1
|
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.
Collapse
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
| |
Collapse
|
2
|
Dutta A, Singh M, Kumar K, Ribera Navarro A, Santiago R, Kaul RP, Patil S, Kalaskar DM. Accuracy of 3D printed spine models for pre-surgical planning of complex adolescent idiopathic scoliosis (AIS) in spinal surgeries: a case series. ANNALS OF 3D PRINTED MEDICINE 2023; 11:None. [PMID: 37592961 PMCID: PMC10427719 DOI: 10.1016/j.stlm.2023.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/15/2023] [Indexed: 08/19/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a noticeable spinal deformity in both adult and adolescent population. In majority of the cases, the gold standard of treatment is surgical intervention. Technological advancements in medical imaging and 3D printing have revolutionised the surgical planning and intraoperative decision making for surgeons in spinal surgery. However, its applicability for planning complex spinal surgeries is poorly documented with human subjects. The objective of this study is to evaluate the accuracy of 3D printed models for complex spinal deformities based on Cobb angles between 40° to 95°.This is a retrospective cohort study where, five CT scans of the patients with AIS were segmented and 3D printed for evaluating the accuracy. Consideration was given to the Inter-patient and acquisition apparatus variability of the CT-scan dataset to understand the effect on trueness and accuracy of the developed CAD models. The developed anatomical models were re-scanned for analysing quantitative surface deviation to assess the accuracy of 3D printed spinal models. Results show that the average of the root mean square error (RMSE) between the 3DP models and virtual models developed using CT scan of mean surface deviations for the five 3d printed models was found to be 0.5±0.07 mm. Based on the RMSE, it can be concluded that 3D printing based workflow is accurate enough to be used for presurgical planning for complex adolescent spinal deformities. Image acquisition and post processing parameters, type of 3D printing technology plays key role in acquiring required accuracy for surgical applications.
Collapse
Affiliation(s)
- Abir Dutta
- UCL Institute of Orthopaedic & Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, London, United Kingdom
- Royal National Orthopaedic Hospital NHS Trust, Spinal Surgery Unit, Stanmore, HA7 4LP, London, United Kingdom
| | - Menaka Singh
- UCL Institute of Orthopaedic & Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, London, United Kingdom
| | - Kathryn Kumar
- UCL Institute of Orthopaedic & Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, London, United Kingdom
| | - Aida Ribera Navarro
- UCL Institute of Orthopaedic & Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, London, United Kingdom
| | - Rodney Santiago
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Ruchi Pathak Kaul
- UCL Institute of Orthopaedic & Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, London, United Kingdom
| | - Sanganagouda Patil
- Royal National Orthopaedic Hospital NHS Trust, Spinal Surgery Unit, Stanmore, HA7 4LP, London, United Kingdom
| | - Deepak M Kalaskar
- UCL Institute of Orthopaedic & Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, London, United Kingdom
- Royal National Orthopaedic Hospital NHS Trust, Spinal Surgery Unit, Stanmore, HA7 4LP, London, United Kingdom
| |
Collapse
|
3
|
Vendeuvre T, Tabard-Fougère A, Armand S, Dayer R. Test characteristics of rasterstereography for the early diagnosis of adolescent idiopathic scoliosis. Bone Joint J 2023; 105-B:431-438. [PMID: 36924187 DOI: 10.1302/0301-620x.105b4.bjj-2021-1440.r3] [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: 03/18/2023]
Abstract
This study aimed to evaluate rasterstereography of the spine as a diagnostic test for adolescent idiopathic soliosis (AIS), and to compare its results with those obtained using a scoliometer. Adolescents suspected of AIS and scheduled for radiographs were included. Rasterstereographic scoliosis angle (SA), maximal vertebral surface rotation (ROT), and angle of trunk rotation (ATR) with a scoliometer were evaluated. The area under the curve (AUC) from receiver operating characteristic (ROC) plots were used to describe the discriminative ability of the SA, ROT, and ATR for scoliosis, defined as a Cobb angle > 10°. Test characteristics (sensitivity and specificity) were reported for the best threshold identified using the Youden method. AUC of SA, ATR, and ROT were compared using the bootstrap test for two correlated ROC curves method. Of 212 patients studied, 146 (69%) had an AIS. The AUC was 0.74 for scoliosis angle (threshold 12.5°, sensitivity 75%, specificity 65%), 0.65 for maximal vertebral surface rotation (threshold 7.5°, sensitivity 63%, specificity 64%), and 0.82 for angle of trunk rotation (threshold 5.5°, sensitivity 65%, specificity 80%). The AUC of ROT was significantly lower than that of ATR (p < 0.001) and SA (p < 0.001). The AUCs of ATR and SA were not significantly different (p = 0.115). The rasterstereographic scoliosis angle has better diagnostic characteristics than the angle of trunk rotation evaluated with a scoliometer, with similar AUCs and a higher sensitivity.
Collapse
Affiliation(s)
- Tanguy Vendeuvre
- Division of Pediatric Orthopaedics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Anne Tabard-Fougère
- Division of Pediatric Orthopaedics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Romain Dayer
- Division of Pediatric Orthopaedics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| |
Collapse
|
4
|
Use of a high-speed drill in robotics coupled with navigation for pediatric spine surgery. J Robot Surg 2023:10.1007/s11701-023-01534-w. [PMID: 36862349 DOI: 10.1007/s11701-023-01534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/08/2023] [Indexed: 03/03/2023]
Abstract
With the increasing number of surgeries for pediatric spinal deformities, the aim has been to reduce the associated complications, such as those caused by screw malposition. This case series is an intra-operative experience with a new navigated high-speed revolution drill (Mazor Midas, Medtronic, Minneapolis, MN) for pediatric spinal deformity to assess accuracy and workflow. 88 patients, ranging from 2 to 29 years of age, were included who underwent posterior spinal fusion with the navigated high-speed drill. Diagnoses, Cobb angles, imaging, surgical time, complications, and total number of screws placed are described. Screw positioning was evaluated using fluoroscopy, plain radiography, and CT. Mean age was 15.4 years old. Diagnoses included 47 adolescent idiopathic scoliosis, 15 neuromuscular scoliosis, 8 spondylolisthesis, 4 congenital scoliosis, and 14 other. The mean Cobb angulation for scoliosis patients was 64° and the mean number of levels fused was 10. 81 patients had registration via intraoperative 3-D imaging and 7 had pre-operative CT scan to fluoroscopy registration. There were a total of 1559 screws with 925 placed robotically. 927 drill paths were drilled with the Mazor Midas. 926 out of 927 drill paths were accurate. The mean surgical time was 304 min with the mean robotic time being 46 min. This is the first intra-operative report to our knowledge documenting the experience with the Mazor Midas drill in pediatric spinal deformity showing decreased skiving potential, decreased torque when drilling, and lastly increased accuracy. Level of evidence: level III.
Collapse
|
5
|
Long-Term Clinical, Radiographic, and Cost Analysis of Corrective Spine Surgery for Adult Symptomatic Lumbar Deformity With a Mean of 7.5 years Follow-Up. Spine (Phila Pa 1976) 2023; 48:335-343. [PMID: 36730058 DOI: 10.1097/brs.0000000000004551] [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: 10/21/2022] [Accepted: 11/22/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Multicenter retrospective study. OBJECTIVE This study reports long-term clinical and radiographic outcomes in surgically treated patients with adult symptomatic lumbar deformity (ASLD). SUMMARY OF BACKGROUND DATA The short-term results of corrective spinal surgery for ASLD are often favorable despite a relatively high complication profile. However, long-term outcomes have not been completely characterized. METHODS A total of 169 surgically treated consecutive ASLD patients (≥50 yr) who achieved minimum 5 year follow-up were included (average 7.5 yr observation window, average age 67±8 yr, 96% female). The subjects were stratified by current age (50s, 60s, and 70s) and compared. Kaplan-Meier analysis was used to estimate the cumulative incidence of unplanned reoperation stratified by age group. Initial and overall direct costs of surgery were also analyzed. RESULTS The SRS-22 at final follow-up was similar among the three groups (50s, 60s, and 70s; 4.0±0.5 vs. 3.8±0.7 vs. 3.8±0.7, respectively). The overall major complication rate was 56%, and 12% experienced late complications. The cumulative reoperation rate was 23%, and 4% required late reoperation. Patients in their 70s had a significantly higher reoperation rate (33%) and overall complication rate (65%). However, the late complication rate was not significantly different between the three groups (9% vs. 12% vs. 13%). Sagittal alignment was improved at two years and maintained to the final follow-up, whereas reciprocal thoracic kyphosis developed in all age groups. The direct cost of initial surgery was $45K±9K and increased by 13% ($53K±13K) at final follow-up. CONCLUSIONS Long-term surgical outcomes for ASLDs were favorable, with a relatively low rate of late-stage complications and reoperations, as well as reasonable direct costs. Despite the higher reoperation and complication rate, ASLD patients of more advanced age achieved similar improvement to those in the younger age groups.
Collapse
|
6
|
Paediatric Spinal Deformity Surgery: Complications and Their Management. Healthcare (Basel) 2022; 10:healthcare10122519. [PMID: 36554043 PMCID: PMC9778654 DOI: 10.3390/healthcare10122519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
Surgical correction of paediatric spinal deformity is associated with risks, adverse events, and complications that must be preoperatively discussed with patients and their families to inform treatment decisions, expectations, and long-term outcomes. The incidence of complications varies in relation to the underlying aetiology of spinal deformity and surgical procedure. Intraoperative complications include bleeding, neurological injury, and those related to positioning. Postoperative complications include persistent pain, surgical site infection, venous thromboembolism, pulmonary complications, superior mesenteric artery syndrome, and also pseudarthrosis and implant failure, proximal junctional kyphosis, crankshaft phenomenon, and adding-on deformity, which may necessitate revision surgery. Interventions included in enhanced recovery after surgery protocols may reduce the incidence of complications. Complications must be diagnosed, investigated and managed expeditiously to prevent further deterioration and to ensure optimal outcomes. This review summarises the complications associated with paediatric spinal deformity surgery and their management.
Collapse
|
7
|
Rutges JPHJ, Renkens JJM, Kempen DHR, Faber C, Stadhouder A, Kruyt MC, Mostert A, Horsting PP, de Klerk LWL, de Kleuver M, Castelein RM, Schlösser TPC. The risk of delayed spinal cord injury in pediatric spinal deformity surgery. Spine Deform 2022; 11:617-625. [PMID: 36459389 DOI: 10.1007/s43390-022-00626-1] [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: 07/04/2022] [Accepted: 11/14/2022] [Indexed: 12/04/2022]
Abstract
Delayed spinal cord injury (SCI) hours or days after surgery, with uneventful monitoring and initial normal postoperative neurological examination, is a rare complication. Based on anecdotal evidence, the risk of delayed spinal cord injury might be higher than previously assumed. Therefore the aim of this study was to determine the risk of delayed SCI after pediatric spinal deformity surgery between 2013-2019 in the Netherlands. The total number of pediatric spinal deformity surgeries performed for scoliosis or kyphosis between 2013-2019 was obtained from the Dutch National Registration of Hospital Care. All eleven Dutch hospitals that perform pediatric spinal deformity surgery were contacted for occurrence of delayed SCI. From the identified patients with delayed SCI, the following data were collected: patient characteristics, details about the SCI, the surgical procedure, management and degree of improvement.2884 pediatric deformity surgeries were identified between 2013-2019. Seven patients (0.24%) with delayed SCI were reported: 3 idiopathic, 2 neuromuscular (including 1 kypho-scoliosis) and 2 syndromic scoliosis. The risk of delayed SCI after pediatric deformity surgery was 1:595 in idiopathic scoliosis, 1:214 in syndromic scoliosis, 1:201 in neuromuscular scoliosis. All seven patients had a documented normal neurological examination in the first postoperative period; neurological deficits were first diagnosed at a median 16h (range 2.5-40) after surgery. The risk of delayed SCI after pediatric deformity surgery is higher than previously reported, especially in patients with non-idiopathic scoliosis. Regular postoperative testing for late neurologic deficit should be performed for timely diagnosis and management of this devastating complication.
Collapse
Affiliation(s)
- J P H J Rutges
- Department of Orthopedics and Sports Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - J J M Renkens
- Department of Orthopedics and Sports Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - D H R Kempen
- Department of Orthopedics, Onze Lieve Vrouwe Gasthuis OLVG, Amsterdam, The Netherlands
| | - C Faber
- Department of Orthopedics, UMC Groningen, Groningen, The Netherlands
| | - A Stadhouder
- Department of Orthopedics, Amsterdam UMC, Amsterdam, The Netherlands
| | - M C Kruyt
- Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - A Mostert
- Department of Orthopedics, Isala Zwolle, Zwolle, The Netherlands
| | - P P Horsting
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - L W L de Klerk
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - M de Kleuver
- Department of Orthopedics, Radboud UMC, Nijmegen, The Netherlands
| | - R M Castelein
- Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - T P C Schlösser
- Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| |
Collapse
|
8
|
A comparison of the reliability and vulnerability of 3D sterEOS and 2D EOS when measuring the sagittal spinal alignment of patients with adolescent idiopathic scoliosis. Spine Deform 2022; 10:1029-1034. [PMID: 35384609 DOI: 10.1007/s43390-022-00499-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE An essential component of making the diagnosis of adolescent idiopathic scoliosis (AIS) is standing anteroposterior and lateral radiographs. Two-dimensional (2D) radiographs inevitably fail to reflect every plane of the three-dimensional (3D) deformity in scoliosis. We have tested the hypothesis that there is no difference in the assessment of the sagittal plane deformity when measured with either 2D or 3D EOS radiography. METHODS A retrospective radiographic analysis was performed on patients diagnosed with AIS, with subdivided into three groups according to the coronal angular deformity (mild group: 45°-69°, moderate group: 70°-89°, and severe group: 90° +). The sagittal parameters were compared between manual measurement with 2D sterEOS and those made using computer-aided 3D reconstruction. RESULTS Fifty-two patients were included in each group. The inter-study reliability when measuring the thoracic Kyphosis (TK) and lumbar lordosis (LL) between the two study modalities was excellent in mild group (ICC: 0.90, 95% CI 0.82 ~ 0.94 and ICC: 0.84, 95% CI 0.74 ~ 0.91), excellent in TK and fair in LL in moderate group (ICC: 0.76, 95% CI 0.61 ~ 0.85 and ICC: 0.70, 95% CI 0.53 ~ 0.81), and fair in TK and LL in severe group, respectively (ICC: 0.74, 95% CI 0.57 ~ 0.84 and ICC: 0.65, 95% CI 0.46 ~ 0.84). A Bland-Altman plot showed proportional bias in TK measurements in each group and LL in moderate group, which means the measured value is underestimated in 2D method when the angle is small. CONCLUSION 3D sterEOS is less vulnerable to the influence of coronal plane than 2D EOS in evaluating the sagittal spinal parameters of patients with a coronal deformity exceeding 70°.
Collapse
|
9
|
Mehdian H, Haddad S, Pasku D, Masek C, Nasto LA. A Modified Self-Growing Rod Technique for Treatment of Early-Onset Scoliosis. JBJS Essent Surg Tech 2022; 12:e21.00042. [PMID: 36816531 PMCID: PMC9931046 DOI: 10.2106/jbjs.st.21.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Surgical treatment of early-onset scoliosis (EOS) remains challenging as no definitive surgical technique has emerged as the single best option in this varied patient population1-3. Although the available surgical techniques may differ substantially, they all share the same goals of achieving and maintaining deformity correction, allowing physiological spinal growth, and reducing the number of operations and complications. Herein, we present a modified self-growing rod technique that represents a valid alternative to the existing surgical procedures for EOS. Description The patient is positioned prone on a radiolucent table, and the spine is prepared and draped in a standard fashion. A posterior midline skin incision is made from the upper to the lower instrumented level. Subperiosteal exposure of the spine is carried out, ensuring that capsules of the facet joints are spared. Pedicle screws are inserted bilaterally at the cranial and caudal ends of the instrumentation. Fixation with pedicle screws of at least 3 levels at the top and bottom end is usually advised; in nonambulatory patients with pelvic obliquity, caudal fixation can be extended to the pelvis with bilateral iliac screws. Sublaminar wires are positioned bilaterally at every level between the cranial and caudal ends of the instrumentation and are passed as medially as possible to avoid damage to the facet joints. Four 5-mm cobalt-chromium rods are cut, contoured, and inserted at each end of the construct. Ipsilateral rods are secured with use of sublaminar wires, making sure that they overlap over a sufficient length to allow for the remaining spinal growth. Correction of the deformity is achieved with use of a combination of cantilever maneuvers and apical translation by progressive and sequential tightening of the sublaminar wires. The wound is closed in layers over a subfascial drain. The patient is allowed free mobilization after surgery. No postoperative brace is required. Alternatives Nonoperative alternative treatment for EOS includes serial cast immobilization and bracing4. Alternative surgical treatments include traditional growing rods5, magnetically controlled growing rods6, the vertical expandable prosthetic titanium rib-expansion technique7, and the Shilla technique8. The use of compression-based systems (i.e., staples or tether)9 or early limited fusion has also been reported by other authors. Rationale The main advantage of our technique is that it relies on physiological spinal growth and does not require surgery or external devices for rod lengthening, which is particularly beneficial in frail patients with a neuromuscular disease in whom repeated surgery is not advised. Segmental fixation by sublaminar wires allows good control of the deformity apex during growth. Concerns regarding early fusion of the spine have not been confirmed in our mid-term follow-up study10. Expected Outcomes This technique allows correction of the deformity and continuous spinal growth in the years following surgery. At 6.0 years postoperatively, the average main curve correction was reported to be 61% and the average pelvic obliquity correction was 69%. The spine was reported to lengthen an average of 40.9 mm (range, 14.0 to 84.0 mm) immediately postoperatively, and the T1-S1 segment was reported to continue growing at 10.5 mm/year (range, 3.6 to 16.5 mm/year) thereafter10. The most common complication is rod breakage at the thoracolumbar junction, which seems to be more common in patients with idiopathic or cerebral palsy EOS and during the pubertal growth spurt10. Important Tips Subperiosteal exposure of the spine should be carried out, making sure to preserve facet joints in the unfused area of the spine.Achieve segmental fixation with use of sublaminar wires at every level and pedicle screws at the top and bottom ends of the instrumentation.If pelvic imbalance is present and the patient is nonambulatory, pelvic fixation with iliac screws is advised.First round correction of the deformity is achieved with a cantilever technique; correction fine-tuning can be performed by tightening sublaminar wires.Consider utilizing thicker rods in cases of idiopathic or cerebral palsy EOS. Acronyms and Abbreviations EOS = early-onset scoliosisAP = anteroposteriorEV = end vertebraSSEP = somatosensory evoked potentialsMEP = motor evoked potentialsPJK = proximal junctional kyphosisSMA = spinal muscular atrophyCP = cerebral palsyPACU = post-anesthesia care unit.
Collapse
Affiliation(s)
- Hossein Mehdian
- The Centre for Spinal Studies and Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Sleiman Haddad
- Spine Surgery Unit, Department of Orthopaedic Surgery and Traumatology, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Dritan Pasku
- The Centre for Spinal Studies and Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | - Luigi Aurelio Nasto
- Department of Orthopaedics, “Luigi Vanvitelli” University Hospital, Naples, Italy,Email for corresponding author:
| |
Collapse
|
10
|
Yaokreh JB, Yapo Kouamé GS, Ali C, Odéhouri-Koudou TH, Ouattara O. Epidemiological and diagnostic characteristics of scoliosis in children in a single tertiary centre in Abidjan. Afr J Paediatr Surg 2022; 19:171-175. [PMID: 35775520 PMCID: PMC9290356 DOI: 10.4103/ajps.ajps_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Scoliosis is the most frequent spine deformity in children. Epidemiological data are available in Western countries due to the systematic screening policies implemented at school. Unfortunately, in our country, there are neither national data nor screening policy for scoliosis. Are the epidemiological and diagnostic characteristics of scoliosis in our practice similar to the data in the literature? PATIENTS AND METHODS We retrospectively reviewed 106 medical records of patients under 19 years old between 2010 and 2019 at the 'Vivre Debout' Centre for structural scoliosis confirmed by spine X-ray with a Cobb angle ≥10°. The epidemiological and diagnostic characteristics were noted. The data were treated with Excel 2010. RESULTS The mean frequency of scoliosis was 10 cases/year. The male-to-female sex ratio was 1:1.3. The mean age at diagnosis was 11.2 ± 2.13 years. There was a family history of scoliosis in two cases (1.8%). Twenty-four girls (39.3%) out of 61 had had menarche at the time of diagnosis. The mean time from noticing deformity to consultation was 17.9 ± 21.9 months. Lateral deviation of the spine (n = 77; 72.6%), hump (n = 12; 11.3%) and pain (n = 3; 2.8%) were the main complaints for consultation. In 14 cases (13.2%), the discovery was fortuitous during a medical examination for another complaint. The curvature was single in 88 cases (83%) and double in 18 (17%). The convexity was right in 69 cases (65.1%) and left in 37 (34.9%). Curvatures were thoracic (n = 57; 53.8%), lumbar (n = 10; 9.4%) and thoracolumbar (n = 39; 36.8%). The average Cobb angle was 35.2° ±10.71° (range: 11°-90°). Curvatures were moderate (20°-40°) in 49 cases (46.2) and severe (>40°) in 18 (17%). The aetiologies were predominated by idiopathic causes (n = 79; 74.5%), followed by congenital (n = 16; 15.1%) and neuromuscular (n = 11; 10.4%) causes. CONCLUSION Scoliosis is uncommon in our practice. It is characterised by single curvature. The predominance of moderate and severe curvatures was due to delayed consultation.
Collapse
Affiliation(s)
| | | | - Cissé Ali
- Centre "Vivre Debout", Yopougon Teaching Hospital, Abidjan, Côte d'Ivoire
| | - Thierry-Hervé Odéhouri-Koudou
- Department of Pediatric Surgery, Yopougon Teaching Hospital; Department of Medicine and Surgery, Emergency Yopougon Teaching Hospital, Abidjan, Côte d'Ivoire
| | - Ossénou Ouattara
- Department of Pediatric Surgery, Yopougon Teaching Hospital, Abidjan, Côte d'Ivoire
| |
Collapse
|
11
|
Ionițe C, Rotariu M, Osean V, Mitran C, Condurache I. Scoliosis incidence and treatment methods. BALNEO AND PRM RESEARCH JOURNAL 2022. [DOI: 10.12680/balneo.2022.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Scoliosis is defined as a three-dimensional deformity of the spine that is of particular interest to the lateral curvature of the spine. Various types of treatment approaches have been recommended for patients with scoliosis. The aim of this study was to provide an up-to-date review of scoliosis, focusing on issues such as its incidence and treatment methods. The ISI-Thomson Web Of Science International Virtual Library was accessed for this review. The search criteria selected were 'title', 'abstract' and 'keywords'. In the ISI Thomson Web of Science virtual library platforms, the keywords in the articles search were "scoliosis incidence" and "scoliosis treatment". Over the years, different therapeutic strategies have been addressed for patients with scoliosis, they differ depending on the type of scoliosis, the patient's age and the available therapeutic means.
Keywords: Scoliosis, Incidence, Physical Treatment;
Collapse
Affiliation(s)
- Cătălin Ionițe
- Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iași, Ro-mania
| | - Mariana Rotariu
- Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iași, Ro-mania
| | | | | | - Iustina Condurache
- Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iași, Ro-mania
| |
Collapse
|
12
|
Li J, Hu Z, Qian Z, Tang Z, Qiu Y, Zhu Z, Liu Z. The prognosis and recovery of major postoperative neurological deficits after corrective surgery for scoliosis : an analysis of 65 cases at a single institution. Bone Joint J 2022; 104-B:103-111. [PMID: 34969290 DOI: 10.1302/0301-620x.104b1.bjj-2021-0772.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The outcome following the development of neurological complications after corrective surgery for scoliosis varies from full recovery to a permanent deficit. This study aimed to assess the prognosis and recovery of major neurological deficits in these patients, and to determine the risk factors for non-recovery, at a minimum follow-up of two years. METHODS A major neurological deficit was identified in 65 of 8,870 patients who underwent corrective surgery for scoliosis, including eight with complete paraplegia and 57 with incomplete paraplegia. There were 23 male and 42 female patients. Their mean age was 25.0 years (SD 16.3). The aetiology of the scoliosis was idiopathic (n = 6), congenital (n = 23), neuromuscular (n = 11), neurofibromatosis type 1 (n = 6), and others (n = 19). Neurological function was determined by the American Spinal Injury Association (ASIA) impairment scale at a mean follow-up of 45.4 months (SD 17.2). the patients were divided into those with recovery and those with no recovery according to the ASIA scale during follow-up. RESULTS The incidence of major deficit was 0.73%. At six-month follow-up, 39 patients (60%) had complete recovery and ten (15.4%) had incomplete recovery; these percentages improved to 70.8% (46) and 16.9% (11) at follow-up of two years, respectively. Eight patients showed no recovery at the final follow-up. The cause of injury was mechanical in 39 patients and ischaemic in five. For 11 patients with misplaced implants and haematoma formation, nine had complete recovery. Fisher's exact test showed a significant difference in the aetiology of the scoliosis (p = 0.007) and preoperative deficit (p = 0.016) between the recovery and non-recovery groups. A preoperative deficit was found to be significantly associated with non-recovery (odds ratio 8.5 (95% confidence interval 1.676 to 43.109); p = 0.010) in a multivariate regression model. CONCLUSION For patients with scoliosis who develop a major neurological deficit after corrective surgery, recovery (complete and incomplete) can be expected in 87.7%. The first three to six months is the time window for recovery. In patients with misplaced implants and haematoma formation, the prognosis is satisfactory with appropriate early intervention. Patients with a preoperative neurological deficit are at a significant risk of having a permanent deficit. Cite this article: Bone Joint J 2022;104-B(1):103-111.
Collapse
Affiliation(s)
- Jie Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zongshan Hu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhikai Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ziyang Tang
- 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
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| |
Collapse
|
13
|
Sim FCJ, Birley E, Khan AL, Loughenbury PR, Millner P. Increased prevalence of idiopathic scoliosis in patients treated for childhood haematopoietic malignancy. Bone Joint J 2021; 103-B:1400-1404. [PMID: 34334046 DOI: 10.1302/0301-620x.103b8.bjj-2020-2112.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to determine whether there is an increased prevalence of scoliosis in patients who have suffered from a haematopoietic malignancy in childhood. METHODS Patients with a history of lymphoma or leukaemia with a current age between 12 and 25 years were identified from the regional paediatric oncology database. The medical records and radiological findings were reviewed, and any spinal deformity identified. The treatment of the malignancy and the spinal deformity, if any, was noted. RESULTS From a cohort of 346 patients, 19 (5.5%) had radiological evidence of scoliosis, defined as a Cobb angle of > 10°. A total of five patients (1.4% of the total cohort) had a Cobb angle of > 40°, all of whom had corrective surgery. No patient with scoliosis had other pathology as a possible cause of the scoliosis and all had been treated with high doses of steroids for leukaemia, either acute or chronic myeloid, or acute lymphoblastic. CONCLUSION There is an increased prevalence of idiopathic-like scoliosis and larger curves (Cobb angle of > 40°) associated with childhood leukaemia, which has not been previously reported in the literature. Causative factors may relate to the underlying disease process and/or its treatment. Cite this article: Bone Joint J 2021;103-B(8):1400-1404.
Collapse
Affiliation(s)
- Francis C J Sim
- Trauma and Orthopaedics Department, Leeds General Infirmary, Leeds, UK
| | - Emma Birley
- The Usher Institute, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Almas L Khan
- Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, St James's Hospital, Leeds, UK
| | - Peter R Loughenbury
- Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, St James's Hospital, Leeds, UK
| | - Peter Millner
- Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, St James's Hospital, Leeds, UK
| |
Collapse
|
14
|
Incidence and Surgery Rate of Idiopathic Scoliosis: A Nationwide Database Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158152. [PMID: 34360445 PMCID: PMC8346015 DOI: 10.3390/ijerph18158152] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022]
Abstract
Idiopathic scoliosis is the most common cause of three-dimensional deformities of the spine. Most of the previous studies have been cross-sectional studies to estimate the prevalence in the general population. An age-matched, population-based study is performed using nationwide databases between 2011 and 2015. The incidence rates of idiopathic scoliosis by age group, sex, and region are identified. We also investigate the pattern of medical institution use and the surgery rate of patients with idiopathic scoliosis. Our results show that a total of 268,372 patients were diagnosed with idiopathic scoliosis. The overall incidence was 0.497%, and the incidence for females was 1.44 times higher than for males. By age group, the incidence of adolescent idiopathic scoliosis in patients aged 10–14 years was 0.821% compared to 0.029%, 0.192%, and 0.709% for those patients aged 0–2, 3–9, and 15–19 years, respectively. Both male and female urban populations had higher incidences than rural populations with no age differences at diagnosis. Survival analysis confirmed that 0.7% of diagnosed patients underwent surgical treatment within five years. Understanding the epidemiology of idiopathic scoliosis is helpful in diagnosing high risk patients and monitoring surgical interventions.
Collapse
|
15
|
Magampa RS, Dunn R. Surgeon-directed transcranial motor evoked potential spinal cord monitoring in spinal deformity surgery. Bone Joint J 2021; 103-B:547-552. [PMID: 33641421 DOI: 10.1302/0301-620x.103b3.bjj-2020-1278.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Spinal deformity surgery carries the risk of neurological injury. Neurophysiological monitoring allows early identification of intraoperative cord injury which enables early intervention resulting in a better prognosis. Although multimodal monitoring is the ideal, resource constraints make surgeon-directed intraoperative transcranial motor evoked potential (TcMEP) monitoring a useful compromise. Our experience using surgeon-directed TcMEP is presented in terms of viability, safety, and efficacy. METHODS We carried out a retrospective review of a single surgeon's prospectively maintained database of cases in which TcMEP monitoring had been used between 2010 and 2017. The upper limbs were used as the control. A true alert was recorded when there was a 50% or more loss of amplitude from the lower limbs with maintained upper limb signals. Patients with true alerts were identified and their case history analyzed. RESULTS Of the 299 cases reviewed, 279 (93.3%) had acceptable traces throughout and awoke with normal clinical neurological function. No patient with normal traces had a postoperative clinical neurological deficit. True alerts occurred in 20 cases (6.7%). The diagnoses of the alert group included nine cases of adolescent idiopathic scoliosis (AIS) (45%) and six of congenital scoliosis (30%). The incidence of deterioration based on diagnosis was 9/153 (6%) for AIS, 6/30 (20%) for congenital scoliosis, and 2/16 (12.5%) for spinal tuberculosis. Deterioration was much more common in congenital scoliosis than in AIS (p = 0.020). Overall, 65% of alerts occurred during rod instrumentation: 15% occurred during decompression of the internal apex in vertebral column resection surgery. Four alert cases (20%) awoke with clinically detectable neurological compromise. CONCLUSION Surgeon-directed TcMEP monitoring has a 100% negative predictive value and allows early identification of physiological cord distress, thereby enabling immediate intervention. In resource constrained environments, surgeon-directed TcMEP is a viable and effective method of intraoperative spinal cord monitoring. Level of evidence: III Cite this article: Bone Joint J 2021;103-B(3):547-552.
Collapse
Affiliation(s)
- Ramanare Sibusiso Magampa
- Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Robert Dunn
- Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
16
|
Mehdian H, Haddad S, Pasku D, Nasto LA. Mid-term results of a modified self-growing rod technique for the treatment of early-onset scoliosis. Bone Joint J 2020; 102-B:1560-1566. [PMID: 33135451 DOI: 10.1302/0301-620x.102b11.bjj-2020-0412.r3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To report the mid-term results of a modified self-growing rod (SGR) technique for the treatment of idiopathic and neuromuscular early-onset scoliosis (EOS). METHODS We carried out a retrospective analysis of 16 consecutive patients with EOS treated with an SGR construct at a single hospital between September 2008 and December 2014. General demographics and deformity variables (i.e. major Cobb angle, T1 to T12 length, T1 to S1 length, pelvic obliquity, shoulder obliquity, and C7 plumb line) were recorded preoperatively, and postoperatively at yearly follow-up. Complications and revision procedures were also recorded. Only patients with a minimum follow-up of five years after surgery were included. RESULTS A total of 16 patients were included. Six patients had an idiopathic EOS while ten patients had a neuromuscular or syndromic EOS (seven spinal muscular atrophy (SMA) and three with cerebral palsy or a syndrome). Their mean ages at surgery were 7.1 years (SD 2.2) and 13.3 years (SD 2.6) respectively at final follow-up. The mean preoperative Cobb angle of the major curve was 66.1° (SD 8.5°) and had improved to 25.5° (SD 9.9°) at final follow-up. The T1 to S1 length increased from 289.7 mm (SD 24.9) before surgery to 330.6 mm (SD 30.4) immediately after surgery. The mean T1 to S1 and T1 to T12 growth after surgery were 64.1 mm (SD 19.9) and 47.4 mm (SD 18.8), respectively, thus accounting for a mean T1 to S1 and T1 to T12 spinal growth after surgery of 10.5 mm/year (SD 3.7) and 7.8 mm/year (SD 3.3), respectively. A total of six patients (five idiopathic EOS, one cerebral palsy EOS) had broken rods during their growth spurt but were uneventfully revised with a fusion procedure. No other complications were noted. CONCLUSION Our data show that SGR is a safe and effective technique for the treatment of EOS in nonambulatory hypotonic patients with a neuromuscular condition. Significant spinal growth can be expected after surgery and is comparable to other published techniques for EOS. While satisfactory correction of the deformity can be achieved and maintained with this technique, a high rate of rod breakage was seen in patients with an idiopathic or cerebral palsy EOS. Cite this article: Bone Joint J 2020;102-B(11):1560-1566.
Collapse
Affiliation(s)
- Hossein Mehdian
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Sleiman Haddad
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK.,Spine Surgery Unit, Department of Orthopaedic Surgery and Traumatology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Dritan Pasku
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Luigi Aurelio Nasto
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK.,Department of Paediatric Orthopaedics, IRCCS Istituto G. Gaslini, Genoa, Italy
| |
Collapse
|