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Chopra S, Larson AN, Milbrandt TA, Kaufman KR. Outcome of bracing vs. surgical treatment in adolescents with idiopathic scoliosis based on device measured daily physical activity: a prospective pilot study. J Pediatr Orthop B 2023; 32:517-523. [PMID: 36445379 DOI: 10.1097/bpb.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) can be treated with bracing or surgery, which may affect patient's physical activity (PA). However, there are limited objective assessments of PA in patients with AIS. This study aims to compare the outcome of spinal bracing vs. surgery in patients with AIS based on a device that measured daily PA. In total 24 patients with AIS participated, including 12 patients treated with bracing and 12 with spinal surgery. Daily PA was measured throughout 4 consecutive days using four tri-axial accelerometers and patient-reported functional status was reported using the SRS-22 questionnaire. The participants were assessed both before the treatment and after treatment at a 12-month follow-up. Patients with AIS had no significant change in their PA levels at the 12-month follow-up after surgical correction. On the contrary, patients with AIS following a year-long bracing treatment had significantly reduced time spent active ( P = 0.04) with an average reduction in walking steps by 2137 steps/day ( P = 0.005). There was no significant difference in function, pain, self-image and mental health domains following both treatments, as reported by the SRS-22. There was a significant improvement in satisfaction for both treatment groups ( P ≤ 0.02). Significantly reduced PA and increased sedentary time are reported in patients with AIS following bracing treatment. An objective PA assessment is recommended to track the effect of scoliosis treatment on PA. Patients with AIS should be actively encouraged to achieve and maintain their recommended daily PA levels irrespective of the type of treatment. Level of evidence: Level II.
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Affiliation(s)
- Swati Chopra
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Golden Jubilee National Hospital, Clydebank, Scotland
| | - A Noelle Larson
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, USA
| | - Todd A Milbrandt
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, USA
| | - Kenton R Kaufman
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, USA
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Navarrete-Zampaña MD, Fernández-Baillo N, Pizones J, Sánchez-Márquez JM, Sellán-Soto MC. The post-surgical transition in adolescents who have idiopathic scoliosis. A qualitative study. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:361-369. [PMID: 37478906 DOI: 10.1016/j.enfcle.2023.07.004] [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: 02/08/2023] [Accepted: 06/06/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To know the process experienced by adolescents suffering from idiopathic scoliosis when undergoing surgery to correct the physical deformity. METHOD Qualitative study with a symbolic interactionism approach. 22 semi-structured interviews were conducted with adolescents who underwent posterior spinal fusion in a third-level hospital in Madrid between May 2019 and January 2021. Taylor and Bogdan's analysis in progress was carried out. RESULTS Patients with adolescent idiopathic scoliosis present with a complex simultaneous health/illness and developmental transition. The main inhibitory conditions of the transition are the meanings about: their identity, social, beliefs about surgery, ignorance about the pathology, the surgical process, and their recovery. As facilitating conditions, we find: a positive attitude towards physical, aesthetic, and social change, socioeconomic level, and family support. CONCLUSIONS The informants of this study refer that aesthetic affectation and physical limitations are the main elements that cause them discomfort. Surgical intervention is presented as the solution to this situation. Recovery is a critical point in the transition process mainly due to pain. They accept the discomfort suffered during the recovery because they hope to obtain an improvement in the image and physical limitations. The changes and differences they experience during the transition make them think that they will be able to lead a «normal life» to which they constantly refer in their speeches.
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Affiliation(s)
| | | | - Javier Pizones
- Unidad de Columna, Hospital Universitario La Paz, Madrid, Spain
| | | | - María Carmen Sellán-Soto
- Red ENSI-España, Madrid, Spain; Departamento de Enfermería, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; IdiPAZ, Madrid, Spain
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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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Early Adherence to Prescribed Brace Wear for Adolescent Idiopathic Scoliosis Is Associated With Future Brace Wear. Spine (Phila Pa 1976) 2023; 48:8-14. [PMID: 35917288 DOI: 10.1097/brs.0000000000004446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To assess if initial adherence to prescribed brace wear for adolescent idiopathic scoliosis (AIS) predicts future adherence and curve improvement. SUMMARY OF BACKGROUND DATA AIS bracing can be effective if patients adhere to prescribed brace wear. Previous research has associated age, sex, and brace prescription length with future adherence. We hypothesize that a patient's initial adherence to brace wear may be associated with future adherence and outcomes. MATERIALS AND METHODS Consecutive AIS patients who met the Scoliosis Research Society (SRS) criteria for bracing from 2015 to 2019 at a single center were reviewed. Patients were stratified into groups based on their adherence during the initial one-month brace wean-in period-adherent patients were defined as wearing the brace >80% of the daily prescribed amount. Brace wear was recorded by a thermosensor and assessed during the wean-in period, six-, 12-, and 24-month postbracing appointments. Statistical testing was conducted to analyze if initial adherence was associated with future adherence, curve change, and bracing success -defined as reaching Risser stage 4 with a Cobb angle <40°. RESULTS Sixty patients (mean age=12.5 yr) were included, of which the majority were females (83%) with thoracic curves (70%). Thirty-two patients were considered adherent, and this cohort demonstrated improved adherence relative to the nonadherent group at the six-, 12-, and 24-month appointments ( P <0.001). Adherent patients also showed a significant reduction in their scoliosis at the 12-month appointment, unlike nonadherent patients ( P <0.001). Ninety-seven percent of adherent patients achieved bracing success compared with 71% of nonadherent ( P =0.016). Females were more likely to be adherent than males. CONCLUSIONS Initial adherence to prescribed AIS brace wear was associated with future adherence, bracing success, and curve improvement. Early recognition of nonadherence may offer an opportunity for supportive intervention to improve brace wear behavior.
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The preliminary outcomes of vertebral body tethering in treating adolescent idiopathic scoliosis: a systematic review. Spine Deform 2022; 10:1233-1243. [PMID: 35841473 DOI: 10.1007/s43390-022-00546-0] [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: 03/10/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE VBT is a novel alternative to spinal fusion surgery to treat skeletally immature AIS and was approved to correct idiopathic scoliosis in August 2019 by US Federal Drug Administration (FDA). To systemically review the preliminary outcomes of vertebral body tethering (VBT) in treating adolescent idiopathic scoliosis. METHODS The electronic databases PubMed, EMBASE, and Web of Science were queried up to January 2022 for articles regarding VBT. Basic characteristics of patients, changes of radiographic parameters in coronal and sagittal planes, and clinical outcomes of surgical treatment of VBT including complication and revision rates were summarized. RESULTS Twenty five studies met the inclusion criteria. Most studies (23/25) included patients with only skeletal immaturity. The average % correction of the main/tethered curve at final follow-up, and % correction of thoracic kyphosis at final follow-up were reported to be 15.6-106.5% and - 31.8 to 20.0%, respectively. The most common complications for VBT were tether breakage (n = 145;21.3%), pulmonary complications (n = 49; 6.9%), and overcorrection (n = 30; 4.2%). The revision rate was 13.1%. CONCLUSION VBT could effectively and safely correct spinal deformity in skeletally immature patients with AIS and preserve the motion and growth of the spine. However, VBT has a relatively high complication and revision rates. Therefore, surgeons should cautiously consider VBT for treating AIS. Future research efforts are needed to lower the complication and revision rates. Whatever, VBT is still in its infancy and may have a promising future as a non-fusion solution for AIS.
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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: 12] [Impact Index Per Article: 4.0] [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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Gomez JA, Ge D. 50 Years Ago in TheJournalofPediatrics: How the Milwaukee Brace Shaped the Treatment of Scoliosis. J Pediatr 2021; 232:191. [PMID: 33896454 DOI: 10.1016/j.jpeds.2021.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jaime A Gomez
- Departments of Orthopedic Surgery and Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - David Ge
- Departments of Orthopedic Surgery and Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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Catanzano AA, Esposito VR, Dial BL, Wu CJ, Hinton ZW, Risoli TJ, Green CL, Fitch RD, Lark RK. Staying ahead of the curve: the use of spinopelvic parameters to predict curve progression and bracing success in adolescent idiopathic scoliosis. Spine Deform 2020; 8:1213-1222. [PMID: 32696447 DOI: 10.1007/s43390-020-00159-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/08/2020] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To investigate radiographic sagittal and spinopelvic parameters of patients with adolescent idiopathic scoliosis (AIS) treated with bracing and assess differences among those treated successfully and unsuccessfully. AIS is a three-dimensional deformity of the spine, sharing an intricate relationship with pelvic morphology. However, the most relevant predictors of curve progression have historically been coronal parameters and skeletal maturity. Sagittal and spinopelvic parameters have not been thoroughly investigated as predictors of curve progression and brace treatment success. METHODS Retrospective review of AIS patients who underwent brace treatment. Coronal Cobb angles (CC), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), lumbar lordosis (LL), and thoracic spinopelvic angles (T1SP, T9SP) were measured prior to initiation of bracing. The sagittal and spinopelvic parameters of patients requiring surgical treatment due to curve progression were compared to those treated successfully with bracing. RESULTS No significant differences were found for age, race, gender, Risser category (0/1 vs 2/3), initial CC, TK, LL, T1SP, or T9SP between cohorts. The cohort requiring surgery had significantly lower PI (p < 0.001, 42.0 v. 54.6), SS (p < 0.001, 37.0 v. 44.5), and PT (p = 0.003, 5.0 v. 10.2) compared to those successfully treated with bracing. Multivariable models controlling for Risser stage and Initial CC revealed the odds for successful brace treatment increases with an increase in PI (OR = 1.47, CI 1.18-1.83, p < 0.001), SS (OR = 1.26, CI 1.07-1.48, p = 0.006), and PT (OR = 1.43, CI 1.09-1.86, p = 0.006) (Table 3). The odds of successful brace treatment is given per one-unit increase for each radiographic measure after adjusting for Initial CC and Risser sign which were forced into each multivariable model. CONCLUSIONS Spinopelvic parameters may indicate potential spine adaptability and skeletal maturity. For these reasons, we proposed that spinopelvic parameters may be a potential predictor of curve progression and brace treatment success. Our results demonstrated a higher risk of curve progression with lower PI, PT, or SS which support this hypothesis, however, given the small sample size and high variability, the magnitude of this effect should be viewed with caution and should serve as an impetus to further, larger scale studies to investigate the value spinopelvic parameters in curve progression and bracing efficacy. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anthony A Catanzano
- Department of Orthopaedic Surgery, Duke University Health System, DUMC Box 3000, Durham, 27710, NC, USA.
| | | | - Brian L Dial
- Department of Orthopaedic Surgery, Duke University Health System, DUMC Box 3000, Durham, 27710, NC, USA
| | | | | | - Thomas J Risoli
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, USA
| | - Robert D Fitch
- Department of Orthopaedic Surgery, Duke University Health System, DUMC Box 3000, Durham, 27710, NC, USA
| | - Robert K Lark
- Department of Orthopaedic Surgery, Duke University Health System, DUMC Box 3000, Durham, 27710, NC, USA
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Establishing consensus on the best practice guidelines for the use of bracing in adolescent idiopathic scoliosis. Spine Deform 2020; 8:597-604. [PMID: 32026441 DOI: 10.1007/s43390-020-00060-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Survey. OBJECTIVES Bracing is the mainstay of conservative treatment in Adolescent Idiopathic Scoliosis (AIS). The purpose of this study was to establish best practice guidelines (BPG) among a multidisciplinary group of international bracing experts including surgeons, physiatrists, physical therapists, and orthotists utilizing formal consensus building techniques. Currently, there is significant variability in the practice of brace treatment for AIS and, therefore, there is a strong need to develop BPG for bracing in AIS. METHODS We utilized the Delphi process and the nominal group technique to establish consensus among a multidisciplinary group of bracing experts. Our previous work identified areas of variability in brace treatment that we targeted for consensus. Following a review of the literature, three iterative surveys were administered. Topics included bracing goals, indications for starting and discontinuing bracing, brace types, brace prescription, radiographs, physical activities, and physiotherapeutic scoliosis-specific exercises. A face-to-face meeting was then conducted that allowed participants to vote for or against inclusion of each item. Agreement of 80% throughout the surveys and face-to-face meeting was considered consensus. Items that did not reach consensus were discussed and revised and repeat voting for consensus was performed. RESULTS Of the 38 experts invited to participate, we received responses from 32, 35, and 34 for each survey, respectively. 11 surgeons, 4 physiatrists, 8 physical therapists, 3 orthotists, and 1 research scientist participated in the final face-to-face meeting. Experts reached consensus on 67 items across 10 domains of bracing which were consolidated into the final best practice recommendations. CONCLUSIONS We believe that adherence to these BPG will lead to fewer sub-optimal outcomes in patients with AIS by reducing the variability in AIS bracing practices, and provide a framework future research. LEVEL OF EVIDENCE Level IV.
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Fan Y, Ren Q, To MKT, Cheung JPY. Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review. BMC Musculoskelet Disord 2020; 21:495. [PMID: 32718339 PMCID: PMC7385878 DOI: 10.1186/s12891-020-03517-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/20/2020] [Indexed: 12/27/2022] Open
Abstract
Background Adolescent idiopathic scoliosis (AIS) is the most common pediatric spinal deformity with reported complications including pain, mental health concern and respiratory dysfunction. The scoliosis-specific exercise (SSE) is prescribed throughout pubertal growth to slow progression although effects are unclear. This review aims to establish the effectiveness of SSE for alleviating AIS in terms of reducing Cobb angle, improving trunk asymmetry and quality of life (QoL). Additionally, it aims to define the effects of age, skeletal maturity, curve magnitude and exercise compliance on the outcomes of SSE. Methods A systematic reviewed was conducted to net SSE articles. Searched databases included PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL and Google scholar. The quality of study was critically appraised according to the PEDro scale. Results A total of ten trials with an average PEDro score of 6.9/10 were examined in this study. Two randomized controlled trials (RCTs) and two clinical controlled trials suggested that SSE alone and with bracing or traditional exercise had clinical significance in reducing Cobb angle more than 5°. One RCT specifically implicated no comparable effects between bracing and SSE in prevention of curve progression for moderate scoliosis. There was insufficient evidence to support the positive effects of SSE on improving truck asymmetry (n = 4) and QoL (n = 3). Five studies evaluated the interaction effects of age (n = 2), skeletal maturity (n = 1) and curve magnitude (n = 2) with SSE in reducing Cobb angle yet without drawing any firm conclusions. Conclusions Insufficient evidence is available to prove that SSE with or without other conservative treatments can reduce Cobb angle, improve trunk balance and QoL. The interaction effects of age, skeletal maturity, curve magnitude, and exercise compliance with SSE in reducing Cobb angle are not proven. Future studies should investigate the relationship of influencing factors and SSE in treating AIS but not only testing its effectiveness. Trial registration INPLASY202050100.
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Affiliation(s)
- Yunli Fan
- Department of Orthopaedics and Traumatology, The University of Hong Kong - Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen, Guangdong, China.,Department of Physiotherapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong province, China.,Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professional Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Qing Ren
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professional Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Michael Kai Tsun To
- Department of Orthopaedics and Traumatology, The University of Hong Kong - Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen, Guangdong, China.,Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professional Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong - Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen, Guangdong, China. .,Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professional Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
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Early-term postoperative thoracic outcomes of videothoracoscopic vertebral body tethering surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:526-531. [PMID: 32082921 DOI: 10.5606/tgkdc.dergisi.2019.17889] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/30/2019] [Indexed: 11/21/2022]
Abstract
Background This study aims to discuss the early-term postoperative thoracic complications in videothoracoscopic anterior vertebral body tethering surgery. Methods The study included 56 patients (3 males, 53 females; mean age 12.6 years; range, 10 to 16 years) operated with a total of 65 videothoracoscopic anterior vertebral body tethering surgeries between April 2014 and November 2018. Surgical indications were adolescents with different growth potentials, who had thoracic, thoracolumbar or double curves less than 70°. Surgical details and postoperative thoracic complications were recorded. Results Forty-two patients were administered thoracic tether, whereas five and nine patients were administered thoracolumbar tether and both approaches concomitantly, respectively. Two patients developed ipsilateral total atelectasis, one patient contralateral lobar atelectasis, one patient chylothorax, one patient pleural effusion, and one patient pneumothorax after chest drain removal. Overall thoracic complication rate was 9.2% and 30-day readmission rate was 1.8%. All patients achieved their rehabilitation goals. Conclusion Videothoracoscopy-assisted anterior vertebral body tethering is a safe and efficient technique that yields low complication rates. Early postoperative functional results are promising with high patient satisfaction. Pre- and postoperative respiratory rehabilitation may decrease thoracic complication rates.
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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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Treatment of adolescent idiopathic scoliosis and evaluation of the adolescent patient. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Homans JF, Tromp IN, Colo D, Schlösser TPC, Kruyt MC, Deeney VFX, Crowley TB, McDonald-McGinn DM, Castelein RM. Orthopaedic manifestations within the 22q11.2 Deletion syndrome: A systematic review. Am J Med Genet A 2017; 176:2104-2120. [DOI: 10.1002/ajmg.a.38545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/07/2017] [Accepted: 10/27/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Jelle F. Homans
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Isabel N. Tromp
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Dino Colo
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Tom P. C. Schlösser
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Moyo C. Kruyt
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Vincent F. X. Deeney
- Department of Orthopaedic Surgery; The Children's Hospital of Philadelphia (CHOP) and The Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - Terrence B. Crowley
- Division of Human Genetics and 22q and You Center; The Children's Hospital of Philadelphia (CHOP); Philadelphia Pennsylvania
| | - Donna M. McDonald-McGinn
- Division of Human Genetics and 22q and You Center; The Children's Hospital of Philadelphia (CHOP); Philadelphia Pennsylvania
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - René M. Castelein
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
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