Cobb Angle Research Articles

Asymmetric Osteopenia in Adolescent Idiopathic Scoliosis Based on Hounsfield Unit of Computed Tomography.

To characterize the asymmetrical loss of bone mass and identify the association between scoliosis and osteopenia in patients with adolescent idiopathic scoliosis (AIS). Demographic information, Cobb angle, and Hounsfield unit (HU) of the neutral vertebra (NV) and apical vertebra (apex) of the major curve were collected retrospectively in 54 AIS patients. For 84 control subjects, HU values were measured at T12 and L5. Propensity score matching was performed to balance the interference of age and BMI. In the AIS group, the concave and convex lateral HU of the NV and the convex lateral HU of the apex were negatively correlated with the Cobb angle. The AIS patients had lower bilateral HU. The mean HU and the apex-convex HU were also lower in the AIS group, while the apex-concave HU was slightly higher. After matching, the apex-convex HU of the AIS group remained lower, while the apex-concave HU was higher. Patients with AIS exhibit osteopenia, particularly on the convex side. The severity of scoliosis was found to be directly proportional to the severity of bone loss and the degree of bilateral osteopenia asymmetry. Appropriate intervention for bone loss may be able to curb the progression of scoliosis.

Awareness of Current Surgical Practice for Congenital Scoliosis and Optimal Timing of Treatment Among Physicians and Patients' Families in Saudi Arabia.

Congenital scoliosis (CS) is a developmental spinal deformity characterized by an abnormal curvature of the spine, affecting one in 1,000 births. The mainstay of treatment involves either observation or surgery in significant curve progression. The optimal timing of surgical intervention is debated, with early intervention preferred. Therefore, understanding physicians' and patients' families' perspectives is crucial for optimizing surgical outcomes in CS. To assess the awareness and knowledge of physicians and patients' families regarding current, as well as new surgical practices and the optimal timing of treatment for CS. A cross-sectional study was conducted in Saudi Arabia using an online self-administered questionnaire distributed through social media platforms and neurosurgery clinics. Levels of awareness were assessed by a knowledge-scoring system. The study involved 403 participants, primarily patients' families (85.1%, N = 343) and physicians (14.9%, N = 60). The results show that physicians had a significantly higher correct response than patients' families regarding the ideal age for surgical correction of CS, the timing of surgical intervention whether before or after maturity, and the role of conservative management, as evident from statistically significant p-values of <0.001, 0.031, and <0.001, respectively. On the contrary, patients' families excelled in understanding interventions irrespective of symptomatic status if Cobb's angle is 40 degrees or above, with a statistically significant p-value of 0.031. Both groups exhibited a good level of overall knowledge, as evidenced by mean awareness scores of 12.18 and 11.64, respectively. Additionally, physicians had a statistically significanthigher level of awareness compared to patients' families, with a p-value of (0.014). However, both groups demonstrated poor knowledge of the latest techniques, including distraction-based magnetically controlled growing rods (MCGRs), growth-guided modern Luque trolleys, and posterior dynamic deformity correction (ApiFix). The mean awareness score of both physicians and patients' families indicates a good level of knowledge. However, both groups exhibited poor knowledge in relation to the optimal timing of treatment and new surgical techniques.

Severe Rigid Scoliosis Deformity Correction Using Extended Posterior Release and Instrumentation: A Retrospective Study.

Sever rigid scoliotic deformity (magnitude of the curve >80° and <25% correction on bending film) correction is a great challenge to spine surgeons. Severe scoliosis when untreated or not treated properly, may lead to severe complications due to curve progression. The aim of operative management is to achieve significant correction of sagittal, coronal, and rotational deformity to avoid neurodeficit, maintain sagittal balance, and improve cardiopulmonary function. In this retrospective study, eight patients with severe rigid scoliosis who underwent through single-staged extended posterior release and spinal fusion between March 2022 and November 2023. The surgical procedures were the excision of the posterior ligament and spinous process, laminectomy, excision of ligament flavum, facetectomy, and posterior spinal fusion utilizing pedicle screws, rods, and sub-laminar wires. Patients were evaluated radiologically using posteroanterior and lateral X-rays of the whole spine and computed tomography scans. Demographic data, pre- and post-operative cobbs angle, osteotomized segment, instrumentation segments, blood loss, operation duration, follow-up duration, and complications were recorded. Pre-operative mean cobbs angle was 94.1° (range 83-110°) and post-operative mean cobbs angle was 33.3° (range 28-42°) with 64.6% scoliosis correction. The mean estimated blood loss was 517 mL (range 300-580 mL). The mean operation duration was 272.5 min (210-340 min). Mean spinal fixation fusion segments were 11.1 (range 8-14). No major complications were noted. Our study concluded that extended posterior-only release, facetectomy, and posterior spinal fusion by utilizing pedicle screws and pre-contoured rods significantly corrected severe and rigid scoliosis with a high correction rate and avoid complications of anterior release. Hence, we can achieve remarkable correction in rigid scoliosis using the proper choice of levels, proper implant, and extended posterior release.

Clinical efficacy of one-stage anterior debridement and bone graft fusion for the treatment of cervical pyogenic spondylodiscitis

Objective: To investigate the efficacy of one-stage anterior debridement and bone graft fusion for the treatment of cervical pyogenic spondylodiscitis. Methods: This is a retrospective case series study. Retrospective analysis of clinical data from 23 patients with cervical pyogenic spondylodiscitis treated with one-stage anterior approach debridement and bone graft fusion was performed in the Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2020. There were 14 males and 9 females,aged (51.9±12.8) years (range:26 to 82 years). Preoperatively, 14 patients had neurological deficits, classified according to the American Spinal Injury Association (ASIA) impairment scale as follows: grade A in 1 case, grade B in 1 case, grade C in 5 cases, and grade D in 7 cases. All patients underwent the one-stage anterior debridement and fusion procedure. The surgical time, blood loss, hospital stay, fusion time, and surgical complications were documented. Clinical efficacy was assessed using the visual analogue scale (VAS), the neck disability index (NDI), and the ASIA impairment scale. Preoperative and postoperative data were compared using paired sample t tests, repeated measures analysis of variance, and generalized estimating equations. Results: All the 23 patients underwent the operative procedures successfully. The operation time was (102.8±19.8) minutes (range:60 to 140 minutes), blood loss was (84.4±40.2) ml (range:30 to 160 ml), and the length of hospital stay was (17.4±6.0) days (range:10 to 30 days). Blood cultures were positive for the causative pathogen in 14 cases (60.8% positivity rate), while 9 cases had negative results. Irrigation fluid cultures yielded the causative pathogen in 19 cases (82.6% positivity rate), with 4 cases negative. All patients were followed up for more than 12 months, with a follow-up duration of (19.0±5.9) months (range:12 to 36 months). At the final follow-up, VAS improved from (5.9±1.1) points preoperatively to (0.8±0.3) points; NDI improved from (38.3±6.0)% preoperatively to (9.3±3.0)%, with statistically significant differences (both P<0.01). All patients experienced improvement in neurological function, with the exception of one patient in grade C and two in grade D, all other patients recovered to grade E. The C2-7 Cobb angle and the affected segment Cobb angle were corrected. white blood cell, erythrocyte sedimentation rate and C-reactive protein levels returned to normal. All patients achieved bony fusion, with a fusion time of (8.9±1.9) months (range:6 to 12 months). Two diabetic patients developed postoperative incision infection; no other surgery-related complications occurred in the remaining patients. Conclusion: One-stage anterior debridement and bone graft fusion can correct kyphosis, restore normal alignment, and improve neurological function in the treatment of single and double segment cervical pyogenic spondylodiscitis, representing a viable treatment option for cervical pyogenic spondylodiscitis.

The Schroth Method for Pediatric Scoliosis: A Systematic and Critical Analysis Review.

The Schroth method is the most commonly used patient scoliosis-specific exercise paradigm for treating pediatric scoliosis. The aim of this study is to systematically and critically examine the evidence for the Schroth method for pediatric scoliosis. PubMed, MEDLINE, CINAHL, and Web of Science were searched through April 5, 2024, for articles examining the Schroth method for pediatric scoliosis (<18 years old). Thirteen review questions were created spanning the study aim. Each included article was independently assessed for the level of evidence (I-IV). Research questions were given a grade of recommendation (A, B, C, and I [insufficient]). A total of 29 articles (41.4% Level I, 31.0% Level II, 13.8% Level II, and 13.8% Level IV) met inclusion criteria out of 845 initially retrieved, describing 1,555 patients with scoliosis aged 4 to 18 years. There was grade A evidence that the Schroth method is most commonly used for adolescent idiopathic scoliosis (AIS), can improve the angle of trunk rotation, and is safe; grade B evidence for improvement in posture; and grade I evidence for improvement in Cobb angle, cosmetic deformity, quality of life, ideal treatment parameters, economic value, utility in delaying/preventing surgery, effectiveness in relation to patient characteristics (e.g., skeletal maturity or curve size), and comparative effectiveness to other conservative interventions. While there is good evidence that the Schroth method is commonly and safely used in AIS and can minimally improve the angle of trunk rotation and fair evidence of improvement in posture, there is insufficient evidence regarding multiple important clinical and economic outcomes, such as comparative effectiveness to other conservative interventions and improvement of Cobb angle. Although clinicians may consider the Schroth method as 1 option of several conservative strategies, clinical benefit may be limited, and further high-quality research is needed to evaluate its performance in areas of insufficient evidence.

Comparative analysis of early versus late surgical intervention for lumbosacral hemivertebra: a minimum 2-year follow-up retrospective study

BACKGROUND CONTEXTLumbosacral hemivertebra (LSHV) is a complex and unique congenital spinal deformity characterized by early severe trunk imbalance and progressive compensatory curve. Previous studies have proved the efficiency of posterior LSHV resection. However, the optimal timing for surgical intervention of LSHV still remains controversial. Few studies compare the surgical outcomes in patients of different age groups. PURPOSETo evaluate the influence of posterior-only LSHV resection surgery timing on clinical and radiographic results. STUDY DESIGNRetrospective analysis. PATIENT SAMPLEWe retrospectively analyzed 58 LSHV patients undergoing posterior-only LSHV resection with short-segment fusion at our institution between 2010 and 2020, with a mean follow-up of 7.5 years. OUTCOME MEASUREThe following data were observed for all cases: patient demographics, clinical outcomes measured by operating time, intraoperative blood loss, complications, and Health-Related Quality of Life, radiographic parameters included Cobb angles, trunk shift and sagittal spinal parameters. METHODSFrom 2010 to 2020, a consecutive series of 58 LSHV patients treated by posterior LSHV resection with short segmental fusion were investigated retrospectively, with a 7.5-year average follow-up period. Patients were stratified into 2 groups based on the timing of surgery: Group E (≤6 years old, representing the early-surgery) and Group L (>6 years old, representing the late-surgery). Radiographic assessments included pre- and postoperative measurements of main scoliosis, compensatory scoliosis, trunk shift, and sagittal balance parameters. Operative data, perioperative complications and SRS-22 questionnaires were also collected. RESULTSCompared to Group L, Group E exhibited a lower intraoperative blood loss (p<.001), higher final main curve correction rate (p=.037), smaller post-op compensatory curve (p=.031), higher sagittal vertical axis correction rates at immediate post-op (p=.045) and last follow-up (p=.027), and lower implant failure complications incidence (p=.006). CONCLUSIONThis study suggested that early surgical intervention in LSHV patients can achieve better correction outcomes, while reducing blood loss and postoperative complications in a large-scale cohort.

The Use of Thoracoscopic Release in the Surgical Correction of Thoracic Scoliosis in Children

IntroductionRecently, the use of thoracoscopic methods in spinal deformity surgery has increased, however, the issue of the effectiveness of combining anterior release with posterior spinal fusion compared to single-stage posterior instrumentation remains controversial, which raises the issue of the effectiveness and feasibility of their use. PurposeTo evaluate the effectiveness of endoscopic anterior release for thoracic scoliosis in children. Material and methodA retrospective analysis of the results of surgical treatment of 48 patients with idiopathic scoliosis of the thoracic spine aged 12–17 years, with a thoracic curve of more than 60°, was carried out. To determine the stability of deformity, the stability index according to A.I. Kazmin was used. (SI) defined as the ratio of the angle of deformity in the supine position to the angle of deformity in the standing position. Indications for anterior release were incomplete skeletal growth and relatively stable deformities (SI 0.75–0.85). Group 1 included 27 patients operated on in one stage without anterior release, and group 2 included 21 patients in two stages, with preliminary anterior release using video-assisted thoracoscopy. ResultsIn group 1, the average Cobb angle of deformity was 71.8° with an average stability index of 0.8. In the second group, the average cobb angle of deformity was 69.7°, the average stability index was 0.82. In group 1 after surgery, the average Cobb angle was 27.8°, with an average correction of 63.39%. In the second group, the postoperative deformity angle was 17.4°, the average correction was 76.26%. Thus, we found a statistically significant increase in postoperative correction when using a combined anterior/posterior approach (p < 0.05). ConclusionIn the study, in patients with relatively stable deformities, a statistically significant increase in the degree of postoperative correction was revealed (p < 0.05) when using a combined anterior/posterior approach. Performing an anterior thoracoscopic release for thoracic deformities can improve long-term results due to the formation of 360° spinal fusion at the apex of the deformity, as well as turning off the pathogenetic links in the progression of the deformity. Level of EvidenceIII.

Anterior Cervical Discectomy and Fusion for the Treatment of Pincer Cervical Spondylotic Myelopathy: A Single-Center Retrospective Study

BackgroundAnterior and posterior compression of the cervical spinal cord is usually called pincer cervical spondylotic myelopathy (p-CSM), and surgery is generally recommended; however, there is some controversy about the choice of surgical approach because single anterior or posterior surgery cannot effectively relieve contralateral compression, and combined surgery may cause problems related to trauma and effects on cervical spine function. ObjectiveTo investigate the feasibility and indications of single anterior cervical discectomy and fusion (ACDF) for the treatment of p-CSM. MethodsThe data of twenty-one p-CSM patients who were treated with ACDF at a single center from 2019 to 2022 were collected. Neurological status was evaluated by the Japanese Orthopedic Association (JOA) scoring system. The radiological parameters included the percentage of space occupied by the spinal canal, the cervical sagittal Cobb angle, and the cross-sectional area of the spinal cord before and after the operation. Complications and spinal cord compression rates were also observed. Correlations between the decompressive effects and various prognostic factors were statistically analyzed. ResultsThe mean follow-up period was 24.1±3.55 months. The average JOA score significantly increased, with a mean recovery rate of 65.88±8.97%. The fusion rate was satisfactory. Correlation analysis revealed that the number of operation segments and age were important predictors of decompressive effects. There was no further deterioration of spinal cord function after the operation. ConclusionACDF is an effective method for treating pincer spinal cord compression in terms of neurological recovery, radiological parameters, fusion rates, and complications, especially for patients younger than 60 years of age with single operative segments.

Management of spinal deviations in physical medicine and functional rehabilitation

Objectives: To analyze cases of spinal deviations in the Physical Medicine and Rehabilitation (PMR) department at Mohammed VI University Hospital Center in Marrakech, with a focus on the role of rehabilitation in their management. Methods and Patients: We conducted a cross-sectional, observational descriptive study over a six-month period involving 52 patients with spinal deviations, treated in the PMR department. Data were meticulously collected using a questionnaire completed during consultations with patients selected according to specific criteria. Results: The study revealed that the average age of the patients was 21.25 years, with a predominance of females (68%). Among the spinal deviations, scoliosis was the most common (68%), followed by scoliotic posture (18%), hyperkyphosis (11%), and compensatory lumbar hyperlordosis (3%). The primary reason for consultation was aesthetic concern (56%), with the most frequent symptoms being gibbus deformity (54%) and shoulder asymmetry (35%). Rehabilitation was prescribed for all patients, sometimes as the sole treatment or in combination with bracing. Orthoses were used to correct foot deformities and leg length discrepancies. Only one patient underwent surgical intervention. The outcome was positive for 63% of patients, with improvement in the Cobb angle and pain reduction. However, a 5° worsening was observed in one patient (2% of the sample), while the others remained stable. Conclusion: In conclusion, the therapeutic approaches employed in our sample demonstrated their effectiveness in managing spinal deviations. Rehabilitation proved to be particularly essential as an adjunct treatment, enhancing the outcomes of other therapies and contributing to the relief of back pain, which had a positive impact on patients' quality of life.

Selective Apical Convex Rod Derotation: A Fast and Secure Technique for the Correction of Adolescent Idiopathic Scoliosis-A Case Series of 38 Patients.

We present a novel technique of selective apical convex rod derotation as an effective and safe maneuver for the correction of adolescent idiopathic scoliosis and give the clinical results of our patients. Adolescent idiopathic scoliosis is the three-dimensional deformity of the spine of more than 10° affecting children from 10 to 18 years. The gold standard for the correction of larger curves is posterior fusion. With the help of osteotomies, the spine becomes mobile and the ideal alignment can be achieved with correction maneuvers. Derotations from the concave side harvest numerous complications such as exacerbation of apical rotation, screw pullout, and implant failure. After the transpedicular screws are placed, a short titanium rod is put on the convex-side screws just covering the apex and the screw nuts are loosely tightened. The convex apical rod is held with 2 rod holders and derotation is applied to the rod and the convex spine is pulled toward the midline. After the desired correction is reached, a permanent rod is placed to the concave side and screw nuts are tightened. A total of 38 patients have been included in this study. Preoperative median Cobb angle was 47.19°, postoperative Cobb angle was measured as 18.45°, and 1 year follow-up was 17.25°. Thoracic kyphosis values were 19.07°, 30.52°, and 33.05°, respectively. Lumbar lordosis were measured as 42.63°, 43°, and 45.75°, respectively. Selective apical convex rod derotation is an effective treatment of adolescent idiopathic scoliosis with minimal risk for screw pullout, pedicular bursting, or hypokyphosis. Correction results are similar to classic correction maneuvers.

The effect of brace treatment history on bone density in preoperative patients with adolescent idiopathic scoliosis (AIS) assessed by vertebral bone quality (VBQ) score: a retrospective propensity score-matched analysis

IntroductionAdolescent idiopathic scoliosis (AIS), a prevalent condition among teenagers, is often accompanied by osteopenia. However, the impact of brace treatment on bone density in AIS patients remains a matter of debate. The Vertebral bone quality (VBQ) score, derived from MRI signal intensity, has been shown to correlate with bone mineral density (BMD). Yet, no studies to date have drawn comparisons between VBQ scores in preoperative AIS patients who had brace treatment history and those who have not received brace treatment.ObjectiveThis study aims to elucidate the influence of brace treatment on bone density in AIS patients using VBQ score.MethodsA retrospective analysis was conducted on 243 AIS patients, each with Cobb angles ranging from 50–70°, who had undergone preoperative MRI scans. The patients were segregated into two cohorts: those who received brace treatment (n = 174) and those who did not (n = 69). Through propensity score matching, a total of 53 matched pairs were selected for further analysis. VBQ scores were extracted from T1-weighted MRI scans.ResultsPost-matching, no significant baseline discrepancies were observed between the two groups. Interestingly, brace-treated patients exhibited lower average VBQ scores than their non-brace-treated counterparts (2.43 ± 0.11 vs. 2.55 ± 0.12, p < 0.01), suggesting a higher bone density. Furthermore, a negative correlation was observed between VBQ scores and the duration of brace usage (R2 = 0.3853, p < 0.01).ConclusionBrace treatment may potentially enhance bone density in AIS patients by mitigating vertebral fat infiltration. The utilization of VBQ scores presents an alternative, potentially robust approach to assessing bone quality.

Comparative analysis of percutaneous vertebroplasty and kyphoplasty in the treatment of Stage III Kummell’s disease without neurological symptoms: a retrospective study

ObjectiveThis study analyzes the safety and efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) treatments for Stage III Kummell’s disease without neurological symptoms, comparing the advantages and disadvantages of these two minimally invasive surgical methods.MethodsA retrospective analysis was conducted on 53 patients with non-neurological Stage III Kummell’s disease treated with PVP and PKP at our hospital from December 2018 to January 2023. Patients were divided into PVP (25 cases) and PKP (28 cases) groups based on the surgical method. There were no significant differences in general preoperative data between the two groups (all p > 0.05), ensuring comparability. The study compared surgical duration, volume of bone cement injected, distribution pattern of bone cement, rate of bone cement leakage, and preoperative, postoperative, and final follow-up scores of Visual analogue scale(VAS) and Oswestry disability index(ODI). Additionally, relative anterior height of the injured vertebrae, and Cobb angle of deformity, along with their changes at preoperative, postoperative, and final follow-up stages were calculated and analyzed.ResultsNo significant preoperative differences were observed between the groups (p > 0.05). The PKP group had longer surgeries, higher cement volumes (p < 0.001), and lower leakage rates (p < 0.05), with primarily chunky cement distributions versus mixed distributions in the PVP group. No complications other than cement leakage occurred. VAS and ODI scores showed no significant changes at various time points (p > 0.05) but improved significantly from preoperative (p < 0.001). Both groups saw improved vertebral heights and Cobb angles post-surgery (p < 0.05), with more significant improvements in the PKP group (p < 0.05). Over time, both groups experienced gradual vertebral height loss and increased Cobb angles, more pronounced in the PKP group (p < 0.05). At the final follow-up, there were no statistical differences in vertebral height and Cobb angle between the two groups (p > 0.05).ConclusionThe study evaluates the safety and efficacy of PVP and PKP for Stage III Kummell’s disease without neurological symptoms, comparing the merits of both minimally invasive techniques.

Analysis of odontoid parameters in adolescent idiopathic scoliosis patients with different curve types.

Odontoid incidence (OI) is an important parameter that has recently been developed. However, there are currently no studies on OI in adolescent idiopathic scoliosis (AIS) patients. We aimed to examine the significance of OI in describing cervical sagittal alignment in AIS patients, explore the differences in cervical sagittal parameters among these patients with different curve types, and investigate the correlations between coronal deformity and cervical sagittal parameters in AIS patients. The whole-spine anteroposterior and lateral plain radiographs of AIS patients were retrospectively analyzed. The parameters, including OI, odontoid tilt (OT), C2 slope, cervical lordosis (CL), T1 slope (T1S), and others, were measured. The AIS patients were grouped based on different curve types. Measurement parameters were compared between different groups. Pearson correlation analysis was performed for cervical sagittal parameters and Cobb angle. Ninety AIS patients were included, consisting of 14 males and 76 females. The main thoracic curve group exhibited a smaller OI compared to the main thoracolumbar/lumbar curve group (P < 0.05). In the AIS patients with a main thoracic curve, there was a significant correlation between Cobb angle and OI (r = -0.371, p < 0.01). The odontoid parameters exhibited significant correlations with several classic cervical sagittal parameters in AIS patients with different curve types. The validation of the formula CL = 0.36 × OI-0.67 × OT-0.69 × T1S showed a significant correlation (correlation coefficient = 0.917) between the actual measurements and the predicted values, with a determination coefficient of 0.842. There may be a difference in OI between AIS patients with a main thoracic curve and those with a main thoracolumbar/lumbar curve. Odontoid parameters could be used to describe cervical sagittal alignment in AIS patients with different curve types.

The Role of Paraspinal Muscle in Postoperative Coronal Balance Transition in Degenerative Lumbar Scoliosis: A 2-year Follow-up Study.

Retrospective observational study. The purpose of this study was to determine whether paraspinal muscle could influence postoperative coronal balance and its transition in degenerative lumbar scoliosis (DLS). Although the importance of the paraspinal muscles (PSM) in sagittal alignment is well recognized, there is no information about its role in coronal balance. The study included 102 DLS patients. Evaluation of the PSM on magnetic resonance imaging were conducted at baseline. Coronal measurements included coronal balance distance (CBD), major Cobb angle, L4 coronal tilt, and L5 coronal tilt. The cohort was divided based on postoperative parameters into persistent coronal balance (PCB), worsened coronal imbalance (WCIB), recurrent coronal balance (RCB), and persistent coronal imbalance (PCIB) according to immediate postoperative and follow-up coronal balance. Multivariate logistic regression models for postoperative CIB, follow-up WCIB and follow-up RCB were utilized to identify statistically significant associations while accounting for confounders. The cohort was divided into 57 with PCB, 13 with WCIB, 10 with RCB, and 22 with PCIB. The follow-up groups with CIB exhibited more severe fatty infiltration in the extensor muscle compared to the balanced groups. Specifically, the WCIB group demonstrated the most severe extensor muscle degeneration, particularly on the concave sides, and the most prominent asymmetrical degeneration of the PSM among the four groups. Furthermore, patients with CIB had worse sagittal malalignment compared to those with CB at the last follow up. Patients exhibiting stronger extensor muscle mass were prone to immediate postoperative CB and more likely to experience spontaneous improvement or recurrence of coronal balance during follow-up. Severe extensor muscle degeneration and prominent asymmetrical bilateral PSM degeneration represent potential risk factors for persistent CIB and recurrent CIB. It is crucial to assess the dynamic change during the follow-up period as long-term prognosis may be impacted if CB deteriorates, or otherwise develops during follow-up. 3.

The Role of Sole Lift in Treating Pediatric Idiopathic Scoliosis with Mild Thoracolumbar/Lumbar Curve.

Lower limb discrepancy (LLD) was frequently observed in patients with idiopathic scoliosis (IS), potentially associated with etiopathogenesis. Although sole lifts had been proposed as a conservative treatment for IS, evidence supporting their efficacy was limited. This study aimed to assess the effects of sole lift intervention on pediatric patients with mild IS, specifically focusing on thoracolumbar/lumbar (TL/L) curvature. Twenty patients, with an average age of 12.3 ± 3.1 years and presenting mild TL/L curve (15.6° ± 6.2°), were selected from a pool of 267 pediatric IS patients in the outpatient of our spine center from February 2023 to August 2023. Inclusion criteria comprised a main TL/L curve ranging between 10° and 40°, the lower limb positioned at the convexity of the main curve, and LLD of less than 2 cm; individuals requiring bracing or surgical intervention were excluded. Custom sole lifts were used to address the shorter lower limb with the objective of leveling the pelvis. Radiographic evaluations were conducted both before and after intervention using standing full spine posteroanterior radiographs and full leg length radiographs. Statistical analysis was undertaken to evaluate curve correction and its associations with other influencing factors. The mean structural and functional LLD were 7.1 ± 4.5 mm and 7.1 ± 4.1 mm, respectively. Among the 20 patients, four exhibited structural LLD greater than 10 mm. The average follow-up duration was 6.4 ± 1.9 months (range: 3-8 months). Following sole lift intervention (7.0 ± 3.0 mm), a significant reduction was observed in the TL/L curve compared to the pre-sole lifting measurements (15.6° ± 6.2° vs. 12.1° ± 7.2°, p < 0.001), as well as a notable decrease in the thoracic curve (12.2° ± 4.0° vs. 8.6° ± 6.3°, p = 0.064). Nine patients experienced a significant curve reduction of ≥5°, while eight showed a reduction between 0° and 5°; however, two patients exhibited no change in curve magnitude. Furthermore, the correction rate of the TL/L curve correlated significantly with functional LLD (r = -0.484, p = 0.030) and pelvic obliquity (r = -0.556, p = 0.011), highlighting the active pelvic compensation in maintaining balance between the spine and lower limbs. Conversely, no significant correlation was observed between curve correction and structural LLD (p > 0.05). Additionally, even after adjusting for other influencing factors, the TL/L Cobb angle remained significantly different between pre- and post-sole lifting (p = 0.037). This study confirmed the effectiveness of sole lift intervention in correcting TL/L and thoracic curves among the mild IS children with a main TL/L curve, providing a supplementary conservative treatment option for patients with the lower limb at the convexity of the main curve. Moreover, our findings underscored the active compensation of the lower limbs and the pelvis in the etiopathogenesis of IS, highlighting the importance of considering their influence in treatment strategies.

Clinical significance of modified unilateral puncture percutaneous vertebroplasty guided by 3D- printed guides in the treatment of osteoporotic vertebral compression fractures: a retrospective study

ObjectiveTo investigate the clinical significance of using 3D printing guides in modified unilateral puncture percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fractures (OVCF), and to explore a new method for preventing paravertebral vein leakage during PVP in conjunction with a previous study of the optimal puncture-side bone cement/vertebral volume ratio(PSBCV/VV%).MethodsThis retrospective study analyzed 99 patients who underwent unilateral puncture PVP between January 2023 and December 2023. Patients were divided into a guide plate group (46 patients) and a conventional group (53 patients). The guide plate group underwent modified unilateral puncture PVP with the guidance of 3D printing guides, while the conventional group underwent unilateral puncture PVP using the conventional pedicle approach. The distribution of bone cement, surgical outcomes, and the occurrence of cement leakage into paravertebral veins were observed in both groups.ResultsThe guide plate group had significantly shorter operating time and required fewer fluoroscopies compared to the conventional group. The amount of bone cement volume (BCV) used in the guide plate group was higher, but the amount of bone cement volume on the puncture side(PSBCV), the PSBCV/VV%, and the rate of paravertebral vein leakage were lower in the guide plate group compared to the conventional group (P < 0.05). Within each group, significant improvements in anterior vertebral margin height, Cobb angle, visual analog scale (VAS) score, and Oswestry Disability Index (ODI) were observed at 1 day and 1 month postoperatively compared to preoperative values (P < 0.05).ConclusionUsing 3D printing guides in modified unilateral puncture PVP is a safe and effective method for treating OVCF. And it has the advantages of short operation time, less fluoroscopy, even distribution of bone cement, and a low rate of paravertebral vein leakage.

The Comparison of Partial Hemivertebrae Resection Versus Total Hemivertebrae Resection in Children With Congenital Scoliosis.

The surgical intervention for hemivertebra removal is complex, leading to a lack of a definitive solution. We aim to compare the clinical efficacy of less invasive, partial hemivertebra resection vs total hemivertebra resection in children. Between 2011 and 2016, a retrospective study was conducted on a cohort of 43 patients diagnosed with congenital scoliosis coexisting with hemivertebrae. This study evaluated the outcomes of a posterior-only surgical approach, dividing the cohort into 2 groups based on the surgical technique applied: 23 patients underwent total hemivertebrae resection (TR), whereas 20 patients received partial hemivertebrae resection (PR), accompanied by short-segment fusion. There were 43 patients with congenital scoliosis associated with hemivertebrae in both the PR and TR groups. The average age at the time of surgery was 6.3 ± 2.0 years for the PR group and 6.0 ± 1.9 years for the TR group. The PR group exhibited a comparable correction rate of the Cobb angle at postoperation (4.3 ± 4.9 and 2.2 ± 3.2, P = .174) and the last follow-up (7.8 ± 1.3 and 5.5 ± 2.3, P = .113) compared with the TR group. Partial hemivertebra resection is efficient and secure. A less invasive technique obtained an equivalent, well-maintained correction rate to the total hemivertebra resection. However, this is the initial result, and the patients continue to be followed; we will await the results of the outcome at full-growth sprouts.

Curve progression following selective and nonselective spinal fusion for adolescent idiopathic scoliosis: are selective fusions stable?

The purpose of this study is to compare postoperative outcomes between selective and non-selective fusions longitudinally over the first five postoperative years. Patient parameters were retrieved from a multicenter, prospective, database. Patients with Lenke 1-6, B and C deformities were included. Patients were stratified into 2 groups: selective fusion (SF), if the last instrumented vertebra (LIV) was at or cranial to the lumbar apex, or non-selective fusion (NSF). Differences in coronal and sagittal radiographic outcomes were assessed with generalized linear models (GLMs) at 1-, 2- and 5- year postoperative outcomes. Five-year postoperative categorical radiographic outcomes, flexibility, scoliosis research society scores (SRS), and reoperation rates were compared between groups. Matched cohorts were created for subgroup analysis. 416 (SF:261, NF:155) patients, including 353 females were included in this study. The mean preoperative thoracic and lumbar Cobb angles were 57.3 ± 8.9 and 45.3 ± 8.0, respectively. GLMs demonstrated greater postoperative coronal deformity in the SF group (p < 0.01); however, the difference between groups did not change overtime (p > 0.05) indicating a relatively stable postoperative deformity correction. The SF group had a greater incidence of lumbar Cobb ≥ 26 degrees (p < 0.01). The NSF group demonstrated worse forward and lateral flexibility at 5-year postoperative outcome (p < 0.05). There was no difference in postoperative SRS scores between the SF and NSF groups. Reoperation rates were similar between groups. Selective fusion results in greater coronal plane deformity; however, this deformity does not progress significantly over time compared to non-selective fusion. Selective spinal fusion may be a beneficial option for a larger subset of patients than previously identified. III.

Effects of spinal mobilisation in adolescent idiopathic scoliosis: A randomised controlled trial.

The aim of this study was to evaluate the effects of spinal mobilisation on curvature magnitude, angle of trunk rotation (ATR) and pulmonary function in adolescents with idiopathic scoliosis (AIS). Conducted as a double-blind randomised controlled trial, the study included 40 patients with AIS (Cobb angles 10°-25°) randomised to experimental (n = 20; female = 12, male = 8; age = 12.9 ± 1.8 mean ± SD) and control (n = 20; female = 13, male = 7; age = 12.85 ± 1.81 mean ± SD) groups. The experimental group received spinal mobilisation for 30 min per session followed by 60 min of core stabilisation exercises (CSE), twice a week for 10 weeks. The control group received CSE only at the same frequency and duration. Evaluation of Cobb angle, ATR and pulmonary function tests (PEF: Peak Expiratory Flow, FEV1: Forced Expiratory Volume in 1 s, FVC: Forced Vital Capacity, and FEV1/FVC: Tiffeneau index) were performed at baseline and after the intervention. Both groups showed significant improvements in Cobb angle, ATR, PEF and FVC, with the experimental group showing significantly greater improvements in Cobb angle (-7.65 ± 3.17) and ATR (-2.5 ± 1.43) compared to the control group (P < 0.05). In addition, while the control group showed no change in FEV1, the experimental group showed improvement. There was no change in FEV1/FVC ratio in either group. These results indicate that adding spinal mobilisation to treatment sessions can effectively reduce the magnitude of curvature and improve scoliosis-related problems in the short term.

99. Impact of decompression location for lumbar canal stenosis in degenerative scoliosis patients with Cobb angle over 20°

99. Impact of decompression location for lumbar canal stenosis in degenerative scoliosis patients with Cobb angle over 20°