Adolescent Scoliosis Patients Research Articles

Using Photogrammetry to Analyze Anatomical Changes in the Nipple in Juvenile and Adolescent Scoliosis Patients.

The need for an objective set of anterior trunk measurements, such as nipple and clavicular shoulder joints, is essential to quantify the anterior asymmetry present in scoliosis. This study aims to characterize breast asymmetry (BA) in young individuals with scoliosis using photogrammetry. Digital photographs of the anterior trunk of the 51 scoliosis patients aged 4-20years were taken from an anterior perspective. These images were then transferred to a computer. Ten parameters were measured using the ImageJ software. The positions of patients' nipples were classified into 6 types based on ratios on the x-axis. The majority of patients had a right breast that was larger, intensifying the apparent BA due to trunk rotation. The apical vertebra level in patients was found at T8 in 23.6% and T9 in 45.1%. In 92.5% of the patients, the right breast was consistently larger. The lengths between the lateral boundaries and nipples of the right and left breasts and between the medial boundary and nipple of the right breast were statistically significantly higher in males than in females (p < 0.05). Significant differences were found when comparing the values of the lengths between the medial boundaries and nipples of the right and left breasts, the difference in length between the right and left acromioclavicular joint lines, and the angles of the nipple and acromioclavicular joint with the degrees of scoliosis in juvenile and adolescents (p < 0.05). Pearson regression analysis revealed a significant correlation between BA differences and the Cobb angle with a correlation coefficient of 0.901. Factors related to breast aesthetics, like differences in the height of nipples and the distance from the sternal notch to the nipple, represent 30% of the overall score. The study concluded that there is a significant correlation between the severity of scoliosis and BA differences. Augmentation mammaplasty for BA not only decreased the breast difference but also leveled the nipple disparities. Photogrammetry is considered to be an alternative to other methods and is believed to contribute to the follow-up of BA. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

What is the relationship between health-related quality of life among scoliosis patients and their caregiver burden? A cross-sectional study in China

BackgroundCaregivers play a vital role in the recovery of scoliosis patients, but limited studies evaluate the caregivers’ HRQoL and burden in health care. This study aimed to explore the health-related quality of life (HRQoL) of scoliosis patients and their caregivers, and identify the factors influencing caregiver burden in Eastern China.MethodsThis cross-sectional study was conducted from August 2018 to January 2019 at the Shandong Provincial Hospital, Jinan, China. The HRQoL of scoliosis patients was measured by the Scoliosis Research Society-22r (SRS-22r), five-level EQ-5D (EQ-5D-5L) and Child Health Utility 9D (CHU9D). The caregivers’ questionnaires consist of the EQ-5D-5L, WHO-five wellbeing index (WHO-5), 22-item Zarit Caregiver Burden Interview (ZBI-22) and Social Support Rating Scale (SSRS). Spearman correlation coefficients were used to estimate the relationship among caregivers’ burden, social support, HRQoL, and SWB. Cohen’s effect size (Cohen’s d) was used to assess the ZBI-22 total score between different groups. Multiple stepwise hierarchical linear regression models were conducted to assess the associated factors of caregiver burden.ResultsThere were 59 scoliosis patients and their caregivers (n = 59) included in the analysis. The mean health state utility of adolescent scoliosis patients (n = 39) was 0.718 (95%CI: 0.654, 0.782) based on CHU9D and adult scoliosis patients (n = 20) was 0.663 (95%CI: 0.471, 0.855) based on EQ-5D-5L. The mean health state utility of male scoliosis patients (0.792/0.667) was higher than females (0.681/0.662) based on CHU9D and EQ-5D-5L (p > 0.05), respectively. The ZBI-22 total score of scoliosis patients’ caregivers was 27.86 (SD: 20.59). Scoliosis patients’ HRQoL was significantly inversely correlated with caregiver burden, and the HRQoL and subjective wellbeing (SWB) of caregivers were moderately and inversely correlated with caregiver burden. The regression results showed that the patients’ age and caregivers’ SWB were key characteristics associated with caregiver burden.ConclusionsThe caregiver burden of adolescent patients was higher than that of adult patients, and the satisfaction rate of adolescent scoliosis patients was higher than that of adult scoliosis patients. Improving the functional state of scoliosis patients and providing appropriate nursing practice education from health professionals would be necessary to effectively improve caregivers SWB and alleviate caregiver burden.

The Interrater and Intrarater Reliability of the Humeral Head Ossification System and the Proximal Femur Maturity Index Assessments for Patients with Adolescent Idiopathic Scoliosis.

Skeletal maturity can evaluate the growth and development potential of children and provide a guide for the management of adolescent idiopathic scoliosis (AIS). Recent studies have demonstrated the advantages of the Humeral Head Ossification System (HHOS) and the Proximal Femur Maturity Index (PFMI), based on standard scoliosis films, in the management of AIS patients. We further assessed the HHOS and the PFMI method's reliability in the interrater and intrarater. The data from 38 patients, including the humeral head and proximal femur on standard scoliosis films, were distributed to the eight raters in the form of a PowerPoint presentation. On 38 independent standard spine radiographs, raters utilized the HHOS and PFMI to assign grades. The PPT sequence was randomly changed and then reevaluated 2 weeks later. For every system, the 95% confidence interval (95% CI) and intraclass correlation coefficient (ICC) were calculated to evaluate the interrater and intrarater reliability. The HHOS was extremely reliable, with an intraobserver ICC of 0.802. In the first round, the interobserver ICC reliability for the HHOS was 0.955 (0.929-0.974), while in the second round, it was 0.939 (0.905-0.964). The PFMI was extremely reliable, with an intraobserver ICC of 0.888. In the first round, the interobserver ICC reliability for the PFMI was 0.967 (0.948-0.981), while in the second round, it was 0.973 (0.957-0.984). The HHOS and PFMI classifications had excellent reliability. These two methods are beneficial to reduce additional exposure to radiation and expense for AIS. There are advantages and disadvantages to each classification. Clinicians should choose a personalized and reasonable method to assess skeletal maturity, which will assist in the management of adolescent scoliosis patients.

The effect of the caudal insertion angle of pedicle screws on postoperative thoracic kyphosis in adolescent idiopathic scoliosis: a pilot study.

The study was a prospective analysis of collected data to compare the effect of the insertion angle (parallel or oblique relative to the upper-end plates) of thoracic pedicle screws on postoperative thoracic kyphosis in patients with idiopathic thoracic scoliosis. This study was conducted on idiopathic adolescent scoliosis (AIS) patients. Two groups of patients were defined according to the insertion angle of thoracic pedicle screws in relation to the upper-end plate of the corresponding vertebra, the insertion angles being either oblique or parallel. Seven consecutive AIS patients were compared in each group. Pre- and postoperative standing X-rays were obtained. Cobb's angles, sagittal parameters such as thoracic kyphosis (TK) (T1-T12) and lumbar lordosis (LL) (L1-S1) were all measured. The average of the main curve or compensatory curve corrections showed no significant differences between the two groups. From a sagittal profile perspective, the mean TK in the oblique screw group was 39.3 ± 11.5 preoperatively, which was reduced to 30.9 ± 6.41 after surgery. The mean TK in the parallel group was 36.4 ± 14 preoperatively and 42.1 ± 13.9 postoperatively. There was a significant reduction in TK in the oblique screws group compared with the second group ( P = 0.038). The insertion angle of pedicle screws had no significant effect on Cobb's angle and lumbar lordosis changes. However, oblique insertion of thoracic screws decreased thoracic kyphosis postoperatively, which could be considered a negative point. As such, the insertion of thoracic screws in a caudal direction should not be routinely used because of its lordogenic effect.

Impact of Gensingen brace treatment on Lenke 5 curvatures and chronic low back pain in late adolescent and adult scoliosis patients.

BackgroundLenke 5C (lumbar and or thoracolumbar) curve patterns lead to loss of lumbar lordosis which is associated with low back pain in later adulthood. We undertook our study to investigate if brace treatment may have an effect on low back pain and on improving the cosmetic appearance in late adolescents and adults.ObjectivesTo estimate if conservative treatment may have an effect on pain in single lumbar curvatures in late adolescent and adult patients with Adolescent Idiopathic Scoliosis (AIS) using a Gensingen Brace by Weiss (GBW).MethodWe investigated AIS patients with Lenke 5C pattern who wore a GBW prospectively. The inclusion criteria of our study were age over 15 years, Cobb angle greater than 20° before treatment and Risser 4 or 5. A verbal pain rating scale was used (no pain, mild pain, moderate pain, severe pain, very severe pain).ResultsA total of 26 patients met the inclusion criteria. The average age was 17.7 years and the average Cobb angle was 41.5°. Nineteen patients (73.1%) experienced mild or moderate chronic low back pain before treatment and seven patients (26.9%) were asymptomatic but seeking treatment for cosmetic reasons. At follow-up, a 23% correction of the curve was achieved. All previously symptomatic patients reported that they no longer experienced low back pain after having worn the brace regularly.ConclusionHigh correction bracing seems to have a positive effect on the curve and on chronic low back pain in patients with a scoliosis and a Lenke 5C curve pattern.Clinical implicationsHigh correction, pattern specific bracing with a GBW may be applied aiming at reducing structural curves and chronic low back pain in late adolescent and adult patients with AIS and with a single lumbar curvature.

QUALITY OF LIFE IN PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS

&lt;p&gt;Idiopathic Adolescent Scoliosis (AIS) is a 3D spinal deformity that arises approximately during puberty. In some cases, the curvature of AIS continues to progress toward more severe over adulthood, which generally requires an invasive surgery reconstruction. To investigate quality and status of life (QOL) in patients with idiopathic adolescent scoliosis (AIS). Inclusion criteria were patients with non-surgical treatment for AIS with Cobb angle over or 10º, and age &amp;lt; 23 years old. A total of 45 patients with AIS were included and divided into three groups ( single main thoracic MT the curve group, n = 15); (single thoracolumbar curve TL/L group, n = 20); (double major thoracic lumbar curve DM group, n = 10), based on the location of the curve in skeletal maturity. Postero-anterior standing Formetric (Functional Analysis of the Musculoskeletal System), were evaluated at skeletal maturity. QOL was evaluated using the visual analogue scale (VAS) for back pain (BP) (maximum: 10 cm), the SRS -22, and the Oswestry Disability Index Questionnaire (ODIQ). In all groups, severe scoliosis progressed by approximately 0.5º/for year from the time of skeletal maturity. The TL/L and DM groups showed a significantly worse visual analogue scale, scores for back pain compared to MT group (p&amp;lt;0.05). The groups involved showed significantly worse results for the SRS-22 self-imaging domain. The TL/L group showed worse outcomes for walking ability and areas of social function of the Oswestry Disability Index Questionnaire for the assessment of back pain (p&amp;lt;0.005). AIS patients with single MT curve maintain equal QOL (Quality of life) status compared to the other groups. Patients with TL/L structural curves are likely to experience a greater annual curve progression due to substantial back pain or more specific back pain where the QOL status during the daily activity is deplorable.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/edu_01/0951/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Determination of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Correction Fusion using Pedicle Screw Versus Hook Plus Screw Pedicle Instrumentation

Introduction: Spinal instrumentation in idiopathic adolescent scoliosis (AIS) aims to correct spinal deformity, and maintain spinal stability. Proximal junctional kyphosis (PJK) is a relatively common postoperative complication. Posterior-only fusion using diverse instruments such as pedicle screw and hybrid hook plus screw is favored to correct spinal deformity. The current study aims to compare PJK incidence between pedicle screw versus hybrid hook plus screw.&#x0D; Methods: This non-randomized clinical trial has been conducted on 71 AIS patients undergone posterior-only spinal deformity fusion using pedicle screw only (n=42) or hook plus pedicle (n=29) implantation in 2015-20. The proximal thoracic (PT), main thoracic (MT), T5-T12 sagittal Cobb angles and proximal junctional angle (PJA) were evaluated through radiographies taken at baseline, immediately postoperative, within 6 and 18 months. PJK was defined as PJA &gt;10 degrees. &#x0D; Results: Using both pedicle screw only and hook plus pedicle have led to significant improvement in MT, PT, PJA and T5-T12 angles (P-value&lt;0.05); however, the two groups were not statistically different (P-value&gt;0.05). Seventeen cases (23.9%) presented PJK among which 11 (26.2%) and 6 (20.7%) ones were in the predicle screw versus hook plus screw implantation groups, respectively (P-value=0.54). The comparison of PJA and T5-T12 Cobb angles revealed significant difference between the PJK versus non-PJK cases (P-value&lt;0.05).&#x0D; Conclusion: AIS instrumentation was accompanied by satisfying outcomes using pedicle screw or hook plus screw. However, none of the applied instruments was superior over the other; PJK occurred in fewer cases undergone posterior-only approach of AIS correctional surgery using hook and screw.

Post-marketing surveillance on safety and efficacy of posterior spinal correction and fusion with the CD Horizon Solera instrumentation for adolescent idiopathic scoliosis. A retrospective cohort study

BackgroundPost-Market Clinical Follow-Up has been integrated into the new Medical Device Regulations since 2020. The CD Horizon Solera 4.75 mm instrumentation (CD-Solera) was introduced worldwide in 2009, and specifically intended for surgical treatment of pediatric and adolescent scoliosis patients. The objective of this study was to evaluate the safety and efficacy of the CD-solera 4.75 instrumentation in surgical treatment of adolescent idiopathic scoliosis (AIS). Methods94 consecutive AIS patients, 82 female, 12 male, who underwent posterior correction with CD-Solera instrumentation between 2010 and 2016 at age 14.8 ± 1.6 years, were retrospectively included. The minimum follow-up was two years. On pre- and postoperative biplanar full spine radiographs Cobb angles of the primary and secondary curves and sagittal profile were measured before surgery, immediately postoperative, and at two-year follow-up. Medical records were reviewed for complications. Clinical outcome was analyzed using theSRS-22r questionnaire. ResultsIn this study 77% of the patients had a structural thoracic curve (type Lenke 1 or 2), and 23% had a structural (thoraco-)lumbar curve (Lenke 3-6). A correction of 55.1% and 51.7% was achieved respectively immediately post-operative, and at last-year follow up for the primary curve. The mean loss of correction was 2°. Health related quality of life was 4.0 (good) on the SRS-22r-questionnaire. In total six revision operations were executed, of which one was related to the material (rod breakage). Other reasons for revision operation were not due to the material. No neurological problems were encountered. ConclusionIn patients with AIS the initial correction and maintenance of correction as achieved by posterior spinal fusion using the CD-Solera instrumentation, is comparable to other reported devices. Complication rates are low and health related quality of life comparable to literature. The CD-Solera can be regarded as a safe and effective instrumentation in surgical treatment of AIS.

The smartphone as a tool to screen for scoliosis, applicable by everyone

Purpose (main purposes and research question)The purpose of this study is to assess the accuracy and precision of the smartphone with application and casing (Scolioscreen) compared to the Scoliometer.MethodsThe Axial Trunk Rotation (ATR) was measured in adolescent scoliosis patients visiting the outpatient clinic while performing the Adam Forward Bending Test. The Scolioscreen measurements were performed by the orthopedic surgeon and a parent. They were compared to the measurement with the Scoliometer by the orthopedic surgeon, the gold standard. The accuracy was determined with the Pearson’s correlation coefficient, and precision was determined by assessing the intra- and inter-variability with the intra-class correlation coefficient (ICC).ResultsFifty patients with adolescent idiopathic scoliosis (44 girls) were included with a mean age of 14.1 years and a mean Cobb angle of 38.5°. The accuracy of both the parents and orthopedic surgeon was excellent with a Pearson correlation coefficient of 0.92 and 0.97, respectively. All the ICC’s, both intra- and inter-observer, were over 0.92 demonstrating excellent precision.ConclusionThis study confirms the accuracy and precision of the Scolioscreen when measuring the ATR on patients with AIS. Therefore, the Scoliometer can be replaced by the more easily available Scolioscreen which can be used by both physician and parents.

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.

Retrospective propensity score matching (PSM) study. To investigate the perioperative outcomes comparing adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) patients following posterior spinal fusion (PSF). 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. 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. Adolescent and adult female scoliosis patients had comparable perioperative outcome following PSF surgery that was carried out using a dual attending surgeon strategy.

The Virtual Spine Examination: Telemedicine in the Era of COVID-19 and Beyond

Study Design:Narrative review.Objectives:Describe a comprehensive spine telemedicine examination.Methods:We discuss telemedicine examination techniques for commonly encountered spine conditions.Results:Techniques to evaluate gait, the cervical spine, the lumbar spine, adult spinal deformity patients, and adolescent scoliosis patients via telemedicine are described. We review limitations of the spine telemedicine examination and discuss special considerations such as patient safety and criteria for in-person assessment.Conclusions:While there are limitations to the spine telemedicine examination, unique strategies exist to provide important information to the examiner. Efforts have already been undertaken to validate and expand the capabilities of the spine telemedicine examination.

A case series of eight scoliosis patients undergone pedicle screw placement with freehand technique: study for safety and accuracy

BACKGROUND Pedicle screws and rods are routinely inserted in the vertebrae thoracic to lumbar in scoliosis reconstruction surgery to gain deformity correction and fusion. Intraoperative imaging is often needed to ensure accuracy, but surgical time will be longer and there will be more radiation exposure. Meanwhile, freehand technique is accepted as safe. This study was aimed to evaluate the accuracy of screw insertion in the freehand technique used in adolescent scoliosis surgery.&#x0D; METHODS This case series evaluated a total of 127 pedicle screws inserted using the freehand technique in 8 out of 28 adolescent scoliosis patients from 2011 to 2016 whom agreed for computed tomography (CT) scan follow-up from 2011 to 2016 in Dr. Seotomo Hospital, Surabaya. The accuracy and safety of the freehand technique were evaluated postoperatively in each patient using a CT scan. A successful screw was considered accurate if it was within the vertebral body and inside the safety zone within the limit of 2–4 mm to the medial or lateral side of the vertebral body.&#x0D; RESULTS Of the 127 screws inserted, 106 (83.5%) were accurately placed, and 110 (86.6%) were within the safe zone. According to the level of the spine, in the upper and middle thoracic spine, the inserted screws were accurate in 69.4% and 74.9% within the safety zone, whereas in the lower thoracic and lumbar spine, 94.0% and 95.0% within the safety zone.&#x0D; CONCLUSIONS The freehand technique in scoliosis reconstructive surgery performed by experienced surgeons is accurate and safe.

An analysis of clinical risk factors for adolescent scoliosis caused by spinal cord abnormalities in China: proposal for a selective whole-spine MRI examination scheme

BackgroundApproximately 80% of adolescent scoliosis cases are idiopathic, and some non-idiopathic scoliosis cases caused by spinal cord abnormalities are misdiagnosed as idiopathic scoliosis. This study examined the risk factors for non-idiopathic scoliosis with intramedullary abnormalities, explored the feasibility of whole-spine MRI, and provided a theoretical basis for the routine diagnosis and treatment of adolescent idiopathic scoliosis.MethodThe clinical data of adolescent scoliosis patients who were admitted to Shanghai Tongren Hospital and Shanghai Changhai Hospital between July 1, 2013, and December 31, 2018, were reviewed. According to the whole-spine MRI results, the patients were divided into either the idiopathic group or the intramedullary abnormality group. Sex, age, main curvature angle, main curvature direction, kyphosis angle, scoliosis type, coronal plane balance, sagittal plane balance, abdominal wall reflex, sensory abnormality, ankle clonus and tendon reflexes were compared between the two groups. Student’s t test was used to evaluate the differences in the continuous variables, and the chi-square test was used to evaluate the differences in the categorical variables. Fisher’s exact test was applied to detect the difference in the rate of intraspinal anomalies between the groups. Logistic regression was used to evaluate the correlation between the multivariate risk factors and intramedullary abnormalities.ResultA total of 714 adolescent scoliosis patients with a mean age of 13.5 (10–18 years) were included in the study, and intramedullary abnormalities were found in 68 (9.5%) patients. There were statistically significant differences in the incidence rates of intramedullary abnormalities between males and females, left and right thoracic curvatures, angular scoliosis and smooth scoliosis, and abnormal abdominal wall reflex and ankle clonus (P < 0.01). Logistic regression showed that the ratios for sex, scoliosis direction, scoliosis type, abdominal wall reflex and ankle clonus were 2.987, 3.493, 4.823, 3.94 and 8.083, respectively. The ROC curve showed a sensitivity of 66.18% and a specificity of 89.01%, and the Youden index corresponding to the optimal critical point was 0.5519.ConclusionRisk factors associated with adolescent scoliosis caused by abnormal intramedullary abnormalities included male sex, thoracic scoliosis on the left side, sharp curvature of the spine, abnormal abdominal wall reflex and ankle clonus. In adolescent scoliosis patients, the incidence of scoliosis caused by intramedullary abnormalities was approximately 9.5%. These clinical indicators suggest that there is a high-risk adolescent scoliosis population who should undergo whole-spinal MRI preoperatively to rule out intramedullary abnormalities.

Characteristics of stress symptoms before and after adolescent idiopathic scoliosis surgery and the correlations with postoperative pain

Objective To analyze the characteristics of stress symptoms before and after surgery in adolescent idiopathic scoliosis (AIS) patients and their correlation with postoperative pain. Methods Fifty-four AIS patients aged 13-18 years from January 2015 to June 2018 in Foshan Traditional Chinese Medicine Hospital were selected. The anxiety, stress and stress symptoms of the patients before and 6 months after operation were assessed by the Trauma Symptom Checklist for Children-Alternative version (TSCC-A) and the Youth Self-Report (YSR). The pain was assessed by Visual Analogue Scale. The correlation between the stress symptoms of the patients and postoperative pain were analyzed by linear regression equation. Results The score of anxiety/depression and internalization problems in YSR before operation was (5.40±2.48) and (12.19±4.67) respectively, and 6 months after operation, the score was (4.10±1.92) and (9.81±3.46) respectively, there were significant differences between preoperative and 6 months after operation (t value was 7.266, 8.107, P < 0.05). Before operation, the scores of anger in TSCC-A, the scores of social problems and attention problems in YSR were positively correlated with postoperation pain (P < 0.05), while postoperation pain was positively correlated with the scores of anxiety in TSCC-A, the scores of social problems and attention problems in YSR 6 months after operation (P < 0.05). Conclusions Preoperative stress symptoms of AIS patients are associated with postoperative pain, while postoperative pain is associated with postoperative recovery anxiety. Preoperative intervention should be actively taken to reduce perioperative stress symptoms and postoperative pain, so as to further improve the quality of nursing. Key words: Adolescent; Scoliosis; Stress, psychological; Pain, postoperative; Correlation

Predicting lowest hemoglobin level and risk of blood transfusion in spinal fusion surgery for adolescent idiopathic scoliosis.

The aim of this study was to evaluate the factors associated with timing of lowest hemoglobin (Hb) level and the need for postoperative blood transfusion in posterior spinal fusion for adolescent idiopathic scoliosis. We conducted a retrospective review of all adolescent scoliosis patients undergoing posterior spinal fusion at our institution, 2002-2014. Surgery consisted of segmental pedicle screw fixation using multi-level pedicle screws. Blood-saving techniques were used in all patients. Data included Cobb angle, pre- and postoperative Hb levels, preoperative autologous blood donation (PABD), surgery duration, and allogeneic or autologous transfusion. We used linear and logistic regressions for statistical analysis. There were 456 patients (402 female, 54 male), mean age 16 ± 5years. Lowest Hb was observed on postoperative Days 2 (32.2%) and 3 (33.3%); 45.1% of postoperative transfusions occurred on Day 2. One hundred and eighty-eight (41%) patients who provided PABD had significantly lower preoperative Hb and received more transfusions intraoperatively (22.6% vs. 5.2%) and postoperatively (20% vs. 6.3%) than others. Probability of transfusion increased 49.6 (95% CI 17.40-141.37) times with preoperative Hb < 11g/dL as compared to preoperative Hb > 14g/dL. Probability of transfusion increased 4.3- and 9.8-fold when surgery duration exceeded 5 and 6h, respectively. Probability of transfusion increased 3.3- and 5.3-fold with Cobb angle > 70° and 80°, respectively. We identified clear patient-specific perioperative parameters that affect risk of perioperative blood transfusion, including Cobb angle, PABD and preoperative Hb. Hb measurement beyond postoperative Day 3 is considered unnecessary unless clinically indicated. These slides can be retrieved under Electronic Supplementary Material.

Changing pelvic incidence with the anatomical morphology during adolescence

Objective To evaluate the changing pattern of pelvic incidence (PI) during peak skeleton growth in adolescence and to study whether PI is associated with the anatomical morphology changes of pelvis and sacrum. Methods This retrospective longitudinal study recruited adolescent idiopathic scoliosis (AIS) patients, age between 9 and 18 years with full spine images and have at least 3 times' follow-up. The radiological anatomical parameters were measured in each follow-up including PI, pelvic height (PH), pelvic width (PW), sacral width (SW), femoral head-sacrum (FH-S), sacrum-coccyx (S-C) length, sacrum-coccyx (S-C) distance and sacral curvature ratio. ΔParameter and growth velocity of each parameters were calculated. According to the skeletal maturity, all subjects were divided into 3 groups: Low Risser Group (first visit at Risser 0 and follow up through Risser 0 to 1), Moderate Risser Group (first visit at Risser 1 and follow up through Risser 1 to 3) and High Risser group (first visit at Risser 3 and follow up through Risser 3 to 5). Each group has 106 patients. We increased the male ratio to detect the gender difference. A total of 318 AIS patients were included in our study and there are 117 male patients. Descriptive analysis was conducted on the sample age, gender and measured parameter values with mean and standard deviation (SD). The intra- and inter-observer reliability analysis, and the intraclass correlation coefficient (ICC) were calculated. The correlation between ΔPI and Δparameter was evaluated by calculating Pearson correlation coefficient R value. Results The mean age of all subjects was 12.86 years and the mean Cobb angle was 26.67° at first visit. The peak growth velocity of PI was in Risser 1 (female 1.5°/year and male 1.6°/year). The PI was also increasing rapidly in Risser 0.5 (female 1.2°/year and male 1.5°/year) and Risser 2 (female 1.1°/year and male 1.4°/year). When the Risser grade reached 3 which was a sign of the end of skeleton growth, the PI still had increasing potential and it increased slower in Risser 4 and Risser 5. There showed significant correlation between ΔPI and Δage in the three group(P<0.05) and the correlation was stronger in Low Risser group and Moderate Risser group than that in High Risser group. There showed significant correlation between ΔPW and ΔPI in all groups while ΔPH and ΔPI showed correlation only in Low Risser group. There showed significant correlation between ΔSW and ΔPI, ΔFH-S and ΔPI, ΔS-C length and ΔPI (P<0.05) except ΔS-C length in male Low Risser group and ΔFH-S in female High Risser group and the Moderate Risser group had the strongest correlation. The ΔS-C distance and ΔS-C ratio didn't show any correlation with ΔPI (P<0.05) expect the male of High Risser group. Conclusion Pelvic incidence is increasing during skeleton growth at the age of 9 to 17. It has the peak growth velocity in Risser 1 and remains growth potential in Risser 5. PI growth is correlated with pelvic height, femoral head-sacrum distance, pelvic width and sacral width. Key words: Scoliosis; Pelvimetry; Adolescent; Pelvis; Sacrum; Growth and development

(200) - Preliminary analysis of a novel objective assessment of kinesiophobia in adolescent scoliosis patients scheduled for corrective surgery

(200) - Preliminary analysis of a novel objective assessment of kinesiophobia in adolescent scoliosis patients scheduled for corrective surgery

Analysis of cardiopulmonary exercise testing results of 46 adolescent idiopathic scoliosis patients without pulmonary dysfunction

Objective To explore the cardiopulmonary function and exercise capacity of adolescent idiopathic scoliosis (AIS) patients without pulmonary dysfunction. Methods In this retrospective study, the results of exercise tests administered to AIS patients without pulmonary dysfunction were reviewed seeking any consistent relationship between scoliosis location and severity and the test results. Correlations relating pulmonary function, body mass index (BMI), age and exercises tolerance were also sought. Results Forty-six patients were included, 17 with solely thoracic scoliosis, 11 with solely thoracolumbar scoliosis and 18 with both thoracic and thoracolumbar scoliosis. Ten of those studied (21.74%) had normal exercise tolerance, while in 24 exercise tolerance was mildly impaired, in 11 moderately and in 1 severely. The average peak minute ventilation (MV) of the thoracic scoliosis group [(43.11±8.47) L/min] was significantly lower than that of the thoracolumbar scoliosis group [(50.81±10.11) L/min]. The average VO2AT/kg of the thoracic+ thoracolumbar scoliosis group [(14.16±2.04) ml/kg/min] was significantly lower than that of the thoracic scoliosis group [(16.82±2.87) ml/kg/min] and of the thoracolumbar scoliosis group [(17.78±4.34) ml/kg/min]. Among the thoracic scoliosis patients, no significant difference in exercise tolerance was observed between those with moderate and severe scoliosis. The peak VO2% pred was negatively correlated with BMI, but not significantly correlated with pulmonary function or age. Conclusions Although without pulmonary dysfunction, the AIS patients showed a significantly lower tolerance for maximum exercise generally. The average peak ME was significantly lower in the thoracic scoliosis group than in the thoracolumbar scoliosis group, while the average VO2AT/kg was significantly lower in the thoracic + thoracolumbar scoliosis group than in the solely thoracic and thoracolumbar scoliosis groups. Exercise tolerance was negatively correlated with BMI, but uncorrelated with the severity of the scoliosis, pulmonary function or age. Key words: Adolescent idiopathic scoliosis; Cardiopulmonary exercise testing; Body mass index

Research on in vivo kinematics characteristics of the spine in adolescent idiopathic scoliosis patients based on 3D image volume fusion technique

Objective To characterize the spinal motion of 6 degrees of freedom (6DOF) under the fulcrum bending in Lenke type 1 adolescent idiopathic scoliosis (AIS) patients using 3D image volume fusion technique. Methods Ten volunteers with Lenke type 1 AIS were examined by the Gemstone Spectral Imaging to obtain their T1-S1 vertebral morphological data in the supine position and fulcrum bending position. With the computer software, images of 2 different positions were fused with the 3D image to obtain in vivo kinematics data of each vertebral body in the target area. Results In the apical vertebrae (AV) region, the main range of motion in the fulcrum bending position ranged from -2.57°±0.95° to -1.37°±0.65°, showing significant differences between segments (P 0.05); along the vertical axis, coupling rotation ranged from 0.18°±0.47° to 1.35°±0.52°; along the coronal axis, coupling flexion and extension ranged from 1.62°± 0.41° to 2.07°± 0.37°. In the lower end vertebrae (LEV) region, the main movement ranged from -0.79°±0.63° to 0.73°±1.09°, showing significant differences between the 3 segments (P< 0.05); along the vertical axis, the coupling rotation ranged from -1.62°±1.05° to -0.60°±0.60°; along the coronal axis, the coupling flexion extension ranged from -1.41°±0.87° to -0.75°±0.66°. Conclusions In the fulcrum bending position, Lenke type 1 AIS shows a unique motion and coupling mechanism in the spine. The coupling rotational movement in the UEV region is at the same side as the lateral flexion movement. The coupling rotational motion in the AV and LEV regions is opposite the lateral flexion movement. Key words: Scoliosis; Imaging, three-dimensional; Range of motion, articular; Adolescent

Bilateral ipilateral and contralateral motor evoked potentials in scoliosis

Intraoperative monitoring (IOM) during spinal cord surgery are effectively obtained with percutaneous cortical stimulation. Ipsilateral MEPs have significantly larger amplitudes, and lower thresholds than contralateral MEPs. MEP onset latencies were not significantly different, suggesting transcallosal stimulation of the contralateral motor cortex resulted in ipsilateral MEPs as composites from early ipsilaterally conducted descending motor tracts (via corticoreticulospinal or corticopropriospinal pathways) and late transcallosally stimulated components. Cross scalp stimulation position is advocated to elicit larger amplitude MEPs when anaesthetic agents may cause suppression of cortical or spinal excitability. Although less focal in nature, cross scalp stimulation would be most suitable for infratentorial or spinal surgery. Mechanical compromise of ipsilaterally and contralaterally descending motor tracts suggest a critically large functional derangement enough to result in visible neurological deficits. Conversely, sole reduction of ipsilateral or contralateral MEP amplitudes may not have resulted in a significant dysfunction of the motor tracts to cause visible neurological deficit. Concurrent ipsilateral and contralateral MEP amplitude changes point to a definite surgical urgency. Ipsilateral MEPs are of value in reducing false positive observations during IOM. Comparison of IOM data between neurologically normal adolescent and degenerative scoliosis patients suggests inherent motor system dysfunction in the former. These novel findings will be discussed.