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Gottlieb R, Smith J, Miyanji F, Rodriguez-Olaverri J, El-Hawary R, Li Y. Do Caregivers and Patients With Early-Onset Scoliosis Share the Same Perspective on Health-Related Quality of Life? A Comparison of 24-item Early-Onset Scoliosis Questionnaire and 22-item Scoliosis Research Society Questionnaire Scores. J Pediatr Orthop 2024; 44:e555-e559. [PMID: 38488141 DOI: 10.1097/bpo.0000000000002675] [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: 06/06/2024]
Abstract
OBJECTIVE The 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) is validated in patients with early onset scoliosis (EOS) aged 0 to 18 years and the 22-item Scoliosis Research Society (SRS-22) questionnaire is validated in idiopathic scoliosis patients 10 years and older. EOSQ-24 is completed by the caregiver and SRS-22 is completed by the patient. A prior study comparing patient-reported outcome measures completed by older pediatric patients and their parents showed a low level of agreement. Our purpose was to compare EOSQ-24 and SRS-22 scores completed at the same time point and at subsequent time points, in patients aged 5 to 18 years with idiopathic or congenital EOS without developmental delay. METHODS This was a multicenter retrospective study. We identified pairs of EOSQ-24 and SRS-22 completed on the same day or within 6 months. Some patients had multiple pairs of surveys over time. EOSQ-24 and SRS-22 questions were matched and domain scores for Pain, Function, Mental Health, and Satisfaction were compared. Patients with a change in treatment between surveys were excluded. Pearson correlation coefficients ( r ) were used to compare domain scores, with r ≥0.7 indicating a strong relationship. RESULTS There were 228 patient-caregiver dyads who completed 411 pairs of EOSQ-24 and SRS-22 on the same day. A strong correlation was found only for the Pain domain ( r =0.77). Function, Mental Health, and Satisfaction domains had positive but not strong correlations ( r = 0.58, r = 0.50, r = 0.41, respectively). Subanalysis based on age also showed a strong correlation only for Pain. There were 76 patient-caregiver dyads who completed 134 pairs of surveys with SRS-22 completed within 6 months after an EOSQ-24. All domains demonstrated a positive but not strong correlation, with Pain showing the highest correlation ( r = 0.64). CONCLUSIONS EOSQ-24 and SRS-22 had a strong correlation only for Pain when completed at the same time point. EOSQ-24 and SRS-22 completed within 6 months lacked a strong correlation for all domains. Our findings suggest that parents and children with EOS may not share the same perspective on their health. Self-reported questionnaires should be used when possible to assess health-related quality of life in older children and adolescents with EOS who are developmentally neurotypical. LEVEL OF EVIDENCE Level III-diagnostic.
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Affiliation(s)
| | | | - Firoz Miyanji
- Department of Orthopaedics, BC Children's Hospital, Vancouver, BC, Canada
| | | | - Ron El-Hawary
- Department of Orthopaedic Surgery, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Ying Li
- Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI
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Mughal ZUN, Haseeb A, Rangwala BS. Letter to Editor Regarding "Butterfly Vertebra: A Retrospective Study of 30 Patients". World Neurosurg 2024; 187:270. [PMID: 38970190 DOI: 10.1016/j.wneu.2024.03.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 07/08/2024]
Affiliation(s)
| | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan.
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Todderud JE, Milbrandt TA, Floyd E, Haft G, El-Hawary R, Albert M, Larson AN. Preliminary Study of Motion Preservation Following Posterior Dynamic Distraction Device in Adolescent Idiopathic Scoliosis Patients. J Pediatr Orthop 2024:01241398-990000000-00607. [PMID: 38946041 DOI: 10.1097/bpo.0000000000002739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
BACKGROUND Motion-sparing scoliosis surgeries such as the posterior dynamic distraction device (PDDD) are slowly increasing in use. However, there is limited clinical data documenting postoperative motion across the PDDD construct. With this cohort study, we aim to measure sagittal and coronal motion following PDDD. We hypothesize coronal and sagittal spinal motion will be partially preserved across the construct. METHODS Retrospective review of prospectively collected data. Preoperative and minimum 1-year postoperative coronal range of motion across the instrumented levels was compared. Available flexion/extension radiographs were evaluated postoperatively to assess sagittal arc of motion. Radiographs from latest follow-up were used. RESULTS At a mean of 1.9 years (1 to 5 y), flexibility radiographs were available on 29 patients treated with PDDD (17 thoracic, 12 lumbar). Mean age at surgery was 16 years (12 to 25). Postoperative coronal arc of motion in PDDD patients was 11 degrees (3 to 19 degrees) in the thoracic spine and 10 degrees (0 to 28 degrees) in the lumbar spine. Compared with preoperative motion, the thoracic arc of motion was maintained by 33% (35 to 11 degrees) and lumbar motion was maintained by 30% (34 to 10 degrees). Flexion-extension radiographs were available on 7 patients. Sagittal arc for the upper instrumented vertebral end plate to the lower instrumented vertebral endplate of the cohort was 10 degrees in the thoracic spine (6 to 18) and 14 degrees in the lumbar spine (5 to 21). Sagittal measurements for the changes in the arc of the upper and lower screws on the construct were 4 degrees in the thoracic group (2 to 8) and 9 degrees in the lumbar group (2 to 17). By latest follow-up 11 patients (38%) underwent reoperation, with most cases due to implant breakage (N=4, 14%), extender misalignment (N=2, 7%), and screw misplacement (N=2, 7%). CONCLUSION At mean 1.9 years postoperatively, PDDD preserves measurable spinal motion over the construct both in the coronal and the sagittal plane without evidence for autofusion. Coronal arc of motion averages 10 to 12 degrees and sagittal arc of motion ranged from 4 to 14 degrees, although this varies by patient. This study confirms that PDDD for pediatric scoliosis preserves a measurable degree of postoperative flexibility both in the sagittal and coronal planes. LEVEL OF EVIDENCE Level II-therapeutic study.
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Affiliation(s)
| | | | - Edward Floyd
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
- Sanford Health, Sanford Orthopedics & Sports Medicine
| | - Geoffrey Haft
- Department of Orthopedic Surgery, Avera Health, Sioux Falls, SD
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD
| | - Ron El-Hawary
- Department of Orthopedic Surgery, Avera Health, Sioux Falls, SD
| | - Michael Albert
- Department of Surgery, IWK Health, Halifax, Nova Scotia, Canada
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Xie B, Yan T, Ni H, Zhu K, Zhang S, Song P, Xu P, Shen C, Dong F. Butterfly Vertebra: A Retrospective Study of 30 Patients. World Neurosurg 2024; 185:e995-e1003. [PMID: 38462068 DOI: 10.1016/j.wneu.2024.03.009] [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: 12/16/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Butterfly vertebra (BV) is a rare congenital spinal anomaly for which there is a paucity of large-scale retrospective studies and established guidelines for treatment. The objective of this study was to elucidate the clinical characteristics, imaging findings, and therapeutic approaches for BV. METHODS We conducted a retrospective analysis of 30 patients diagnosed with BV at our hospital from 2009 to 2023, examining clinical data, imaging findings, and clinical interventions. RESULTS The analysis comprised a cohort of 30 patients, consisting of 15 males and 15 females, with a mean age of 27.63 ± 19.84 years. Imaging studies indicated that the majority of vertebral bodies affected by BV were single-segmented (63.3%, 19/30) and less commonly multi-segmented (36.7%, 11/30). These findings frequently coexisted with other medical conditions, most notably spinal scoliosis (76.7%, 23/30). Furthermore, the study identified a range of spinal abnormalities among patients, including hemivertebral deformity (30.0%, 9/30), spinal cleft (10.0%, 3/30), lumbar disc protrusion or herniation (10.0%, 3/30), vertebral slippage (10.0%, 3/30), thoracic kyphosis deformity (6.67%, 2/30), vertebral fusion deformity (6.67%, 2/30), compressive fractures (3.3%, 1/30), and vertebral developmental anomalies (3.3%, 1/30). Clinical intervention resulted in symptom relief for 23 nonsurgical patients through lifestyle modifications, analgesic use, and physical therapy. Seven surgical patients underwent appropriate surgical procedures, leading to satisfaction and adherence to regular postoperative follow-up appointments. CONCLUSIONS BV is a rare vertebral anomaly that can be easily misdiagnosed due to its similarity to other diseases. Consequently, it is imperative to enhance vigilance in the differential diagnosis process in order to promptly recognize BV. Furthermore, in cases where patients present with additional associated radiographic findings, a thorough evaluation is typically warranted and timely measures should be taken for treatment.
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Affiliation(s)
- Bingyong Xie
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tingfei Yan
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Haoyu Ni
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kun Zhu
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Siya Zhang
- School of Basic Medical Sciences, Anhui Medical University, Hefei, China; Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peiwen Song
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peng Xu
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cailiang Shen
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fulong Dong
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China; School of Basic Medical Sciences, Anhui Medical University, Hefei, China.
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Zhu W, Zhang X, Cao J, Zhang B, Chen W, Bai Y, Guo D, Yao Z. Comparison of the efficacy of the convex side short fusion combined with concave side single growing rod technique and the traditional bilateral growing rod technique in the treatment of early onset scoliosis. BMC Musculoskelet Disord 2024; 25:338. [PMID: 38671421 PMCID: PMC11055317 DOI: 10.1186/s12891-024-07457-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES The application of a growing rod technique can retain the growth and development potential of the spine and thorax while controlling the progression of scoliosis deformity. Theoretically, convex side short fusion combined with a concave side single growing rod technique can significantly reduce the asymmetric growth of the spine in the vertex region in most patients. However, the final clinical outcome of various techniques is yet to be clearly determined and compared between studies. Therefore, we compared the efficacy of these two growing rod techniques in treating early onset scoliosis. METHODS In a retrospective study of 152 EOS patients seen between 2013.1 and 2019.12, 36 cases of EOS patients were selected for inclusion. Among the 36 cases, 11 cases were treated with convex side short fusion combined with a concave side single growing rod technique, group (A) The remaining 25 cases were treated with traditional bilateral growing rod technique, group (B) Age, gender, etiology, follow-up time, Cobb angle of main curve, T1-S1 height, coronal trunk shift, sagittal vertical axis (SVA), Cobb angle of thoracic kyphosis at last follow-up, and Cobb angle at proximal junction kyphosis of the first and last post-operation follow-up were recorded. In addition, internal fixation related complications, infection, nervous system complications were recorded as well. RESULTS There was no statistically significant difference between group A and group B in preoperative age, Cobb angle of main curve, coronal trunk shift, T1-S1 height, SVA, Cobb angle of thoracic kyphosis (p > 0.05). However, at the last follow-up (Group A, mean 4.4 ± 1.01 years; Group B, mean 3.6 ± 0.01 years) the Cobb angle of the main curve was less and T1-S1 height greater in group A compared with group B (p < 0.05). There was no statistically significant difference between group A and group B in the correction rate of the Cobb angle of the main curve or the growth rate of T1-S1 height (p > 0.05). There was no statistically significant difference in the coronal imbalance ratio, thoracic kyphosis abnormality ratio, or the occurrence PJK ratio between group A and group B at the last follow-up (p > 0.05), but the sagittal imbalance ratio and internal fixation abnormality ratio were higher in group A than in the group B (p < 0.05). CONCLUSIONS During the treatment of EOS, both the convex side short fusion combined with concave side single growing rod technique and traditional bilateral growing rod technique can correct the Cobb angle of main curve with no significant hindering of the spinal growth observed. The traditional bilateral growing rod technique has advantages in control of the sagittal balance of the spine, and the complications associated with internal fixation were lower.
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Affiliation(s)
- Weiwei Zhu
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Xuejun Zhang
- Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Jun Cao
- Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Baihui Zhang
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wenhao Chen
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yunsong Bai
- Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Dong Guo
- Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Ziming Yao
- Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
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Du Y, Bian Y, Zhao Y, Yang Y, Lin G, Han B, Zhang H, Li C, Ye X, Li Z, Zhang J, Wang S. A Novel growth guidance system for early onset scoliosis: a preliminary in vitro study. J Orthop Surg Res 2024; 19:259. [PMID: 38659060 PMCID: PMC11040790 DOI: 10.1186/s13018-024-04720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE The purpose of the study was to describe a novel growth guidance system, which can avoid metal debris and reduce the sliding friction forces, and test the durability and glidability of the system by in vitro test. METHOD Two major modifications were made to the traditional Shilla system, including the use of ultra-high molecular weight polyethylene (UHMWPE) gaskets to avoid direct contact between the screw and rod, and polishing the surface of the sliding part of the rod. We tested the durability of the system by a fatigue test, which the samples were test on the MTS system for a 10 million cycle of a constant displacement. Pre and post-testing involved weighing the UHMWPE gaskets and observing the wear conditions. The sliding ability were measured by a sliding displacement test. The maximum sliding displacement of the system was measured after a 300 cycles of dynamic compressive loads in a sinusoidal waveform. RESULTS After the fatigue test, all the UHMWPE gaskets samples showed some of the fretting on the edge of the inner sides, but its still isolated and avoided the friction between the screws and rods. There was no production of metallic fretting around the sliding screws and rods. The average wear mass of the UHMWPE gaskets was 0.002 ± 0.001 g, less than 1.7% of the original mass. In the sliding test, the novel growth guidance system demonstrated the best sliding ability, with an average maximum sliding distance(AMSD) of 35.75 ± 5.73 mm, significantly better than the group of the traditional Shilla technique(AMSD 3.65 ± 0.46 mm, P < 0.0001). CONCLUSION In conclusion, we modified the Shilla technique and designed a novel growth guidance system by changing the friction interface of sliding screw and rod, which may significantly reduce the metallic debris and promote spine growth. The fatigue test and sliding dislocation test demonstrated the better durability and glidability of the system. An in vivo animal experiment should be performed to further verify the system.
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Affiliation(s)
- You Du
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Yanyan Bian
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Yiwei Zhao
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Yang Yang
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Guanfeng Lin
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Bingtai Han
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Haoran Zhang
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Chenkai Li
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Xiaohan Ye
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Zhiyi Li
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China.
| | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China.
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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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Miladi L, Solla F, Gaume M. The Minimally Invasive Bipolar Fixation for Pediatric Spinal Deformities: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:228. [PMID: 38397340 PMCID: PMC10887551 DOI: 10.3390/children11020228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
Growing rod techniques are increasingly used for early-onset scoliosis in children. Unfortunately, they are associated with many complications, particularly neuromuscular scoliosis, favored by the poor general condition of these patients and the fragility of their osteoporotic bones. Furthermore, these interventions are often iterative and usually followed by vertebral fusion at the end of growth. This is a review of the literature on a recent fusionless technique, minimally invasive bipolar fixation, which is more stable than the traditional growing rod techniques and less aggressive than vertebral arthrodesis. It allows the avoidance of arthrodesis, owing to the solidity of the construct and the stability of the results, leading to progressive spinal stiffening that occurs over time. The results of this technique have been published with a long follow-up period and have confirmed that it can completely replace posterior vertebral arthrodesis, especially in the most complicated scoliosis. Because it preserves growth, this technique should be recommended for early-onset scoliosis before the age of 10 years. The use of a self-expanding rod can avoid the need for repeated surgery, thereby reducing the risk of complications and the overall cost of treatment.
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Affiliation(s)
- Lotfi Miladi
- Pediatric Orthopedic Surgery Department, Necker Hospital, Assistance Publique des Hopitaux de Paris (APHP), University of Paris-Cité, 75105 Paris, France;
| | - Federico Solla
- Pediatric Orthopaedic Surgery, Lenval University Children’s Hospital, 06200 Nice, France;
| | - Mathilde Gaume
- University Institute for Spine Surgery, Armand Trousseau Hospital, Sorbonne University, 75012 Paris, France
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Du Y, Zhang H, Wang Y. Clinical outcomes and spinal growth after posterior hemivertebra resection and short segment fusion in children. Sci Rep 2024; 14:2755. [PMID: 38307939 PMCID: PMC10837147 DOI: 10.1038/s41598-024-53290-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 01/30/2024] [Indexed: 02/04/2024] Open
Abstract
To evaluate the corrective effect of posterior hemivertebra resection and short-segment fusion surgery on pediatric patients and to assess the impact of short-segment fixation surgery on vertebral development during follow-up, a retrospective analysis was performed on 28 pediatric patients who underwent posterior hemivertebra resection surgery. The corrective effect was evaluated by comparing indicators such as segmental scoliosis Cobb angle, upper and lower compensatory curves and trunk balance at different time points. Meanwhile, the vertebral and spinal canal diameters of instrumented vertebrae and adjacent noninstrumented vertebrae were measured and compared to assess vertebral and spinal canal development. The correction rate of segmental scoliosis was 72.2%. The estimated mean vertebral volume of the instrumented vertebra was slightly lower than that of the unfused segment at the final follow-up, but the difference was not statistically significant. The growth rate of the spinal canal during follow-up was much smaller than that of the vertebral body. In summary, internal fixation at a young age shows no significant inhibitory effects on spinal development within the fusion segment. Posterior hemivertebra resection and short-segment fusion surgery are safe and effective.
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Affiliation(s)
- Yuxuan Du
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, China
| | - Hongqi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, China.
- From National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China.
| | - Yuxiang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, China.
- From National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China.
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Wang C, Guo X, Zhu H, Zou Y, Wu M, Meng Z. Analysis of the factors affecting the loss of correction effect in patients with congenital scoliosis after one stage posterior hemivertebrae resection and orthosis fusion. BMC Musculoskelet Disord 2023; 24:960. [PMID: 38082325 PMCID: PMC10712081 DOI: 10.1186/s12891-023-07060-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND To analyze the factors affecting the loss of correction effect in patients with congenital scoliosis after one stage posterior hemivertebra resection, orthosis, fusion and internal fixation. METHODS Thirty-nine patients with congenital scoliosis (CS) who underwent one-stage posterior hemivertebra resection, orthosis, fusion and internal fixation were retrospectively included in Hebei Children's Hospital General demographic information of patients was collected. Preoperative and postoperative imaging indicators were compared, Including cobb Angle of the main curvature of the spine, segmental Cobb Angle, compensatory cephalic curve, compensatory curve on the caudal side, segmental kyphosis, coronal balance, sagittal balance, thoracic kyphosis, lumbar lordosis, and apical vertebra translation. Correlation analysis is used to evaluate the factors affecting the loss of judgment and correction effect, and the correlation indicators are included in the multi-factor Logistics regression. RESULTS In terms of radiographic indicators in the coronal plane, compared to preoperative values, significant improvements were observed in postoperative Cobb Angle of main curve (8.00°±4.62° vs. 33.30°±9.86°), Segmental Cobb angle (11.87°±6.55° vs. 31.29°±10.03°), Compensatory cephalic curve (6.22°±6.33° vs. 14.75°±12.50°), Compensatory curve on the caudal side (5.58°±3.43° vs. 12.61°±8.72°), coronal balance (10.95 mm ± 8.65 mm vs. 13.52 mm ± 11.03 mm), and apical vertebra translation (5.96 mm ± 5.07 mm vs. 16.55 mm ± 8.39 mm) (all P < 0.05). In the sagittal plane, significant improvements were observed in Segmental kyposis Angle (7.60°±9.36° vs. 21.89°±14.62°, P < 0.05) as compared to preoperative values. At the last follow-up, Segmental kyphosis Angle (6.09°±9.75° vs. 21.89°±14.62°, P < 0.05), Thoracic kyphosis (26.57°±7.68° vs. 24.06°±10.49°, P < 0.05) and Lumbar lordosis (32.12°±13.15° vs. 27.84°±16.68°, P < 0.05) had statistical significance compared with the preoperative department. The correlation analysis showed that the correction effect of the main curve Cobb angle was correlated with fixed segment length (rs=-0.318, P = 0.048), postoperative segment Cobb angle (rs=-0.600, P < 0.001), preoperative apical vertebra translation (rs = 0.440, P = 0.005), and spinal cord malformation (rs=-0.437, P = 0.005). The correction effect of segmental kyphosis was correlated with age (rs = 0.388, P = 0.037). The results of the multivariate logistic regression analysis revealed that postoperative segmental Cobb angle > 10° (OR = 0.011, 95%CI:0.001-0.234, P = 0.004), associated spinal cord anomalies (OR = 24.369, 95%CI:1.057-561.793, P = 0.046), and preoperative apical translation > 10 mm (OR = 0.012, 95%CI:0.000-0.438, P = 0.016) were influential factors in the progression of the main curve Cobb angle. CONCLUSION The one-stage posterior hemivertebra resection and short-segment corrective fusion with internal fixation are effective means to treat congenital scoliosis. However, attention should be paid to the loss of correction and curve progression during follow-up. Patients with spinal cord malformation and a large preoperative apical vertebra translation have a greater risk of losing the correction after surgery.
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Affiliation(s)
- Chen Wang
- Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China
| | - Xuzhao Guo
- Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China
| | - Hua Zhu
- Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China
| | - Yan Zou
- Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China
| | - Ming Wu
- Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China
| | - Zhao Meng
- Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China.
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11
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Mbamalu EK, Hyacinthe J, Hui A, Tirabady P, Alvandi L, Gomez J. Early Onset Scoliosis and Adolescent Idiopathic Scoliosis: A Review of the Literature and Correlations With Pulmonary Dysfunction. Cureus 2023; 15:e48900. [PMID: 38111427 PMCID: PMC10726067 DOI: 10.7759/cureus.48900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/20/2023] Open
Abstract
In the management of early onset scoliosis (EOS) and adolescent idiopathic scoliosis (AIS), orthopedic surgeons are tasked with considering the effects that curves and their treatment can have on the respiratory system, possibly the most relevant being pulmonary dysfunction due to thoracic cage changes. The pulmonary impairment that occurs as a result of scoliosis varies widely and requires a multimodal response, including physiologic testing, such as pulmonary function tests (PFTs) and consistent psychosocial monitoring of the patient. This forces healthcare providers to consider all factors affecting the patient's quality of life (QOL) and not just the primary pathology they are treating. One method that could be utilized to ensure a more holistic approach to treatment is the use of patient-reported outcome measures (PROMs) to assess the QOL domains. Thus, this review serves to highlight the importance of addressing and correcting pulmonary dysfunction in the care of children with EOS and AIS in a holistic manner.
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Affiliation(s)
| | - Julia Hyacinthe
- Orthopaedic Surgery, Albert Einstein College of Medicine, New York, USA
| | - Aaron Hui
- Orthopaedic Surgery, Albert Einstein College of Medicine, New York, USA
| | - Parsa Tirabady
- Orthopaedic Surgery, Albert Einstein College of Medicine, New York, USA
| | - Leila Alvandi
- Orthopaedic Surgery, Montefiore Medical Center, New York, USA
| | - Jaime Gomez
- Orthopaedic Surgery, Montefiore Medical Center, New York, USA
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12
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Mehta JS, Tognini M, Hothi H. Growing rods in Early Onset Scoliosis: The current scenario. J Orthop 2023; 42:63-69. [PMID: 37519912 PMCID: PMC10372050 DOI: 10.1016/j.jor.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023] Open
Abstract
Background and aims The treatment of early onset scoliosis is a challenge. Some curves resolve spontaneously, while the more aggressive ones require surgical intervention. Several surgical strategies have been explored in this unique group of patients, though the distraction based growing rods are the mainstay of treatment. The aim of this paper is to consider the current scenario with the surgical treatment for early onset scoliosis with growing rods. Methods This is a narrative review that explores the various types of growing rod options that are currently available. The results, as reported in literature, are discussed. The complications and problems with the commonly used growing rods are explored, based on the reported literature and on retrieval analysis that we have published. We discuss some of the newer modifications of growing rods. Results There is no real consensus on the ideal timing for the surgery or ways to assess the outcomes of the treatment. The Cobb angle measurement and measures of thoracic growth are surrogate markers. The main indication for surgery is to an increase in the thoracic dimensions and allowing for lung growth. Measures that are linked to lung function are more useful. We report some newer MRI scanning technology. Distraction-based growing rods have been reported to produce consistent and good results. Frequent return to theatre with the Traditional Growing Rods (TGR) and the metallosis related problems with the MCGR are reported. Conclusions We have learned a lot from the TGR and MCGR experiences. There is a scope for ongoing research to improve the design of the implant systems and better assess the outcomes on lung function. This review outlines these and helps identify the future trends.
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Affiliation(s)
- Jwalant S. Mehta
- Royal Orthoapedic Hospital, UK
- Birmingham Childrens' Hospital, UK
| | - Martina Tognini
- Institute of Orthopaedics and Musculoskeletal Science, University College London, UK
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Harry Hothi
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
- Department of Mechanical Engineering, University College London, UK
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13
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Johnson MA, Cirrincione PM, Zucker CP, Blanco JS, Widmann RF, Heyer JH. Changes in height, weight, and body mass index after posterior spinal fusion in juvenile and adolescent idiopathic scoliosis. J Child Orthop 2023; 17:354-359. [PMID: 37565004 PMCID: PMC10411370 DOI: 10.1177/18632521231177041] [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: 02/15/2023] [Accepted: 04/21/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose Posterior spinal fusion for idiopathic scoliosis is known to increase spinal height, but the impacts on weight and resulting body mass index are unknown. This study assesses body mass index, weight, and height percentile changes over time after posterior spinal fusion for idiopathic scoliosis. Methods Body mass index, weight, and height age- and sex-adjusted percentiles for patients with idiopathic scoliosis undergoing posterior spinal fusion between January 2016 and August 2022 were calculated based on growth charts from the Centers for Disease Control for Disease Control and compared to preoperative values at 2 weeks, 3 months, 6 months, 1 year, and 2 years. The data were analyzed for normality with a Shapiro-Wilk test, and percentiles were compared with the Wilcoxon signed-rank tests. Results On average, 12.1 ± 2.3 levels were fused in 269 patients 14.4 ± 1.9 years, and percentiles for body mass index, weight, and height preoperatively were 55.5 ± 29.4%, 57.5 ± 28.9%, and 54.6 ± 30.4%, respectively. Body mass index and weight percentiles decreased at 2 weeks (-10.7%, p < 0.001; -4.6%, p < 0.001, respectively) and 3 months (-6.9%, p < 0.001; -3.2%, p < 0.001, respectively) postoperatively. Postoperative weight loss at 2 weeks averaged 2.25 ± 3.09% of body weight (0.98 ± 4.5 kg), normalizing by 3 months. Body mass index percentile normalized at 1 year, but height percentile was increased at 2 weeks (2.42 ± 1.72 cm, p < 0.001) and through 2 years. Conclusion Despite initial height increase due to deformity correction, acute postoperative weight and body mass index percentile decreases postoperatively normalize by 1-year body mass index percentile. Physicians may benefit from utilizing this information when discussing the postoperative course of posterior spinal fusion with idiopathic scoliosis. Level of evidence 4, Retrospective Case Series.
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14
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Faust M, Allahabadi S, Louer C, Sponseller P, Strum P, Boachie-Adjei O, Oetgen M, Swarup I. Intraoperative Antibiotic Use in Patients With Early-onset Scoliosis: Current Practices and Trends. J Pediatr Orthop 2023; 43:373-378. [PMID: 36941112 DOI: 10.1097/bpo.0000000000002392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Best Practice Guidelines (BPGs) regarding antibiotic prophylaxis in early-onset scoliosis (EOS) patients were published in September 2019. Recommendations included using intravenous cefazolin and topical vancomycin for all index procedures, plus gram-negative coverage for neuromuscular patients. Guideline adherence is unknown. This study aimed to characterize antibiotic prophylaxis at the time of index growth-friendly procedures and assess changes in practice patterns over time. MATERIALS AND METHODS This retrospective review of data collected through a multicenter study group included EOS patients undergoing index growth-friendly procedures between January 2018 and March 2021, excluding revisions, lengthenings, and tetherings. Demographics, clinical measurements, intraoperative antibiotics, and 90-day complications were recorded. Descriptive and univariate statistics were utilized. Antibiotic prophylaxis from April 2018 through September 2019 and October 2019 through March 2021 were compared with evaluate change after BPG publication. RESULTS A total of 562 patients undergoing growth-friendly procedures were included. The most common scoliosis types included neuromuscular (167, 29.7%), syndromic (134, 23.8%), and congenital (97, 17.3%). Most index procedures involved magnetically controlled growing rods (417, 74%) followed by vertical expandable prosthetic titanium rib or traditional growing rods (105, 19%). Most patients received cefazolin alone at index procedure (310, 55.2%) or cefazolin with an aminoglycoside (113, 20.1%). Topical antibiotics were used in 327 patients (58.2%), with most receiving vancomycin powder. There was increased use of cefazolin with an aminoglycoside after BPG publication (16% vs. 25%) ( P =0.01). Surgical site infections occurred in 12 patients (2.1%) within 90 days of index procedure, 10 pre-BPGs (3%), and 2 post-BPGs (0.9%), with no significant difference in surgical site infection rate by type of antibiotic administered ( P >0.05). CONCLUSIONS Historical variability exists regarding antibiotic prophylaxis during index growth-friendly procedures for EOS. There continues to be variability following BPG publication; however, this study found a significant increase in antibiotic prophylaxis against gram-negative bacteria after BPG publication. Overall, greater emphasis is needed to decrease variability in practice, improve compliance with consensus guidelines, and evaluate BPG efficacy. LEVEL OF EVIDENCE Level III-retrospective.
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Affiliation(s)
- Millis Faust
- University of California, San Francisco School of Medicine
| | - Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco
- Department of Orthopaedic Surgery, University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, CA
| | - Craig Louer
- Vanderbilt Children's Orthopaedics, Nashville, TN
| | - Paul Sponseller
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter Strum
- Department of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital, Cincinnati, OH
| | | | - Matthew Oetgen
- Department of Pediatric Orthopaedic Surgery, Children's National Hospital, Washington, DC
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco
- Department of Orthopaedic Surgery, University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, CA
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15
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Zhang H, Xiang G, Li J, He S, Wang Y, Deng A, Wang Y, Guo C. Promotion effect of FGF23 on osteopenia in congenital scoliosis through FGFr3/TNAP/OPN pathway. Chin Med J (Engl) 2023; 136:1468-1477. [PMID: 37192015 PMCID: PMC10278695 DOI: 10.1097/cm9.0000000000002690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Congenital scoliosis (CS) is a complex spinal malformation of unknown etiology with abnormal bone metabolism. Fibroblast growth factor 23 (FGF23), secreted by osteoblasts and osteocytes, can inhibit bone formation and mineralization. This research aims to investigate the relationship between CS and FGF23. METHODS We collected peripheral blood from two pairs of identical twins for methylation sequencing of the target region. FGF23 mRNA levels in the peripheral blood of CS patients and age-matched controls were measured. Receiver operator characteristic (ROC) curve analyses were conducted to evaluate the specificity and sensitivity of FGF23. The expression levels of FGF23 and its downstream factors fibroblast growth factor receptor 3 (FGFr3)/tissue non-specific alkaline phosphatase (TNAP)/osteopontin (OPN) in primary osteoblasts from CS patients (CS-Ob) and controls (CT-Ob) were detected. In addition, the osteogenic abilities of FGF23-knockdown or FGF23-overexpressing Ob were examined. RESULTS DNA methylation of the FGF23 gene in CS patients was decreased compared to that of their identical twins, accompanied by increased mRNA levels. CS patients had increased peripheral blood FGF23 mRNA levels and decreased computed tomography (CT) values compared with controls. The FGF23 mRNA levels were negatively correlated with the CT value of the spine, and ROCs of FGF23 mRNA levels showed high sensitivity and specificity for CS. Additionally, significantly increased levels of FGF23, FGFr3, OPN, impaired osteogenic mineralization and lower TNAP levels were observed in CS-Ob. Moreover, FGF23 overexpression in CT-Ob increased FGFr3 and OPN levels and decreased TNAP levels, while FGF23 knockdown induced downregulation of FGFr3 and OPN but upregulation of TNAP in CS-Ob. Mineralization of CS-Ob was rescued after FGF23 knockdown. CONCLUSIONS Our results suggested increased peripheral blood FGF23 levels, decreased bone mineral density in CS patients, and a good predictive ability of CS by peripheral blood FGF23 levels. FGF23 may contribute to osteopenia in CS patients through FGFr3/TNAP / OPN pathway.
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Affiliation(s)
- Hongqi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Gang Xiang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Jiong Li
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Sihan He
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Yunjia Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Ang Deng
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Yuxiang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Chaofeng Guo
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
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16
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Soini V, Schreiber G, Wilken B, Hell AK. Early Development of Spinal Deformities in Children Severely Affected with Spinal Muscular Atrophy after Gene Therapy with Onasemnogene Abeparvovec-Preliminary Results. CHILDREN (BASEL, SWITZERLAND) 2023; 10:998. [PMID: 37371230 DOI: 10.3390/children10060998] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Spinal muscular atrophy (SMA) is a rare genetic disorder, with the most common form being 5q SMA. Survival of children with severe SMA is poor, yet major advances have been made in recent years in pharmaceutical treatment, such as gene-therapy, which has improved patient survival. Therefore, clinical problems, such as the development of spinal deformities in these genetically treated SMA children represent an unknown challenge in clinical work. In a retrospective case series, the development of spinal deformities was analyzed in 16 SMA children (9 male, 7 female) treated with onasemnogene abeparvovec in two institutions during the years 2020 to 2022. Ten out of sixteen patients had a significant kyphosis, and nine out of sixteen patients had significant scoliosis, with the mean curvature angles of 24 ± 27° for scoliosis, and 69 ± 15° for kyphosis. Based on these preliminary data, it can be assumed that early-onset kyphosis presents a clinical challenge in gene-therapy-treated SMA children. Larger datasets with longer follow-up times need to be collected in order to verify these preliminary observations.
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Affiliation(s)
- Venla Soini
- Paediatric Orthopaedics, Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Göttingen, 37075 Göttingen, Germany
- Department of Paediatric Surgery and Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, FI-20520 Turku, Finland
| | - Gudrun Schreiber
- Department of Pediatric Neurology, Social Pediatric Center, Medical Center Kassel, 34127 Kassel, Germany
| | - Bernd Wilken
- Department of Pediatric Neurology, Social Pediatric Center, Medical Center Kassel, 34127 Kassel, Germany
| | - Anna Kathrin Hell
- Paediatric Orthopaedics, Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Göttingen, 37075 Göttingen, Germany
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17
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Balioğlu MB, Abul K, Akpolat AO, Özlük AV, Saçık N, Aksay MF, Çetinkaya M. Implant-Related Complications Do Not Interfere with Corrections with the Shilla Technique in Early Onset Scoliosis: Preliminary Results. CHILDREN (BASEL, SWITZERLAND) 2023; 10:947. [PMID: 37371179 DOI: 10.3390/children10060947] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Abstract
Growth-preservation techniques are utilized in early onset scoliosis (EOS) cases requiring surgical intervention. The Shilla technique corrects the deformity by reducing additional surgeries with its growth-guidance effect. As with other techniques, various problems can be encountered following the administration of the Shilla technique. The aim of this study was to examine the effect of complications encountered with the Shilla treatment on correction and growth. Sixteen patients with a follow-up period of at least one year after receiving Shilla growth guidance for EOS were included in this retrospective study. No complications occurred, and no unplanned surgery was required in 50% of the cases. Of the remaining eight patients with postoperative implant-related complications (50%), six (37.5%) required unplanned surgery; this consequently caused implant failure in the proximal region in five cases (31.25%) and deep tissue infection around the implant in one case (6.25%). Deformity correction, spine length, and quality-of-life scores significantly improved in EOS through Shilla growth guidance. In terms of spinal growth and deformity correction, there were no significant differences between patients with implant-related problems and individuals without occurrences. Although implant-related problems were detected in our dataset and corresponding unexpected surgeries were necessary, these complications had no significant unfavorable influence on correction and spine growth.
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Affiliation(s)
- Mehmet Bülent Balioğlu
- Department of Orthopedics and Traumatology, Başakşehir Pine and Sakura City Hospital, 34480 Istanbul, Turkey
| | - Kadir Abul
- Department of Orthopedics and Traumatology, Başakşehir Pine and Sakura City Hospital, 34480 Istanbul, Turkey
| | - Ahmet Onur Akpolat
- Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, 34752 Istanbul, Turkey
| | - Ali Volkan Özlük
- Department of Orthopedics and Traumatology, Başakşehir Pine and Sakura City Hospital, 34480 Istanbul, Turkey
| | - Nurullah Saçık
- Department of Orthopedics and Traumatology, Başakşehir Pine and Sakura City Hospital, 34480 Istanbul, Turkey
| | - Mehmet Fatih Aksay
- Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, 34752 Istanbul, Turkey
| | - Mehmet Çetinkaya
- Department of Orthopedics and Traumatology, Başakşehir Pine and Sakura City Hospital, 34480 Istanbul, Turkey
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18
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Tognini M, Hothi H, Bergiers S, Broomfield E, Tucker S, Henckel J, Hart A. Rod Fracture in Magnetically Controlled Growing Spine Rods. J Pediatr Orthop 2023; 43:211-217. [PMID: 36737055 PMCID: PMC9981316 DOI: 10.1097/bpo.0000000000002361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The mechanisms of fracture in magnetically controlled growing rods (MCGRs) and the risk factors associated with this are poorly understood. This retrospective analysis of explanted MCGRs aimed to add understanding to this subject. METHODS From our cohort of over 120 retrieved MCGRs, we identified 7 rods that had fractured; all were single-rod constructs, retrieved from 6 patients. These were examined and compared with 15 intact single-rod constructs. Retrieval and fractographic analyses were used to determine the failure mode at the fracture site and the implant's functionality. Cobb angle, degree of rod contouring, and the distance between anchoring points were computed on anteroposterior and lateral radiographs. RESULTS 5/7 versus 3/15 rods had been inserted after the removal of a previously inserted rod, in the fractured versus control groups. All fractured rods failed due to bending fatigue. Fractured rods had greater rod contouring angles in the frontal plane ( P = 0.0407) and lateral plane ( P = 0.0306), and greater distances between anchoring points in both anteroposterior and lateral planes ( P = 0.0061 and P = 0.0074, respectively). CONCLUSIONS We found all failed due to a fatigue fracture and were virtually all single rod configurations. Fracture initiation points corresponded with mechanical indentation marks induced by the intraoperative rod contouring tool. Fractured rods had undergone greater rod contouring and had greater distances between anchoring points, suggesting that it is preferable to implant double rod constructs in patients with sufficient spinal maturity to avoid this complication. CLINICAL RELEVANCE Level III.
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Affiliation(s)
- Martina Tognini
- Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore
| | - Harry Hothi
- Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore
| | - Sean Bergiers
- Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore
| | - Edel Broomfield
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stewart Tucker
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Johann Henckel
- Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore
| | - Alister Hart
- Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore
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19
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O'Donnell J, Garcia S, Ali S, Asturias A, Swarup I. Indications and Efficacy of Halo-Gravity Traction in Pediatric Spinal Deformity: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202303000-00001. [PMID: 36881664 DOI: 10.2106/jbjs.rvw.22.00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
» Halo-gravity traction (HGT) is a well-established technique for correcting severe spinal deformity in pediatric patients. » HGT induces soft-tissue relaxation and gradually lengthens the spine, and it can be used preoperatively and intraoperatively. » It is typically indicated for spinal deformity over 90° in any plane and medical optimization. » There are several complications associated with the use of HGT, and it is critical to follow a protocol and perform serial examinations to minimize this risk.
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Affiliation(s)
- Jennifer O'Donnell
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital, University of California San Francisco, Oakland, California
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20
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Wang S, Zhao Y, Yang Y, Lin G, Shen J, Zhao Y, Wu N, Zhuang Q, Du Y, Zhang J. Hybrid technique versus traditional dual growing rod technique to treat congenital early-onset scoliosis: a comparative study with more than 3 years of follow-up. J Neurosurg Spine 2023; 38:199-207. [PMID: 36208432 DOI: 10.3171/2022.8.spine22618] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' objective was to compare the intermediate outcomes of patients with severe congenital early-onset scoliosis (CEOS) treated with posterior vertebrectomy/hemivertebrectomy with short fusion and dual growing rods (hybrid technique [HT]) and those treated with traditional dual growing rods (TDGRs). METHODS A retrospective study of patients who underwent the HT and TDGR technique for CEOS was conducted. The inclusion criteria were CEOS (age < 10 years), Risser stage 0, treatment with HT or TDGR, index surgery performed between 2004 and 2017, and minimum follow-up of 3 years. For patients who completed lengthening procedures, the last lengthening procedure was considered the latest follow-up. Demographic, radiographic, clinical, and patient-reported outcomes and revisions were compared between groups. RESULTS Sixty-one patients with CEOS were included in this study, with 16 treated with HT and 45 with TDGR technique. There were no differences in age at index surgery, duration of treatment, or number of lengthening procedures. The lengthening interval was longer in the HT group. The preoperative mean ± SD main curve was 81.8° ± 17.1° for the HT group and 63.3° ± 16.9° for the TDGR group (p < 0.05). However, main curve correction was better in the HT group, and no differences in residual curve were found between groups. Although the preoperative apex vertebral translation (AVT) of the HT group was greater, the correction of AVT was better in the HT group (p < 0.05). No differences in T1-S1 and T1-12 height were found between groups at the latest follow-up. The growth of T1-S1 height was less in the HT group (p < 0.05), whereas the growth of T1-12 height was similar between groups. Patients in the HT group had a lower risk of mechanical complications but higher risks of dural tears and neurological complications. CONCLUSIONS HT may provide better correction and apex control ability than TDGR for EOS patients with severe and rigid deformity at the apex level, and it significantly decreased the risk of mechanical complications with little influence on growth of the thoracic spine. HT may be an option for patients with severe CEOS with large asymmetrical growth potential around the apex of the curve.
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Roye BD, Fano AN, Quan T, Matsumoto H, Garg S, Heffernan MJ, Poon SC, Glotzbecker MP, Fletcher ND, Sturm PF, Ramirez N, Vitale MG, Anari JB. Modified Clavien-Dindo-Sink system is reliable for classifying complications following surgical treatment of early-onset scoliosis. Spine Deform 2023; 11:205-212. [PMID: 36053431 DOI: 10.1007/s43390-022-00573-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/13/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Appropriately measuring and classifying surgical complications is a critical component of research in vulnerable populations, including children with early-onset scoliosis (EOS). The purpose of this study was to assess the inter- and intra-rater reliability of a modified Clavien-Dindo-Sink system (CDS) classification system for EOS patients among a group of pediatric spinal deformity surgeons. METHODS Thirty case scenarios were developed and presented to experienced surgeons in an international spine study group. For each case, surgeons were asked to select a level of severity based on the modified CDS system to assess inter-rater reliability. The survey was administered on two occasions to allow for assessment of intra-rater reliability. Weighted Kappa values were calculated, with 0.61 to 0.80 considered substantial agreement and 0.81 to 1.00 considered nearly perfect agreement. RESULTS 11/12 (91.7%) surgeons completed the first-round survey and 8/12 (66.7%) completed the second. Inter-observer weighted kappa values for the first and second survey were 0.75 [95% CI 0.56-0.94], indicating substantial agreement, and 0.84 [95% CI 0.70-0.98], indicating nearly perfect agreement, respectively. Intra-observer reliability was 0.86 (range 0.74-0.95) between the first and second surveys, indicating nearly perfect agreement . CONCLUSION The modified CDS classification system demonstrated substantial to nearly perfect agreement between and within observers for the evaluation of complications following the surgical treatment of EOS patients. Adoption of this reliable classification system as a standard for reporting complications in EOS patients can be a valuable tool for future research endeavors, as we seek to ultimately improve surgical practices and patient outcomes. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Benjamin D Roye
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Adam N Fano
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Theodore Quan
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA.
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Sumeet Garg
- Department of Orthopaedic Surgery, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO, 80045, USA
| | - Michael J Heffernan
- Department of Orthopaedic Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Selina C Poon
- Department of Orthopaedic Surgery, Shriners Children's Southern California, 909 S Fair Oaks Ave, Pasadena, CA, 91105, USA
| | - Michael P Glotzbecker
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Nicholas D Fletcher
- Department of Orthopedic Surgery, Children's Healthcare of Atlanta, 1400 Tullie Rd NE 2nd Floor, Atlanta, GA, 30329, USA
| | - Peter F Sturm
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Norman Ramirez
- Department of Orthopaedic Surgery, Hospital de la Concepción, CARR 2 KM 173, San Germán, PR, 00683, USA
| | - Michael G Vitale
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Jason B Anari
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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22
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O'Donnell JM, Metz L, Swarup I. Surgical Correction of Neuromuscular Scoliosis Secondary to Congenital Zika Syndrome: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00016. [PMID: 36302062 DOI: 10.2106/jbjs.cc.22.00342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/28/2022] [Indexed: 06/16/2023]
Abstract
CASE Congenital Zika syndrome (CZS) has been noted after the South American pandemic of Zika virus which peaked in 2015 to 2016, and the associated sequelae are still being described. Scoliosis has been noted in patients with CZS; however, there is a paucity of literature on the prevalence or management of scoliosis secondary to this condition. We report the case of a 5-year-old girl with severe neuromuscular scoliosis due to CZS that was managed with halo-gravity traction, followed by a growth-friendly construct. CONCLUSION This case report highlights the need for more research focusing on the survivors of the Zika pandemic.
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Affiliation(s)
| | - Lionel Metz
- University of California-San Francisco, San Francisco, California
- UCSF Benioff Children's Hospital of Oakland, Oakland, California
| | - Ishaan Swarup
- University of California-San Francisco, San Francisco, California
- UCSF Benioff Children's Hospital of Oakland, Oakland, California
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23
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Kim G, Sammak SE, Michalopoulos GD, Mualem W, Pinter ZW, Freedman BA, Bydon M. Comparison of surgical interventions for the treatment of early-onset scoliosis: a systematic review and meta-analysis. J Neurosurg Pediatr 2022; 31:342-357. [PMID: 36152334 DOI: 10.3171/2022.8.peds22156] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/03/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Several growth-preserving surgical techniques are employed in the management of early-onset scoliosis (EOS). The authors' objective was to compare the use of traditional growing rods (TGRs), magnetically controlled growing rods (MCGRs), Shilla growth guidance techniques, and vertically expanding prosthetic titanium ribs (VEPTRs) for the management of EOS. METHODS A systematic review of electronic databases, including Ovid MEDLINE and Cochrane, was performed. Outcomes of interest included correction of Cobb angle, T1-S1 distance, and complication rate, including alignment, hardware failure and infection, and planned and unplanned reoperation rates. The percent changes and 95% CIs were pooled across studies using random-effects meta-analysis. RESULTS A total of 67 studies were identified, which included 2021 patients. Of these, 1169 (57.8%) patients underwent operations with TGR, 178 (8.8%) Shilla growth guidance system, 448 (22.2%) MCGR, and 226 (11.1%) VEPTR system. The mean ± SD age of the cohort was 6.9 ± 1.2 years. The authors found that the Shilla technique provided the most significant improvement in coronal Cobb angle immediately after surgery (mean [95% CI] 64.3% [61.4%-67.2%]), whereas VEPTR (27.6% [22.7%-33.6%]) performed significantly worse. VEPTR also performed significantly worse than the other techniques at final follow-up. The techniques also provided comparable gains in T1-S1 height immediately postoperatively (mean [95% CI] 10.7% [8.4%-13.0%]); however, TGR performed better at final follow-up (21.4% [18.7%-24.1%]). Complications were not significantly different among the patients who underwent the Shilla, TGR, MCGR, and VEPTR techniques, except for the rate of infections. The TGR technique had the lowest rate of unplanned reoperations (mean [95% CI] 15% [10%-23%] vs 24% [19%-29%]) but the highest number of planned reoperations per patient (5.31 [4.83-5.82]). The overall certainty was also low, with a high risk of bias across studies. CONCLUSIONS This analysis suggested that the Shilla technique was associated with a greater early coronal Cobb angle correction, whereas use of VEPTR was associated with a lower correction rate at any time point. TGR offered the most significant height gain at final follow-up. The complication rates were comparable across all surgical techniques. The optimal surgical approach should be tailored to individual patients, taking into consideration the strengths and limitations of each option.
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Affiliation(s)
- Gloria Kim
- 1Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Sally El Sammak
- 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota; and.,Departments of3Neurologic Surgery and
| | - Giorgos D Michalopoulos
- 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota; and.,Departments of3Neurologic Surgery and
| | - William Mualem
- 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota; and.,Departments of3Neurologic Surgery and
| | | | | | - Mohamad Bydon
- 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota; and.,Departments of3Neurologic Surgery and
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24
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Aili A, Ma Y, Sui J, Dai J, Zhu X, Muheremu A. Application of 3D printed models in the surgical treatment of spinal deformity. Am J Transl Res 2022; 14:6341-6348. [PMID: 36247257 PMCID: PMC9556452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To test if preoperative planning with 3 dimensional (3D)-printed spine models can increase the effectiveness and safety of spinal deformity surgery. METHODS A total of 53 patients who were treated in our center for spinal deformities from January 2010 to January 2018 were included in the current study. They were divided into two groups based on whether 3D-printed models were used in the surgical planning. A total of 28 patients who were treated with 3D-printed models were assigned to the experimental group, and 25 patients who were treated with conventional methods were assigned to the control group. Duration of surgery, intraoperative hemorrhage, incidence of surgery related complications, Oswestry disability index (ODI), visual analogue scale (VAS), and Cobb's angle were compared between the two groups before and after surgery. RESULTS There were significant differences in the duration of surgery, intraoperative hemorrhage and intraoperative x-ray exposure between the two groups (P<0.01). Cobb's angle was smaller in the experimental group than in the control group when measured three days and a year after surgery (P<0.01). Although there was no significant difference between the experimental and control groups (P>0.05), Oswestry disability index and VAS pain scores were lower a month and a year after the surgery than before the surgery (P<0.01). CONCLUSION Surgical planning using 3D-printed spine models can decrease the operation time, intraoperative hemorrhage, and x-ray exposure, and help achieve satisfactory structural restoration in patients with severe spinal deformity.
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Affiliation(s)
- Abudunaibi Aili
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Yuan Ma
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Jiangtao Sui
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Jie Dai
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Xu Zhu
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Aikeremujiang Muheremu
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
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25
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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: 0] [Impact Index Per Article: 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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26
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Zhang W, Yao Z, Guo R, Li H, Zhao S, Li W, Zhang X, Hao C. Molecular identification of T-box transcription factor 6 and prognostic assessment in patients with congenital scoliosis: A single-center study. Front Med (Lausanne) 2022; 9:941468. [PMID: 36035411 PMCID: PMC9403053 DOI: 10.3389/fmed.2022.941468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Congenital scoliosis (CS) is characterized by vertebral malformations. The precise etiology of CS is not fully defined. A compound inheritance of TBX6 was identified in 10% of patients with CS in Han Chinese and formed a distinguishable subtype named TBX6-associated congenital scoliosis (TACS). Methods To investigate the variants and risk haplotype of TBX6, we recruited 121 patients with CS at Beijing Children’s Hospital. We collected the clinical characteristics and surgical treatment options and followed their postoperative prognoses. Results Eight patients (6.6%) were molecularly diagnosed with TACS and carried the previously defined pathogenic TBX6 compound heterozygous variants. All the eight patients with TACS had the typical TACS clinical feature of hemivertebrae in the lower part of the spine. These patients received posterior hemivertebra resection combined with segmental fusion. Follow-ups revealed satisfactory correction without postoperative complications. Conclusion We observed a 6.6% prevalence of TACS in our CS cohort. Follow-ups further highlighted that surgical treatment of hemivertebra resection combined with segmental fusion performed well with prognosis for patients with TACS. This could provide valuable information for CS individuals with compound heterozygosity in TBX6.
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Affiliation(s)
- Wenyan Zhang
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, Beijing, China
- Ministry of Education of the People’s Republic of China (MOE) Key Laboratory of Major Diseases in Children, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Ziming Yao
- Department of Orthopedics, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Ruolan Guo
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, Beijing, China
- Ministry of Education of the People’s Republic of China (MOE) Key Laboratory of Major Diseases in Children, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
- Henan Key Laboratory of Pediatric Inherited and Metabolic Diseases, Henan Children’s Hospital, Zhengzhou Hospital of Beijing Children’s Hospital, Zhengzhou, China
| | - Haichong Li
- Department of Orthopedics, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Shuang Zhao
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, Beijing, China
- Ministry of Education of the People’s Republic of China (MOE) Key Laboratory of Major Diseases in Children, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, Beijing, China
- Ministry of Education of the People’s Republic of China (MOE) Key Laboratory of Major Diseases in Children, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
- Henan Key Laboratory of Pediatric Inherited and Metabolic Diseases, Henan Children’s Hospital, Zhengzhou Hospital of Beijing Children’s Hospital, Zhengzhou, China
| | - Xuejun Zhang
- Department of Orthopedics, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xuejun Zhang,
| | - Chanjuan Hao
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, Beijing, China
- Ministry of Education of the People’s Republic of China (MOE) Key Laboratory of Major Diseases in Children, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
- Henan Key Laboratory of Pediatric Inherited and Metabolic Diseases, Henan Children’s Hospital, Zhengzhou Hospital of Beijing Children’s Hospital, Zhengzhou, China
- Chanjuan Hao,
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Yang B, Xu L, Zhou Q, Qian Z, Wang B, Zhu Z, Qiu Y, Sun X. Relook into the Risk Factors of Proximal Junctional Kyphosis in Early Onset Scoliosis Patients: Does the Location of Upper Instrumented Vertebra in Relation to the Sagittal Apex Matter? Orthop Surg 2022; 14:1695-1702. [PMID: 35766793 PMCID: PMC9363734 DOI: 10.1111/os.13380] [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: 01/05/2022] [Revised: 05/29/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Growing rods surgery is the mainstay of treatment for early-onset scoliosis (EOS) while proximal junctional kyphosis (PJK) is one of the most commonly reported postoperative complications. We sought to investigate the impact of the location of upper instrumented vertebra (UIV) in relation to the sagittal apex on proximal junctional kyphosis in EOS after traditional growing rods (GRs) treatment. METHODS A total of 102 EOS patients who received traditional growing rods treatment with a follow-up of at least 2 years between 2009 and 2020 were retrospectively reviewed. Radiographic measurements were performed before and after the index surgery and at the latest follow-up. We investigated the coronal Cobb angle and spinopelvic parameters of the whole spine. The location of the UIV, apex, lower instrumented vertebra (LIV), inflection vertebra (IV), the number and distance of UIV-apex, LIV-apex and IV-apex were also recorded. Risk factors for PJK were analyzed by logistic regression analysis. RESULTS PJK was observed in 21 patients (20.6%) during the follow-up period. The PJK group showed a younger age at the index surgery (5.9 vs. 7.1 years, P = 0.042), more lengthening procedure times (5.0 vs. 4.0, P = 0.032), larger preoperative coronal Cobb angle (82.0 vs. 75.6°, P = 0.038), higher correction rate (51.2% vs. 44.4%, P = 0.047) and larger postoperative proximal junctional angle (PJA) (13.9 vs. 5.5°, P < 0.001) than the non-PJK group. The ratio of the number and distance from UIV-apex to IV-apex also differed significantly between the two groups. The logistic regression revealed that age at the index surgery ≤ 7 years, the ratio of the number from UIV- apex to IV- apex ≤ 0.6 and the ratio of the distance from UIV- apex to IV- apex ≤ 0.6 were independent risk factors for postoperative PJK. CONCLUSION Besides younger age, a closer location of UIV relative to the sagittal apex is identified to be an independent risk factor of postoperative PJK. Selection of UIV at a relatively farther location away from the sagittal apex might help prevent occurrence of PJK.
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Affiliation(s)
- Bo Yang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Liang Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qingshuang Zhou
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhuang Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Early outcomes of growth friendly instrumentation in children with Williams syndrome. Spine Deform 2022; 10:717-725. [PMID: 35000131 DOI: 10.1007/s43390-021-00453-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Although scoliosis and kyphosis have been associated with Williams Syndrome (WS), no previous literature has reported on surgical treatment for early onset scoliosis (EOS) in WS. The aim of this case series is to report on the outcomes of spine deformity surgery in patients with EOS and WS and any perioperative anesthetic or cardiovascular complications. METHODS One multicenter database was queried for all patients with WS who underwent growth-friendly (GF) treatment before age 12 between 2000 and 2017. Demographics, surgical, and growth-friendly data were queried. Radiographs were measured for curve magnitude, T1-T12 length, and T1-S1 length. RESULTS Seven patients were analyzed (3 males, 4 females). Patients were at a median age of 2.8 years at initial surgery with median follow-up 3.6 years (range 2.0-12 years) after index surgery. The initial surgical treatments were as follows: 2 traditional growing rods (TGR), 2 magnetically controlled growing rods (MCGR), and 3 vertical expandable prosthetic titanium ribs (VEPTR). The median duration of growth-friendly treatment was 5.0 years (range, 2.6-10.4 years) with a median number of 9 device lengthenings. The median improvement in coronal curve magnitude from preoperative to most recent follow-up was 19° (range, 54°-9°). Three patients have completed GF treatment: one underwent definitive fusion, and two are under observation with apparent spontaneous fusion and retain the original GF implants. No peri-operative anesthetic or cardiovascular complications occurred. CONCLUSIONS Few studies have reported on surgical outcomes in WS patients with EOS. In this case series, 6/7 patients experienced curve improvement with growth-friendly spine instrumentation. This study suggests that growth-friendly instrumentation for severe EOS in WS can be used for control of spinal deformity while allowing for further growth. Associated complications were typical of distraction-based EOS surgical treatment. There were 62 total procedures with general anesthesia, but no perioperative cardiac complications occurred.
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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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Abstract
BACKGROUND Patients with early-onset scoliosis (EOS) and spasticity may receive treatment with an intrathecal baclofen pump. We assessed how baclofen pumps are associated with the odds of complications and secondary interventions after growth-friendly (GF) spine surgery for EOS and analyzed infectious complications within the pump cohort. METHODS Using a prospectively maintained, international multicenter database, we studied patients with neuromuscular EOS with baclofen pumps who underwent GF spine surgery from 2002 through 2019 (n=25). Baclofen pumps were implanted before GF instrumentation in 18 patients, during in 2 patients, and after in 5 patients. Patients with existing pumps at initial GF spine surgery were matched 1:3 with 54 patients (control group) without pumps according to treatment center, year of surgery, diagnosis, surgery type, and preoperative curve magnitude. Univariate analysis and multivariate logistic regression were performed to compare complications and secondary interventions between the 2 cohorts. RESULTS Patients with baclofen pumps had 4.8 times the odds [95% confidence interval (CI): 1.5-16] of experiencing any complication within 1 year after initial GF spine surgery compared with controls. During mean follow-up of 6.9±4.3 years, they had 4.7 times the odds (95% CI: 1.3-16) of deep surgical site infection and 5.6 times the odds (95% CI: 1.2-26) of spinal rod removal after any complication. Differences in rates of mechanical complication, such as rod migration and breakage, were nonsignificant between the 2 groups. For the 9 patients (50%) with pumps who experienced infections, the most common microorganisms were Staphylococcus aureus (4 patients) and Pseudomonas aeruginosa (2). The pump/catheter was revised or removed, in addition to antibiotic therapy or surgical irrigation and debridement, in 2 patients. CONCLUSIONS Among patients with neuromuscular EOS, those with baclofen pumps are much more likely to experience complications within 1 year after GF spine surgery. They are also more likely to have deep surgical site infections, with S. aureus and P. aeruginosa being the most common causative organisms, and to require spinal rod removal. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Weiss HR, Nan X, Potts MA. Is there an indication for surgery in patients with spinal deformities? - A critical appraisal. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1569. [PMID: 34859161 PMCID: PMC8603189 DOI: 10.4102/sajp.v77i2.1569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/11/2021] [Indexed: 11/01/2022] Open
Abstract
Background High-quality evidence exists to support physiotherapy and brace treatment for scoliosis and other spinal deformities. However, according to previous systematic reviews, it seems that no evidence exists for surgery. Nevertheless, the number of research articles focussing on spinal surgery highly exceeds the number of articles focussing on conservative treatment. Objective The purpose of this study is to conduct an updated search for systematic reviews providing high-quality evidence for spinal surgery in patients with spinal deformities. Method A narrative review including PubMed and the Cochrane database was conducted on April 12, 2020, with the following search terms: (1) spinal deformities, surgery, systematic review and outcome; (2) kyphosis, surgery, systematic review and outcome; (3) Scheuermann's disease, surgery, systematic review and outcome, and (4) scoliosis, surgery, systematic review and outcome. Results No reviews containing prospective controlled or randomised controlled studies were found providing evidence for surgery. Conclusions A general indication for spine surgery just based on the Cobb angle is not given. In view of the long-term unknown variables and the possible long-term complications of such treatment, a surgical indication for patients with spinal deformities must be reviewed on an individual basis and considered carefully. A current systematic review appears necessary in order to be able to draw final conclusions on the indication for surgery in patients with spinal deformities. Clinical implications In view of the increasing number of surgeons with an affiliation to industry, the indication for surgery needs to be given by independent conservative specialists for spinal deformities in order to provide an objective recommendation.
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Affiliation(s)
| | - Xiaofeng Nan
- Nan Xiaofeng's Spinal Orthopedic Workshop, Xi 'an, China
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Does vertebral body tethering cause disc and facet joint degeneration? A preliminary MRI study with minimum two years follow-up. Spine J 2021; 21:1793-1801. [PMID: 34033932 DOI: 10.1016/j.spinee.2021.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/15/2021] [Accepted: 05/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Vertebral body tethering (VBT), a flexible compression-based growth modulation technique, was claimed to prevent disc degeneration due to its less rigid nature compared to other growth-friendly techniques. Yet, the consequences of VBT surgery on discs and facet joints have not been precisely acknowledged. PURPOSE The purpose of this study was to determine the changes in the intermediate and adjacent levels at least 2 years after surgery. STUDY DESIGN/SETTING Prospectively-followed consecutive patient cohort PATIENT SAMPLE: Adolescent idiopathic scoliosis patients who underwent thoracoscopic VBT between 2014 and 2017 were included. OUTCOME MEASURES Degeneration of the intervertebral discs using the Pfirrmann classification; Degeneration of facet joints using a scale of 0 to 3. METHODS Demographic, perioperative, clinical, radiographic data were collected. Skeletal maturity and height gain were assessed in every follow-up. Overcorrection, tether breakage, mechanical and pulmonary complications as well as readmission and reoperations were recorded. MRIs taken before surgery and at a minimum of 2 years follow-up were evaluated for degeneration at the intermediate and adjacent segment intervertebral discs and facet joints by a blinded senior radiologist and compared. RESULTS Twenty-five patients with a mean of 38.6±10.6 months (24-62) of follow-up were included. The mean age at surgery was 12.2 (10-14), and the median Sanders stage was 3 (1-7). A mean of 7.7±1.1 (6-11) levels were tethered. The mean preoperative main thoracic curve magnitude of 46°±7.7° was corrected to 23.3°±5.9° postoperatively, which was subsequently modulated to 12° ±11.5° during the follow-up. At the time of the MRI (mean 29±9.5 (24-62) months), the median Sanders stages was 7 (5-8). A total of 217 levels of discs and bilateral facet joints were evaluated in the preoperative and follow-up MRI images. Analyses of disc and facet scores revealed no significant differences between patients. Deterioration of previously degenerated discs was noted in one patient (from grade 2 to 3), while previously healthy lower adjacent facet joints were degenerated (grade 2) in another patient. CONCLUSIONS Intermediate discs and facet joints were preserved after growth modulation with VBT surgery at a mean of 29 months of follow-up. Studies in larger cohorts with longer follow-up are warranted to have more in-depth analyses of the effects of relative stabilization and altered biomechanical loads.
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Prevalence of junctional kyphosis in early-onset scoliosis: can it be corrected at final fusion? 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; 30:3563-3569. [PMID: 34455481 DOI: 10.1007/s00586-021-06968-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 06/30/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the risk and predictive factors of junctional issues after conversion from Traditional growing rod (TGR) to definitive spinal fusion in Early-onset scoliosis (EOS). METHODS Retrospective review of a multicenter EOS database. TGR patients who received final fusion with at least two-year follow-up were included. Proximal (PJA) and Distal junctional angles (DJA) on pre-final fusion, post-final fusion (within one year of surgery), and at latest follow-up were measured on lateral upright spinal radiographs. Differences in values among designated time points and predictive factors of junctional issues were evaluated statistically. RESULTS Forty-six of 251 patients (28 females, 18 males and mean age at final fusion: 12 ± 2 [9-17] years) met the inclusion criteria. Mean follow-up between first postoperative measurement and latest follow-up was 49 ± 22 (24-112) months. No statistical differences in PJA and DJA values were available at pre-fusion, first post-fusion, or latest follow-up (p = 0.827, p = 0.076). Fifty percent of patients had extension of TGR instrumentation at fusion, either proximal or distal. No factor including sex and etiology, lumbar lordosis, thoracic kyphosis, major curve magnitude, PJA, and DJA at pre-fusion was found to be a predictive issue for extension of index TGR instrumentation, except the history of at least one implant-related complication during the period from index surgery to the definitive fusion. CONCLUSION PJA and DJA remained stable when transitioning from TGR to final posterior spinal fusion. But 50% of patients had extension of construction at fusion, either proximal or distal.
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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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Li Q, Cui Y, Xu B, Wang Y, Lv F, Li Z, Li H, Chen X, Peng X, Chen Y, Wu E, Qu D, Jian Y, Si H. Main active components of Jiawei Gegen Qinlian decoction protects against ulcerative colitis under different dietary environments in a gut microbiota-dependent manner. Pharmacol Res 2021; 170:105694. [PMID: 34087350 DOI: 10.1016/j.phrs.2021.105694] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 02/07/2023]
Abstract
As an effective drug against acute enteritis diarrhea, Gegen Qinlian decoction (GQD) has a history of 2000 years. However, the potential molecular mechanism through which GQD could protect intestinal barrier from ulcerative colitis (UC) still remains undefined. As an important part of the homeostasis of the colon, gut microbiota is closely related to the dynamic evolution of the surrounding environment and the adjustment of dietary structure. At present, the effectiveness and mechanism of Jiawei Gegen Qinlian decoction against UC in different dietary environments are not clear. Here, the main active components of Jiawei Gegen Qinlian Decoction (PBM), were selected to construct a reasonable and effective compound scheme. We adopted "5% dextran sulfate sodium (DSS)" and "high temperature and humidity + high sugar and high fat + alcohol + 5%DSS" to induce UC rat models in general environment and UC rat models in Lingnan area, respectively. Then, we examined the therapeutic effects of PBM (89.96 mg/kg and 179.92 mg/kg) on two kinds of UC rats. The role of gut microbiota in the anti-UC effect of PBM was identified by intestinal flora consumption and fecal microbiota transplantation (FMT) experiments. Subsequently, we monitored the alterations of gut microbiota and fecal metabolism in the rat colon by 16Sr DNA technique and targeted metabonomics, respectively. The colon inflammation of the PBM-treated and the FMT-treated rats both showed significant relief, as evidenced by a reduction in body weight loss, bloody stool, diarrhea, disease activity index (DAI) score, shortening of colon length as well as decreased colon histology damage. Interestingly enough, the depletion of intestinal flora took away the protective effect of PBM, confirming the importance of intestinal flora in the anti-UC effect of PBM. Then our findings suggested that PBM could not only regulate the gut microbiota by increasing Akkermansia and Romboutsia but also decrease Escherichia-Shigella. More importantly, PBM could increase the production of propionate and total short-chain fatty acids (SCFAs) in colitis rats, regulate medium and long chain fatty acids (M-LCFAs), maintain bile acids (BAs) homeostasis, and regulate amino acids (AAs) metabolism. The transformation of intestinal environment might be related to the upregulation of anti-inflammation, anti-oxidation and tight junction protein expression in colonic mucosa. In summary, PBM showed potential for anti-UC activity through gut microbiota dependence and was expected to be a complementary and alternative medicine herb therapy.
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Affiliation(s)
- Qinmei Li
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Yao Cui
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Baichang Xu
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Yuhan Wang
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Feifei Lv
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Zheng Li
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Huan Li
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Xiaogang Chen
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Xiaomin Peng
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Yating Chen
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Enyun Wu
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Dongshuai Qu
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Yichen Jian
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
| | - Hongbin Si
- College of Animal Sciences and Technology, Guangxi University, Nanning, China.
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Bin Majid O, Al-Zayed ZS, Alsehly M, Almonaie SH. Sprengel's Deformity With Congenital Scoliosis Successfully Treated With Combined Posterior Spinal Instrumented Fusion and Modified Woodward's Procedure in a 14-Year-Old Patient With MURCS Association. Cureus 2021; 13:e15669. [PMID: 34277260 PMCID: PMC8282152 DOI: 10.7759/cureus.15669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/05/2022] Open
Abstract
Müllerian duct aplasia-renal agenesis-cervicothoracic somite dysplasia (MURCS) association is a rare syndrome. This unique condition consists of Müllerian duct aplasia, cervicothoracic somite dysplasia, and renal aplasia, and skeletal abnormalities manifesting in childhood. We report the case of a 14-year-old girl who presented to the orthopedic clinic with spinal deformity and Sprengel's shoulder complicated by a background of MURCS association. The treatment modalities of scoliosis include posterior spinal fusion and the vertical expandable prosthetic titanium rib. On the other hand, Sprengel's deformity is surgically managed by Woodward's procedure. The management plan for our patient involved correcting scoliosis by the posterior spinal fusion procedure and performing Woodward's procedure to correct Sprengel's deformity simultaneously. Simultaneous scoliosis correction with posterior spinal instrumented fusion and Sprengel's deformity correction with modified Woodward's procedure is a promising surgical technique that can lead to favorable outcomes.
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Affiliation(s)
- Ozair Bin Majid
- Department of Orthopaedic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Zayed S Al-Zayed
- Department of Orthopaedic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Mohamed Alsehly
- Department of Orthopaedic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Shahd H Almonaie
- Department of Orthopaedic Surgery, Alfaisal University College of Medicine, Riyadh, SAU
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Liu Z, Liu T, Hai Y, Wu L, Hai JJ, Gao K, Guo X, Yang H, Kang N, Zhao F. Evaluation of changes in shoulder balance and prediction of final shoulder imbalance during growing-rod treatment for early-onset scoliosis. BMC Musculoskelet Disord 2021; 22:354. [PMID: 33853576 PMCID: PMC8045187 DOI: 10.1186/s12891-021-04221-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/30/2021] [Indexed: 01/30/2023] Open
Abstract
Background Obtaining and maintaining final shoulder balance after the entire treatment course is essential for early-onset scoliosis (EOS) patients. The relatively small number of growing-rod (GR) graduates who complete final fusion has resulted in an overall paucity of research on the GR treatment of EOS and a lack of research on the shoulder balance of EOS patients during GR treatment. Methods Twenty-four consecutive patients who underwent GR treatment until final fusion were included. Radiographic shoulder balance parameters, including the radiographic shoulder height (RSH), clavicle angle (CA), and T1 tilt angle (T1T), before and after each step of the entire treatment were measured. Shoulder balance changes from GR implantation to the last follow-up after final fusion were depicted and analysed. Demographic data, surgical-related factors, and radiographic parameters were analysed to identify risk factors for final shoulder imbalance. The shoulder balance of patients at different time points was further analysed to explore the potential effect of the series of GR treatment steps on shoulder balance. Results The RSH showed substantial improvement after GR implantation (P = 0.036), during the follow-up period after final fusion (P = 0.021) and throughout the entire treatment (P = 0.011). The trend of change in the CA was similar to that of the RSH, and the T1T improved immediately after GR implantation (P = 0.037). Further analysis indicated that patients with shoulder imbalance before final fusion showed significantly improved shoulder balance after fusion (P = 0.045), and their RSH values at early postfusion and the final follow-up did not show statistically significant differences from those in the prefusion shoulder balance group (P > 0.05). Early postfusion shoulder imbalance (odds ratio (OR): 19.500; 95% confidence interval (CI) = 1.777–213.949; P = 0.015) was identified as an independent risk factor for final shoulder imbalance. Conclusions Shoulder balance could be improved by GR implantation but often changes during the multistep lengthening process, and the final result is relatively unpredictable. Final fusion could further adjust the prefusion shoulder imbalance. Focusing on the prefusion shoulder balance of GR graduates and providing patients with early shoulder balance after fusion might be necessary. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04221-9.
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Affiliation(s)
- Ziyang Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti North Rd, No. 8, Beijing, 100020, China
| | - Tie Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti North Rd, No. 8, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti North Rd, No. 8, Beijing, 100020, China.
| | - Lingyun Wu
- Karolinska Institutet, Stockholm, Sweden
| | | | - Kang Gao
- Capital Medical University, Beijing, China
| | - Xuanrong Guo
- University of Wisconsin Madison, Madison, WI, USA
| | - Honghao Yang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti North Rd, No. 8, Beijing, 100020, China
| | - Nan Kang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti North Rd, No. 8, Beijing, 100020, China
| | - Fan Zhao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti North Rd, No. 8, Beijing, 100020, China
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Tognini M, Hothi H, Dal Gal E, Shafafy M, Nnadi C, Tucker S, Henckel J, Hart A. Understanding the implant performance of magnetically controlled growing spine rods: a review article. 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; 30:1799-1812. [PMID: 33666742 DOI: 10.1007/s00586-021-06774-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/14/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Early-Onset Scoliosis (EOS) (defined as a curvature of the spine ≥ 10° with onset before 10 years of age) if not properly treated, can lead to increased morbidity and mortality. Traditionally Growing Rods (TGRs), implants fixated to the spine and extended every 6-8 months by surgery, are considered the gold standard, but Magnetically Controlled Growing Rods (MCGRs) avoid multiple surgeries. While the potential benefit of outpatient distraction procedure with MCGR is huge, concerns still remain about its risks, up to the release of a Medical Device Alert (MDA) by the Medicines and Healthcare Regulatory Agency (MHRA) advising not to implant MCGRs until further notice. The aim of this literature review is to (1) give an overview on the use of MCGRs and (2) identify what is currently understood about the surgical, implant and patient factors associated with the use of MCGRs. METHODS Systematic literature review. RESULTS Surgical factors such as use of single rod configuration or incorrect rod contouring might affect early failure of MCGRs. Patient's older age and higher BMI are correlated with rod slippage. Wear debris and distraction mechanism failure may result from implant design and iteration. CONCLUSION Despite the complications reported, this technology still offers one of the best solutions to spine surgeons dealing with severe EOS. Lowering the complication rate by identifying risk factors for failure is possible and further studies in this direction are required. Once the risk factors are well described, some of these can be addressed enabling a safer use of MCGRs.
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Affiliation(s)
- Martina Tognini
- The Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, UK.
| | - Harry Hothi
- The Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, UK
| | - Elisabetta Dal Gal
- The Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, UK
| | - Masood Shafafy
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Colin Nnadi
- Nuffield Orthopaedic Centre, Oxford University Hospital, Headington, Oxford, UK
| | - Stewart Tucker
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Johann Henckel
- The Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, UK
| | - Alister Hart
- The Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, UK
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Schupper AJ, Neifert SN, Martini ML, Gal JS, Yuk FJ, Caridi JM. Surgeon experience influences patient characteristics and outcomes in spine deformity surgery. Spine Deform 2021; 9:341-348. [PMID: 33105015 DOI: 10.1007/s43390-020-00227-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/10/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To characterize differences in patient demographics and outcomes by surgeon experience in a cohort of patients undergoing adult spinal deformity surgery. METHODS Patients undergoing degenerative spinal deformity were included. Patients whose surgeons graduated from fellowship ≤ 5 years prior to surgery versus > 5 years were compared. Multivariable linear and logistic regression, controlling for age, sex, comorbidity burden, number of segments fused, blood loss and operative time were used to evaluate differences in outcomes. Characteristics of operative invasiveness were plotted against surgeons' level of experience, and trends in these measures were assessed with univariate linear regression. RESULTS Three-hundred sixty-three patients were included. 147 patients' surgeons had ≤ 5 years of experience. Patient demographics were evenly matched. Patients with junior surgeons had more pre-existing medical complications, and senior surgeons were less likely to take care of patients with Medicare/Medicaid (p < 0.001). Junior surgeons were more likely to operate on non-elective patients (p < 0.001). Patients of junior surgeons received larger fusions (9.6 vs. 7.6 segments fused, p < 0.001). There were no differences in complication rates or death. Patients of junior surgeons had longer overall length of stays (p = 0.037) and higher rates of nonhome discharge (OR 2.0, p < 0.001), 30- and 90-day (p < 0.005) ED visits, and higher costs (+ $8548, 95% CI: $1596 to $15,502; p = 0.016). CONCLUSION Junior surgeons tend to perform more extensive deformity operations on more medically complex patients compared to senior surgeons, associated with higher costs and more resource utilization than senior surgeons.
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Affiliation(s)
- Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Sean N Neifert
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Michael L Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jonathan S Gal
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Frank J Yuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - John M Caridi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
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