Cobb Angle Values Research Articles

Hounsfield Unit for Assessing Vertebral Bone Quality and Asymmetrical Vertebral Degeneration in Degenerative Lumbar Scoliosis.

Retrospective analysis. The aim of this study was to demonstrate the correlation between degenerative lumbar scoliosis (DLS) and osteoporosis based on Hounsfield unit (HU) measurement from computed tomography (CT) scans, and to investigate the asymmetrical vertebral degeneration in DLS. The correlation between DLS and osteoporosis measured by dual-energy x-ray absorptiometry (DEXA) is debated, since T-scores measured by DEXA scan can be overestimated due to abdominal vessel wall calcification, degenerative bony spurs, and facet hypertrophy. The reliability and accuracy of HU to determine osteoporosis are shown in many reports, but it has never been used to assess the vertebral bone quality for DLS patients. Nighty-five DLS patients were retrospectively reviewed. Regions of interest for HU were measured on three coronal images of the lumbar vertebrae. HU measurement of the whole vertebrae from L1 to L5 was obtained, then HU measurement within concave and convex sides were obtained separately in L5, upper and lower end vertebrae, apex vertebrae, neutral vertebrae, stable vertebrae. HU value presented a gradually increasing trend from L1 to L5. No correlation was detected between Cobb angle and mean HU value of the 5 lumbar vertebrae, or between Cobb angle and HU value of every lumbar vertebrae separately. HU value was higher within concavity than that within convexity of the same vertebrae both in major and compensatory curve. Asymmetric HU ratio in apex vertebrae positively correlated with Cobb angle. Stable vertebrae were the first proximal vertebrae that present opposite orientation of asymmetric HU ratio from the other lumbar vertebrae. Progression of degenerative scoliosis presents no correlation with osteoporosis based on HU measurement but could increase the asymmetrical vertebral degeneration, especially in apex vertebrae. Distraction of the pedicle screws at concave side, instead of compression of pedicle screws at convex side, should be a priority to correct lumbosacral curve. 3.

THE IMPORTANCE OF CLAVICLE ANGLE AND HEIGHT OF THE CORACOID PROCESS IN IDIOPATHIC SCOLIOSIS

ABSTRACT Objective The aim of this study was to correlate the parameters of shoulder alignment with the Cobb angle value of the proximal thoracic curve in the pre and postoperative periods. Methods A retrospective data collection study was carried out, in which 30 medical records and radiographic examinations of patients submitted to surgical treatment for correction of deformity in AIS were performed in a single center from 2010 to 2017. Results The risk of CHD> 3 mm at 1 year postoperatively was similar between patients who had high thoracic curve (HTC) less than or equal to 25 degrees and those who had HTC greater than 25 degrees and not structured (relative risk = 1.75, P-value = 0.552). The risk of presenting CA> 2 degrees in the postoperative period of 1 year was similar between patients having HTC less than or equal to 25 degrees and those who had HTC greater than 25 degrees and not structured (relative risk = 1.31, P-value = 0.567). Conclusions We observed that when the proximal thoracic curve is not structured, even with a high Cobb angle, there is no need for instrumentation, presenting a satisfactory shoulder alignment in the postoperative period . Level of Evidence III; Retrospective and Comparative.

Internet Usage Profile of Medical Students and Effects of Internet Addiction on Sagittal Balance

Objective: The risk of internet addiction increases as the time of internet usage increases. Long-term internet usage may effect the posture of the person. This may cause the change of the gravity center and may effect the segmental degeneration. Methods: In Suleyman Demirel University, 168 medical students had internet addiction scale. The scores ≥81 accepted as internet addicted. Equal number of adolescents who got the diagnosis of internet addicted and not had cervical/lumbar x-ray graphics. Sagittal alignments were evaluated by using Cobb’s method. Probable internet addicted descriptive analysis, TwoStep Cluster Analysis, ANOVA, Independent Samples t-Test, Product-Moment Correlation, Mann-Whitney U analysis were used.Results: Nine(5,4%) students were internet addicted. There was a significant difference between internet usage habits and internet addiction scores, but the highest difference was found between “intermittent+long time usage” and “total usage in once”. There was only a negative(r = -.341) and significant relation(p= .021) between internet addiction and lumbar Cobb angle. As the score of internet usage increases, value of lumbar Cobb angle decreases. Only lumbar Cobb angle values were significantly different(p= .030) for devices used for internet access. According to the Rank values, students’ lumbar Cobb angle using laptop as internet access device(13,07) were lower than the students’ using cell phone or pads(21,07). Conclusion: Being in the same and unsuited anatomical position while using internet for a long time may cause changes in the sagittal alignment. Loadings and stresses on spinal structures influence the spinal morphology and cause the occurrence of disc degeneration.

Self-evaluation of Trunk Aesthetics in Conservatively Treated Children and Adolescents with Idiopathic Scoliosis.

Trunk deformity is an important manifestation of idiopathic scoliosis (IS). Patients' perception of spinal deformity and its impact on their quality of life (QoL) are important aspects of scoliosis treatment. The aim of this study was to determine the correlation between radiographic parameters (Cobb angle), clinical parameters (angle of trunk rotation, ATR), and the type of conservative treatment used vs the perception of trunk aesthetics as well as QoL in IS patients. The study enrolled 90 subjects (68 females, 22 males) diagnosed with IS (age: 9-18 years, 14.3± 2.1; Cobb angle 10-66°, 22.2°±12.2; ATR 2-20°, 7.6°±3.9). The study group was divided into (1) patients treated with bracing and physiotherapy (n=35) and (2) subjects undergoing physiotherapy alone (n=55). The perception of trunk deformity was analysed with the TAPS visual scale. QoL was measured with the Polish version of the SRS-22 questionnaire. The study showed that the patients' perception of their trunk aesthetics significantly worsened with increasing Cobb angle (TAPS, rS= -0.327, p<0.01) and ATR (TAPS, rS= -0.228, p<0.05) values. Moreover, higher ATR values sig-ni-ficantly decreased the patients' QoL (SRS-22, rS= -0.232, p<0.05). Bracing significantly worsened the patients' perception of aesthetics and QoL (TAPS, 3.2±0.8 vs 3.8±0.6, p<0.05; SRS-22, 3.9±0.4 vs 4.0±0.4, p<0.05 for patients treated with bracing and physiotherapy alone, respectively). 1. The magnitude of scoliosis, angle of trunk rotation, and bracing leads to worsen perception of trunk aesthetics and quality of life. 2. The curvature angle, angle of trunk rotation, brac-ing, female sex, and age are all associated with a worse perception of trunk aesthetics and quality of life. Self-evaluation of trunk aesthetics and qua-lity of life do not depend on the type of scoliosis. 3. In planning the management of idiopathic sco-lio-sis, one should take into account the impact of spi-nal deformity on worse patient-rated body aes-thetics.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P29. Does the true AP radiograph for scoliosis differ from ancient convention? Lessons from 3D imaging

BACKGROUND CONTEXT Scoliosis is a three-dimensional deformity. As such, the rotational component must be considered during its evaluation and management. However, the severity of scoliosis has long been measured in the 2D coronal plane using the Cobb angle – a modality unable to account for axial vertebral rotation (VR). In the past, the Stagnara lateral radiograph has attempted to compensate for VR. To date, no similar radiographic view has been described for the AP plane. Recent advances in 3D CT imaging may allow clinicians to more accurately measure Cobb angles in scoliosis by compensating for axial VR. Here, we present a retrospective study comparing Cobb angle measurements taken from both traditional 2D radiographs, and rotationally compensated CT images. PURPOSE The purpose of this study is to compare Cobb angle measurements routinely made for AIS in both rotationally compensated and standard imaging. STUDY DESIGN/SETTING Retrospective matched cohort study. PATIENT SAMPLE A total of 66 patients diagnosed with AIS. OUTCOME MEASURES PT, MT, and TL/L curve Cobb angle values, coronal balance, thoracic and lumbar apical vertebral translation (T/L-AVT), thoracic and lumbar apical vertebral rotation (T/L-AVR), thoracic kyphosis, and sagittal balance. METHODS In this retrospective study, standard AP, lateral, and bending radiographs of 66 patients age 10-19 with AIS were obtained. Using multiplanar 3D CT, the coronal plane was reconstructed within the plane of the vertebral axis to form a rotationally compensated 3D CT image (RC-3DCT). The following measurements were made on both imaging modalities: PT, MT, TL/L curve, coronal balance, T/L-AVT, T/L-AVR, thoracic kyphosis, and sagittal balance. RESULTS Mean MT curve was found to be 40.56° on AP radiograph versus 35.39° on RC-3DCT (n=63, P=.00039). In 28 patients (42.4%), rotational compensation altered the end vertebra of the major curve by at least 1 level. The mean TL curve obtained on radiograph, was significantly larger than that of RC-3DCT (n=62; 35.34° vs. 30.98° ; P=.0046). AP films overstated coronal balance by over 50% when compared to RC-3DCT Mean T-AVT was measured to be 25.28 mm on conventional films and 19.46 mm on RC-3DCT (n=62; P=.00033). RC-3DCT L-AVT was significantly smaller than that of standard films (P=.0094). Mean T-AVT on standing film was 26.2±31.0°. The mean proximal thoracic kyphosis did not differ between the two modalities: 20.66° on radiograph versus 21.062° on RC-3DCT (P=.41). CONCLUSIONS Measurements traditionally made on AP radiograph to evaluate scoliosis may be inaccurate due to VR. Our data suggest that axial rotation of a patient 19° per Nash–Moe grade with respect to the coronal plane may adequately compensate for the rotational component of deformity without the need for CT. Additionally, rotational compensation may yield end vertebrae levels different from those obtained traditionally. In 42% of patients, VR compensation altered end vertebral designation by at least 1 level.

Determinants of the biomechanical and radiological outcome of surgical correction of adolescent idiopathic scoliosis surgery: the role of rod properties and patient characteristics.

Aim of the study was to evaluate the role of the mechanical properties of the rod and of the characteristics of the patients (age, skeletal maturity, BMI, and Lenke type) in determining the deformity correction, its maintenance over time and the risk of mechanical failure of the instrumentation. From March 2011 to December 2014 120 patients affected by AIS underwent posterior instrumented fusion. Two 5.5-mm CoCr rods were implanted in all patients. For every patient, age, sex, Risser grade, Lenke type curve, flexibility of the main curve, body mass index (BMI), and percentage of correction were recorded. In all patients, the Cobb angle value and rod curvature angle (RC) were evaluated. RC changes were registered and correlated to each factor to establish a possible statistically significance in a multivariate analysis. A biomechanical model was constructed to study the influence of rod diameter and material as well as the density of the anchoring implants in determining stress and deformation of rods after contouring and implantation. Radiographic and biomechanical analysis showed a different mean rod deformation for concave and convex side: 7.8° and 3.9°, respectively. RC mean value at immediate follow-up was 21.8° for the concave side and 14.6° for the convex. At 2-year minimum follow-up, RC value increases 1.5° only for the concave side. At 3.5-year mean follow-up, RC value increases 2.7°, p=0.003, for the concave side and 1.3° for the convex, p=0.06. The use of the stiffest material as well as of the lowest diameter resulted in higher stresses in the rods. The use of either a low or a high instrumentation density resulted only in minor differences in the loss of correction. Rod diameter and material as well as patient characteristics such as BMI, age, and Risser grade play an important role in deformity correction and its maintenance over time.

Magnetically Controlled Growing Rods for the Management of Early-onset Scoliosis: A Preliminary Report.

A new method for the management of early-onset scoliosis (EOS) has been recently introduced: it consists of a magnetically controlled growing rod (MCGR) that allows gradual outpatient distractions under control of an external remote device. The aim of the present study is to present a series of 10 patients with EOS managed with MCGR (Ellipse TM MAGEC System, Irvine, CA). We implanted MCGR in 10 patients affected by EOS. Scoliosis and kyphosis angles, T1-T12 and T1-S1 length were evaluated preoperatively, postoperatively, and at the last follow-up. A visual analogue scale score was used to evaluate pain during outpatient rod distraction procedures. The mean follow-up is 27 months. All patients attended distractions of the magnetic rod through an external remote control every 3 months. The mean predicted distraction was 3 mm at each lengthening session. The mean Cobb angle value was 64.7±17.4 degrees (range, 45 to 100 degrees) preoperatively and 28.5±13.9 degrees (range, 15 to 59 degrees) at the latest follow-up. The mean T1-S1 length value was 27.1±5.4 cm (range, 16 to 34.8 cm) preoperatively and 32.8±4 cm (range, 26.5 to 39 cm) at the latest follow-up. The mean T1-T12 length value was 16.2±2.7 cm (range, 10 to 19 cm) preoperatively and 20.6±2.9 cm (range, 15.5 to 23.5 cm) at the latest follow-up.The average monthly T1-T12 height increase was 0.8 mm, whereas the average monthly T1-S1 increase was 0.9 mm.Two patients experienced a rod breakage and 1 patient had a pull-out of the apical hooks. Although implant-related complications could occur, as in all EOS growing rods procedures, MCGR can be effectively used in patients with EOS. This spinal instrumentation can overcome many of the complications related with the traditional growing rods implants. This procedure can be effectively used in outpatient settings, minimizing surgical scarring, surgical site infection, and psychological distress due to multiple surgeries needed in the traditional growing rods system, improving quality of life, and saving health care costs. Level IV.

Geometric Torsion in Adolescent Idiopathic Scoliosis: A Surgical Outcomes Study of Lenke Type 1 Patients.

Consecutive case series analysis. To evaluate the surgical outcomes of patients with thoracic adolescent idiopathic scoliosis (AIS) in relation to different degrees of geometric torsion. AIS is a three-dimensional (3D) deformity of the spine. A 3D classification of AIS, however, remains elusive because there is no widely accepted 3D parameter in the clinical practice. Recently, a new method of estimating geometric torsion has been proposed and detected two potential new 3D subgroups based on geometric torsion values. This is an analysis of 93 patients with Lenke type-1 deformity from our institution. 3D reconstructions were obtained using biplanar radiographs both pre- and postoperatively. Geometric torsion was computed using a novel technique by approximating local arc lengths at the neutral vertebra in the thoracolumbar segment. An inter- and intragroup statistical analysis was performed to compare clinical indices of patients with different torsion values. A qualitative assessment was also performed on each patient by two senior staff surgeons. Statistically significant differences were observed in clinical indices between high (2.85 mm) and low torsion (0.83 mm) Lenke type 1 subgroups. Preoperatively, the high torsion group showed higher Cobb angle values in the thoracic segment (71.18° vs. 63.74°), as well as higher angulation in the thoracolumbar plane of maximum deformity (67.79° vs. 53.30°). Postoperatively, a statistically significant difference was found in the orientation of the plane of maximum deformity in the thoracolumbar segment between the high and low torsion groups (47.95° vs. 30.03°). Results from the qualitative evaluation of surgical results showed different results between the two staff surgeons. These results suggest a link between preoperative torsion values and surgical outcomes within Lenke type 1 deformities. These results will need to be validated by an independent group, as it is a single-center study. 4.

EVALUATION OF THE RESULTS OF THE USE OF VEPTR IN PATIENTS WITH SCOLIOSIS

ABSTRACT Objective: Evaluation of the results of the use of VEPTR (Vertical Expandable Prosthetic Titanium Rib - Synthes Spine Co.(r), West Chester, Pennsylvania, USA) as an option in spinal instrumentation without fusion in younger children with scoliosis, considering the complications inherent to spinal fusion in this age group. Methods: Sixteen (16) patients with scoliosis, regardless of etiology, with a mean age of 5.2 (3-8) years, were followed up by Spine Surgery Group at Hospital Getúlio Vargas, Recite-PE, and were submitted to surgical correction of the deformity using VEPTR, from April/2009 to July/2014. The survey was conducted through medical register review, and photographic and radiographic records, with the measurement of pre- and postoperative curves by the Cobb method. Results: The mean values of Cobb angle in the preoperative period, in the immediate postoperative period and after the last distraction were, respectively, 84.1° (112°-60°), 55.4° (92°-16°) and 64.4° (100°-16°), with an average initial correction of 28.7° (34.1%) and final correction of 19.7° (23.4%). The mean follow-up was 23.1 (0-61) months with an average distraction of 3.1 (0-8). The complication rate in this study was 62.5%. Conclusion: The VEPTR presented considerable correction rates of scoliosis curves in patients whose age contraindicate the spinal fusion methods. It is necessary to improve the technique and the implant itself in order to reduce complication rates, which can be considered relatively high, in addition to the conduction of more studies with longer follow-up to determine the actual efficacy of the implant and the maintenance of long-term correction.

What Extent a Higher Implants Density Gives More Correction? Correlation of Scoliosis Curve Correction with the Type and Density of Implants

Introduction Corrective Surgery for Adolescent Idiopathic Scoliosis (AIS) has evolved with the utilization of more sophisticated implants and higher implants density looking forward a better correction though a posterior approach. But, is this correction myth or reality? Our objective is to analyze the relationship between implant density and deformity correction, comparing two different instrumentations. Materials and Methods A retrospective cohort study was performed using patients from the database of our institution between 2009–2012. Inclusion criteria were diagnosis of AIS, age between 12–18 year-old, surgeries performed in our institution, complete radiological study and a minimum follow-up of two years. No curve restriction was considered. Analysis of radiology was done in three different moments for each patient: pre-op, first control after surgery and one year follow-up. Coronal and sagittal parameters were considered to evaluate deformity severity. Pre-op bending X-rays were analyzed for flexibility measurement. Post-operatively they were measured implant density for each group, fusion levels and deformity correction for both coronal and sagittal planes. Patients were classified following Lenke and divided in two groups: all pedicle screws instrumentation (APS) and hybrid instrumentation (HY). Statistical study was made using the T-Student test to analyze differences between cohorts and Pearson's Test for correlating variables. Results They were collected in total 82 cases, 67 of which were females. The mean age was 16 year-old. The 61% of total patients presented a Lenke type 1 curve. 35 patients were treated with APS instrumentation and 47 using a HY construction. Values for Cobb angle, flexibility and T5-T12 kyphosis pre-op were homogeneous between both groups. Post-operatively there were no significant statistical differences comparing fusion levels and percentage of coronal deformity correction between the two groups. Nevertheless, they were remarkable the 40% of implant density difference and the higher loss of kyphosis in APS group as compared with HY. Pearson's test evidenced that, in general, the only variable, which was statistically significant correlated with a higher coronal deformity correction, was pre-op flexibility; not implant density, fusion levels or type of instrumentation used. Significant differences were found comparing loss of thoracic kyphosis after surgery between groups, finding a significant correlation which indicated that using pedicle screws the higher implant density used, the bigger the loss of kyphosis. Loss of kyphosis was not statistically significant when correlated with percentage of coronal deformity correction. One-year follow-up X-ray did not show significant differences when values of Cobb angle and thoracic kyphosis were analyzed among groups. Conclusions Both hybrid and all pedicle screws instrumentations achieve equal coronal deformity correction operating on flexible curves, we do not obtain a bigger deformity correction with a higher implant density all pedicle screws instrumentation produce a higher loss of thoracic kyphosis.

Magnetically Controlled Growing Rods for the Management of Early-onset Scoliosis: Results and Complications at 3-year Follow-up

Introduction A new method for the management of early-onset scoliosis (EOS) has been recently introduced: it consists of a magnetically controlled growing rod (MCGR) that allows gradual outpatient distractions under control of an external remote device. We present a series of 14 patients with EOS managed with MCGR (Ellipse TM MAGEC System, Irvine, CA). Material and Methods We implanted MCGR in 14 patients affected by EOS with various etiology. Scoliosis and kyphosis angles, T1-T12 and T1-S1 length were evaluated preoperatively, postoperatively, and at the last follow-up. A visual analogue scale score was used to evaluate pain during outpatient rod distraction procedures. The mean follow-up is 34 months. All patients attended distractions of the magnetic rod through an external remote control every 3 months. The mean predicted distraction was 3 mm at each lengthening session. Results The mean Cobb angle value was 64.7 ± 17.4 degrees (range, 45 to 100 degrees) preoperatively and 28.5 ± 13.9 degrees (range, 15 to 59 degrees) at the latest follow-up. The mean T1-S1 length value was 27.1 ± 5.4 cm (range, 16 to 34.8 cm) preoperatively and 32.8 ± 4 cm (range, 26.5 to 39 cm) at the latest follow-up. The mean T1-T12 length value was 16.2 ± 2.7 cm (range, 10 to 19 cm) preoperatively and 20.6 ± 2.9 cm (range, 15.5 to 23.5 cm) at the latest follow-up. The average monthly T1-T12 height increase was 0.8 mm, whereas the average monthly T1-S1 increase was 0.9 mm. Two patients experienced a rod breakage and 1 patient had a pull-out of the apical hooks. In cases of rod breakage, the magnetic rod was removed and replaced. In case of pull-out, apical pedicle screws have been positioned in substitution of hooks. Conclusion Although implant-related complications could occur, as in all EOS growing rods procedures, MCGR can be effectively used in patients with EOS. This spinal instrumentation can overcome many of the complications related with the traditional growing rods implants. In our experience, rod breakage occurred only in patients with a single magnetic rod instrumentation. First case was a patient with a severe thoracic kyphosis. In effect, the management of kyphosis with the MCRG is quite challenging. Moreover, a marked kyphosis was also the cause of pull-out of the apical hooks. Instead, in the second case of rod breakage, we reported a failure of the internal magnet of the rod. In conclusion, this procedure can be effectively used in outpatient settings, minimizing surgical scarring, surgical site infection, and psychological distress due to multiple surgeries needed in the traditional growing rods system, improving quality of life, and saving health care costs.

Crankshaft Phenomenon in Patients Operated for Adolescent Idiopathic Scoliosis

Introduction Crankshaft phenomenon is determined as a loss of three-dimensional correction of the scoliosis curve, which occurs after posterior fusion in children who have not completely finished skeletal growth. Dubousset named this phenomenon when he noticed that the entire spine and torso gradually turn and deform anterior spine, which continues to grow and rake around the axis of the fusion mass. This is mostly seen in infantile and juvenile idiopathic scoliosis, however this also occur in adolescents who are immature at the time of the last fusion. Aim To analyze this phenomenon in adolescents who have not finished skeletal growth and were operated for idiopathic scoliosis. Material and Methods This retrospective–prospective study analyzed 48 randomly selected adolescents operated for idiopathic scoliosis in Clinic for Orthopaedic and Traumatology in Tuzla between 1996 and 2011. Patients operated only with a posterior stabilization and fusion were divided into two groups. One group consisted of adolescents with intensive growth (12 years for girls and 14 years for boys) and another group consisted of adolescents at final stage of skeletal growth (14 years for girls and 16 years for boys). We measured Cobb angle at standard X-rays performed in an upright posture immediately after the surgery and at the latest X-rays done at the end of skeletal growth at the age of 18 years. Results Increasing Cobb angle was noted in 53% of studied patients. In group A higher values of Cobb angle noted in 69.56% examinees and in 36% in group B. When we analyzed both groups Cobb angle increased from preoperative 19.6 degrees to postoperative 22 degrees (2.4 degrees—12.2%) ( r = 0.98), In group A preoperative Cobb angle increased from preoperative 20.6% degrees to postoperative 24 degrees (3.4 degrees—16.22%) ( r = 0.97), while in group B from 18.60 to 20 degrees (1.4 degrees—7.52%) ( r = 0.98). Conclusion Postoperative deformity progression of anterior column in adolescents operated for idiopathic scoliosis could be seen even if the stable fusion achieved. The risk for progression is higher in younger patients.

Early Results of Magnetically Controlled Growing Rods in the Management of Early-Onset Scoliosis

Introduction To present a series of nine patients with early-onset scoliosis (EOS) managed with magnetically controlled growing rods (Ellipse TM MAGEC System). Material and Methods We implanted magnetically controlled growing rods in nine patients affected by early-onset scoliosis. Scoliosis and Kyphosis angles, T1–T12, and T1–S1 distances were evaluated preoperatively, postoperatively, and at the last follow-up. A visual analogue scale score was used to evaluate pain during outpatient rod distraction procedures. The mean follow-up is 24.5 months. All patients attended distractions of the magnetic rod through an external remote control every 3 months. Results The mean Cobb angle value was 66.3 ± 17.6 degrees (range, 45–100 degrees) preoperatively and 30 ± 13.8 degrees (range, 15–59 degrees) at the latest follow-up. The mean T1–S1 length value was 27.2 ± 5.7 cm (range, 16–34.8 cm) preoperatively and 33.2 ± 4 cm (range, 26.5–39 cm) at the latest follow-up. The mean T1–T12 length value was 16.3 ± 2.9 cm (range, 10–19 cm) preoperatively and 20.9 ± 2.9 cm (range, 15.5–23.5 cm) at the latest follow-up. The average monthly T1–T12 height increase was 0.8 mm while the average monthly T1–S1 increase was 0.9 mm. Two patients experienced a rod breakage and one patient had a pullout of the apical hooks. Conclusion Although implant-related complications could occur, magnetically controlled growing rods can be effectively used in patients with EOS. This spinal instrumentation can overcome many of the complications related with the traditional growing rods implants. This procedure can be effectively used in outpatient settings, minimizing surgical scarring, and psychological distress due to multiple surgeries needed in the traditional growing rods system, improving quality of life, and saving health care costs.

Severe idiopathic Knee arthrodesis scoliosis. Does the approach and the instruments used modify the results?

ObjectiveThe aim of this work is to evaluate and compare the radiographic results and complications of the surgical treatment in adolescents with idiopathic scoliosis greater than 75 degrees, using a double approach (DA) or an isolated posterior approach with hybrid instruments (posterior hybrid [PH]), or with “all-pedicle screws” (posterior screws [PS]). Materials and methodsA retrospective review was performed on 69 patients with idiopathic scoliosis greater than 75°, with a follow-up of more than 2 years, to analyze the flexibility of the curves, the correction obtained, and the complications depending on the type of surgery.The Kruskal–Wallis test for non-parametric variables was used for the statistical analysis. ResultsThere were no statistically significant differences between the 3 patient groups in the pre-surgical Cobb angle values (DA=89°, PH=83°, PS=83°), in the immediate post-surgical (DA=34°, PH=33°, PS=30°), nor at the end of follow-up (DA=36°, PH=36°, PS=33°) (P>.05). The percentage correction (DA=60%, PH=57%, PS=60%) was similar between groups (P>.05).The percentage of complications associated with the procedure was 20.8% in DA, 10% in PH and 20% in PS. Two patients in the PS group showed changes, with no neurological lesions, in the spinal cord monitoring, and one patient in the same group suffered a delayed and transient incomplete lesion. Discussion and conclusionsNo significant differences were observed in the correction of severe idiopathic scoliosis between patients operated using the double or isolated posterior approach, regardless of the type of instrumentation used.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ПРИМЕНЕНИЯ ВЕНТРАЛЬНОГО И ЗАДНЕГО КОРРИГИРУЮЩЕГО СПОНДИЛОДЕЗА У ПАЦИЕНТОВ С ИДИОПАТИЧЕСКИМ СКОЛИОЗОМ ТИПА LENKE 1А И 5С

Objective. To perform a comparative analysis of the results of anterior versus posterior spinal fusion in patients with idiopathic scoliosis. Material and Methods. A total of 30 patients with idiopathic scoliosis were operated on. Group I included patients who underwent anterior spinal fusion, and Group II - those who underwent posterior spinal fusion. Cobb angles of the primary curve and countercurve, thoracic kyphosis and lumbar lordosis before surgery and 2 years after treatment, average number of fixed vertebrae, intraoperative blood loss, surgery duration, and duration of hospital stay were assessed. Results. The study revealed no statistically significant differences between groups in the pre- and postoperative Cobb angle values in both the frontal and sagittal planes. Both methods equally allowed to carry out the correction of all components of scoliotic curvature. Statistically significant difference in thoracic kyphosis and lumbar lordosis angles is caused by anatomic features of sagittal contour in two groups of patients. At the same time a normal sagittal contour of the spine was disturbed neither by anterior no by posterior fusion, and postoperative parameters were within permissible limits. Conclusion. Application of anterior corrective spinal fusion methods reduces intraoperative blood loss, length of spine fixation, and duration of hospital stay, and improves the patient’s quality of life. Hir. Pozvonoc. 2014; (1): 36-41.

Escoliosis idiopáticas graves. ¿El abordaje y la instrumentación modifican los resultados?

ObjectiveThe aim of this work is to evaluate and compare the radiographic results and complications of the surgical treatment of adolescents with idiopathic scoliosis greater than 75 degrees, using a double approach (DA) or an isolated posterior approach with hybrid instruments (posterior hybrid [PH]), or with «all-pedicle screws» (posterior screws [PS]). Material and methodA retrospective review was performed on 69 patients with idiopathic scoliosis greater than 75°, with a follow-up of more than 2 years, to analyze the flexibility of the curves, the correction obtained, and the complications depending on the type of surgery.The Kruskal-Wallis test for non-parametric variables was used for the statistical analysis. ResultsThere were no statistically significant differences between the 3 patient groups in the pre-surgical Cobb angle values (DA=89°, PH=83°, PS=83°), in the immediate post-surgical (DA=34°, PH=33°, PS=30°), nor at the end of follow-up (DA=36°, PH=36°, PS=33°) (P>.05). The percentage correction (DA=60%, PH=57%, PS=60%) was similar between groups (P>.05).The percentage of complications associated with the procedure was 20.8% in DA, 10% in PH and 20% in PS. Two patients in the PS group showed changes, with no neurological lesions, in the spinal cord monitoring, and one patient in the same group suffered a delayed and transient incomplete lesion. Discussion and conclusionsNo significant differences were observed in the correction of severe idiopathic scoliosis between patients operated using the double or isolated posterior approach, regardless of the type of instrumentation used.

Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

The main aim of this study was to compare clinical and radiological outcomes after stabilization by a percutaneous transpedicular system and stabilization from the standard open approach for thoracolumbar spine injury. Thirty-seven consecutive patients were enrolled in the study over a period of 16 months. Patients were included in the study if they experienced 1 thoracolumbar fracture (A3.1-A3.3, according to the AO/Magerl classification), had an absence of neurological deficits, had no other significant injuries, and were willing to participate. Eighteen patients were treated by short-segment, minimally invasive, percutaneous pedicle screw instrumentation. The control group was composed of 19 patients who were stabilized using a short-segment transpedicular construct, which was performed through a standard midline incision. The pain profile was assessed by a visual analog scale (VAS), and overall satisfaction by a simple 4-stage scale relating to performance of daily activities. Working ability and return to original occupation were also monitored. Radiographic follow-up was defined by the vertebral body index (VBI), vertebral body angle (VBA), and bisegmental Cobb angle. The accuracy of screw placement was examined using CT. The mean surgical duration in the percutaneous screw group was 53 ± 10 minutes, compared with 60 ± 9 minutes in the control group (p = 0.032). The percutaneous screw group had a significantly lower perioperative blood loss of 56 ± 17 ml, compared with 331 ± 149 ml in the control group (p < 0.001). Scores on the VAS in patients in the percutaneous screw group during the first 7 postoperative days were significantly lower than those in the control group (p < 0.001). There was no significant difference between groups in VBI, VBA, and Cobb angle values during follow-up. There was no significant difference in screw placement accuracy between the groups and no patients required surgical revision. There was no significant difference between groups in overall satisfaction at the 2-year follow-up (p = 0.402). Working ability was insignificantly better in the percutaneous screw group; previous working position was achieved in 17 patients in this group and in 12 cases in the control group (p = 0.088). This study confirms that the percutaneous transpedicular screw technique represents a viable option in the treatment of preselected thoracolumbar fractures. A significant reduction in blood loss, postoperative pain, and surgical time were the main advantages associated with this minimally invasive technique. Clinical, functional, and radiological results were at least the same as those achieved using the open technique after a 2-year follow-up. The short-term benefits of the percutaneous transpedicular screw technique are apparent, and long-term results have to be studied in other well-designed studies evaluating the theoretical benefit of the percutaneous technique and assessing whether the results of the latter are as durable as the ones achieved by open surgery.

Progresión en el adulto joven de la escoliosis idiopática tratada con ortesis

ObjectiveThis study has aimed to evaluate the evolution of idiopathic scoliosis treated with a brace and assess its progression in young adults. Patient and methodA retrospective study of 71 patients with idiopathic scoliosis treated with a brace between years 1978-1996 was conducted. It included patients attending post-discharge visits and excluded those requiring surgery and age>40 years. Two groups were compared: patients in whom the scoliosis had progressed and those in whom it had not progressed. The following variables were studied: a) morphology type and classification of the curve; b) type of scoliosis: adolescent, youth and child; c) Cobb angle value on diagnosis, at end of treatment and at last control; d) brace used; e) orthotic treatment duration; and f) evolution time (between removal of brace and last control). Statistical analysisChi square was used for comparative analysis for categorical variables and the Student's t test for continuous variables with normal distribution. Nonparametric tests were used for all other variables. A statistical significance level of P<.05 was assumed. ResultsThe curve progressed in 22 patients (31%), with a mean increase of 9.5 (SD:4.5) during 9.7 years. The group with progression had higher angle values at baseline (dif:3.9; 95% CI:−1.76 to 9..6), end of treatment (dif:4.8; 95% CI:−1.6 to 11.2), which were significant at the last control (dif:14.5; 95% CI:7.9-21.1), with no differences between the other variables studied. ConclusionsProgression was 2.8° over 8 years. There as no progression in 69% compared to 31% who progressed 9.5°.

Dolor en el adulto joven después del tratamiento con ortesis de la escoliosis idiopática juvenil y adolescente

ObjectiveTo study the presence of back pain in the young adult with idiopathic scoliosis who has been treated orthopedically. Patients and methodA retrospective study was performed in a group of 71 patients with idiopathic scoliosis treated with containment orthosis between the years 1978 and 1996. It included all the patients treated with any type of brace who came to periodic controls every 5 years, beginning at the age of 20. All those who were treated surgically or were older than 40 year were excluded. Main study variableBack pain. Other variables were curve location, scoliosis (brace) type, Cobb angle value, orthesic treatment duration, age at diagnosis, current and last control, follow-up time, treatment carried out and scoliosis severity. Statistical analysisThe mean, median, range and standard deviation for continuous variables were determined, Frequencies for categorical variables, Chi-square, Student's T test and non-parametric tests were determined. A statistical significance level of P<.05 was assumed. ResultsA total of 27 patients had back pain (38%). A significant difference was observed between the groups with and without pain in the follow-up time, these being 10.3 years versus 7.3 (95% CI: 5-1) and the age of patients at the time of the last check-up, i.e. 27.3 versus 24.6 (95% CI: 4.8-0.8)

Reliability of Radiographic Measures for Infantile Idiopathic Scoliosis

Radiographic measures such as the rib vertebral angle difference (RVAD), Cobb angle, and space available for the lung (SAL) help to guide treatment and measure treatment effects in patients with infantile idiopathic scoliosis. This study aimed to evaluate the intraobserver and interobserver reliability of these radiographic measures. Forty-five spine radiographs of skeletally immature patients (age, two months to four years) with infantile idiopathic scoliosis were measured with use of Surgimap software. Three pediatric orthopaedic surgeons and a pediatric orthopaedic fellow identified the major curve apex, rib-vertebra phase, Cobb angle, and end vertebrae and calculated the RVAD and SAL values at two separate time points. Interobserver and intraobserver reliability of the RVAD, Cobb angle, and SAL values were assessed with use of intraclass correlation coefficients (ICCs). Fleiss kappa coefficients were calculated for categorical variables. The RVAD (ICC = 0.86 to 0.92) and Cobb angle (ICC = 0.99) measurements had high reliability. The SAL value had substantial interobserver reliability (ICC = 0.66) and moderate intraobserver reliability (ICC = 0.73). Despite the high agreement for the Cobb angle, the choice of the major curve vertebrae (kappa = 0.19 to 0.39) and apical vertebra varied (kappa = 0.57 to 0.62). Observers were more likely to choose the same apical vertebra in large curves (r = 0.483, p = 0.001). The agreement for the apical rib-vertebra phase was substantial (kappa = 0.67). Paired RVAD measurements fell within ≤ 10° of each other in 82% of cases, but the remaining 18% of the RVAD measurements showed >10° of variation. Measurements used to guide treatment of infantile idiopathic scoliosis curves were reliable despite standard radiographic measurement error and the difficulty in obtaining quality images in young patients. Clinicians are dependent on seemingly objective radiographic data. The reliability of the Cobb angle and RVAD measurements in infantile scoliosis was high but not devoid of variability that could skew the ability to accurately and reliably suggest the best course of treatment. The SAL value was a less reliable measure. Treatment recommendations for infantile idiopathic scoliosis should rely on the synthesis of objective and clinically subjective data, as variations in radiographic measurements can lead to inconsistencies in management and to inconsistent treatment outcomes.