlated with serum β-CTX levels. Functional analysis revealed significant differences in starch and sucrose metabolism, pyruvate and cysteine, and methionine metabolism between NOR and OPN groups. CONCLUSION The alterations of GM in AIS patients are correlated with osteopenia. The association between enriched species, BMD, and bone turnover markers provides novel diagnostic and therapeutic targets for the clinical management of AIS.
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Affiliation(s)
- Jie Li
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Changwei Liu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityNanjingChina
| | - Yanjie Xu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Chen Ling
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityNanjingChina
| | - Ziyang Tang
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityNanjingChina
| | - Abdukahar Kiram
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Zongshan Hu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityNanjingChina
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityNanjingChina
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityNanjingChina
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Zeng H, Zhou K, Ge S, Gao Y, Zhao J, Gao S, Zheng R. Anatomical Prior and Inter-Slice Consistency for Semi-Supervised Vertebral Structure Detection in 3D Ultrasound Volume. IEEE J Biomed Health Inform 2024; 28:2211-2222. [PMID: 38289848 DOI: 10.1109/jbhi.2024.3360102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Three-dimensional (3D) ultrasound imaging technique has been applied for scoliosis assessment, but the current assessment method only uses coronal projection images and cannot illustrate the 3D deformity and vertebra rotation. The vertebra detection is essential to reveal 3D spine information, but the detection task is challenging due to complex data and limited annotations. We propose VertMatch to detect vertebral structures in 3D ultrasound volume containing a detector and classifier. The detector network finds the potential positions of structures on transverse slice globally, and then the local patches are cropped based on detected positions. The classifier is used to distinguish whether the patches contain real vertebral structures and screen the predicted positions from the detector. VertMatch utilizes unlabeled data in a semi-supervised manner, and we develop two novel techniques for semi-supervised learning: 1) anatomical prior is used to acquire high-quality pseudo labels; 2) inter-slice consistency is used to utilize more unlabeled data by inputting multiple adjacent slices. Experimental results demonstrate that VertMatch can detect vertebra accurately in ultrasound volume and outperforms state-of-the-art methods. Moreover, VertMatch is also validated in automatic spinous process angle measurement on forty subjects with scoliosis, and the results illustrate that it can be a promising approach for the 3D assessment of scoliosis.
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Machida M, Rocos B, Machida M, Nomura K, Nemoto N, Oikawa N, Taira K. The Prevalence of Scoliosis after Fontan Circulation Surgery Followed-Up to Adolescence. Spine Surg Relat Res 2024; 8:212-217. [PMID: 38618220 PMCID: PMC11007251 DOI: 10.22603/ssrr.2023-0164] [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: 07/11/2023] [Accepted: 09/10/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction The advancement of surgical techniques and perioperative management for congenital heart disease (CHD) has increased life expectancy. The surgical creation of the Fontan circulation maintains pulmonary blood flow without relying on an effective pump from the abnormal heart, relying on peripheral vascular resistance to maintain effective flow through the lungs. Unfortunately, this delicate mechanism is compromised when scoliosis restricts ventilation, leading to Fontan failure and a poor prognosis for life. This report describes the prevalence of scoliosis with Fontan completion surgery and the role of screening and surgical correction. Methods Ninety-six consecutive Japanese patients undergoing Fontan completion surgery for CHD between 2000 and 2017 were identified in our institutional records. The inclusion criterion was at least 7 years of follow-up after Fontan completion surgery, while the exclusion criteria were congenital, syndromic, and neuromuscular scoliosis. Radiographic and clinical parameters, including cardio-thoracic ratio (CTR) for cardiomegaly and cyanosis saturation, were compared between with and without scoliosis. Results There were 23 and 40 patients in the scoliosis and no scoliosis groups, respectively. The mean age at the final follow-up was 18.5 and 16.7 years in the scoliosis and no scoliosis groups, respectively (p=0.02). Mean CTR was 43.7% and 39.4% in the scoliosis and no scoliosis groups (p=0.016), and the mean saturation in room air at the final follow-up was 88.8% and 93.2%, respectively (p=0.036). There were no significant differences to clarify the risk factors with multivariate logistic regression analysis. Conclusions The prevalence of scoliosis with Fontan completion surgery was 36.5%. Screening for scoliosis is important for children with Fontan circulation surgery as part of their routine follow-up at least until they reach adolescence. Evidence Level: 4.
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Affiliation(s)
- Masayoshi Machida
- Department of Orthopaedic Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Brett Rocos
- Division of Spine Surgery, Duke Orthopedic Surgery, Durham, USA
| | - Masafumi Machida
- Department of Orthopaedic Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Koji Nomura
- Department of Cardiovascular Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Naho Nemoto
- Department of Orthopaedic Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Noboru Oikawa
- Department of Orthopaedic Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Katsuaki Taira
- Department of Orthopaedic Surgery, Saitama Children's Medical Center, Saitama, Japan
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Katzouraki G, Vasiliadis ES, Kaspiris A, Evangelopoulos DS, Grivas TB, Pneumatikos SG. Sagittal Balance Parameters and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis. J Clin Med 2024; 13:1895. [PMID: 38610660 PMCID: PMC11012752 DOI: 10.3390/jcm13071895] [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: 11/26/2023] [Revised: 01/17/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Background: To review and evaluate multiple preoperative and postoperative sagittal parameters and their association with the risk of developing proximal junctional kyphosis (PJK) in patients with adolescent idiopathic scoliosis (AIS) who undergo correction surgery. Methods: A systematic search was performed in December 2022 in PubMed, Embase and the Cochrane Library to retrieve all the studies relevant to our research. After the study selection and data extraction following PRISMA guidelines, RevMan 5.3 was used for statistical analysis. All the analyzed factors were evaluated by using odds ratios and weighted mean differences with 95% confidence intervals. Moreover, the meta-analysis of proportions via MedCalc was used for analyzing quantitative data from the studies. Results: A total of 22 studies were included in our meta-analysis. All the available values of sagittal parameters were evaluated. Among all the potential risk factors, higher preoperative thoracic kyphosis (Test for overall effect Z = 11.79, p < 0.00001), higher preoperative sagittal vertical axis (SVA) (test for overall effect Z = 11.19, p < 0.00001), greater thoracic kyphosis change post-op. compared to pre-op. (test for overall effect Z = 6.02, p < 0.00001), increased postoperative lumbar lordosis (test for overall effect Z = 3.65, p = 0.0003), higher post-op. SVA (test for overall effect Z = 24.93, p < 0.00001) and a larger pelvic incidence/lumbar lordosis (PI/LL) mismatch (test for overall effect Z = 20.50, p < 0.00001) were found to be the risk factors for PJK after AIS surgery. Moreover, a decreased rod contour angle (RCA) (test for overall effect Z = 3.79, p < 0.0002) and higher proximal junctional angle-rod contour angle (PJA-RCA) (test for overall effect Z = 39.18, p < 0.00001) play a significant role in the risk of developing PJK after AIS correction. Conclusions: Sagittal balance is of great importance when considering the surgical correction of AIS. Many factors in our meta-analysis were found to increase the incidence for PJK such as higher preoperative thoracic kyphosis and pre-op. SVA. Furthermore, increased thoracic kyphosis change, increased post-operative lumbar lordosis, SVA and PI/LL mismatch are also factors that influence the possibility of post-op. PJK. Lastly, RCA and PJA-RCA are two important factors that need attention during AIS, as over-contouring of the rod could lead to PJK in AIS patients.
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Affiliation(s)
- Galateia Katzouraki
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (G.K.); (A.K.); (D.-S.E.); (S.G.P.)
| | - Elias S. Vasiliadis
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (G.K.); (A.K.); (D.-S.E.); (S.G.P.)
| | - Angelos Kaspiris
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (G.K.); (A.K.); (D.-S.E.); (S.G.P.)
| | - Dimitrios-Stergios Evangelopoulos
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (G.K.); (A.K.); (D.-S.E.); (S.G.P.)
| | - Theodoros B. Grivas
- Former Head of Department of Orthopedics & Traumatology, “Tzaneio” General Hospital of Piraeus, 185 36 Piraeus, Greece;
| | - Spiros G. Pneumatikos
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (G.K.); (A.K.); (D.-S.E.); (S.G.P.)
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Fan Y, Zheng H, Feng L, To MKT, Kuang GM, Yeung EHK, Cheung KMC, Liu L, Cheung JPY. Elasticity and cross-sectional thickness of paraspinal muscles in progressive adolescent idiopathic scoliosis. Front Pediatr 2024; 12:1323756. [PMID: 38516354 PMCID: PMC10954774 DOI: 10.3389/fped.2024.1323756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Objectives (1) Compare the cross-sectional thickness (CST) and shear wave speed (SWS) of paraspinal muscles (PSM) in adolescent idiopathic scoliosis (AIS) with and without curve progression; (2) investigate the relationship between CST/SWS and radiographic characteristics in AIS with curve progression; (3) compare the CST/SWS between AIS and non-scoliosis controls. Methods This cross-sectional study analyzed the CST and SWS of PSM in 48 AIS with mild to moderate curvature and 24 non-scoliosis participants. Participants with scoliosis greater than 45° of Cobb angles were excluded. The Change of Cobb angles within the last 6-months was retrieved to allocate AIS into progression and non-progression groups. The SWS and CST of multifidus; longissimus and iliocostalis of the major curve were measured using B-mode ultrasound image with an elastography mode. Discrepancies of the SWS (SWS-ratio: SWS on the convex side divided by SWS on the concave side) and CST (CST-ratio: CST on the convex side divided by CST on the concave side) at the upper/lower end and apical vertebrae were studied. Results A higher SWS at the apical vertebrae on the concave side of the major curve (multifidus: 3.9 ± 1.0 m/s vs. 3.1 ± 0.6 m/s; p < 0.01, longissimus: 3.3 ± 1.0 m/s vs. 3.0 ± 0.9 m/s; p < 0.01, iliocostalis: 2.8 ± 1.0 m/s vs. 2.5 ± 0.8 m/s; p < 0.01) was observed in AIS with curve progression. A lower SWS-ratio at apical vertebrae was detected with a greater vertebral rotation in participants with curve progression (multifidus [grade II]: 0.7 ± 0.1 vs. grade I: 0.9 ± 0.2; p = 0.03, longissimus [grade II]: 0.8 ± 0.2 vs. grade I: 1.1 ± 0.2; p < 0.01). CST was not different among the progressive, non-progressive AIS and non-scoliosis controls. Conclusions Increased SWS of PSM without change of CST was observed on the concave side of the major curve in participants with progressive AIS.
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Affiliation(s)
- Yunli Fan
- Department of Physiotherapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Haiping Zheng
- Department of Medical Imaging-Ultrasound Division, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Lin Feng
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Michael K T To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Guan-Ming Kuang
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Eric H K Yeung
- Department of Physiotherapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Li Liu
- Department of Medical Imaging-Ultrasound Division, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
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Vo Q, Nguyen H, Nguyen HT, Pham BN, Truong TK. Shoulder and Neck Balance in Adolescent Idiopathic Scoliosis: Which Radiographic Indices are Reliable and Practical? Malays Orthop J 2024; 18:51-59. [PMID: 38638659 PMCID: PMC11023348 DOI: 10.5704/moj.2403.007] [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: 02/08/2023] [Accepted: 07/07/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction Deformities of the spine and thorax in adolescent idiopathic scoliosis affect appearance. They are a cause of inferiority, affecting psychological well-being and the social life of the patients. To contribute to curve evaluation, planning in curve correction, and improving the post-operative aesthetics, many studies on the correlation between appearance and radiography in the assessment of shoulder and neck balance have been reported recently. In general, these studies did not clarify which indices are required to evaluate shoulder and neck balance. This study aimed to learn about indices to assess shoulder and neck balance in adolescent idiopathic scoliosis in correlation between clinical appearance and radiography. Materials and methods This observational study recruited 50 patients with adolescent idiopathic scoliosis who were 12 to 18 years of age with Cobb angle >10°. Based on Pearson correlation coefficient, radiographic parameters such as coracoid height difference (CHD), clavicle rib intersection distance (CRID), clavicle angle (CA), clavicle chest cage angle difference (CCAD), and T1 tilt angle were evaluated in correlation with clinical shoulder and neck balance by difference of inner shoulder height (SHi), difference of outer shoulder height (SHo), and neck tilt angle. Results SHi was moderately correlated with T1 tilt angle (r [hereafter] = 0.45), CA (0.47), and CHD (0.57), high-moderately correlated with CRID (0.64), very-highly correlated with CCAD (0.84). SHo was moderately correlated with T1 tilt angle (0.43), highly correlated with CHD (0.60), CA (0.63), and CRID (0.72), and very-highly correlated with CCAD (0.89). T1 tilt angle was high-moderately correlated with neck tilt angle (0.76). The correlation coefficients between clinical and radiographic shoulder and neck balance according to sex, BMI, type of main curve, severity of main curve did not change significantly. Conclusion There was a very high correlation between SHo (shoulder tilt) and CCAD (0.89); the correlation between SHo and CRID was high-moderate (0.72), but CRID is easier than CCAD to evaluate on radiographs. On the other hand, T1 tilt angle, which is the easiest radiographic parameter to evaluate, had a high-moderate correlation with neck tilt angle (0.76) but a moderate correlation with SHo (0.43).
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Affiliation(s)
- Qdn Vo
- Department of Pediatric Orthopaedic, Hospital for Traumatology and Orthopedics, Ho Chi Minh City, Vietnam
| | - Hhh Nguyen
- Department of Orthopaedic, Tay Nguyen University, Buon Ma Thuot, Vietnam
| | - H T Nguyen
- Department of Pediatric Orthopaedic, Hospital for Traumatology and Orthopedics, Ho Chi Minh City, Vietnam
| | - B N Pham
- Department of Pediatric Orthopaedic, Hospital for Traumatology and Orthopedics, Ho Chi Minh City, Vietnam
| | - T K Truong
- Department of Pediatric Orthopaedic, Hospital for Traumatology and Orthopedics, Ho Chi Minh City, Vietnam
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Fan Y, To MK, Kuang GM, Cheung JPY. The Relationship Between Compliance of Physiotherapeutic Scoliosis Specific Exercises and Curve Regression With Mild to Moderate Adolescent Idiopathic Scoliosis. Global Spine J 2024; 14:447-457. [PMID: 35762385 PMCID: PMC10802514 DOI: 10.1177/21925682221109565] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective Case-control Study. OBJECTIVES To determine the requisite exercise compliance (EC) of physiotherapeutic scoliosis-specific exercise (PSSE) for achieving curve regression; to analyze whether the apical translation (AT), apical wedging (AW), and apical rotation (AR) of the major curve improve with regression effect. METHODS Between 2019 and 2021, a total of 763 patients undertook a 6-month PSSE treatment. This resulted 426 compliable and 302 uncompliable patients remained available for analysis. For compliable patients, 213 with curve regression and 213 age-/sex-matched with curve stabilization/deterioration at the 6-month, were eligible for regression analysis to detect the relationship between EC and regression effect at the 6-month; receiver operating characteristic (ROC) curve analysis and Youden's index were applied to identify the threshold of EC leading to curve regression at the 6-month. The AT, AW, and AR of the major curve were compared before and after 6-month PSSE to investigate the radiographic parameters that improved with regression effect. RESULTS EC was correlated with regression effect (odds ratio: 19.9, 95% confidence interval: 11.3-35.0, P < .001) and the cutoff threshold of EC was 4.4 h/week for 6 months to realize such an effect. AT was improved by 47.6% with curve regression, in which 152 cases remained curve regression and no case progressed into the operative threshold at the 1.5- to 2-year. CONCLUSIONS A 6-month PSSE protocol of 4.4 hours per week was potentially leading to curve regression in treating mild to moderate scoliosis. An improvement in AT of the major curve was observed with the regression effect.
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Affiliation(s)
- Yunli Fan
- Department of Orthopaedics, The University of Hong Kong - Shenzhen Hospital, Shenzhen, People's Republic of China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
- Department of Physiotherapy, The University of Hong Kong - Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Michael Kt To
- Department of Orthopaedics, The University of Hong Kong - Shenzhen Hospital, Shenzhen, People's Republic of China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Guan-Ming Kuang
- Department of Orthopaedics, The University of Hong Kong - Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics, The University of Hong Kong - Shenzhen Hospital, Shenzhen, People's Republic of China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Li J, Chan EA, Li M, Lam YP, Wong AYL, Cheung JPY, Li Y. "Am I different?" Coping and mental health among teenagers with adolescent idiopathic scoliosis: A qualitative study. J Pediatr Nurs 2024; 75:e135-e141. [PMID: 38216347 DOI: 10.1016/j.pedn.2024.01.004] [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: 11/07/2023] [Revised: 12/17/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
PURPOSE To explore the stressors, coping strategies, and mental health of adolescents diagnosed with idiopathic scoliosis. DESIGN AND METHODS This study adopted a descriptive qualitative study design. Twelve participants were recruited from a local non-government organization in Hong Kong. Semi-structured interviews were conducted to collect data. Verbatim transcriptions of interviews were coded and analyzed using thematic analysis. The guideline of the Consolidated Criteria for Reporting Qualitative Studies was used to report the findings. RESULTS Five themes were identified: "Disease- and treatment-induced changes and stressors", "Cognitive assessment and personal perceptions", "Behavioral and emotional coping strategies", "Social interactions and social support", and "Deteriorating or thriving in psychological development and well-being". CONCLUSIONS Adolescents with idiopathic scoliosis experienced a variety of physical and psychological stressors. It is imperative to prioritize efforts to promote adaptive coping and activate social support systems to achieve better outcomes in this population. PRACTICAL IMPLICATIONS Healthcare providers should aim to comprehend the experiences of adolescents with idiopathic scoliosis for improved clinical interactions and holistic care. Future research should prioritize coping-based interventions, to enhance adaptive coping behaviors and the well-being of this population.
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Affiliation(s)
- Jiaying Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Engle Angela Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Mengqi Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yim Ping Lam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
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Lau KKL, Kwan KYH, Cheung JPY, Wong JSH, Shea GKH, Law KKP, Cheung KMC. Incidence of back pain from initial presentation to 3 years of follow-up in subjects with untreated adolescent idiopathic scoliosis. Spine Deform 2024; 12:357-365. [PMID: 38015385 PMCID: PMC10866791 DOI: 10.1007/s43390-023-00794-8] [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: 09/14/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Although back pain may be present in subjects with adolescent idiopathic scoliosis (AIS), its natural history is unknown. Therefore, this study evaluated the incidence of back pain in scoliotic adolescents longitudinally. METHODS This retrospective analysis examined prospectively collected pain subscale data of the Scoliosis Research Society questionnaire between the initial presentation and up to 3 years of follow-up. Consecutive subjects with AIS aged 10-18 at baseline managed by observation within the study period were included. Study subjects with at least one time point of follow-up data were considered. Alternatively, a group with physiotherapy-treated was also included for comparison. RESULTS We enrolled 428 subjects under observation. The incidence of back pain among study subjects was 14.7%, 18.8%, and 19.0% for the first year, second year, and third year of follow-up, respectively. Most experienced mild pain (1 out of 5 points) throughout the study. Neither incidence nor intensity of pain significantly differed between subjects under observation and received physiotherapy. Additionally, study subjects with a new onset of back pain had poorer function, self-image, and mental health scores than those without pain. CONCLUSION We investigated the incidence of back pain longitudinally in subjects suffering from AIS. Further validation of the current results is warranted.
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Affiliation(s)
- Kenney Ki Lee Lau
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kenny Yat Hong Kwan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Janus Siu Him Wong
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Graham Ka Hon Shea
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Karlen Ka Pui Law
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
- Department of Orthopaedics and Traumatology, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.
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Kluszczyński M, Zaborowska-Sapeta K, Kowalski I, Karpiel I. The Effectiveness of Early Rehabilitation in Limiting the Progression of Idiopathic Scoliosis. J Clin Med 2024; 13:1422. [PMID: 38592211 PMCID: PMC10932466 DOI: 10.3390/jcm13051422] [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: 01/14/2024] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The purpose of this study was to assess specific rehabilitation methods' effectiveness in early idiopathic scoliosis (IS) development, focusing on lower limb functional inequality's role in scoliosis progression. Materials and Methods: This study comprised 812 patients aged 6-16 years at risk of developing idiopathic scoliosis (IS). The mean (SD) age was 10.66 (3.16) years. Patients were categorized into high- and medium-risk groups based on the angle of trunk rotation (ATR) size. Specific scoliosis physiotherapy was used, and the average follow-up period was 28.1 ± 14.5 months. Changes in ATR, Cobb angle, and functional length of the lower limbs pre- and post-treatment were statistically analyzed across three age groups (6-9, 10-12, and 13-16 years) and three scoliosis locations. Results: Significant effectiveness of early rehabilitation was observed in the high-risk group of children aged 6-9 years. In the medium-risk group, significant reductions in ATR were observed in both the 6-9 and 10-12 age groups across all three scoliosis locations. Additionally, there was a significant decrease in the Cobb angle in the thoracolumbar region and a significant reduction in lower limb inequality across all age groups and scoliosis locations. Conclusions: The early implementation of specific physiotherapy may enhance the efficacy of idiopathic scoliosis treatment by attenuating factors contributing to its progression.
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Affiliation(s)
- Marek Kluszczyński
- Collegium Medicum, Jan Dlugosz University, 4/8 Waszyngtona, 42-200 Częstochowa, Poland
| | - Katarzyna Zaborowska-Sapeta
- Department of Rehabilitation and Orthopedics, School of Medicine, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
- Regional Specialized Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Ireneusz Kowalski
- Department of Rehabilitation and Orthopedics, School of Medicine, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
- Regional Specialized Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Ilona Karpiel
- Łukasiewicz Research Network—Krakow Institute of Technology, The Centre for Biomedical Engineering, Zakopianska Str. 73, 30-418 Krakow, Poland
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