Kyphosis Research Articles

Severe (>100 Degrees) Thoracic Adolescent Idiopathic Scoliosis - A Comparison of Surgical Approaches.

Retrospective. Severe curves >100° in adolescent idiopathic scoliosis (AIS) are rare and require careful operative planning. The aim of this study was to assess baseline, perioperative, and 2-year differences between anterior release with posterior instrumentation (AP), posterior instrumentation with posterior column osteotomies (P), and posterior instrumentation with 3-column vertebral osteotomies (VCR). Two scoliosis datasets were queried for primary cases of severe thoracic AIS (≥100°) with 2-year follow-up. Pre- and 2-year postoperative radiographic measures (2D and estimated 3D kyphosis), clinical measurements, and SRS-22 outcomes were compared between three approaches. Sixty-one patients were included: 16 AP (26%), 38 P (62%), 7 VCR (11%). Average age was 14.4 ± 2.0 years; 75.4% were female. Preoperative thoracic curve magnitude (AP: 112°, P: 115°, VCR: 126°, P = 0.09) and T5-T12 kyphosis (AP: 38°, P: 59°, VCR: 70°, P = 0.057) were similar between groups. Estimated 3D kyphosis was less in AP vs P (-12° vs 4°, P = 0.016). Main thoracic curves corrected to 36° in AP vs 49° and 48° for P and VCR, respectively (P = 0.02). Change in estimated 3D kyphosis was greater in AP vs P and VCR (34° vs 13°, P = 0.009; 34° vs 7°, P = 0.046). One incomplete spinal cord injury had residual deficits (P; 1/61, 1.6%). All SRS-22 domains improved postoperatively. All approaches obtained satisfactory coronal and sagittal correction, but AP had smaller residual coronal deformity and greater kyphosis restoration than the other approaches. This information may help inform the decision of whether to include an anterior release for large thoracic AIS curves.

Musculoskeletal spine modeling in large patient cohorts: how morphological individualization affects lumbar load estimation.

Introduction: Achieving an adequate level of detail is a crucial part of any modeling process. Thus, oversimplification of complex systems can lead to overestimation, underestimation, and general bias of effects, while elaborate models run the risk of losing validity due to the uncontrolled interaction of multiple influencing factors and error propagation. Methods: We used a validated pipeline for the automated generation of multi-body models of the trunk to create 279 models based on CT data from 93 patients to investigate how different degrees of individualization affect the observed effects of different morphological characteristics on lumbar loads. Specifically, individual parameters related to spinal morphology (thoracic kyphosis (TK), lumbar lordosis (LL), and torso height (TH)), as well as torso weight (TW) and distribution, were fully or partly considered in the respective models according to their degree of individualization, and the effect strengths of these parameters on spinal loading were compared between semi- and highly individualized models. T-distributed stochastic neighbor embedding (T-SNE) analysis was performed for overarching pattern recognition and multiple regression analyses to evaluate changes in occurring effects and significance. Results: We were able to identify significant effects (p < 0.05) of various morphological parameters on lumbar loads in models with different degrees of individualization. Torso weight and lumbar lordosis showed the strongest effects on compression (β ≈ 0.9) and anterior-posterior shear forces (β ≈ 0.7), respectively. We could further show that the effect strength of individual parameters tended to decrease if more individual characteristics were included in the models. Discussion: The induced variability due to model individualization could only partly be explained by simple morphological parameters. Our study shows that model simplification can lead to an emphasis on individual effects, which needs to be critically assessed with regard to in vivo complexity. At the same time, we demonstrated that individualized models representing a population-based cohort are still able to identify relevant influences on spinal loading while considering a variety of influencing factors and their interactions.

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.

The Surgical Management of Severe Scoliosis in Immature Patient with a Very Rare Disease Costello Syndrome-Clinical Example and Brief Literature Review.

Costello syndrome (CS) is a rare genetic syndrome in which, due to the occurrence of a mutation in the HRAS gene on chromosome 11 that causes the manifestation, a set of features such as a characteristic appearance, many congenital defects, intellectual disability and a genetic predisposition to cancer, friendly personality, and others can be identified. CS is very rare, with an incidence of ~1/300,000, but it belongs to one of the largest groups of congenital syndromes, called RASopathies, occurring with an incidence of 1/1000 people. Scoliosis and kyphosis, as well as other spinal defects, are common, in 63% and 58% of patients, respectively, and a study conducted among adult patients showed the presence of scoliosis in 75% of patients; there may be excessive lordosis of the lumbar section and inverted curvatures of the spine (lordosis in the thoracic section and kyphosis in the lumbar section). The aim of our study is to present a case report of treatment of severe scoliosis of 130 degrees in a 14-year-old patient with Costello syndrome, with coexisting Chiari II syndrome and syrinx in the absence of skeletal maturity. This patient underwent foramen magnum decompression 3 months before planned surgical correction for severe scoliosis. The patient was qualified for surgical treatment using magnetically controlled growing rods (MCGR). After spine surgery using MCGR, we gradually performed MCGR distraction over the next 2 years; we performed the final surgery, conversion to posterior spinal fusion (PSF) with simultaneous multi-level Ponte osteotomy, which gave a very good and satisfactory surgical result. In the perioperative period, two serious complications occurred: pneumothorax caused by central catheter and gastrointestinal bleeding due to previously undiagnosed gastrointestinal varices. This case shows that the treatment of severe and neglected scoliosis is complicated and requires special preparation and a surgical plan with other cooperating specialists. The scoliosis was corrected from 130 degrees to approximately 48 degrees, sagittal balance was significantly improved, and the surgical outcome was very pleasing, significantly improving quality of life and function for the patient.

Strategies for Minimizing the Effects of Observer Variability on Sagittal Parameter Measurements of the Spine.

Exploratory-descriptive study. Evaluate the influence of observer variability on the measurements of both thoracic kyphosis (TK) and lumbar lordosis (LL) obtained with anatomic and functional spinal segmentation methods. Parametric analysis for spinal surgery planning typically relies on anatomic parameters. However, incorporating functional parameters that consider the vertebrae orientation is important to minimizing surgical calculation errors. The authors developed parametric analysis software that integrates traditional and functional methodologies. The proposed method included functional thoracic kyphosis and functional lumbar lordosis calculated from the lines normal to the inflection points of the spine model. Using a synthetic lateral X-ray, the observer variability was computer-simulated generating 20 landmark sets that replicate the annotations of 20 observers. The analysis also included 10 clinical X-rays, annotated twice by 3 judges with a minimum 1-week interval. The spinal curvature angles were derived using the anatomic and functional methods. Statistical analysis were performed for comparison. For the synthetic X-ray, the proposed method presented significantly less variability: TK (<±2.5 degrees, P=0.00023) and LL (<±5 degrees, P=0.00012). For the clinical X-rays, the interobserver reliability analysis yielded higher intraclass correlation coefficients (ICC) for functional TK (ICC>0.97) and functional LL (ICC>0.87) than for TK (ICC<0.91) and LL (ICC<0.89). Statistically significant differences were observed for both TK (P=0.001) and LL (P=0.030). Under the traditional method, observer variability led to measurement differences surpassing ±19 degrees, whereas differences with the proposed method were within ±10 degrees for both parameters. The vertebral endplate is not the most suitable place to measure spinal sagittal curvatures. Small changes in landmark position significantly alter the measured Cobb angle. The proposed method offers a substantial advantage regarding the influence of observer variability, in addition to the more individualized analysis.

Patient-specific 3D-printed Brace for Adolescent Idiopathic Scoliosis: A Prospective Cohort Study

To evaluate the efficacy, safety of patient-tailored 3D printed brace in the treatment of adolescent idiopathic scoliosis (AIS), and to compare the health-related quality of life (HRQoL) of patients treated with two different types of brace. From September 2017 to August 2020, 103 AIS patients requiring non-operative management were prospectively recruited in this study. All patients were followed up every 6 months, clinical and radiological examination were assessed at each follow-up time. Full-length anteroposterior X-ray of the spine in the standing position was performed obtained. At the last follow-up, each patient completed a standardized HRQoL questionnaire. Compliance is defined as that the patient insists on wearing the brace for ≥ 23h every day (full-time wearing) and follow-up every 6 months until bone maturity.The rate of major curve Cobb progression was defined that maximum Cobb Angle of major curve greater than 6° compared with that at the initial diagnosis, or aggravated to more than 45° so that orthopedic surgery was recommended during treatment, which was defined as the rate of conversion to surgery. The effects of these two types of braces on the rate of major curve Cobb progression and HRQoL were analyzed by independent sample t-test ad Chi-square test. The thickness was 4 mm for thoracolumbosacral orthosis (TLSO) and 3 mm for 3D-printed brace (3DPB). In addition, compared with the material used in TLSO, the weight (600-800 grams) of the 3DPB materials with the same area is reduced by about 25-30%. 55 patients (49.1%) and 48 patients (33.1%) were respectively included in the 3DPB cohort and the TLSO cohort.The maximum Cobb angle of major curve in the 3DPB cohort was significantly lower than those in the TLSO cohort at 6 months, 12 months and the last follow-up (p < 0.01). The thoracic kyphosis (TK) and lumbar lordosis (LL) of the two cohorts at the last follow-up were lower than those before brace treatment, in addition, there was a significant difference in TK (p = 0.001) and LL (p = 0.004) between the two cohorts at the follow-up. The scores of physical function, pain, self-image, mental health and treatment satisfaction in the Chinese version of SRS-22 in the 3DPB cohort were higher than those in the TLSO cohort (p < 0.01 and p < 0.05, respectively). The scores of the 3DPB cohort were significantly higher than those of the TLSO group in the four dimensions (p = 0.008, 0.013, 0.015, and 0.002, respectively) of the EuroQol-5D health description system except for mobility, and the overall health status of EuroQol-5D was higher for the 3DPB cohort (p < 0.001). At the last follow-up, One patient in the 3DPB cohort and ten patients in the TLSO cohort had major curve Cobb progression of greater than 6°, and the rate of major curve Cobb progression in 3DPB cohort was significantly lower than that in the TLSO cohort (OR 14.2, 95% CI 1.7∼115.8, p < 0.01). One patient in the 3DPB and seven patients in the TLSO cohorts received subsequent surgery or was recommended for surgery, and the rate of conversion to surgery was significantly lower than in the 3DPB cohort (OR 9.2, 95% CI 1.1∼77.9, p < 0.05). Patient-tailored 3D-printed brace is lighter, thinner, and more comfortable than conventional braces in the treatment of AIS. It can substantially improve the HRQoL of patients and can significantly reduce the progression of major curve Cobb progression and rate of conversion of surgery.

Determining the vertebra for pedicle subtraction osteotomy in surgical correction for ankylosing spondylitis with thoracolumbar kyphosis

OBJECTIVE This study aimed to provide a method for determining the apical vertebra for pedicle subtraction osteotomy (PSO) in corrective surgery for patients with ankylosing spondylitis (AS) with thoracolumbar kyphosis (TLK). METHODS The medical records of AS patients with TLK who underwent PSO between May 2009 and August 2022 were retrospectively reviewed, and 235 patients were included in the study. Using the proposed method, choosing the vertebra based on Kim’s apex (KA), which is defined as the farthest vertebra from a line drawn from the center of the T10 vertebral body to the midpoint of the S1 upper endplate, the authors analyzed 229 patients with apices at T12, L1, or L2 (excluding L3 because of the small sample size, n = 6). They divided all patients into two groups. Group A (n = 144) underwent PSO at the KA vertebra, while group B (n = 85) underwent PSO at a different level. Demographic and radiological data, including sagittal spinopelvic parameters of the entire spine, were collected. An additional analysis was performed on patients with the same KA vertebra. RESULTS The vertebra distributions of patients based on KA were T12 (28 [12.2%]), L1 (119 [52.0%]), and L2 (82 [35.8%]). The corrections of sagittal vertical axis (SVA; 101.0 ± 48.5 mm vs 82.0 ± 53.8 mm, p = 0.010), global kyphosis (GK; 31.6° ± 10.0° vs 26.4° ± 10.5°, p = 0.005), and TLK (29.4° ± 10.2° vs 24.2° ± 12.9°, p = 0.012) in group A were significantly greater than those in group B, and there was no difference in the corrections of thoracic kyphosis (TK), lumbar lordosis, and pelvic incidence between the two groups. On further analysis, group A showed greater correction in TK (26.2° ± 13.7° vs 0.1° ± 8.1°, p = 0.013) for patients with T12 as the KA; greater improvements in SVA (101.5 ± 44.2 mm vs 73.4 ± 48.7 mm, p = 0.020), GK (30.6° ± 11.0° vs 25.0° ± 10.4°, p = 0.046), and TLK (32.6° ± 7.8° vs 26.7° ± 9.9°, p = 0.012) for those with L1 as the KA; and significant correction in TLK (30.0° ± 6.3° vs 4.3° ± 19.5°, p = 0.008) for patients with L2 as the KA, compared with group B. CONCLUSIONS PSO at the apical vertebra provides a greater degree of correction of sagittal imbalance. The proposed method, selecting the vertebra based on KA, is easily reproducible for determining the apex level in AS patients with TLK.

Pre-contoured patient-specific rods result in superior immediate sagittal plane alignment than surgeon contoured rods in adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) surgery typically involves posterior spinal fusion (PSF) using rods contoured by the surgeon, which may be time-consuming and may not reliably restore optimal sagittal alignment. However, pre-contoured patient-specific rods may more optimally restore sagittal spinal alignment. This study evaluates the radiographic outcomes of AIS patients who underwent PSF utilizing surgeon contoured vs. pre-contoured rods. This is a retrospective cohort study of AIS patients who underwent PSF with either surgeon contoured or pre-contoured rods. Demographics, Lenke classification, fused levels, osteotomies, estimated blood loss (EBL), and surgical time were also obtained via chart review. Coronal curve magnitude, T5-T12 thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PI-LL mismatch, and T1 pelvic angle (TPA) were obtained pre-operatively, postoperatively and at last follow up. Outcome measures included rate of achievement of postoperative radiographic alignment goals (TK between 20 and 40 degrees, PI-LL mismatch within 10 degrees, and TPA <14 degrees). Predicted post-operative sagittal alignment was also compared with observed measurements. Student's and paired t-tests were performed to determine significant mean differences for continuous variables, and chi-square for categorical variables. No differences were found in demographics, Lenke classification, preop radiographic measurements, fused levels, osteotomies, EBL, and surgical time in the surgeon contoured cohort (n=36; average follow up 11.3 months) and pre-contoured cohort (n=22; average follow up 9.7 months). At last follow up, 95.5% of patients with pre-contoured rods vs. 61.1% of patients with surgeon contoured rods (P=0.004) met TK goal. During assessment of first standing postoperative X-ray, 72.7% of patients with pre-contoured rods vs. 33.3% of patients with surgeon contoured rods met PI-LL mismatch goal (P=0.004). Other radiographic measurements were similar. Artificial intelligence (AI) predicted and observed differences for the pre-contoured group were 3.7 for TK (P=0.005), -7.6 for PI-LL mismatch (P=0.002), and -2.6 for TPA (P=0.11). AI and pre-contoured rods help achieve global sagittal balance with high accuracy and improved kyphosis restoration and PI-LL mismatch than surgeon contoured rods in AIS patients.

Importance of the lumbar paraspinal muscles on the maintenance of global sagittal alignment after lumbar pedicle subtraction osteotomy.

There are limited data about the influence of the lumbar paraspinal muscles on the maintenance of sagittal alignment after pedicle subtraction osteotomy (PSO) and the risk factors for sagittal realignment failure. The authors aimed to investigate the influence of preoperative lumbar paraspinal muscle quality on the postoperative maintenance of sagittal alignment after lumbar PSO. Patients who underwent lumbar PSO with preoperative lumbar MRI and pre- and postoperative whole-spine radiography in the standing position were included. Spinopelvic measurements included pelvic incidence, sacral slope, pelvic tilt, L1-S1 lordosis, T4-12 thoracic kyphosis, spinosacral angle, C7-S1 sagittal vertical axis (SVA), T1 pelvic angle, and mismatch between pelvic incidence and L1-S1 lordosis. Validated custom software was used to calculate the percent fat infiltration (FI) of the psoas major, as well as the erector spinae and multifidus (MF). A multivariable linear mixed model was applied to further examine the association between MF FI and the postoperative progression of SVA over time, accounting for repeated measures over time that were adjusted for age, sex, BMI, and length of follow-up. Seventy-seven patients were recruited. The authors' results demonstrated significant correlations between MF FI and the maintenance of corrected sagittal alignment after PSO. After adjustment for the aforementioned parameters, the model showed that the MF FI was significantly associated with the postoperative progression of positive SVA over time. A 1% increase from the preoperatively assessed total MF FI was correlated with an increase of 0.92 mm in SVA postoperatively (95% CI 0.42-1.41, p < 0.0001). This study included a large patient cohort with midterm follow-up after PSO and emphasized the importance of the lumbar paraspinal muscles in the maintenance of sagittal alignment correction. Surgeons should assess the quality of the MF preoperatively in patients undergoing PSO to identify patients with severe FI, as they may be at higher risk for sagittal decompensation.

Effect of adding diaphragmatic breathing to corrective exercises on kyphotic angle and diaphragmatic excursion in postmenopausal kyphotic women: A randomized controlled trial.

Age-related thoracic kyphosis can impair posture, diaphragmatic excursion, respiratory function, and overall quality of life (QoL). This randomized controlled trial aimed to compare the effects of corrective exercises alone versus combined with diaphragmatic breathing exercises on thoracic kyphosis, diaphragmatic excursion, thoracic pain, and QoL in postmenopausal kyphotic women. Forty postmenopausal women diagnosed with thoracic kyphosis were randomly divided into two groups. Group A received corrective exercises for 12weeks (n=20), while Group B received both diaphragmatic breathing exercises and corrective exercises for the same duration (n=20). Primary outcome measures were thoracic kyphosis angle and diaphragmatic excursion, while secondary outcome measures were thoracic pain and QoL. Both groups were assessed pre- and post-intervention using a flexible curve ruler for the thoracic kyphosis angle, ultrasonography for the diaphragmatic excursion, the visual analog scale for thoracic pain, and the Arabic version of the QoL Questionnaire of the European Foundation for Osteoporosis for QoL. Both groups showed significant within-group improvements in all measures post-intervention (p<0.05). Between-group comparisons post-intervention revealed no significant differences (p>0.05) except for diaphragmatic excursion, where Group B showed significantly greater improvement (p<0.05). A 12-week program of corrective exercises alone or combined with diaphragmatic breathing exercises significantly improved kyphosis angle, thoracic pain, and QoL in postmenopausal kyphotic women. The addition of diaphragmatic breathing exercises provided further benefits by increasing diaphragmatic excursion to a greater degree compared with corrective exercises alone.

Lateral Epicondylalgia and Thoracic Kyphosis: A Study on Young Athletes.

The etiology of lateral epicondylalgia (LE) remains unclear, although it has been linked to various factors. Recent theories suggest a potential connection between LE and impairments in the kinetic chain. In our study, we aimed to investigate the association between another factor influencing kinetic chain impairment, specifically an increased angle of thoracic kyphosis, and the presence of initial signs of LE in young athletes. This study employed an observational, case-control design. The participants underwent examination during a routine preventive checkup conducted by a sports physician at Novi Sad Healthcare Center, Sports Medicine Center. One hundred young athletes aged 10 to 15 years were included in the study. Half of the participants reported pain in the lateral aspect of the elbow during maximal hand grip, while the remaining athletes served as controls and did not experience any pain. Thoracic kyphosis inclination angles were measured using a digital inclinometer. Pain was assessed using the pressure pain threshold at a specific point associated with lateral epicondylalgia, measured by a digital algometer. Participants exhibiting initial signs of LE displayed significantly different angles of anteroposterior curvatures of the spine compared with the control group. Moreover, the angle of thoracic kyphosis was significantly associated with pain in the lateral aspect of the elbow. Our findings confirm an association between initial signs of lateral epicondylalgia and the grade of thoracic kyphosis in young athletes.

Association Between Radiological Severity of Lumbar Spinal Stenosis and Spinopelvic Parameters in Adult Patients With Achondroplasia.

Adults with achondroplasia are more vulnerable to suffer from neurogenic claudication because of a congenital narrow spinal canal, which makes them susceptible to lumbar spinal stenosis (LSS). The study aims to investigate the correlations between sagittal alignment parameters and the degree of LSS in patients with achondroplasia with LSS. The radiological data of adult achondroplasts presented to the neurosurgical clinic of our medical center from 2019 to 2022 were collected. Lumbar stenosis was graded using the Schizas scale, and the dural sac cross-sectional area (DSCA) was measured. The angles defining the spinopelvic parameters comprising lumbar lordosis, thoracolumbar kyphosis, sagittal vertical axis, pelvic tilt, sacral slope, and pelvic incidence were measured. Spearman or Pearson correlation was used to investigate the association between sagittal misalignment and LSS. A total of 34 achondroplastics were enrolled, with a median age of 44.3 ± 15.5 years, ranging from 18.6 to 78.5 years. Larger thoracolumbar kyphosis was associated with more severe stenosis according to the Schizas scale of the L12 lumbar level (r = 0.44, P = .020, 95% CI [0.08, 0.70]). Larger sagittal vertical axis correlated with a smaller DSCA at L23 (r = -0.53, P = .036, 95% CI [-0.81, -0.04]) and L45 (r = -0.66, P = .004, 95% CI [-0.87, -0.26]). Larger pelvic tilt was demonstrated to be associated with a smaller DSCA of the L34 lumbar level (r = -0.42, P = .027, 95% CI [-0.68, -0.05]) and the L45 lumbar level (r = -0.47, P = .011, 95% CI [-0.71, -0.12]). The upper LSS may be attributed to an increased kyphosis of the thoracolumbar spine. On the contrary, the lower LSS seemed to be correlated with a more backward tilt of the pelvis.

Long-term follow-up of adolescent idiopathic scoliosis surgery with Harrington instrumentations: a systematic review and meta-analysis.

In the 1960s, Harrington instrumentation (HRI) revolutionized the surgical treatment of adolescent idiopathic scoliosis (AIS). Despite the transition to more innovative techniques, concerns regarding its impact on sagittal alignment, associations with low back pain, and correction loss have consistently persisted. The aim of this meta-analysis is precisely to evaluate the clinical and radiological outcomes, as well as the complications of patients treated with HRI over an extended follow-up period. A systematic search of articles about AIS patients who underwent HRI and reported long-term outcomes (> 10years) was conducted on electronic databases according to PRISMA guidelines. Data regarding radiographic and clinical outcomes were extracted and meta-analyses were performed. Eleven studies comprising 644 patients were included. The mean follow-up ranged from 10.8 to 51.7years. Radiographic analysis revealed a decrease in the main curve Cobb angle from 60.6° to 38.3°, with a correction loss of - 9.49° between postoperative and last follow-up. Concerning sagittal parameters, preoperative thoracic kyphosis was 19.65° at last follow-up, and preoperative lumbar lordosis was 42.94°. Additional spine surgeries were required in 42% of patients. Clinical outcomes varied among studies, but overall, HRI patients showed comparable quality of life and function to controls, although a higher incidence of low back pain was reported. Patients who underwent HRI exhibited suboptimal correction of rib deformity and a flattened sagittal spinal alignment. However, they generally displayed favourable long-term functional outcomes. Despite the implant's tendency to reduce lumbar curvature, patients achieved good clinical outcomes and functional scores comparable to age-matched individuals, suggesting that disability is not an inevitable consequence of lumbar flattening.

Sagittal spinal curvatures of young adults in the context of their self-reported physical activity and somatic parameters

The objective of this study was to assess the thoracic kyphosis (ThKA) and lumbar lordosis (LLA) in healthy young adults and to investigate potential relationships between spinal curvatures, self-reported physical activity (PA), and somatic parameters. The study included 380 female students and 211 male students aged 20.7 ± 1.5 years. The ThKA and LLA were measured using a Plurimeter-V gravity inclinometer. The level of PA was estimated using the International Physical Activity Questionnaire. ThKA was lower in women compared to men, while LLA was higher in women than in men (p < 0.0001). Female students reported lower PA than male students (p < 0.001). Female students with ThKA within normal values reported a significantly higher amount of low-intensity PA compared to those with ThKA below or above the norm. A correlation was found between ThKA and body mass index (BMI), body adiposity index (BAI), WC, and fat percentage (rho < 0.2), whereas LLA showed correlations with BMI, BAI, waist circumference, and fat percentage (rho < 0.2). Among male students, a correlation was found between LLA and BMI as well as WC (rho < 0.2). Maintaining a healthy body composition may be instrumental in mitigating the risk of developing spinal curvature abnormalities.

Correlation between Acetabular Anteversion with a False-Profile View and Spinopelvic Parameters in Adult Spinal Deformity after Long-Segment Corrective Spinal Surgery.

Studies describing the relationship between the hip and spine have reported that corrective spinal surgery for adult spinal deformity (ASD) affects the orientation of the acetabulum. However, the extent to which spinal correction in ASD affects acetabular anteversion in the standing position is unclear, especially after total hip arthroplasty, for which dislocation is a concern. The purpose of this study was to evaluate changes in anterior acetabular coverage in the upright position due to extensive correction surgery for ASD. Thirty-six consecutive patients who had undergone spinal corrective surgery from the thoracolumbar region to the pelvis were enrolled and evaluated. The ventral-central-acetabular (VCA) angle and anterior acetabular head index (AAHI) were measured with a false-profile view to evaluate the relationship between acetabular anteversion in the standing position and spinopelvic parameters before and after surgery. The spinopelvic parameters measured included thoracic kyphosis, pelvic incidence, pelvic tilt (PT), sacral slope, lumbar lordosis (LL), sagittal vertical axis, and global tilt. The VCA angle and AAHI were significantly increased after spinal deformity correction (p<0.001). The changes in LL and PT were correlated with the VCA angle (LL: right, ρ=0.56; left, ρ=0.55, p<0.001; PT: right, ρ=-0.59; left, ρ=-0.64, p<0.001) and AAHI (LL: right, ρ=0.51; left, ρ=0.58, p<0.01; PT: right, ρ=-0.52; left, ρ=-0.59, p<0.01), respectively. Linear regression analysis revealed that a 10° increase in LL results in 1.4°-1.9° and 1.6%-2% increases in the VCA angle and AAHI, respectively. Surgical correction for ASD significantly affects sagittal spinopelvic parameters, resulting in increased acetabular anteversion. The anterior coverage of the acetabulum in the postoperative standing position could be predicted with the intraoperatively measured LL, and evaluation using a false-profile was considered useful for treating ASD, particularly in patients after total hip arthroplasty.

Anterior vertebral tethering for adolescent idiopathic scoliosis: our initial ten year clinical experience

BackgroundAnterior vertebral tethering (AVT) is a minimally invasive alternative to fusion surgery for adolescent idiopathic scoliosis (AIS) that offers the potential for definitive scoliosis treatment with the possibility of preservation of the growth, motion, function and overall health of the spine. This study represents our first ten years using AVT to treat AIS.MethodsIn this retrospective review we analyzed our first 74 AIS patients treated with AVT 2010–2020. Multiple Lenke curve types 33–70° were treated with skeletal maturity spanning Risser -1 to 5.ResultsOf 74 consecutive AIS patients treated with AVT, 52 patients (47 female, 5 male) had sufficient 2-year follow-up for inclusion. Forty-six of these 52 patients (88%) with 65 curves (35T, 30TL/L) were satisfactorily treated with AVT demonstrating curve correction from 48.6° pre-op (range 33°–70°) at age 15.1 years (range 9.2–18.8) and skeletal maturity of Risser 2.8 (range -1 to 5) to 23.2° post-op (range 0°–54°) and 24.0° final (range 0°–49°) at 3.3 years follow-up (range 2–10 years). Curve corrections from pre-op to post-op and pre-op to final were both significant (p < 0.001). The 0.8° change from post-op to final was not significant but did represent good control of scoliosis correction over time. Thoracic kyphosis and lumbar lordosis were maintained in a normal range throughout while axial rotation demonstrated a slight trend toward improvement. Skeletal maturity of Risser 4 or greater was achieved in all but one patient. Four of the 52 patients (8%) required additional procedures for tether rupture (3 replacements) or overcorrection (1 removal) to achieve satisfactory treatment status after AVT. An additional 6 of the 52 patients (12%), however, were not satisfactorily treated with AVT, requiring fusion for overcorrection (2) or inadequate correction (4).ConclusionsIn this study, AIS was satisfactorily treated with AVT in the majority of patients over a broad range of curve magnitudes, curve types, and skeletal maturity. Though late revision surgery for overcorrection, inadequate correction, or tether rupture was not uncommon, the complication of overcorrection was eliminated after our first ten patients by a refinement of indications.Level of EvidenceIV

Online exercise added to ergonomic advice for reducing habitual upper body postures: A randomized trial

BackgroundOnline learning during the COVID-19 pandemic is associated with unfavorable habitual upper body postures. ObjectiveThis study explored whether adding a remedial exercise routine to an ergonomic advice intervention, delivered remotely, is helpful for reducing habitual postures of the neck, shoulders, and upper back. DesignPragmatic randomized controlled trial. Methods42 male adolescent students, initially selected with a forward head posture, were randomized to one of two intervention groups: ergonomic advice alone or exercise + ergonomic advice. Outcome measures were specific postural angles of, measured by a photogrammetric profile technique using a bespoke app before and after the 8-week intervention period. ResultsDuring online learning, most students used mobile phones (76%), while 35% used a table-chair-computer arrangement. At 8-week follow-up, a statistically significant reduction of forward head, shoulder protraction, and thoracic kyphosis angles was found in both groups (P < 0.001). However, the effect was significantly greater in the exercise + ergonomic advice group (P < 0.001): forward head, shoulder protraction, and thoracic kyphosis angles reduced by some 9, 6, and 5° respectively, compared with 4° for head and 2° for shoulder and thoracic angles for the ergonomic advice alone group. ConclusionThe results show that, a remedial online exercise routine is a beneficial addition to an ergonomic advice program for improving unfavorable habitual upper body postures. The impact of this intervention may extend beyond postural issues related just to online learning at home.

Estimating thoracic kyphosis without information on upper thoracic kyphosis: an observational study on 455 patients examined by EOS imaging

BackgroundPhysiological thoracic kyphosis (TK) allows sagittal balance of human body. Unlike lumbar lordosis (LL), TK has been relatively neglected in the literature. EOS is an imaging technique employing high-sensitivity xenon particles, featured by low-dose exposure combined with high accuracy compared to conventional radiography. The aim of this study was to investigate predictors of TK in patients with phyiological spine morphology using EOS imaging.MethodsEOS images of 455 patients without spinal anomalies were retrospectively assessed for TK (T1- T12), upper thoracic kyphosis (UTK, T1-T5), lower thoracic kyphosis (LTK, T5-T12), LL (L1-S1) and pelvic incidence (PI). The latter curves were measured by two researchers separately and the average of the two measurements was used for further analysis.Spearman non-parametric correlation was estimated for age, PI, LL, LTK, UTK and TK. Multiple robust linear regression analysis was employed to estimate TK, controlling for the effect of age, sex, LL and LTK.ResultsThe mean age of patients was 28.3 ± 19.2 years and 302 (66.4%) of them were females. The mean TK, UTK and LTK was 45.5° ± 9.3, 16 ± 7.4° and 29.7° ± 8.9, respectively. The mean UTK in people under 40 years of age was 17.0° ± 7.2, whereas for patients 40+ years old it was 13.6° ± 7.4. At univariable analysis TK positively correlated with UTK (p<0.001), LTK (p<0.001) an LL (p<0.001). At multivariable linear regression TK increased with LTK (RC = 0.67; 95%CI: 0.59; 0.75) or LL (RC = 0.12; 95%CI: 0.06; 0.18), whereas it decreased with age (RC = -0.06; 95%CI: -0.09;—0.02).ConclusionIf EOS technology is available, the above linear regression model could be used to estimate TK based upon information on age, sex, LL and LTK. Alternatively, TK could be estimated by adding to LTK 17.0° ± 7.4 for patients < 40 years of age, or 13.6° ± 7.4 in patients 40 + years old. The evidence from the present study may be used as reference for research purposes and clinical practice, including spine examination of particular occupational categories or athletes.

Ефективність впровадження програми корекційно-профілактичних заходів для офісних працівників з різним станом біомеханіки опорно-рухового апарату

Topicality. Today's challenges require further improvement of technologies for correcting the motor activity of office workers through the use of a wide range of health fitness tools, which are gaining more and more popularity at the current stage. Goal. To determine the effectiveness of implementing a program of corrective and preventive measures for men aged 36–45 who work in offices at a computer. Research Methods: comparative analysis of the angular characteristics of the biogeometric profile of men's posture and indicators of their physical fitness before and after the study. The Results of the conducted research proved the effectiveness of corrective and preventive classes in terms of the positive impact on indicators of body goniometry and physical fitness of men in the second period of maturity with a round back. Thus, in men aged 36–45, the head tilt angle (a1) increased statistically significantly (T=0; Z=3,516; p=0,0004) by 10,5 %, a statistically significant (T=0; Z=3,516; p=0,0004) increase in the visual angle (a2) by 1,60 % was also recorded, and the angle of inclination of the trunk (a3) decreased statistically significantly (T=1,5; Z=3,439; p=0,0006) by 20,0 %. Recorded: statistically significant (T=0; Z=3,516; p=0,0004) increase in upper limb strength by 40 %, statistically significant (T=0; Z=3,296; p=0,00104) increase in speed-power index abilities by 66,67 %, a statistically significant (T=0; Z=3,516; p=0,0004) increase in the flexibility index by 62,5 %, and the shoulder girdle strength index is statistically significant (T=0; Z=3,516; p =0,0004) increased by only 7,55 %. Conclusion. According to the results of the comparative analysis, it was found that in both subgroups of men, angle α1 and angle α2 increased statistically significantly (p&lt;0,05), and angle α3 decreased statistically significantly (p&lt;0,05), while in men 36–40 years, the angle α1 and angle α2 increased more rapidly. The comparative analysis of physical fitness indicators before and after the study made it possible to state a statistically significant (p&lt;0,05) improvement in both men 36–40 and men 41–45 years old. Thus, the conducted research confirmed the effectiveness of our proposed program.

Minimally Invasive Controlled Growing Rods for the Surgical Treatment of Early-Onset Scoliosis—A Surgical Technique Video

Background: Spinal deformities in children and adolescents can be easily divided into those occurring and diagnosed before the age of 10—early-onset scoliosis—and those occurring and diagnosed after the age of 10—late-onset scoliosis. When the curvature continues to progress and exceeds a Cobb angle of more than 60–65 degrees, surgical treatment should be considered. The most common treatment procedure for EOS is the surgical correction of the deformity using standard growing rods (SGRs), and in the case of congenital defects with additional hemivertebrae, it is the resection of the hemivertebra and short fusion. Minimally invasive controlled growing rods (MICGRs) need to be distracted every 6–9 months through a minimally invasive approach that involves sedation and neuromonitoring to obtain the best possible correction while minimizing complications. The aim of our study is to present a less-invasive surgical technique for MICGR implantation based on a two-case presentation—early-onset idiopathic scoliosis and congenital kyphosis. The surgical technique is the less-invasive percutaneous and subfascial implantation of MICGRs without long incisions in the back. Conclusions: The use of MICGRs is an alternative and safe surgical technique for patients undergoing surgical treatment for EOS. Without the risk of metallosis, like in other implant systems, and the need for replacement after 2 years of use, like in using magnetically controlled growing rods (MCGRs), the MICGR system can be used as a less-invasive procedure, allowing for the avoidance of many periodic invasive procedures in children with a wider opening of the spine (like in using standard growing rods), minimizing the number of planned hospitalizations, reducing the length of hospital stays, and reducing the physical and mental burdens on young patients, parents, and families.