Lenke Classification Research Articles

Association Between Lenke Classification, The Extent of Lumbar Spinal Fusion, and Health-Related Quality of Life After Instrumented Spinal Fusion for Adolescent Idiopathic Scoliosis.

Prospective cohort study. Lenke classification is used to define the curve type in adolescent idiopathic scoliosis (AIS). The association of Lenke classification and long-term postoperative health-related quality of life (HRQoL) remains unclear. The purpose of this study was to assess the association between Lenke classification and HRQoL in patients who underwent spinal fusion for AIS. In all, 146 consecutive patients (mean age 15.1yr) operated for AIS between 2007 and 2019 with a minimum 2-year follow-up were included. Fifty-three (36%) patients reached the 10-year follow-up. Their HRQoL was assessed with the SRS-24 questionnaire preoperatively, at six months, two years, and 10 years after surgery. The preoperative major curve was the largest in Lenke 3 (mean 63 ° ) and 4 (mean 62 ° ) groups and the lowest in Lenke 5 groups (mean 48 ° , P <0.05). These curves were corrected to a mean of 15 ° with no differences between groups. We found no evidence of differences between the preoperative HRQoL scores between the Lenke groups. The self-image domain of SRS-24 was lower in patients with isolated major thoracolumbar scoliosis (Lenke 5) when compared with double-thoracic (Lenke 2) group at the two-year follow-up (mean [95% CI] 3.6 [3.3-3.9] vs. 4.3 [4.1-4.6]). The postoperative satisfaction domain was lower in Lenke 5 group when compared with main thoracic (Lenke 1) group (mean [95% CI] 3.8 [3.5-4.0] vs. 4.3 [4.2-4.5]) and Lenke 2 group (mean 4.4, 95% CI 4.2-4.6) at the two-year follow-up. The mean total score of SRS-24 at the 10-year follow-up was highest in Lenke 1 group (mean 4.06, 95% CI 3.79-4.33) and lowest in Lenke 6 group (mean 2.92, 95% CI 2.22-3.61). Lenke classification and especially its curve type (major thoracic vs. major thoracolumbar scoliosis) was associated with long-term health-related quality of life after instrumented spinal fusion for AIS.

Providence Bracing: Predicting the Progression to Surgery in Patients With Braced Idiopathic Scoliosis.

Idiopathic scoliosis (IS) is a common spinal abnormality, in which orthotic management can reduce progression to surgery. However, predictors of bracing success are still not fully understood. We studied a large patient population treated with the nighttime Providence orthosis, utilizing multivariable logistic regression to assess results and predict future spine surgery. We retrospectively reviewed patients with IS meeting Scoliosis Research Society inclusion and assessment criteria presenting from April 1994 to June 2020 at a single institution and treated with a Providence orthosis. A predictive logistic regression model was developed utilizing the following candidate features: age, sex, body mass index, Risser classification, Lenke classification, curve magnitude at brace initiation, percentage correction in a brace, and total months of brace use. Model performance was assessed using the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity. The importance of individual features was assessed using the variable importance score. There were 329 consecutive patients with IS with a mean age of 12.8 ± 1.4 years that met inclusion and assessment criteria. Of these, 113 patients (34%) ultimately required surgery. The model's area under the curve (AUC) was 0.72 on the testing set, demonstrating good discrimination. The initial curve magnitude (Importance score: 100.0) and duration of bracing (Importance score: 82.4) were the 2 most predictive features for curve progression leading to surgery. With respect to skeletal maturity, Risser 1 (Importance score: 53.9) had the most predictive importance for future surgery. For the curve pattern, Lenke 6 (Importance score: 52.0) had the most predictive importance for future surgery. Out of 329 patients with IS treated with a Providence nighttime orthosis, 34% required surgery. This is similar to the findings of the BrAist study of the Boston orthosis, in which 28% of monitored braced patients required surgery. In addition, we found that predictive logistic regression can evaluate the likelihood of future spine surgery in patients treated with the Providence orthosis. The severity of the initial curve magnitude and total months of bracing were the 2 most important variables when assessing the probability of future surgery. Surgeons can use this model to counsel families on the potential benefits of bracing and risk factors for curve progression.

Risk factors for distal construct failure in posterior spinal instrumented fusion for adolescent idiopathic scoliosis: a retrospective cohort study.

To evaluate risk factors for distal construct failure (DCF) in posterior spinal instrumented fusion (PSIF) in adolescent idiopathic scoliosis (AIS). We hypothesise increased inferior angulation of the pedicle screw in the lowest instrumented vertebra (LIV) predisposes to failure and aim to find the critical angle that predisposes to failure. A retrospective cohort study was performed on all patients who underwent PSIF for AIS at our institution from 2010 to 2020. On lateral radiographs, the angle between the superior endplate of the LIV was measured against its pedicle screw trajectory. Data on demographics, Cobb angle, Lenke classification, instrumentation density, rod protrusion from the most inferior screw, implants and reasons for revision were collected. Of 256 patients, 9 patients had DCF with 3 further failures post-revision, giving 12 cases to analyse. The DCF rate was 4.6%. The mean trajectory angle of DCF patients compared to non-DCF was 13.3° (95% CI 9.2° to 17.4°) vs. 7.6° (7.0° to 8.2°), p = 0.0002. The critical angle is less than 11° (p = 0.0076), OR 5.15. Lenke 5 and C curves, lower preoperative Cobb angle, titanium only rod constructs and one surgeon had higher failure rates. 9.6% of rods protruding less than 3mm from its distal screw disengaged. Increased inferior trajectory of the LIV screw increases the rate of DCF; inferior trajectory greater than 11° predisposes to failure. Rod protrusion less than 3mm from the distal screw increases rate of disengagement. III.

Are torso asymmetry and torso displacements in a computer brace model associated with initial in-brace correction in adolescent idiopathic scoliosis?

BackgroundLack of initial in-brace correction is strongly predictive for brace treatment failure in adolescent idiopathic scoliosis (AIS) patients. Computer-aided design (CAD) technology could be useful in quantifying the trunk in 3D and brace characteristics in order to further investigate the effect of brace modifications on initial in-brace correction and subsequently long-term brace treatment success. The purpose of this pilot study was to identify parameters obtained from 3D surface scans which influence the initial in-brace correction (IBC) in a Boston brace in patients with AIS.MethodsTwenty-fiveAIS patients receiving a CAD-based Boston brace were included in this pilot study consisting of 11 patients with Lenke classification type 1 and 14 with type 5 curves. The degree of torso asymmetry and segmental peak positive and negative torso displacements were analyzed with the use of patients’ 3D surface scans and brace models for potential correlations with IBC.ResultsThe mean IBC of the major curve on AP view was 15.9% (SD = 9.1%) for the Lenke type 1 curves, and 20.1% (SD = 13.9%) for the type 5 curves. The degree of torso asymmetry was weakly correlated with patient’s pre-brace major curve Cobb angle and negligible correlated with major curve IBC. Mostly weak or negligible correlations were observed between IBC and the twelve segmental peak displacements for both Lenke type 1 and 5 curves.ConclusionBased on the results of this pilot study, the degree of torso asymmetry and segmental peak torso displacements in the brace model alone are not clearly associated with IBC.

Enhanced recovery following posterior spinal fusion for adolescent idiopathic scoliosis: A medical and economic study in a French private nonprofit pediatric hospital

IntroductionLittle data exist on the efficacy of enhanced recovery after surgery (ERAS) protocols in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). HypothesisERAS reduces hospital costs (HC) and length of stay (LOS) without increasing pain or complications. Materials and methodsThis was a retrospective comparative medical and economic study of 2 cohorts of patients who underwent PSF for AIS: a prospective group who underwent surgery with an ERAS protocol without a specially assigned care coordinator from 2020 to 2021 (n=30) and a retrospective group (control) who received standard care from 2017 to 2018 (n=30). The key amendments to the ERAS protocol were reduced preoperative investigations, opioid-sparing analgesia, ambulation starting on postoperative day (POD) 1, early resumption of oral diet, and early transition to oral analgesics. Moreover, an intensive care unit (ICU) stay, surgical drainage, and the postoperative CT scan were no longer routine. The discharge criteria were the same for both groups: normal bowel function, independent walking, pain Visual Analog Scale (VAS)<3 without strong opioids, and no signs of complications. The endpoints were: decreased HC (calculated by subtracting the costs of hospital days and complementary exams that were not carried out) and LOS, complications, and postoperative pain according to the VAS on POD 1, POD 3, and discharge. All means were reported with the standard deviation. ResultsThe mean age of patients undergoing surgery (14.5±1.7 years), sex ratio, curve type according to the Lenke classification, mean Cobb angle (54±12°), and the number of instrumented vertebrae (9±2) were similar in both groups (p>0.5).The HC decreased on average by 3029€ per patient. The mean LOS was 5±0.9 days in the ERAS group versus 6.5±0.6 days in the control group (p<0.001). The VAS scores on POD 1 and POD 3 were lower in the ERAS group. One postoperative complication was noted in each group. ConclusionImplementing an ERAS protocol without a specifically assigned care coordinator for patients with AIS undergoing PSF significantly decreased HC, LOS, and early postoperative pain. Level of evidenceIII; retrospective comparative study.

Lenke Classification of Scoliosis Based on Segmentation Network and Adaptive Shape Descriptor

Scoliosis is a common spinal deformity that seriously affects patients’ physical and mental health. An accurate Lenke classification is greatly significant for evaluating and treating scoliosis. Currently, the clinical diagnosis mainly relies on manual measurement; however, using computer vision assists with an intelligent diagnosis. Due to the complex rules of Lenke classification and the characteristics of medical imaging, the fully automated Lenke classification of scoliosis remains a considerable challenge. Herein, a novel Lenke classification method for scoliosis using X-rays based on segmentation networks and adaptive shape descriptors is proposed. Three aspects of our method should be noted in comparison with the previous approaches. We used Unet++ to segment the vertebrae and designed a post-processing operation to improve the segmentation effect. Then, we proposed a new shape descriptor to extract the shape features for segmented vertebrae in greater detail. Finally, we proposed a new Lenke classification framework for scoliosis that contains two schemes based on Cobb angle measurement and shape classification, respectively. After rigorous experimental evaluations on a public dataset, our method achieved the best performance and outperformed other sophisticated approaches.

Time to surgery for adolescent idiopathic scoliosis: How long does it take? A multicenter study

Study designRetrospective review of multicentric data. ObjectivesTo estimate the time from initial visit to surgery in adolescent idiopathic scoliosis (AIS) patients and the main reasons for the time to surgery in a multicenter study. MethodsThis retrospective study evaluated 509 patients with AIS from 16 hospitals across six Latin American countries. From each hospital's deformity registry, the following patient data were extracted: demographics, main curve Cobb angle, Lenke Classification at the initial visit and time of surgery, time from indication-for-surgery to surgery, curve progression, Risser skeletal-maturity score and causes for surgical cancelation or delay. Surgeons were asked if they needed to change the original surgical plan due to curve progression. Data also were collected on each hospital's waiting list numbers and mean delay to AIS surgery. Results66.8% of the patients waited over six months and 33.9% over a year. Waiting time was not impacted by the patient's age when surgery first became indicated (p = 0.22) but waiting time did differ between countries (p < 0.001) and hospitals (p < 0.001). Longer time to surgery was significantly associated with increasing magnitude of the Cobb angle through the second year of waiting (p < 0.001). Reported causes for delay were hospital-related (48.4%), economic (47.3%), and logistic (4.2%). Oddly, waiting time for surgery did not correlate with the hospital's reported waiting-list lengths (p = 0.57) ConclusionProlonged waits for AIS surgery are common in Latin America, with rare exceptions. At most centers, patients wait over six months, most commonly for economic and hospital-related reasons. Whether this directly impacts surgical outcomes in Latin America still must be studied.

Outcomes of vertebral body tethering in the lumbar spine.

The use of vertebral body tethering (VBT) for the treatment of main thoracic deformities in adolescent idiopathic scoliosis patients is becoming increasingly more common, but limited data exist on its safety and efficacy in thoracolumbar deformities. We aimed to evaluate the postoperative outcomes of patients with thoracolumbar (TL) deformities that were treated with VBT. We assessed clinical and radiographic data from twenty-eight consecutive patients that were surgically managed with VBT, all of whom exhibited a TL deformity with at least two years (mean: 44.7 ± 14.5months) of postoperative follow-up. Standard radiographic parameters were extracted from left hand wrist and standing posterior-anterior and lateral spine radiographs at various timepoints. Outcome variables were assessed based on preoperative Lenke Classification and included: deformity measures, complications, surgical revisions, and postoperative success. The mean age at the time of instrumentation was 13.4 ± 1.3years, with an average preoperative Sanders Stage of 4.6 ± 1.4. A significant reduction in preoperative deformities was observed at most postoperative timepoints. A perioperative complication was observed in three patients and surgical revision was required in another four patients. A suspected broken tether was observed in sixteen patients, most of which occurred at the apex of the lumbar deformity. Only one patient required surgical revision due to a suspected broken tether. We observed an overall success rate of 57%, regardless of Lenke Classification. These data indicate that VBT can successfully correct TL deformity patterns in 57% of patients without an increase in the rate of perioperative complications, suspected broken tethers, or surgical revisions.

RISK FACTORS FOR DISTAL CONSTRUCT FAILURE IN POSTERIOR SPINAL INSTRUMENTED FUSION FOR ADOLESCENT IDIOPATHIC SCOLIOSIS: A RETROSPECTIVE COHORT STUDY

The purpose of this study is to evaluate risk factors for distal construct failure (DCF) in posterior spinal instrumented fusion (PSIF) in adolescent idiopathic scoliosis (AIS). We observed an increased rate of DCF when the pedicle screw in the lowest instrumented vertebra (LIV) was not parallel to the superior endplate of the LIV, however this has not been well studied in the literature. We hypothesise a more inferiorly angled LIV screw predisposes to failure and aim to find the critical angle that predisposes to failure.A retrospective cohort study was performed on all patients who underwent PSIF for AIS at the Starship Hospital spine unit from 2010 to 2020. On a lateral radiograph, the angle between the superior endplate of the LIV was measured against its pedicle screw trajectory. Data on demographics, Cobb angle, Lenke classification, instrumentation density, rod protrusion from the most inferior screw, implants and reasons for revision were collected.Of 256 patients, 10.9% (28) required at least one revision. The rate of DCF was 4.6% of all cases (12 of 260) and 25.7% of revisions were due to DCF. The mean trajectory angle of DCF patients compared to all others was 13.3° (95%CI 9.2° to 17.4°) vs 7.6° (7° to 8.2°), p=0.0002. The critical angle established is 11°, p=0.0076. Lenke 5 and C curves, lower preoperative Cobb angle, titanium only rod constructs and one surgeon had higher failure rates than their counterparts. 9.6% of rods protruding less than 3mm from its distal screw disengaged.We conclude excessive inferior trajectory of the LIV screw increases the rate of DCF and a screw trajectory greater than 11° predisposes to failure. This is one factor that can be controlled by the surgeon intraoperatively and by avoiding malposition of the LIV screw, a quarter of revisions can potentially be eliminated.

Understanding the Lenke Classification for Adolescent Idiopathic Scoliosis (AIS)

For over 20 years, the Lenke classification has been used as a standard to describe and classify scoliosis patterns in patients with adolescent idiopathic scoliosis (AIS). Based on this classification, patients are given a treatment recommendation, which is usually surgical. The Lenke classification has proven to be a reliable and reproducible classification for patients with AIS; however, it still proves to be complex in daily clinical practice. This study presents a simple approach to the Lenke classification for AIS patients that is easier to understand and to apply.

Association between Lenke classification and health-related quality of life after instrumented spinal fusion for adolescent idiopathic scoliosis

Association between Lenke classification and health-related quality of life after instrumented spinal fusion for adolescent idiopathic scoliosis

Scoliosis After Liver Transplantation in Pediatric Patients

Objective: Little is known about the development of scoliosis after pediatric liver transplantation. In this study, we aimed to evaluate the frequency of scoliosis and its relationship with potential risk factors in children after liver transplantation. Methods: Pediatric liver transplantations (under of age 18) performed between January 2009 and December 2017 at Malatya İnönü University Institute of Liver Transplantation were scanned retrospectively. In the spinal axis, &gt;10° lateral deviations were accepted as scoliosis. The curve patterns were classified according to the Lenke classification. Results: Among 287 pediatric liver transplantationss, 17 of them were scoliosis (6%). Nine patients were females and eight were males. The median Cobb angle was 12° at the time of diagnosis and then 17° at the last follow-up. According to the Lenke classification, 11 patients had type 5 curve pattern. During the follow-up period (ranging from 1 to 11 years), scoliosis progression was slow and no patient requiring surgical treatment was detected. Conclusion: We found that the prevalence of scoliosis increased after pediatric liver transplantation, but we do not have any definite information about the cause. Comparable new studies with more patients are needed to make a definitive conclusion in this regard.

Semi-automatic method for pre-surgery scoliosis classification on X-ray images using Bending Asymmetry Index.

Bending Asymmetry Index (BAI) has been proposed to characterize the types of scoliotic curve in three-dimensional ultrasound imaging. Scolioscan has demonstrated its validity and reliability in scoliosis assessment with manual assessment-based X-ray imaging. The objective of this study is to investigate the ultrasound-derived BAI method to X-ray imaging of scoliosis, with supplementary information provided for the pre-surgery planning. About 30 pre-surgery scoliosis subjects (9 males and 21 females; Cobb: 50.9 ± 19.7°, range 18°-115°) were investigated retrospectively. Each subject underwent three-posture X-ray scanning supine on a plain mattress on the same day. BAI is an indicator to distinguish structural or non-structural curves through the spine flexibility information obtained from lateral bending spinal profiles. BAI was calculated semi-automatically with manual annotation of vertebral centroids and pelvis level inclination adjustment. BAI classification was validated with the scoliotic curve type and traditional Lenke classification using side-bending Cobb angle measurement (S-Cobb). 82 curves from 30 pre-surgery scoliosis patients were included. The correlation coefficient was R2 = 0.730 (p < 0.05) between BAI and S-Cobb. In terms of scoliotic curve type classification, all curves were correctly classified; out of 30 subjects, 1 case was confirmed as misclassified when applying to Lenke classification earlier, thus has been adjusted. BAI method has demonstrated its inter-modality versatility in X-ray imaging application. The curve type classification and the pre-surgery Lenke classification both indicated promising performances upon the exploratory dataset. A fully-automated of BAI measurement is surely an interesting direction to continue our endeavor. Deep learning on the vertebral-level segmentation should be involved in further study.

Intraobserver and Interobserver Reliability of the Lenke Classification Among Spine Surgeons

Objective: The objective of this study was to analyze the intraobserver and interobserver reliability of the Lenke classification among spine surgeons from the city of Salvador, Bahia. Methods: Preoperative imaging (front, profile and lateral inclinations) examinations of 20 patients at the Outpatient Clinic of the of Santa Izabel Hospital Orthopedic Department, Salvador, Bahia, who had been diagnosed with adolescent idiopathic scoliosis, were selected to be evaluated by 15 spine surgeons two times at an interval of 30 days, for analysis of the intraobserver and interobserver reliability of the Lenke classification. The project was first submitted for ethical analysis to the Institutional Review Board of the Santa Izabel Hospital - Santa Casa de Misericórdia da Bahia / Prof. Dr. Celso Figueirôa and approved with voucher number 002650/2019. All the participants signed the Informed Consent Form (ICF). Results: Analyzing the concordance using the Kappa index, interobserver reproducibilities of 0.755, 0.525 and 0.840 were obtained for the type of curve and the lumbar and sagittal modifiers, respectively, while the intraobserver reliabilities for the same parameters were 0.921, 0.370 and 0.929. Conclusion: For the study population, the reliability of Lenke’s classification was moderate to almost perfect. Level of evidence III; Interobserver and intraobserver reliability.

P73. Change of cervical sagittal alignment after surgery for adolescent idiopathic scoliosis (AIS): comparison of vertebral body tethering (VBT) versus posterior spinal fusion

P73. Change of cervical sagittal alignment after surgery for adolescent idiopathic scoliosis (AIS): comparison of vertebral body tethering (VBT) versus posterior spinal fusion

Postoperative improvement in leg length discrepancy in adolescent idiopathic scoliosis differs between right and left legs

BackgroundIn adolescent idiopathic scoliosis (AIS) patients, leg length discrepancies (LLDs) often occur to compensate for scoliosis. However, there have been no reports on the LLD changes after corrective surgery for AIS. This study aimed to clarify the difference of LLD changes after corrective surgery for AIS by classifying LLD based on the shortened side. MethodsWe analyzed preoperative and postoperative radiographs of 94 consecutive AIS patients who underwent posterior corrective surgery between 2012 and 2018. The patients enrolled were divided into three groups according to the presence of preoperative LLD of more than 5 mm and the LLD side: the left leg shortened group (L group), the non-LLD group (N group), and the right leg shortened group (R group). The three groups were compared with regard to age, sex, Lenke classification, Risser grade, fused levels, and radiographic parameters before surgery and at 6-month follow-up (thoracic Cobb angle, lumbar Cobb angle, L4 tilt, coronal balance, T1 tilt, and LLD). ResultsThe L, N, and R groups included 23 (24%), 60 (64%), and 11 patients (12%), respectively. The demographics and radiographic parameters were not significantly different among the groups except for preoperative L4 tilt. In the L group only, the LLD decreased from 7.9 ± 2.2 mm to 5.7 ± 3.7 mm (p = 0.002) after surgery. In contrast, the LLD in the N and R groups did not change significantly. ConclusionsThe postoperative improvement of LLD in AIS patients differed between the left and right sides. Different pathologies may contribute to the LLD on the left and right sides.

Complications following posterior spinal fusion for adolescent idiopathic scoliosis: a retrospective cohort study using the modified Clavien-Dindo-Sink system.

Published complication rates after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) range from 1 to 22%. Complications are often minor and may be underestimated in registries. This study describes complications of PSF for AIS, classifies them according to a Clavien-Dindo-Sink (CDS) system, and investigates risk factors for occurrence of a complication. This retrospective cohort study at two academic centers included all AIS patients aged 10-18 who underwent primary PSF 4/2014-12/2019. Data included demographics, comorbidities, curve magnitude, Lenke classification, levels osteotomized/fused, implant density, 90-day emergency department visits, readmissions, reoperations, and complications as defined by Harms Study Group. Among 424 patients, mean age was 14.7, mean BMI 22, 77% were female, and 57% had no comorbidities. There were 270 complications (0.64 per patient); 198 patients (47%) had ≥ 1 complication; and 63 patients (15%) had CDS grade ≥ II complications (deviation from standard postoperative course). Complications not related to persistent pain occurred in 103 patients (24%). Ninety-three percent of complications did not require readmission or reoperation (CDS I-II). Within 90days, 8% presented to an ED, 2% required readmission, and 2% required reoperation. Common complications were back pain > 6weeks postoperatively (26%), surgical site complications (7%), and ileus/prolonged constipation (3%). Risk factors for experiencing any complication were BMI ≥ 34 (OR 3.44) and Lenke 6 curve (OR 1.95). One in four AIS patients experiences a complication not related to persistent pain after primary PSF, higher than rates published from self-reported registries. Obesity and Lenke 6 curve may increase risk. While most do not require readmission or surgery, 15% of patients have their postoperative course altered by complications. III-retrospective cohort study.

Circumferential Bone Fusion in Adult Spinal Deformity via Combination of Oblique Lateral Interbody Fusion and Grade 2 Posterior Column Osteotomy.

Retrospective study. The combination of oblique lateral interbody fusion (OLIF) with grade 2 posterior column osteotomy (PCO) is an effective treatment for adult spinal deformity. However, grade 2 PCO may lead to pseudoarthrosis because it involves complete removal of the bilateral posterior facet joints. The main study objective was to determine the achievement rate of anterior and posterolateral fusion resulting in circumferential fusion in patients who underwent combined OLIF and grade 2 PCO. This retrospective study included consecutive patients who underwent OLIF and grade 2 PCO. The group comprised a long fusion group, with fusion from the thoracic level to the ilium, and a short fusion group, with fusion within the lumbar region. The OLIF with percutaneous pedicle screw insertion group was also used for reference. The Brantigan-Steffee-Fraser classification was used to assess interbody fusion and Lenke classification for assessment of posterolateral fusion. Sixty-six patients with 109 lumbar levels were included in the study. We observed 100% anterior fusion in all 3 groups. The fusion rate for posterolateral fusion between the OLIF-grade 2 PCO group was 97%, with very low (3%) non-circumferential fusion (pseudoarthrosis only at the osteotomy site). In most cases, solid posterolateral fusions (Lenke A) occurred within 24 months. The combination of OLIF and grade 2 PCO resulted in circumferential fusion for most (97%) of the cases within 24 months. OLIF and grade 2 PCO are considered a good combination treatment to achieve sufficient lumbar lordosis and solid bone fusion.

Polymorphisms in paired box 1 gene were associated with susceptibility of adolescent idiopathic scoliosis: A case–control study

BackgroundAssociation of genetic polymorphisms in paired box 1 (PAX-1) gene can influence the development of adolescent idiopathic scoliosis (AIS). PAX-1 is mainly expressed in the region of the vertebral bodies and intervertebral discs, being important for the proper formation of spinal structures.Objectives:The objective of this study was to evaluate the association of polymorphisms in PAX-1 gene with the susceptibility of AIS.Settings and Design:This was an analytical observational case–control study.Materials and Methods:Samples of 59 AIS indicated for surgical treatment, and 119 controls, without spinal disease were genotyped for PAX-1 rs6137473 and rs169311 polymorphisms.Statistical Analysis:The association of the polymorphisms with AIS was evaluated by a multivariable logistic regression model, using odds ratios (OR) and 95% confidence intervals (CI).Results:According to Lenke's classification, 89.8% had Type I and 10.2% II curves. The mean value of the Cobb angle of the proximal thoracic curve was 30.8°, 58.7° thoracic, and 30.4° for the lumbar and on the bending films 14.6°, 40.7°, and 11°, respectively. Among the AIS group, there was a predominance of females (8.8:1). The PAX-1 rs169311 and rs6137473 polymorphisms were positively associated with developing the AIS (OR = 1.98; 95% CI = 1.2–3.3 and OR = 3.16; 95% CI = 1.4–7.3, respectively). The rs6137473 polymorphism was associated with the lumbar modifier B and C compared to A (OR = 2.52; 95% CI = 1.1–5.8).Conclusions:PAX-1 polymorphisms were associated with an increased risk of developing the AIS and with curve severity and can be used as a biomarker to map the risk of developing surgical-grade AIS, guiding the treatment of patients.

Relationship between distal adding-on phenomenon and vertebral body rotation in Lenke classification type 1A-R cases of adolescent idiopathic scoliosis

Relationship between distal adding-on phenomenon and vertebral body rotation in Lenke classification type 1A-R cases of adolescent idiopathic scoliosis