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Kabir MH, Reformat M, Southon Hryniuk S, Stampe K, Lou E. Automated Method for Growing Rod Length Measurement on Ultrasound Images in Children With Early Onset Scoliosis. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00269-2. [PMID: 39127521 DOI: 10.1016/j.ultrasmedbio.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To develop and validate machine learning algorithms to automatically extract the rod length of the magnetically controlled growing rod from ultrasound images (US) in a pilot study. METHODS Two machine-learning (ML) models, called the "Boundary model" and "Rod model," were developed to identify specific rod segments on ultrasound images. The models were developed utilizing Mask Regional Convolutional Neural Networks (Mask RCNN). Ninety US images were acquired from 23 participants who had early onset scoliosis (EOS) surgeries; among those, 70 were used for model development, including training and validation, and 20 were used for testing by comparing the AI-based vs. manual measurements. RESULTS The average precision (AP) of the ML models was 88.5% and 60.2%, respectively. The inter-method correlation coefficient (ICC) was 0.98, and the mean absolute difference ± standard deviation (MAD ± SD) between AI and manual measurements was 0.86 ± 1.0 mm. The Bland-Altman analysis showed no bias, and 90% of the data were within the 95% confidence interval. The automated method was reliable, accurate, and fast. Measurements were displayed in 4.6 seconds after the US image was inputted. CONCLUSION This was the first AI-based method to measure the MCGR rod length on US images automatically.
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Affiliation(s)
- Mohammad Humayun Kabir
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Marek Reformat
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | | | - Kyle Stampe
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Edmond Lou
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada.
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Glowka P, Grabala P, Gupta MC, Pereira DE, Latalski M, Danielewicz A, Grabala M, Tomaszewski M, Kotwicki T. Complications and Health-Related Quality of Life in Children with Various Etiologies of Early-Onset Scoliosis Treated with Magnetically Controlled Growing Rods-A Multicenter Study. J Clin Med 2024; 13:4068. [PMID: 39064107 PMCID: PMC11277853 DOI: 10.3390/jcm13144068] [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: 06/23/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Early-onset scoliosis (EOS) refers to spinal deformities that develop and are diagnosed before the age of 10. The most important goals of the surgical treatment of EOS are to stop the progression of curvature, achieve the best possible correction, preserve motion, and facilitate spinal growth. The objectives of this multicenter study were to analyze the risk of complications among patients with EOS treated using magnetically controlled growing rods (MCGRs) and assess the patients' and their parents' quality of life after diagnosis and treatment with a minimum two-year follow-up. Methods: Patients given an ineffective nonoperative treatment qualified for surgery with MCGRs. This study involved 161 patients (90 females and 71 males) who were classified according to the etiology of curvature. The intraoperative and postoperative complications and those that occurred during the continuation of treatment with MCGRs were recorded and analyzed. The 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) was used to evaluate the patients' quality of life and satisfaction with the treatment. Results: Implant-related complications requiring instrumentation revision were recorded in 26% of the patients. Medical complications occurred in 45% of the population. The EOSQ-24 revealed a significant improvement in the average scores during the follow-up. Conclusions: The treatment of early-onset scoliosis with MCGRs carries 66% risks of incurring medical and mechanical complications, the latter 26% of patients requiring revision procedures. Children with neuromuscular scoliosis, females, and with curvature greater than 90 degrees are at a higher risk of developing complications. Limiting the number of elective surgeries necessitated to prolong the instrumentation and treatment process for patients with MCGRs can greatly enhance their quality of life and satisfaction throughout the follow-up period.
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Affiliation(s)
- Pawel Glowka
- Department of Spine Disorders and Pediatric Orthopaedics, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, no. 135/147, 61-545 Poznań, Poland; (P.G.); (M.T.); (T.K.)
| | - Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, University Children’s Hospital, Waszyngtona 17, 15-274 Bialystok, Poland
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
| | - Munish C. Gupta
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Ave., St. Louis, MO 63110, USA; (M.C.G.); (D.E.P.)
| | - Daniel E. Pereira
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Ave., St. Louis, MO 63110, USA; (M.C.G.); (D.E.P.)
| | - Michal Latalski
- Paediatric Orthopaedic Department, Medical University of Lublin, Gebali 6, 20-093 Lublin, Poland; (M.L.); (A.D.)
| | - Anna Danielewicz
- Paediatric Orthopaedic Department, Medical University of Lublin, Gebali 6, 20-093 Lublin, Poland; (M.L.); (A.D.)
| | - Michal Grabala
- 2nd Clinical Department of General and Gastroenterogical Surgery, The Medical University of Bialystok Clinical Hospital, Medical University of Bialystok, M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland;
| | - Marek Tomaszewski
- Department of Spine Disorders and Pediatric Orthopaedics, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, no. 135/147, 61-545 Poznań, Poland; (P.G.); (M.T.); (T.K.)
| | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopaedics, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, no. 135/147, 61-545 Poznań, Poland; (P.G.); (M.T.); (T.K.)
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Menapace B, Jain V, Sturm P. Autofusion in early-onset scoliosis growing constructs: occurrence, risk factors, and impacts. Spine Deform 2024; 12:1155-1163. [PMID: 38573486 DOI: 10.1007/s43390-024-00853-8] [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: 09/11/2023] [Accepted: 02/20/2024] [Indexed: 04/05/2024]
Abstract
PURPOSES Autofusion (AF) during growing rod (GR) instrumentation for early-onset scoliosis (EOS) has been reported, but AF incidence, causation, and clinical implications remain unknown. This article aims to (1) quantify frequency and severity of AF, (2) determine risk factors for AF, and (3) assess the influence of AF on final curve correction and spinal lengthening. METHODS EOS patients were prospectively enrolled (2016-2021). Patients underwent evaluation, GR implantation, lengthenings, and posterior spinal fusion (PSF). Cobb angle and spinal length measurements were collected. AF was assessed and graded, with grades I-II being low-grade and III-V being high-grade. Exposure analysis quantified risk factors' impact via odds ratios and Pearson regression correlates. Statistical significance was p ≤ 0.05 or ≥ 0.95. RESULTS 28 patients, with variable EOS diagnoses, were included. On average, GR were implanted at 8.54-year-old and lengthened over 4.66 years. 53.6% of patients received magnetically controlled GR (MCGR) and 46.4% traditional GR (TGR). The average construct bridged 13.4 levels. Over the lengthening period, for all indications, patients averaged 2.9 total open procedures. Curves corrected from 68.5º preoperatively to 35.3º after index GR to 35.6º after PSF. Spinal length increased from 30.0 cm preoperatively to 33.9 cm after index GR to 39.5 cm after PSF. AF grading was: 28.6% Grade I, 25.0% Grade II, 17.9% Grade III, 25.0% Grade IV, and 3.6% Grade V. Idiopathic EOS tended to have lower AF grades (p = 0.37). AF risk factors included GR age < 8 (10.4×, p = 0.01), any interval open procedures (6.3×, p = 0.05), and residual curve > 30º after index GR (13.7×, p = 0.02). Protective factors included preoperative spinal length of > 30.0 cm (0.11×, p = 0.01) and index MCGR (0.16×, p = 0.03). Maintenance of Cobb angles from index GR through PSF was relatively better in low-grade patients (p = 0.08). Spinal length gained was no different between low- and high-grade AF (p = 0.50). CONCLUSIONS This largest-to-date evaluation found AF is nearly ubiquitous in GR constructs, but with variable severity. Both risk factors and protective factors coincide with AF. Ultimately, even in high-grade AF, curve correction was maintained, and spinal lengthening was achieved. LEVEL OF EVIDENCE Level II-prospective cohort study.
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Affiliation(s)
- Bryan Menapace
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA.
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Viral Jain
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Peter Sturm
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Furuya M, Takeoka Y, Yurube T, Ito M, Suzuki T, Kakutani K, Uno K. Two-Staged Surgery for Kyphoscoliosis in Larsen Syndrome with A 30-Year Follow-Up: A Case Report. Spine Surg Relat Res 2024; 8:338-341. [PMID: 38868788 PMCID: PMC11165505 DOI: 10.22603/ssrr.2023-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/21/2023] [Indexed: 06/14/2024] Open
Affiliation(s)
- Masahiko Furuya
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Yoshiki Takeoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaaki Ito
- Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Teppei Suzuki
- Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koki Uno
- Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
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Grabala P. Minimally Invasive Controlled Growing Rods for the Surgical Treatment of Early-Onset Scoliosis-A Surgical Technique Video. J Pers Med 2024; 14:548. [PMID: 38929769 PMCID: PMC11205236 DOI: 10.3390/jpm14060548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Spinal deformities in children and adolescents can be easily divided into those occurring and diagnosed before the age of 10-early-onset scoliosis-and those occurring and diagnosed after the age of 10-late-onset scoliosis. When the curvature continues to progress and exceeds a Cobb angle of more than 60-65 degrees, surgical treatment should be considered. The most common treatment procedure for EOS is the surgical correction of the deformity using standard growing rods (SGRs), and in the case of congenital defects with additional hemivertebrae, it is the resection of the hemivertebra and short fusion. Minimally invasive controlled growing rods (MICGRs) need to be distracted every 6-9 months through a minimally invasive approach that involves sedation and neuromonitoring to obtain the best possible correction while minimizing complications. The aim of our study is to present a less-invasive surgical technique for MICGR implantation based on a two-case presentation-early-onset idiopathic scoliosis and congenital kyphosis. The surgical technique is the less-invasive percutaneous and subfascial implantation of MICGRs without long incisions in the back. CONCLUSIONS The use of MICGRs is an alternative and safe surgical technique for patients undergoing surgical treatment for EOS. Without the risk of metallosis, like in other implant systems, and the need for replacement after 2 years of use, like in using magnetically controlled growing rods (MCGRs), the MICGR system can be used as a less-invasive procedure, allowing for the avoidance of many periodic invasive procedures in children with a wider opening of the spine (like in using standard growing rods), minimizing the number of planned hospitalizations, reducing the length of hospital stays, and reducing the physical and mental burdens on young patients, parents, and families.
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Affiliation(s)
- Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, Medical University of Bialystok, 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, Medical University of Bialystok Clinical Hospital, ul. M. Sklodowskiej-Curie 24A, 15-276 Balystok, Poland
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Zhang H, Liu H, Zhang X, Zhao M, Guo D, Bai Y, Qi X, Shi H, Li D. Short-term outcomes of an enhanced recovery after surgery pathway for children with congenital scoliosis undergoing posterior spinal fusion: a case-control study of 70 patients. J Pediatr Orthop B 2024; 33:258-264. [PMID: 37339529 DOI: 10.1097/bpb.0000000000001105] [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: 06/22/2023]
Abstract
Increasing evidence demonstrates the advantages of an enhanced recovery after surgery (ERAS) protocol; however, few studies have evaluated ERAS in pediatric patients. This study aimed to evaluate the effect of ERAS in pediatric patients with congenital scoliosis. Seventy pediatric patients with congenital scoliosis underwent posterior hemivertebra resection and fusion with pedicle screws and were prospectively randomly assigned to the ERAS group ( n = 35) and control group ( n = 35). ERAS management comprised 15 elements including a shortened fasting time, optimized anesthesia protocol, and multimodal analgesia. The control group received traditional perioperative management. Clinical outcome was evaluated by hospital stay, surgery-related indicators, diet, pain scores, laboratory tests, and complications. The surgical outcome showed a similar correction rate in the ERAS group (84.0%) and control group (89.0%; P = 0.471). The mean fasting time was significantly shorter in the ERAS group than in the control group. Compared with the control group, the ERAS group had significantly shorter mean times to postoperative hospital stay, first anal exhaust and defecation, significantly lower mean pain scores in the first 2 days postoperatively ( P < 0.05), and a significantly lower mean interleukin-6 concentration on postoperative day 1 ( P < 0.001). The incidence of complications was similar in the ERAS group and control group ( P > 0.05). The ERAS protocol is effective and safe for pediatric patients with congenital spinal deformity and may significantly improve the treatment efficacy compared with traditional perioperative management methods. Levels of Evidence: III.
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Affiliation(s)
- Hanwen Zhang
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Haonan Liu
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Xuejun Zhang
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Mengqi Zhao
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Dong Guo
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Yunsong Bai
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Xinyu Qi
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Haixia Shi
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Duoyi Li
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Studer D, Hasler CC. Diagnostic and therapeutic strategies in early onset scoliosis: A current concept review. J Child Orthop 2024; 18:113-123. [PMID: 38567043 PMCID: PMC10984154 DOI: 10.1177/18632521241228141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 04/04/2024] Open
Abstract
Substantial advances in the treatment of early onset scoliosis (EOS) over the past two to three decades have resulted in significant improvements in health-related quality of life of affected children. In addition to classifications that address the marked heterogeneity of this patient population, increasing understanding of the natural history of the disease, and new implants and treatment techniques have resulted in innovations unlike any other area of pediatric orthopedics. The growing understanding of the interaction between spinal and thoracic growth, as well as dependent lung maturation, has had a lasting impact on the treatment strategy of this potentially life-threatening disease. The previous treatment approach with early corrective fusion gave way to a growth-friendly concept. Despite the steady development of new growth-friendly surgical treatment options, whose efficacy still needs to be validated, as well as a revival of conservative growth control with serial casts and/or braces, the psychosocial burden of the long lasting and complication-prone treatments remains high. As a consequence, EOS still represents one of the greatest pediatric orthopedic challenges.
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Affiliation(s)
- Daniel Studer
- Orthopaedic Department, University Children’s Hospital Basel UKBB, Basel, Switzerland
| | - Carol Claudius Hasler
- Orthopaedic Department, University Children’s Hospital Basel UKBB, Basel, Switzerland
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Zhang Y, Li Q, Shi Z, Li Q, Dai X, Pan C, Ma Y, Yan R, Fei D, Xie J. A novel growth-friendly system alleviates pulmonary dysplasia in early-onset scoliosis combined with thoracic insufficiency syndrome: Radiological, pathological, and transcriptomic assessments. Heliyon 2024; 10:e27887. [PMID: 38509966 PMCID: PMC10951595 DOI: 10.1016/j.heliyon.2024.e27887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
Background The posterior procedure utilizing growth-friendly techniques is the golden standard for patients with early-onset scoliosis combined with thoracic insufficiency syndrome (EOS + TIS). Pulmonary hypoplasia is the main cause of dying prematurely in the EOS + TIS. This study assessed the therapeutic impact of a novel growth-friendly system on the pulmonary development of piglet's EOS + TIS model. Methods The animal procedure period lasts 12 weeks, of which the construction of the EOS + TIS was performed at 0-8 weeks, and implantation of a novel growth-friendly system was applied at 8-12 weeks. During the animal procedure, X-rays and CT were performed to observe scoliosis, thorax, and lungs. After 12 weeks, pathological changes in lung tissue were assessed using HE and IHC staining. RNA-seq characterized novel growth-friendly system-associated differentially expressed genes (DEGs) and validated using RT-qPCR, western blotting, and IHC. Results Implantation of the novel growth-friendly system increased body weight, body length, and total lung volume, as well as decreased the coronal and sagittal Cobb angles for the EOS + TIS model. It also ameliorated EOS + TIS-induced thickening of the alveolar wall, increased alveolar spaces, and decreased alveolar number and diameter. In lung tissue, a total of 790 novel growth-friendly system-associated DEGs were identified, and they were mainly involved in the regulation of immune, inflammatory, calcium transport, and vascular development. Among these DEGs, BDKRB1, THBS1, DUSP1, IDO1, and SPINK5 were hub genes, and their differential expression was consistent with RNA-seq results in lung tissues. Conclusion The novel growth-friendly system has mitigated scoliosis and pulmonary hypoplasia in the EOS + TIS model. We further elucidate the molecular mechanisms underlying the amelioration of pulmonary hypoplasia.
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Affiliation(s)
- Ying Zhang
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Quan Li
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Zhiyue Shi
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Qitang Li
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Xinfei Dai
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Cheng Pan
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Yujian Ma
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Rongshuang Yan
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Derui Fei
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Jingming Xie
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
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Lim HJ, Yoon H, Kim J, Han K, So Y, Park M, Park KB, Lee MJ. Comparison of elasticity changes in the paraspinal muscles of adolescent patients with scoliosis treated with surgery and bracing. Sci Rep 2024; 14:5623. [PMID: 38453994 PMCID: PMC10920829 DOI: 10.1038/s41598-024-56189-w] [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: 12/11/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
Scoliosis is a three-dimensional spinal deformity, and paraspinal muscles play an important role as stabilizers of the spinal curve. In this prospective study, we compared elasticity changes in the paraspinal muscles of adolescent patients with scoliosis after surgery or bracing. Elasticity was measured on the concave and convex sides of the paraspinal muscles at the apex of the curve at the beginning of treatment and 6 and 12 months after treatment. Twenty-six patients with correction surgery (n = 15) or bracing (n = 11) were included. At initial evaluation, the Cobb angle was larger in the surgery group (72.3 ± 20.2° in surgery vs. 30.6 ± 5.1° in brace, p < 0.001). The estimated mean elasticity value of the paraspinal muscles was lower in the surgery group at baseline on the convex side (15.8 vs. 22.8 kPa, p = 0.037) and 6 months on both the concave (12.1 vs. 22.7 kPa, p = 0.004) and convex (13.4 vs. 23.8 kPa, p = 0.005) sides. There was a significant stiffness decrease from baseline to 6 months on the concave side in the surgery group (5.9 kPa, p = 0.025). However, the elasticity change recovered at 12 months without significant differences between the two groups.
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Affiliation(s)
- Hyun Ji Lim
- Department of Pediatric Radiology, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Haesung Yoon
- Department of Pediatric Radiology, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Jisoo Kim
- Department of Pediatric Radiology, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Yuri So
- Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, South Korea
| | - Mincheol Park
- Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kun-Bo Park
- Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea.
| | - Mi-Jung Lee
- Department of Pediatric Radiology, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Heemskerk JL, Willigenburg NW, Veraart BEEMJ, Bakker EW, Castelein RM, Altena MC, Kempen DHR. Heath-related quality of life and functional outcomes in patients with congenital or juvenile idiopathic scoliosis after an average follow-up of 25 years: a cohort study. Spine J 2024; 24:462-471. [PMID: 38029931 DOI: 10.1016/j.spinee.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/01/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND CONTEXT Congenital and juvenile scoliosis are both early-onset deformities that develop before the age of 10. Children are treated to prevent curve progression and problems in adulthood such as back pain and a decreased quality of life but literature on long-term outcomes remains scarce. PURPOSE To evaluate the health-related quality of life (HRQoL) and potential disability of children with congenital scoliosis (CS) or juvenile idiopathic scoliosis (JIS) after a minimum of 20 years follow-up. STUDY DESIGN Comparative cohort study. PATIENT SAMPLE A consecutive cohort of CS and JIS patients were retrospectively identified from a single-center scoliosis database. Patients born between 1968 and 1981 and treated during skeletal growth were eligible for participation. OUTCOME MEASURES HRQoL (SF-36, SRS-22r, ODI). METHODS The primary aim was to evaluate the HRQoL of CS and JIS patients using the general SF-36 questionnaire. Both patient cohorts were compared with age-matched national norms. The secondary aim was to analyze the differences between conservatively and surgically treated patients using the scoliosis-specific Scoliosis Research Society-22r questionnaire (SRS-22r) and the Oswestry Disability Index (ODI). T-tests were used for statistical comparison. RESULTS In total, 114 patients (67% of the eligible patients) completed the questionnaire, with a mean follow-up of 25.5±5.5 years after their final clinical follow-up. Twenty-nine patients with CS were included with a mean age of 44.4±3.8 years (79.3% female), and 85 patients with JIS with a mean age of 43.7±4.2 years (89.4% female). Of the SF-36 domains, only the vitality score (60.6±18.0 for CS and 58.1±17.6 for JIS cohort) and mental health score (70.0±18.4 for CS and 72.1±18.1 for JIS cohort) were significantly lower compared with the general population (68.6±19.3 for vitality, and 76.8±17.4 for mental health). These decreased scores were larger than the determined minimum clinically important difference threshold of 4.37. Surgically treated JIS patients had a significantly lower score on the SRS-22r pain domain than their nonsurgically treated peers (3.6±0.9 vs 4.1±0.7l p=.019). Surgically treated CS patients had a significantly higher score on the SRS-22r mental health domain than their nonsurgically treated peers (4.3±0.5 vs 3.5±1.0; p=.023). No significant differences were found in the other domains. CONCLUSIONS Except for vitality and mental health domains, congenital and juvenile idiopathic scoliosis patients treated during skeletal growth had similar HRQoL on most SF-36 domains in adulthood compared with national norms. Surgical treated JIS patients experienced more pain compared with brace treated patients, while braced CS patients had a significantly lower mental scores compared with surgical treated patients. These long-term outcomes are essential to inform patients and can guide shared decision-making between clinicians and patients.
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Affiliation(s)
- Johan L Heemskerk
- Department of Orthopedic Surgery, OLVG hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
| | - Nienke W Willigenburg
- Department of Orthopedic Surgery, OLVG hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Ben E E M J Veraart
- Department of Orthopedic Surgery, OLVG hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Eric W Bakker
- Department of Clinical Epidemiology and biostatistics, Meibergdreef 9, 1105 AZ, Amsterdam Medical Center location AMC, Amsterdam, The Netherlands
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX , The Netherlands
| | - Mark C Altena
- Department of Orthopedic Surgery, OLVG hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands; Department of Orthopedic Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Diederik H R Kempen
- Department of Orthopedic Surgery, OLVG hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands; Department of Orthopedic Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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11
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Wacker EM, Schultz L, Leitsinger N, Jain VV, Sturm PF. Growing Rod versus Posterior Spinal Fusion Treatment of Juvenile Idiopathic Scoliosis: Unique Characteristics and Surgical Outcomes. Healthcare (Basel) 2024; 12:489. [PMID: 38391864 PMCID: PMC10887821 DOI: 10.3390/healthcare12040489] [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: 01/09/2024] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024] Open
Abstract
Progressive spinal curvature in juvenile idiopathic scoliosis (JIS) is challenging to treat. When conservative management fails, treatments include growing rods (GRs) or posterior spinal fusion (PSF). The purpose of this study is to compare the patient characteristics and outcomes of GR and PSF treatment of JIS. We performed a retrospective review of demographic, radiographic, and surgical data for all JIS patients requiring surgical treatment between 2012 and 2020. Patients who underwent any GR treatment were compared to PSF patients. A total of 36 patients (13 GR, 23 PSF) were reviewed. PSF patients had a larger pre-operative spinal height (p = 0.002), but similar pre-operative major curve magnitudes (p = 0.558). PSF treatment resulted in similar change in the T1-S1 length (p = 0.002), but a greater correction of the curve magnitude (p < 0.055) compared to GR patients. Eight patients initially treated with GRs later underwent definitive PSF treatment. This subset of patients had a greater spinal height before PSF (p = 0.006), but similar immediate post-PSF T1-S1 lengths (p = 0.437) and smaller changes in spinal height from PSF (p = 0.020) than primary PSF patients. At final follow-up, patients who underwent primary PSF versus PSF after GR had similar spinal heights (p = 0.842). The surgical intervention chosen to manage progressive JIS often differs based on patient characteristics. While this choice may impact immediate outcomes, the outcomes at final follow up are similar.
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Affiliation(s)
- Elizabeth M Wacker
- University of Cincinnati Medical Center, Cincinnati, OH 45219, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Lindsay Schultz
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nichole Leitsinger
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Viral V Jain
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Peter F Sturm
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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12
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Gurel R, Elbaz E, Sigal A, Gigi R, Otremski H, Lebel DE, Ovadia D. Magnetically Controlled Growing Rods Graduation: Lessons From a Single-center Series of 48 Patients. J Pediatr Orthop 2024; 44:e157-e162. [PMID: 37937343 DOI: 10.1097/bpo.0000000000002560] [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: 11/09/2023]
Abstract
BACKGROUND Magnetically controlled growing rod (MCGR) treatment for early-onset scoliosis (EOS) has become a widely utilized method of deformity control, but long-term follow-up reports are sparse. We evaluated the outcomes of a large group of consecutive pediatric patients diagnosed with EOS who were treated by MCGR to the endpoint of definitive spinal fusion in a single center. We hypothesized that lessons learned from treating a large volume of MCGR patients would lower the complication rate in comparison to what was previously reported by other studies. METHODS The records of 48 EOS patients with varied etiologies who were treated by MCGR between 2012 and 2022 and reached the end of treatment were analyzed retrospectively for baseline and final radiographic measurements and surgery-related complications. RESULTS The mean percent of improvement in the major coronal deformity was 51.7±25.0% and the mean T1 to T12 total growth was 52.9±21.9 mm. The total complication rate was 22.9% of which 12.5% required a single unplanned surgery, 6.3% required multiple unplanned surgeries, and 4% did not require any unplanned surgery. CONCLUSION MCGR treatment provides adequate control of EOS, enabling satisfactory growth of the thoracic spine. The complication rate in a single large volume center is moderate. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ron Gurel
- Department of Orthopedic Surgery and Pediatric Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Etay Elbaz
- Department of Orthopedic Surgery and Pediatric Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Sigal
- Department of Orthopedic Surgery and Pediatric Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Gigi
- Department of Orthopedic Surgery and Pediatric Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Otremski
- Department of Orthopedic Surgery and Pediatric Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David E Lebel
- Hospital for Sick Children, Toronto, Canada Affiliated to the Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dror Ovadia
- Department of Orthopedic Surgery and Pediatric Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Lau RWL, Hung ALH, Kee HM, Wong LCH, Chan VKW, Chung DWY, Chan JKT, Chau BKP, Leung SHF, Cheng JCY, Lam TP, Lau AYC. Clinical Outcomes of 111 Patients with Early Onset Idiopathic Scoliosis (EOIS) Receiving Brace Treatment: A Longitudinal Retrospective Cohort Study. J Clin Med 2024; 13:767. [PMID: 38337461 PMCID: PMC10856002 DOI: 10.3390/jcm13030767] [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: 11/29/2023] [Revised: 12/29/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Introduction: Bracing is one of the first-line treatment for early-onset idiopathic scoliosis (EOIS) to control curves from progression. This study aimed to explore the determinants that govern bracing effectiveness in EOIS. Methods: One hundred and eleven patients with EOIS (mean age of 8.6 ± 1.25 at diagnosis) received bracing treatment and had a final follow-up beyond skeletal maturity were identified from records between 1988 and 2021. Demographic data and clinical features of spinal curvature were obtained for correlation analyses to determine the associations between curve outcomes and clinical features. Results: Most patients were female (85.6%) and had a major curve on the left side (67%). The mean baseline Cobb angle of major curves was 21.73 ± 7.92°, with a mean Cobb angle progression of 18.05 ± 19.11°. The average bracing duration was 5.3 ± 1.9 years. Only 26 (23.4%) of them underwent surgery. The final Cobb angle and curve progression at the final follow-up with a Cobb angle of ≥50° were positively correlated with the initial Cobb angle (r = 0.206 and r = 0.313, respectively) and negatively correlated with maturity parameters. The lumbar curve type was found to correlate with a smaller final Cobb angle. Conclusions: The majority of patients had a final Cobb angle < 50°, which was considered a successful bracing outcome. The final Cobb angle correlated with the initial Cobb angle and curve types observed in EOIS.
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Affiliation(s)
- Rufina Wing-Lum Lau
- School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR, China;
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China (J.C.-Y.C.); (T.-P.L.)
| | - Alec Lik-Hang Hung
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China (J.C.-Y.C.); (T.-P.L.)
| | - Ho-Man Kee
- Department of Prosthetics and Orthotic, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Leo Chung-Hei Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| | - Victor Kin-Wai Chan
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| | - Derek Wai-Yin Chung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| | - Jerry Kwok-To Chan
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| | - Bosco Kin-Pok Chau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| | - Stanley Ho-Fung Leung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| | - Jack Chun-Yiu Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China (J.C.-Y.C.); (T.-P.L.)
| | - Tsz-Ping Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China (J.C.-Y.C.); (T.-P.L.)
| | - Adam Yiu-Chung Lau
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China (J.C.-Y.C.); (T.-P.L.)
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
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14
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Heyer JH, Anari JB, Baldwin KD, Mitchell SL, Flynn JM, Sankar WN, Andras LM, Skaggs DL, Smith JT, Luhmann SJ, Swarup I, Truong WH, Brooks JT, Fitzgerald R, Li Y, Cahill PJ. Rib-to-spine and rib-to-pelvis magnetically controlled growing rods: does the law of diminishing returns still apply? Spine Deform 2023; 11:1517-1527. [PMID: 37450222 DOI: 10.1007/s43390-023-00718-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/03/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The Law Of Diminishing Returns (LODR) has been demonstrated for traditional growing rods, but there is conflicting data regarding the lengthening behavior of Magnetically Controlled Growing Rods (MCGR). This study examines a cohort of patients with early-onset scoliosis (EOS) with rib-to-spine or rib-to-pelvis-based MCGR implants to determine if they demonstrate the LODR, and if there are differences in lengthening behaviors between the groups. METHODS A prospectively collected multicenter EOS registry was queried for patients with MCGR with a minimum 2-year follow-up. Patients with rib-based proximal anchors and either spine- or pelvis-based distal anchors were included. Patients with non-MCGR, unilateral constructs, < 3 lengthenings, or missing > 25% datapoints were excluded. Patients were further divided into Primary-MCGR (pMCGR) and Secondary-MCGR (sMCGR). RESULTS 43 rib-to-spine and 31 rib-to-pelvis MCGR patients were included. There was no difference in pre-implantation, post-implantation and pre-definitive procedure T1-T12 height, T1-S1 height, and major Cobb angles between the groups (p > 0.05). Sub-analysis was performed on 41 pMCGR and 19 sMCGR rib-to-spine patients, and 31 pMCGR and 17 sMCGR rib-to-pelvis patients. There is a decrease in rod lengthenings achieved at subsequent lengthenings for each group: rib-to-spine pMCGR (rho = 0.979, p < 0.001), rib-to-spine sMCGR (rho = 0.855, p = 0.002), rib-to-pelvis pMCGR (rho = 0.568, p = 0.027), and rib-to-pelvis sMCGR (rho = 0.817, p = 0.007). Rib-to-spine pMCGR had diminished lengthening over time for idiopathic, neuromuscular, and syndromic patients (p < 0.05), with no differences between the groups (p > 0.05). Rib-to-pelvis pMCGR neuromuscular patients had decreased lengthening over time (p = 0.01), but syndromic patients had preserved lengthening over time (p = 0.65). CONCLUSION Rib-to-spine and rib-to-pelvis pMCGR and sMCGR demonstrate diminished ability to lengthen over subsequent lengthenings.
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Affiliation(s)
- Jessica H Heyer
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Jason B Anari
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Keith D Baldwin
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Stuart L Mitchell
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC, USA
| | - John M Flynn
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Wudbhav N Sankar
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Lindsay M Andras
- Department of Orthopaedics, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - David L Skaggs
- Department of Orthopaedics, Cedars Sinai, Los Angeles, CA, USA
| | - John T Smith
- Department of Orthopaedics, University of Utah Health, Salt Lake City, UT, USA
| | - Scott J Luhmann
- Department of Orthopaedic Surgery, Shriners Children's Pediatric Specialty Care, St. Louis, MO, USA
| | - Ishaan Swarup
- Department of Orthopaedics, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | - Walter H Truong
- Department of Orthopaedics, Gilette Children's, St. Paul, MN, USA
| | - Jaysson T Brooks
- Department of Orthopaedics, Scottish Rite for Children, Dallas, TX, USA
| | - Ryan Fitzgerald
- Children's Orthopaedic and Scoliosis Surgery Associates, St. Petersburg, FL, USA
| | - Ying Li
- Department of Orthopaedics, Univeristy of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Patrick J Cahill
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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15
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Wang H, Zhang T, Zhang C, Shi L, Ng SYL, Yan HC, Yeung KCM, Wong JSH, Cheung KMC, Shea GKH. An intelligent composite model incorporating global / regional X-rays and clinical parameters to predict progressive adolescent idiopathic scoliosis curvatures and facilitate population screening. EBioMedicine 2023; 95:104768. [PMID: 37619449 PMCID: PMC10470293 DOI: 10.1016/j.ebiom.2023.104768] [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: 05/11/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) affects up to 5% of the population. The efficacy of school-aged screening remains controversial since it is uncertain which curvatures will progress following diagnosis and require treatment. Patient demographics, vertebral morphology, skeletal maturity, and bone quality represent individual risk factors for progression but have yet to be integrated towards accurate prognostication. The objective of this work was to develop composite machine learning-based prediction model to accurately predict AIS curves at-risk of progression. METHODS 1870 AIS patients with remaining growth potential were identified. Curve progression was defined by a Cobb angle increase in the major curve of ≥6° between first visit and skeletal maturity in curves that exceeded 25°. Separate prediction modules were developed for i) clinical data, ii) global/regional spine X-rays, and iii) hand X-rays. The hand X-ray module performed automated image classification and segmentation tasks towards estimation of skeletal maturity and bone mineral density. A late fusion strategy integrated these domains towards the prediction of progressive curves at first clinic visit. FINDINGS Composite model performance was assessed on a validation cohort and achieved an accuracy of 83.2% (79.3-83.6%, 95% confidence interval), sensitivity of 80.9% (78.2-81.9%), specificity of 83.6% (78.8-84.1%) and an AUC of 0.84 (0.81-0.85), outperforming single modality prediction models (AUC 0.65-0.78). INTERPRETATION The composite prediction model achieved a high degree of accuracy. Upon incorporation into school-aged screening programs, patients at-risk of progression may be prioritized to receive urgent specialist attention, more frequent follow-up, and pre-emptive treatment. FUNDING Funding from The Society for the Relief of Disabled Children was awarded to GKHS.
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Affiliation(s)
- Hongfei Wang
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Teng Zhang
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Changmeng Zhang
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Liangyu Shi
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Samuel Yan-Lik Ng
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Ho-Cheong Yan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | | | - Janus Siu-Him Wong
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Kenneth Man-Chee Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Graham Ka-Hon Shea
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China.
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16
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Van Halm-Lutterodt NI, Al-Saidi NN, Mandalia K, Mesregah MK, Ghanem KM, Storlie NR, Huang WH, Chen WC, Bartels-Mensah M, Chen XY, Ye Z, Zhang Y, Pan A, Kim SS, Lonner B, Alanay A, Hai Y. Comparison of Overall Complication Rates in VCR-Based vs Non-VCR-Based Corrective Techniques in Severe Rigid Kyphoscoliosis Patients: A Systematic Review and Meta-Analysis. Global Spine J 2023; 13:1646-1657. [PMID: 36548436 PMCID: PMC10448105 DOI: 10.1177/21925682221146502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Compilation of complication outcomes data from the surgical management of severe rigid kyphoscoliosis patients using VCR-based vs non-VCR-based corrective maneuvers is lacking. This meta-analysis aimed to compare complication outcomes between those classified osteotomy approaches. METHODS Thorough literature review and meta-analysis were conducted between January 2000 and September 2021. The selection criteria were studies: i) reporting major curve Cobb angle of ≥80° and flexibility of <25% or 30%; ii) comparing VCR or ≥ Type V Schwab osteotomy defined as VCR-based vs [non-VCR-based] techniques, (any osteotomy or technique other than VCR); iii) published in English with ≥10 patients; iv) reporting complication rates; and v) having minimum of 2-year follow-up. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Significance level was set at (P < .05). RESULTS Of the 174 patients included, 52.30% (n = 91) and 47.70% (n = 83) were VCR-based and non-VCR-based, respectively. The incidence of dural tears/nerve injuries/significant intraoperative-neuromonitoring changes was significantly higher; [OR = 6.78, CI= (1.75 to 26.17), I2 = 0%, (P = .006)] in the VCR-based group than the non-VCR-based group. The 'overall surgical and medical' complication rate was significantly higher in the VCR-based group, [OR = 1.94, CI= (1.02 to 3.67), I2 = 31%, (P = .04)]. CONCLUSION Both VCR-based and non-VCR-based surgical techniques for management of severe rigid scoliosis and kyphoscoliosis patients pose comparable overall surgical complication rates, while a significantly higher perioperative neurological complication incidence was associated with VCR-based technique compared to the non-VCR-based techniques. The VCR-based technique was associated with 6.78 times higher incidence of neurological complications compared to non-VCR-based techniques.
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Affiliation(s)
- Nicholas Ishmael Van Halm-Lutterodt
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China
- Department of Orthopedics Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
| | | | | | - Mohamed Kamal Mesregah
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
| | | | | | - Wei-Hsun Huang
- Beijing Friendship Hospital Affiliated-Capital Medical University, China
| | - Wei-Cheng Chen
- Beijing Tongren Hospital Affiliated-Capital Medical University, China
| | | | - Xin Yuan Chen
- Department of Arts and Sciences, Concordia University, Montreal, QC, Canada
| | - Ziyang Ye
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
- Department of Business Analytics, University of Chicago, IL, USA
- Tristate Brain, and Spine Institute, Alexandria, MN, USA
| | - Yangpu Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
| | - Sunny Sik Kim
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
- Tristate Brain, and Spine Institute, Alexandria, MN, USA
| | - Baron Lonner
- Department of Orthopedics Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
| | - International Spinal Deformity Review Study Group (ISDRSG)
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China
- Department of Orthopedics Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
- Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
- Tufts University School of Medicine, Boston, MA, USA
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
- Creighton University School of Medicine, Omaha, NE, USA
- Beijing Friendship Hospital Affiliated-Capital Medical University, China
- Beijing Tongren Hospital Affiliated-Capital Medical University, China
- University of Debrecen School of Medicine, Hungary
- Department of Arts and Sciences, Concordia University, Montreal, QC, Canada
- Department of Business Analytics, University of Chicago, IL, USA
- Tristate Brain, and Spine Institute, Alexandria, MN, USA
- Department of Orthopedics Surgery, The Mount Sinai Hospital, New York, NY, USA
- Department of Orthopedics and Traumatology, Acibadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
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17
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Lamb CD, Quinones A, Zhang JY, Paik G, Chaluts D, Carr M, Lonner BS, Margetis K. Evaluating Adult Idiopathic Scoliosis as an Independent Risk Factor for Critical Illness in SARS-CoV-2 Infection. World Neurosurg 2023; 177:S1878-8750(23)00810-0. [PMID: 37343676 PMCID: PMC10279461 DOI: 10.1016/j.wneu.2023.06.041] [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: 05/24/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Thoracic spinal deformities may reduce chest wall compliance, leading to respiratory complications. The first SARS-CoV-2 (L-variant) strain caused critical respiratory illness, especially in vulnerable patients. This study investigates the association between scoliosis and SARS-CoV-2 (COVID-19) disease course severity. METHODS Clinical data of 129 patients treated between March 2020 to June 2021 who received a positive COVID-19 polymerase chain reaction result from Mount Sinai and had a scoliosis ICD-10 code (M41.0-M41.9) was retrospectively analyzed. Degree of coronal plane scoliosis on imaging was confirmed by 2 independent measurers and grouped into no scoliosis (Cobb angle <10°), mild (10°-24°), moderate (25°-39°), and severe (>40°) cohorts. Baseline characteristics were compared, and a multivariable logistic regression controlling for clinically significant comorbidities examined the significance of scoliosis as an independent risk factor for hospitalization, intensive care unit (ICU) admission, acute respiratory distress syndrome (ARDS), mechanical ventilation, and mortality. RESULTS The no (n = 42), mild (n = 14), moderate (n = 44), and severe scoliosis (n = 29) cohorts differed significantly only in age (P = 0.026). The percentage of patients hospitalized (P = 0.59), admitted to the ICU (P = 0.33), developing ARDS (P = 0.77), requiring mechanical ventilation (P = 1.0), or who expired (P = 0.77) did not significantly differ between cohorts. The scoliosis cohorts did not have a significantly higher likelihood of hospital admission (mild P = 0.19, moderate P = 0.67, severe P = 0.98), ICU admission (P = 0.97, P = 0.94, P = 0.22), ARDS (P = 0.87, P = 0.74, P = 0.94), mechanical ventilation (P = 0.73, P = 0.69, P = 0.70), or mortality (P = 0.74, P = 0.87, P = 0.66) than the no scoliosis cohort. CONCLUSIONS Scoliosis was not an independent risk factor for critical COVID-19 illness. No trends indicated any consistent effect of degree of scoliosis on increased adverse outcome likelihood.
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Affiliation(s)
- Colin D Lamb
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA.
| | - Addison Quinones
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Jack Y Zhang
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Gijong Paik
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Danielle Chaluts
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Matthew Carr
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Baron S Lonner
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
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Braun S, Brenneis M, Schönnagel L, Caffard T, Diaremes P. Surgical Treatment of Spinal Deformities in Pediatric Orthopedic Patients. Life (Basel) 2023; 13:1341. [PMID: 37374124 DOI: 10.3390/life13061341] [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: 05/18/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Scoliosis and Scheuermann's disease are common spinal deformities that affect a substantial population, particularly adolescents, often impacting their quality of life. This comprehensive review aims to present a detailed understanding of these conditions, their diagnosis, and various treatment strategies. Through an extensive exploration of current literature, the review discusses the etiology of these spinal deformities and the use of diagnostic tools such as X-rays and MRI. It further delves into the range of treatment options available, from conservative approaches such as physiotherapy and bracing to more invasive surgical interventions. The review underscores the necessity of an individualized treatment approach, taking into account factors such as the patient's age, the severity of the curvature, and overall health. This all-encompassing perspective on scoliosis and Scheuermann's disease will aid in evidence-based decision making in their management with the goal of improving patient outcomes.
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Affiliation(s)
- Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Marco Brenneis
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Lukas Schönnagel
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 10117 Berlin, Germany
- Spine Care Institute, Hospital for Special Surgery, New York, NY 10021, USA
| | - Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Orthopaedic Surgery, University of Ulm, 89075 Ulm, Germany
| | - Panagiotis Diaremes
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
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Wang Y, Wang D, Zhang G, Ma B, Ma Y, Yang Y, Xing S, Kang X, Gao B. Effects of spinal deformities on lung development in children: a review. J Orthop Surg Res 2023; 18:246. [PMID: 36967416 PMCID: PMC10041811 DOI: 10.1186/s13018-023-03665-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 03/01/2023] [Indexed: 03/28/2023] Open
Abstract
Scoliosis before the age of 5 years is referred to as early-onset scoliosis (EOS). While causes may vary, EOS can potentially affect respiratory function and lung development as children grow. Moreover, scoliosis can lead to thoracic insufficiency syndrome when aggravated or left untreated. Therefore, spinal thoracic deformities often require intervention in early childhood, and solving these problems requires new methods that include the means for both deformity correction and growth maintenance. Therapeutic strategies for preserving the growing spine and thorax include growth rods, vertically expandable titanium artificial ribs, MAGEC rods, braces and casts. The goals of any growth-promoting surgical strategy are to alter the natural history of cardiorespiratory development, limit the progression of underlying spondylarthrosis deformities and minimize negative changes in spondylothorax biomechanics due to the instrumental action of the implant. This review further elucidates EOS in terms of its aetiology, pathogenesis, pathology and treatment.
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Affiliation(s)
- Yonggang Wang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Dongmin Wang
- Medical College of Northwest Minzu University, No. 1 Northwest Xincun, Lanzhou, 730030, Gansu Province, China
| | - Guangzhi Zhang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Bing Ma
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Yingping Ma
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Yong Yang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Shuai Xing
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Xuewen Kang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Bingren Gao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China.
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Grabala P, Helenius IJ, Chamberlin K, Galgano M. Less-Invasive Approach to Early-Onset Scoliosis—Surgical Technique for Magnetically Controlled Growing Rod (MCGR) Based on Treatment of 2-Year-Old Child with Severe Scoliosis. CHILDREN 2023; 10:children10030555. [PMID: 36980113 PMCID: PMC10047795 DOI: 10.3390/children10030555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023]
Abstract
Background: Spinal deformities in children can be caused by various etiologies, such as congenital, syndromic, neuromuscular, or idiopathic. Early-onset scoliosis (EOS) is diagnosed before the age of ten years, and when the curvature continues to progress and exceeds a Cobb angle of 60–65 degrees, surgical treatment should be considered. Initial minimally invasive surgery and the implantation of magnetically controlled growing rods (MCGRs) allows for the noninvasive distraction of the spine, growing, and avoids multiple operations associated with the classic distractions of standard growing rods. Case presentation: A 2-year-old girl was admitted to our clinic with rapidly progressive thoracic scoliosis. The major curve of the thoracic spine Cobb angle was 122° at 30 months. No congenital deformities were detected. The surgical technique was the less-invasive percutaneous and subfascial implantation of MCGRs, without long incisions on the back and the non-invasive ambulatory lengthening of her spine over the next 4 years. Conclusions: MCGR is a safe procedure for EOS patients. It is extremely effective at correcting spinal deformity; controlling the growth and curvature of the spine as the child develops during growth; reducing the number of hospitalizations and anesthesia; and minimizing the physical and mental burden of young patients, parents, and their families.
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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
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
- Correspondence:
| | - Ilkka J. Helenius
- Department of Orthopedics and Traumatology, Helsinki University Hospital, 00260 Helsinki, Finland
| | - Kelly Chamberlin
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Michael Galgano
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27516, USA
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Diseases and comorbidities associated with early-onset scoliosis: a retrospective multicenter analysis. Spine Deform 2023; 11:481-486. [PMID: 36380109 DOI: 10.1007/s43390-022-00613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the frequencies of various diseases associated with all types of early-onset scoliosis, both idiopathic and nonidiopathic. METHODS Retrospective collection of patients within a 21-year interval. Children under 10 years old presenting with scoliosis were included. Medical records were used to collect: identifier, date of birth, sex, diagnosis, follow-up, curve pattern, comorbidities, initial and final cobb angle. Different patient variables were tabulated with associated comorbidities for comparison. RESULTS The cohort contained 469 patients, with 227(48.4%) males and 242(51.6%) females. Total comorbidities equaled 1051, where 190 were unique. Only 124(26.4%) patients had an isolated diagnosis of early-onset scoliosis, 79(16.8%) had a single comorbidity, and 266(56.7%) had multiple comorbidities. "Global developmental delay" was most commonly observed, 198(42.2%) times. The central nervous system was involved more often than other organ systems, seen in 394(54.4%) instances. Males had more comorbidities than females. Idiopathic patients had the least number of comorbidities, while neuromuscular patients had the most. Idiopathic types had more musculoskeletal conditions, while congenital types had more cardiovascular diseases. Curve sides did not affect distributions. Cases which progressed had more comorbidities, especially in the respiratory, digestive, and cardiovascular systems. Diseases that could affect either extremity or side, were more likely to be bilateral. CONCLUSIONS Early-onset scoliosis patients may present with complex comorbidities in multiple organ systems. The most commonly observed disease entities were: global developmental delay, developmental dysplasia of the hip, and epilepsy. Clinicians should be aware of the common associations, in order to screen for and begin appropriate investigations, referrals, and treatments in affected cases. LEVEL OF EVIDENCE Level III.
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22
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Shaw KA, Ramo B, McClung A, Thornberg D, Yazsay B, Sturm P, Jo CH, Oetgen ME. Impact of surgical treatment on parent-reported health related quality of life measures in early-onset scoliosis: stable but no improvement at 2 years. Spine Deform 2023; 11:213-223. [PMID: 36181618 DOI: 10.1007/s43390-022-00572-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/13/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The etiology of early-onset scoliosis (EOS) has been shown to significantly influence baseline parent-reported health-related quality of life (HRQoL) measures as assessed by the Early Onset Scoliosis Questionnaire (EOSQ). We sought to assess the influence of distraction-based surgery and scoliosis etiology on EOSQ 2 years following surgical intervention remains unclear. METHODS A retrospective review of a multi-center prospective EOS database was performed. Children untreated with distraction-based, growth friendly instrumentation for EOS with completed baseline and 2-year post-surgical EOSQ were included. Children were subdivided by curve etiology individually and in combined cohorts (congenital/idiopathic [C/I], neuromuscular/syndromic [NMS]). EOSQ domains and compositive HRQoL score at presentation and 2-year follow-up were compared across C-EOS etiologies. Minimal clinically important difference (MCID) was defined as ≥ 20% change in domain score and compared across etiologies. RESULTS 150 children with EOS met inclusion criteria (mean 7.09 ± 2.6 years, 58.9% female). There were no differences in EOSQ domains between Congenital vs. Idiopathic nor NM vs. Syndromic etiologies at any timepoint. Combined C/I children demonstrated significantly higher EOSQ scores than combined NMS at initial and 2-years post-treatment. Etiology remained the only independent predictor of 2-year EOSQ composite HRQoL score. Overall, the vast majority of children demonstrated stable HRQoL composite scores, with a trend toward more positive MCID in NMS etiologies. CONCLUSION EOS etiology remains the most significant influence on EOSQ scores 2 years following surgical intervention. However, the majority of patients, regardless of etiology, maintain stable HRQoL scores suggesting that surgery may only serve to stabilize HRQoL at 2 years.
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Affiliation(s)
- K Aaron Shaw
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA.
| | - Brandon Ramo
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - Anna McClung
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - David Thornberg
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - Burt Yazsay
- Division of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Peter Sturm
- Department of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Chan-Hee Jo
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - Matthew E Oetgen
- Department of Pediatric Orthopaedic Surgery, Children's National Hospital, Washington, DC, USA
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Vertebral body tethering for non-idiopathic scoliosis: initial results from a multicenter retrospective study. Spine Deform 2023; 11:139-144. [PMID: 36070136 DOI: 10.1007/s43390-022-00575-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Vertebral body tethering (VBT) has been described for patients with idiopathic scoliosis. Results of the technique for non-idiopathic scoliosis have not yet been reported. METHODS An international multicenter registry was retrospectively queried for non-idiopathic scoliosis patients who underwent VBT with minimum 2-year follow-up. Success at 2 years was defined as Cobb angle < 35 degrees and no fusion surgery. RESULTS Of the 251 patients treated with VBT, 20 had non-idiopathic scoliosis and minimum 2-year follow-up. Mean age at surgery was 12.4 years (range 10 to 17 years). Mean major Cobb angle at enrollment was 56 degrees. Of those, 18 patients had a major thoracic curve and two had a major lumbar curve. Of the 20 patients, nine met criteria for success (45%). Eight of the 20 patients had poor outcomes (four fusions, four with curve > 50 degrees). Success was associated with smaller preoperative Cobb angle (50 vs. 62 degrees, p = 0.01) and smaller Cobb angle on initial postop imaging (28 degrees vs. 46 degrees, p = 0.0007). All patients with Cobb angle < 35 degrees on 1st postop imaging had a successful result, with the exception of one patient who overcorrected and required fusion. Syndromic vs. neuromuscular patients had a higher likelihood of success (5 of 7, 71%, 2 of 10, 20%, p = 0.03). CONCLUSION Selected non-idiopathic scoliosis can be successfully treated with VBT, but failure rates are high and were associated with large curves, inadequate intraoperative correction and neuromuscular diagnosis. Achieving a Cobb angle less than 35 degrees on 1st standing radiograph was associated with a successful outcome which was achieved in 45% of patients. LEVEL OF EVIDENCE Level IV (retrospective review study).
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24
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Paediatric Spinal Deformity Surgery: Complications and Their Management. Healthcare (Basel) 2022; 10:healthcare10122519. [PMID: 36554043 PMCID: PMC9778654 DOI: 10.3390/healthcare10122519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
Surgical correction of paediatric spinal deformity is associated with risks, adverse events, and complications that must be preoperatively discussed with patients and their families to inform treatment decisions, expectations, and long-term outcomes. The incidence of complications varies in relation to the underlying aetiology of spinal deformity and surgical procedure. Intraoperative complications include bleeding, neurological injury, and those related to positioning. Postoperative complications include persistent pain, surgical site infection, venous thromboembolism, pulmonary complications, superior mesenteric artery syndrome, and also pseudarthrosis and implant failure, proximal junctional kyphosis, crankshaft phenomenon, and adding-on deformity, which may necessitate revision surgery. Interventions included in enhanced recovery after surgery protocols may reduce the incidence of complications. Complications must be diagnosed, investigated and managed expeditiously to prevent further deterioration and to ensure optimal outcomes. This review summarises the complications associated with paediatric spinal deformity surgery and their management.
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25
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Fludder CJ, Keil BG. "Letter to the Editor: Treatment of infantile idiopathic scoliosis using a novel thoracolumbosacral orthosis: a case report". J Med Case Rep 2022; 16:451. [PMID: 36471436 PMCID: PMC9720913 DOI: 10.1186/s13256-022-03560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/06/2022] [Indexed: 12/12/2022] Open
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Tsukahara K, Mayer OH. Thoracic insufficiency syndrome: Approaches to assessment and management. Paediatr Respir Rev 2022; 44:78-84. [PMID: 35339395 PMCID: PMC9448829 DOI: 10.1016/j.prrv.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/25/2022] [Indexed: 12/14/2022]
Abstract
Thoracic insufficiency syndrome (TIS) was described in 2003 as the inability of the thorax to support normal respiration or lung growth. TIS includes a broad and disparate group of typically degenerative thoracospinal conditions. Although TIS arises due to a heterogeneous group of disorders and thus its incidence is not well quantified, general approaches to management and treatment exist. Evolving imaging techniques and measurements of health-related quality of life augment tests of pulmonary function to quantify disease burden, longitudinally and pre- and post-intervention. Intervention is primarily via growth-sparing surgery, for which several device options exist, to preserve vertical growth prior to a definitive spinal fusion at skeletal maturity.
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Affiliation(s)
- Katharine Tsukahara
- The Children's Hospital of Philadelphia, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, United States.
| | - Oscar Henry Mayer
- Perelman School of Medicine at The University of Pennsylvania, Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, Philadelphia, PA 19104, United States
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Heyer JH, Anari JB, Baldwin KD, Mitchell SL, Luhmann SJ, Sturm PF, Flynn JM, Cahill PJ. Lengthening Behavior of Magnetically Controlled Growing Rods in Early-Onset Scoliosis: A Multicenter Study. J Bone Joint Surg Am 2022; 104:2186-2194. [PMID: 36367763 DOI: 10.2106/jbjs.22.00483] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The "law of diminishing returns" is described for traditional growing rods. Magnetically controlled growing rods (MCGRs) have become a preferred implant for the surgical treatment of early-onset scoliosis (EOS). We examined a large cohort of patients with EOS to determine whether the law of diminishing returns applies to MCGRs. METHODS A prospectively collected, multicenter registry was queried for patients with EOS treated with MCGRs. Patients with only spine-based implants and a minimum of 2 years of follow-up were included; patients with congenital scoliosis, single rods, <3 lengthenings, or >25% missing data were excluded. Patients were analyzed in 3 cohorts: primary MCGR (pMCGR) had first-time MCGR implants, secondary MCGR (sMCGR) were converted from an MCGR to a new MCGR, and conversion MCGR (cMCGR) were converted from a non-MCGR implant to MCGR. RESULTS A total of 189 patients in the pMCGR group, 44 in the cMCGR group, and 41 in the sMCGR group were analyzed. From post-MCGR placement to the most recent follow-up or pre-definitive procedure, there were no differences in the changes in major Cobb angle, T1-S1 height, or T1-T12 height over time between the pMCGR and cMCGR groups. There was a decrease in length achieved at subsequent lengthenings in all cohorts (p < 0.01), and the sMCGR group had a significantly poorer ability to lengthen at each subsequent lengthening versus the pMCGR and cMCGR groups (p < 0.02). The 1-year survival rate was 90.5% for pMCGR, 84.1% for sMCGR, and 76.4% for cMCGR; 2-year survival was 61.5%, 54.4%, and 41.4%, respectively; and 3-year survival was 37.6%, 36.7%, and 26.9%, respectively. Excluding MCGRs still expanding, 27.6% of pMCGRs, 8.8% of sMCGRs, and 17.1% of cMCGRs reached the maximum excursion. Overall, 21.7% reached the maximum excursion. Within the pMCGR cohort, idiopathic and neuromuscular etiologies had a decline in lengthening achieved over time (p < 0.001), while syndromic EOS demonstrated a preserved ability to lengthen over time (p = 0.51). When the etiological groups were compared with each other, the neuromuscular group had the least ability to lengthen over time (p = 0.001 versus syndromic, p = 0.02 versus idiopathic). CONCLUSIONS The MCGR experiences the law of diminishing returns in patients with EOS. We found that only 21.7% of rods expanded to within 80% of the maximum excursion. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Jason B Anari
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Keith D Baldwin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Peter F Sturm
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John M Flynn
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Pan A, Ding H, Wang J, Zhang Z, Zhang H, Liu Y, Hai Y. The application of finite element analysis to determine the optimal UIV of growing-rod treatment in early-onset scoliosis. Front Bioeng Biotechnol 2022; 10:978554. [PMID: 36118572 PMCID: PMC9478657 DOI: 10.3389/fbioe.2022.978554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives: To analyze the stress distribution in the proximal vertebral body and soft tissue of dual growing-rod (GR) with different upper instrumented vertebra (UIV) to determine the optimal UIV. Methods: A ten-year-old male EOS case treated with GR was selected. Based on spiral computed tomography (CT) scanning performed in 0.6 mm thick slices, a finite element model (FEM) of the preoperative state (M0, the original spine state) of the patient was created. Subsequently, four models with different UIV fixations were numerically analyzed by FEM, including M1 (UIV = T1, i.e., the upper-end vertebrae (UEV) of the upper thoracic curve), M2 (UIV = T2), M3 (UIV = T3) and M4 (UIV = T4, i.e., the lower end vertebrae (LEV) of the upper thoracic curve). Displacement and maximum stress in the proximal vertebral body and soft tissue were measured and compared among the five models. Results: The spine model was fixed with the sacrum, and the gravity conditions were imposed on each vertebral body according to the research of Clin and Pearsall. The results are as follows:M4 model has the largest overall displacement, while M1 has the least displacement among the four models. Except M2, the maximum normalized stress of UIV increases with the downward movement of UIV. M1 has the lowerest annulus fibrosus stress and highest joint capsule stress, which is characterized by the vertebrae backward leaning, while M4 is the opposite. The supraspinous ligament stress of M3 and M4 is significantly higher than that of M1 and M2. This suggests that UIV downshift increases the tendency of the proximal vertebral bodies to bend forward, thereby increasing the tension of the posterior ligaments (PL). Conclusion: The UIV of the GR is recommended to be close to the UEV of the upper thoracic curve, which can reduce the stress of the proximal PL, thereby reducing the occurrence of proximal junctional kyphosis (PJK).
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Affiliation(s)
- Aixing Pan
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongtao Ding
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Junjie Wang
- School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, China
| | - Zhuo Zhang
- School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, China
| | - Hongbo Zhang
- School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, China
| | - Yuzeng Liu
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yong Hai, ; Yuzeng Liu,
| | - Yong Hai
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yong Hai, ; Yuzeng Liu,
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The Spring Distraction System for Growth-Friendly Surgical Treatment of Early Onset Scoliosis: A Preliminary Report on Clinical Results and Safety after Design Iterations in a Prospective Clinical Trial. J Clin Med 2022; 11:jcm11133747. [PMID: 35807030 PMCID: PMC9267814 DOI: 10.3390/jcm11133747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background: The Spring Distraction System (SDS) is a dynamic growth-friendly implant to treat early onset scoliosis (EOS). Previous SDS studies showed promising results in terms of curve correction and complication profile. Nevertheless, complications did occur, which led to modifications in the implant design. The main iterations were a larger rod diameter and a more sagittal stable sliding mechanism. The purpose of this study was to investigate the performance of these iterations. Methods: All patients treated with the modified SDS and >1 year follow-up were included. Radiographic outcomes, severe adverse events (SAEs), unplanned returns to the operating room (UPRORs) and health-related quality of life (HRQoL) were investigated. Results: Seventeen EOS patients (three congenital, four idiopathic, nine neuromuscular, one syndromic) were included. Mean age at surgery was 9.5 ± 2.5 years. Similar to the first generation SDS, about 50% initial correction was achieved and maintained, and spinal growth was near physiological. Most importantly, SAEs and UPRORs were diminished and favorable with 0.10/patient/year. In addition, HRQoL increased during the first year postoperatively, indicating the implant was well accepted. Conclusion: These preliminary results indicate that the iterations of the SDS are effective in terms of reducing SAEs and UPRORs and increasing HRQoL in patients with EOS.
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30
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How does magnetically controlled growing rods insertion affect sagittal alignment in ambulatory early onset scoliosis patients? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1036-1044. [PMID: 34997318 DOI: 10.1007/s00586-021-07071-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/10/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The importance of sagittal alignment restoration in early onset scoliosis (EOS) management has rarely been investigated to date. The aim was to report the influence of magnetically controlled growing rods (MCGR) insertion on the sagittal alignment of EOS patients. METHODS All consecutive ambulatory patients operated with MCGR rods between 2011 and 2018 were retrospectively included in four institutions. Standing biplanar radiographs were performed preoperatively, in the early postoperative period and at latest follow-up. Global and local sagittal parameters, spinal global shape and harmony were investigated. RESULTS A total of 37 ambulatory EOS patients were included (mean age at surgery 8.5 (± 2) years). 70% had a balanced construct postoperatively. Both MaxTK (- 17°, p = 0.02) and MaxLL (- 15°, p = 0.001) were significantly reduced, particularly at the instrumented levels. The number of vertebrae included in the lumbar lordosis significantly increased (+ 2 levels, p = 0.02), as well as the thoraco-lumbar inflexion point (+ 2 levels, p < 0.001) and the kyphosis apex (+ 1 level, p < 0.001). Overall mechanical failure rate was 40.5%, and radiological PJK was observed in 43% of the patients, with 11 remaining asymptomatic. Patients with initial hyperkyphosis (> 50°) developed more complications (62% vs. 28%, p = 0.04). CONCLUSION MCGR insertion flattened the spine in EOS, at both instrumented and non-instrumented levels. Overall spinal harmony was modified, with a cranial shift of the thoraco-lumbar inflexion point and the thoracic kyphosis apex, associated with a lengthening of the lumbar lordosis. The rate of complication remained high, some explanations being found in the radiological changes reported such as the preoperative location of the TK apex. LEVEL OF EVIDENCE IV.
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Ulusaloglu AC, Asma A, Rogers KJ, Bowen JR, Mackenzie WG, Mackenzie WGS. Elongation-Derotation-Flexion Casting Treatment of Early-Onset Progressive Scoliosis in Skeletal Dysplasia. J Pediatr Orthop 2022; 42:e229-e233. [PMID: 34967803 DOI: 10.1097/bpo.0000000000002037] [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: 02/07/2023]
Abstract
BACKGROUND Early-onset scoliosis in children with skeletal dysplasia is progressive, contributing to cardiopulmonary restrictive disease. Serial elongation-derotation-flexion (EDF) casting, used in other etiologies of scoliosis to delay curve progression, may be beneficial in maximizing spine growth. Our hypothesis is serial EDF casting can be safely used as a temporary alternative to surgery, delaying progression and preserving growth, to treat scoliosis in skeletal dysplasia. METHODS All patients with skeletal dysplasia treated at a single institution with serial EDF casting for scoliosis were reviewed retrospectively. Radiographic parameters: Cobb angle of major and minor curves, curve location, thoracic height, thoracolumbar height, space available for lung, and rib vertebra angle difference were measured before casting (C1), in first casting (C2), in last casting (C3), and out of last casting (C4). Peak inspiratory pressure (PIP) values were monitored and recorded during the casting application. RESULTS Eleven patients met the inclusion criteria (mean 9.7 castings). The mean duration of EDF serial casting was 35 months. The mean major Cobb angles were 54 degrees° (C1), 30 degrees (C2), 37 degrees (C3), and 49 degrees (C4) with no statistically significant differences. The mean minor Cobb angles were 35 degrees (C1), 25 degrees (C2), 33 degrees (C3), and 51 degrees (C4) with no statistically significant differences. The mean thoracic heights were 130 mm (C1), 155 mm (C2), 173 mm (C3), and 160 mm (C4). The 19-mm mean difference between C2 and C3 represents spinal growth. The PIP-1, PIP-2, and PIP-3 mean values were 15, 27, and 18 cmH2O, respectively. Changes in PIP-1 and PIP-2 and PIP-2 and PIP-3 were statistically significant. CONCLUSION Serial EDF casting can delay surgical scoliosis correction in children younger than 7 years with a diagnosis of skeletal dysplasia. Our study showed that serial casting controls progression of the major curve and allows longitudinal growth of the spine with possible expansion of lung volume for nearly 3 years. During cast application, PIP increased with molding and traction, and improved until windowing and trimming of the cast. LEVEL OF EVIDENCE Level IV-retrospective study.
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Guzek RH, Murphy R, Hardesty CK, Emans JB, Garg S, Smith JT, Roye BD, Glotzbecker MP, Sturm PF, Snyder BD, Poon SC, Poe-Kochert C, Anari JB. Mortality in Early-Onset Scoliosis During the Growth-friendly Surgery Era. J Pediatr Orthop 2022; 42:131-137. [PMID: 35138296 DOI: 10.1097/bpo.0000000000001983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Early-onset scoliosis (EOS) is a spinal deformity that occurs in patients 9 years of age or younger. Severe deformity may result in thoracic insufficiency, respiratory failure, and premature death. The purpose of this study is to describe the modern-day natural history of mortality in patients with EOS. METHODS The multicenter Pediatric Spine Study Group database was queried for all patients with EOS who are deceased, without exclusion. Demographics, underlying diagnoses, EOS etiology, operative and nonoperative treatments or observation, complications, and date of death were retrieved. Descriptive statistics and survival analysis with Kaplan-Meier curves were performed. RESULTS There were 130/8009 patients identified as deceased for a registry mortality rate of 16 per 1000 patients. The mean age at death was 10.6 years (range: 1.0 to 30.2 y) and the most common EOS etiology was neuromuscular (73/130, 56.2%; P<0.001). Deceased patients were more likely be treated operatively than nonoperatively or observed (P<0.001). The mean age of death for patients treated operatively (12.3 y) was older than those treated nonoperatively (7.0 y) or observed (6.3 y) (P<0.001) despite a larger deformity and similar index visit body mass index and ventilation requirements. Kaplan-Meier analysis confirmed an increased survival time in patients with a history of any spine operation compared with patients without a history of spine operation (P<0.0001). Operatively treated patients experienced a median of 3.0 complications from diagnosis to death. Overall, cardiopulmonary related complications were the most common (129/271, 47.6%; P<0.001), followed by implant-related (57/271, 21.0%) and wound-related (26/271, 9.6%). The primary cause of death was identified for 78/130 (60.0%) patients, of which 57/78 (73.1%) were cardiopulmonary related. CONCLUSIONS This study represents the largest collection of EOS mortality to date, providing surgeons with a modern-day examination of the effects of surgical intervention to better council patients and families. Both fatal and nonfatal complications in children with EOS are most likely to involve the cardiopulmonary system. LEVEL OF EVIDENCE Level IV-therapeutic.
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Affiliation(s)
- Ryan H Guzek
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robert Murphy
- Medical University of South Carolina, Charleston, SC
| | | | | | | | | | | | | | - Peter F Sturm
- Cincinnati Children's Hospital and Medical Center, Cincinnati, OH
| | | | | | | | - Jason B Anari
- Children's Hospital of Philadelphia, Philadelphia, PA
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Hu Z, Xu Y, Li J, Zhu Z, Qiu Y, Liu Z. Bioinformatics Analysis and Experimental Verification Identify Downregulation of COL27A1 in Poor Segmental Congenital Scoliosis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2616827. [PMID: 35186112 PMCID: PMC8849967 DOI: 10.1155/2022/2616827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Congenital scoliosis (CS) represents the congenital defect disease, and poor segmental congenital scoliosis (PSCS) represents one of its types. Delayed intervention can result in disability and paralysis. In this study, we would identify the core biomarkers for PSCS progression through bioinformatics analysis combined with experimental verification. METHODS This work obtained the GSE11854 expression dataset associated with somite formation in the GEO database, which covers data of 13 samples. Thereafter, we utilized the edgeR of the R package to obtain DEGs in this dataset. Then, GO annotation, KEGG analyses, and DO annotation of DEGs were performed by "clusterProfiler" of the R package. This study performed LASSO regression for screening the optimal predicting factors for somite formation. Through RNA sequencing based on peripheral blood samples from healthy donors and PSCS cases, we obtained the RNA expression patterns and screen out DEGs using the R package DESeq2. The present work analyzed COL27A1 expression in PSCS patients by the RT-PCR assay. RESULTS A total of 443 genes from the GSE11854 dataset were identified as DEGs, which were involved in BP associated with DNA replication, CC associated with chromosomal region, and MF associated with ATPase activity. These DEGs were primarily enriched in the TGF-β signaling pathway and spinal deformity. Further, LASSO regression suggested that 9 DEGs acted as the signature markers for somite formation. We discovered altogether 162 DEGs in PSCS patients, which were involved in BP associated with cardiac myofibril assembly and MF associated with structural constituent of muscle. However, these 162 DEGs were not significantly correlated with any pathways. Finally, COL27A1 was identified as the only intersected gene between the best predictors for somite formation and PSCS-related DEGs, which was significantly downregulated in PSCS patients. CONCLUSION This work sheds novel lights on DEGs related to the PSCS pathogenic mechanism, and COL27A1 is the possible therapeutic target for PSCS. Findings in this work may contribute to developing therapeutic strategies for PSCS.
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Affiliation(s)
- Zongshan Hu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yanjie Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Jie Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
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Liu Z, Gao K, Hai Y, Liu T. Developments, Focuses, and Trends in Early-Onset Scoliosis From 2005 to 2020: A Systematic Bibliometric Analysis. World Neurosurg 2021; 158:e697-e710. [PMID: 34798338 DOI: 10.1016/j.wneu.2021.11.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although several studies have been reported on early-onset scoliosis (EOS), a bibliometric analysis is still lacking. A systematic bibliometric analysis will enable researchers to understand the scope of the research topics, identify research focuses and key literature, and predict future research directions. METHODS Literature data were retrieved from the Web of Science Core Collection database. The Web of Science Results Analysis and Citation Report were used to analyze the reported studies in different views. CiteSpace and VOSviewer were used for further analysis, including a cooperation network analysis of the authors, institutions, countries and/or regions, discipline and journal analysis, reference co-citation analysis, and keyword co-occurrence analysis. RESULTS The final analysis included 674 relevant studies reported from 2005 to 2020. During the study period, the field of EOS has expanded rapidly. Multiple cooperation was found among the authors, institutions, and countries and/or regions, with some making great contributions. The results of the reference co-citation analysis showed that the studies had several main focuses, including the growing rod (GR), magnetically controlled GR, an EOS 24-item questionnaire, and a growth evaluation. CONCLUSIONS From 2005 to 2020, surgical treatment has remained the focus of research in the EOS field. The magnetically controlled GR is the latest research focus, which might become more comprehensive in the future. The Gr has remained the most popular topic, and potential new surgical techniques might require improvement to become the favored techniques. In addition, assessing the health-related quality of life and growth parameters of patients with EOS have become a popular topic.
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Affiliation(s)
- Ziyang Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kang Gao
- Dental Implant Center, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Tie Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Park KB. Diagnosis and treatment of congenital scoliosis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.11.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Congenital scoliosis is caused by anomalies of the vertebra, such as hemivertebra or unsegmented bar, which result in asymmetric growth of the spine. The disruption of vertebra development during embryogenesis may be accompanied by other congenital multi-organ anomalies. The progression of the scoliotic curve may also hinder the development of other organs.Current Concepts: Hemivertebra excision and short spinal fusion have demonstrated favorable outcomes. However, the need for spinal growth and lung development has led to new treatment modalities. Growth-friendly surgeries, such as with a growing rod or vertical expandable rib-based distraction device, have demonstrated good results with curve correction while maintaining spinal growth. Although the outcome of conservative treatment for congenital scoliosis is questionable, casting may be effective as a “time-buying strategy” to delay the need for surgery.Discussion and Conclusion: It is essential to decide on a treatment plan considering the progression of the curve and growth of the spine and lungs through an individualized approach.
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Onuki T, Ohtsu Y, Hiroshima S, Sawano K, Nagasaki K. Two cases of cytochrome P450 oxidoreductase deficiency with severe scoliosis and surgery requirement. Congenit Anom (Kyoto) 2021; 61:202-203. [PMID: 34155696 DOI: 10.1111/cga.12434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/20/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Takanori Onuki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshiaki Ohtsu
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shota Hiroshima
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kentaro Sawano
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Danzig JA, Katz EB. Musculoskeletal and skin considerations in children with medical complexity: Common themes and approaches to management. Curr Probl Pediatr Adolesc Health Care 2021; 51:101074. [PMID: 34656455 DOI: 10.1016/j.cppeds.2021.101074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The term "children with medical complexity" (CMC) describes a population of heterogeneous genetic and metabolic disorders with multi-system involvement, with shared common abnormalities within the musculoskeletal system. Disorders that affect the central nervous system (CNS) result in abnormal muscular tone, ranging from dystonia and spasticity, to hypotonia, to combinations of both (axial hypotonia with appendicular hypertonia). Abnormal tone can impair movement and function and contribute to development of contractures, progressive scoliosis and hip dislocation. Impaired mobility, chronic illness and polypharmacy can result in fragile bones and increased risk of fracture, which can be difficult to diagnose and associated with pain. Additionally, CMC with impaired ability to communicate, total dependence on caregivers and frequent use of support devices can develop unintended skin injuries. There are a variety of treatments available for CMC with musculoskeletal disorders ranging from physical supports to pharmacologic treatments to surgeries. Medical and surgical treatments can promote changes in tone and support bone health to improve comfort, hygiene and proper positioning. These therapies may also carry significant risk in medically fragile patients. It is important for CMC to have a care team with a good understanding of the patient's overall health and goals of care and that can advocate for the patient to balance optimization of function and reduction of pain while also minimizing risk.
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Affiliation(s)
- Jennifer A Danzig
- Division of General Pediatrics, The Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
| | - Elana B Katz
- Center for Rehabilitation, The Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
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Latalski M, Fatyga M, Sowa I, Wojciak M, Starobrat G, Danielewicz A. Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review. World J Orthop 2021; 12:584-603. [PMID: 34485105 PMCID: PMC8384615 DOI: 10.5312/wjo.v12.i8.584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/12/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The treatments for early-onset scoliosis (EOS), defined as curvature of the spine with onset before 10 years of age, continue to pose a great challenge for pediatric orthopedics. The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function. Different surgical techniques have different advantages and drawbacks; however, the two major concerns in the management of EOS are repeated surgeries and complications.
AIM To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries.
METHODS In January 2021 two independent reviewers systematically searched three electronic medical databases (PubMed, the Cochrane Library, and Embase) for relevant articles. Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Due to the heterogeneity of articles and topics after data analysis, a descriptive (synthetic) analysis was performed.
RESULTS A total of 2136 articles were found. Forty articles were included in this systematic review, after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of complications. The most frequent complications were categorized as implant (54%), general (17%), wound (15%) and alignment (12%). The rate of complications might have been even higher than reported, as some authors do not report all types of complications. About 54% of patients required unplanned surgeries due to complications, which comprised 15% of all surgeries.
CONCLUSION The literature concerning the definitions, collection, and interpretation of data regarding EOS surgery complications is often difficult to interpret. This creates problems in the comparison, analysis, and improvement of spine surgery practice. Additionally, this observation indicates that data on the incidence of complications can be underestimated, and should be interpreted with caution. Awareness of the high rate of complications of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.
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Affiliation(s)
- Michał Latalski
- Children Orthopaedic Department, Medical University of Lublin, Lublin 20-093, Poland
| | - Marek Fatyga
- Children Orthopaedic Department, University Hospital for Children, Lublin 20-093, Poland
| | - Ireneusz Sowa
- Department of Analytical Chemistry, Medical University of Lublin, Lublin 20-093, Poland
| | - Magdalena Wojciak
- Department of Analytical Chemistry, Medical University of Lublin, Lublin 20-093, Poland
| | - Grzegorz Starobrat
- Children Orthopaedic Department, University Hospital for Children, Lublin 20-093, Poland
| | - Anna Danielewicz
- Children Orthopaedic Department, Medical University of Lublin, Lublin 20-093, Poland
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Obid P, Yiu K, Cheung K, Kwan K, Ruf M, Cheung JPY. Magnetically controlled growing rods in early onset scoliosis: radiological results, outcome, and complications in a series of 22 patients. Arch Orthop Trauma Surg 2021; 141:1163-1174. [PMID: 32556642 DOI: 10.1007/s00402-020-03518-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Magnetically controlled growing rods (MCGR) for the surgical treatment of early onset scoliosis (EOS) allow non-invasive outpatient based distractions during spinal growth. The purpose of this study is to present the results of a single center case series of 22 patients, evaluate the effect of MCGR treatment on the development of spino-pelvic parameters during growth, and report initial outcomes after end of treatment. MATERIALS AND METHODS Prospectively collected data of 22 EOS patients with MCGR treatment has been analyzed. The following radiological parameters were measured before index surgery, after index surgery, 1 year after index surgery, and at last follow-up: Cobb angle of the major curves, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Mean age at index surgery was 9.5 years (range: 4-14 years). Mean length of follow-up was 47.6 months (range: 25-121 months). Etiology of diagnosis was idiopathic in 14 patients, associated with neurofibromatosis in 2 patients, and neuromuscular or syndromic in 6 patients. RESULTS Mean Cobb angle of the major curve was 57° preoperatively and 29° at last follow-up (p < 0.0005). Mean TK was 20.1° preoperatively and 20° at last follow-up (p > 0.05). Mean LL was 52.8° preoperatively and 53.2° at last follow-up (p > 0.05). Mean PI was 43.2° preoperatively and 46.3° at last follow-up (p > 0.05). Mean PT was 4.1° preoperatively and 5.8° at last follow-up (p > 0.05). Mean SS was 39.2° preoperatively and 41.7° at last follow-up (p > 0.05). 14 patients finished treatment: nine received final fusion and five received rod removal without fusion. Twelve complications occurred: one deep wound infection, six patients developed proximal junctional kyphosis (PJK), one rod fracture, two rods failed to distract, one deformity progressed after rod removal and required spinal fusion, and one patient developed autofusion of the spine prior to end of treatment. CONCLUSION MCGR treatment is able to control deformity progression. Complication rate was 54.5%. Sagittal balance was not altered and treatment does not seem to have a negative impact on the development of spino-pelvic parameters during growth. Optimal end of treatment for the individual patient still has to be defined.
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Affiliation(s)
- Peter Obid
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China. .,Spine Surgery / Scoliosis Center, Asklepios Paulinen Klinik, Geisenheimer Straße 10, 65197, Wiesbaden, Germany.
| | - Karen Yiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Kenneth Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Kenny Kwan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Michael Ruf
- Center for Spine Surgery, SRH-Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Lloyd AP, Jones MEB, Gardner A, Newton Ede MP. Index radiographic measurements in the prediction of progression in infantile idiopathic scoliosis: a comparative analysis and description of a novel predictive model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1858-1864. [PMID: 33687542 DOI: 10.1007/s00586-021-06795-3] [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: 10/30/2020] [Revised: 02/09/2021] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the comparative accuracy of commonly utilised index radiological measurements in the prognosis of infantile idiopathic scoliosis (IIS) and build a parsimonious prognostic model utilising these measurements. METHODS This was a retrospective analysis of a UK population of patients with IIS. Index radiological parameters were analysed, and outcome of their condition was determined over long-term follow-up. Comparative accuracy of each radiological measurement category was determined by logistic regression analyses and the corresponding receiver operating characteristic (ROC) curve. A predictive model of IIS progression using these measurements was then created. RESULTS All three radiological measurement categories were predictive of IIS progression. However, on pairwise comparison of ROC curves and multivariate analysis, the index Cobb angle proved the most significant predictor of curve progression. Using the index Cobb angle only, a predictive model of curve progression achieved an accuracy of 81.18% with a cut-off Cobb angle of 34.5° found to be the optimal threshold to discriminate a progressive from resolving curve. CONCLUSION Of the three analysed index radiological parameters commonly used by surgeons in the prognosis of IIS, we found that the Cobb angle is the most accurate predictive measure. Further, neither addition of the RVAD nor convex RVA provided significant further prognostic value in a multivariate model of progression. However, not even the Cobb angle model was accurate in all cases; emphasising caution should be applied when relying on index radiological measurements to predict IIS outcomes.
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Affiliation(s)
- Adam P Lloyd
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
| | - Morgan E B Jones
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Lloyd AP, Jones MEB, Gardner A, Newton Ede MP. Long-term follow-up of patients with infantile idiopathic scoliosis: is the rib vertebra angle difference (RVAD) a reliable indicator of evolution? Spine Deform 2021; 9:579-585. [PMID: 33136264 DOI: 10.1007/s43390-020-00232-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Since its original description by Mehta, the rib vertebra angle difference (RVAD) and, in particular, a threshold of 20° have become an accepted and widely utilised prognostic indicator in the assessment of patients presenting with an infantile idiopathic scoliosis (IIS). However, uncertainty in the utility of the RVAD in the prognosis of IIS remains. The aims of this study were to investigate the prognostic significance of the RVAD and to describe the changes in RVAD over long-term follow-up of patients with progressive and resolving IIS. METHODS This was a retrospective analysis of patients presenting with IIS at a tertiary spinal deformity unit in the UK. Serial patient radiographs were reviewed and a logistic regression model using the patients index RVAD was created to predict the likelihood of curve progression. RESULTS At both index presentation and over long-term follow-up, patients with a progressive curve had significantly greater mean Cobb angle and RVAD measurements than those with resolving curves. The RVAD and Cobb were found to correlate positively in both groups, reflecting the underlying costovertebral pathoanatomy. The logistic regression model demonstrated that the optimal RVAD threshold in predicting IIS progression was lower at 17.1° than the 20° cut-off previously advocated. CONCLUSION This study describes the utility of the RVAD in predicting IIS evolution. From this analysis, we would advise caution in predicting outcomes based on the index RVAD at presentation. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Adam P Lloyd
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
| | - Morgan E B Jones
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Abstract
"Pediatric spinal deformities may be associated with pulmonary complications in a patient's lifetime. A review of the diagnosis of spinal abnormalities includes classifications of scoliosis and kyphosis, correlating physical examination findings and radiographic interpretation. The natural history of untreated spine deformities is reviewed along with the associated altered pulmonary compromise. Treatment options for children affected by spinal deformities are discussed, including the relative indications, the efficacy, pros and cons of different treatment options, along with the evidence to support these. This overview of spine deformities includes research outcomes to support the care of these pediatric patients."
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Affiliation(s)
- Diane Dudas Sheehan
- Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 69, Chicago, IL 60611, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA.
| | - John Grayhack
- Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 69, Chicago, IL 60611, USA; Department of Orthopaedic Surgery, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
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LaValva SM, MacAlpine EM, Kawakami N, Gandhi JS, Morishita K, Sturm PF, Garg S, Glotzbecker MP, Anari JB, Flynn JM, Cahill PJ. Awake serial body casting for the management of infantile idiopathic scoliosis: is general anesthesia necessary? Spine Deform 2020; 8:1109-1115. [PMID: 32383143 DOI: 10.1007/s43390-020-00123-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN It is a retrospective cohort study. OBJECTIVES To compare the radiographic and clinical outcomes of serial body casting for infantile idiopathic scoliosis (IIS) with versus without the use of general anesthesia (GA). Serial body casting for IIS has traditionally been performed under GA. However, reports of neurotoxic effects of anesthetics in young children have prompted physicians to consider instead performing these procedures while patients are awake and distracted by electronic devices. METHODS Patients from a multicenter registry who underwent serial casting for IIS were included. The patients were divided into asleep (GA) and awake (no GA) cohorts. Comparisons were made between pre-casting, first in-cast, and post-casting radiographic measures in each cohort. The rates of successful casting (≥ 10° major CA improvement), curve progression, and incidence of casting abandonment for surgical intervention were also compared. RESULTS One-hundred and twenty-one patients who underwent serial casting for IIS were included. Ninety-two (76%) patients were asleep during casting procedures, while 29 (24%) were awake. Patients in the awake cohort were older (p < 0.01), had a lower BMI (p = 0.03), and more severe curve magnitudes (p < 0.01) at baseline. Patients in the awake cohort experienced greater first-in-cast correction of the major curve (p = 0.01) and improvement in thoracic spine height (p < 0.01). The rate of casting success was higher in the awake cohort (72%) as compared to the asleep cohort (48%) (p = 0.02), although the rate of curve progression (worsening) was similar (p = 0.880). Lastly, there was a lower rate of conversion to surgery at 2 years post-initiation of casting, although this was not statistically significant (0% vs. 8%; p = 0.126). CONCLUSIONS Patients who underwent awake serial casting had similar radiographic outcomes as compared to those who were under general anesthesia during the procedures. Thus, awake casting may provide a safe and effective alternative to the use of general anesthesia in patients with idiopathic infantile scoliosis. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | | | - Noriaki Kawakami
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Jigar S Gandhi
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kazuaki Morishita
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | | | - Sumeet Garg
- Children's Hospital Colorado, Aurora, CO, USA
| | | | | | - John M Flynn
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Is Growth-friendly Surgical Treatment Superior to One-stage Posterior Spinal Fusion in 9- to 11-year-old Children with Congenital Scoliosis? Clin Orthop Relat Res 2020; 478:2375-2386. [PMID: 32568886 PMCID: PMC7491883 DOI: 10.1097/corr.0000000000001377] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The distraction-based growth-friendly technique has become a mainstay of treatment for young children with long-spanned congenital scoliosis. However, in patients who are 9 years to 11 years old, the choice is much less clear, and posterior spinal fusion is also a potential option. QUESTIONS/PURPOSES Comparing growth-friendly scoliosis surgery and posterior spinal fusion, which technique (1) provides greater correction of spinal deformity, (2) is associated with more surgical complications, and (3) results in greater improvement in pulmonary function tests, health-related quality of life scores, other patient-reported outcomes? METHODS Between 2009 and 2017, one spinal center performed 212 spinal interventions for scoliosis in patients aged between 9 years and 11 years old and who had open triradiate cartilage, including 40 patients with growth-friendly approaches (34 with growing-rod technique and six with a vertical expandable prosthetic titanium rib) and 172 with one-stage posterior spinal fusion, respectively. During this period, our general indications for using growth-friendly surgery were patients with open triradiate cartilage, major curve higher than 40°, and upper and lower end vertebrae involving at least eight segments. Twelve patients with a median (range) age of 9.3 years (9 to 11) treated with growth-friendly surgery met the following inclusion criteria: (1) had at least two lengthening procedures before definitive spinal fusion along with 2 years of follow-up after definitive spinal fusion; (2) had been followed until skeletal maturity (Risser grade ≥ 4); and (3) with complete radiographic and clinical data (health-related quality of life (HRQoL) and pulmonary function test results) preoperatively and at the latest follow-up. A group of patients between 9 years and 11 years old and underwent one-stage posterior spinal fusion was selected from our database of patients with congenital scoliosis. Our general indications for using one-stage posterior spinal fusion were patients with a major curve greater than 40°, and with thoracic height higher than 18 cm. Sixty-two patients who had open triradiate cartilage and had been followed until skeletal maturity (Risser grade ≥ 4) were accounted for. In this retrospective, controlled study, we matched patients in the posterior spinal fusion group to those 12 patients who had growth-friendly surgery by age, sex, pathologic findings, major curve size, and location of the apex of the major curve (2:1 matching provided 24 patients in the control group). The median (range) age was 9.8 years (9 to 11). We then compared the groups in terms of magnitude of correction and postoperative complications. Surgical complications, including infection, implant-related complications, and alignment-related complications were evaluated and classified using the surgical complications grading system. Pulmonary function tests and HRQoL were also compared between groups. Pulmonary function tests were performed at the same center with a spirometer. HRQoL were assessed by questionnaire, including the 24-item Early-onset Scoliosis questionnaire for parent-reported outcomes and the Scoliosis Research Society-22 questionnaire for patient-reported outcomes. All patients involved in this study gave their informed consent. RESULTS The posterior spinal fusion group achieved a greater correction magnitude at the latest follow-up (median [range] 46% [28 to 70] versus median 34% [9 to 58], difference of medians = 11%; p < 0.001) than the growth-friendly group. A higher proportion of patients in the growth-friendly group had complications than in the posterior spinal fusion group (7 of 12 versus 4 of 24; p = 0.03). There were no between-group differences in terms of pulmonary function tests. Few differences were found between the groups in terms of 24-item Early-onset Scoliosis parental impact (median [range] 60 [44 to 83] for the growth-friendly group versus median 71 [55 to 87] for the posterior spinal fusion group, difference of medians = 13; p = 0.001), financial burden (median 44 [30 to 55] for the growth-friendly group versus median 62 [53 to 75] for the posterior spinal fusion group, difference of medians = 16; p < 0.001) and the Scoliosis Research Society-22 self-image scores (median 3.8 [3.2 to 4.3] for the growth-friendly group versus median 4.4 [4.1 to 4.6] for the posterior spinal fusion group, difference of medians = 0.5; p = 0.006) at the latest follow-up, and those differences that were observed all favored the posterior spinal fusion group. CONCLUSIONS In light of the superior deformity correction and fewer observed complications with posterior spinal fusion, and the absence of important differences in validated outcomes scores or pulmonary function tests, posterior spinal fusion might be a better choice for 9- to 11-year-old children with long-spanned congenital scoliosis and limited growth potential in the intended instrumentation area. LEVEL OF EVIDENCE Level III, therapeutic study.
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