Adolescent Scoliosis Patients Research Articles

Health-related Quality-of-life in Adolescent Idiopathic Scoliosis Patients 25 years after Treatment

Introduction The purpose of this study was to evaluate the long-term clinical outcomes using validated measures of health-related quality of life (HRQOL), 25 years after termination of scoliosis treatment, in a cohort of Adolescent Idioapthic Scoliosis Patients. Material and Methods 219 consecutive patients treated with Boston brace or posterior spinal fusion using Harrington-DTT between 1983–90, were invited to participate in a long-term evaluation study. A validated Danish version of the Scoliosis Research Society 22R (SRS22R) and Short Form-36 (SF36V1) were administered to the patients two weeks before the clinical and radiological examination. Results 159 (72,6%) patients participated in the clinical follow up and questionnaires, 11 patients participated only in the questionnaires, 8 emigrated, 4 were excluded due to progressive neurological disease and 2 were deceased. The total follow up was 170 patients (83%), average follow up was 24,4 years (22–30 years). SRS 22-R domains scores were within the range described as normal for the general population with no statistical difference between the two treatment groups except in the Satisfaction domain, were the PSF group had better scores than the braced group. The SF 36 PCS and MCS scores in both AIS cohorts were similar to the scores for the general population. Conclusion HRQOL, as measured by the SRS 22-R and SF-36, of adult AIS patients treated with Boston brace or PSF during adolescents were similar to the general population. No clinical progression of the deformity has been detected during the 25-follow up period. The PSF group had a small but statistical significant higher score in the Satisfaction domain compared with the braced group.

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.

Different potential risk of injury from thoracic pedicle screw insertion between left and right main-stem bronchus in Lenke 1 type adolescent idiopathic scoliosis.

The changed relative anatomic position of trachea with increased potential risk of injury from thoracic pedicle screw (TPS) has been reported in Lenke 1 type adolescent idiopathic scoliosis (AIS) patients. However, such change of main-stem bronchus has not been investigated. The purposes of this study were to evaluate the altered positions of both left and right main-stem bronchus in Lenke 1 type patients and to assess the potential risks of main-stem bronchus injuries from TPS screw insertion in these patients. A total of 19 Lenke 1 type AIS patients and 15 normal teenagers were included. Axial computed tomography (CT) images at T5 level were obtained in all these subjects to evaluate the main-stem bronchus-vertebral distance (MVD, the closet distance between the main-stem bronchus and vertebral body) and main-stem bronchus-vertebral angle (MVA, defined as 0° when the main-stem bronchus was located directly lateral to the left and 180° when directly lateral to the right) on both left and right sides. The percentage of main-stem bronchus located adjacent to vertebrae and in the direction of screw passage was calculated to analyze potential risks of injuries from pedicle screw placement. Both the average left and right MVD were significantly smaller in AIS patients when compared with normal teenagers at T5 level (P<0.05). Both the mean left and right MVA were lower in AIS patients than those in normal teenagers at T5 level (P<0.05). All the AIS patients (100%) had the right main-stem bronchus with high risk of injury from right TPS placement and only five AIS patients (26.3%) had left main-stem bronchus with high risk of injury from left TPS placement at T5 level. No main-stem bronchus was found to be at risk of injury from TPS placement on both two sides in normal teenagers at this level. Both the right and left main-stem bronchus were located much closer to the vertebrae in Lenke 1 type AIS patients when compared with normal teenagers. However, the potential risk of injury of main-stem bronchus from TPS placement was higher on the right side than that on the left side.

The Vestibular-Evoked Postural Response of Adolescents with Idiopathic Scoliosis Is Altered

Adolescent idiopathic scoliosis is a multifactorial disorder including neurological factors. A dysfunction of the sensorimotor networks processing vestibular information could be related to spine deformation. This study investigates whether feed-forward vestibulomotor control or sensory reweighting mechanisms are impaired in adolescent scoliosis patients. Vestibular evoked postural responses were obtained using galvanic vestibular stimulation while participants stood with their eyes closed and head facing forward. Lateral forces under each foot and lateral displacement of the upper body of adolescents with mild (n = 20) or severe (n = 16) spine deformation were compared to those of healthy control adolescents (n = 16). Adolescent idiopathic scoliosis patients demonstrated greater lateral displacement and net lateral forces than controls both during and immediately after vestibular stimulation. Altered sensory reweighting of vestibular and proprioceptive information changed balance control of AIS patients during and after vestibular stimulation. Therefore, scoliosis onset could be related to abnormal sensory reweighting, leading to altered sensorimotor processes.

Study of bone strength in patients with adolescent idiopathic scoliosis

Objective To investigate the bone strength of adolescent idiopathic scoliosis (AIS) patients. Methods A total of 68 AIS patients and 20 healthy subjects were recruited. Speed of sound (SOS), Z-score and percentile of distal radius of normal subjects and AIS patients were measured using the quantitative ultrasound. Results Compared with normal controls, AIS had significantly lower average SOS, Z value and percentile. No significant difference was found among different curve patterns and gender of AIS patients. There was a positive correlation between SOS and age in AIS patients. However, there was no correlation between SOS and maximal Cobb angle in AIS patients. Conclusions AIS patients have lower bone strength generally. The bone strength has a positive correlation with the age, but no correlation with the curve pattern and gender in AIS patients. Key words: Adolescent; Idiopathic; Scoliosis; Bone strength

Plasma levels of tumor necrosis factor-α in adolescent idiopathic scoliosis patients serve as a predictor for the incidence of early postoperative cognitive dysfunction following orthopedic surgery.

The aim of the present study was to evaluate whether the levels of the plasma biomarkers, cortisol, interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor (TNF)-α, change in adolescent idiopathic scoliosis patients with postoperative cognitive dysfunction (POCD); thus, may serve as predictive factors for POCD. In total, 75 adolescent scoliosis patients, aged between 11 and 18 years and categorized as American Society of Anesthesiologists classification I or II, were scheduled for orthopedic surgery with general anesthesia. Blood samples were collected on the day of admission and at day 2 following surgery. The plasma levels of IL-1β, IL-6, IL-10 and TNF-α were measured using an enzyme-linked immunosorbent assay, while the concentrations of cortisol were determined using a radioimmunoassay. Cognitive function was assessed one day prior to and at day 7 following the surgery in a quiet room with the guidance of a Chinese version protocol. In total, 66 patients completed the sample collection and neurocognitive tests. According to the criteria for the diagnosis of POCD, 19 patients (28.8%) developed POCD within seven days of surgery. No statistically significant differences were observed in the baseline concentrations of cortisol, TNF-α, IL-1β, IL-10 or IL-6 between the POCD and non-POCD groups. However, the baseline plasma level of TNF-α on day 2 in the POCD group was found to be higher compared with the non-POCD group. In addition, at day 2 after surgery, the concentration of cortisol in the non-POCD group was higher compared with the POCD group. Therefore, the plasma level of TNF-α in adolescent idiopathic scoliosis patients at day 2 following orthopedic surgery may be a predictor for the incidence of early POCD.

The possibilities of using elastic therapeutic (Kinesio) tape in patients with scoliosis

Elastic Therapeutic (Kinesio Tape) has rapidly become a recognised therapeutic modality in many musculoskeletal and neurological disorders. This tape, applied with a certain amount of stretch to its own paper backing is known under many names making research into it a challenging task. Its recoil properties make it a very suitable tool to assist in current scoliosis management. The studies of the various elastic therapeutic tape brands have reported positive effects on pain, ROM, balance, strength, function and proprioception. A large amount of anecdotal evidence has been published and warrants further research. It is reasonable to assume that the outcome of the research on the effects of taping on both upper and lower extremities by means of Functional Magnetic Resonance Imaging and Ultrasonic Imaging is transferable to the trunk. Both the research on the physiological movement of the skin of the trunk captured by three-dimensional motion analysis system (Vicon Motion Systems) by T. Fukui and the videos of the skins’ anatomy and physiology by Dr. J.C. Guimberteau have resulted in novel ways to use the tape. A number of these tape possibilities will be presented and their function addressed. The use of elastic therapeutic tape applications to: - assist patients to 'hold' their corrected posture (Schroth, SEAS exercises). In both Idiopathic Adolescent Scoliosis and adult scoliosis patients this extra stimulus gives 24hours a day sensory information. - help relieve pain in the (elderly) scoliosis patient with postural collapse. - assist pulmonary function in the both patients with Idiopathic Adolescent Scoliosis and neuromuscular scoliosis will all be presented and discussed. Elastic Therapeutic Tape is a wonderful new extra tool in the management of scoliosis patients.

Relationship between the occurrence of postoperative cognitive dysfunction and the levels of serum interleukin-1 beta/ interleukin-6 during perioperative period in idiopathic adolescent scoliosis patients

Objective To observe the occurrence of postoperative cognitive dysfunction (POCD) in adolescent scoliosis patients after orthopedic surgery and study its association with levels of serum interleukin (IL)-1β/IL-6 during perioperative period.Methods Sixty-seven adolescent scoliosis patients,who were scheduled for orthopedic surgery with general anesthesia were proposed to be enrolled.The levels of serum IL-1β and IL-6 were measured on the day for admission(T0),before surgery(T1),at the end of the surgery (T2) and the second day after surgery (T3) respectively and neurocognitive testing was performed at 1 d before surgery and 1 week after operation.Age,sex,years of education,past medical history,and visual analogue scale score after surgery,duration of surgery and other intraoperative indexes and also postoperative complications were recorded.According to the diagnostic criteria of POCD,patients were divided into two groups:POCD and NPOCD.All the data were put for statistical analysis.Results Sixty-six patients completed all these tests.Nineteen patients developed POCD,so the occurrence was 28.8％ at 7 d postoperatively.Statistical analysis showed that there were no differences in the levels of serum IL-1β and IL-6 at T0 and T1 in all the patients,while the concentrations increased at T2 and T3,but there were no differences between the two groups.In addition,comparisons between the two groups showed that the infusion of the volume of autologous blood in POCD group [(380±341) ml]was more than that in NPOCD group [(218±270) ml](P＜0.05).Conclusions The incidence of POCD is 28.8％ on the seventh day after scoliosis orthopedic surgery.It reminds us that we should cause enough attention on such surgeries.We did not found the relationship between the levels of serum IL-1beta/IL-6 and the occurrence of POCD,but the result sμggested that the volume of infused autologous blood might be associated with the occurrence of POCD,and further research was needed. Key words: Adolescent ; Scoliosis orthopedic surgery ; Postoperative cognitive dysfunction ; Interleukin-1beta ; Interleukin-6 ;

SU‐E‐I‐15: Comparison of Radiation Dose for Radiography and EOS in Adolescent Scoliosis Patients

Purpose:To estimate patient radiation dose for whole spine imaging using EOS, a new biplanar slot‐scanning radiographic system and compare with standard scoliosis radiography.Methods:The EOS imaging system (EOS Imaging, Paris, France) consists of two orthogonal x‐ray fan beams which simultaneously acquire frontal and lateral projection images of a standing patient. The patient entrance skin air kerma was measured for each projection image using manufacturer‐recommended exposure parameters for spine imaging. Organ and effective doses were estimated using a commercially‐available Monte Carlo simulation program (PCXMC, STUK, Radiation and Nuclear Safety Authority, Helsinki, Finland) for a 15 year old mathematical phantom model. These results were compared to organ and effective dose estimated for scoliosis radiography using computed radiography (CR) with standard exposure parameters obtained from a survey of pediatric radiographic projections.Results:The entrance skin air kerma for EOS was found to be 0.18 mGy and 0.33 mGy for posterior‐anterior (PA) and lateral projections, respectively. This compares to 0.76 mGy and 1.4 mGy for CR, PA and lateral projections. Effective dose for EOS (PA and lateral projections combined) is 0.19 mSv compared to 0.51 mSv for CR.Conclusion:The EOS slot‐scanning radiographic system allows for reduced patient radiation dose in scoliosis patients as compared to standard CR radiography.

Abnormal growth of spine in patients with adolescent idiopathic thoracic scoliosis

To investigate if the growth patterns of the spine and pelvis are consistent in adolescent idiopathic scoliosis (AIS) patients with single thoracic curves. Forty-eight thoracic adolescent idiopathic scoliosis (T-AIS) female patients and 48 healthy age-matched adolescents were recruited consecutively between December 2011 and October 2012. Radiographic parameters including height of spine (HOS), length of spine (LOS), height of thoracic spine (HOT), length of thoracic spine (LOT), height of pelvis (HOP), width of pelvis (WOP) and width of thorax (WOT) were measured on the long-cassette posteroanterior standing radiographs. In addition, ratios including HOS/HOP, LOS/HOP, HOT/HOP, LOT/HOP, LOS/LOT, WOT/WOP were also calculated. Independent t-test was performed to compare the radiographic parameters and ratios between the two groups. Compared to the age-matched healthy adolescents, T-AIS patients had a significantly higher LOS and LOT (t = -2.364 and -1.495, P = 0.020 and 0.043) and smaller HOS and HOT (t = 2.060 and 3.359, P = 0.042 and 0.001). Yet, all of HOP, WOP and WOT showed no significant difference between T-AIS patients and healthy adolescents. Similarly, LOS/HOP and LOT/HOP were significantly higher in T-AIS patients as may be expected with an average LOS/HOP of 2.26 ± 0.14 in normal controls.In addition, LOS/LOT in normal controls had a trend of increase with age which was different from the stable LOS/LOT in T-AIS patients, indicating an increased growth of thoracic vertebra compared to lumbar vertebra. Compared to the age-matched healthy adolescents, T-AIS patients have an abnormal growth characteristics with longer spine. The growth of pelvis and thorax show no significant differences between T-AIS patients and healthy adolescents.

Changhai fulcrum bending radiographic technique to assess curve flexibility in patients with adolescent idiopathic scoliosis

To evaluate the role and value of Changhai fulcrum bending radiograph(CH-FBR) in curve flexibility assessment of adolescent idiopathic scoliosis(AIS) patients. Thirty-seven AIS patients treated between June 2012 and August 2013 were enrolled, including 31 female and 6 male patients whose age ranged from 10 to 19 years, averaged of 15.0 years. The assessment of radiographs included preoperative standing posterior-anterior radiograph, supine side-bending radiograph, traditional fulcrum bending radiograph, Changhai fulcrum bending radiograph and postoperative standing posterior-anterior radiograph. Postoperatively, radiographs were assessed at one week. The CH-FBR was performed at the lowest height and the optimized height which means the weight on the fulcrum touch the maximum. All measurements of angle were made with use of the Cobb method. The flexibility of the curve as well as the correction rate and fulcrum bending correction index (FBCI) were calculated for all patients. The maximum height of CH-FBR, basic weight and maximum weight were measured for all AIS. Paired t-tests were used to assess differences between preoperative and postoperative curves within group samples. The Pearson correlation coefficients were calculated using bivariate analysis between CH-FBR flexibility rate and correction rate, the maximum height of CH-FBR and maximum weight, the height changes of CH-FBR and weight changes. A total of 46 curves were involved in this study, including 28 thoracic and 18 thoracolumbar/lumbar curves. Preoperatively, the mean Cobb angle of the 46 structural curves was 47° ± 11°. Postoperatively, the mean Cobb angle was 11° ± 5°. Cobb's angle in supine side-bending(t = 7.2, P = 0.001), traditional fulcrum bending (t = 7.1, P = 0.001) and lowest height of Changhai fulcrum bending (t = 6.5, P = 0.001) were significantly different from the postoperative Cobb angle; Cobb's angle in traditional FBR (t = 11.0, P = 0.001) and lowest height of Changhai fulcrum bending (t = 13.6, P = 0.001) were significantly different from the optimized height CH-FBR Cobb angle. There was no significant difference found between traditional FBR Cobb angle and lowest height CH-FBR Cobb angle (t = 2.0, P = 0.051), optimized height CH-FBR Cobb angle and postoperative Cobb angle (t = 0.9, P = 0.36), lowest height CH-FBR Cobb angle and traditional FBR Cobb angle(t = 2.0, P = 0.051). The maximum height of CH-FBR, basic weight and maximum weight were (29.6 ± 1.4)cm,(20 ± 6)kg, and (40 ± 6) kg. Preoperatively, the mean Cobb angle of the 28 structural curves(main thoracic curves) was 46° ± 11°. Postoperatively, the mean Cobb angle was 12° ± 6°. Preoperatively, the mean Cobb angle of the 18 structural curves(thoracolumbar/lumbar curves) was 49° ± 12°. Postoperatively, the mean Cobb angle was 10° ± 5°. The results were same in 28 structural curves, 18 structural curves as well as 46 curves. Correlation analysis of 46 curves indicated that the maximum height of CH-FBR positively correlated with maximum weight (r = 0.69, r(2) = 0.47, P = 0.001), the height changes of CH-FBR positively correlated with weight changes on CH-FBR (r = 0.62, r(2) = 0.38, P = 0.001). CH-FBR is a more reliable and effective method than traditional FBR and supine side-bending for curve flexibility evaluation in AIS patients. Moreover, compared to the traditional FBR and side-bending radiograph, the flexibility suggested by the optimized height CH-FBR more closely approximates the postoperative result made by pedicle screws fixation and fusion.

Sagittal Cervical Alignment in Adolescent Idiopathic Scoliosis

Study DesignRetrospective case series of surgically treated adolescent scoliosis patients. ObjectivesTo assess the radiographic changes of cervical kyphosis and identify the possible factors affecting postoperative sagittal cervical kyphosis in surgically treated patients with adolescent idiopathic scoliosis. Summary of Background DataCervical kyphosis is a well-recognized phenomenon in patients with adolescent idiopathic scoliosis. Despite recent reports, the prevalence, radiographic changes, and possible factors affecting postoperative sagittal cervical kyphosis are controversial. Materials and MethodsA retrospective review of a single-center database was performed on 133 consecutive patients with adolescent idiopathic scoliosis treated with long instrumented (more than 5 levels) spine fusion (minimum, 2 years; mean, 3.3 years; range, 2 to 5.5 years). A total of 89 patients met all of the inclusion criteria. Preoperative and postoperative radiographic measurements and patient demographics were investigated. ResultsPostoperative cervical kyphosis was observed in 46 patients. Cobb angle decreased from 48.1° ± 13.1° to 15.4° ± 11.1° at the final follow-up. Cervical kyphosis significantly decreased from 5.5° ± 8.9° preoperatively to −1.5° ± 8.9° at the final follow-up. No difference was observed for T2–T5, T5–T12, lumbar lordosis, sacral slope, pelvic incidence, pelvic tilt, and sagittal vertical axis during the follow-up. Notably, T2 sagittal tilt was significantly increased from preoperatively to the final follow-up. Pearson correlation coefficient test showed a strong correlation between postoperative cervical lordosis and T2 sagittal tilt (r = 0.73; p < .001). ConclusionsDespite the significant increase of cervical lordosis, 85% of patients still have a kyphotic or less lordotic cervical spine. The strong positive association between cervical lordosis and T2 sagittal tilt suggests that the sagittal cervical alignment of adolescent idiopathic scoliosis patients is closely related to the global sagittal spine balance rather than thoracic kyphosis.

Lumbo-abdominal muscle activity while standing in adolescents with idiopathic scoliosis

Objective To characterize the lumbo-abdominal muscles activities of adolescent idiopathic scoliosis (AIS) patients in different standing postures by using surface electromyography (sEMG).Methods A total of 33 AIS patients and 15 healthy subjects were recruited.The sEMG signals from the lumbo-abdominal muscles of the healthy subjects and AIS patients were measured with the FlexComp Infiniti apparatus.The sEMG signals were recorded in different standing postures with and without visual and auditory input.The activation of the lumbo-abdominal muscles was compared between healthy subjects and AIS patients.Results In different standing posture with and without visual and auditory information input,the activation rate of the concave side of the apex level paraspinal muscle was 4.91％ MVIC,5.22％ MVIC,5.51％ MVIC,6.01％ MVIC,and the activation rate of the convex side of the apex level paraspinal muscle was 6.45％ MVIC,7.69％ MVIC,8.31％ MVIC,8.77％ MVIC.The activation of the paraspinal muscles at the concave side of the apex level was lower than that of the convex side in the AIS group in different standing postures with and without visual and auditory input.The activation of the paraspinal muscles at the convex side of the apex level was lower during standing on the stable plane with visual and auditory input than during standing on the soft cushion without visual and auditory input in the AIS group.Conclusion The activation of the bilateral apex level paraspinal muscles is asymmetry in AIS patients.It is easier to activate the paraspinal muscles at the convex side of the apex level during standing on the soft cushion without visual and auditory input in AIS patients. Key words: Adolescents; Scoliosis; Lumbo-abdominal muscles; Surface electromyography

Rasterstereographic Evaluation of Interobserver and Intraobserver Reliability in Postsurgical Adolescent Idiopathic Scoliosis Patients

Evaluation of rasterstereographic examinations in postsurgical adolescent scoliosis patients: a reliability study. To investigate the interobserver and intraobserver reliability of rasterstereographic 3-dimensional back surface analysis and reconstruction of spine parameters including trunk length, trunk inclination, lateral deviation, kyphotic and lordotic angles in adolescent idiopathic scoliosis patients after scoliosis surgery. The rasterstereography device formetric III 4D has been in routine clinical use for patients with scoliosis and other spinal deformities, reducing the patients' radiation exposure considerably. The reliability of this device has previously been examined in healthy volunteers but not in patients after scoliosis surgery. Thirty-nine adolescent idiopathic scoliosis patients (32 women and 7 men) after scoliosis surgery with a mean age of 23.5 years (±10.6 y) were examined rasterstereographically by 5 investigators. Each investigator made a series of 3 measurements of each participating patient consecutively. The intraclass correlation coefficient (ICC) and the Pearson product moment correlation were calculated. In addition, the comparative analysis of the first and 15th measurements was assessed. The ICCs of all investigated parameters demonstrated very high interobserver and intraobserver reliability. The maximum ICC (0.988) for interobserver reliability of the 5 investigators was found for the trunk length and the minimum ICC (0.918) for lateral deviation. There were highly significant positive correlations between the first, second, and third measurements (r=0.994-0.697; P<0.001) for intraobserver reliability. Overall highly significant correlation was found comparing the results of the first and the 15th rasterstereographic measurement. The reliability of rasterstereography formetric III 4D in regard to the investigated parameters is excellent. The device can be used very efficiently by 1 or multiple investigators to analyze postsurgical adolescent idiopathic scoliosis patients in clinical practice, requiring only a single investigational exposure.

La scoliosi dell’adulto: il trattamento chirurgico

Surgical treatment of adult scoliosis still presents many points of discussion. In decision making it is mandatory to evaluate all the possible alternatives to surgery. Progression of deformity to an unacceptable degree and pain resistant to conservative treatments are the usual surgical indications in the middle-aged and older adult. For the younger adult magnitude of deformity and progression of deformity are relative indications. Correction of deformity and aesthetic improvement are only requested in young adults, while older patients require pain relief and improvement of quality of life. Posterior fusion and pedicle screws instrumentation, with lumbar osteotomies, provide a satisfactory correction. Complications and pseudoarthroses occur much more frequently in adults compared to the adolescent scoliosis patients. Surgical treatment of scoliosis in adulthood is a challenge to the experienced spinal deformity surgeon. A correct surgical indication and appropriate surgical technique con reduce the rate of complications.

The influence of the Risser sign on the post-operative sagittal profile of idiopathic thoracic scoliosis patients treated with the anterior instrumentation

Objective To analyze the influence of the Risser sign on the sagittal compensatory mode of the spine in idiopathic thoracic scoliosis after anterior spinal fusion.Methods Between June 2002 and November 2006,43 adolescent idiopathic scoliosis(AIS)patients(Lenke 1)undergone anterior correction with a minimum 2 years follow-up were included in this study.The patients were divided into three groups according to the Risser sign:group A(Risser 0),group B(Risser 1-3),and group C(Risser 4-5).The preoperative,postoperative and follow-up sagittal profile were evaluated by the following radiological parameters measured on the lateral radiograph,including the thoracic kyphosis,the lumbar lordosis,the thoracolumbar junction kyphosis,the distal junctional kyphosis,and the sagittal vertical axis.Results In group A,the thoracolumbar junction kyphosis significantly changed from-1.7° preoperative to 6.6° at the final follow-up,with an average increase of 8.3°.Similarly,in group B,the thoracolumbar junction kyphosis changed from -7.3° before surgery to 0.6° at the final follow-up,with an average variation of 7.9°.No obvious change of the thoracolumbar junction kyphosis was observed in group C.At the final follow-up,the average thoracic kyphosis in three groups was 21.2°,18.4° and 14.7°,respectively.No significance of the variation of the thoracic kyphosis was observed in the three groups,however,in group A and B,the thoracic kyphosis showed an ascending trend during the follow-up without significant statistical difference,in addition; the ratio of the thoracic kyphosis increased in group A was higher compared with group B and C.Conclusion For AIS patients with low Risser sign,the increased thoracic kyphosis,and the thoracolumbar junction kyphosis may be ascribed to the decompensation of thoracolumbar region caused by the reconstruction of sagittal alignment due to the continued growth of posterior elements of the thoracic spine. Key words: Scoliosis; Adolescent; Spinal fusion

Simultaneous translation on two rods is an effective method for correction of hypokyphosis in AIS: radiographic results of 24 hypokyphotic thoracic scoliosis with 2 years minimum follow-up

Recent publications confirm that moderate correction of thoracic hypokyphosis can be achieved by posterior instrumentation with hooks or pedicle screws. Twenty-four prospective and consecutive thoracic adolescent scoliosis patients with hypokyphosis (<20°) were operated on by posterior spinal fusion (PSF) with a specific method of reduction: Simultaneous translation on two rods (ST2R), performed by the same surgeon using stable anchorages such as screws or self-stabilizing claws. Radiographic parameters were measured preoperatively, at 1 month, 1 year and at 2 years minimum follow-up. In the coronal plane, the average main curve was significantly reduced from 51° to 17° and maintained at last follow-up, corresponding to an average correction of 67%. In the sagittal plane, the average kyphosis angle was significantly improved from 9° to 30° postoperatively and to 32° at last follow-up, corresponding to a mean gain of 23°. The 24 patients reported normal kyphosis at last follow-up (≥20°). Reduction of scoliosis by ST2R is an effective method that gives coronal correction equivalent to all screw constructs and allows restoration of normal thoracic kyphosis.

Prevalence of valvular regurgitation in adolescent idiopathic scoliosis patients

Sixty-seven adolescent scoliosis patients with thoracic curve (Lenke type 1, 3, and 6) and 16 nonthoracic curve patients (Lenke type 5) were evaluated with color Doppler echocardiography to identify and compare the prevalence and frequency of valvular regurgitation. Regurgitation of one or more valves was detected in 36 thoracic curve patients (53.73%) and seven nonthoracic curve patients (43.75%). Regurgitation with tricuspid valve involvement was statistically significant in patients with thoracic curve (P=0.0216). Frequency of tricuspid valve involvement was statistically significant (28.57 vs. 83.33%, P=0.0076) in patients with thoracic curve. Those without cardiac disease had a higher incidence of valvular regurgitation.

Comparison of all segmental pedicle screws versus selective segmental pedicle screws instrumentation in severe rigid adolescent idiopathic scoliosis

Objective To compare the corrective results of treatments between all segmental pedicle screws (ASPS) and selective segmental pedicle screws (SSPS). Methods A retrospective study of 48 severe rigid adolescent idiopathic scoliosis (AIS) patients under only posterior pedicle screws instrumentation and fusion in our department during March 2003 to December 2008 was made. Patients with a major thoracic curve >70° and flexibility <30% in antero-posterior standing radiograph and supine bending radiograph were screened. There were 48 patients suitable for this study selected from 327 AIS ones. Of them, 22 cases were fixed with SSPS and 26 with ASPS. Statistic parameters of age, preoperative Cobb angle of major thoracic curve, flexibility, blood loss during operation, correction rate of major thoracic curve in coronal plane one week after operation and last follow-up were compared between two groups. Results Mean age was 15.65 years and 17.32 years respectively in ASPS group and SSPS group, preoperative Cobb angle of major tho-racic curve in standing coronal plane was 86.77°±11.71° (71.31°-107.51°) and 87.56°±14.88° (70.10°- 117.83°), flexibility was 15.82%±7.37% (6.82%-29.74%)and 19.30%±9.19% (0.89%-29.71%), operation time was (280.69±35.92) min and (275.10±33.91) min, blood loss during operation was (988.50±287.80) ml and (800.98±360.47) ml, correction rate of major thoracic curve in coronal plane one week after operation were 60.07%±8.80% and 46.79%±14.90% respectively. Lose of correction was observed in one patient in ASPS group because of broken of the convex side rod. Conclusion There is a higher postoperative correc-tion rate of major thoracic curve in coronal plane of severe rigid AIS in ASPS group than in SSPS group. Key words: Scoliosis; Adolescent; Spinal fusion

PLATE-ROD SYSTEM IN THE MANAGEMENT FOR PROGRESSIVE SCOLIOSIS IN GROWING CHILDREN

Objective: To study the therapeutic mechanism of an innovative instrumentation — Plate-Rod System for Scoliosis (PRSS) and its effectiveness for the surgical management of early onset scoliosis (EOS) and adolescent scoliosis (AIS). Method: A new device — PRSS was developed in our department. Between June 2000 and July 2008, 23 patients with progressive EOS, and from October 1998 to August 2003, a total of 66 AIS patients, who underwent one-stage PRSS procedure without bony fusion and had been followed up for more than two years, were evaluated prospectively. The mean age at the time of surgery was 7.98 years in the EOS group, and was 12.15 years in the AIS group. Experimental studies including X-ray analysis, photo-elastic test and type X collagen were used to test the therapeutic mechanism. Results: The subjects were followed up for more than 2 years. The mean scoliosis improved from 80.7° to 30.5° after surgery with a corrective rate of 62.2%. The length of the growth of the instrumented spine was on average 13.3 mm in EOS group. In AIS group, the mean precentage of correction was 68.86%. There were no severe complications in our studies. When PRSS was in place, compressive stress was found to exert on the convex side, while tensile stress on the concave side of the curvature, which was reflected by the changes in the color band in the photo-elastic test and the changes in the width of the disc spaces, and more type X collagen was expressed on the convex side than the concave side. This suggests that compressive stress leads to increase in earlier cartilage degeneration of end plate on the convex side, which is correlated with the decreased growth of the end plate of this side, resulting in maximum spinal realignment. Conclusion: The PRSS which dispenses with spinal fusion and allows extension along with the children's growth, is able to provide and maintain desirable correction of scoliosis in the later growing years due to its modulating efficiency in normalizing the spinal growth. This new device is an effective instrumentation for correcting scoliosis, especially for EOS.