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Lee YJ, Wang WJ, Mohamad SM, Chandren JR, Gani SMA, Chung WH, Chiu CK, Chan CYW. A comparison between Boston brace and European braces in the treatment of adolescent idiopathic scoliosis (AIS) patients: a systematic review based on the standardised Scoliosis Research Society (SRS) inclusion criteria for brace treatment. Eur Spine J 2024; 33:630-645. [PMID: 37924388 DOI: 10.1007/s00586-023-08007-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/01/2023] [Accepted: 10/15/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE To compare the Boston brace and European braces using a standardised Scoliosis Research Society (SRS) inclusion criteria for brace treatment as well as consensus recommendations for treatment outcome. METHODS This was a systematic review that was carried out using MeSH terminology in our search protocol in PubMed, Cochrane Library, Scopus, Clinicaltrials.gov and Web of Science database between 1976 and 29th of Jan 2023. All studies that were included in this review had applied fully/partially the SRS inclusion criteria for brace wear. Outcome measures were divided into primary and secondary outcome measures. RESULTS 3830 literatures were found in which 176 literatures were deemed relevant to the study once duplicates were removed and titles and abstracts were screened. Of these literatures, only 15 had fulfilled the eligibility criteria and were included in the study. 8 of the studies were Level IV studies, 5 were Level III studies and 2 studies were Level I studies (1 prospective randomised controlled trial (RCT) and 1 Quasi-RCT). The percentage of patients who avoided surgery for European braces ranged from 88 to 100%, whereas for Boston brace ranged from 70 to 94%. When treatment success was assessed based on the final Cobb angle > 45°, approximately 15% of patients treated with European braces had treatment failure. In contrast, 20-63% of patients treated with Boston brace had curves > 45° at skeletal maturity. The BrAIST study used a cut-off point of 50° to define failure of treatment and the rate of treatment failure was 28%. Curve correction was not achieved in most patients (24-51% of patients) who were treated with the Chêneau brace and its derivatives. However, none of the patients treated with Boston brace achieved curve correction. CONCLUSION Boston brace and European braces were effective in the prevention of surgery. In addition, curve stabilisation was achieved in most studies. Limitation in current literature included lack of studies providing high level of evidence and lack of standardisation in terms of compliance to brace as well as multidisciplinary management of brace wear.
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Affiliation(s)
- Yu Jie Lee
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wee Jieh Wang
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Siti Mariam Mohamad
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Josephine Rebecca Chandren
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Chan CYW, Gani SMA, Chung WH, Chiu CK, Hasan MS, Kwan MK. A Comparison Between the Perioperative Outcomes of Female Adolescent Idiopathic Scoliosis (AIS) Versus Adult Idiopathic Scoliosis (AdIS) Following Posterior Spinal Fusion: A Propensity Score Matching Analysis Involving 425 Patients. Global Spine J 2023; 13:81-88. [PMID: 33648369 PMCID: PMC9837521 DOI: 10.1177/2192568221991510] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
STUDY DESIGN Retrospective propensity score matching (PSM) study. OBJECTIVE To investigate the perioperative outcomes comparing adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) patients following posterior spinal fusion (PSF). METHODS 425 female AIS and AdIS patients who were operated (between January 2015 to March 2020) using a dual attending surgeon strategy were stratified into G1 (AIS aged 10-16 years old) and G2 (AdIS > 20 years old). PSM analysis with one-to-one, nearest neighbor matching technique with match tolerance of 0.001 was used to matched 357 AIS patients to 68 AdIS patients. Operation duration, intraoperative blood loss (IBL), blood loss percentage, hemoglobin drift, blood salvaged, postoperative wound length, allogenic blood transfusion requirement, postoperative hospital stay, postoperative Cobb, correction rate and postoperative complications were documented and reported. RESULTS Following PSM, G1 and G2 each had 50 patients with comparable and balanced covariates. As anticipated, G2 patients were heavier, taller and had higher body mass index compared to G1 patients (P < 0.05). We could not find any significant differences in the perioperative outcome comparing this 2 groups. AIS and AdIS patients had similar operation duration (125.9 ± 27.2 min vs 127.3 ± 37.8 min), IBL (749.8 ± 315.7 ml vs 723.8 ± 342.1 ml) and length of hospital stay (3.3 ± 0.4 days vs 3.5 ± 0.8 days) (P > 0.05). Hemoglobin drift and amount of blood salvaged were comparable (P > 0.05). G2 had stiffer curves. There was a trend toward a lower correction rate in G2 in the immediate postoperative period, however it did not reach statistical significance (61.8 ± 11.2% vs. 66.3 ± 11.6%, P = 0.051). No patients required blood transfusion and none had any postoperative complications. CONCLUSION Adolescent and adult female scoliosis patients had comparable perioperative outcome following PSF surgery that was carried out using a dual attending surgeon strategy.
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Affiliation(s)
- Chris Yin Wei Chan
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty
of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Mun Keong Kwan, Department of Orthopedic
Surgery, National Orthopedic Centre of Excellence for Research and Learning
(NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur,
Malaysia.
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Makram AM, Phu Tran V, Elsheikh R, Hau NTH, Abd Gani SM, Huy NT. Is it still suitable to depend on AstraZeneca for COVID-19 vaccine donations to developing countries? Curr Med Res Opin 2022; 38:2127-2130. [PMID: 36164756 DOI: 10.1080/03007995.2022.2129233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Abdelrahman M Makram
- School of Public Health, Imperial College London, London, UK
- Faculty of Medicine, October 6 University, Giza, Egypt
- Online Research Club, Nagasaki, Japan
| | - Van Phu Tran
- Online Research Club, Nagasaki, Japan
- Department of Medicine, Tra Vinh University, Tra Vinh City, Vietnam
| | - Randa Elsheikh
- Faculty of Medicine, October 6 University, Giza, Egypt
- Online Research Club, Nagasaki, Japan
| | - Nguyen Thi Hien Hau
- Online Research Club, Nagasaki, Japan
- Faculty of Medicine, College of Medicine and Pharmacy, Duy Tan University, Da Nang City, Vietnam
- Institute for Research and Training in Medicine, Biology and Pharmacy, Duy Tan University, Da Nang City, Vietnam
| | - Siti Mariam Abd Gani
- Online Research Club, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Chiu CK, Tan RL, Gani SMA, Chong JSL, Chung WH, Chan CYW, Kwan MK. Feasibility of Single-Stage Posterior Passive Correction and Fusion Surgery for Congenital Scoliosis in Adolescent Patients Who Have Attained Skeletal Maturity. Asian Spine J 2021; 16:315-325. [PMID: 33957021 PMCID: PMC9260400 DOI: 10.31616/asj.2020.0649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/24/2021] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective study. Purpose To report the perioperative and radiological outcomes of single-stage posterior passive correction and fusion (SSPPCF) in adolescent patients who present with congenital scoliosis. Overview of Literature The surgical treatment for congenital scoliosis is complex. There is no definitive guide on surgical options for skeletally matured adolescent patients who have congenital scoliosis. Methods Patients with congenital scoliosis who underwent SSPPCF using a pedicle screw system were reviewed. We identified the following three surgical indications: (1) hemivertebra or wedge vertebra over the thoracic or thoracolumbar region with structural lumbar curves, (2) hemivertebra or wedge vertebra at the lumbar region with significant pelvic obliquity or sacral slanting, and (3) mixed or complex congenital scoliosis. The demographic, perioperative, and radiographic data of these patients were collected. Results Thirty-four patients were reviewed. The mean patient age was 14.6±3.4 years. There were 13 hemivertebrae, three wedged vertebrae, two butterfly vertebrae, three hemivertebrae with butterfly vertebra, eight unsegmented bars, and five multiple complex lesions. The average surgical duration was 219.4±68.8 minutes. The average blood loss was 1,208.4±763.5 mL. Seven patients required allogeneic blood transfusion. The mean hospital stay duration was 6.1±2.5 days. The complication rate was 11.8% (4/34): one patient had severe blood loss, one had rod breakage, and two had distal adding-on. The Cobb angle reduced from 65.9°±17.4° to 36.3°±15.3° (p<0.001) with a correction rate (CR) of 44.8%±17.4%. The regional kyphotic angle decreased from 39.9°±20.5° to 27.5°±13.9° (p=0.001) with a CR of 19.3%±49.6%. Radiographic parameters (radiographic shoulder height, clavicle angle, T1 tilt, cervical axis, pelvic obliquity, coronal balance, and apical vertebral translation) showed significant improvement postoperatively. Conclusions SSPPCF was a feasible option for adolescent patients with congenital scoliosis who were skeletally matured.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rommel Lim Tan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Davao Doctors Hospital, Davao City, Philippines
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jessamine Sze Lynn Chong
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chiu CK, Chan CYW, Cheung JPY, Cheung PWH, Gani SMA, Kwan MK. Personal protective equipment usage, recycling and disposal among spine surgeons: An Asia Pacific Spine Society survey. J Orthop Surg (Hong Kong) 2021; 29:2309499020988176. [PMID: 33569998 DOI: 10.1177/2309499020988176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE In this study we investigated on the personal protective equipment (PPE) usage, recycling, and disposal among spine surgeons in the Asia Pacific region. METHODS A cross-sectional survey was carried out among spine surgeons in Asia Pacific. The questionnaires were focused on the usage, recycling and disposal of PPE. RESULTS Two hundred and twenty-two surgeons from 19 countries participated in the survey. When we sub-analysed the differences between countries, the provision of adequate PPE by hospitals ranged from 37.5% to 100%. The usage of PPE was generally high. The most used PPE were surgical face masks (88.7%), followed by surgical caps (88.3%), gowns (85.6%), sterile gloves (83.3%) and face shields (82.0%). The least used PPE were powered air-purifying respirators (PAPR) (23.0%) and shoes/boots (45.0%). The commonly used PPE for surgeries involving COVID-19 positive patients were N95 masks (74.8%), sterile gloves (73.0%), gowns (72.1%), surgical caps (71.6%), face shields (64.4%), goggles (64.0%), shoe covers (58.6%), plastic aprons (45.9%), shoes/boots (45.9%), surgical face masks (36.5%) and PAPRs (21.2%). Most PPE were not recycled. Biohazard bins were the preferred method of disposal for all types of PPE items compared to general waste. CONCLUSIONS The usage of PPE was generally high among most countries especially for surgeries involving COVID-19 positive patients except for Myanmar and Nepal. Overall, the most used PPE were surgical face masks. For surgeries involving COVID-19 positive patients, the most used PPE were N95 masks. Most PPE were not recycled. Biohazard bins were the preferred method of disposal for all types of PPE.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, 25809The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, 25809The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
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Chan CYW, Gani SMA, Lim MY, Chiu CK, Kwan MK. APSS-ASJ Best Clinical Research Award: Is There a Difference between Patients' and Parents' Perception of Physical Appearance in Adolescent Idiopathic Scoliosis? Asian Spine J 2018; 13:216-224. [PMID: 30472823 PMCID: PMC6454293 DOI: 10.31616/asj.2018.0151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/16/2018] [Indexed: 01/22/2023] Open
Abstract
Study Design Prospective study. Purpose To compare patients’ and parents’ perceptions of physical attributes (PAs) of adolescent idiopathic scoliosis (AIS) patients and to report any correlations between their perceptions and Scoliosis Research Society-22r (SRS-22r) scores. Overview of Literature Few studies have looked into the differences between patients’ and parents’ perceptions of their appearance. Methods AIS patient–parent pairs (n=170) were recruited. The patients’ and parents’ perceptions of six PAs were evaluated: waist asymmetry (WA), rib hump (RH), shoulder asymmetry (SA), neck tilt, breast asymmetry (BrA), and chest prominence. These PAs were ranked, and an aggregate PA (Agg-PA) score was derived from a score assigned to the attribute (6 for the most important PA and 1 for the least important). The patients also completed the SRS-22r questionnaire. Results Ninety-nine patients (58.2%) and 71 patients (41.8%) had thoracic and lumbar major curves, respectively. WA was ranked first by 54 patients (31.8%) and 50 parents (29.4%), whereas RH was ranked first by 50 patients (29.4%) and 38 parents (22.4%). The overall Agg-PA scores were similar for patients and parents (p>0.05). However, for thoracic major curves (TMCs) >40°, a significant difference was noted between the Agg-PA scores of patients and parents for SA (3.5±1.6 vs. 4.2±1.6, p=0.041) and BrA (3.0±1.6 vs. 2.2±1.3, p=0.006). For TMCs <40°, a significant difference was found between the Agg-PA scores of patients and parents for WA (3.7±1.6 vs. 4.4±1.5, p=0.050). BrA was negatively correlated with total SRS-22r score. Conclusions There were no significant differences between patients and parents in their ranking of the most important PAs. For TMCs >40°, there were significant differences in the Agg-PA for SA and BrA. Pa¬tients were more concerned about BrA and parents were more concerned about SA. Patients’ perception of the six PAs had weak correlation with SRS-22r scores.
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Affiliation(s)
- Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Min Yuen Lim
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kwan MK, Chiu CK, Chan TS, Abd Gani SM, Tan SH, Chan CYW. Flexibility assessment of the unfused thoracic segments above the "potential upper instrumented vertebrae" using the supine side bending radiographs in Lenke 5 and 6 curves for adolescent idiopathic scoliosis patients. Spine J 2018; 18:53-62. [PMID: 28751241 DOI: 10.1016/j.spinee.2017.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/19/2017] [Accepted: 06/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Selection of upper instrumented vertebra for Lenke 5 and 6 curves remains debatable, and several authors have described different selection strategies. OBJECTIVE This study analyzed the flexibility of the unfused thoracic segments above the "potential upper instrumented vertebrae (UIV)" (T1-T12) and its compensatory ability in Lenke 5 and 6 curves using supine side bending (SSB) radiographs. STUDY DESIGN A retrospective study was used. PATIENT SAMPLE This study comprised 100 patients. OUTCOME MEASURES The ability of the unfused thoracic segments above the potential UIV, that is, T1-T12, to compensate in Lenke 5 and 6 curves was determined. We also analyzed postoperative radiological outcome of this cohort of patients with a minimum follow-up of 12 months. METHODS Right and left SSB were obtained. Right side bending (RSB) and left side bending (LSB) angles were measured from T1 to T12. Compensatory ability of thoracic segments was defined as the ability to return to neutral (center sacral vertical line [CSVL]) with the assumption of maximal correction of lumbar curve with a horizontal UIV. The Lenke 5 curves were classified as follows: (1) Lenke 5-ve (mobile): main thoracic Cobb angle <15° and (2) Lenke 5+ve (stiff): main thoracic Cobb angle 15.0°-24.9°. This study was self-funded with no conflict of interest. RESULTS There were 43 Lenke 5-ve, 31 Lenke 5+ve, and 26 Lenke 6 curves analyzed. For Lenke 5-ve, >70% of thoracic segments were able to compensate when UIV were at T1-T8 and T12 and >50% at T9-T11. For Lenke 5+ve, >70% at T1-T6 and T12, 61.3% at T7, 38.7% at T8, 3.2% at T9, 6.5% at T10, and 22.6% at T11 were able to compensate. For Lenke 6 curve, >70% at T1-T6, 69.2% at T7, 19.2% at T8, 7.7% at T9, 0% at T10, 3.8% at T11, and 34.6% at T12 were able to compensate. There was a significant difference between Lenke 5-ve versus Lenke 5+ve and Lenke 5-ve versus Lenke 6 from T8 to T11. There were no significance differences between Lenke 5+ve and Lenke 6 curves from T1 to T11. CONCLUSIONS The compensatory ability of the unfused thoracic segment of Lenke 5+ve curves was different from the Lenke 5-ve curves, and it demonstrated characteristics similar to the Lenke 6 curves.
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Affiliation(s)
- Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Teik Seng Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shun Herng Tan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Lee CK, Chan CYW, Gani SMA, Kwan MK. Accuracy of cannulated pedicle screw versus conventional pedicle screw for extra-pedicular screw placement in dysplastic pedicles without cancellous channel in adolescent idiopathic scoliosis: a computerized tomography (CT) analysis. Eur Spine J 2017; 26:2951-2960. [DOI: 10.1007/s00586-017-5266-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/06/2017] [Accepted: 08/12/2017] [Indexed: 11/24/2022]
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Kwan MK, Chiu CK, Gani SMA, Wei CCY. Accuracy and Safety of Pedicle Screw Placement in Adolescent Idiopathic Scoliosis Patients: A Review of 2020 Screws Using Computed Tomography Assessment. Spine (Phila Pa 1976) 2017; 42:326-335. [PMID: 27310021 DOI: 10.1097/brs.0000000000001738] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of CT scan. OBJECTIVE To investigate the accuracy and safety of pedicle screws placed in adolescent idiopathic scoliosis (AIS) patients. SUMMARY OF BACKGROUND DATA The reported pedicle screws perforation rates for corrective AIS surgery vary widely from 1.2% to 65.0%. Knowledge regarding the safety of pedicle screws in scoliosis surgery is very important in preventing complications. METHODS This study investigates the accuracy and safety of pedicle screws placed in 140 AIS patients. CT scans were used to assess the perforations that were classified according to Rao et al (2002): grade 0, grade 1 (<2 mm), grade 2 (2-4 mm), and grade 3 (>4 mm). Anterior perforations were classified into grade 0, grade 1 (<4 mm), grade 2 (4-6 mm), and grade 3 (>6 mm). Grade 2 and 3 (excluding lateral grade 2 and 3 perforation over thoracic vertebrae) were considered as critical perforations. RESULTS A total of 2020 pedicle screws from 140 patients were analyzed. The overall total perforation rate was 20.3% (410 screws) with 8.2% (166 screws) grade 1, 2.9% (58 screws) grade 2 and 9.2% (186 screws) grade 3 perforations. Majority of the perforations was because of lateral perforation occurring over the thoracic region, as a result of application of extrapedicular screws at this region. When the lateral perforations of the thoracic region were excluded, the perforation rate was 6.4% (129 screws), grade 2, 1.4% (28 screws) and grade 3, 0.8% (16 screws). There were only two symptomatic left medial grade 2 perforations: one screw at T12 presented with postoperative iliac crest numbness and another screw at L2 presented with radicular pain that subsided with conservative treatment. There were six anterior perforations abutting the right lung, four anterior perforations abutting the aorta, two anterior perforations abutting the esophagus, and one abutting the trachea was noted. CONCLUSION Pedicle screws insertion in AIS has a total perforation rate of 20.3%. After exclusion of lateral thoracic perforations, the overall perforation rate was 8.6% with a critical perforation rate of 2.2% (44/2020). The rate of symptomatic screw perforation leading to radicular symptoms was 0.1%. There was no spinal cord, aortic, esophageal, or lung injuries caused by malpositioned screws in this study. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Mun Keong Kwan
- Department of Orthopedic Surgery, National Orthopedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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