Correction Of Hyperkyphosis Research Articles

Perioperative complications following spinal fusion in idiopathic scoliosis: A review of 825 cases from the German Spine Registry (DWG-register) – Perioperative complications in idiopathic scoliosis

Background: Overview of the literature: Idiopathic scoliosis (IS) is most commonly developed during adolescence and affects 2%–3% of the population. The overall complication rate for corrective surgeries in adolescent IS patients is described as 6.3%. Perioperative complications include intraoperative blood loss, neurological deficit, and infection, with excessive blood loss being one of the most common. The aim of the study is to evaluate the prevalence of major and minor complications following posterior or anterior fusion for IS. Methods: Retrospective multicenter study of data from the DWG-Register of patients who underwent operative treatment for IS from January 2017 to September 2022. Inclusion criteria: IS, age between 10 and 30 years. Results: In total, 825 IS patients undergoing fusion were identified in the registry; n = 801 (Group 1) did not have operative complications and n = 24 had a complication related to surgical procedure (Group 2); therefore, the complications rate was 2.9%. A 1.3% rate of major complications and 1.6% rate of minor complications were recorded as follows: spinal cord damage n = 2 (8.4%), subfaszial hematoma n = 2 (8.4%), motor dysfunction n = 1 (4.2%), cerebrospinal fluid (CSF)-leakage n = 7 (29.2%), sensory dysfunction n = 6 (25%), bowel/bladder dysfunction n = 1 (4.2%), superficial site infection n = 2 (8.4%), and pulmonary lung atelectasis n = 3 (12.5%). According to the logistic regression model, an odds ratio for pedicel screws versus laminar hooks for hyperkyphosis correction of 3.73 and for Ponte-osteotomy of 11.5 was found. Conclusions: In IS patients treated operatively, the prevalence of nonneurologic postoperative complications following corrective surgery was 1.80% with CSF leak being the leading risk of complication at 0.84.%. These findings should guide surgeons in their intraoperative Dural tear repair particularly osteotomies. Alternate level pedicle-screw placement with laminar hooks leads to higher operation time and more extensive fusion with consequent slightly prevalence in perioperative complications.

Maria Adelaide brace in the management of Scheuermann\u2019s Kyphosis

PurposeThis prospective observational study aims to assess the MA brace effectiveness in hyperkyphosis correction, focusing also on patients’ compliance of bracing and its psychological impact.MethodsPatients referring to our spine outpatient department with Scheuermann’s kyphosis (SK) from January 2011 to January 2017 were prospectively recruited. Patients were divided into two groups, according to their global thoracic kyphosis (TK): Group-A TKT0 < 60°, Group-B TKT0 ≥ 60°.The MA brace was prescribed according to SRS criteria. Full spine X-rays were analyzed at conventional times: at the beginning of treatment (T0), at 6-months follow-up (T1, in-brace X-rays), at the end of treatment (T2) and at 2-year minimum follow-up from bracing removal (T3). At T0, T2 and T3 all the patients were assessed using the Italian Version of the SRS-22 Patient Questionnaire (I-SRS22). Variability between and within-groups was assessed; a p value < 0.05 was considered significant.Results192 adolescents (87 girls and 105 boys, mean age 13.1) were recruited. The mean global TK at recruitment was 61.9° ± 11.3°, the mean follow-up time was 57.4 months. A good patients’ reported compliance was observed: 84.9% of patients used the brace as scheduled. A mean in-brace correction (in-brace TK%) of 37.4% was observed and a mean final correction (TK%T3) of 31.6%. At final follow-up (T3), curve reduction (ΔTK ≤ − 5°) was observed in 60.4% of patients and curve stabilization (− 5° < ΔTK < 5) in 29.7% of patients. At baseline, worse SRS22-mental health (p = 0.023) and self-image mean scores (p = 0.001) were observed in Group-B, compared with Group-A. At the end of treatment (T2), an improvement of all items was observed, wit significantly better improvement of self-image domain in Group-B.ConclusionThe MA brace has shown to be effective in the management of SK; good patients’ reported compliance and a positive effect on the patients’ mental status were recorded.

4273 An innovative rib construct for treatment of pediatric spinal deformity

OBJECTIVES/GOALS: The rib construct is a novel device for treating childhood hyperkyphosis and kyphoscoliosis. The purpose of this study was to investigate the biomechanics, mechanism, and clinical outcomes of this device. The overarching hypothesis was that the rib construct is safe and effective for correcting hyperkyphotic spinal deformity. METHODS/STUDY POPULATION: Biomechanical evaluation: An ex vivo porcine spine biomechanical study compared traditional pedicle screw proximal fixation to the rib construct in terms of proximal fixation strength and construct stiffness. Porcine model hyperkyphosis correction with rib construct: An in vivo hyperkyphotic porcine model was used to study the ability of the rib construct to correct hyperkyphosis in the developing porcine spine. Human hyperkyphotic correction with rib construct: A retrospective study was conducted to examine the radiographic outcomes, complication rates, procedure times, and blood losses experienced by human patients that received rib construct surgery. RESULTS/ANTICIPATED RESULTS: Biomechanical evaluation: The rib construct was significantly less prone to proximal fixation failure and less stiff compared to pedicle screws. Porcine model hyperkyphosis correction with rib construct: The average T6-T14 thoracic kyphosis was 35.8 ± 3.2° at the time of hyperkyphosis creation surgery. In response to corrective surgery with the rib-hook construct, T6-T14 thoracic hyperkyphosis decreased immediately post-op to 11.3 ± 7.8° and continued to decrease to 7.8 ± 7.6° until final follow-up 8 weeks post-op (n = 3). Human hyperkyphosis correction with rib construct: Pre-op sagittal Cobb angle was 81 ± 31° and fell to 43 ± 24° post-op and to 38 ± 24° at final follow-up; indicating ~100% correction (normal thoracic kyphosis is 40°). DISCUSSION/SIGNIFICANCE OF IMPACT: The results suggest that the rib construct is a highly effective technique and superior to existing methods.

How does the cervical spine respond to hyperkyphosis correction in Scheuermann's disease?

This study aimed to quantify the response of the cervical spine to the surgical correction of Scheuermann's kyphosis (SK) and to postoperative proximal junctional kyphosis (PJK). Fifty-nine patients (mean age 14.6 ± 2.3 years) were enrolled in the study: 35 patients in a thoracic SK (T-SK) group and 24 in a thoracolumbar SK (TL-SK) group. The mean follow-up period was 47.2 ± 17.6 months. Radiographic data, PJK-related complications, and patient-reported outcomes were compared between groups. The global kyphosis significantly decreased postoperatively, and similar correction rates were observed between the two groups (mean 47.1% ± 8.6% [T-SK] vs 45.8% ± 9.4% [TL-SK], p = 0.585). The cervical lordosis (CL) in the T-SK group notably decreased from 21.4° ± 13.3° to 13.1° ± 12.4° after surgery and was maintained at 14.9° ± 10.7° at the latest follow-up, whereas in the TL-SK group, CL considerably increased from 7.2° ± 10.7° to 11.7° ± 11.1° after surgery and to 13.8° ± 8.9° at the latest follow-up. PJK was identified in 16 patients (27.1%). Its incidence in the TL-SK group was notably higher than it was in the T-SK group (41.6% [n = 10] vs 17.1% [n = 6], p = 0.037). Compared with non-PJK patients, PJK patients had greater CL and lower pain scores on the Scoliosis Research Society-22 questionnaire (p < 0.05). Hyperkyphosis correction eventually resulted in reciprocal changes in the cervical spine, with CL notably decreased in the T-SK group but significantly increased in the TL-SK group. Patients developing PJK have increased CL, which seems to have a negative effect on patients' health-related quality of life.

The Effect of Dynamic Hyperextension Brace on Osteoporosis and Hyperkyphosis Reduction in Postmenopausal Osteoporotic Women.

Osteoporosis and hyperkyphosis could impose a considerable financial and therapeutic burden on the affected society. Thus, new strategies to prevent or manage such complications are of significant importance. Here we evaluate the effect of 'Dynamic Hyperextension Brace' (DHB) on bone density, and hyperkyphosis correction. Sixty postmenopausal women were randomly assigned to the case and control groups and followed for one year. DHB was applied in the case group according to the pre-designed protocol and the patients' clinical and paraclinical parameters, including bone mineral density (BMD), kyphosis angle, osteoporotic fracture, and serum alkaline phosphatase (ALP) were evaluated in two groups. Despite no significant difference in basic BMD and kyphosis between the case and control groups, BMD and kyphosis were significantly improved in the DHB treated group, at the end of the study (P=0.003 and P=0.001, respectively). Serum ALP level was significantly higher in cases compared to the controls (P=0.48). The vertebral fracture rate was also lower in the case group compared to the controls. The efficacy of bracing in osteoporosis and kyphosis management should be more emphasized. However, more detailed and controlled studies with more patients and a longer follow-up period is needed to adequately evaluate the long-term results of braces, including DHB.

Difference in Selective Muscle Activity of Thoracic Erector Spinae During Prone Trunk Extension Exercise in Subjects With Slouched Thoracic Posture

BackgroundThe prone trunk extension (PTE) exercise is often used to strengthen the back extensors. Although altered trunk posture is associated with movement impairment, the influences of a slouched thoracic posture on muscle activity of the thoracic erector spinae and thoracic movement during the PTE exercise were overlooked in previous studies. ObjectivesTo compare the muscle activity of the erector spinae muscles and the relative ratio of the thoracic and lumbar erector spinae muscles during a PTE exercise in subjects with and without slouched thoracic posture. DesignCross-sectional. SettingUniversity motion analysis laboratory. ParticipantsThe study included 22 subjects with slouched thoracic posture (defined as ≥40°) and 22 age- and gender-matched healthy subjects. MethodsAll participants performed the PTE exercise. Main outcome measuresBilateral surface electromyographic signals of the longissimus thoracis, iliocostalis lumborum pars thoracis, and pars lumborum muscles were measured during PTE exercises. Thoracic kyphosis (the angle of T1 minus T12) and lumbar lordosis (absolute value of the angle of L5 minus T12) were recorded using inclinometers during the PTE exercise. ResultsThe results showed no difference in muscle activity of the erector spinae in subjects with slouched thoracic posture versus those without during the PTE exercise. However, selective recruitment of the erector spinae pars thoracis was decreased significantly, and the thoracic kyphotic angle and lumbar lordotic curve were increased, during the PTE exercise in subjects with a slouched posture. ConclusionsAlthough the PTE exercise has historically been a key component of correction of hyperkyphosis, the increased spinal curvature inhibits muscle activation of the erector spinae pars thoracis in these individuals, thus limiting effective strength gains. Therefore, modified methods to maintain a neutral posture of the spine and facilitate muscle activation of the erector spinae pars thoracis are needed in these individuals.

LONG-TERM RESULTS OF ANTERIOR SPINAL FUSION WITH VASCULARIZED RIB GRAFT FOR SEVERE KYPHOSCOLIOSIS IN NEUROFIBROMATOSIS

The paper presents results of long-term (12 and 18 years) follow- up after the treatment of two patients with severe kyphoscoliosis in neurofibromatosis type 1 who underwent anterior spinal fusion with application of pedicled vascularized rib autograft. Surgery provided the graft convertion into a regenerate having a form of a support column. At the final follow-up a correction of hyperkyphosis was maintained in both cases, and scoliosis progressed in one patient.

Delayed-onset neurological deficit following correction of severe thoracic kyphotic deformity

There are many potential risks associated with spinal deformity correction procedures including transient and/or permanent neurological deficits. Typically, neurological deficits caused by the surgical correction of spinal kyphosis occur acutely during surgery or immediately after surgery. Delayed postoperative neurological deficits are extremely rare. The authors report a case of delayed neurological deficit that occurred 48 hours after surgical correction of thoracic hyperkyphosis. An 18-year-old man with myotonic dystrophy presented with a 110 degrees T7-L1 kyphosis. The patient underwent an uneventful two-stage correction procedure of the hyperkyphotic deformity. First, anterior discectomies and fusion were performed from T-7 to L-1 using rib autograft, and all segmental vessels were preserved. Subsequently, on the same day, the patient underwent posterior Smith-Petersen osteotomies and T7-L2 pedicle screw fixation. Intact somatosensory and motor evoked potentials were maintained throughout both operations. Postoperatively, he remained neurologically intact without sequelae for nearly 48 hours. On postoperative Day 2, the patient developed delayed monoplegia of the left leg and sensory level loss below T-10. Medical management enabled complete reversal of the patient's monoplegia and sensory loss. At 2-year follow-up, the patient had no adverse neurological sequelae. In this case, a delayed postoperative neurological deficit occurred following spinal hyperkyphosis correction. The authors discuss the possible etiological mechanisms behind this complication and suggest strategies for its management.

Surgical correction of hyperkyphosis: new etiology for acute biliary obstruction

Surgical correction of hyperkyphosis: new etiology for acute biliary obstruction