Cases Of Idiopathic Scoliosis Research Articles

The effect of surgical time on perioperative complications in adolescent idiopathic scoliosis cases. A propensity score analysis.

Posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS) can be lengthy and complication-ridden. The aim of this study was to evaluate the effect of surgical time on perioperative complications in this procedure when controlling for confounding variables with propensity score analysis. This was an IRB-approved review of electronic health records from 2010 to 2019 at a single tertiary care children's hospital. Patients undergoing PSIF were grouped into "short" (< 6h) or "long" (≥ 6h) surgical time groups. Outcome measures were estimated blood loss (EBL), cell saver transfusions, packed red blood cell (pRBC) transfusions, length of stay (LOS), intraoperative monitoring (IOM) alerts, hematocrit, ICU transfer, neurologic loss, surgical site infection, and 90-day readmissions. We controlled for age, sex, BMI, curve severity, number of segments fused, and surgeon factors. After propensity score matching there were 113 patients in each group. The short surgical time group had lower EBL (median 715, IQR 550-900 vs median 875, IQR 650-1100cc; p < 0.001), received less cell saver blood (median 120, IQR 60-168 vs median 160, IQR 97-225cc; p = 0.001), received less intraoperative pRBCs (median 0, IQR 0-0 vs median 0, IQR 0-320, p = 0.002), had shorter average LOS (4.8 ± 1.7 vs 5.4 ± 2.5days; p = 0.039), and fewer IOM alerts (4.3% vs 18%, p = 0.003). Patients with shorter surgical times had less blood loss, received less transfused blood, had a shorter LOS, and fewer IOM alerts compared to patients with longer surgical times. Surgical times < 6h may have safety and efficacy advantages over longer times. III.

Untargeted Serum Proteomics Profiling in Female Patients with Idiopathic Scoliosis

Background: Idiopathic scoliosis is a common structural spine curvature of unknown etiology. Scoliosis onset and progression are likely related to the interplay between genetics and the environment. Serum protein levels are influenced by both genetic and environmental factors and thus, are a promising methodology. Aims: We aimed to determine whether serum protein levels differed between idiopathic scoliosis cases and controls. In scoliosis cases, we also aimed to determine if protein levels were correlated with curve severity. Methods: In the discovery population, serum blood samples were obtained from 7 females with severe scoliosis and 11 unaffected female controls. Liquid chromatography-mass spectroscopy was used to quantify protein levels. Wilcoxon rank sum tests were used to test for differences between cases and controls. Within scoliosis cases, Spearman correlation coefficients were used to test the correlation between curve severity and age-adjusted protein levels. Candidate proteins were defined as proteins that significantly differed between cases and controls and were moderately or strongly correlated with curve severity (ρ&gt;0.30). We validated candidate proteins using the SomaScan Discovery v4.1 proteomics platform with serum from 11 females with scoliosis. Results: In the discovery analysis, 10 proteins differed between cases and controls (p&lt;0.05) and were correlated with protein levels (ρ=0.36-0.65). Of these candidate proteins, one protein, alpha 2-HS glycoprotein (AHSG), was significantly correlated with curve severity (p=0.0323) in the validation population. Fixed effects meta-analysis showed a strong inverse correlation between curve severity and decreasing alpha 2-HS glycoprotein levels (meta-combined ρ: -0.67, p=0.0052). Conclusion: Alpha 2-HS glycoprotein met our criteria for significance in both the discovery and validation populations. Developing a proteomic signature for idiopathic scoliosis has important clinical implications. This study supports the feasibility of untargeted proteomics and provides evidence for the potential role of alpha 2-HS glycoprotein levels in scoliosis etiology.

Range of surgical strategies for individual adolescent idiopathic scoliosis cases: evaluation of a multi-centre survey

PurposeSurgical treatment of adolescent idiopathic scoliosis (AIS) is very complex, involves many critical decisions and modern instrumentation techniques, and offers multiple possibilities. It is known that the surgical strategy may vary strongly between surgeons for AIS cases. The goal of this study was to document, summarize, and analyse the current biomechanical relevant variabilities in the surgical treatments of individual AIS patient cases.MethodsEight experienced scoliosis surgeons from different hospitals were asked to plan surgeries on 12 representative patients with AIS. The surgeons were provided with radiographs during upright standing in the coronal and sagittal plane, as well as lateral bending images to the left and right. The surgeons were asked to specify the Lenke type, their surgical approach, the resection steps, the planned fusion length, and the type of implants. The data were analysed with respect to the inter-rater variability, which was quantified using the Fleiss Kappa method.ResultsIn the selection of the surgical approach, the surgeons concurred most with Lenke curve types 2 (κ = 0.88) and 4 (κ = 0.75). The largest differences were shown at Lenke 1 (κ = 0.39) and 5 (κ = 0.32). Anterior approaches were selected in the majority of cases at Lenke types 5, with an average of 50%. The strongest deviation in fusion length was documented at Lenke curve type 6.ConclusionThe survey highlighted differences in the surgical strategy depending on the Lenke curve type, the direction of the surgical approach, and the surgeon. The main discrepancies between the surgeons were found for Lenke 1, 5, and 6 curves, and consistencies for Lenke 2, 3, and 4. The documented discrepancies indicate the remaining open questions in the surgical treatment and understanding of scoliosis biomechanics.

Administration of Spinal Anaesthesia with Modified Paramedian Technique in a Patient with Kyphoscoliosis: A Case Report

Kyphoscoliosis is a condition that affects the spine, with adolescents accounting for 75-90% of cases of idiopathic scoliosis. Scoliosis patients may experience difficulties when receiving anaesthesia during surgical procedures. There is often multisystem involvement, including the cardiovascular, nervous, and respiratory systems. Patients who have scoliosis often have difficulties with their airways (affected airway morphology, difficult intubation with laryngoscopy), respiratory systems (hypoxia, alveolar vascular constriction, pulmonary hypertension), and cardiac systems (cardiomyopathy, right ventricular enlargement, but also cor pulmonale). Scoliosis can bring on a restrictive pulmonary disease, which can lead to a decrease in both total lung volume and functional residual capacity, as well as an increase in breathing rate. Owing to the deformities of the vertebra, subarachnoid blocks in patients with kyphoscoliosis generally constitute a special hurdle for the anaesthesiologist. Midline and paramedian approach for spinal anaesthesia has been practiced since long but a novel approach as modified paramedian technique allows the entry of the needle from far away from midline hence reducing the number of punctures taken and lesser complications. Respiratory and airway concerns are customarily addressed in kyphoscoliotic patients. Authors present a unique case of 35-year-old male with severe kyphoscoliosis with neurofibromatosis posted for right above knee amputation by spinal anaesthesia using modified paramedian technique. Authors planned for subarachnoid block for this patient with modified paramedian approach which resulted in right-sided dense block with patchy sensory and motor block on left-side. For a successful operation, scoliosis patients require a thorough preoperative evaluation, a well-equipped set-up, and a teamwork.

Adolescent idiopathic scoliosis : a review of aetiological theories of a multifactorial disease.

Adolescent idiopathic scoliosis (AIS), defined by an age at presentation of 11 to 18 years, has a prevalence of 0.47% and accounts for approximately 90% of all cases of idiopathic scoliosis. Despite decades of research, the exact aetiology of AIS remains unknown. It is becoming evident that it is the result of a complex interplay of genetic, internal, and environmental factors. It has been hypothesized that genetic variants act as the initial trigger that allow epigenetic factors to propagate AIS, which could also explain the wide phenotypic variation in the presentation of the disorder. A better understanding of the underlying aetiological mechanisms could help to establish the diagnosis earlier and allow a more accurate prediction of deformity progression. This, in turn, would prompt imaging and therapeutic intervention at the appropriate time, thereby achieving the best clinical outcome for this group of patients. Cite this article: Bone Joint J2022;104-B(8):915-921.

Three-dimensional corrective exercise therapy for idiopathic scoliosis: study protocol for a prospective non-randomized trial

BackgroundAlthough physiotherapeutic scoliosis-specific exercises (PSSEs) with or without other conservative treatments may improve scoliotic deformities, the evidence is insufficient. Three-dimensional corrective exercises (TDCEs) for scoliosis are based on the theory of PSSEs and are characterized by a combination of outpatient treatment and home-based exercise. This study aims to evaluate the effectiveness of TDCEs for idiopathic scoliosis (IS).MethodsThe participants will be divided into two age- and sex-matched groups: an experimental group (EG) treated with three-dimensional corrective exercise therapy (TDCET) and a control group (CG) receiving generalized exercise therapy. In each arm, mild and moderate IS cases will be reclassified based on the Cobb angle and biopsy results. The primary endpoint is the change in the largest Cobb angle; the secondary endpoints are the sagittal index, forced vital capacity, peak oxygen uptake, and peak oxygen uptake. Sixty-six patients with mild IS and 78 patients with moderate IS will be included.DiscussionThis study is the first controlled trial to systematically assess the effectiveness of TDCEs for IS. In addition to TDCET including three-dimensional corrective exercises, family rehabilitation and basic body awareness therapy may help patients adopt supportive attitudes and appropriate behaviours, thus enhancing their compliance with exercises and achieving better outcomes.Trial registrationThe study protocol was registered at www.clinicaltrials.gov (number identifier: NCT04539522). Registered on August 27, 2020.

Hanging radiograph in idiopathic scoliosis patients: significance as a preoperative stress X-ray.

Before corrective surgery for idiopathic scoliosis, the stress X-rays are indispensable to collect information regarding the reducibility of deformity, deciding fusion levels, and categorizing curve types and so on. The hanging radiograph has not been conducted preoperatively so far as known. The objective of this study was to investigate retrospectively the significance of the hanging radiograph for prediction of the curve correction with surgical procedure by comparing with the side-bending and the traction radiographs. The subjects enrolled in current study were 22 cases of idiopathic scoliosis who performed posterior instrumentation and fusion by ISOLA method between 2008 and 2014. They included 2 males and 20 females, with a mean age of 16 years and 8 months. The type of curves by Lenke classification were type 1 in 20 cases, type 2 in 1 case, and type 3 in 1 case. We investigated the correction rates of main thoracic curves in side-bending, traction, and hanging positions and compared them with that after surgery. In addition, correction indices were also calculated and compared among these stress X-rays. The correction rate after surgery was 65.9% that was statistically higher than those in side-bending (44.2%), traction (46.6%), and hanging (22.1%) positions. There were statistical correlations between the correction rates after surgery and in side-bending position (R=0.73) and those after surgery and in traction position (R=0.57). However, there was no statistical correlation between the correction rates after surgery and in hanging position (R=-0.01). With regard to the correction indices, that in hanging position (3.67) was statistically higher than those in side-bending (1.51) and traction (1.45) positions. The correction rates in side-bending and traction positions seem to be useful to estimate the amount of curve correction before surgery. Whereas, that in hanging position did not have any significance as preoperative evaluation.

Comparison of manual versus automated measurement of Cobb angle in idiopathic scoliosis based on a deep learning keypoint detection technology

PurposeThe present study compared manual and automated measurement of Cobb angle in idiopathic scoliosis based on deep learning keypoint detection technology.MethodsA total of 181 anterior–posterior spinal X-rays were included in this study, including 165 cases of idiopathic scoliosis and 16 normal adult cases without scoliosis. We labeled all images and randomly chose 145 as the training set and 36 as the test set. Two state-of-the-art deep learning object detection models based on convolutional neural networks were used in sequence to segment each vertebra and locate the vertebral corners. Cobb angles measured from the output of the models were compared to manual measurements performed by orthopedic experts.ResultsThe mean Cobb angle in test cases was 27.4° ± 19.2° (range 0.00–91.00°) with manual measurements and 26.4° ± 18.9° (range 0.00–88.00°) with automated measurements. The automated method needed 4.45 s on average to measure each radiograph. The intra-class correlation coefficient (ICC) for the reliability of the automated measurement of the Cobb angle was 0.994. The Pearson correlation coefficient and mean absolute error between automated positioning and expert annotation were 0.990 and 2.2° ± 2.0°, respectively. The analytical result for the Spearman rank-order correlation was 0.984 (p < 0.001).ConclusionThe automated measurement results agreed with the experts’ annotation and had a high degree of reliability when the Cobb angle did not exceed 90° and could locate multiple curves in the same scoliosis case simultaneously in a short period of time. Our results need to be verified in more cases in the future.

Comparison of interventions and outcomes of enhanced recovery after surgery: a systematic review and meta-analysis of 2456 adolescent idiopathic scoliosis cases.

The objective of this meta-analysis and systematic review is to compare the methodology and evaluate the efficacy of Enhanced recovery after Spine Surgery (ERAS) for adolescent idiopathic scoliosis (AIS) and to compare the outcomes with traditional discharge (TD) pathways. Using major databases, a systematic search was performed. Studies comparing the implementation of ERAS or ERAS-like and TD pathways in patients with AIS were identified. Data regarding methodology and outcomes were collected and analyzed. Fourteen studies (n = 2456) were included, comprising 1081 TD and 1375 ERAS or ERAS-like patients. Average age of patients was 14.6 ± 0.4years. Surgical duration was on average 35.6min shorter for the ERAS group compared to TD cohort ([2.8, 68.3], p = 0.03), and blood loss was 112.3 milliliters less ([102.4, 122.2], p < 0.00001). ERAS group reached first ambulation 29.6h earlier ([11.2, 48.0], p-0.002), patient-controlled-analgesia (PCA) discontinuation 0.53day earlier ([0.4, 0.6], p < 0.00001), urinary catheter discontinuation 0.5day earlier ([0.4, 0.6], p < 0.00001), and length-of-stay (LOS) was 1.6days shorter ([1.4, 1.8], p < 0.00001). Rates of complications and 30-day-readmission-to-hospital were similar between both groups. Pain scores were significantly lower for ERAS group on days 0 through 2 post-operatively. Use of ERAS after AIS is safe and effective, decreasing surgical duration and blood loss. ERAS methodology effectively focused on reducing time to first ambulation, PCA discontinuation, and urinary catheter removal. Outcomes showed significantly decreased LOS without a significant increase in complications. There should be efforts to incorporate ERAS in AIS surgery. Further studies are necessary to assess patient satisfaction. Meta-analysis of Level 3 studies.

How can directional and fluctuating asymmetry help in the prognosis of scoliosis along the course of the condition?

Fluctuating asymmetry (FA) is an indicator of developmental instability referred to random deviations from mean asymmetry. That average asymmetry is the directional asymmetry (DA), which, in the particular case of adolescent idiopathic scoliosis (AIS), corresponds to a right thoracic and left lumbar curves. Investigating the presence of FA and DA in AIS has never been done, and it is a key element of the pathophysiology of the scoliotic condition. Thirty-six X-rays of patients with AIS were digitized and analysed using Geometric Morphometric analyses to test for both statistical effects. The individual FA score for each patient was calculated using Procrustes ANOVA and a methodology based on the components of shape was used to estimate the individual DA score. DA is a stronger effect than FA (2.12 to 1), as it has been found in other clinical conditions. The individual DA score, with an effect size of 0.58, is a better predictor of the Cobb angle than FA score. The methodology presented in this paper to estimate DA score is a valid approach in the study of asymmetries in AIS. FA should be correlated in future studies with environmental covariates to serve as a variable in the medical prognosis, while DA will serve as a good predictor of the Cobb angle during the course of the condition, avoiding the abuse of X-rays. This potential use of DA should be tested on 3D shape due to the three-dimensional clinical presentation of AIS.

The Demographics and Epidemiology of Infantile, Juvenile, and Adolescent Idiopathic Scoliosis in a Southern California Integrated Health Care System.

Prognostic study, Level III. The aim of this study was to determine the incidence and demographics of idiopathic scoliosis (IS) in a large cohort of children in a Southern California integrated healthcare system, and to identify the demographic or clinical factors associated with the greatest risk of IS. Although many authors have reported on the incidence and prevalence of IS in children, there have been few incidence studies in the United States on large, self-contained populations. A retrospective chart analysis was done on diagnosed cases of IS within our integrated health care system in patients under age 18 years during the entire 2013 calendar year. Patient demographics were recorded and the incidence of IS was determined. Odds ratios (ORs) for having IS and for having more severe initial curve magnitudes based on demographics were determined using logistic regression models. IS Incidence was 3.9, 28.6, and 393 per 100,000, respectively, for the infantile, juvenile, and adolescent group. The female incidence was more than twice that of males in all age groups. Multivariate logistic regression analysis showed Asians and non-Hispanic Whites had the highest OR of IS (OR 1.54 and 1.32 with 95% confidence interval [CI] 1.33-1.79 and 1.19-1.47). Whites, Blacks, and mixed-race patients had a significantly higher initial curve magnitude than Hispanics; females also had a significantly greater initial curve magnitude than boys (18.1° vs. 16.7°). Underweight patients had a 50% increased OR of IS versus normal weight (95% CI 1.16-1.94) with a progressively decreased OR of IS as weight increased. Our study of a large integrated healthcare system sheds light on the incidence of IS and the ORs based on weight, sex, and ethnicity/race. The overall incidence was lower overall than previously thought.Level of Evidence: 3.

Retrospective Analysis on Intraoperative Neuromonitoring (IOM) of Potential Nerve Injury in Scoliosis Correction Surgery

Iatrogenic spinal injury resulting in paraplegia or paraparesis after surgical correction of scoliosis deformity is a rare complication but is very detrimental to the patient. Intraoperative Neuromonitoring (IOM) has become the gold standard to monitor surgical procedures which has potential risks to damage the spinal cord. This study aimed to retrospectively analyze the role of IOM in predicting the severity and extent of neurological injury during and after spinal correction surgery in adult idiopathic scoliosis cases related to surgical variables. This was a retrospective cohort study conducted at Dr. Cipto Mangunkusumo National Central Hospital, Fatmawati Central Hospital, and dr. Drajat Prawiranegara General Hospital during the period of 20 March 2018 to 20 August 2019. The primary outcomes were intraoperative monitoring status and post-operative neurological deficits status. Confounder data on scoliosis correction degree, intraoperative hemorrhage, and type of anesthesia used during surgery were retrieved. Chi-Square statistic was used in the analysis. Out of the ninety three patients eligible for this study, twenty two patients was detected as positive in IOM assessment. Four of the patients were found to be positive for post-operative neuromuscular defect. Thereby it can be concluded that IOM procedure can effectively prevent neurological deficits post-surgery with 81.8% specificity and 95.7% sensitivity among thosepositively detected by IOM. Some of the factors that could potentially influence false positive IOM results such as anesthetic used; dosage and administration procedures; magnitude of the scoliosis correction angle; and amount of bleeding during surgery have to be carefully analyzed.

Dual attending surgeon strategy learning curve in single-staged posterior spinal fusion (PSF) surgery for 415 idiopathic scoliosis (IS) cases

BACKGROUND CONTEXTThe implementation of a dual attending surgeon strategy had improved perioperative outcomes of idiopathic scoliosis (IS) patients. Nevertheless, the learning curve of a dual attending surgeon practice in single-staged posterior spinal fusion (PSF) surgery has not been established. OBJECTIVETo evaluate the surgical learning curve of a dual attending surgeon strategy in IS patients. STUDY DESIGNRetrospective study. PATIENT SAMPLE415 IS patients (Cobb angle <90°) who underwent PSF using a dual attending surgeon strategy OUTCOME MEASURESPrimary outcomes included operative time, total blood loss, allogenic blood transfusion requirement, length of hospital stay and perioperative complication rate. METHODSRegression analysis using Locally Weighted Scatterplot Smoothing (LOWESS) method was applied to create the best-fit-curve between case number versus operative time and total blood loss in identifying cut-off points for the learning curve. RESULTSThe mean Cobb angle was 60.8±10.8°. Mean operative time was 134.4±32.1 minutes and mean total blood loss was 886.0±450.6 mL. The mean length of hospital stay was 3.0±1.6 days. The learning curves of a dual attending surgeon strategy in this study were established at the 115th case (operative time) and 196th case (total blood loss) respectively (p<.001). In comparison of cases before and after the cut-off points, mean operative time reduced significantly from 147.2±36.5 minutes to 129.5±28.9 minutes and mean total blood loss reduced significantly from 1015.1±506.6 mL to 770.4±357.3 mL (p<.001). No allogenic blood transfusion was required and there were 7 perioperative complications (n=7/415, 1.7%) recorded. CONCLUSIONThe learning curve of a dual surgeon strategy in single-staged PSF surgery based on operative time and total blood loss were established at 115th case and 196th case respectively (p<.001).

Intraoperative red blood cell salvage in posterior spinal fusions for idiopathic scoliosis: identifying potential criteria for selective use.

Retrospective. Evaluate the role and effectiveness of ICS in primary posterior spinal fusion (PSF) for idiopathic scoliosis (IS). Intraoperative cell salvage (ICS) minimizes blood loss and need for allogeneic transfusions. However, it adds substantial charges ($800-1200 US) and may be of less clinical benefit in some PSF for IS. This was a single-hospital, retrospective analysis of 178 consecutive IS cases (10-18years of age) who underwent primary PSF by a single pediatric spine surgeon. Overall, 41% of cases received a mean 167cc of ICS blood, after a mean EBL of 528mL (range 200-1800mL). No blood was returned in 59% of cases, with a mean EBL of 293mL (range 75-700mL). Only 6.5% of the entire cohort received > / = 250cc via ICS, after a mean EBL of 773mL. A positive correlation exists between EBL and vertebral levels fused, preoperative major Cobb angle, and length of anesthesia (p < 0.001). ICS may be more efficacious at an inflection point of 12 vertebral fusion levels, preoperative major Cobb angles > / = 55°, anesthesia exposure > / = 6h, and with use of posterior column osteotomies (PCOs) (p < 0.05). In addition, lack of tranexamic acid use lead to greater EBL (p < 0.0001) and ICS volumes (p = 0.008). The use of ICS in IS patients undergoing PSF resulted in the return of > / = 250cc of ICS blood (similar volume to one allogeneic unit) in only 6.5% of cases. Charges for ICS set-up and processing of one bowl of ICS is much higher than for one allogeneic unit ($1200 vs. $462 US), hence transfusing lower volumes of autologous ICS blood is not cost-effective for all PSF for IS. IV; Therapeutic studies.

Hanging Radiograph in Idiopathic Scoliosis Patients:Significance as a Preoperative Stress X-Ray

Introduction: Before corrective surgery for idiopathic scoliosis, the stress x-rays are indispensable to collect information regarding the reducibility of deformity, deciding fusion levels, and categorizing curve types and so on. The hanging radiograph has not been conducted preoperatively so far as known. The objective of this study was to investigate retrospectively the significance of the hanging radiograph for prediction of the curve correction with surgical procedure by comparing with the side-bending and the traction radiographs. Methods: The subjects enrolled in current study were 22 cases of idiopathic scoliosis who performed posterior instrumentation and fusion by ISOLA method between 2008 and 2014. They included 2 males and 20 females, with a mean age of 16 years and 8 months. The type of curves by Lenke classification were type 1 in 20 cases, type 2 in 1 case, and type 3 in 1 case. We investigated the correction rates of main thoracic curves in side-bending, traction, and hanging positions and compared them with that after surgery. In addition, correction indices were also calculated and compared among these stress x-rays. Results: The correction rate after surgery was 65.9% that was statistically higher than those in side-bending (44.2%), traction (46.6%), and hanging (22.1%) positions. There were statistical correlations between the correction rates after surgery and in side-bending position (R=0.73) and those after surgery and in traction position (R=0.57). However, there was no statistical correlation between the correction rates after surgery and in hanging position (R=-0.01). With regard to the correction indices, that in hanging position (3.67) was statistically higher than those in side-bending (1.51) and traction (1.45) positions. Conclusion: The correction rates in side-bending and traction positions seem to be useful to estimate the amount of curve correction before surgery whereas, that in hanging position did not have any significance as preoperative evaluation.

One stage or two? A cohort analysis of anterior-posterior spinal fusions for severe pediatric scoliosis.

Retrospective case-series study of prospectively collected data. We sought to identify the differences in outcomes between one-stage (single surgical episode) and two-stage (separate day) anterior and posterior spinal fusion and segmental spinal instrumentation surgeries in severe non-idiopathic and idiopathic scoliosis cases. Patients with severe pediatric spine deformity may require combined anterior and posterior fusion procedures. Given their increased complexity and morbidity, surgeons may consider staging these procedures on separate days. A retrospective cohort study was performed on a prospective Pediatric Spine Database. Patients 21years of age or under with pediatric scoliosis who underwent primary anterior and posterior spinal deformity correction surgery either through a one-stage or planned two-stage sequence with greater than 2-year follow-up were included. Differences in demographics, comorbidities, surgical details, perioperative morbidity, complications, and outcomes were assessed based on scoliosis etiology. Multivariate models were utilized to control for confounders. There were 70 non-idiopathic (14 two-stage vs. 56 one-stage) and 65 idiopathic scoliosis (8 two-stage vs. 57 one-stage) patients. Mean follow-up was 90.1 ± 54.7months. In non-idiopathic scoliosis patients, two-stage surgery was independently associated with a 140-min increased surgical time (95% confidence interval: 52-229min, p = 0.002) and an 8.2-day (95% confidence interval: 2.3-14.1days, p = 0.007) increased hospital length of stay. In idiopathic scoliosis patients, two-stage surgery was independently associated with a 2108ml increase in crystalloid use (95% confidence interval: 834-3381ml p = 0.002) and a 5.3-day increased hospital length of stay (95% confidence interval: 4.0-6.5days, p < 0.001). There were no significant differences in blood loss, transfusions, complications, or post-operative curves on multivariate analysis between one-stage and two-stage surgery cohorts in either non-idiopathic or idiopathic scoliosis patient groups. Two-stage surgery was associated with increased crystalloid use in idiopathic scoliosis patients and longer operative times in non-idiopathic scoliosis patients, and longer hospital length of stay in both populations, without significant difference in complications or deformity correction. In the appropriate patient, one-stage anterior-posterior scoliosis surgery may be preferable to two-stage surgery. Level III Retrospective Comparative Study.

Corrective exercises specific for adolescent idiopathic scoliosis presented with bilateral leg pain: a case report describing an adaptive program and the recorded improvement as expressed by Cobb angle

Adolescent idiopathic scoliosis is considered as the most common type of scoliosis. A 13-year-old female complained of bilateral leg pain, left &gt; right, and severe headache. She was referred to an orthopaedic physical therapy clinic. Spinal X-ray revealed right thoracolumbar scoliosis with Cobb angle of about 48°. The primary curve was in the lumbar vertebrae, directed to the left, and the secondary curve was in the thoracic vertebrae, directed to the right. Two surgeons recommended corrective surgery, while one recommended physiotherapy for 6 months. The third surgical opinion was based on magnetic resonance imaging that presented normal cervical spine, mild scoliotic deformity of lower dorsal vertebrae with right-sided convexity and of lumbar vertebrae with left-sided convexity, L4–5 broad based posterior and left posterolateral disc protrusion, and L5–S1 mild central posterior disc protrusion. At the final evaluation after 18 months of a corrective exercise program, the patient reported no symptoms at rest or with exercises. The improvement was evidenced by Cobb angle change from 48° to 21°, pelvic shift, and general spinal flexibility and strength. The current case report describes a specific corrective exercise protocol adapted to a case of adolescent idiopathic scoliosis that presented with bilateral leg pain.

Anterior and Posterior Fusion for Large, Rigid Idiopathic Scoliosis: Does Implant Density Matter?

Despite advancements in surgical techniques, controversy remains regarding the optimal implant density for the correction of idiopathic scoliosis. Recent evidence has suggested that equivalent radiographic and clinical outcomes can be achieved with lower implant densities for those with moderate curves and good flexibility. Among the experts, the consensus has continued that higher implant densities should be used for larger, stiffer curves. The purpose of the present study was to compare the radiographic results between high-implant density (HID) and low-implant density (LID) constructs in patients with large (>65°), rigid (<50% flexibility) curves who had undergone anterior release and posterior spinal fusion. We reviewed the idiopathic scoliosis cases performed at a single institution from 2006 to 2014. Only those meeting the inclusion criteria were selected. The patients were divided into HID and LID groups. The postoperative radiographs were compared for coronal correction, thoracic kyphosis, pelvic tilt, lumbar lordosis, and sagittal vertical axis. A statistically significant improvement in coronal correction was detected in the HID group at all follow-up points (final follow-up: HID, 81.1% vs. LID, 70.4%; P= 0.01). When preoperative thoracic kyphosis was considered, no differences were found between the 2 groups. No differences were found in the other sagittal parameters. In patients with large, rigid idiopathic scoliosis undergoing anterior release and posterior spinal fusion, a small, but statistically, significant improvement in the coronal Cobb angle was seen. It remains to be determined whether this small difference in radiographic correction will have any influence on the clinical outcome.

A Case of Idiopathic Scoliosis with Bronchial Stenosis Improved by Posterior Thoracic Spinal Fusion

A Case of Idiopathic Scoliosis with Bronchial Stenosis Improved by Posterior Thoracic Spinal Fusion

Significant variability in surgeons\u2019 preferred correction maneuvers and instrumentation strategies when planning adolescent idiopathic scoliosis surgery

BackgroundIncreased implant number is thought to provide better control on the scoliotic spine, but there is limited scientific evidence of improved deformity correction and surgical outcomes with high-density constructs. The objective is to assess key anchor points used by experienced spinal deformity surgeons and to evaluate the effect of implant density pattern on correction techniques.MethodsSeventeen experienced spine surgeons reviewed five Lenke 1 adolescent idiopathic scoliosis cases and provided their preferred posterior correction technique (implant pattern, correction maneuvers, and implants used for their execution) and an alternative technique with the minimal implant density they felt would be acceptable (170 surgical plans total). Additionally, for each case, they selected acceptable screw patterns for surgery from seven published implant configurations. Variability in the surgeons’ plans was assessed, including instrumentation and correction strategies.ResultsThe preferred correction plan involved an average of 1.65 implants/vertebra, with 88% of the available anchor points at the apex ± 1 vertebra used for the execution of correction maneuvers and only 43% of possible anchor points used proximal and distal to the apical area. The minimal density that surgeons found acceptable was 1.24 implants/vertebra. The minimal density plan involved more in situ rod contouring (53 vs. 41%), fewer vertebral derotation maneuvers (82 vs. 96%), and fewer implants used for compression/distraction maneuvers (1.18 and 1.42 respectively) (p < 0.05). Implant placement at alternate levels or dropout of convex implants above and below the apical area was most frequently considered acceptable (> 70% agreement).ConclusionsImplant position and number affect surgeons correction maneuvers selection. For low implant density constructs, dropout in the convexity and particularly in the periapical region is accepted by surgeons, with minor influence on planned correction maneuvers. Thus, preoperative implant planning must take into account which anchor points are needed for desired correction maneuvers.