Management Of Adolescent Idiopathic Scoliosis Research Articles

Long-term outcomes of spinal fusion in adolescent idiopathic scoliosis: a literature review

Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity in the younger population. The surgical management for these patients improved constantly over the last year and might not be comparable to modern treatment strategies. However, under this aspect the present investigation updates and discusses current evidence regarding the long-term outcome of the surgical management of AIS. All the clinical studies which evaluated the long-term outcomes of spinal fusion were considered. Level of evidence, clinical and radiological data, results of health-related questionnaires and surgery-associated complications during long-term follow-up, e.g., proximal and distal junctional kyphosis (PJK/DJK), and adjacent segment degeneration (ASD), are presented. Data concerning the following patient-reported outcomes measures were collected: Oswestry Disability Index (ODI), Scoliosis Research Society (SRS) Outcome Questionnaire, visual analogue scale (VAS), and short form-12 and 36 (SF-12/SF-36). Overall, data from 1115 patients were included. Of them, 324 underwent anterior and 791 posterior spinal fusion. One study focuses on a combined anterior/posterior fusions. The mean follow-up was 22.6 years (posterior fusion: 24.6 years, anterior fusion: 18.31 years). Seven studies focus on the thoracic segments, while 12 focus on the lumbar spine. Data on imaging was reported in 13 studies and those on PROMs in 15 investigations. In conclusion, there is low quality and paucity of long-term data on AIS. However, the long-term results of the implicated studies on AIS patients in this review appear to be satisfactory, although there are limitations in the outcome compared to healthy comparison cohorts. Adjacent degenerations appear to be the most common mechanical complication after long-segment fusions, despite their influence on the outcome remains unclear. With regard to pregnancies, there are slightly increased cesarean section rates, which could be explained by deviations in the sagittal profile.

Current issues in the treatment of adolescent idiopathic scoliosis: a comprehensive narrative review.

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.

Critical Evaluation of the 2016 SOSORT Clinical Guidelines on the Detection and Clinical Management of Adolescent Idiopathic Scoliosis Using the AGREE II Tool: A Chiropractic Perspective

ObjectiveThe objective of this study is to assess the methodological quality of the 2016 Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) guidelines for the detection and management of adolescent idiopathic scoliosis. MethodsA diverse group of experts, including practicing chiropractors, chiropractors with a Diplomate by the American Chiropractic Board of Radiology, chiropractors with PhD degrees, and chiropractors involved in teaching within chiropractic programs was invited to participate in the study. Experts independently evaluated the guidelines using the Appraisal of Guidelines for Research and Evaluation II tool. Individual scaled scores were calculated for each item and the 6 domains, with methodological quality considered good if the score was equal to or greater than 70%. ResultsThe 19 experts, including 6 clinicians, 4 chiropractic radiologists, 6 researchers, and 3 lecturers, represented Canada (n = 3), United states (n = 4), France (n = 2), Australia (n = 1), United Kingdom (n = 1), Switzerland (n = 1), Sweden (n = 3), Denmark (n = 2), China (n = 1), and Côte d'Ivoire (n = 1). Domain scaled scores ranged from 38% to 90%. The 4 items of the applicability domain scored between 26% and 45%. The experts made suggestions for improving the applicability of the guidelines’ recommendations. ConclusionThe methodological quality of the 2016 SOSORT clinical practice guidelines was deemed good. However, strategies should be devised to improve their applicability. This could be achieved by involving a more diverse representation of healthcare professions in the development of future guidelines.

Effectiveness of Orthopedic Bracing in the Management of Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial

Effectiveness of Orthopedic Bracing in the Management of Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial

Spinal deformity surgery in Scheuermann's kyphosis versus adolescent idiopathic scoliosis: meta-analysis of complications and clinical outcomes.

Surgical management of adolescent idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) may be associated with several complications including extended length of stay and unplanned reoperations. Several studies have previously compared postoperative complications and functional outcomes for AIS and SK patients with mixed results. However, a meta-analysis compiling the literature on this topic is lacking. Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1-20) were accessed and explored until April 2024. The extracted data consisted of complications (overall and surgical-site infections [SSI]), readmissions, reoperations, and Scoliosis Research Society-22 (SRS-22) score. Mean differences (MD) with 95% CI were used for continuous data and odds ratio (OR) was utilized for dichotomous data were calculated across studies. Seven retrospective articles were included in the meta-analysis, including 4866 patients, with 399 in the SK group and 4467 in the AIS group. SK patients were found to have statistically significantly higher rates of overall complications (OR = 5.41; 95% CI 3.69-7.93, p < .001), SSI (OR = 11.30; 95% CI 6.14-20.82, p < .001), readmissions (OR = 2.81; 95% CI 1.21-6.53, p = 0.02), and reoperations (OR = 7.40; 95% CI 4.76-11.51, p < .001) than AIS patients. However, they had similar SRS-22 scores postoperatively (MD = -0.06; 95% CI -0.16 to 0.04, p = 0.26) despite the SK group having lower SRS-22 scores preoperatively (MD = -0.30; 95% CI -0.42 to -0.18, p < .001). In this meta-analysis of studies comparing spinal deformity surgery outcomes in AIS and SK patients, SK was associated with more complications, readmissions, and reoperations. SK did have equivalent SRS-22 scores postoperatively to AIS patients, highlighting the benefit of surgical treatment despite higher complication rates. This data may help inform healthcare institutions, payors, and quality monitoring organizations who examine outcomes of pediatric and adult spinal deformity surgery.

Lessons from the pandemic era: do we need new strategies to improve conservative treatment adherence in adolescent idiopathic scoliosis? A retrospective analysis.

This study aims to examine whether the COVID-19 pandemic affected the adherence to conservative AIS treatment. Adolescent Idiopathic Scoliosis (AIS) is characterized by a lateral curvature of the spine of at least 10 degrees. Compliance rates in conservative treatments are influenced by various factors. From a database of AIS patients, we selected 30 AIS patients who were assessed before, during, and after the COVID-19 pandemic. Data regarding Cobb's angle, brace prescription, prescribed brace wear time, brace wear compliance, and time dedicated to sports activities were collected over a six-year period from January 2018 to December 2023, divided into three 2-year time periods (before, during, and after COVID-19). There was an increased percentage of AIS patients prescribed with a brace during the pandemic. However, no significant differences in Cobb's angle were observed. Additionally, the prescribed wear time showed a significant decrease from the pre-COVID period to the post-COVID period (p-value = 0.03). Wear compliance exhibited a decreasing trend from pre- to during- and post-COVID-19 periods without reaching statistically significant differences, and the time dedicated to sports statistically significantly decreased. These differences were statistically significant when comparing the pre- vs. post- and pre- vs. during-COVID-19 periods (p-values 0.01, 0.04, respectively). Our study highlights changes in AIS conservative treatment during and after the COVID-19 pandemic. The increase in the number of patients prescribed with a brace during the pandemic, although not supported by an increase in Cobb's angle, may be attributed to the concerns about regular monitoring during the reduction of rehabilitation services. The observed decreases in brace compliance and involvement in sport activities, which persisted even in the post-pandemic period, emphasizes the lasting impact of the pandemic on AIS management, necessitating innovative approaches to address these ongoing concerns.

Prognosticating accelerated deterioration in skeletally mature adolescent idiopathic scoliosis curves of 40-50° using uniplanar radiographic measures of axial rotation.

The management of adolescent idiopathic scoliosis (AIS) curves between 40 and 50° is controversial. Here, we investigated the prognostic significance of simple radiographic rotational parameters to identify curves of this magnitude with accelerated deterioration following skeletal maturity. Seventy-three patients were identified with AIS and Cobb angles of the major curve between 40 and 50° at skeletal maturity. We defined fastprogressive curves as those increasing by ≥ 2° per year after skeletal maturity. From the apical vertebra of the major curve upon presentation and skeletal maturity, we determined the modified Nash-Moe index (×100), and from thoracic major curves, the Rib Index. T tests were performed to compare fast-progressive curves with those that deteriorated by < 2° per year. Receiver operator characteristic (ROC) curves were plotted to establish optimal cutoffs, sensitivity, and specificity measures for rotational parameters. The average duration of follow-up post was 11.8 ± 7.3years. Thirteen out of seventy-three patients were fast progressors. The modified Nash-Moe index was similar between groups at presentation (p = 0.477) but significantly higher in fast progressors than non-fast progressors at maturity for major thoracic curves (25.40 ± 6.60 vs. 19.20 ± 4.40, p < 0.001). Rib Index values were also higher among fast progressors at skeletal maturity (2.50 ± 0.90 vs. 1.80 ± 0.60, p = 0.026). An ROC curve for a modified Nash-Moe index of 0.235 for thoracic curves achieved an area under the curve (AUC) of 0.76 for discriminating fast progressors. A threshold of 1.915 for Rib Index at maturity achieved an AUC of 0.72 for discriminating fast progressors. In combining both rotational parameters, an AUC of 0.81 was achieved. These simple rotational parameters may be useful to predict fast progression in 40-50° AIS curves following skeletal maturity indicated for early fusion, but further validationupon larger cohorts and non-thoracic majorcurves is required.

Comparative study of low-density versus high-density pedicular screw implantations in management of adolescent idiopathic scoliosis: a randomized clinical trial

BackgroundA number of studies have yielded disparate findings regarding the relationship between implant density and curve correction in adolescent idiopathic scoliosis (AIS) surgery. This study compared the efficacy and safety of low-density (LD) versus high-density (HD) pedicular screw implants in the correction of deformity in AIS regarding clinical, radiological, and quality of life outcomes. MethodsThis study was a single-blind, parallel, randomized trial that enrolled 20 adolescent patients with idiopathic scoliosis scheduled for posterior spinal fusion surgery with all pedicle screw constructs. Patients were randomized into two groups of 10 patients each. The LD group included patients in whom the number of screws per fused spinal level had a density of 1.5 or less, while the HD group had a density greater than 1.5. The primary outcomes were the radiological findings of curve correction. The secondary outcomes included the correlation between implant density and curve correction, the amount of blood loss, operation time, number of screws, fusion level, hospital stay duration, and quality of life assessed by the Scoliosis Research Society 22r questionnaire. ResultsRadiologically, the postoperative main curves Cobb angles and their changes were comparable between both approaches without statistical correlation with the implant density (p˃0.05). The LD approach significantly shortened the operative time (p=0.015), number of screws (p=0.011), implant density (p<0.001), and hospital stay (p<0.001). However, quality of life scores before surgery and at final follow-up did not differ between the two techniques (p˃0.05). ConclusionsThe use of a low-density approach is an effective and safe methodology for attaining satisfactory deformity correction in AIS patients. Furthermore, this approach confers the additional advantage of reduced operative time, number of screws, implant density, and hospital stay in comparison to the high-density approach.Trial registration Pan African Clinical Trial Registry, PACTR202404611444119. Registered 28 March 2024-Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=29382

Advancements in minimally invasive surgery for adolescent idiopathic scoliosis: A case series and literature review

ABSTRACT Objectives: Minimally invasive surgery (MIS) has emerged as a promising alternative to conventional open techniques in the management of adolescent idiopathic scoliosis (AIS). Materials and Methods: This study presents a case series of six patients who underwent MIS for AIS at a spine center, employing a synergistic blend of intraoperative fluoroscopy, cone-beam computed tomography scans, and three-dimensional navigation technology. The surgical procedures were meticulously guided, with a focus on ensuring safety and precision in posterior pedicle fixation. Results: Our findings demonstrate substantial correction of spinal curvature postoperatively, with a mean Cobb’s angle reduction of 51.75%. In addition, MIS facilitated a mean estimated blood loss of 241.67 ml and a mean surgical duration of 391.33 min. Conclusion: Comparison with conventional open techniques reveals comparable or superior outcomes in terms of correction rates, patient recovery, and opioid usage. This study underscores the potential of MIS in achieving favorable clinical outcomes while minimizing surgical impact and advancing the treatment landscape for AIS.

Adolescent idiopathic scoliosis in adulthood.

Adolescent idiopathic scoliosis (AIS) is an abnormal coronal curvature of the spine that most commonly presents in adolescence. While it may be asymptomatic, AIS can cause pain, cosmetic deformity, and physical and psychological disability with curve progression. As adolescents with AIS enter adulthood, condition outcomes vary with some experiencing curve stabilization and others noting further curve progression, chronic pain, osteoporosis/fractures, declines in pulmonary and functional capacity, among others. Regular monitoring and individualized management by healthcare professionals are crucial to address the diverse challenges and provide appropriate support for a fulfilling adult life with AIS. This review examines the prevalence, risk factors, presenting symptoms, diagnosis, management, and complications of AIS in the adult population, informing targeted interventions by clinicians caring for adult patients with AIS.

From Rib Hump to Baby Hump-Common Questions of Patients Suffering from and Undergoing Treatment for Scoliosis-A Comprehensive Literature Review.

Background: Scoliosis, the most prevalent spinal deformity in children, is often associated with adolescent idiopathic scoliosis (AIS). Curves surpassing 50 degrees can deteriorate, especially thoracic curves, leading to pulmonary limitations. Surgical intervention is usually advised for curvatures exceeding 50 degrees to halt further progression. Severe AIS is notably more frequent in females, yet knowledge regarding subsequent pregnancies and associated risks is scarce. Female patients often inquire about conception, pregnancy, labor, and future back pain (BP) concerns. Reports on the long-term outcomes after pediatric AIS treatment and pregnancy consequences remain limited. Uncertainty looms over the likelihood of increased back pain (BP), cesarean sections (CSs), or other pregnancy-related issues following surgical AIS management. In this investigation, an attempt was made to scrutinize the existing research on individuals afflicted with scoliosis who received either conservative or surgical treatment, with the aim of delineating crucial and pragmatic findings that can serve as a compass for spine surgeons when counseling young patients with adolescent idiopathic scoliosis regarding the ailment, its repercussions, the available treatment modalities, and the associated outcomes. A comprehensive analysis pinpointed the optimal data at hand. Consequently, the primary objective of this investigation was to assess the patient-reported and clinical consequences in scoliosis patients who have undergone segmental posterior fusion and subsequently conceived. Conclusions: While the majority of individuals with AIS are capable of conceiving and bearing children, they may encounter greater challenges in fertility than healthy women unaffected by AIS. Pregnant women with a prior history of spinal fusion for AIS can undergo pregnancy and childbirth with no significant escalation in perinatal complications. Women who have undergone surgical procedures for AIS have been observed to exhibit a prevalence of back pain comparable with that of healthy pregnant women; however, a higher incidence of low back pain is evident when spinal fusion is extended to the L3 or L4 vertebra. Although back pain is a common occurrence in pregnant women with AIS, the spinal alterations induced by pregnancy are typically minor and transient. In comparison with healthy women, individuals with a history of spinal fusion necessitate cesarean sections more frequently. The degree of correction loss during pregnancy is lower in previous reports involving pedicle screw instrumentation than in previous reports involving Harrington or hybrid segmental instrumentation.

A survey of practice in the anesthetic management of adolescent idiopathic scoliosis spine fusion by the North American Pediatric Spine Anesthesiologists Collaborative.

Adolescent Idiopathic Scoliosis (AIS) affects 2%-4% of the general pediatric population. While surgical correction remains one of the most common orthopedic procedures performed in pediatrics, limited consensus exists on the perioperative anesthetic management. To examine the current state of anesthetic management of typical AIS spine fusions at institutions which have a dedicated pediatric orthopedic spine surgeon. A web-based survey was sent to all members of the North American Pediatric Spine Anesthesiologists (NAPSA) Collaborative. This group included 34 anesthesiologists at 19 different institutions, each of whom has a Harms Study Group surgeon performing spine fusions at their hospital. Thirty-one of 34 (91.2%) anesthesiologists completed the survey, with a missing response rate from 0% to 16.1% depending on the question. Most anesthesia practices (77.4%; 95% confidence interval [CI], 67.7-93.4) do not have patients come for a preoperative visit prior to the day of surgery. Intravenous induction was the preferred method (74.2%; 95% CI 61.3-89.9), with the majority utilizing two peripheral IVs (93.5%; 95% CI 90.3-100) and an arterial line (100%; 95% CI 88.8-100). Paralytic administration for intubation and/or exposure was divided (51.6% rocuronium/vecuronium, 45.2% no paralytic, and 3.2% succinylcholine) amongst respondents. While tranexamic acid was consistently utilized for reducing blood loss, dosing regimens varied. When faced with neuromonitoring signal issues, 67.7% employ a formal protocol. Most anesthesiologists (93.5%; 95% CI 78.6-99.2) extubate immediately postoperatively with patients admitted to an inpatient floor bed (77.4%; 95% CI 67.7-93.3). Most anesthesiologists (87.1%; 95% CI 80.6-99.9) report the use of some form of an anesthesia-based protocol for AIS fusions, but our survey results show there is considerable variation in all aspects of perioperative care. Areas of agreement on management comprise the typical vascular access required, utilization of tranexamic acid, immediate extubation, and disposition to a floor bed. By recognizing the diversity of anesthetic care, we can develop areas of research and improve the perioperative management of AIS.

Quantitative computed tomography assessment of bone mineral density in adolescent idiopathic scoliosis: correlations with Cobb angle, vertebral rotation, and Risser sign.

Adolescent idiopathic scoliosis (AIS) is a prevalent spinal disorder that can potentially influence bone mineral density (BMD), thereby increasing the susceptibility to osteoporosis and fractures. Early identification of reduced bone mass in AIS patients is crucial for clinicians to develop effective preventive strategies against fractures. This study aims to elucidate the correlation between BMD, as measured by quantitative computed tomography (QCT), and various clinical parameters in AIS, including the Cobb angle, vertebral rotation, and the Risser sign. By revealing the potential influences of these factors on BMD, our findings aim to assist clinicians in making informed and timely decisions regarding AIS management, particularly in situations where QCT is unavailable. A cross-sectional study was conducted on 129 adolescents with AIS who were enrolled at The Third People's Hospital of Chengdu, Sichuan, China, between 2021 and 2023. QCT was employed to assess BMD and vertebral rotation. The Cobb angle and Risser sign were determined through radiographic evaluation, while anthropometric and biochemical data were also collected. Statistical analyses, including Pearson and Spearman rank correlation and regression models, were used to investigate the associations between BMD and clinical measures. A significant negative correlation was found between BMD and Cobb angle (coefficient =-0.663; P<0.001), as well as between BMD and vertebral rotation angle (coefficient =-0.442; P<0.001) in patients with AIS. BMD was positively correlated with increased height (coefficient =0.355; P<0.001) and BMI (coefficient =0.199; P=0.02). A significant association was detected between BMD and the Risser sign (P=0.002). No significant sex-based differences in BMD were observed (P=0.052). No significant correlations were observed between BMD and levels of potassium (K), calcium (Ca), inorganic phosphate (P), and iron (Fe) (P>0.05 all). The binary logistic regression analysis identified Cobb angle as a risk factor of lower BMD presence in AIS patients (coefficient =0.072; OR=1.075; P<0.001). Furthermore, the receiver operating characteristic (ROC) analysis of the combined model for predicting low BMD in AIS patients yielded an area under the curve (AUC) value of 0.900, with an optimal threshold determined as 0.398. The sensitivity and specificity were calculated as 0.816 and 0.900, respectively, indicating a robust predictive capacity. This study highlights the significant inverse correlation observed between BMD measured by QCT and both Cobb angle and vertebral rotation angle in patients with AIS. Furthermore, a notable variation in BMD was found across different Risser sign categories, with BMD values generally increasing as Risser sign levels increased. Additionally, our findings indicate that Cobb angle serves as a risk factor for low BMD presence. Moreover, a combined model was developed to predict the likelihood of low BMD occurrence in AIS patients.

Gut Microbiota Alterations in Adolescent Idiopathic Scoliosis Are Associated with Aberrant Bone Homeostasis.

Low bone mineral density is the major prognostic factor for adolescent idiopathic scoliosis (AIS), but the underlying mechanisms remain unclear. Accumulating evidence suggests that gut microbiota (GM) have the potential to affect bone development, and the GM signatures are altered in AIS patients. However, the effect of GM alterations on aberrant bone homeostasis in AIS remains unclear. This study aims to investigate the GM profile in AIS patients with different bone mineral density (BMD) and explore the association between GM, osteopenia, and aberrant bone turnover. A total of 126 patients with AIS who received surgical treatment were retrospectively included in this study. We analyzed the composition of the GM by 16S rRNA sequencing and BMD by dual X-ray absorptiometry. Based on the BMD of the femur neck, the patients were divided into the osteopenia group (OPN) if the Z score < -1, and the normal (NOR) group if the Z score ≥ -1 SD compared to the healthy control. For the 16S rRNA sequencing, the raw reads were filtered to remove low-quality reads, and operational taxonomic units were identified with the Uparse program. Weighted UniFrac distance matrix for the beta-diversity metrics and principal coordinate analysis (PCoA) was performed, and the statistical comparisons were made with permutational multivariate analysis of variance (PERMANOVA) and analysis of similarity (ANONISM). Linear discriminant analysis effect size (LEfSe) was used to identify the enriched species in two groups. The "Random forest" was applied to determine the optimal biomarker for OPN according to the mean decrease in Gini value. The metabolic function was predicted by the Tax4Fun analysis. The Pearson correlation coefficient was used to evaluate the associations between GM species, bone turnover markers, and BMD. The serum β-CTX was increased in the OPN group (n = 67) compared to the NOR group (n = 59). Patients in OPN groups showed significantly decreased α diversity indicated by the Shannon index. Principal coordinate analysis (PCoA) analysis showed significant clustering of GM between OPN and NOR groups. At genus level, the Escherichia-Shigella and Faecalibacterium were significantly enriched in the OPN group compared to that in the NOR group (p < 0.05), whereas the abundance of Prevotella was significantly decreased (p = 0.0012). The relative abundance of Megamonas and Prevotella was positively correlated with the femur BMD. The abundance of Escherichia-Shigella was negatively correlated with femur BMD and positively correlated with serum β-CTX levels. Functional analysis revealed significant differences in starch and sucrose metabolism, pyruvate and cysteine, and methionine metabolism between NOR and OPN groups. The alterations of GM in AIS patients are correlated with osteopenia. The association between enriched species, BMD, and bone turnover markers provides novel diagnostic and therapeutic targets for the clinical management of AIS.

Exploring the Impact of Spinal Mobilization in Adolescent Idiopathic Scoliosis

Background: Adolescent idiopathic scoliosis (AIS) is a prevalent musculoskeletal condition in adolescents, characterized by a complex etiology and significant impact on health. The condition is typically managed through various physical therapies, but the effectiveness of combining different therapeutic approaches, particularly the integration of spinal mobilization with conventional exercises, is not well established. Objective: This study aimed to evaluate the effectiveness of combining Schroth exercises with spinal mobilization in improving Cobb's angle in patients with AIS, compared to Schroth exercises alone. Methods: A randomized controlled trial was conducted at Mubarak Hospital, Sargodha, involving 12 patients aged 10-20 years with diagnosed AIS. Participants were divided into two groups: a Control Group (n=6) receiving Schroth exercises and an Experimental Group (n=6) receiving Schroth exercises plus spinal mobilization. The treatment duration was four weeks. Pre- and post-intervention Cobb's angles were measured using radiographs. Data analysis was performed using SPSS version 25. Results: Both groups demonstrated a significant reduction in Cobb's angle post-intervention. The Control Group showed a decrease from a mean ± SD of 20 ± 3.46 degrees to 17.5 ± 3.61 degrees (P &lt; 0.001). The Experimental Group exhibited a more pronounced reduction, from 20.3 ± 2.80 degrees to 15.5 ± 3.08 degrees (P &lt; 0.001). Conclusion: The study concluded that the integration of spinal mobilization with Schroth exercises is more effective in reducing Cobb's angle in patients with AIS compared to Schroth exercises alone. This combination therapy may represent a more potent approach for the management of AIS.

ADOLESCENT IDIOPATHIC SCOLIOSIS WITH CONCOMITANT SPONDYLOLYSIS: CHOICE OF FUSION LEVELS EVALUATION OF THE OUTCOMES OBTAINED LEAVING THE LYTIC LEVEL NOT INSTRUMENTED

7% of adolescent idiopathic scoliosis (AIS) patients also present with a pars defect. To date, there are no available data on the results of fusion ending proximal to a spondylolysis in the setting of AIS. The aim of this study was to analyze the outcomes of posterior spinal fusion (PSF) in this patient cohort, to investigate if maintaining the lytic segment unfused represents a safe option.Retrospective review of all patients who received PSF for AIS, presented with a spondylolysis or spondylolisthesis and had a min. 2-years follow-up. Demographic data, instrumented levels and preoperative radiographic data were collected. Mechanical complications, coronal or sagittal parameters, amount of slippage and pain levels were evaluated.Data from 22 patients were available (age 14.4 ± 2.5 years), 18 Lenke 1–2 and four Lenke 3–6. Five patients (24%) had an isthmic spondylolisthesis, all Meyerding I. The mean preoperative Cobb angle of the instrumented curves was 58 ± 13°. For 18 patients the lowest instrumented vertebra (LIV) was the last touched vertebra (LTV); for two LIV was distal to the LTV; for two, LIV was one level proximal to the LTV. The number of segments between the LIV and the lytic vertebra ranged from 1 to 6. At the last follow-up, no complications were observed. The residual curve below the instrumentation measured 8.5 ± 6.4°, the lordosis below the instrumented levels was 51.4 ± 13°. The magnitude of the isthmic spondylolisthesis remained constant for all included patients. Three patients reported minimal occasional low back pain.The LTV can be safely used as LIV when performing PSF for the management of AIS in patients with L5 spondylolysis

Utility of postoperative laboratory testing after posterior spinal fusion for adolescent idiopathic scoliosis.

With advancements to blood management strategies, risk of perioperative transfusion following surgical treatment of adolescent idiopathic scoliosis (AIS) has diminished. We hypothesize that routine laboratory testing on postoperative-day 1 (POD1) and beyond is unnecessary. The purpose of this study is to determine necessity of POD1 labs, particularly hematocrit and hemoglobin levels, following surgical management of AIS. We performed a retrospective cohort study of consecutive AIS patients aged 11-19 who underwent posterior spinal fusion (PSF) at a single institution. Univariable logistic regression was utilized to determine factors associated with hematocrit ≤ 22% on POD1 or a postoperative transfusion. Firth's penalized logistic regression was used for any separation in data. Youden's index was utilized to determine the optimal point on the ROC curve that maximizes both sensitivity and specificity. 527 patients qualified for this study. Among the eight total patients with POD1 hematocrit ≤ 22, none underwent transfusion. These patients had lower last intraoperative hematocrit levels compared to patients with POD1 hematocrit > 22% (24.1% vs 31.5%, p < 0.001), and these groups showed no difference in preoperative hematocrit levels (38.2% vs 39.8%, p = 0.11). Four patients underwent postoperative transfusion. Both preoperative hematocrit levels (34.0% vs 39.9%, p = 0.001) and last intraoperative hematocrit levels (25.1% vs 31.4%, p = 0.002) were lower compared to patients without transfusion. Intraoperative hematocrit < 26.2%, operative time of more than 35.8min per level fused, or cell salvage > 241cc were significant risk factors for postoperative transfusion. Transfusion after PSF for AIS is exceedingly rare. POD1 labs should be considered when last intraoperative hematocrit < 26%, operative time per level fused > 35min, or cell salvage amount > 241cc. Otherwise, unless symptomatic, patients do not benefit from postoperative laboratory screening.

Deep Learning Model to Classify and Monitor Idiopathic Scoliosis in Adolescents Using a Single Smartphone Photograph

Adolescent idiopathic scoliosis (AIS) is the most common pediatric spinal disorder. Routine physical examinations by trained personnel are critical to diagnose severity and monitor curve progression in AIS. In the presence of concerning malformation, radiographs are necessary for diagnosis or follow-up, guiding further management, such as bracing correction for moderate malformation and spine surgery for severe malformation. If left unattended, progressive deterioration occurs in two-thirds of patients, leading to significant health concerns for growing children. To assess the ability of an open platform application (app) using a validated deep learning model to classify AIS severity and curve type, as well as identify progression. This diagnostic study was performed with data from radiographs and smartphone photographs of the backs of adolescent patients at spine clinics. The ScolioNets deep learning model was developed and validated in a prospective training cohort, then incorporated and tested in the AlignProCARE open platform app in 2022. Ground truths (GTs) included severity, curve type, and progression as manually annotated by 2 experienced spine specialists based on the radiographic examinations of the participants' spines. The GTs and app results were blindly compared with another 2 spine surgeons' assessments of unclothed back appearance. Data were analyzed from October 2022 to February 2023. Acquisitions of unclothed back photographs using a mobile app. Outcomes of interest were classification of AIS severity and progression. Quantitative statistical analyses were performed to assess the performance of the deep learning model in classifying the deformity as well as in distinguishing progression during 6-month follow-up. The training data set consisted of 1780 patients (1295 [72.8%] female; mean [SD] age, 14.3 [3.3] years), and the prospective testing data sets consisted of 378 patients (279 [73.8%] female; mean [SD] age, 14.3 [3.8] years) and 376 follow-ups (294 [78.2%] female; mean [SD] age, 15.6 [2.9] years). The model recommended follow-up with an area under receiver operating characteristic curve (AUC) of 0.839 (95% CI, 0.789-0.882) and considering surgery with an AUC of 0.902 (95% CI, 0.859-0.936), while showing good ability to distinguish among thoracic (AUC, 0.777 [95% CI, 0.745-0.808]), thoracolumbar or lumbar (AUC, 0.760 [95% CI, 0.727-0.791]), or mixed (AUC, 0.860 [95% CI, 0.834-0.887]) curve types. For follow-ups, the model distinguished participants with or without curve progression with an AUC of 0.757 (95% CI, 0.630-0.858). Compared with both surgeons, the model could recognize severities and curve types with a higher sensitivity (eg, sensitivity for recommending follow-up: model, 84.88% [95% CI, 75.54%-91.70%]; senior surgeon, 44.19%; junior surgeon, 62.79%) and negative predictive values (NPVs; eg, NPV for recommending follow-up: model, 89.22% [95% CI, 84.25%-93.70%]; senior surgeon, 71.76%; junior surgeon, 79.35%). For distinguishing curve progression, the sensitivity and NPV were comparable with the senior surgeons (sensitivity, 63.33% [95% CI, 43.86%-80.87%] vs 77.42%; NPV, 68.57% [95% CI, 56.78%-78.37%] vs 72.00%). The junior surgeon reported an inability to identify curve types and progression by observing the unclothed back alone. This diagnostic study of adolescent patients screened for AIS found that the deep learning app had the potential for out-of-hospital accessible and radiation-free management of children with scoliosis, with comparable performance as spine surgeons experienced in AIS management.

Pubertal Stage-Dependent Anthropometric Variations in Turkish Children with Adolescent Idiopathic Scoliosis: An In-Depth Analysis.

BACKGROUND Identifying predictive factors for anthropometric changes during puberty in adolescent idiopathic scoliosis (AIS) is critical for prognosis and management. This study aimed to discern these factors in the Turkish AIS population, by analyzing variations against female breast development stages and male testicular volume, benchmarked against national standards. MATERIAL AND METHODS A cross-sectional study was conducted between 2018 and 2022, involving children aged 10 to 18 years from the Orthopedics and Pediatrics Clinics. AIS patients and controls were assessed concerning pubertal status (Tanner stage), chronological age, skeletal maturation (Tanner-Whitehouse), and anthropometric parameters (height, weight, and body mass index). RESULTS AIS patients were compared to controls, stratified by pubertal stages. In girls across all stages, significant differences emerged in bone age, BMI, and weight between AIS and controls (p<0.01). In boys, AIS patients significantly differed in bone age from controls across all stages (p<0.001). At stage V, controls demonstrated higher BMI than AIS boys (p<0.001), while at stage I, AIS boys had significantly higher height and weight compared to controls (p<0.001). CONCLUSIONS AIS patients demonstrate distinctive pubertal growth abnormalities, with males and females presenting divergent patterns. Understanding these variations could inform better management of AIS during the critical pubertal growth period.

Adolescent idiopathic scoliosis with concomitant spondylolysis: choice of fusion levels and evaluation of the outcomes obtained leaving the lytic level not instrumented

Purpose7% of adolescent idiopathic scoliosis (AIS) patients also present with a pars defect. To date, there are no available data on the results of fusion ending proximal to a spondylolysis in the setting of AIS. The aim of this study was to analyze the outcomes of posterior spinal fusion (PSF) in this patient cohort, to investigate if maintaining the lytic segment unfused represents a safe option.MethodsRetrospective review of all patients who received PSF for AIS, presented with a spondylolysis or spondylolisthesis and had a min. 2-year follow-up. Demographic data, instrumented levels, and preoperative radiographic data were collected. Mechanical complications, coronal or sagittal parameters, amount of slippage, and pain levels were evaluated.ResultsData from 22 patients were available (age 14.4 ± 2.5 years), 18 Lenke 1–2 and 4 Lenke 3–6. 5 patients (24%) had an isthmic spondylolisthesis, all Meyerding I. The mean preoperative Cobb angle of the instrumented curves was 58 ± 13°. For 18 patients, the lowest instrumented vertebra (LIV) was the last touched vertebra (LTV); for 2, LIV was distal to the LTV; for 2, LIV was one level proximal to the LTV. The number of segments between the LIV and the lytic vertebra ranged from 1 to 6. At the last follow-up, no complications were observed. The residual curve below the instrumentation measured 8.5 ± 6.4°, the lordosis below the instrumented levels was 51.4 ± 13°. The magnitude of the isthmic spondylolisthesis remained constant for all included patients. Three patients reported minimal occasional low back pain.ConclusionThe LTV can be safely used as LIV when performing PSF for the management of AIS in patients with L5 spondylolysis.