Correction Of Adolescent Idiopathic Scoliosis Research Articles

Analysis of the Biomechanical Effects of Vertebral Body Tethering with Apical Fusion.

Biomechanical study by using a multi-body simulation approach. Objectification of spinal biomechanics after Vertebral Body Tethering with and without Apical Fusion. Vertebral body tethering, a motion preserving surgical technique for correction of adolescent idiopathic scoliosis, is increasingly being used for thoracolumbar curves. However, tether breakage remains a common problem with breakage rates up to 60% for TL curves. Therefore, surgeons have begun to adapt their surgical technique by fusing the apex. The short-term clinical studies show a significant reduction of the tether breakage rate to 10%, but little is known about the biomechanical reasons. Therefore, this study analyzes the intervertebral compression and tether force in a tethered spine without apical fusion and in a tethered spine with apical fusion between L1/2. A multi-body simulation approach was chosen to analyze the biomechanical effects of two surgical techniques during different physiological movements. The tether and intervertebral compression forces in the different instrumented segments are once analyzed for a T10-L3 tethered spine and once for a T10-L3 tethered with additional L1/2 fusion using an intervertebral cage. VBT with apical fusion reduces the prevailing tether forces not only at the fused level by nearly 861 N, but also at the adjacent spinal segments by around 100 N. However, a significant increase in intervertebral compression force of approximately 706 N can be observed, especially at the adjacent spinal segments. L1/2 fusion in a tethered spine reduces tether forces in adjacent segments and thus might decrease the rate of tether breakage. However, fusion results in increased intervertebral compression forces by up to 31% compared to an unfused spine. Long-term clinical studies are needed to further analyze and evaluate the biomechanical consequences.

Correlation Between Deformity Correction and Patient-Reported Outcomes in Adolescent Idiopathic Scoliosis

Correlation Between Deformity Correction and Patient-Reported Outcomes in Adolescent Idiopathic Scoliosis

Incidence of and Factors Associated with Spontaneous Correction of Postoperative Shoulder Imbalance in Adolescent Idiopathic Scoliosis Patients: A Retrospective Cohort Study

BackgroundAs far as we know, no study has investigated spontaneous postoperative shoulder imbalance (PSI) correction in adolescent idiopathic scoliosis (AIS) patients. The objective is to assess the incidence of and associated factors for spontaneous PSI correction in AIS patients.MethodsThe study evaluated 144 postoperative AIS patients with PSI aged 10–20 years between 2010 and 2018. An analysis included demographic data and radiographic measurements (Risser grading, Lenke type, upper instrumented vertebra [UIV], and lowest instrumented vertebra [LIV]). Preoperative, postoperative, and follow-up radiographs were evaluated for shoulder parameters: radiologic shoulder height (RSH); T1 tilt angle; clavicle angle (CA); proximal thoracic curve (PTC), main thoracic curve (MTC), and lumbar curve (LC) Cobb measurements; and apical vertebral translation (AVT) of the PTC, MTC, and LC.ResultsSpontaneous PSI correction was observed in 99 (68.75%) patients. The spontaneous correction and nonspontaneous correction groups differed significantly in terms of Lenke-type preoperative LC (23° vs 26°; P = 0.091), postoperative LC (11° vs 8°; P = 0.013), LC at follow-up (13.5° vs 9°; P = 0.028), postoperative AVT of LC (− 0.8° vs − 0.4°; P = 0.033), AVT of LC at follow-up (− 0.7° vs − 0.1°; P = 0.091), PTC at follow-up (16° vs 20°; P = 0.019), and AVT of PTC at follow-up (0° vs -0.3°; P = 0.029). Multivariate analysis identified postoperative T1 tilt and postoperative LC as significantly associated with PSI correction.ConclusionsThe incidence of spontaneous PSI correction is high. Postoperative T1 tilt and postoperative LC are significantly associated with spontaneous PSI correction.

Learning curve and long-term outcomes of minimally invasive correction and fusion for adolescent idiopathic scoliosis.

Retrospective analysis. This study sought to report the long-term outcomes of patients that underwent minimally invasive surgery (MIS) correction for Adolescent Idiopathic Scoliosis (AIS) in terms of radiographic, clinical, and patient-reported outcomes. Furthermore, we examined the learning curve of MIS technique over the course of 13years. Both MIS and open techniques are used to surgically address AIS. MIS techniques are purported to preserve the midline spinal musculature and to decrease estimated blood loss (EBL) and hospital length of stay (LOS). Data were collected at a single tertiary care center of all consecutive AIS patients undergoing deformity surgery from January 2008 to October 2021. Demographic, clinical, and radiographic data were collected at various intervals. Descriptive and inferential analyses were conducted. 70 AIS patients were included in the study. Mean patient age was 16.2years of which 95.7% were female, with a mean BMI of 21.7. The majority of the patients were Lenke type 1A (60%) followed by Lenke 1B (18.6%) with mean preop Cobb angle as 52.2°. The mean follow-up was approximately 6years with 35.7% of our cohort meeting the long-term follow-up landmark (> 5years, 2-11). The mean number of spinal levels treated was 9.3 with mean ASA score of 1.7. Overall, mean EBL was 151cc with mean OR of 308min. The mean LOS was 3.94days with postop Day 1 as the initiation of ambulation. Overall, the percent correction at the last visit was significantly greater than preop (Cobb: 77.6%, p < 0.05). Mean loss of correction on follow-ups was less than 5º. The overall revision rate was 2.9%. At 2years postop, 98.6% (69/70) of the patients achieved fusion with 100% (24/24) at 5years, and 96% (24/25) beyond the 5-year mark. Surgeon's technical proficiency in performing MIS for the treatment of AIS corrections was achieved after 23 cases. Based on our cohort's 2-11year follow-up data, we conclude that MIS provides an effective treatment option for AIS reconstruction. Our study indicates that MIS can achieve adequate deformity correction and positive long-term clinical outcomes as indicated by Cobb angle, VAS, ODI, and SRS-22r scores during follow-ups. If the individual goals of AIS surgery can be achieved, consideration should be given to less-invasive techniques. IV.

Analysis of adolescent idiopathic scoliosis population for Surgical Site Infection Risk Factors

ObjectiveThe incidence of surgical site infection (SSI) in adolescent idiopathic scoliosis (AIS) patients undergoing surgical correction varies but is commonly reported between 0.5 and 6.7 %. The identification of modifiable risk factors is crucial to preventing these infections in the AIS population. Some potential modifiable risk factors include the use of stainless-steel implants, a larger volume of instrumentation and an increased volume of blood products transfused. However, evidence in support of these factors and others representing true risk for the development of SSI is limited and often varies. We aimed to determine the incidence of SSI in AIS undergoing primary scoliosis fusion at our hospital, and explore demographic and clinical variables in the development of SSI in AIS. MethodsThis was a case control retrospective study. Patients aged 10-19 year-old that underwent posterior spinal fusion for initial correction of AIS at our hospital between the years 2012–2020 were eligible. Patients with any previous spine surgery or spine fracture were excluded. A descriptive analysis was then performed on the data. ResultsOf the 334 patients on which data was collected, one SSI was identified resulting in an incidence of infection of 0.3 %. The largest ethnicity represented was Caucasian with 254 patients. The average age was 14.3 years with averaged follow-up of 6.6 years. The majority of patients (252) received implants composed of titanium and cobalt chrome. The average operation duration was 5 h and 7.7 min, and the average hospital stay was 4.2 days. The average amount of blood loss was 553 ml. Chlorhexidine wipes or some other antimicrobial preparation was used on 197 patients and betadine solution was used on 321.185 patients were recorded to have received either antibiotic-loaded allograft or antibiotic powder and 326 patients were recorded to have received intraoperative antibiotics. ConclusionsThe long term clinical follow up of our study and low incidence of infection provide additional evidence for the benefit of antimicrobial techniques and risk factor mitigation previously suggested in the literature for the prevention of SSI in AIS. Level of evidenceLevel III.

Pediatric obesity and adverse outcomes following deformity correction surgery for adolescent idiopathic scoliosis: A cross-sectional analysis using 2015-2019 NIS data.

Obesity in the pediatric population has been a growing medical concern over the last few decades with a prevalence of 19.7% as of 2017-2020. Obesity is a risk factor for greater scoliotic curves and failure of conservative therapy for adolescent idiopathic scoliosis (AIS). Establishing a correlation between obesity and a wide variety of adverse outcomes following scoliosis surgery can assist in the preoperative consultation with the family and proper optimization of the patient for scoliosis fusion surgery. The National Inpatient Sample (NIS) was used to access inpatient data from 2015 to 2019. Pediatric patients with idiopathic scoliosis admitted for spinal deformity correction via posterior spinal fusion of over 8 levels were identified. Patients were stratified based on the comorbid diagnosis of obesity. Variables that were significantly associated with outcomes (p < 0.05) were used in a multivariable logistic regression to control for confounders. Backwards stepwise p-value removal was used to build the final model and model fit was assessed using the area under the curve. A total of 855 obese and 17,285 non-obese pediatric patients undergoing posterior instrumented fusion for scoliotic deformity correction were identified. The obese group was associated with a higher rate of SSI (0.6% vs 0.1%, p < 0.001), UTI (1.2% vs. 0.3%, p < 0.001), and AKI (0.6% vs 0.1%, p = 0.12) compared to the normal BMI group. Obese patients were also more likely to have a non-routine discharge when compared to non-obese (4.7% vs. 2.3%, p < 0.001). The rate of having more than one complication occurring postoperatively was higher in the obese group, however, this finding was not significant (0.6%, vs 0.4%, p = 0.385). On multivariate regression analysis, obesity was positively associated with SSI (OR = 2.758, CI = 0.999-7.614, p = 0.050), UTI (OR = 2.221, CI = 1.082-4.560, p = 0.030), non-routine discharge (OR = 1.515, CI = 1.070-2.147, p = 0.019), and an extended LOS (OR = 1.869, CI = 1.607-2.174, p < 0.001). Obesity was associated with postoperative blood transfusion, SSI, UTI, increased length of stay, and non-routine discharge after pediatric AIS deformity surgery. In addition to the increased morbidity seen in obese patients, we also identified the significantly increased cost of care for this group when compared to non-obese patients. These data should be used for a robust preoperative risk assessment and evidence for BMI optimization prior to deformity correction for AIS.

Intravenous lidocaine infusion therapy and intraoperative neurophysiological monitoring in adolescents undergoing idiopathic scoliosis correction: A retrospective study.

Posterior spinal instrumentation and fusion is an established surgical procedure for the correction of adolescent idiopathic scoliosis. Intraoperative neurophysiological monitoring is standard practice for this procedure. Anesthetic agents can have different, but significant, effects on neurophysiological monitoring outcomes. To determine if intravenous lidocaine infusion therapy has an impact on the intraoperative neurophysiological monitoring during posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis. Following ethical approval, we conducted a retrospective review of charts and the archived intraoperative neurophysiological data of adolescents undergoing posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis. Intraoperative neurophysiological monitoring data included the amplitude of motor evoked potentials and the amplitude and latency of somatosensory evoked potentials. A cohort who received intraoperative lidocaine infusion were compared to those who did not. Eighty-one patients were included in this analysis, who had surgery between February 4, 2016 and April 22, 2021: 39 had intraoperative intravenous lidocaine infusion and 42 did not. Based on hourly snapshot data, there was no evidence that lidocaine infusion had a detrimental effect on the measured change from baseline for MEP amplitudes in either lower (mean difference 41.9; 95% confidence interval -304.5 to 388.3; p = .182) or upper limbs (MD -279.0; 95% CI -562.5 to 4.4; p = .054). There was also no evidence of any effect on the measured change from baseline for SSEP amplitudes in either lower (MD 16.4; 95% CI -17.7 to 50.5; p = .345) or upper limbs (MD -2.4; 95% CI -14.5 to 9.8; p = .701). Finally, there was no evidence of a difference in time to first reportable neurophysiological event (hazard ratio 1.13; 95% CI 0.61 to 2.09; p = .680). Data from these two cohorts provide preliminary evidence that intravenous lidocaine infusion has no negative impact on intraoperative neurophysiological monitoring during PSIF for adolescent idiopathic scoliosis.

Return to sports activities following posterior scoliosis correction and instrumented fusion for adolescent idiopathic scoliosis and its correlation to Lenke classification

Introduction: There is a paucity of information or guidelines regarding return to sports activities after posterior scoliosis surgery for adolescent idiopathic scoliosis (AIS). Research Question: Review the rate of return to sports and correlation to Lenke type following surgery for AIS in a tertiary center for pediatric spinal deformity. Materials and Methods: Ninety patients were identified to have undergone surgery for AIS from 2016 to 2017 and were sent a return to sport questionnaire. Sixty-six responses were received and analyzed. For comparison, Lenke classification was divided into Subgroup 1 (Lenke type 1 and 2), Subgroup 2 (Lenke type 3 and 4), and Subgroup 3 (Lenke type 5 and 6). Results: The average age at the time of surgery was 14.81 (11–18) years. There were Lenke 1 (31), Lenke 2 (7), Lenke 3 (12), Lenke 4 (8), Lenke 5 (7), and Lenke 6 (1). The average number of levels fused was 10.27 (7–16). 89.3% of patients returned to school between 1 and 3 months. 19.6% of patients returned to physical education (PE) within 7–12 months, while 31.8% returned to running within 4–6 months. 7.5% of patients did not do PE and 18.2% never ran after surgery. 63.6% of patients returned to contact sports after surgery, majority within 7–12 months. 91% of patients felt that they were able to achieve their preoperative performance level. Comparing the subgroups, 92% of Subgroup 1 returned to school within 2 months, while majority of them returned to PE and running within 6 months. 60% of them returned to the same level of contact/noncontact sports level prior to surgery and 40% within 6 months. Patients in Subgroup 2 and 3 returned later to school. Patients in Subgroup 2 and 3 returned later to school, PE and running with less patients returning to contact/noncontact sports. Conclusion: This study was able to identify Lenke classification as an important predictor of patients returning to school, PE, and running earlier along with return to preoperative levels of contact/noncontact sports.

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.

Comparison between the lowest instrumented vertebrae L3 with the use of direct vertebrae rotation (DVR) and the lowest instrumented vertebrae L4 for non-DVR in adolescents with idiopathic scoliosis Lenke 5C/6C: when LEV is L4

ObjectiveAs there are no substantial selection criteria for determining the lowest instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) Lenke 5C/6C, thus, many surgeons base their selection on experience. The study aims to compare the selection of the lowest instrumented vertebrae (LIV) lumbar vertebra three (L3) with the use of direct vertebrae rotation (DVR) to the lowest instrumented vertebrae (LIV) lumbar vertebra four (L4) with the use of non-DVR for the correction of adolescent idiopathic scoliosis (AIS) Lenke 5C/6C when the lower end vertebrae (LEV) is at lumbar vertebrae four (L4).MethodsThis prospective study involved 101 patients who were divided into two groups based on different techniques. The patients were prospectively followed up for at least four years. All patients included in the study had a lower end vertebra (LEV) at L4, while patients older than 18 years and patients with prior surgical procedures were excluded. The DVR group consisted of 49 patients, and the non-DVR group included 51 patients.ResultsThe preoperative mean LIV disc angle was 3.1 ± 3 and 3.1 ± 1, P = 0.097, which corrected to 1.2 ± 0 and 1.1 ± 0 in both groups at 4-year follow-up without statistical significance. The LIVDA and LIVT were statistically insignificant at the preoperative, and there were no significant differences at the follow-up visitation. The DVR group achieved a satisfactory coronal and Cobb’s angle correction compared to the NDVR group; however, there were no statistical differences at the follow-up visitations. Both groups achieve a satisfactory correction rate without substantial significance in clinical and radiological outcomes. Furthermore, no post-surgical complications were recorded in either group.ConclusionsDVR is suitable for selecting L3 as the LIV in AIS Lenke 5C/6C compared to L4 in non-DVR. DVR preserved more segments without substantial complications during the follow-up visitations. Nevertheless, both groups will continue to be followed up to prevent adding-on post-surgical complications.

Comparative study of low-density versus high-density pedicular screw implantations in management of adolescent idiopathic scoliosis: a randomized clinical trial

BackgroundA number of studies have yielded disparate findings regarding the relationship between implant density and curve correction in adolescent idiopathic scoliosis (AIS) surgery. This study compared the efficacy and safety of low-density (LD) versus high-density (HD) pedicular screw implants in the correction of deformity in AIS regarding clinical, radiological, and quality of life outcomes. MethodsThis study was a single-blind, parallel, randomized trial that enrolled 20 adolescent patients with idiopathic scoliosis scheduled for posterior spinal fusion surgery with all pedicle screw constructs. Patients were randomized into two groups of 10 patients each. The LD group included patients in whom the number of screws per fused spinal level had a density of 1.5 or less, while the HD group had a density greater than 1.5. The primary outcomes were the radiological findings of curve correction. The secondary outcomes included the correlation between implant density and curve correction, the amount of blood loss, operation time, number of screws, fusion level, hospital stay duration, and quality of life assessed by the Scoliosis Research Society 22r questionnaire. ResultsRadiologically, the postoperative main curves Cobb angles and their changes were comparable between both approaches without statistical correlation with the implant density (p˃0.05). The LD approach significantly shortened the operative time (p=0.015), number of screws (p=0.011), implant density (p<0.001), and hospital stay (p<0.001). However, quality of life scores before surgery and at final follow-up did not differ between the two techniques (p˃0.05). ConclusionsThe use of a low-density approach is an effective and safe methodology for attaining satisfactory deformity correction in AIS patients. Furthermore, this approach confers the additional advantage of reduced operative time, number of screws, implant density, and hospital stay in comparison to the high-density approach.Trial registration Pan African Clinical Trial Registry, PACTR202404611444119. Registered 28 March 2024-Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=29382

Direct Vertebral Rotation versus Simple Rod Derotation Techniques in Correction of Adolescent Idiopathic Scoliosis

Abstract Background One method for treating adolescent idiopathic scoliosis (AIS), which is characterised by abnormal spinal alignment in the coronal, sagittal, and rotational planes, is surgical correction. The two surgical techniques most typically used to correct spine alignment are simple rod derotation (SRD) and direct vertebral rotation (DVR). Aim The study's goal was to assess the effectiveness of two treatment methods for adolescent idiopathic scoliosis: simple rod derotation and direct vertebral rotation. Subjects and Methods A randomised controlled research involving 36 adolescents with idiopathic scoliosis was done. patients were randomly split into one of two groups: 18 patients in group A had DVR treatment, while 18 patients in group B received SRD with a 2-year follow-up. Results Apical Vertebral Rotation measured from CT scans in DVR group was 24.4° ±8.38° preoperatively and it decreased significantly postoperatively to 14.4°±4.61 °with (42.22%) correction rate while in SRD group it was 25.03°±7.99° preoperatively and it also decreased significantly postoperatively to a mean value of 21.41°±7.01° with (14.65%) correction rate. There were statistically significant differences between both groups postoperative (P &amp;lt; 0.001) Conclusion The most noticeable difference between DVR and SRD was clinical rib hump correction, which was explained by apical vertebral rotation correction determined on an axial CT scan. It also demonstrates that there is no significant difference in coronal curve correction, shoulder height difference, or patient satisfaction between the two techniques.

Do low-density screws influence pelvic incidence in adolescent idiopathic scoliosis correction?

Low-density screw constructs yield significant radiographic and clinical improvements with reduced risk of neurological complications. This study aimed to investigate the relationship between coronal Cobb angle and pelvic incidence (PI) in the correction of adolescent idiopathic scoliosis (AIS) using a low-density construct, as well as the association between PI and functional outcomes. This prospective cohort study involved 60 posteriorly instrumented AIS patients, aged 10-16 years, with Cobb angles ranging from 45° to 90° of various Lenke types. Radiological assessments were conducted pre- and postsurgery at 1, 3, 6, 12, and 24 months. Functional evaluation utilized the Scoliosis Research Society score form (SRS-30). A positive correlation was observed between screw density and operation time, blood loss, and degree of correction with SRS change (P = 0.004). No correlation was found between screw density and hospital stay, loss of correction, correction rate, SRS change, change in PI, or Cobb angle. Correction of AIS through a posterior approach using a low-density construct can lead to satisfactory curve correction, impacting spinopelvic parameters. However, PI alone does not directly influence patient functional outcomes assessed by SRS-30. Low-density implant constructs reduce operative time, blood loss, costs, and complication risks.

Adolescent idiopathic scoliosis: a prospective randomised trial protocol comparing clinical and radiological outcomes in minimally invasive surgery versus standard posterior spinal fusion in a single-centre, the Rizzoli Orthopaedic Institute, Bologna, Italy

IntroductionMinimally invasive spine surgery (MISS) has been shown to be safe and effective in adolescent idiopathic scoliosis (AIS) correction, even though there is no consensus on which treatment provides the...

An Evaluation of Sagittal Balance and the Influence of Spinopelvic Components on Sagittal Balance through the Correction and Stabilization Using the Pedicle Screw Rod System on Patients with Adolescent Idiopathic Scoliosis

Background The pedicle screw rod system is believed to correction of 3-dimensional deformity and maintain the results of the correction, so the better sagittal balance correction can be expected. Methods We conducted a retrospective cohort study on 43 adolescent idiopathic scoliosis (AIS) patients who performed correction, stabilization and posterior fusion to determine the effect of spinal and spinopelvic components on sagittal balance correction. X-ray data were measured for thoracic kyphosis and lumbar lordosis as the spinal components and pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) as the spinopelvic components. Further evaluations include sagittal spinal balance (C7PL), global sagittal balance, and sacrofemoral distance pre- and post-surgery. Statistical evaluation is performed to determine the correlation between the spinal and the spinopelvic components and the achievement of sagittal balance correction. Results TK/Sagittal Modifier obtained a significant correction with an average is 18.69° (±9.57), while LL (lumbar lordosis) has 44.58 ° (±11.94). Average of C7PL correction is 0.68 cm (±3.13), Global Sagittal Balance is -2.04 cm (±3.24), and SCFD is 2.69 cm (±2.48). The TK/LL degree doesn’t significantly influence on Global Sagittal Balance and C7PL. The TK degree significantly affects SCFD, whereas LL doesn’t significantly affect SCFD. Changes in each spinopelvic component are not significant in affecting Global Sagittal Balance. Conclusions Correction and stabilization of AIS’s patients using the pedicle screw rod system resulted in significant Spinal Component TK/Sagittal Modifier and LL correction. Meanwhile, Spinopelvic Components didn’t achieve significant correction. Mean correction of C7PL is -2.66 (±4.4) and Global Sagittal is -3.11 cm (±4.94), SCFD only managed to correct 37.3%. Global Sagittal Balance is not significantly affected by all components of Spinopelvic components, while the C7PL is only affected by PT. Only PT and SS that significantly affected SCFD.

Impact of Different Operative Techniques for Patients With Adolescent Idiopathic Scoliosis on Frontal Curve Correction and Sagittal Balance.

Surgical correction of adolescent idiopathic scoliosis from the posterior approach can be performed by the "all screws" technique; hybrid technique with screws and hooks; hybrid technique or with screws, hooks, and tapes; or selective fusion (SF) or nonselective fusion (NSF). The aim of the present investigation was to analyze the influence from different operative techniques on frontal curve correction and sagittal profile in patients with adolescent idiopathic scoliosis. We conducted a retrospective analysis on 55 consecutive patients with scoliosis who had been treated by posterior instrumented fusion. We collected demographic data and analyzed pre- and postoperative radiographs. Statistical analysis was performed using SPSS version 25. Because data showed normal distribution, t tests were performed. Twenty-two patients were treated using the hybrid technique with screws and hooks; 25 were treated using the hybrid technique with screws, hooks, and tape; and 8 were treated using the all screws technique. An SF was performed in 32 patients and NSF in 23 patients. There was no significant difference with regard to curve correction of the main curve between the different techniques. Correction of the minor curve was significantly higher in NSF than in SF patients. In SF, there was a correction of the minor curve of 43.9%. Impact on sagittal balance showed no significant differences between NSF and SF. The different operative techniques did not show a difference with regard to the correction of the main curve. NSF showed a significantly higher degree of correction of the minor curve than SF. However, we still found a correction of 43.9% of the noninstrumented minor curve in SF. Thus, SF and hybrid techniques do not lead to inferior radiographic outcome. SF and hybrid techniques are safe and effective techniques that could be used as an alternative to NSF and all screw fixation in the operative treatment for scoliosis.

Comparative Analysis of Monoaxial and Polyaxial Pedicle Screws in the Surgical Correction of Adolescent Idiopathic Scoliosis.

Background: Although several biomechanical studies have been reported, few clinical studies have compared the efficacy of monoaxial and polyaxial pedicle screws in the surgical treatment of adolescent idiopathic scoliosis (AIS). This study aims to compare the radiological and clinical outcomes of mono- and polyaxial pedicle screws in the surgical treatment of AIS. Methods: A total of 46 AIS patients who underwent surgery to treat scoliosis using pedicle screw instrumentation (PSI) and rod derotation (RD) were divided into two groups according to the use of pedicle screws: the monoaxial group (n = 23) and polyaxial group (n = 23). Results: The correction rate of the main Cobb's angle was higher in the monoaxial group (70.2%) than in the polyaxial group (65.3%) (p = 0.040). No differences in the rotational correction of the apical vertebra were evident between the two groups. SRS-22 scores showed no significant differences according to the type of pedicle screws used. Conclusions: The use of polyaxial pedicle screws resulted in coronal, sagittal, and rotational correction outcomes comparable to those associated with the use of monoaxial pedicle screws for surgical treatment using PSI and RD to treat moderate cases of AIS.

Improvement in axial rotation with bracing reduces the risk of curve progression in patients with adolescent idiopathic scoliosis.

New evidence highlights the significance of 3D in-brace correction for Adolescent Idiopathic Scoliosis (AIS) patients. This study explores how axial parameters relate to treatment failure in braced AIS patients. AIS patients (Sanders 1-5) undergoing Rigo-Chêneau bracing at a single institution were included. Axial vertebral rotation (AVR) was determined by utilizing pre-brace and in-brace 3D reconstructions from EOS® radiographs. The primary outcome was treatment failure: surgery or coronal curve progression > 5°. Minimum follow-up was two years. 75 patients (81% female) were included. Mean age at bracing initiation was 12.8 ± 1.3years and patients had a pre-brace major curve of 31.0° ± 6.5°. 25 patients (76% female) experienced curve progression > 5°, and 18/25 required surgical intervention. The treatment failure group had larger in-brace AVR than the success group (5.8° ± 4.1° vs. 9.9° ± 7.6°, p = 0.003), but also larger initial coronal curve measures. In-brace AVR did not appear to be associated with treatment failure after adjusting for the pre-brace major curve (Hazard Ratio (HR):0.99, 95% Confidence Interval (CI):0.94-1.05, p = 0.833). Adjusting for pre-brace major curve, patients with AVR improvement with bracing had an 85% risk reduction in treatment failure versus those without (HR:0.15, 95% CI:0.02-1.13, p = 0.066). At the final follow-up, 42/50 (84%) patients without progression had Sanders ≥ 7. While in-brace rotation was not an independent predictor of curve progression (due to its correlation with curve magnitude), improved AVR with bracing was a significant predictor of curve progression. This study is the first step toward investigating the interplay between 3D parameters, skeletal maturity, compliance, and brace efficacy, allowing a future prospective multicenter study. Retrospective study; Level III.

Outcome of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society outcome questionnaire

BackgroundAdolescent idiopathic scoliosis (AIS) is a structural deformity of the spine. Posterior deformity correction represents the gold standard of the surgical treatment of AIS. The fixation technique was shifted from hybrid fixation to the all pedicle screw construct, which could produce superior deformity correction. Patient-oriented outcome questionnaires have become an important measure of the success of surgical correction. This study was conducted to assess the outcome of all pedicle screw constructs in treating AIS using the Scoliosis Research Society (SRS)-24 outcome questionnaire.Patients and methodsSeventy-nine AIS patients were included with a minimum 2-year follow-up. Clinical and radiographic measurements were evaluated at preoperative, postoperative, and final follow-up periods. Complications and results of the SRS-24 questionnaire were analyzed. Sex, Lenke classification, levels of the lowest instrumented vertebra, curve magnitude, and percentage of curve correction were correlated with the SRS-24 questionnaire results.ResultsThere were 59 females and 20 males. The mean age of the patients was 14.2 ± 2.5 years. According to Lenke classification, the majority of the curves were type 1 (57 patients), followed by type 5 (11 patients), type 2 (six patients), type 3 (three patients), type 6 (two patients), and no type 4. The mean preoperative major curve Cobb angle was 59.3 ± 9.045° and the mean postoperative Cobb angle was 5.82 ± 5.932°. The average score for SRS-24 was 4.17. The mean preoperative pain score was 3.29, which improved to 4.30 after at least 2 years of follow-up (P˂0.005). Statistically significant improvement was seen in the general self-image, function from back condition, and level of activity. After surgery, the mean score for self-image was 4.19, and for function was 3.55. The postoperative function was the lowest, while the postoperative satisfaction score was the best of all domains, with a mean score of 4.55. About 90% of patients were satisfied with the results of their surgical correction. Magnitude of curve and amount of correction did not significantly alter the SRS scores.ConclusionAll pedicle screw construct is an efficient and safe method in AIS correction. The surgical treatment in our AIS patients has resulted in a perceived benefit in all domains of SRS-24 questionnaire.

Sagittal Balance Parameters and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis.

Background: To review and evaluate multiple preoperative and postoperative sagittal parameters and their association with the risk of developing proximal junctional kyphosis (PJK) in patients with adolescent idiopathic scoliosis (AIS) who undergo correction surgery. Methods: A systematic search was performed in December 2022 in PubMed, Embase and the Cochrane Library to retrieve all the studies relevant to our research. After the study selection and data extraction following PRISMA guidelines, RevMan 5.3 was used for statistical analysis. All the analyzed factors were evaluated by using odds ratios and weighted mean differences with 95% confidence intervals. Moreover, the meta-analysis of proportions via MedCalc was used for analyzing quantitative data from the studies. Results: A total of 22 studies were included in our meta-analysis. All the available values of sagittal parameters were evaluated. Among all the potential risk factors, higher preoperative thoracic kyphosis (Test for overall effect Z = 11.79, p < 0.00001), higher preoperative sagittal vertical axis (SVA) (test for overall effect Z = 11.19, p < 0.00001), greater thoracic kyphosis change post-op. compared to pre-op. (test for overall effect Z = 6.02, p < 0.00001), increased postoperative lumbar lordosis (test for overall effect Z = 3.65, p = 0.0003), higher post-op. SVA (test for overall effect Z = 24.93, p < 0.00001) and a larger pelvic incidence/lumbar lordosis (PI/LL) mismatch (test for overall effect Z = 20.50, p < 0.00001) were found to be the risk factors for PJK after AIS surgery. Moreover, a decreased rod contour angle (RCA) (test for overall effect Z = 3.79, p < 0.0002) and higher proximal junctional angle-rod contour angle (PJA-RCA) (test for overall effect Z = 39.18, p < 0.00001) play a significant role in the risk of developing PJK after AIS correction. Conclusions: Sagittal balance is of great importance when considering the surgical correction of AIS. Many factors in our meta-analysis were found to increase the incidence for PJK such as higher preoperative thoracic kyphosis and pre-op. SVA. Furthermore, increased thoracic kyphosis change, increased post-operative lumbar lordosis, SVA and PI/LL mismatch are also factors that influence the possibility of post-op. PJK. Lastly, RCA and PJA-RCA are two important factors that need attention during AIS, as over-contouring of the rod could lead to PJK in AIS patients.