Curve Cobb Angle Research Articles

Directed Versus non-directed Standing Postures in Adolescent Idiopathic Scoliosis: Its Impact on Curve Magnitude, Alignment and Clinical Decision Making.

Prospective study. To investigate the difference in major curve Cobb angle and alignment between directed and non-directed positioning for adolescent idiopathic scoliosis (AIS) and to evaluate implications on treatment decision-making. Proper positioning of patients with spinal deformities is important for assessing usual functional posture in standing, so management strategies can be customized accordingly. Whether postural variability affects coronal and sagittal radiological parameters and the impact of posture on management decisions remain unknown. Patients with AIS presenting for initial consultation at the tertiary scoliosis clinic were recruited. They were asked to stand in two positions: passive, non-directed position; and directed position by the radiographer. Radiological assessment included major and minor Cobb angle, coronal balance, spinopelvic parameters, sagittal balance and alignment. Cobb angle difference >5⁰ between directed and non-directed positioning was considered clinically impactful. Patients with or without such difference were compared. Over- or under-estimation of the major curve (at 25⁰ or 40⁰) by non-directed positioning were examined due to relevance to bracing and surgical indications. This study included 198 patients, with 22.2% experiencing Cobb angle difference (>5⁰) between positioning. The major curve Cobb angle was smaller in non-directed than directed positioning (median difference: -6.0⁰, upper and lower quartile: -7.8, 5.8), especially for curves ≥30⁰. Patients with a Cobb angle difference had changes in shoulder balance (P=0.007) when assuming a directed position. Non-directed positioning had 14.3% of major Cobb 25⁰ underestimated and 8.8% overestimated, whereas 11.1% of curves >40⁰ were underestimated. Strict adherence to a standardized radiographic protocol is mandatory for reproducing spine radiographs reliable for curve assessment, as a non-directed position demonstrates smaller Cobb angles. Postural variation may lead to over-, or under-estimation, of the curve size relevant for both bracing and surgical decision-making. II.

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

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

Vertebral body tethering in adolescent idiopathic scoliosis with more than 2years of follow-up- systematic review and meta-analysis.

Whilst spinal fusion remains the gold standard in the treatment of adolescent idiopathic scoliosis (AIS), anterior vertebral body tethering (AVBT) is gaining momentum with relatively few studies on its efficacy thus far. To conduct a systematic review reporting on the early results of AVBT for patients undergoing surgery for AIS. We aimed to systematically evaluate the relevant literature pertaining to the efficacy of AVBT with respect to degree of correction of the major curve Cobb angle, complications and revision rates. Systematic review. Of a total of 259 articles, 9 studies met the inclusion criteria and were analysed. Overall, 196 patients of (mean age 12.08years) underwent an AVBT procedure for correction of AIS with a mean follow-up of 34months. Degree of Cobb angle correction, complications and revision rates were used as outcome measures. A systematic review of the literature on AVBT was performed for studies published between Jan 1999-March 2021 applying the PRISMA guidelines. Isolated case reports were excluded. Overall, 196 patients of (mean age 12.08years) underwent an AVBT procedure for correction of AIS with a mean follow-up of 34months. There was a significant correction of the main thoracic curve of scoliosis (mean preoperative Cobb angle 48.5°, post-operative Cobb angle at final follow-up of 20.1°, P = 0.01). Overcorrection and mechanical complications were seen in 14.3% and 27.5% of cases, respectively. Pulmonary complications including atelectasis and pleural effusion were seen in 9.7% of patients. Tether revision was performed in 7.85%, and revision to a spinal fusion in 7.88%. This systematic review incorporated 9 studies of AVBT and 196 patients with AIS. The complication and revision to spinal fusion rates were 27.5% and 7.88%, respectively. The current literature on AVBT is restricted largely to retrospective studies with non-randomised data. We would recommend a prospective, multi-centre trial of AVBT with strict inclusion criteria and standardised outcome measures.

Can placement of hook at the upper instrumented level decrease the proximal junctional kyphosis risk in adolescent idiopathic scoliosis?

Proximal junctional kyphosis is a commonly encountered clinical and radiographic phenomenon after pediatric and adolescent spinal deformity surgery that may lead to postoperative deformity, pain, and dissatisfaction. The purpose of the study was to identify whether the placement of transverse process hooks is an effective way to prevent PJK. Adolescent idiopathic scoliosis patients who underwent posterior spinal fusion between November 2015 and May 2019 were retrospectively analyzed. A minimum 2-year follow-up was required. Demographic and surgical data included UIV level type of instrumentation (hook vs screw) were reported. Radiologic parameters included main curve Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), and proximal junctional angle (PJA) were assessed. Patients were divided into two groups based on the type of instrumentation at the UIV level whether placement of hook versus pedicle screw. Three hundred and thirty-seven patients were included with the mean age 14.2 ± 1.9years. Thirty patients (8.9%) were diagnosed with proximal junctional kyphosis radiographically. PJK incidence was found 3.2% (5/154) in the hook group and 13.3% (23/172) in the screw group and the difference found statistically significant. In the PJK group, preoperative thoracic kyphosis and the degree of kyphosis correction were also significantly higher than non-PJK patients. Placement of transverse process hooks at the UIV level in posterior spinal fusion surgery for AIS patients was associated with decreased risk of PJK. A larger preoperative kyphosis and greater degree of kyphosis correction correlated with PJK.

Are torso asymmetry and torso displacements in a computer brace model associated with initial in-brace correction in adolescent idiopathic scoliosis?

BackgroundLack of initial in-brace correction is strongly predictive for brace treatment failure in adolescent idiopathic scoliosis (AIS) patients. Computer-aided design (CAD) technology could be useful in quantifying the trunk in 3D and brace characteristics in order to further investigate the effect of brace modifications on initial in-brace correction and subsequently long-term brace treatment success. The purpose of this pilot study was to identify parameters obtained from 3D surface scans which influence the initial in-brace correction (IBC) in a Boston brace in patients with AIS.MethodsTwenty-fiveAIS patients receiving a CAD-based Boston brace were included in this pilot study consisting of 11 patients with Lenke classification type 1 and 14 with type 5 curves. The degree of torso asymmetry and segmental peak positive and negative torso displacements were analyzed with the use of patients’ 3D surface scans and brace models for potential correlations with IBC.ResultsThe mean IBC of the major curve on AP view was 15.9% (SD = 9.1%) for the Lenke type 1 curves, and 20.1% (SD = 13.9%) for the type 5 curves. The degree of torso asymmetry was weakly correlated with patient’s pre-brace major curve Cobb angle and negligible correlated with major curve IBC. Mostly weak or negligible correlations were observed between IBC and the twelve segmental peak displacements for both Lenke type 1 and 5 curves.ConclusionBased on the results of this pilot study, the degree of torso asymmetry and segmental peak torso displacements in the brace model alone are not clearly associated with IBC.

Can the proximal humeral ossification system (PHOS) effectively guide brace weaning in patients with adolescent idiopathic scoliosis?

PurposeThe proximal humeral epiphyses can be conveniently viewed in routine spine radiographs. This study aimed to investigate whether the proximal humeral epiphyseal ossification system (PHOS) can be used to determine the timing of brace weaning in adolescent idiopathic scoliosis (AIS), as assessed by the rate of curve progression after brace weaning.MethodsA total of 107 patients with AIS who had weaned brace-wear at Risser Stage ≥ 4, no bodily growth and post-menarche ≥ 2 years between 7/2014 and 2/2016 were studied. Increase in major curve Cobb angle > 5° between weaning and 2-year follow-up was considered curve progression. Skeletal maturity was assessed using the PHOS, distal radius and ulna (DRU) classification, Risser and Sanders staging. Curve progression rate per maturity grading at weaning was examined.ResultsAfter brace-wear weaning, 12.1% of the patients experienced curve progression. Curve progression rate for weaning at PHOS Stage 5 was 0% for curves < 40°, and 20.0% for curves ≥ 40°. No curve progression occurred when weaning at PHOS Stage 5 with radius grade of 10 for curves ≥ 40°. Factors associated with curve progression were: Months post-menarche (p = 0.021), weaning Cobb angle (p = 0.002), curves < 40° versus ≥ 40° (p = 0.009), radius (p = 0.006) and ulna (p = 0.025) grades, and Sanders stages (p = 0.025), but not PHOS stages (p = 0.454).ConclusionPHOS can be a useful maturity indicator for brace-wear weaning in AIS, with PHOS Stage 5 having no post-weaning curve progression in curves < 40°. For large curves ≥ 40°, PHOS Stage 5 is also effective in indicating the timing of weaning together with radius grade ≥ 10.

Does Progesterone Affect Perioperative Blood Loss during Posterior Spinal Fusion Surgeries in Female Patients with Adolescent Idiopathic Scoliosis? A Retrospective Study.

Menstruation is considered a contraindication for elective surgery for higher operative blood loss. Progesterone is often used to postpone menstruation to avoid surgery during menstruation. This study aimed to explore whether using progesterone to postpone menstruation affects perioperative blood loss and complications in female patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion (PSF) surgery. A retrospective study was performed for female patients diagnosed with AIS who underwent PSF surgery between March 2013 and January 2021. Patients scheduled to undergo PSF surgery from 2 days before menstruation to 3 days after menstruation were treated with progesterone preoperatively. The patients were divided into two groups according to progesterone use (progesterone injection group; control group). Demographic and surgical data including intraoperative blood loss (IBL), normalized blood loss (NBL), total blood loss (TBL), transfusion rate, perioperative complications, postoperative drainage time, postoperative hospital stay, and preoperative coagulation function data were collected. A total of 206 patients were included in the study. Among them, the progesterone injection group included 41 patients, with an average age of 14.8 years. While the control group included 165 patients, with an average age of 14.9 years. The two groups were matched for age, height, weight, operation time, Risser sign, correction rate, mean curve Cobb angle, bending Cobb angle, number of internal fixations, and number of fused levels (all P > 0.05). Regarding coagulation function, no significant differences were found in thrombin time, activated partial thromboplastin time, fibrinogen, prothrombin time, and platelet count between the two groups (all P > 0.05). IBL, NBL, and TBL were higher in progesterone injection group; however, the difference was nonsignificant (all P > 0.05). Transfusion rate, perioperative complications, postoperative drainage time, and postoperative hospital stay were not statistically different between groups (all P > 0.05). Intramuscular injection of progesterone to avoid menstruation during PSF surgery did not affect perioperative blood loss and complications in AIS patients. It may be a safe method for AIS patients to avoid menstrual problems affecting the operation time and receive PSF surgery as scheduled.

Time to surgery for adolescent idiopathic scoliosis: How long does it take? A multicenter study

Study designRetrospective review of multicentric data. ObjectivesTo estimate the time from initial visit to surgery in adolescent idiopathic scoliosis (AIS) patients and the main reasons for the time to surgery in a multicenter study. MethodsThis retrospective study evaluated 509 patients with AIS from 16 hospitals across six Latin American countries. From each hospital's deformity registry, the following patient data were extracted: demographics, main curve Cobb angle, Lenke Classification at the initial visit and time of surgery, time from indication-for-surgery to surgery, curve progression, Risser skeletal-maturity score and causes for surgical cancelation or delay. Surgeons were asked if they needed to change the original surgical plan due to curve progression. Data also were collected on each hospital's waiting list numbers and mean delay to AIS surgery. Results66.8% of the patients waited over six months and 33.9% over a year. Waiting time was not impacted by the patient's age when surgery first became indicated (p = 0.22) but waiting time did differ between countries (p < 0.001) and hospitals (p < 0.001). Longer time to surgery was significantly associated with increasing magnitude of the Cobb angle through the second year of waiting (p < 0.001). Reported causes for delay were hospital-related (48.4%), economic (47.3%), and logistic (4.2%). Oddly, waiting time for surgery did not correlate with the hospital's reported waiting-list lengths (p = 0.57) ConclusionProlonged waits for AIS surgery are common in Latin America, with rare exceptions. At most centers, patients wait over six months, most commonly for economic and hospital-related reasons. Whether this directly impacts surgical outcomes in Latin America still must be studied.

The clinical role of preoperative fulcrum-bending and supine side-bending radiographs on the prediction of curve correction in adolescent idiopathic scoliosis.

Preoperative curve assessment is important in adolescent idiopathic scoliosis (AIS). Our objective is to clarify the role of side-bending radiographs (SBR) and fulcrum-bending radiographs (FBR) in predicting postoperative Cobb angle in nonstructural and structural curves. Twenty-five consecutive patients with AIS who underwent correction surgery were included. The Cobb angles of structural and nonstructural curves were determined. Cobb angles were measured based on pre- and postoperative standing anteroposterior radiographs of the whole spine. The Cobb angles of SBR and FBR were measured preoperatively. The difference between the Cobb angle at each bending and the preoperative Cobb angle was defined as the predicted correction angle, whereas the difference between the preoperative Cobb angle and postoperative Cobb angle was defined as the surgical correction angle. The correction index was calculated by dividing the surgical correction angle by the predicted correction angle. The difference between the predicted correction angle and surgical correction angle was defined as the prediction error. We compared SBR and FBR for both structural and nonstructural curves in these terms. For both curves, the predicted correction angle of FBR was significantly higher than that of SBR, and the correction index of FBR was significantly lower than that of SBR. Patients with a correction index close to 1 and small prediction error had undergone FBR in the structural curve and SBR in the nonstructural curve. FBR is predictive of postoperative correction angle of the structural curve, whereas SBR is predictive of postoperative correction angle of the nonstructural curve.

Traditional versus magnetically controlled growing rods in early onset scoliosis surgical treatment.

Growing rod surgeries are common methods in the treatment of early onset scoliosis. Magnetic growing rod (MGR) surgery, in particular, has become more widespread in the last 10years. The aim of this study was to compare the effects of traditional and magnetically controlled growing rod techniques on efficacy, safety, spinal growth, and lung development. A retrospective analysis was made of 24 TGR and 17 MGR patients. Inclusion criteria were patients aged < 10years, curvature > 40° or a progression of > 10° in the 4-6month follow-up for curves between 25 and 40°. There were 9 males and 15 females in the TGR cohort and 7 males and 10 females in the MGR cohort. The mean age at first surgery was 6.1years and 7.1years, respectively. Major curve Cobb angles of TGR were preop. 51.5°, postop. 21.4° and 18.1° at the final follow-up. In the MGR cohort, these values were 60.4°, 41.8°, and 36.4°, respectively. The mean T1-S1 lengthening velocity was calculated as 1.12cm/year (0.9318mm/month) in the TGR group and 1.27cm/year (1.0571mm/month) in the MGR group. In the TGR cohort, a total of 99 procedures were performed as 24 initial surgeries and 75 additional procedures (5 lengthening during unplanned surgery due to complications; 4 revision, 1 debridement). In the MRG cohort, a total of 25 surgical procedures were performed as 17 initial surgeries and 7 additional procedures (3 debridements, 5 revisions). The results of this study showed that the TGR system provided better correction in the coronal plane and was superior in kyphosis restoration than the MGR system. Both methods were successful in lengthening, but complication rates were slightly higher in the MGR cohort. The most common complication was the pullout of the proximal anchors, and this was more common in the MGR. Both TGR and MGR were found to be effective treatments. Lengthening without surgery is a significant advantage of the MGR system, but it has a high revision rate, and Cobb angle correction was found to be less effective than with TGR.

Comparison of Overall Complication Rates in VCR-Based vs Non-VCR-Based Corrective Techniques in Severe Rigid Kyphoscoliosis Patients: A Systematic Review and Meta-Analysis.

Systematic review and meta-analysis. Compilation of complication outcomes data from the surgical management of severe rigid kyphoscoliosis patients using VCR-based vs non-VCR-based corrective maneuvers is lacking. This meta-analysis aimed to compare complication outcomes between those classified osteotomy approaches. Thorough literature review and meta-analysis were conducted between January 2000 and September 2021. The selection criteria were studies: i) reporting major curve Cobb angle of ≥80° and flexibility of <25% or 30%; ii) comparing VCR or ≥ Type V Schwab osteotomy defined as VCR-based vs [non-VCR-based] techniques, (any osteotomy or technique other than VCR); iii) published in English with ≥10 patients; iv) reporting complication rates; and v) having minimum of 2-year follow-up. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Significance level was set at (P < .05). Of the 174 patients included, 52.30% (n = 91) and 47.70% (n = 83) were VCR-based and non-VCR-based, respectively. The incidence of dural tears/nerve injuries/significant intraoperative-neuromonitoring changes was significantly higher; [OR = 6.78, CI= (1.75 to 26.17), I2 = 0%, (P = .006)] in the VCR-based group than the non-VCR-based group. The 'overall surgical and medical' complication rate was significantly higher in the VCR-based group, [OR = 1.94, CI= (1.02 to 3.67), I2 = 31%, (P = .04)]. Both VCR-based and non-VCR-based surgical techniques for management of severe rigid scoliosis and kyphoscoliosis patients pose comparable overall surgical complication rates, while a significantly higher perioperative neurological complication incidence was associated with VCR-based technique compared to the non-VCR-based techniques. The VCR-based technique was associated with 6.78 times higher incidence of neurological complications compared to non-VCR-based techniques.

Providence nighttime brace is as effective as fulltime Boston brace for female patients with adolescent idiopathic scoliosis: A retrospective analysis of a randomized cohort

BackgroundProgressive moderate scoliotic curves in patients with adolescent idiopathic scoliosis (AIS) are usually treated with a fulltime brace, e.g., the Boston brace (BB). The Providence nighttime brace (PNB), is an alternative which is designed to reach the same treatment effectiveness by nighttime wear only. Few studies compared treatment effectiveness between full and nighttime bracing with contradictory results. MethodsImmature female patients older than 10 years with progressive moderate AIS curves with an apex below T6 were randomized into PNB (n=62) or BB (n=49) treatment. Inclusion criteria were AIS, age ≥ 10 years, no previous treatment, main curve Cobb angle 20°-40° and skeletal immaturity. The increase of the main curve by > 5° of Cobb angle at the final follow-up was established as the primary outcome measure. Secondary outcome measures included (1) the Scoliosis Research Society assessment criteria of effectiveness for brace studies, (2) progression of secondary curves, (3) in-brace correction and (4) compliance to the treatment. The patients were followed until 1 year after reaching maturity. ResultsA total of 105 patients (n=62 and n=43 in PNB and BB group, respectively) completed the follow-up (95%). In the PNB group, 71% patients were treated successfully compared to 65% patients in the BB group (p=.67). No significant difference of the curve progression was found between the groups (3.1°±6.3° and 2.6°±8.3° in PNB and BB group, respectively; p=.73). No significant differences were found for the thoracic or thoracolumbar/lumbar subgroups. PNB showed a superior in-brace correction for all curve types. One of four secondary curves progressed > 5°. The compliance to the treatment was significantly higher in the PNB than BB group. ConclusionsBoth brace regimes are equally effective in treating moderate AIS curves with apex of the main curve below T6 in immature female patients older than 10 years.

Hounsfield unit for assessing asymmetrical loss of vertebral bone mineral density and its correlation with curve severity in adolescent idiopathic scoliosis.

BackgroundLow bone mass concomitantly occurs in patients with adolescent idiopathic scoliosis (AIS) and can persist until skeletal maturity. The purpose of this study was to assess the asymmetrical loss of vertebral bone mineral density (vBMD) and its correlation with curve severity in patients with AIS using Hounsfield unit (HU) values measured from computed tomography scans.MethodsA total of 93 AIS patients were retrospectively recruited. The HU values of the vertebral body (VB-HU) and pedicle screw trajectory (PST-HU) were measured from four vertebrae above (Apex − 4) to four below (Apex + 4) the apical vertebra (Apex) of the major curve. The VB-HU and PST-HU at the upper end vertebra, Apex, and lower end vertebra within the concave and convex sides of the major and minor curves and stable vertebrae were obtained.ResultsA significant correlation was found between the Cobb angle and VB-HU at the periapical levels of the major curve. VB-HU and PST-HU at periapical levels were significantly greater within the concavity than the convexity of both major and minor curves. The asymmetric ratios of VB-HU and PST-HU were significantly correlated with the major curve Cobb angle, peaked at the apex, and gradually diminished from the apex to the end vertebrae. The asymmetrical loss of vBMD aggravated with the progression of curve severity, presenting as VB-HU, significantly decreased within the convexity and insignificantly decreased within the concavity of the major curve.ConclusionThe asymmetrical loss of vBMD was associated with the progression of curve severity in AIS. For patients with severe AIS, the distraction of the pedicle screws at the concave side should be a priority in correcting the major curve, and supplemental anchors and larger-sized screws should be placed within the convex side around the apex of the major curve to reduce the risk of screw loosening after surgery.

Strategy and Efficacy of Surgery for Congenital Cervicothoracic Scoliosis with or without Hemivertebra Osteotomy.

ObjectiveCervicothoracic scoliosis will cause severe deformities in the early stage, and its structure is complex and the surgical methods are varied. The purpose of this research is to explore the indication and analyze the corrective effect of the two different posterior approach surgical strategies, including correction with fusion and hemivertebra osteotomy, for congenital cervicothoracic scoliosis deformities in children and adolescents.MethodsThis was a retrospective study of 21 patients with cervicothoracic scoliosis who received surgical treatment from January 2010 to June 2020, including nine cases of posterior hemivertebra osteotomy and fusion surgery and 12 cases of posterior correction and fusion alone. The Cobb angle, T1 tilt angle, clavicular angle, neck tilt angle, radiographic shoulder height, sagittal vertical axis, coronal balance distance, and local kyphosis angle were measured preoperatively, postoperatively, and at the last follow‐up. Posterior approach hemivertebra resection or correction with fusion surgery was adopted based on the different individual characteristics of deformity such as main curve Cobb angle, growth potential, and flexibility. Patients were divided into two groups (osteotomy group and nonosteotomy group) according to whether a hemivertebra osteotomy was performed, and the corrective results in the two groups were compared. Paired‐sample t tests or independent‐sample t tests were used.ResultsThe median follow‐up after surgery of the 21 patients was 36 months (range, 18–72 months). The Cobb angle was corrected from 45.81° ± 14.23° preoperatively to 10.48° ± 5.56° postoperatively (correction rate, 77.78% ± 8.93%). The T1 tilt angle decreased from 15.26° ± 7.08° preoperatively to 3.33° ± 2.14° postoperatively (correction rate,73.42% ± 21.86%). The radiographic shoulder height was corrected from 1.13 ± 0.74 cm preoperatively to 0.52 ± 0.42 cm postoperatively (correction rate, 39.51% ± 35.65%). The clavicular angle improved from 2.52° ± 1.55° preoperatively to 1.16° ± 0.96° postoperatively (correction rate, 47.18% ± 35.84%). No significant differences were found at the last follow‐up (p > 0.05). The Cobb angle of the main curve, T1 tilt angle, clavicular angle, cervical tilt angle, and shoulder height difference were similar in the two groups (p > 0.05).ConclusionsPosterior approach hemivertebra resection or correction with fusion surgery can be used in the treatment of congenital cervicothoracic scoliosis with satisfactory results, and the surgeon can make an individualized surgical plan according to individual characteristics of deformity.

Benefits of fixing 3 proximal vertebral bodies vs. 2 in the treatment of early-onset scoliosis with growing rods.

Additional proximal fixation for growing rods in early-onset scoliosis (EOS) may offer a more effective and safer option for severe scoliosis patients with hyper-kyphosis. Here, we compared the outcomes of EOS patients treated with growing rods in which 6 proximal anchor points on 3 vertebrae were used vs. 4 proximal anchor points on 2 vertebrae. The records of patients with EOS treated surgically from January 2016 to December 2017 were retrospectively reviewed. In the Proximal 4 group, 2 vertebral bodies were anchored proximally with 4 anchor points; in the Proximal 6 group, 3 vertebral bodies were anchored proximally with 6 anchor points. Forty-two patients (mean age 5.11 ± 1.93 years) were included; 22 Proximal 4 group, 20 Proximal 6 group. Mean follow-up was 40.86 ± 13.49 months. The decrease in main curve Cobb angle postoperatively was significantly greater in the Proximal 6 group (33.22° vs. 19.08°) ( P < 0.05). Cobb thoracic kyphosis (TK) was significantly decreased postoperatively in the Proximal 6 group (mean 20.70°); no significant decrease occurred in the Proximal 4 group. The main curve Cobb angle decrease at last follow-up was significantly greater in the Proximal 6 group (37.84° vs. 24.23°) ( P < 0.05). Cobb TK was significantly decreased at last follow-up in the Proximal 6 group (mean 25.17°, P < 0.05); no significant decrease occurred in the Proximal 4 group. Instrument complications were lower in the Proximal 6 group (15.00% vs. 45.45%) ( P < 0.05). No proximal junctional kyphosis was noted. Fixing 3 proximal vertebral bodies with 6 anchors improves radiographic outcomes of EOS treated with growing rods, and has a lower rate of screw pull-out.

Simultaneous Hypercorrection of Lowest Instrumented Vertebral Tilt and Main Thoracic Curve is Associated With Progression of Residual Lumbar Curve in Adolescent Idiopathic Scoliosis

A retrospective cohort study. To determine radiographic parameters, including the lowest instrumented vertebral (LIV) tilt, related to the postoperative magnitude and progression of residual lumbar curves (LCs) in adolescent idiopathic scoliosis patients who underwent posterior spinal fusion with LIV at or above L1. Although several guidelines have been proposed for thoracic curve fusion, factors related to the postoperative magnitude and potential progression of unfused LCs remained undetermined. The effect of the LIV tilt on residual LCs is also unclear. Patients with Lenke type 1 to 4 curves who underwent posterior spinal fusion with LIV at or above L1 with a minimum follow-up period of 2 years were evaluated. Prediction models for residual LCs were developed using multivariate linear regressions with selected radiographic parameters. Subgroup analyses, followed by sensitivity tests, were then performed for variables best predicting the progression of residual LCs. A total of 130 patients were included. Multivariate linear regression analysis showed that the immediate postoperative LIV-tilt angle was associated with the immediate postoperative LCs and the prediction model for residual LCs, with high accuracy ( R =0.93 and 0.77, respectively). Sensitivity tests revealed immediate postoperative LIV-tilt angle <10° and correction rate of main thoracic curve Cobb angle >53% as predictors for progression of residual LCs, and they reached moderate discrimination when combined together as one criterion (odds ratio=16.3, 95% confidence interval=5.3-50.1; sensitivity=89%, specificity=67%, positive predicted value=51%, negative predicted value=94%). The current study revealed that LIV tilt, as an operable factor during surgery, is not only a determinant in prediction models showing high correlation with the magnitude of postoperative LCs but a predictor for progression of residual LCs. "Immediate postoperative LIV-tilt angle <10° and correction rate of main thoracic curve Cobb angle >53%," as a united criterion, could serve as a predictor for progression of residual LCs.

Adolescent and Juvenile Idiopathic Scoliosis: Which Patients Obtain Good Results with 12 Hours of Cheneau-Toulouse-Munster Nighttime Bracing?

Background: The results of 12 h nighttime Cheneau–Toulouse–Munster (CTM) brace wear on adolescent idiopathic scoliosis are poorly described. Objective: The main objective was to analyze the efficiency of 12 h nighttime CTM brace wear on adolescent idiopathic scoliosis. The secondary objective was to identify the factors influencing good results. Methods: One hundred and fifty consecutive patients treated between 2006 and 2017 were retrospectively analyzed with subgroup analysis for the main curve pattern (main thoracic or main lumbar). The inclusion criteria were evolutive scoliosis, 12 h nighttime CTM brace wear, Risser stages 0-1-2 at the time of the prescription, and Cobb angle below 45 degrees. Success was defined as no surgery, and the main curve Cobb angle (CA) progression ≤5°. The overcurve was defined as the proximal thoracic curve above the main thoracic and mid-thoracic above the main lumbar curves. A logistic regression model was built to assess the predictors of success. RESULTS: Overall success was 70%: 60% for main thoracic (MT) and 84% for main lumbar scoliosis (ML) (p = 0.003). Efficacy was 62% at Risser stage 0 and 78% at Risser stage 1–2 (p = 0.054). For MT, failure was associated with high in-brace sagittal C7 tilt (Odds Ratio = 0.72, p = 0.014) and low initial overcurve CA (Odds Ratio = 0.42, p = 0.044). For ML, a high standing height was associated with success (OR = 1.42, p = 0.035), and frontal unbalanced C7 tilt was associated with failure (OR = 0.43, p = 0.02). Conclusion: Twelve-hour nighttime CTM brace wear provided good results for main lumbar curves with balanced frontal C7 tilt. For MT, this treatment is indicated if the in-brace sagittal C7 tilt is well balanced from Risser stage 2.

Health-Related Quality of Life Assessment in Idiopathic Early-Onset Scoliosis Treated by Serial Mehta Casting.

This was a retrospective clinical study of patients with idiopathic early-onset scoliosis (IEOS) treated by serial Mehta derotational cast in a single facility. A standardized casting protocol was used for patients aged ≤5 years with IEOS (curve ≥20°). Patients' demographics, clinical and radiological outcomes, and major curve Cobb angle were recorded, and health-related quality of life (HRQoL) using the 24-item early-onset scoliosis questionnaire (EOSQ-24) was assessed. A total of 15 patients with IEOS were managed by serial Mehta cast between October 2014 and September 2018 with a mean follow-up period of 42.33 ± 6.37 (range 32-55) months. The mean precast curve was 56.8° ± 12.01°, and the mean final postcast curve was 26.4° ± 19.12° (P = 0.0008). The EOSQ-24 was inversely proportional to the magnitude of the residual curve. There were 2 cases with superficial skin irritation and a single case with repeated vomiting after casting. IEOS can be managed effectively by serial Mehta cast, which is proved not only by the clinical and radiological outcome but also by the improvement of the quality of life of the patients and their families as measured by the EOSQ-24.

Assessment of Average Correction of Cobb’s Angle Post Instrumentation in Adolescent Ideopathic Scoliosis in Lenknee Type 1 Curve

Introduction: Preferred instrumentation for adolescent idiopathic scoliosis (AIS) remains controversial. Surgical correction is classically indicated for progressive curves more than 40° in the skeletally immature patient. Aims and objectives: The basic aim of the study is to analyse the average correction of Cobb’s angle post instrumentation in adolescent ideopathic scoliosis in lenknee type 1 curve. Material and methods: This descriptive study was conducted in Services hospital, Lahore during 2020 to 2021. This study was done with the approval of ethical committee of hospital. There are 27 patients that were included in this study. The age range for the selected patients was 14-20 years from which 15 female and 12 male. The total duration of the study was 2 years. Results: The data was collected from 27 patients. In three patients with Lenke type 1 curve, the apex of curve was the disc at T8/9 or the vertebral body at T9. The mean coronal Cobb angle of the main thoracic curve was 43.7° and the Cobb angles of the compensatory curves on thoracolumbar or lumbar region were less than 20°. On scoliometer measurement of the rib hump averaged 18.5°. On the lateral bending film the mean Cobb angle of main thoracic curve was corrected to 15.7°. Conclusion: It is concluded that patients with Lenke 1 increasing the cost density of instrumentation does not translate into improving the Cobb angle of the uninstrumented spine and does not change any of the cosmetic parameters measured on clinical patient photographs.

Analysis of Posture Parameters in Patients with Idiopathic Scoliosis with the Use of 3D Ultrasound Diagnostics-Preliminary Results.

(1) Background: Idiopathic scoliosis occurs in 2 to 4% of children between 10 and 16 years of age. Due to the harmfulness of radiological examination, non-invasive devices, including the 3D ultrasound technology and Scolioscan apparatus, are more and more frequently used for postural diagnostics. The aim of the study was to analyze the parameters of posture in patients with idiopathic scoliosis with the use of 3D ultrasound diagnostics. (2) Methods: The study included 20 girls, aged 10 to 16 years, with double-curve idiopathic scoliosis (the value of primary curve ranged from 25–50°), types I and II according to King–Moe classification. On the basis of X-ray scan, the Cobb angle of primary and secondary curves was assessed, the skeletal maturity was evaluated with the Risser test, and the type of scoliosis was determined. The girls participated in a 3-week rehabilitation program. The examinations were performed before and after therapy. A scoliometer was used for measurements. Each of the participants underwent individual therapy. The three-plane approach to asymmetric exercises was based largely on positions that included primary curve correction with hypercorrection of the secondary curve. (3) Results: After the therapy, values of trunk rotation angles and the angle of scoliotic curvature of secondary curve were significantly lower than before the therapy, except for the value of the primary curve angle. The parameters measured by X-ray were significantly and positively related to the results obtained with the scoliometer and the scolioscan. (4) Conclusions: The application of therapy that takes into account summing parameters may prevent the deterioration of the secondary curve when treating patients with idiopathic scoliosis. The observed correlations between the parameters of the radiological examination, the scoliometer, and the scolioscan prove the possibility of their interchangeable application in the assessment of effects of the therapy. Three-dimensional ultrasound diagnostics may become an alternative to radiological examination in assessing the treatment effects of patients with idiopathic scoliosis.