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Labrom FR, Izatt MT, Askin GN, Labrom RD, Claus AP, Little JP. Segmental deformity markers offer novel indicators of deformity progression risk in deformity-matched adolescent idiopathic scoliosis patients. Spine Deform 2024; 12:1647-1655. [PMID: 39044108 PMCID: PMC11499335 DOI: 10.1007/s43390-024-00927-7] [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: 12/13/2023] [Accepted: 07/01/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE Identification of adolescent idiopathic scoliosis (AIS) patients with mild curvatures who pose significant risk of progressing to severe levels of curvatures is of paramount importance for clinical care. This study aimed to compare segmental deformity changes in AIS sub-cohorts that are dichotomised by progression status. METHODS Thirty-six female participants with Lenke 1 AIS curves were investigated with sequential MRIs during growth. Scans were reformatted to measure orthogonal segmental parameters, including sagittal/coronal wedging angles and axial rotation angles. Participants were dichotomised by progression. Two-tailed, independent sample t-tests were used to compare sub-cohort multi-segmental and segmental deformity parameters. Measurements were compared at each scan number and variable rates of change were determined using actual time between measures. RESULTS AIS progression status sub-cohorts were comparable at scan 1 for multi-segmental deformity parameters (e.g. major thoracic curve angle, rib hump, kyphosis) (P > 0.05). However, apical measures of coronal IVD wedging, axial IVD rotation and axial vertebral rotation were segmental parameters at scan 1 which were larger for participants whose AIS would later go on to clinically progress (all P < 0.05). Measures of segmental hypokyphosis were comparable between groups. As development was tracked at each subsequent scan, coronal and axial plane differences between groups increased in both magnitude and number of differences. CONCLUSION Initial disparity and then subsequent increasing magnitude of change of axial rotation may indicate a higher propensity to clinically progress in the future. This knowledge hopes to provide useful management information for AIS care providers and prognostic education for patients alike. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Fraser R Labrom
- Biomechanics & Spine Research Group, Level 5, Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham St, South Brisbane, 4101, Australia.
- Queensland Children's Hospital and Mater Health Services, Brisbane, Australia.
| | - Maree T Izatt
- Biomechanics & Spine Research Group, Level 5, Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham St, South Brisbane, 4101, Australia
- Queensland Children's Hospital and Mater Health Services, Brisbane, Australia
| | - Geoffrey N Askin
- Biomechanics & Spine Research Group, Level 5, Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham St, South Brisbane, 4101, Australia
- Queensland Children's Hospital and Mater Health Services, Brisbane, Australia
| | - Robert D Labrom
- Biomechanics & Spine Research Group, Level 5, Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham St, South Brisbane, 4101, Australia
- Queensland Children's Hospital and Mater Health Services, Brisbane, Australia
| | - Andrew P Claus
- Tess Cramond Pain and Research Centre, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia
| | - J Paige Little
- Biomechanics & Spine Research Group, Level 5, Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham St, South Brisbane, 4101, Australia
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Kim H, Chang BS, Chang SY. Current issues in the treatment of adolescent idiopathic scoliosis: a comprehensive narrative review. Asian Spine J 2024; 18:731-742. [PMID: 39434233 PMCID: PMC11538816 DOI: 10.31616/asj.2024.0367] [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: 09/05/2024] [Revised: 09/09/2024] [Accepted: 09/18/2024] [Indexed: 10/23/2024] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of unknown etiology that commonly affects adolescents, imposing significant socioeconomic burdens. Effective management necessitates a comprehensive approach that takes into account multiple factors, including growth potential and psychological issues. Despite significant advancements in AIS management, several questions regarding optimal treatment strategies persist. Recent technological advancements are transforming the treatment landscape, encompassing advancements in bracing, robotic-assisted deformity corrections, and other interventions. This review explores current issues debated in the literature concerning the treatment of AIS, focusing on contemporary high-level evidence (e.g., meta-analyses and randomized controlled trials). Furthermore, this review explores cutting-edge developments and future directions in AIS management, including the integration of artificial intelligence and augmented reality.
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Affiliation(s)
- Hyoungmin Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Bong-Soon Chang
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sam Yeol Chang
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
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Huang Y, Zhu C, Wang Y, Feng G, Liu L. A Novel Deformity Correction Manipulation System for Better Correction of Large Thoracic Scoliosis. Orthop Surg 2024; 16:2436-2446. [PMID: 39072994 PMCID: PMC11456703 DOI: 10.1111/os.14169] [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: 02/27/2024] [Revised: 06/18/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE Treating patients with large thoracic scoliosis (between 70° and 100°) poses technical challenges, particularly with traditional correction techniques (TCT). To address this, we developed a novel deformity correction manipulation system (DCMS) aimed at reducing surgical complexity and trauma. This study aims to assess the safety and effectiveness of DCMS in treating large thoracic scoliosis. METHODS From January 2016 to June 2021, 76 patients with large thoracic scoliosis were included in this retrospective study. The patients were divided into two groups: DCMS (n = 34) and TCT (n = 42). Basic patient data including age at surgery, sex, etiology, Risser sign, flexibility of the main thoracic curve, instrumented levels, number of screws, duration of hospital stay, and follow-up time were collected and analyzed. Radiographic and clinical outcomes, as measured by various radiographic parameters and Scoliosis Research Society-30 (SRS-30) scores, were retrospectively analyzed and compared between the two groups. Adverse events were also documented. Statistical analyses were performed using two-tailed independent t-tests, chi-square tests, and Fisher's exact test. RESULTS The DCMS group exhibited significantly shorter operative times, reduced blood loss, and shorter hospital stays compared to the TCT group. However, there were no significant differences between the two groups in terms of age at surgery, sex, etiology, Risser sign, flexibility of the main curve, instrumented levels, number of screws, and follow-up time. While preoperative major curves were statistically similar between the two groups, the DCMS group achieved a superior correction rate compared to the TCT group (74.2% ± 8.8% vs 68.1% ± 10.5%). No significant differences were observed in other radiographic parameters, SRS-30 scores, or the incidence of adverse events. CONCLUSION The application of DCMS resulted in shorter operative times, reduced blood loss, shorter hospital stays, and greater curve correction compared to TCT. DCMS proves to be a safe and effective technique for treating large thoracic curves.
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Affiliation(s)
- Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Yongliang Wang
- Department of Orthopedic SurgeryPangang Group General HospitalPanzhihuaChina
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
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Fu X, Meng S, Huang X, Li W, Ye B, Chen S. The prevalence of scoliosis among adolescents in China: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:585. [PMID: 39342221 PMCID: PMC11437733 DOI: 10.1186/s13018-024-05077-0] [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: 07/05/2024] [Accepted: 09/12/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND To systematically evaluate the prevalence of scoliosis in adolescents aged 10-18 years in China, and to provide evidence-based evidence for the early identification, prevention, and management of scoliosis in adolescents. METHODS We searched 7 databases of CNKI, Wanfang, VIP, PubMed, Web of Science, Embase, and Cochrane Library from January 2000 to June 2024, and included related studies on scoliosis among Chinese adolescents aged 10-18. The quality evaluation criteria of cross-sectional studies recommended by the Agency for Healthcare Research and Quality (AHRQ) were used for literature quality evaluation. Stata 18.0 software was used for statistical analysis. RESULTS We finally included 42 studies, involving a total of 1,149,330 subjects from 30 regions. The results showed that the prevalence of scoliosis in Chinese adolescents aged 10-18 years was 1.2% [95%CI (1.1%, 1.4%)]. The results of the subgroup analyses are as follows: ① The prevalence of scoliosis in adolescent women (1.6%) was higher than that in men (1.0%). ② The prevalence of scoliosis in adolescents aged 16-18 (1.3%) was higher than that in adolescents aged 10-15 (1.1%). ③ By region, the prevalence of scoliosis was slightly higher in the North (1.3%) than that in the South (1.2%). ④ According to the time of publication, the prevalence of scoliosis in Chinese adolescents increased from 0.9% during 2000-2015 to 1.6% during 2016-2024. ⑤ According to the degree of the Cobb angle, the curve magnitude was mainly mild (Cobb angle: 10°-19°), and the prevalence rate was 0.7%; the second was moderate (Cobb angle: 20°-39°), with a prevalence of 0.2%. CONCLUSION The prevalence of scoliosis in adolescents aged 10-18 years in China is 1.2%, suggesting that the prevalence may be gradually increasing in recent years. In addition, the degree of scoliosis is mainly mild, and timely intervention and prevention are necessary.
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Affiliation(s)
- Xinlei Fu
- The First School of Clinical Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Shilong Meng
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Xiating Huang
- The First School of Clinical Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Wei Li
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Baisheng Ye
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Siwen Chen
- Xiamen Hospital of Traditional Chinese Medicine Affiliated to Beijing University of Chinese Medicine, Xiamen, 361006, China.
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Payas A, Kocaman H, Yıldırım H, Batın S. Prediction of adolescent idiopathic scoliosis with machine learning algorithms using brain volumetric measurements. JOR Spine 2024; 7:e1355. [PMID: 39011367 PMCID: PMC11247394 DOI: 10.1002/jsp2.1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/05/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024] Open
Abstract
Background It is known that neuroanatomical and neurofunctional changes observed in the brain, brainstem and cerebellum play a role in the etiology of adolescent idiopathic scoliosis (AIS). This study aimed to investigate whether volumetric measurements of brain regions can be used as predictive indicators for AIS through machine learning techniques. Methods Patients with a severe degree of curvature in AIS (n = 32) and healthy individuals (n = 31) were enrolled in the study. Volumetric data from 169 brain regions, acquired from magnetic resonance imaging (MRI) of these individuals, were utilized as predictive factors. A comprehensive analysis was conducted using the twelve most prevalent machine learning algorithms, encompassing thorough parameter adjustments and cross-validation processes. Furthermore, the findings related to variable significance are presented. Results Among all the algorithms evaluated, the random forest algorithm produced the most favorable results in terms of various classification metrics, including accuracy (0.9083), AUC (0.993), f1-score (0.970), and Brier score (0.1256). Additionally, the most critical variables were identified as the volumetric measurements of the right corticospinal tract, right corpus callosum body, right corpus callosum splenium, right cerebellum, and right pons, respectively. Conclusion The outcomes of this study indicate that volumetric measurements of specific brain regions can serve as reliable indicators of AIS. In conclusion, the developed model and the significant variables discovered hold promise for predicting scoliosis development, particularly in high-risk individuals.
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Affiliation(s)
- Ahmet Payas
- Faculty of Medicine, Department of Anatomy Amasya University Amasya Turkey
| | - Hikmet Kocaman
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation Karamanoglu Mehmetbey University Karaman Turkey
| | - Hasan Yıldırım
- Faculty of Kamil Özdağ Science, Department of Mathematics Karamanoğlu Mehmetbey University Karaman Turkey
| | - Sabri Batın
- Orthopedics and Traumatology Department Kayseri City Education and Training Hospital Kayseri Turkey
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Khan MA, Quiceno E, Ravinsky RA, Hussein A, Abdulla E, Nosova K, Moniakis A, Bauer IL, Pico A, Dholaria N, Deaver C, Barbagli G, Prim M, Baaj AA. Is young adult idiopathic scoliosis a distinct clinical entity from adolescent idiopathic scoliosis? a Systematic Review and Meta-analysis comparing pre-operative characteristics and operative outcomes. Spine Deform 2024; 12:1241-1251. [PMID: 38722532 DOI: 10.1007/s43390-024-00892-1] [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: 12/26/2023] [Accepted: 05/01/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE This study aims to conduct a systematic review of the literature comparing pre-operative, intraoperative, and post-operative characteristics between adolescent idiopathic scoliosis (AIS) and young adult idiopathic scoliosis (YAdIS) patients. METHODS Following PRISMA guidelines, we conducted a search of the PubMed/Medline, EMBASE, and Cochrane Central databases to identify full-text articles in the English-language literature. Our inclusion criteria were studies that compared preoperative, intraoperative, and postoperative characteristics between AIS and YAdIS patients. We performed a meta-analysis reporting mean difference (MD) for continuous variables and Odds ratios (ORs) to assess differences in postoperative complications. RESULTS Seven studies consisting of 1562 patients were included in the meta-analysis. The AIS group exhibited less intraoperative bleeding and shorter surgical procedures, with a mean difference between groups of 122.3 ml (95% CI 46.2-198.4, p = 0.002) and 28.7 min (95% CI 6.5-50.8, p = 0.01), respectively. Although the preoperative Cobb angle did not differ between groups (p = 0.65), patients with AIS achieved superior postoperative deformity correction, with a mean difference of 7.3% between groups, MD - 7.3 (95% CI - 9.7, - 4.8, p < 0.00001), and lower postoperative Cobb angles of the major curve, MD 4.2 (95% CI 3.1, 5.3, p < 0.00001). YAdIS patients were fused, on average, 0.2 more vertebral levels than AIS patients, MD 0.2 (95% CI 0.01, 0.5, p = 0.04). AIS patients experienced a significantly shorter length of stay after the surgical procedure, with an MD of 0.8 days (95% CI 0.1, 1.6, p = 0.02). No significant difference was found between groups in terms of complications (p = 0.19). CONCLUSIONS YAdIS should be regarded as a distinct surgical entity, characterized by increased bleeding, longer surgical duration, greater deformity correction challenges, and the need for fusion of additional vertebral levels compared to AIS. Surgeons should be mindful of these differences and discuss them with patients and their families, especially in cases where the correction of the AIS deformity is delayed and there is a high risk of progression after skeletal maturity. Further research is needed to explore alternative surgical techniques and enhance outcomes for YAdIS patients.
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Affiliation(s)
- Monis A Khan
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Esteban Quiceno
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA.
| | - Robert A Ravinsky
- Department of Orthopedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Amna Hussein
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Ebtesam Abdulla
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Kristin Nosova
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Alexandros Moniakis
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Isabel L Bauer
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Annie Pico
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Nikhil Dholaria
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Courtney Deaver
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Giovanni Barbagli
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Michael Prim
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Ali A Baaj
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
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Li L, Zhang T, Lin F, Li Y, Wong MS. Automated 3D Cobb Angle Measurement Using U-Net in CT Images of Preoperative Scoliosis Patients. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01211-w. [PMID: 39117939 DOI: 10.1007/s10278-024-01211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 08/10/2024]
Abstract
To propose a deep learning framework "SpineCurve-net" for automated measuring the 3D Cobb angles from computed tomography (CT) images of presurgical scoliosis patients. A total of 116 scoliosis patients were analyzed, divided into a training set of 89 patients (average age 32.4 ± 24.5 years) and a validation set of 27 patients (average age 17.3 ± 5.8 years). Vertebral identification and curve fitting were achieved through U-net and NURBS-net and resulted in a Non-Uniform Rational B-Spline (NURBS) curve of the spine. The 3D Cobb angles were measured in two ways: the predicted 3D Cobb angle (PRED-3D-CA), which is the maximum value in the smoothed angle map derived from the NURBS curve, and the 2D mapping Cobb angle (MAP-2D-CA), which is the maximal angle formed by the tangent vectors along the projected 2D spinal curve. The model segmented spinal masks effectively, capturing easily missed vertebral bodies. Spoke kernel filtering distinguished vertebral regions, centralizing spinal curves. The SpineCurve Network method's Cobb angle (PRED-3D-CA and MAP-2D-CA) measurements correlated strongly with the surgeons' annotated Cobb angle (ground truth, GT) based on 2D radiographs, revealing high Pearson correlation coefficients of 0.983 and 0.934, respectively. This paper proposed an automated technique for calculating the 3D Cobb angle in preoperative scoliosis patients, yielding results that are highly correlated with traditional 2D Cobb angle measurements. Given its capacity to accurately represent the three-dimensional nature of spinal deformities, this method shows potential in aiding physicians to develop more precise surgical strategies in upcoming cases.
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Affiliation(s)
- Lening Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Teng Zhang
- School of Artificial Intelligence, Nanjing University of Information Science and Technology, Nanjing, China
- Institute for Artificial Intelligence in Medicine, Nanjing University of Information Science and Technology, Nanjing, China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
- Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China.
| | - Yuting Li
- Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Man-Sang Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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Song J, Rui H, Xie Y, Wang Y, Li T, Chi X, Tong M, Lin F. Early-onset scoliosis in children aged 4-7 years in Nanjing, China: A cross-sectional study. HEALTH CARE SCIENCE 2024; 3:274-285. [PMID: 39220431 PMCID: PMC11362652 DOI: 10.1002/hcs2.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024]
Abstract
Background This study aimed to investigate the potential variance in the prevalence of early-onset scoliosis among children aged 4-7 years and analyze the influencing factors. The goal was to establish a crucial reference point for monitoring and evaluating spinal curvature development in preschoolers, ultimately to reduce the occurrence of adverse health outcomes. Methods Children aged 4-7 years within the main urban area of Nanjing were selected using a stratified random sampling method. A team of four senior therapists conducted screenings for spinal curvature among children using visual inspection, the Adams forward bending test, and an electronic scoliometer to measure the angle of trunk rotation (ATR) and identify children displaying signs of scoliosis. Children with suspected scoliosis in the initial screening underwent X-ray Cobb angle assessment for confirmation. The prevalence of early-onset scoliosis was then determined from the screening results. R version 4.2.0 software was used to analyze the factors associated with scoliosis among children using partial least squares structural equation modeling. Results A total of 2281 children were included in this study, consisting of 1211 boys and 1070 girls, with a mean age of 5.44 ± 0.81 years (ranging from 4 to 7 years). Among them, 7.58% exhibited positive signs of scoliosis, 5.87% had early-onset scoliosis, and the positive predictive value was 77.5%. Significant differences in ATR were observed among children in different age groups (Kruskal-Wallis = 15, p = 0.0104) and by sex (t = 3.17, p = 0.00153). Significant variations in ATR were noted in children with scoliosis (t = -22.7, p < 0.001), with a cutoff at ATR = 4.5°, and auxiliary values of 0.947 and 0.990. Children diagnosed with early-onset scoliosis generally exhibited lower body mass index values, with a statistically significant difference (t = 2.99, p = 0.003). Conclusions Using visual inspection, the Adams test, and an electronic scoliometer to measure the ATR, the present triad method is more sensitive for early scoliosis screening in children with abnormal posture aged 4-7 years. A full spine X-ray is advised in children with an ATR over 4.5° and poor posture.
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Affiliation(s)
- Jun Song
- Women's Hospital of Nanjing Medical University (Nanjing Women and Children's Healthcare Hospital)NanjingJiangsuChina
| | - Hong‐xin Rui
- Women's Hospital of Nanjing Medical University (Nanjing Women and Children's Healthcare Hospital)NanjingJiangsuChina
| | - Ya‐chun Xie
- Women's Hospital of Nanjing Medical University (Nanjing Women and Children's Healthcare Hospital)NanjingJiangsuChina
| | - Yan Wang
- Women's Hospital of Nanjing Medical University (Nanjing Women and Children's Healthcare Hospital)NanjingJiangsuChina
| | - Ting Li
- Women's Hospital of Nanjing Medical University (Nanjing Women and Children's Healthcare Hospital)NanjingJiangsuChina
| | - Xia Chi
- Women's Hospital of Nanjing Medical University (Nanjing Women and Children's Healthcare Hospital)NanjingJiangsuChina
| | - Mei‐lin Tong
- Women's Hospital of Nanjing Medical University (Nanjing Women and Children's Healthcare Hospital)NanjingJiangsuChina
| | - Feng Lin
- Department of Rehabilitation MedicineThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
- Department of Rehabilitation Medicine, Sir Run Run HospitalNanjing Medical UniversityNanjingJiangsuChina
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Xu S, Li K, Jin L, Dong Y, Liang Y, Liu C, Wang P, Zhao Z, Wang Y, Guo C, Wang Z, Liu H. Distribution of scoliosis in 2.22 million adolescents in mainland China: A population-wide analysis. J Glob Health 2024; 14:04117. [PMID: 39026457 PMCID: PMC11258535 DOI: 10.7189/jogh.14.04117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Background The characteristics of scoliosis afflicting school children and adolescents in mainland China are still unclear. Therefore, we conducted a systematic review to estimate scoliosis's prevalence and characterise its distribution in China. Methods We screened PubMed, Scopus, WanFang, China National Knowledge Infrastructure, National Science and Technology Library, and WeiPu databases for mainland China articles published between 1 January 1980 and 31 October 2022. Among them, we identified population-wide scoliosis studies in school children and adolescents. The main outcomes were the positive rate of primary screening and the prevalence of final screening. Primary screening mainly included general examination with/without the forward bending test in school. The final screening entailed clinical diagnosis by Röntgen radiation in a hospital (based on primary screening). A meta-analysis of scoliosis distribution by gender was performed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). Further, we analysed the distributions of scoliosis by age, region, aetiological type, and severity of curvature, in addition to the correlation between its prevalence and altitude or latitude. Results 77 studies with 2 224 320 participants were included. The positive rate through primary screening was 3.97%, whereas the prevalence of scoliosis at final screening was 1.20%. Analysing the data revealed a higher prevalence of scoliosis in girls (OR = 1.57; 95% CI = 1.38-1.81). The age-wise peak rate of scoliosis was 15-16 years (1.07%) in boys and 13-14 years (1.42%) in girls. The mean prevalence of scoliosis was 1.07% in the western region, 1.54% in the central, and 1.35% in the eastern. Scoliosis prevalence was not correlated with either altitude or latitude. The prevalence of idiopathic and congenital scoliosis was 1.18 and 0.03%. Among all subjects with scoliosis, 79.10 and 16.80% had mild and medium disease severity. Conclusions According to this comprehensive study using data sets of scoliosis in adolescents across mainland China, the mean prevalence of scoliosis is 1.20%, yet 1.57 times higher in girls than boys, and is most prevalent in the middle region. Overall, scoliosis in adolescents could pose a burden to public health in mainland China. Registration PROSPERO CRD42021231987.
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Affiliation(s)
- Shuai Xu
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, China
| | - Kexin Li
- Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Linyu Jin
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, China
| | - Chenjun Liu
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, China
| | - Peihan Wang
- Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Zhuran Zhao
- Department of Paediatrics, Peking University People’s Hospital, Peking University, Beijing, China
| | - Yixuan Wang
- Department of Pain Medicine Centre, Peking University Third Hospital, Peking University, Beijing, China
| | - Chen Guo
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, China
| | - Zhenbo Wang
- Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, China
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Gouzoulis MJ, Joo PY, Jeong S, Jabbouri SS, Moran J, Zhu JR, Grauer JN. A 10-year perspective on the question of whether surgeries for adolescent idiopathic scoliosis are "one and done"? Spine Deform 2024; 12:903-908. [PMID: 38555557 DOI: 10.1007/s43390-024-00858-3] [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: 01/11/2024] [Accepted: 02/28/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Posterior scoliosis fusion (PSF) for adolescent idiopathic scoliosis (AIS) is considered a highly successful surgery with excellent outcomes. However, especially as many patients "graduate" from their pediatric surgeons, there is the need to quantify the long-term outcomes of such surgeries. METHODS The 2010-2022 Pearldiver M161 dataset was queried for those who were 10 to 18 years old with AIS undergoing PSF with at least 10 years follow-up. Patient characteristics were abstracted. Reoperations were identified based on coding for any subsequent thoracic/lumbar surgery/revision. The 10-year reoperation rate and reasons for reoperation were determined, and multivariate regression was performed to determine risk factors. RESULTS In total, 3,373 AIS PSF patients were identified. Of the study cohort, 324 (9.6%) underwent reoperation within 10-years with an interquartile range for timing of surgery of 81-658 days, of which 29.6% were done for infection. Reoperations were done within the first three months for 152 (46.9% of reoperations), three months to 2 years for 97 (29.9%), and 2 years to 10 years for 74 (22.8%). Based on multivariate regression, need for reoperation was associated with male sex (OR: 1.70), asthma (OR: 1.36) and greater than thirteen segments of instrumentation (OR: 1.48) (p < 0.05 for each) but not age, other comorbidities, or insurance. CONCLUSIONS The current study of a large national AIS PSF population found 9.6% to undergo reoperation in the 10 years following their index operation. Although specifics about the curve pattern could not be determined, the reoperation incidence and correlation with specific risk factors are notable and important for patient counselling.
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Affiliation(s)
- Michael J Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Peter Y Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Seongho Jeong
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Sahir S Jabbouri
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Justin R Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA.
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Sampiev MT, Zagorodniy NV, Gizatullin SK, Dubinin IP, Chemurzieva KHM, Lysenko IS. A novel approach to surgical treatment of adolescent idiopathic scoliosis in skeletally immature patients. World Neurosurg X 2024; 23:100383. [PMID: 38799789 PMCID: PMC11127265 DOI: 10.1016/j.wnsx.2024.100383] [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: 07/17/2023] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose Describe the surgical technique and experience using the LSZ growing system in skeletally immature patients for two-stage surgical treatment of adolescent idiopathic scoliosis (AIS). Methods Eleven skeletally immature patients who underwent two-stage surgical treatment of AIS in our center were retrospectively analyzed. Patients initially treated with the LSZ growing system were observed for an average of 40.5 months (range 23-64 months) and for 4 years after planned replacement of the LSZ growing system with a standard pedicle screw system. Results The average preoperative angle of the main thoracic curve was 64.55 ± 3.21°, and that of the lumbar curve was 46 ± 5.52°. After instrumentation using the LSZ growing system, the thoracic curve was corrected to 17.63 ± 5.14°, and the lumbar curve to 9.2 ± 5.45°. The correction percentages were 72.52 ± 8.35 and 80.59 ± 10.77, respectively. After planned replacement of the LSZ system with a pedicle screw system, the angle of the thoracic curve changed to 11.45 ± 4.84°, and the lumbar curve to 6.4 ± 4.72°. The percentages of final correction were 82,1 ± 7,91 and 85,64 ± 5,47, respectively. The difference in the "LSZ growth coefficient" was 0.063 ± 0.037, which indicates continued growth of the spine along the instrumented region. None of the patients had neurological or infectious complications. Conclusion Our study demonstrates the safety and effectiveness of 2-stage treatment of AIS using the LSZ system, which allows for spine growth during the period between stages.
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Affiliation(s)
- Mukhammad Tablikhanovich Sampiev
- RUDN University, Institute of Medicine, Department of Traumatology and Orthopedics, 117198, Miklukho-Maklaya str.6, Moscow, Russia
| | - Nikolai Vasilevich Zagorodniy
- RUDN University, Institute of Medicine, Department of Traumatology and Orthopedics, 117198, Miklukho-Maklaya str.6, Moscow, Russia
| | | | - Ilya Petrovich Dubinin
- Federal Medical Biophysical Center named after A. I. Burnazyan, Department of Neurology with Neurosurgery course, 123098, Zhivopisnaya str. 46 b. 8, Moscow, Russia
| | - KHava Magomedovna Chemurzieva
- RUDN University, Institute of Medicine, Department of Traumatology and Orthopedics, 117198, Miklukho-Maklaya str.6, Moscow, Russia
| | - Ivan Stanislavovich Lysenko
- RUDN University, Institute of Medicine, Department of Traumatology and Orthopedics, 117198, Miklukho-Maklaya str.6, Moscow, Russia
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12
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Almahmoud OH, Baniodeh B, Musleh R, Asmar S, Zyada M, Qattousah H. Assessment of idiopathic scoliosis among adolescents and associated factors in Palestine. J Pediatr Nurs 2024; 74:85-91. [PMID: 38029690 DOI: 10.1016/j.pedn.2023.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE This study aimed to investigate adolescent idiopathic scoliosis (AIS) and its related risk factors, including body mass index (BMI), physical activity (PA), gender, time of the first menstrual cycle, transportation, backpack weight and the way of carrying a backpack. DESIGN AND METHOD a cross-sectional quantitative design was utilized. A convenient sample of adolescent students in grades seven through ten was included in the study. A self-reported questionnaire with three sections: demographic data; physical data including height, weight and PA; and Adam's forward bend test to determine each student's spine's Cobb angle by measuring the angle of trunk rotation using a scoliometer. The data were analyzed using SPSS version 25, with confidence intervals of 95%. RESULTS A total of 820 schoolchildren participated in the study; 53.7% were female and 46.3% were male. Only 22% of these students engaged in vigorous exercise, compared to 36.7% who engaged in low PA; additionally, 10% of the adolescents had a low BMI. After the analysis, it was found that 5.4% of participants had AIS. Low PA (p = 0.001), being underweight (p = 0.038), and time of first menstrual period (p = 0.033) were significantly associated with AIS, while gender, backpack weight, and way of carrying were not statistically related to AIS. Binary logistic regression identified low PA as an independent predictor of AIS (OR = 7.22, 95%CI [1.64, 31.79]). CONCLUSIONS The frequency of AIS in Palestine was significant, which highlighted the importance of this issue at a national and global level. There was an association between AIS and BMI, PA, and the time of the first menstrual cycle, which signifies the importance of early detection of the problem to limit its burden later in life. PRACTICE IMPLICATIONS Teachers, teenagers, and their parents should be provided with programs that educate and clarify AIS, and a specific protocol should be established for scoliosis screening in schools.
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Affiliation(s)
- Omar H Almahmoud
- Nursing Department, Pharmacy, Nursing and Health Professions College, Birzeit University, Birzeit, Palestine.
| | - Baraa Baniodeh
- Nursing Department, Pharmacy, Nursing and Health Professions College, Birzeit University, Birzeit, Palestine
| | - Reem Musleh
- Nursing Department, Pharmacy, Nursing and Health Professions College, Birzeit University, Birzeit, Palestine
| | - Sanabel Asmar
- Nursing Department, Pharmacy, Nursing and Health Professions College, Birzeit University, Birzeit, Palestine
| | - Mohammed Zyada
- Nursing Department, Pharmacy, Nursing and Health Professions College, Birzeit University, Birzeit, Palestine
| | - Hadeel Qattousah
- Nursing Department, Pharmacy, Nursing and Health Professions College, Birzeit University, Birzeit, Palestine
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Batin S, Payas A, Bal E, Ekinci Y, Kurtoğlu E, Uçar I, Arik M, Seber T, Varol BK, Ulusoy EK, Bayram AK, Ekinci D, Unur E. Evaluation of cerebellum volume and trunk oscillation velocity in cases with adolescent idiopathic scoliosis: a preliminary report. 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 2023; 32:4012-4019. [PMID: 37725163 DOI: 10.1007/s00586-023-07948-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE It has been suggested that the cause of the balance disorder seen in adolescent idiopathic scoliosis (AIS) originates from the central nervous system. However, the extent of the balance problem and the dysfunction of which part of the central nervous system has not been investigated in detail. This study aimed to correlate the values obtained by balance analysis and cerebellum volume measurement in female individuals with AIS with healthy individuals. METHODS Cerebellum volume was calculated via the cloud-based software " https://volbrain.upv.es " using brain magnetic resonance images of 27 healthy and 26 individuals with AIS. The duration of stay in the test positions, the movement strategy used during this time and the amount of postural sway were analyzed by using a computer-assisted force platform and compared statistically. RESULTS Significant differences were found between the AIS and control groups in cerebellum total volume, vermis cerebelli volume (cm3), and trunk oscillation velocity (mm/s) parameters (p < 0.05). Cerebellum and vermis cerebelli volumes were found to be lower and trunk oscillation velocity was found to be greater in patients with AIS. CONCLUSION Balance problems in patients with AIS are correlated with decreased cerebellum volume and increased trunk oscillation velocity.
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Affiliation(s)
- Sabri Batin
- Department of Traumatology, Kayseri City Education and Training Hospital Orthopedics, Kayseri, Turkey
| | - Ahmet Payas
- Vocational College of Sungurlu, Hitit University, Çorum, Turkey
| | - Emre Bal
- Fatih Sultan Mehmet Education and Training Hospital Orthopedics and Traumatology Department, Istanbul, Turkey
| | - Yakup Ekinci
- Department of Traumatology, Kayseri City Education and Training Hospital Orthopedics, Kayseri, Turkey.
| | - Erdal Kurtoğlu
- Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ilyas Uçar
- Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mustafa Arik
- Orthopedics and Traumatology Department, Aksaray Ortaköy Public Hospital, Aksaray, Turkey
| | - Turgut Seber
- Radiology Department, Kayseri City Education and Training Hospital, Kayseri, Turkey
| | - Büşra Kepenek Varol
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Nuh Naci Yazgan University, Kayseri, Turkey
| | | | - Ayşe Kaçar Bayram
- Pediatric Neurology Clinic, Kayseri City Education and Training Hospital, Kayseri, Turkey
| | - Duygu Ekinci
- Pediatrics Clinic, Kayseri City Education and Training Hospital, Kayseri, Turkey
| | - Erdoğan Unur
- Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Achonu JU, Oh K, Shaw J, Rashidian S, Wang F, Komatsu DE, Barsi J. Epidemiologic patterns of adolescent idiopathic scoliosis detection and treatment in new york state. J Pediatr Orthop B 2023; 32:507-516. [PMID: 36847202 DOI: 10.1097/bpb.0000000000001066] [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: 03/01/2023]
Abstract
The purpose of this study is to examine the epidemiologic trends of adolescent idiopathic scoliosis (AIS) detection and treatment in New York State (NYS), including disparities in access. The New York Statewide Planning and Research Cooperative System database was reviewed to identify patients who underwent treatment for, or were diagnosed with, AIS from 2008 to 2016. Age determined adolescence; and the surgery date, 3-digit zip code, sex, race, insurance status, institution and surgeon license number were recorded to identify such trends. The geographical distribution was assembled from an NYS shapefile, obtained from the Topologically Integrated Geographic Encoding and Referencing database with analysis performed using tigris R. In total 54 002 patients with AIS, 3967 of whom were surgically treated, were identified for analysis. Diagnoses spiked in 2010. Females were diagnosed and underwent surgical treatment more frequently than males. AIS was diagnosed and treated in white patients more frequently than in black and Asian patients combined. From 2010 to 2013, the patients self-paying for surgical treatment decreased more than other payment modalities. Medium-volume surgeons continually increased the number of cases performed, whereas low-volume surgeons exhibited the opposite pattern. High-volume hospitals had a decrease in the number of cases from 2012 and were overtaken by medium-volume hospitals in 2015. Most procedures are performed within the New York City (NYC) area, though AIS was common in all NYS counties. AIS diagnoses increased after 2010, with fewer patients self-paying for surgery. White patients underwent more procedures than minority patients. Surgical cases were disproportionally performed in the NYC area compared to statewide.
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Affiliation(s)
| | - Ki Oh
- Department of Statisticsf, Renaissance School of Medicine at Stony Brook University, New York, USA
| | - Joshua Shaw
- Department of Statisticsf, Renaissance School of Medicine at Stony Brook University, New York, USA
| | - Sina Rashidian
- Department of Statisticsf, Renaissance School of Medicine at Stony Brook University, New York, USA
| | - Fusheng Wang
- Department of Statisticsf, Renaissance School of Medicine at Stony Brook University, New York, USA
| | | | - James Barsi
- Department of Orthopaedics, Stony Brook University Hospital
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15
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Neves AB, Martins R, Matela N, Atalaia T. PosturAll: A Posture Assessment Software for Children. Bioengineering (Basel) 2023; 10:1171. [PMID: 37892901 PMCID: PMC10603916 DOI: 10.3390/bioengineering10101171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
From an early age, people are exposed to risk factors that can lead to musculoskeletal disorders like low back pain, neck pain and scoliosis. Medical screenings at an early age might minimize their incidence. The study intends to improve a software that processes images of patients, using specific anatomical sites to obtain risk indicators for possible musculoskeletal problems. This project was divided into four phases. First, markers and body metrics were selected for the postural assessment. Second, the software's capacity to detect the markers and run optimization tests was evaluated. Third, data were acquired from a population to validate the results using clinical software. Fourth, the classifiers' performance with the acquired data was analyzed. Green markers with diameters of 20 mm were used to optimize the software. The postural assessment using different types of cameras was conducted via the blob detection method. In the optimization tests, the angle parameters were the most influenced parameters. The data acquired showed that the postural analysis results were statistically equivalent. For the classifiers, the study population had 16 subjects with no evidence of postural problems, 25 with mild evidence and 16 with moderate-to-severe evidence. In general, using a binary classification with the train/test split validation method provided better results.
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Affiliation(s)
- Ana Beatriz Neves
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal;
| | - Rodrigo Martins
- Escola Superior De Saúde Da Cruz Vermelha Portuguesa, 1300-125 Lisboa, Portugal; (R.M.); (T.A.)
| | - Nuno Matela
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal;
| | - Tiago Atalaia
- Escola Superior De Saúde Da Cruz Vermelha Portuguesa, 1300-125 Lisboa, Portugal; (R.M.); (T.A.)
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16
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Hengartner AC, David WB, Reeves BC, Craft S, Boroumand S, Clappier M, Hansen J, Fernandez T, Koo AB, Tuason DA, DiLuna M, Elsamadicy AA. Effects of delayed ambulation following posterior spinal fusion for adolescent idiopathic scoliosis: a single institutional study. Spine Deform 2023; 11:1127-1136. [PMID: 37093449 DOI: 10.1007/s43390-023-00693-y] [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: 04/10/2022] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Mobilizing out of bed and ambulation are key components of recovery following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). However, there remains a paucity of studies identifying risk factors associated with delayed ambulation and its impact on postoperative outcomes. The aim of this study was to investigate patient- and surgical-level risk factors associated with delayed ambulation and the ramifications of delayed ambulation on healthcare utilization for patients undergoing PSF for AIS. METHODS The medical records of 129 adolescent (10-18 years) patients diagnosed with AIS undergoing posterior spinal fusion at a major academic institution between 2013 and 2020 were reviewed. Patients were categorized based on days from surgery to ambulation: early (≤ 1 day), intermediate (2 days), or late (≥ 3 days). Patient demographics, comorbidities, spinal deformity characteristics, intraoperative variables, postoperative complications, LOS, and unplanned readmissions were assessed. The odds ratios for risk-adjusted delayed ambulation and extended LOS were determined via multivariate stepwise logistic regressions. RESULTS One Hundred and Twenty Nine patients were included in this study, of which 10.8% (n = 14) were classified as Early ambulators, 41.9% (n = 54) Intermediate ambulators, and 47.3% (n = 61) were Late ambulators. Late ambulators were significantly younger than early and intermediate ambulators (Early: 15.7 ± 1.9 years vs. Intermediate: 14.8 ± 1.7 years vs. Late: 14.1 ± 1.9 years, p = 0.010). The primary and secondary spinal curves were significantly worse among Late ambulators (p < 0.001 and p = 0.002 respectively). Fusion levels (p < 0.01), EBL (p = 0.014), and the rate of RBC transfusions (p < 0.001) increased as time to ambulation increased. Transition time from IV to oral pain medications (Early: 1.6 ± 0.8 days vs. Intermediate: 2.2 ± 0.6 days vs. Late: 2.4 ± 0.6 days, p < 0.001) and total hospital length of stay (Early: 3.9 ± 1.4 days vs. Intermediate: 4.7 ± 0.9 days vs. Late: 5.1 ± 1.2 days, p < 0.001) were longer in Late ambulators. On multivariate analysis, significant predictors of delayed ambulation included primary curve degree ≥ 70° [aOR: 5.67 (1.29‒31.97), p = 0.030] and procedure time [aOR: 1.66 (1.1‒2.59), p = 0.019]. CONCLUSIONS Our study suggests that there may be patient- and surgical-level factors that are independently associated with late ambulation following PSF for AIS, including extent of major curve and length of operative time. Additionally, delayed ambulation has implications to length of hospital stay and postoperative complications.
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Affiliation(s)
- Astrid C Hengartner
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Wyatt B David
- Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Sam Boroumand
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Mona Clappier
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Justice Hansen
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA
| | - Tiana Fernandez
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Dominick A Tuason
- Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA
| | - Michael DiLuna
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
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17
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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.
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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
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18
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Nathan P, Chou SM, Liu G. A review on different methods of scoliosis brace fabrication. Prosthet Orthot Int 2023; 47:424-433. [PMID: 36723398 DOI: 10.1097/pxr.0000000000000195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 09/08/2022] [Indexed: 02/02/2023]
Abstract
Adolescent idiopathic scoliosis is a 3D spinal deformity and mostly affects children in the age group of 10-16 years. Bracing is the most widely recommended nonoperative treatment modality for scoliosis in children. Scoliosis brace fabrication techniques have continuously evolved and currently use traditional plaster casting, computer-aided design (CAD) and computer-aided manufacturing (CAM), or 3D printing. This is a mini narrative literature review. The objective of our study is to conduct a narrative review of traditional, CAD-CAM and 3D printed brace manufacture. A narrative literature review of scoliosis brace manufacturing methods was conducted using PubMed, Cochrane, and other databases with appropriate keywords. Data were also collected from white papers of manufacturing companies. A total of 53 articles on scoliosis bracing manufacture were selected from various sources and subjected to detailed review. The shortlisted papers focused on Chêneau derivatives and Boston braces. Computer-aided design-CAM brace fabrication had similar curve correction compared with traditional plaster-cast braces; however, patient satisfaction may be greater in CAD-CAM braces. Traditional brace fabrication using plaster casting may be uncomfortable to patients. Computer-aided design-CAM and 3D printed braces may enhance comfort by augmenting the breathability and reducing brace weight. 3D printing is the most recently used brace fabrication method. 3D printing enables the manufacture of customized braces that can potentially enhance patient comfort and compliance and curve correction. 3D printing may also ease the bracing experience for patients and enhance the productivity of brace making.
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Affiliation(s)
- Parvathi Nathan
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Siaw Meng Chou
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Gabriel Liu
- University Spine Centre, Department of Orthopaedic Surgery, National University Hospital, Singapore
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19
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Is the Integration Problem in the Sensoriomotor System the Cause of Adolescent Idiopathic Scoliosis? J Pediatr Orthop 2023; 43:e111-e119. [PMID: 36418290 DOI: 10.1097/bpo.0000000000002300] [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: 11/25/2022]
Abstract
PURPOSE The reason behind the balance control disorder seen in adolescent idiopathic scoliosis (AIS) has been suggested as a central nervous system dysfunction, yet it has not been investigated in detail whether this problem originates from sensory, motor, or from both systems. This study aimed to reveal the differences in the pathways that provide proprioceptive sense, motor control, and coordination between these 2 systems in female individuals with AIS. METHODS Brain Diffusion Tensor Imaging was applied to 30 healthy individuals and 30 Lenke type 1 AIS patients. All of the individuals included in the study were predominantly right-handed and aged between 10 and 18. Diffusion tensor imaging of both groups were performed bilateral tractography on the corticospinal tract (CS tr), medial lemniscus (ML), superior longitudinal fasciculus (SLF), and inferior longitudinal fasciculus (ILF) tracts using DSI Studio software. RESULTS Significant differences in the parameters of CS tr, ML, SLF, ILF pathways were found between the AIS and the control groups. In the AIS group, significant differences were found in the fiber count and fiber ratio of the ML that carries the proprioceptive sense and CS tr, which is responsible for the somatomotor system. There were also significant differences between the left and right CS tr, ML, SLF, and ILF pathways of the AIS group ( P <0.05). CONCLUSIONS Differences in the CS tr, ML, SLF, and ILF pathways may trigger muscular asymmetry and cause postural instability and thus spinal deformity in AIS.
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Pontes MDDS, Soeira TP, Sampaio ML, Pratali RDR, Pompeu Y, Herrero CFPDS. The impacts of waiting for surgical correction of Adolescent Idiopathic Scoliosis and its repercussions for publicly funded health systems: systematic review. 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 2023; 32:617-624. [PMID: 36520211 DOI: 10.1007/s00586-022-07487-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/14/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate, through a systematic review, the impact of the waiting time for Adolescent Idiopathic Scoliosis (AIS) surgical correction from the point of view of deformity evolution, treatment cost, and quality of life. METHODS PubMed, Embase, LILACS, SciELO, Scopus, Web of Science, LIVIVO, and Cochrane Library databases were searched by two researchers to select the articles. The eligibility criteria were: Patients diagnosed with AIS with indication for surgical correction and submitted to waiting lists until treatment. The risks of bias were evaluated using the Risk Of Bias In Non-randomized Studies-Interventions (ROBINS-I) tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to classify the level of the evidence for each outcome. The summary of the available evidence is presented in a narrative synthesis. RESULTS Six observational studies were included. In a Canadian study, the primary outcome was the need for additional spine surgery in patients who had to wait more than three months due to spine deformity progression. American researchers presented a sample of premenarcheal and skeletally immature patients with AIS showing increased Cobb angle and attributed this to a six-month waiting for the surgical treatment. Another study included 177 patients with AIS with a mean waiting time of 225.7 days. There was a worsening average of 7.7° ± 8.6° in Cobb angle, and there was a change in surgical plan in 28 patients, which increased surgical time. Studies that evaluated the treatment cost showed significantly higher mean costs in those who waited longer than six months. Regarding the quality of life, while waiting for surgery, a retrospective study found that patients who underwent surgery earlier showed better results in a questionnaire that assessed their quality of life compared to those who were still waiting. CONCLUSION Observational studies show that, in individuals who are on waiting lists for AIS surgery, there is a worsening of the spinal deformity (substantial evidence), an increasing cost of treatment (moderate evidence) and it may negatively impact patients' quality of life (insufficient evidence). Performing better methodological quality studies to investigate these outcomes can violate good research practices since randomized clinical trials on this subject have ethical limitations to be carried out. TRIAL REGISTRATION The authors declare that the systematic review protocol was registered at the international prospective register of systematic reviews (PROSPERO), CRD42020212134, and it was accepted for publication.
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Affiliation(s)
- Mariana Demétrio de Sousa Pontes
- Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, 11 Floor - Vila Monte Alegre - CEP 14048-900, Ribeirão Preto, SP, Brazil.
| | - Thabata Pasquini Soeira
- Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, 11 Floor - Vila Monte Alegre - CEP 14048-900, Ribeirão Preto, SP, Brazil
| | | | | | - Yuri Pompeu
- Hospital for Special Surgery, New York, NY, USA
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Rudic TN, Moran TE, Kamalapathy PN, Werner BC, Bachmann KR. Venous Thromboembolic Events are Exceedingly Rare in Spinal Fusion for Adolescent Idiopathic Scoliosis. Clin Spine Surg 2023; 36:E35-E39. [PMID: 35696697 DOI: 10.1097/bsd.0000000000001353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 05/18/2022] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Review of health care record database and determination of population statistics. OBJECTIVE The purpose of this study was to quantify the incidence of clinically significant venous thromboembolic (VTE) events in patients undergoing spinal fusion surgery for adolescent idiopathic scoliosis (AIS) and to identify risk factors for VTE. SUMMARY OF BACKGROUND DATA VTE is a serious complication that can cause disability and even death following surgery. Incidence of VTE following AIS surgery has not been well studied; the use of a national database allows the assessment of rare, yet important complications. MATERIALS AND METHODS The PearlDiver Database was used to identify AIS patients who underwent primary instrumented spinal fusion between 2010 and 2020. Patient records were cross-referenced for documented VTEs within 30 and 90 postoperative days. Patients with nonidiopathic scoliosis were excluded. Logistic regression was used to evaluate risk factors for correlation with VTE events. RESULTS Thirty-eight of 11,775 (0.323%) patients undergoing surgery for AIS developed a VTE complication within 90 postoperative days. Hypercoagulability [odds ratio (OR)=13.50, P <0.0001], spinal fusion involving 13+ vertebral levels (OR=2.61, P <0.0001), obesity (OR=1.30, P <0.005), and older (15-18 y) compared with younger adolescence (10-14 y) (OR=2.12, P <0.0001) were associated with VTE. Seven of 38 (18.4%) patients with a diagnosed thrombophilia experienced VTE. CONCLUSIONS The incidence of clinically significant VTEs in pediatric patients following spinal fusion surgery for AIS is low with an incidence of 0.323%. Postoperative chemoprophylaxis in the general pediatric population is not indicated. Patients with obesity, those undergoing spinal fusion of 13 or more vertebrae, and adolescents 15-18 years old were found to have higher but still small risk of VTE following surgery. Further prospective studies are needed to validate the risk profile of patients with hypercoagulability and establish clinical guidelines for use of postoperative chemoprophylaxis in this cohort. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Thomas E Moran
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Pramod N Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Keith R Bachmann
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
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Bowden D, Michielli A, Merrill M, Will S. Systematic review and meta-analysis for the impact of rod materials and sizes in the surgical treatment of adolescent idiopathic scoliosis. Spine Deform 2022; 10:1245-1263. [PMID: 35737287 PMCID: PMC9579082 DOI: 10.1007/s43390-022-00537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/28/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess surgical and safety outcomes associated with different rod materials and diameters in adolescent idiopathic scoliosis (AIS) surgery. METHODS A systematic literature review and meta-analysis evaluated the surgical management of AIS patients using pedicle screw fixation systems (i.e., posterior rods and pedicle screws) with rods of different materials and sizes. Postoperative surgical outcomes (e.g., kyphosis and coronal correction) and complications (i.e., hyper/hypo-lumbar lordosis, proximal junctional kyphosis, revisions, reoperations, and infections) were assessed. Random-effects models (REMs) pooled data for outcomes reported in ≥ 2 studies. RESULTS Among 75 studies evaluating AIS surgery using pedicle screw fixation systems, 46 described rod materials and/or diameters. Two studies directly comparing titanium (Ti) and cobalt-chromium (CoCr) rods found that CoCr rods provided significantly better postoperative kyphosis angle correction vs. Ti rods during a shorter follow-up (0-3 months, MD = - 2.98°, 95% CI - 5.79 to - 0.17°, p = 0.04), and longer follow-up (≥ 24 months, MD = - 3.99°, 95% CI - 6.98 to - 1.00, p = 0.009). Surgical infection varied from 2% (95% CI 1.0-3.0%) for 5.5 mm rods to 4% (95% CI 2.0-7.0%) for 6 mm rods. Reoperation rates were lower with 5.5 mm rods 1% (95% CI 0.0-3.0%) vs. 6 mm rods [6% (95% CI 2.0-9.0%); p = 0.04]. Differences in coronal angle, lumbar lordosis, proximal junctional kyphosis, revisions, and infections did not differ significantly (p > 0.05) among rods of different materials or diameters. CONCLUSION For AIS, CoCr rods provided better correction of thoracic kyphosis compared to Ti rods. Patients with 5.5 mm rods had fewer reoperations vs. 6.0 and 6.35 mm diameter rods. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dawn Bowden
- DePuy Synthes Spine, Johnson & Johnson Medical Devices, 325 Paramount Drive, Raynham, MA, 02767, USA.
| | - Annalisa Michielli
- DePuy Synthes Spine, Johnson & Johnson Medical Devices, 325 Paramount Drive, Raynham, MA, 02767, USA
| | - Michelle Merrill
- DePuy Synthes Spine, Johnson & Johnson Medical Devices, 325 Paramount Drive, Raynham, MA, 02767, USA
| | - Steven Will
- DePuy Synthes Spine, Johnson & Johnson Medical Devices, 325 Paramount Drive, Raynham, MA, 02767, USA
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Semi-automatic method for pre-surgery scoliosis classification on X-ray images using Bending Asymmetry Index. Int J Comput Assist Radiol Surg 2022; 17:2239-2251. [PMID: 36085434 DOI: 10.1007/s11548-022-02740-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/12/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Bending Asymmetry Index (BAI) has been proposed to characterize the types of scoliotic curve in three-dimensional ultrasound imaging. Scolioscan has demonstrated its validity and reliability in scoliosis assessment with manual assessment-based X-ray imaging. The objective of this study is to investigate the ultrasound-derived BAI method to X-ray imaging of scoliosis, with supplementary information provided for the pre-surgery planning. METHODS About 30 pre-surgery scoliosis subjects (9 males and 21 females; Cobb: 50.9 ± 19.7°, range 18°-115°) were investigated retrospectively. Each subject underwent three-posture X-ray scanning supine on a plain mattress on the same day. BAI is an indicator to distinguish structural or non-structural curves through the spine flexibility information obtained from lateral bending spinal profiles. BAI was calculated semi-automatically with manual annotation of vertebral centroids and pelvis level inclination adjustment. BAI classification was validated with the scoliotic curve type and traditional Lenke classification using side-bending Cobb angle measurement (S-Cobb). RESULTS 82 curves from 30 pre-surgery scoliosis patients were included. The correlation coefficient was R2 = 0.730 (p < 0.05) between BAI and S-Cobb. In terms of scoliotic curve type classification, all curves were correctly classified; out of 30 subjects, 1 case was confirmed as misclassified when applying to Lenke classification earlier, thus has been adjusted. CONCLUSION BAI method has demonstrated its inter-modality versatility in X-ray imaging application. The curve type classification and the pre-surgery Lenke classification both indicated promising performances upon the exploratory dataset. A fully-automated of BAI measurement is surely an interesting direction to continue our endeavor. Deep learning on the vertebral-level segmentation should be involved in further study.
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Cheung MC, Law D, Yip J, Cheung JPY. Adolescents' Experience during Brace Treatment for Scoliosis: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10585. [PMID: 36078297 PMCID: PMC9517878 DOI: 10.3390/ijerph191710585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to explore the subjective experiences of adolescents with scoliosis during brace treatment in order to understand their obstacles and make recommendations to enhance brace compliance. Using purposive sampling, 15 adolescents (2 males and 13 females) with scoliosis aged from 10 to 16 years old during brace treatment were recruited to participate in semi-structured in-depth interviews. The data were recorded, transcribed, and coded using thematic analysis with the qualitative software NVivo 10. Significant statements and phrases were organized into categories and themes to understand adolescents' experiences during brace treatment for scoliosis. In general, the adolescents acknowledged that compliance with brace treatment was essential to reduce or prevent the progression of spinal curvature and tried their best to comply with the treatment. Regarding their subjective experiences during brace treatment, three themes were identified and emerged as obstacles negatively affecting their brace compliance, including physical discomfort due to brace materials and design, reluctance caused by the brace's visual appearance, and passive patient participation during the treatment process. This study reveals insights into the experiences of adolescents with scoliosis during brace treatment and what they perceive as hindrances to compliance. In order to have better brace compliance, adolescents' feelings and difficulties during brace treatment should be recognized and addressed. Therefore, active patient participation throughout the treatment process, involving the co-design of a customized brace, psychosocial interventions, and personalized appearance style management should be considered and promoted to facilitate a more acceptable bracing experience to achieve better brace compliance.
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Affiliation(s)
- Mei-Chun Cheung
- Department of Social Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Derry Law
- Department of Design, Caritas Institute of Higher Education and Caritas Bianchi College of Careers, Tseung Kwan O, New Territories, Hong Kong SAR, China
| | - Joanne Yip
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Bowden JJ, Bowden SA, Ruess L, Adler BH, Hu H, Krishnamurthy R, Krishnamurthy R. Validation of automated bone age analysis from hand radiographs in a North American pediatric population. Pediatr Radiol 2022; 52:1347-1355. [PMID: 35325266 DOI: 10.1007/s00247-022-05310-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 12/21/2021] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Radiographic bone age assessment by automated software is precise and instantaneous. OBJECTIVE The aim of this study was to evaluate the accuracy of an automated tool for bone age assessment. MATERIALS AND METHODS We compared a total of 586 bone age radiographs from 451 patients, which had been assessed by three radiologists from 2013 to 2018, with bone age analysis by BoneXpert, using the Greulich and Pyle method. We made bone age comparisons in different patient groups based on gender, diagnosis and race, and in a subset with repeated bone age studies. We calculated Spearman correlation (r) and accuracy (root mean square error, or R2). RESULTS Bone age analyses by automated and manual assessments showed a strong correlation (r=0.98; R2=0.96; P<0.0001), with the mean bone age difference of 0.12±0.76 years. Bone age comparisons by the two methods remained strongly correlated (P<0.0001) when stratified by gender, common endocrine conditions including growth disorders and early/precocious puberty, and race. In the longitudinal analysis, we also found a strong correlation between the automated software and manual bone age over time (r=0.7852; R2=0.63; P<0.01). CONCLUSION Automated bone age assessment was found to be reliable and accurate in a large cohort of pediatric patients in a clinical practice setting in North America.
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Affiliation(s)
| | - Sasigarn A Bowden
- Department of Pediatric Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Lynne Ruess
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Brent H Adler
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Houchun Hu
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ramkumar Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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Estandia-Ortega B, Fernández-Hernández L, Alcántara-Ortigoza MA, González-Del Angel A. Proposed clinical approach and imaging studies in families with oculo-auriculo-vertebral spectrum to assess variable expressivity. Am J Med Genet A 2022; 188:1515-1525. [PMID: 35119197 DOI: 10.1002/ajmg.a.62678] [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: 06/28/2021] [Revised: 12/03/2021] [Accepted: 01/03/2022] [Indexed: 11/11/2022]
Abstract
A diagnosis of oculo-auriculo-vertebral spectrum (OAVS) is established when microtia is present in association with hemifacial hypoplasia (HH) and/or ocular, vertebral, and/or renal malformations. There is no consensus on which imaging studies should be used to rule out variable expressivity and distinguish "sporadic" from "familial" patients. This observational and descriptive study was performed in a Mexican population of 51 patients (32 males, 19 females, 0-18 years old) with microtia/OAVS, and their available parents. A clinical history, genealogy, and physical examination were obtained from all included patients, as were a computed tomography (CT) scan of the ear, audiological evaluation, orthopantomography, complete spine radiography, and renal ultrasound. The same approach was completed in their available parents (51 mothers and 40 fathers), excluding the CT scan and audiological evaluation. By genealogy, 53% of patients were classified as "sporadic"; of the "familial" patients, at least 79.1% had suggestion of a multifactorial inheritance. In the available parents, orthopantomography, complete spine X-ray, and renal ultrasound identified the following OAVS-related manifestations: HH (16.2%, n = 14/86), vertebral alterations (10.9%, n = 10/91), and renal anomalies (2.2%, n = 2/90). Our evaluation of the parents allowed three patients to be reclassified from "sporadic" to "familial" (5.8%, n = 3/51). Our proposed clinical and imaging approach allowed the identification of variable expressivity that more clearly distinguished between "sporadic" and "familial" OAVS patients, which is of utmost importance in providing proper genetic counseling to these families.
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Affiliation(s)
- Bernardette Estandia-Ortega
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Avenida Insurgentes Sur 3700-C, Insurgentes Cuicuilco, Ciudad de México, México.,Posgrado en Ciencias Biológicas, Unidad de Posgrado, UNAM, Circuito de los Posgrados S/N, Ciudad Universitaria, Ciudad de México, México
| | - Liliana Fernández-Hernández
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Avenida Insurgentes Sur 3700-C, Insurgentes Cuicuilco, Ciudad de México, México
| | - Miguel Angel Alcántara-Ortigoza
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Avenida Insurgentes Sur 3700-C, Insurgentes Cuicuilco, Ciudad de México, México
| | - Ariadna González-Del Angel
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Avenida Insurgentes Sur 3700-C, Insurgentes Cuicuilco, Ciudad de México, México
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Jin H, Zhang Z, Gao Y, He H, Feng S, Xu R, Li Q, Zuo H. Case series: 3D printed orthopedic brace combined with traditional manipulative physiotherapy to treat new-onset scoliosis in adults. Medicine (Baltimore) 2022; 101:e28429. [PMID: 35029888 PMCID: PMC8735782 DOI: 10.1097/md.0000000000028429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION New-onset scoliosis in adults is different from that in congenital and idiopathic scoliosis. We applied personalized custom 3D printed orthopedic braces combined with traditional manipulative physiotherapy to treat adult patients with new-onset scoliosis and observed the effectiveness of the treatment. PATIENT CONCERNS Nine patients aged 20-52 years presented with unequal height of hips and asymmetrical waist. One shoulder was obviously protruding or enlarged compared to the other; when lying on the bed, the legs were not equal in length, and when bending down, the back was not equal on the left and right. DIAGNOSIS New-onset scoliosis. INTERVENTIONS Application of individual customized 3D printing brace combined with traditional treatment. Evaluation of clinical efficacy after treatment, including functional exercise test (FMS) before and after treatment, ability of daily living (ADL), visual analog pain score (VAS), and scoliosis angle (Cobb angle). OUTCOMES The total effective treatment rate was 100.00% (9/9). The VAS score, Cobb angle of the spine, FMS test, and ADL test were significantly improved compared with those before treatment. CONCLUSION The customized 3D printed orthopedic brace combined with traditional techniques to treat scoliosis and innovatively combined human bionic technology with traditional medicine to achieve the continuity and precise correction of scoliosis treatment is a clinically effective technique.
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Affiliation(s)
- Hui Jin
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, PR China
| | - Ziyu Zhang
- Norman Bethune Health Science Center of Jilin University, Changchun, Jilin, PR China
| | - Yao Gao
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, PR China
| | - Huan He
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, PR China
| | - Shibin Feng
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, PR China
| | - Rui Xu
- Department of Endocrinology, Shanghai National Research Center for Endocrine and Metabolic Disease, State Key Laboratory of Medical Genomics, Shanghai Institute for Endocrine and Meta-bolic Disease, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Qiang Li
- Department of Orthopedics, Jilin Provincial People's Hospital, Changchun, Jilin, PR China
| | - Hao Zuo
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, PR China
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Analysis of postural asymmetry on sagittal plane between right and left side views using photogrammetry. J Bodyw Mov Ther 2022; 29:251-256. [DOI: 10.1016/j.jbmt.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/18/2021] [Accepted: 11/05/2021] [Indexed: 11/20/2022]
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Pietton R, Bouloussa H, Langlais T, Taytard J, Beydon N, Skalli W, Vergari C, Vialle R. Estimating pulmonary function after surgery for adolescent idiopathic scoliosis using biplanar radiographs of the chest with 3D reconstruction. Bone Joint J 2022; 104-B:112-119. [PMID: 34969276 DOI: 10.1302/0301-620x.104b1.bjj-2021-0337.r2] [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] [Indexed: 11/05/2022]
Abstract
AIMS This study addressed two questions: first, does surgical correction of an idiopathic scoliosis increase the volume of the rib cage, and second, is it possible to evaluate the change in lung function after corrective surgery for adolescent idiopathic scoliosis (AIS) using biplanar radiographs of the ribcage with 3D reconstruction? METHODS A total of 45 patients with a thoracic AIS which needed surgical correction and fusion were included in a prospective study. All patients underwent pulmonary function testing (PFT) and low-dose biplanar radiographs both preoperatively and one year after surgery. The following measurements were recorded: forced vital capacity (FVC), slow vital capacity (SVC), and total lung capacity (TLC). Rib cage volume (RCV), maximum rib hump, main thoracic curve Cobb angle (MCCA), medial-lateral and anteroposterior diameter, and T4-T12 kyphosis were calculated from 3D reconstructions of the biplanar radiographs. RESULTS All spinal and thoracic measurements improved significantly after surgery (p < 0.001). RCV increased from 4.9 l (SD 1) preoperatively to 5.3 l (SD 0.9) (p < 0.001) while TLC increased from 4.1 l (SD 0.9) preoperatively to 4.3 l (SD 0.8) (p < 0.001). RCV was correlated with all functional indexes before and after correction of the deformity. Improvement in RCV was weakly correlated with correction of the mean thoracic Cobb angle (p = 0.006). The difference in TLC was significantly correlated with changes in RCV (p = 0.041). It was possible to predict postoperative TLC from the postoperative RCV. CONCLUSION 3D rib cage assessment from biplanar radiographs could be a minimally invasive method of estimating pulmonary function before and after spinal fusion in patients with an AIS. The 3D RCV reflects virtual chest capacity and hence pulmonary function in this group of patients. Cite this article: Bone Joint J 2022;104-B(1):112-119.
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Affiliation(s)
- Raphaël Pietton
- Department of Paediatric Orthopaedics, Sorbonne Université, Paris, France.,Arts et Métiers Paris Tech, Institut de Biomécanique Humaine Georges Charpak/IBHCG, Paris, France
| | - Houssam Bouloussa
- Department of Paediatric Orthopaedics, Sorbonne Université, Paris, France
| | - Tristan Langlais
- Department of Paediatric Orthopaedics, Sorbonne Université, Paris, France
| | - Jessica Taytard
- Department of Pediatric Pulmonology, Sorbonne Université, Armand Trousseau Hospital, Paris, France
| | - Nicole Beydon
- Department of Pulmonary Function Test and Sleep Center, Sorbonne Université, Armand Trousseau Hospital, Paris, France
| | - Wafa Skalli
- Arts et Métiers Paris Tech, Institut de Biomécanique Humaine Georges Charpak/IBHCG, Paris, France
| | - Claudio Vergari
- Arts et Métiers Paris Tech, Institut de Biomécanique Humaine Georges Charpak/IBHCG, Paris, France
| | - Raphaël Vialle
- Department of Paediatric Orthopaedics, Sorbonne Université, Paris, France
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Mulkalwar A, Gantaguru A, Marathe N, Mallepally A. Prognostic factors to predict the progression of adolescent idiopathic scoliosis: A narrative review. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2022. [DOI: 10.4103/jodp.jodp_36_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mehkri Y, Hernandez J, McQuerry JL, Carmona J, Ihnow S. Global Spine Range of Motion in Patients With Adolescent Idiopathic Scoliosis Before and After Corrective Surgery. Cureus 2021; 13:e19362. [PMID: 34909319 PMCID: PMC8653949 DOI: 10.7759/cureus.19362] [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] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/16/2022] Open
Abstract
Given the importance of the spine in carrying out daily movements, adolescent idiopathic scoliosis (AIS) can significantly limit the range of motion (ROM). Severe forms of AIS are treated surgically, most commonly with posterior spinal fusion and instrumentation, which may also reduce spine ROM. This review is the first to describe the literature on total spine ROM in patients with AIS before and after corrective surgery. A systematic literature search was performed using PubMed and Google Scholar to identify articles reporting global spine ROM in AIS patients. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 486 articles were initially identified. Two independent reviewers (YM and JH) assessed eligibility for inclusion. A total of 11 articles fit the inclusion criteria. AIS in untreated patients seems to limit axial and coronal plane ROM based on the degree of curve severity, with more severe curves having less ROM. More research comparing total spine ROM in untreated AIS patients to that of healthy controls is needed. In those undergoing spinal fusions, the lowest instrumented vertebra and surgical approach appear to minimize further reductions in ROM; however, the findings are mixed. Vertebral body tethering (VBT) shows promising preliminary results in treating AIS while preserving motion; however, long-term outcomes have yet to be assessed for this novel procedure. The results of this systematic review suggest that further research is required before treatment strategies can be modified for surgically treating patients with AIS to take into account the effects of treatment on changes in spine mobility.
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Affiliation(s)
- Yusuf Mehkri
- Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Jairo Hernandez
- Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Jessica L McQuerry
- Pediatric Orthopaedics, University of Florida College of Medicine, Gainesville, USA
| | - Johanna Carmona
- Pediatric Orthopaedics, University of Florida College of Medicine, Gainesville, USA
| | - Stephanie Ihnow
- Pediatric Orthopaedics, University of Florida College of Medicine, Gainesville, USA
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Wang W, Jiang N, Teng L, Sui M, Li C, Wang L, Li G. Synergy Analysis of Back Muscle Activities in Patients with Adolescent Idiopathic Scoliosis Based on High-Density Electromyogram. IEEE Trans Biomed Eng 2021; 69:2006-2017. [PMID: 34882541 DOI: 10.1109/tbme.2021.3133583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a common structural spinal deformity and is typically associated with altered muscle properties. However, it is still unclear how muscle activities and the underlying neuromuscular control are changed in the entire scoliotic zone, restricting the corresponding pathology investigation and treatment enhancements. In this study, high-density electromyogram (HD-EMG) was utilized to explore the neuromuscular synergy of back muscle activities. For each of ten AIS patients and ten healthy subjects for comparison, a high-density electrode array was placed on their back from T8 to L4 to record EMG signals when performing five spinal motions (flexion/extension, lateral bending, axial rotation, siting, and standing). From the HD-EMG recordings, muscle synergies were extracted using the non-negative matrix factorization method and the topographical maps of EMG root-mean-square were constructed. For both the AIS and healthy subjects, the experimental results indicated that two muscle synergy groups could explain over 90% of recorded muscle activities for all five motions. During flexion/extension, the patients presented statistically significant higher activations on the convex side in the entire root-mean-square maps and synergy vector maps (p <0.05). During lateral bending and axial rotation, the patients exhibited less activated muscles on the dominant actuating side relative to the contralateral side and their synergy vector maps showed a less homogenous and more diffuse distribution of muscle contraction with statistically different centers of gravity. The findings suggest that a scoliotic spine might adopt an altered modular muscular coordination strategy to actuate different dominant muscles as adapted compensations for the deformation.
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Kim HJ, Yang JH, Chang DG, Suk SI, Suh SW, Nam Y, Kim SI, Song KS. Long-Term Influence of Paraspinal Muscle Quantity in Adolescent Idiopathic Scoliosis Following Deformity Correction by Posterior Approach. J Clin Med 2021; 10:jcm10204790. [PMID: 34682913 PMCID: PMC8538741 DOI: 10.3390/jcm10204790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 01/23/2023] Open
Abstract
Pedicle screw instrumentation (PSI) through posterior approach has been the mainstay of deformity correction for adolescent idiopathic scoliosis (AIS). However, changes in the quantity of paraspinal muscles after AIS surgery has remained largely unknown. The aim of this study was to investigate long-term follow-up changes in paraspinal muscle volume in AIS surgery via a posterior approach. Forty-two AIS patients who underwent deformity correction by posterior approach were analyzed through a longitudinal assessment of a cross-sectional area (CSA) in paraspinal muscles with a minimum five-year follow-up. The CSA were measured using axial computed tomography images at the level of the upper endplate L4 by manual tracing. The last follow-up CSA ratio of the psoas major muscle (124.5%) was significantly increased compared to the preoperative CSA ratio (122.0%) (p < 0.005). The last follow-up CSA ratio of the multifidus and erector spine muscles significantly decreased compared to the preoperative CSA ratio (all p < 0.005). The CSA ratio of the erector spine muscle was correlated with the CSA ratio of the psoas major (correlation coefficient = 0.546, p < 0.001). Therefore, minimizing the injury to the erector spine muscle is imperative to maintaining psoas major muscle development in AIS surgery by posterior approach.
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Affiliation(s)
- Hong Jin Kim
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Korea; (H.J.K.); (S.-I.S.)
| | - Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul 08308, Korea; (J.H.Y.); (S.W.S.); (Y.N.)
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Korea; (H.J.K.); (S.-I.S.)
- Correspondence: ; Tel.: +82-2-950-1284
| | - Se-Il Suk
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Korea; (H.J.K.); (S.-I.S.)
| | - Seung Woo Suh
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul 08308, Korea; (J.H.Y.); (S.W.S.); (Y.N.)
| | - Yunjin Nam
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul 08308, Korea; (J.H.Y.); (S.W.S.); (Y.N.)
| | - Sang-Il Kim
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Kwang-Sup Song
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 06973, Korea;
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Yang D, Lee T, Lai K, Wong Y, Wong L, Yang J, Lam T, Castelein R, Cheng J, Zheng Y. A novel classification method for mild adolescent idiopathic scoliosis using 3D ultrasound imaging. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Yataganbaba A, Gahukamble A, Antoniou G, Freeman BJ, Cundy PJ. Local Bone Grafting Is Sufficient for Instrumented Adolescent Idiopathic Scoliosis Surgery: A Preliminary Study. J Pediatr Orthop 2021; 41:e641-e645. [PMID: 34091560 PMCID: PMC8357034 DOI: 10.1097/bpo.0000000000001865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several options for grafting exist; iliac crest bone grafting, allografts, and bone substitutes. Local bone graft (LBG) offers high-quality bone graft and no commercial cost. The aim of this study was to assess the clinical and radiologic results of adolescent idiopathic scoliosis (AIS) surgery with posterior instrumentation and fusion (PIF) in patients using only LBG and to measure the quantities harvested. METHODS A total of 218 AIS patients who underwent pedicle screw PIF surgery using only LBG with a minimum 1-year follow-up were reviewed. Bone was harvested during surgery from the excised facet joints, spinous processes (not from the end instrumented vertebrae) and decortication of laminae and transverse processes in the operative field. The harvested bone graft weight of 127 patients was recorded prospectively and then computed to graft weight per kilogram body weight (GWPK) and graft weight per motion segment (GWPMS). RESULTS The median follow-up time was 24.7 months (12.1 to 133 mo) with 128 of the 218 patients having over 2 years follow-up. A total of 280 curves were fused. One hundred fifty-six of the patients had single curve instrumentation and 62 had double curve surgery. The median preoperative primary Cobb angle was 57.0 (31 to 100) degrees and postoperatively was 20.0 (0 to 66) degrees, indicating a median correction of 65.3% (17.5% to 100%). The median graft weight was 30 g (14 to 62 g), GWPK was 0.54 g/kg (0.24 to 1.29 g/kg) and GWPMS was 3.3 g/motion segments (2.3 to 10.0 g/kg). Twelve of 218 patients (5.5%) required subsequent surgery. Only 2 patients developed pseudarthrosis (0.91%), noting that modern segmental instrumentation warrants longer follow-up for increased confidence of complete fusion. CONCLUSIONS LBG achieved successful fusion in over 99% of patients undergoing PIF for AIS. The described terms GWPK and GWPMS can be insightful for future studies. LBG offers a safe and low-cost solution for bone grafting in AIS surgery. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Abhay Gahukamble
- Department of Orthopaedic Surgery, Women’s and Children’s Hospital
| | - Georgia Antoniou
- Department of Orthopaedic Surgery, Women’s and Children’s Hospital
| | - Brian J.C. Freeman
- Department of Orthopaedic Surgery, Women’s and Children’s Hospital
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, SA, Australia
| | - Peter J. Cundy
- Department of Orthopaedic Surgery, Women’s and Children’s Hospital
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, SA, Australia
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Idiopathic scoliosis: general characteristics and analysis of etiological theories (literature review). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Idiopathic scoliosis is a severe pathology of the musculoskeletal system that affects children and adolescents all over the world. The disease occurs in approximately 0.2-0.6% of the general population, and is the largest subgroup of spinal curvature in humans (70-90% of all known scoliosis cases). In idiopathic scoliosis, a threedimensional deformation of the vertebral column is formed, leading to the formation of a rib hump, curvature of the ribs and chest, asymmetry of the pelvis and impaired development of internal organs. The main feature of the disease is the spontaneous development of deformity during the growth of the child and the tendency to progress. Scoliosis is not only an orthopedic disease, but also a ignificant cosmetic, and, consequently, a psychological and social problem. The standard of treatment for scoliotic disease remains unchanged for a long time: observation, corset treatment and surgical correction. The prognosis for the development of pathology varies depending on the degree of deformation. The corset-therapy, hospitalization, surgery and treatment of chronic back pain have a negative impact on the psychoemotional state of children and adolescents. Despite significant advances in the methods of diagnosis of deformity, improvement of surgical treatment methods and in the study of pathogenesis, the etiological factor of pathology is still unknown. The search for the causes of idiopathic scoliosis covers almost all aspects of its possible origin: genetic, environmental, hormonal, metabolic, biochemical, neurological, and others. In recent decades, relevant theories of the development of scoliosis have been formulated, but none of the theories reveals the essence of the pathological process and has no clear justification. The greatest number of supporters is the genetic theory: genetic factors play a key role in the occurrence and development of idiopathic scoliosis. Understanding the underlying factors of the disease will enable prevention, early diagnosis, and identification of the risk groups of the patients in question.
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Pierce KE, Krol O, Kummer N, Passfall L, O'Connell B, Maglaras C, Alas H, Brown AE, Bortz C, Diebo BG, Paulino CB, Buckland AJ, Gerling MC, Passias PG. Increased cautiousness in adolescent idiopathic scoliosis patients concordant with syringomyelia fails to improve overall patient outcomes. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:197-201. [PMID: 34194168 PMCID: PMC8214240 DOI: 10.4103/jcvjs.jcvjs_25_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Adolescent idiopathic scoliosis (AIS) is a common cause of spinal deformity in adolescents. AIS can be associated with certain intraspinal anomalies such as syringomyelia (SM). This study assessed the rate o f SM in AIS patients and compared trends in surgical approach and postoperative outcomes in AIS patients with and without SM. Methods: The database was queried using ICD-9 codes for AIS patients from 2003–2012 (737.1–3, 737.39, 737.8, 737.85, and 756.1) and SM (336.0). The patients were separated into two groups: AIS-SM and AIS-N. Groups were compared using t-tests and Chi-squared tests for categorical and discrete variables, respectively. Results: Totally 77,183 AIS patients were included in the study (15.2 years, 64% F): 821 (1.2%) – AIS-SM (13.7 years, 58% F) and 76,362 – AIS-N (15.2 years, 64% F). The incidence of SM increased from 2003–2012 (0.9 to 1.2%, P = 0.036). AIS-SM had higher comorbidity rates (79 vs. 56%, P < 0.001). Comorbidities were assessed between AIS-SM and AIS-N, demonstrating significantly more neurological and pulmonary in AIS-SM patients. 41.2% of the patients were operative, 48% of AIS-SM, compared to 41.6% AIS-N. AIS-SM had fewer surgeries with fusion (anterior or posterior) and interbody device placement. AIS-SM patients had lower invasiveness scores (2.72 vs. 3.02, P = 0.049) and less LOS (5.0 vs. 6.1 days, P = 0.001). AIS-SM patients underwent more routine discharges (92.7 vs. 90.9%). AIS-SM had more nervous system complications, including hemiplegia and paraplegia, brain compression, hydrocephalous and cerebrovascular complications, all P < 0.001. After controlling for respiratory, renal, cardiovascular, and musculoskeletal comorbidities, invasiveness score remained lower for AIS-SM patients (P < 0.001). Conclusions: These results indicate that patients concordant with AIS and SM may be treated more cautiously (lower invasiveness score and less fusions) than those without SM.
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Affiliation(s)
- Katherine E Pierce
- Department of Orthopedics and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Oscar Krol
- Department of Orthopedics and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Nicholas Kummer
- Department of Orthopedics and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Lara Passfall
- Department of Orthopedics and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Brooke O'Connell
- Department of Orthopedics and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Constance Maglaras
- Department of Orthopedics and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Haddy Alas
- Department of Orthopedics and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Avery E Brown
- Department of Orthopedics and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Cole Bortz
- Department of Orthopedics and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate, New York, NY, USA
| | - Carl B Paulino
- Department of Orthopaedic Surgery, SUNY Downstate, New York, NY, USA
| | - Aaron J Buckland
- Department of Orthopedics and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Michael C Gerling
- Department of Orthopedics and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Peter G Passias
- Department of Orthopedics and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Zhu F, Hong Q, Guo X, Wang D, Chen J, Zhu Q, Zhang C, Chen W, Zhang M. A comparison of foot posture and walking performance in patients with mild, moderate, and severe adolescent idiopathic scoliosis. PLoS One 2021; 16:e0251592. [PMID: 33999943 PMCID: PMC8128255 DOI: 10.1371/journal.pone.0251592] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. However, the underlying mechanisms linking spinal curvature in AIS to foot characteristics and walking performance remain unclear. Objective This study aimed to compare walking performance between adolescents with mild, moderate, and severe scoliosis and matched healthy peers with foot posture as covariates. Methods This cross-sectional study of 96 adolescents was conducted between April 2020 to October 2020 in China, with 32 healthy peers in the control group and 64 patients in the AIS group. Foot posture and morphology, plantar pressure distribution, and gait characteristics were analyzed. One-way analysis of variance with Bonferroni correction and a post hoc comparison of the mean differences between the different groups was performed. Multiple analyses of covariance adjusted for age, sex, body mass index, foot posture index (FPI), arch index (AI), and walking speed were performed. Results Of the 64 adolescents with scoliosis, 18 had mild AIS, 32 had moderate AIS, and 14 had severe AIS. The AI and FPI were much higher in the moderate and severe AIS groups (p = 0.018) and the severe AIS group (p<0.001), respectively, than in the control group. The severe AIS group had advanced and longer midstance (p = 0.014) and delayed propulsion phase (p = 0.013) than the control group. Patients with moderate and severe AIS had asymmetrical gait periods in the left and right limbs (p<0.05). Significant differences in the center-of-pressure excursion index (CPEI) were found between the moderate and severe AIS and control groups (p = 0.003). Conclusion Moderate and severe AIS significantly influenced walking performance; however, no significant differences were observed between adolescents with mild AIS and healthy controls. Thus, early intervention could target the prevention of specific functional deficits and prevent it from progressing to a severe state.
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Affiliation(s)
- Feilong Zhu
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Qianqin Hong
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Xiaoqi Guo
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Dan Wang
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Jie Chen
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Qian Zhu
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Chong Zhang
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Wei Chen
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- * E-mail: (WC); (MZ)
| | - Ming Zhang
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- * E-mail: (WC); (MZ)
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Lai KKL, Lee TTY, Lee MKS, Hui JCH, Zheng YP. Validation of Scolioscan Air-Portable Radiation-Free Three-Dimensional Ultrasound Imaging Assessment System for Scoliosis. SENSORS (BASEL, SWITZERLAND) 2021; 21:2858. [PMID: 33921592 PMCID: PMC8073843 DOI: 10.3390/s21082858] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/03/2022]
Abstract
To diagnose scoliosis, the standing radiograph with Cobb's method is the gold standard for clinical practice. Recently, three-dimensional (3D) ultrasound imaging, which is radiation-free and inexpensive, has been demonstrated to be reliable for the assessment of scoliosis and validated by several groups. A portable 3D ultrasound system for scoliosis assessment is very much demanded, as it can further extend its potential applications for scoliosis screening, diagnosis, monitoring, treatment outcome measurement, and progress prediction. The aim of this study was to investigate the reliability of a newly developed portable 3D ultrasound imaging system, Scolioscan Air, for scoliosis assessment using coronal images it generated. The system was comprised of a handheld probe and tablet PC linking with a USB cable, and the probe further included a palm-sized ultrasound module together with a low-profile optical spatial sensor. A plastic phantom with three different angle structures built-in was used to evaluate the accuracy of measurement by positioning in 10 different orientations. Then, 19 volunteers with scoliosis (13F and 6M; Age: 13.6 ± 3.2 years) with different severity of scoliosis were assessed. Each subject underwent scanning by a commercially available 3D ultrasound imaging system, Scolioscan, and the portable 3D ultrasound imaging system, with the same posture on the same date. The spinal process angles (SPA) were measured in the coronal images formed by both systems and compared with each other. The angle phantom measurement showed the measured angles well agreed with the designed values, 59.7 ± 2.9 vs. 60 degrees, 40.8 ± 1.9 vs. 40 degrees, and 20.9 ± 2.1 vs. 20 degrees. For the subject tests, results demonstrated that there was a very good agreement between the angles obtained by the two systems, with a strong correlation (R2 = 0.78) for the 29 curves measured. The absolute difference between the two data sets was 2.9 ± 1.8 degrees. In addition, there was a small mean difference of 1.2 degrees, and the differences were symmetrically distributed around the mean difference according to the Bland-Altman test. Scolioscan Air was sufficiently comparable to Scolioscan in scoliosis assessment, overcoming the space limitation of Scolioscan and thus providing wider applications. Further studies involving a larger number of subjects are worthwhile to demonstrate its potential clinical values for the management of scoliosis.
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Affiliation(s)
| | | | | | | | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong; (K.K.-L.L.); (T.T.-Y.L.); (M.K.-S.L.); (J.C.-H.H.)
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Labrom FR, Izatt MT, Claus AP, Little JP. Adolescent idiopathic scoliosis 3D vertebral morphology, progression and nomenclature: a current concepts review. 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; 30:1823-1834. [PMID: 33866395 DOI: 10.1007/s00586-021-06842-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/11/2021] [Accepted: 04/08/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE There has been a recent shift toward the analysis of the pathoanatomical variation of the adolescent idiopathic scoliosis (AIS) spine with the three dimensions, and research of level-wise vertebral body morphology in single anatomical planes is now replete within the field. In addition to providing a precise description of the osseous structures that are the focus of instrumented surgical interventions, understanding the anatomical variation between vertebral bodies will elucidate possible pathoaetiological mechanisms of the onset of scoliotic deformity. METHODS This review aimed to discuss the current landscape of AIS segmental vertebral morphology research and provide a comprehensive report of the typical patterns observed at the individual vertebral level. RESULTS We have detailed how these vertebrae are typically characterised by lateral wedging to the convexity, have a marked degree of anterior overgrowth, are rotated towards the convexity, have inherent gyratory mechanical torsion created within them and are associated with pedicles on the concave side being narrower, longer and more laterally angled. For the most part, these findings are most pronounced at and around the apex of a scoliotic curve, with these deformations reducing towards junctional vertebrae. We have also summarised a nomenclature defined by the Scoliosis Research Society, highlighting the need for more consistent reporting of these level-wise dimensional anatomical changes. CONCLUSION Finally, we emphasised how a marked degree of heterogeneity exists between the included investigations, namely in scoliotic curve-type inclusion, imaging modality and timepoint of analysis within scoliosis' longitudinal development, and how improvement in these study design characteristics will enhance ongoing research.
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Affiliation(s)
- Fraser R Labrom
- Biomechanics and Spine Research Group, Level 5, Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham St, South Brisbane, QLD, 4101, Australia. .,Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia.
| | - Maree T Izatt
- Biomechanics and Spine Research Group, Level 5, Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham St, South Brisbane, QLD, 4101, Australia
| | - Andrew P Claus
- Tess Cramond Pain and Research Centre, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia
| | - J Paige Little
- Biomechanics and Spine Research Group, Level 5, Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham St, South Brisbane, QLD, 4101, Australia
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Karaali E, Çiloğlu O, Görgülü FF, Ekiz T. Ultrasonographic measurement of diaphragm thickness in patients with severe thoracic scoliosis. J Ultrasound 2021; 24:75-79. [PMID: 33550575 DOI: 10.1007/s40477-020-00536-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: 08/19/2020] [Accepted: 10/21/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE This study aimed to measure diaphragm thickness using ultrasound in adult patients with severe idiopathic scoliosis. METHODS This prospective case-control study included patients with severe idiopathic scoliosis and a healthy control group. The control and patient groups' demographic features, pulmonary function tests, diaphragm thickness, and thickening fraction measured using ultrasonography were compared. RESULTS End-expirium values were similar between the two groups (p = 0.902). However, end of inspirium, change level, and diaphragm thickening fraction were significantly lower in the scoliosis group (p < 0.001 for all). Cobb degree values were inversely correlated with forced expiratory volume in 1 s (%) (r = - 0.909, p < 0.001), forced vital capacity (%) (r = - 0.887, p < 0.001), and end-inspirium thickness (r = - 0.673 and p < 0.001) values. Furthermore, diaphragm thickness at the end of inspirium was positively correlated with forced expiratory volume in 1 s (%) (r = 0.636, p = 0.001) and forced vital capacity (%) (r = 0.646, p = 0.001) values. No significant correlation was found between diaphragm thickening fraction and forced expiratory volume in 1 s or forced vital capacity. CONCLUSION Ultrasound can provide valuable information about diaphragm morphology and quantify diaphragm contraction.
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Affiliation(s)
- Evren Karaali
- Department of Orthopedics and Traumatology, University of Health Science Adana City Training and Research Hospital, Mithat Özhan Bulvarı Kışla Mah. No: 1 Yüreği, Adana, Turkey.
| | - Osman Çiloğlu
- Department of Orthopedics and Traumatology, University of Health Science Adana City Training and Research Hospital, Mithat Özhan Bulvarı Kışla Mah. No: 1 Yüreği, Adana, Turkey
| | - Feride Fatma Görgülü
- Department of Radiology, University of Health Science Adana City Training and Research Hospital, Adana, Turkey
| | - Timur Ekiz
- Department of Physical Medicine and Rehabilitation, Türkmenbaşı Medical Center, Adana, Turkey
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Elsamadicy AA, Freedman IG, Koo AB, David WB, Havlik J, Kundishora AJ, Sciubba DM, Kahle KT, DiLuna M. The Effects of Pulmonary Risk Factors on Hospital Resource Use After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Correction. World Neurosurg 2021; 149:e737-e747. [PMID: 33548534 DOI: 10.1016/j.wneu.2021.01.109] [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: 12/07/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine the impact of preoperative pulmonary risk factors (PRFS) on surgical outcomes after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). METHODS A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database from 2016 to 2018. All pediatric patients with AIS undergoing PSF were identified. Patients were then categorized by whether they had recorded baseline PRF or no-PRF. Patient demographics, comorbidities, intraoperative variables, complications, length of stay, discharge disposition, and readmission rate were assessed. RESULTS A total of 4929 patients were identified, of whom 280 (5.7%) had baseline PRF. Compared with the no-PRF cohort, the PRF cohort had higher rates of complications (PRF, 4.3% vs. no-PRF, 2.2%; P = 0.03) and longer hospital stays (PRF, 4.6 ± 4.3 days vs. no-PRF, 3.8 ± 2.3 days; P < 0.001), yet, discharge disposition was similar between cohorts (P = 0.70). Rates of 30-day unplanned readmission were significantly higher in the PRF cohort (PRF, 6.3% vs. no-PRF, 2.7%; P = 0.009), yet, days to readmission (P = 0.76) and rates of 30-day reoperation (P = 0.16) were similar between cohorts. On multivariate analysis, PRF was found to be a significant independent risk factor for longer hospital stays (risk ratio, 0.74; 95% confidence interval, 0.44-1.04; P < 0.001) but not postoperative complication or 30-day unplanned readmission. CONCLUSIONS Our study showed that PRF may be a risk factor for slightly longer hospital stays without higher rates of complication or unplanned readmission for patients with AIS undergoing PSF and thus should not preclude surgical management.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Isaac G Freedman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Wyatt B David
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John Havlik
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adam J Kundishora
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kristopher T Kahle
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
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Elsamadicy AA, Freedman IG, Koo AB, David WB, Havlik J, Kundishora AJ, Hong CS, Sciubba DM, Kahle KT, DiLuna M. Impact of Preoperative Anemia on Outcomes After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. World Neurosurg 2020; 146:e214-e224. [PMID: 33091648 DOI: 10.1016/j.wneu.2020.10.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the relationship of preoperative anemia and outcomes after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). METHODS A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database from 2016 to 2018. All pediatric patients (age 10-18 years) with AIS undergoing PSF were identified. Two cohorts were categorized into anemic and nonanemic cohorts based on age-based and sex-based criteria for anemia. Thirty-day outcomes and readmission rates were evaluated. RESULTS A total of 4929 patients were identified, of whom 592 (12.0%) were found to have preoperative anemia. The anemic cohort had a greater prevalence of comorbidities and longer operative times. Compared with the nonanemic cohort, the anemic cohort experienced significantly higher rates of perioperative bleed/transfusion (nonanemic, 67.4% vs. anemic, 73.5%; P = 0.004) and required a greater total amount of blood transfused (nonanemic, 283.2 ± 265.5 mL vs. anemic, 386.7 ± 342.6 mL; P < 0.001). The anemic cohort experienced significantly longer hospital stays (nonanemic, 3.8 ± 2.2 days vs. anemic, 4.2 ± 3.9 days; P = 0.001), yet discharge disposition (P = 0.58), 30-day complication rates (P = 0.79) and unplanned reoperation rates (P = 0.90) were similar between cohorts. On multivariate analysis, anemia was found to be an independent predictor of perioperative bleed/transfusion (odds ratio, 1.36; 95% confidence interval, 1.12-1.66; P = 0.002) as well as a longer length of hospital stay (relative risk, 0.46; 95% confidence interval, 0.25-0.67; P < 0.001) but was not an independent predictor for postoperative complications (P = 0.85). CONCLUSIONS Our study suggests that preoperative anemia may be a risk factor for a greater perioperative bleed/transfusion event and slightly longer length of stay; however, it was not associated with greater 30-day complication and readmission rates in patients with AIS undergoing PSF.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Isaac G Freedman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Wyatt B David
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John Havlik
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adam J Kundishora
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christopher S Hong
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kristopher T Kahle
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
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Pu Chu EC, Chakkaravarthy DM, Huang KHK, Ho VWK, Lo FS, Bhaumik A. Changes in radiographic parameters following chiropractic treatment in 10 patients with adolescent idiopathic scoliosis: A retrospective chart review. Clin Pract 2020; 10:1258. [PMID: 32952984 PMCID: PMC7482186 DOI: 10.4081/cp.2020.1258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/24/2020] [Indexed: 12/25/2022] Open
Abstract
This retrospective chart review was undertaken to investigate the role of chiropractic intervention for patients with adolescent idiopathic scoliosis (AIS). Ten cases of patients with AIS, mean age 13.3 years, undergoing chiropractic adjustment were retrospectively evaluated. Chart review was performed to extract age, medical history and treatment intervention. The magnitude of scoliosis was quantified using the Cobb method on standing radiographs. A comparison of the measurements from pre- and post-treatment radiographs revealed that Cobb angle reduced from average 29.7° down to average 23.4° (average 21.2% correction). Improvements in spinal morphologies were observed in most curves (64%, n=9/14) and curve stabilization in the rest (36%, n=5/14). A better correction was obtained in cases of mild and moderate AIS. In terms of stabilizing progression (≤5o curve progression) or correcting curvatures (≥6° reduction), radiological changes were observed in all patients.
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Affiliation(s)
- Eric Chun Pu Chu
- New York Chiropractic and Physiotherapy Centre, Mongkok, Hong Kong, China
| | | | | | - Vicky Wei Kye Ho
- New York Chiropractic and Physiotherapy Centre, Mongkok, Hong Kong, China
| | - Fa-Sain Lo
- New York Chiropractic and Physiotherapy Centre, Mongkok, Hong Kong, China
| | - Amiya Bhaumik
- Lincoln University College, Jalan Kota Bharu-Pengkalan Kubor, Kota Bharu, Kelantan, Malaysia
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A novel scoliosis instrumentation using special superelastic nickel-titanium shape memory rods: a biomechanical analysis using a calibrated computer model and data from a clinical trial. Spine Deform 2020; 8:369-379. [PMID: 32096138 DOI: 10.1007/s43390-020-00075-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/01/2019] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Biomechanical analysis of scoliosis instrumentation using superelastic Nickel-titanium shape memory (SNT) rods. OBJECTIVE To compare SNT with conventional Titanium (Ti) and Cobalt-chrome (Co-Cr) rods. A clinical trial has documented comparable efficacy between two adolescent idiopathic scoliosis (AIS) cohorts instrumented using SNT versus conventional Ti rods. The shape memory and superelasticity of the SNT rod are thought to allow easy rod insertion, progressive curve correction, and correction from spinal tissue relaxation, but study is yet to be done to assess the effects of the shape memory and superelasticity. METHODS Instrumentations of AIS patients from the clinical trial were computationally simulated using SNT, Ti and Co-Cr rods (5.5 or 6 mm; 30°, 50° or 60° sagittal contouring angles; 0°, 25° or 50° coronal over-contouring angles). Curve correction, its improvement from stress relaxation in the spine, and loads in the instrumentation constructs were computed and compared. RESULTS The simulated main thoracic Cobb angles (MT) and thoracic kyphosis with the SNT rods were 4°-7° higher and 1°-2° lower than the Ti and Co-Cr rods, respectively. Bone-implant forces with Ti and Co-Cr rods were higher than the SNT rods by 84% and 130% at 18 °C and 35% and 65% at 37 °C, respectively (p < 0.001). Further corrections of the MT from the simulated stress relaxation in the spine were 4°-8° with the SNT rods versus 2°-5° with the Ti and Co-Cr rods (p < 0.001). CONCLUSION This study concurs with clinical observation that the SNT rods are easier to insert and can result in similar correction to the conventional rods. The SNT rods allow significantly lower bone-implant forces and have the ability to take advantage of post-instrumentation correction as the tissues relax.
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Skuplik I, Cobb J. Animal Models for Understanding Human Skeletal Defects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1236:157-188. [DOI: 10.1007/978-981-15-2389-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bozkurt S, Kayalar G, Tezel N, Güler T, Kesikburun B, Denizli M, Tan S, Yilmaz H. Hypermobility Frequency in School Children: Relationship With Idiopathic Scoliosis, Age, Sex and Musculoskeletal Problems. Arch Rheumatol 2019; 34:268-273. [PMID: 31598591 PMCID: PMC6768787 DOI: 10.5606/archrheumatol.2019.7181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/29/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to assess the prevalence of generalized joint hypermobility (GJH) in school children in relation to scoliosis and to identify musculoskeletal problems. Patients and methods This cross-sectional study included 822 school children (413 males, 409 females; mean age 12.2±1.3 years; range, 10 and 15 years). Demographic characteristics of all children were recorded. The presence of GJH was assessed by the Beighton score (≥4 was considered joint hypermobility). Scoliosis screening consisted of forward bend test (FBT) and measurement of angle of trunk rotation (ATR). Positive FBT or ATR ≥5° was referred to a portable X-ray device. The presence of musculoskeletal complaints was determined by a questionnaire. Results Children's Body Mass Index (BMI) was 19.6±4.1. GJH was diagnosed in 151 subjects (18.4%). No significant association was detected between sex and hypermobility. Joint hypermobility was inversely correlated with age and BMI. Scoliosis was found in 43 subjects (5.2%) and all of them except one girl had mild scoliosis. The most common scoliosis pattern was a single left thoracolumbar curve. Seventy-three subjects (8.9%) had Cobb angle under 10°, with a potential for progression. Among subjects having GJH, the most common clinical finding was pes planus (34.3%) and the most common clinical symptom was ankle sprain (31.3%). Conclusion Similar to that found in children from many countries, GJH is a common clinical condition in Turkish children. GJH should be assessed in the differential diagnosis of adolescents with musculoskeletal complaints for effective treatment and reducing morbidity. GJH should be considered in adolescents with scoliosis, which may be an important aspect in treatment.
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Affiliation(s)
- Sinem Bozkurt
- Department of Physical Medicine and Rehabilitation, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Gülseren Kayalar
- Department of Physical Medicine and Rehabilitation, Ankara Memorial Hospital, Ankara, Turkey
| | - Nihal Tezel
- Department of Physical Medicine and Rehabilitation, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Tuba Güler
- Department of Physical Medicine and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Bilge Kesikburun
- Department of Physical Medicine and Rehabilitation, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Merve Denizli
- Department of Physical Medicine and Rehabilitation, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sefa Tan
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hürriyet Yilmaz
- Department of Physical Medicine and Rehabilitation, Haliç University, High School of Health Science, İstanbul, Turkey
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Kim W, Porrino JA, Hood KA, Chadaz TS, Klauser AS, Taljanovic MS. Clinical Evaluation, Imaging, and Management of Adolescent Idiopathic and Adult Degenerative Scoliosis. Curr Probl Diagn Radiol 2019; 48:402-414. [DOI: 10.1067/j.cpradiol.2018.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 12/19/2022]
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Ferràs-Tarragó J, Valencia JMM, Belmar PR, Vergara SP, Gómez PJ, Hermida JLB, Hermida PB, Hermida TB. Cobb angle measurement with a conventional convex echography probe and a smartphone. 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 2019; 28:1955-1961. [PMID: 31201564 DOI: 10.1007/s00586-019-06030-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/05/2019] [Accepted: 06/10/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND CONTEXT Serial X-rays are needed during the follow-up of adolescent idiopathic scoliosis. They are done every 6 or 3 months in cases of high risk of progression. Thanks to the advances in ultrasound techniques, deformity measurement systems free from ionizing radiations have been validated, although spinal surgeons did not use them routinely due to the need of special software. OBJECTIVE The aim of our work is to assess the reproducibility and correlation of an ultrasound measuring system based on the positioning of the transverse processes. STUDY DESIGN Prospective, single center, randomized, triple blinded. METHODS Two independent researchers trained in ultrasound examined the spinal deformities of 31 children. The measurements were compared against those performed with an X-ray by three scoliosis expert surgeons. Statistics were performed by an independent researcher. Parametric methods were used. RESULTS We found a 95% [(0.91-0.97) p < 2.2e-16] correlation between the degree of scoliosis measured with the proposed ultrasound system and the 30 cm × 90 cm X-rays in standing position. There was an intra-observer reliability of 97% [r-squared = 0.97; CI 95% (0.95-0.98) p < 2.2e-16] and an inter-observer reliability of 95% [r-squared = 0.95; CI 95% (0.90-0.97) p < 2.2e-16]. CONCLUSIONS An approximation of the Cobb angle measure is possible with ultrasound by using the transverse processes as reference. This is a very rapid and simple system for assessing the principal spinal deformity measure in young people, although it does not allow estimating the associated axial or sagittal rotation. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Joan Ferràs-Tarragó
- La Fe Hospital, Valencia, Spain.
- , Jorge Juan Street, 14 Bis, 4th, 7th, Castellón de la Plana, Spain.
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Immediate postoperative coronal imbalance in Lenke 5 and Lenke 6 adolescent idiopathic scoliosis: Is it predictable? 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 2019; 28:2042-2052. [DOI: 10.1007/s00586-019-06019-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/10/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
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