Progressive Idiopathic Scoliosis Research Articles

Transitional and spectrum-based care for idiopathic scoliosis.

The goal of this study is to discuss the transitional nature of idiopathic scoliosis and the variation in treatment and management across the spectrum of age presentation. This is a review article that discusses the evaluation, management, and classification of idiopathic scoliosis. The authors searched PubMed/MEDLINE, Google Scholar, and the Cochrane database for articles published up to April 2024. Keywords and MeSH terms relevant to the topic were used, including adolescent idiopathic scoliosis (AIS), adult idiopathic scoliosis (AdIS), adult degenerative scoliosis, young adult idiopathic scoliosis, early-onset scoliosis (EOS), classification, management, follow-up, outcomes, natural history, Cobb angle, and transitional care. Reference lists of selected articles were also searched to identify further articles. Inclusion criteria included English language articles that summarized any type of study design, including randomized controlled trials, observational studies, case-control/series, or metaanalysis, with study populations ranging from infants to > 50-year-old patients. Inter-reviewer disagreement on inclusion of particular articles was resolved through discussion. Related information was analyzed, and relevant concepts related to the transitional period dilemma have been discussed. Each idiopathic scoliosis case needs independent assessment with regard to the age, degree of the curve, and patient-specific presentation. An accurate prediction of the curve progression by considering the patient's remaining growth potential is paramount to the treatment strategy. The classification system for EOS, AIS Lenke classification, AdIS classification, and the Scoliosis Research Society-Schwab classification are important for reliable communication between surgeons treating deformities. Untreated progressive idiopathic scoliosis warrants multidisciplinary management during the transition from EOS stage to AIS and then to AdIS. Also, surgical treatment of untreated AIS transitioning to AdIS is specific and nuanced. AdIS needs to be differentiated from adult degenerative scoliosis because the latter is associated with multiple comorbidities and anatomical differences. Idiopathic scoliosis presents across the age spectrum with specific age-related decisions that transition into adulthood. Integrated models of both surgical and nonsurgical treatment of idiopathic scoliosis are warranted.

The efficacy of bracing in the treatment of progressive early-onset scoliosis

Serial casting as one of the applications to treat early-onset scoliosis has been reported efficiently to improve deformity, but no report has focused on the efficacy of braces in the treatment of congenital early-onset scoliosis and comparison with progressive idiopathic early-onset scoliosis. Patients with progressive EOS treated with braces in our institution with a minimum of 4 years follow-up were reviewed. Two groups according to the etiological diagnosis were analyzed and compared: the congenital scoliosis (CS) group and idiopathic scoliosis (IS) group. The success cases and the failure cases were also compared. 27 patients with an average main Cobb angle of 38.19° (20–55) underwent initial bracing at an average age of 55.7 months (24–108), the average follow-up time was 76.19 months (49–117). In IS group the main Cobb angle was corrected to 18.69 ± 12.06° (48.61%) following the first bracing; the final Cobb angle was 23.08 ± 22.15°(38.76%) after brace removal. In CS group the main Cobb angle was corrected to 33.93 ± 10.31°(17.1%) following the first bracing and 37.93 ± 14.74°(3.53%) after brace removal. Both coronal chest width and T1-T12 height increased dramatically from pre-bracing to the last follow-up. Patients diagnosed as IS tended to have a better result in main Cobb angle correction than that of CS (P = 0.049). By the time of last follow-up, 8 patients had undergone surgery, and the operation time was postponed by 68.88 ± 26.43 months. For patients with progressive early-onset scoliosis, bracing is an efficient nonsurgical alternative to casting, and some of them can be cured; if not, eventual surgical intervention can be delayed for a period of time without restrictions on the thoracic cavity.

Elasticity and cross-sectional thickness of paraspinal muscles in progressive adolescent idiopathic scoliosis.

(1) Compare the cross-sectional thickness (CST) and shear wave speed (SWS) of paraspinal muscles (PSM) in adolescent idiopathic scoliosis (AIS) with and without curve progression; (2) investigate the relationship between CST/SWS and radiographic characteristics in AIS with curve progression; (3) compare the CST/SWS between AIS and non-scoliosis controls. This cross-sectional study analyzed the CST and SWS of PSM in 48 AIS with mild to moderate curvature and 24 non-scoliosis participants. Participants with scoliosis greater than 45° of Cobb angles were excluded. The Change of Cobb angles within the last 6-months was retrieved to allocate AIS into progression and non-progression groups. The SWS and CST of multifidus; longissimus and iliocostalis of the major curve were measured using B-mode ultrasound image with an elastography mode. Discrepancies of the SWS (SWS-ratio: SWS on the convex side divided by SWS on the concave side) and CST (CST-ratio: CST on the convex side divided by CST on the concave side) at the upper/lower end and apical vertebrae were studied. A higher SWS at the apical vertebrae on the concave side of the major curve (multifidus: 3.9 ± 1.0 m/s vs. 3.1 ± 0.6 m/s; p < 0.01, longissimus: 3.3 ± 1.0 m/s vs. 3.0 ± 0.9 m/s; p < 0.01, iliocostalis: 2.8 ± 1.0 m/s vs. 2.5 ± 0.8 m/s; p < 0.01) was observed in AIS with curve progression. A lower SWS-ratio at apical vertebrae was detected with a greater vertebral rotation in participants with curve progression (multifidus [grade II]: 0.7 ± 0.1 vs. grade I: 0.9 ± 0.2; p = 0.03, longissimus [grade II]: 0.8 ± 0.2 vs. grade I: 1.1 ± 0.2; p < 0.01). CST was not different among the progressive, non-progressive AIS and non-scoliosis controls. Increased SWS of PSM without change of CST was observed on the concave side of the major curve in participants with progressive AIS.

Assessment of malalignment at early stage in adolescent idiopathic scoliosis: a longitudinal cohort study.

Our objective was to assess abnormalities of the odontoid-hip axis (OD-HA) angle in a mild scoliotic population to determine whether screening for malalignment would help predict the distinction between progressive and stable adolescent idiopathic scoliosis (AIS) at early stage. All patients (non-scoliotic and AIS) underwent a biplanar X-ray between 2013 and 2020. In AIS, inclusion criteria were Cobb angle between 10° and 25°; Risser sign lower than 3; age higher than 10years; and no previous treatment. A 3D spine reconstruction was performed, and the OD-HA was computed automatically. A reference corridor for OD-HA values in non-scoliotic subjects was calculated as the range [5th-95th percentiles]. A severity index, helping to distinguish stable and progressive AIS, was calculated and weighted according to the OD-HA value. Eighty-three non-scoliotic and 205 AIS were included. The mean coronal and sagittal OD-HA angles in the non-scoliotic group were 0.2° and -2.5°, whereas in AIS values were 0.3° and -0.8°, respectively. For coronal and sagittal OD-HA, 27.5% and 26.8% of AIS were outside the reference corridor compared with 10.8% in non-scoliotic (OR = 3.1 and 3). Adding to the severity index a weighting factor based on coronal OD-HA, for thoracic scoliosis, improved the positive predictive value by 9% and the specificity by 13%. Analysis of OD-HA suggests that AIS patients are almost three times more likely to have malalignment compared with a non-scoliotic population. Furthermore, analysis of coronal OD-HA is promising to help the clinician distinguish between stable and progressive thoracic scoliosis.

Minimally Invasive Posterior Spinal Nonfusion Surgery in Patients With Adolescent Idiopathic Scoliosis Using a Bipolar One-Way Self-Expanding Rod System: Protocol for a Single-Center Clinical Cohort Study.

The current surgical treatment for patients diagnosed with progressive and severe adolescent idiopathic scoliosis (AIS) consists of the correction of the spinal curvature, followed by posterior spinal fusion (PSF). However, research has uncovered short- and long-term complications of posterior spinal fusion in patients with AIS. Minimally invasive growing rod techniques have successfully been used to treat patients with early-onset scoliosis and neuromuscular scoliosis. It may be questioned if minimally invasive posterior spinal nonfusion (PSnF) surgery with bipolar instrumentation can be used for the treatment of AIS. This study will be performed to monitor the efficacy and safety of PSnF surgery by using a commercially available Conformité Européenne-certified spinal implant consisting of bilateral bipolar one-way self-expanding rods (OWSER) for the treatment of patients diagnosed with AIS. In 14 selected patients with AIS with Lenke 1-6 curves, minimally invasive PSnF surgery with the OWSER system is performed after the failure of conservative treatment (curve progression of >5° within 1 year). The patients are over 7 years of age, with a major Cobb angle of ≥30°, sufficient flexibility, and a Risser stage of ≤2. Patients will be followed over time, according to the standard medical care. Efficacy will be measured using radiological and patient satisfaction assessments and safety will be determined by the amount of perioperative complications. Patient inclusion started on November 17, 2021 and we hope to finalize patient inclusion by the beginning of 2025. The first results will be expected by the beginning of 2024. Minimally invasive PSnF in patients with AIS is presented as a less invasive surgical technique that prevents the progression of the scoliotic curve and that allows minor posture correction of coronal imbalance. This will be the first study to examine whether the PSnF bipolar OWSER instrumentation will be the next generation of surgical instrumentation in AIS. ClinicalTrials.gov NCT04441411; https://clinicaltrials.gov/study/NCT04441411. DERR1-10.2196/47222.

Thoracic pediculectomy for acute spinal cord decompression in high-risk spinal deformity correction: illustrative case.

Neurological complications are higher in patients with severe spinal deformities (Cobb angle >100°). The authors highlight a known technique for thoracic concave apical pedicle resection that is useful for spinal cord decompression in patients with high-risk spinal deformities in the setting of intraoperative neuromonitoring (IONM) changes. A 14-year-old female with progressive idiopathic scoliosis presented for evaluation of her clinical deformity. Scoliosis radiographs showed a double major curve pattern comprising a 107° right main thoracic curve and a compensatory 88° left thoracolumbar curve. She underwent 2 weeks of halo-gravity traction that reduced her major thoracic curve to 72°. During thoracic posterior column osteotomies, the authors were alerted to decreases in IONM signals that were not responsive to increases in mean arterial pressure, traction weight reduction, and convex compression maneuvers. The dural surface was tightly draped over the two thoracic apical pedicles of T7 and T8, so emergent pediculectomies were performed at both levels for spinal cord decompression. IONM signals gradually improved and eventually became even better than baseline. The patient woke up without any neurological deficits. Pediculectomy of the concave apical pedicle(s) should be considered for spinal cord decompression if there are IONM changes during high-risk spinal deformity surgery.

THORAX AND IDIOPATHIC SCOLIOSIS

This review is related to the role of thorax in scoliogenesis. The embryology, the prenatal and the postnatal growth of the rib cage of (RC) and the lungs are briefly described. The development of normal RC, the frontal and sagittal diameters of it, the values of mid-thoracic diameters, the thoracic index, the biomechanical contribution of the RC to thoracic stability, the increase in frontal and sagittal thoracic diameter during breathing are defined. The infancy, childhood, puberty (ICP) model of growth is used in both the segmental thoracic ratios (TR) and the Segmental Rib-vertebra angles (RVA) in order to assess the normal and deformed RC in Early Onset (EOS) and Late Onset Scoliosis (LOS). The neuromuscular mechanisms as possible factors causing age-related RVAs changes are discussed. Then the posterior truncal/thoracic asymmetries are reviewed related to school scoliosis screening (SSS) referrals. Next, the development of RC is analyzed in resolving and progressive infantile idiopathic scoliosis (IIS), and in adolescent idiopathic scoliosis (AIS). The menarche and laterality of thoracic scoliotic curves, congenitally fused ribs and pulmonary function in children with idiopathic scoliosis (IS) is also discussed. The pathogenesis of IS according to the Nottingham concept and RC, the thorax and pelvis complex during gait and rotational inertia, the Double Rib Contour Sign (DRCS) and Rib Index (RI), the effect of growth on the relationship of spinal and thoracic deformity are explained. The postoperative fate of IS hump deformity in relation to the RI and the aetiological implications for IS are then stated. The role of the rib-sternum complex is mentioned. John Sevastiks thoracospinal concept of aetiopathogenesis of AIS and his research about IS are described, namely experiments on ribs, correction of experimentally produced scoliosis, suggested surgical intervention on the ribs, experiments on nerves, vascular changes in the chest wall after unilateral resection of the intercostal nerves, and breast asymmetries in female suffering AIS. A biomechanical model using different Cobb angle and rib hump (RH) correction is mentioned. The issue of thoracic kyphosis and hypokyphosis and the impact of the lateral spinal profile (LSP), that is the sagittal plane, is discussed. Finally, IS and evolution of thoracic shape as a scar of evolution are pointed out.

Thoracoscopic Anterior Vertebral Body Tethering in Lenke Type-1 Right Adolescent Idiopathic Scoliosis.

Vertebral body tethering (VBT) is indicated for skeletally immature patients with progressive adolescent idiopathic scoliosis (AIS) who have failed or are intolerant of bracing and who have a major coronal curve of 40° to 65°. The vertebral body must be structurally and dimensionally adequate to accommodate screw fixation, as determined radiographically. The best indication for VBT is a flexible single major thoracic curve with nonstructural compensating lumbar and proximal thoracic curves (Lenke 1A or 1B). VBT allows for progressive correction of the deformity without spinal fusion by utilizing a minimally invasive fluoroscopic technique. The procedure for a right thoracic curve is performed with use of a right thoracoscopic approach with the patient in the left lateral decubitus position. The thoracoscope is introduced through a portal at the apex of the curvature in the posterior axillary line. Instrument portals are created lateral to each vertebral body in the mid-axillary line. Screws are inserted into each vertebral body under biplanar fluoroscopic control and with intraoperative neuromonitoring. An electroconductivity probing device, while not mandatory, is routinely utilized at our practice. The tether is attached to the most proximal screw of the construct, and then reduction is obtained sequentially by tensioning the tether from one vertebral screw to the next. Bracing is the gold-standard treatment for progressive AIS involving the immature spine. The most commonly utilized surgical treatment is posterior spinal fusion (PSF), which should be considered when the major coronal curve exceeds 45°. PSF has proven to be a dependable technique to correct scoliotic deformities. It has a low complication rate and good long-term outcomes. However, concerns exist regarding the stiffness conferred by PSF and the long-term effects of adjacent segment disease. Thus, interest had developed in non-fusion solutions for AIS correction. VBT utilizes the Hueter-Volkmann principle to guide growth and correct deformity. Compressive forces applied to the convexity of the deformity by a polyethylene tether allow the patient's growth to realign the spine. Intraoperative correction triggers growth modulation, and most of the modulation seems to occur during the first 12 months postoperatively. The best results have been seen with a short Lenke type-1A curve in a patient with closed triradiate cartilage, a Risser 3 or lower (ideally Risser 0) iliac apophysis, and a flexible curve characterized by a 50% reduction of the major coronal curve angle on side-bending radiographs. In 57 immature patients with a Lenke type-1A or 1B curve (i.e., a 30° to 65° preoperative Cobb angle), Samdani et al.3 found a main thoracic Cobb angle reduction from 40° ± 7° preoperatively to 19° ± 13° at 2 years after VBT. In the sagittal plane, the T5-T12 kyphosis measured 15° ± 10° preoperatively, 17° ± 10° postoperatively, and 20° ± 13° at 2 years. No major neurologic or pulmonary complications occurred. A total of 7 (12.3%) of the 57 patients underwent surgical revision, including 5 for overcorrection and 2 to span additional vertebrae. In a study of 21 skeletally mature patients, Pehlivanoglu et al.4 found that the Cobb angle was reduced from 48° preoperatively to 16° on the first-erect postoperative radiograph and finally to 10° at the latest follow-up (mean, 27.4 months). The 2 main complications of VBT reported in the literature are overcorrection and tether breakage. Both may require revision, which explains the higher rate of revision observed for VBT compared with PSF. Good patient selection is important. VBT is most appropriate in cases of a flexible Lenke type-1A or 1B curve in an immature child before Risser stage 3 and after triradiate cartilage closure.Always monitor and control screw positioning in both anteroposterior and lateral planes fluoroscopically.The screws should be placed parallel to the vertebral end plates or, even better, be angled inferiorly for the upper vertebrae and angled superiorly for the lower vertebrae to decrease the risk of pull-out when tensioning the device and during growth modulation. Less tension on the uppermost and lowermost instrumented vertebrae than at the apex, as controlled by the tensioning device, can also help to limit pull-out. VBT = vertebral body tetheringAIS = adolescent idiopathic scoliosisIONM = intraoperative neuromonitoringPSF = posterior spinal fusionUIV = upper instrumented vertebraLIV = lower instrumented vertebraAP = anteroposteriorK-wire = Kirschner wire.

TWO-YEAR FOLLOW-UP STUDY FOR PATIENTS UNDERGOING VERTEBRAL BODY TETHERING FOR IDIOPATHIC SCOLIOSIS

Anterior vertebral body tethering (AVBT) is a growth modulating procedure used to manage idiopathic scoliosis by applying a flexible tether to the convex surface of the spine in skeletally immature patients. The purpose of this study is to determine the preliminary clinical outcomes for an adolescent patient cohort.18 patients with scoliosis were selected using a narrow selection criteria to undergo AVBT. Of this cohort, 11 had reached a minimum follow up of 2 years, 4 had reached 18 months, and 3 had reached 6 months. These patients all demonstrated a primary thoracic deformity that was too severe for bracing, were skeletally immature, and were analysed in this preliminary study of coronal plane deformity correction.Using open-source image analysis software (ImageJ, NIH) PA radiographs taken pre-operatively and at regular follow-up visits post-operatively were used to measure the coronal plane deformity of the major and compensatory curves.Pre-operatively, the mean age was 12.0 years (S.D. 10.7 – 13.3), mean Sanders score 2.6 (S.D. 1.8-3.4), all Risser 0 and pre-menarchal, with mean main thoracic Cobb angle of 52° (S.D. 44.2-59.8°). Post-operatively the mean angle decreased to 26.4° (S.D. 18.4-32°) at 1 week, 30.4° (S.D. 21.3-39.6°) at 2 months, 25.7° (S.D. 18.7-32.8°) at 6 months, 27.9° (S.D. 16.2-39.6°) at 12 months, and 36.8° (S.D. 22.6– 51.0°) at 18 months and 38.2° (S.D. 27.6-48.7°) at 2 years. The change in curve at 2 years post-operative was statistically significant (P=0.004).There were 4 tether breakages identified that did not require return to theatre as yet, one patient underwent a posterior spinal instrumented fusion due to curve progression.AVBT is a promising new growth modulation technique for skeletally immature patients with progressive idiopathic scoliosis. This study has demonstrated a reduction in scoliosis severity.

Long-term adjacent segment degeneration at average 21-year follow-up of posterior instrumented fusion for adolescent idiopathic scoliosis.

Posterior instrumented fusion for progressive adolescent idiopathic scoliosis (AIS) is generally considered to have good outcomes, but very long-term reviews are rare. Data on adjacent segment degeneration (ASD) following posterior instrumented thoracic fusion for AIS are lacking. The primary aim was to assess the incidence of ASD and to correlate this with radiographic measures and patient-reported outcome measures (PROMs). The secondary aim was to assess maintenance of curve correction at very long-term follow-up. This single-surgeon consecutive case series of 47 AIS patients was identified from a prospectively collated dataset. As the primary outcome, ASD was assessed radiographically using the Mimura grading system. Pulmonary function tests and PROMs were assessed along with secondary radiographic outcome measures. Radiographic follow-up was achieved in 77% (36/47) of patients at an average of 21years (range, 16.5-26.5years) after surgery. Radiographic evidence of ASD was seen in 64%. PROMs showed a mean Oswestry disability index of 12.1% with an overall Scoliosis Research Society 22 score averaging at 3.7 out of 5. The Coronal Cobb Angle was corrected from an average of 57° preoperatively to 19° immediately postoperatively, deteriorating to 22° at final review, maintaining a 61% curve correction. Radiographic evidence of ASD was found in 64% of the cohort. The patient-reported outcome measures were good, with few limitations to activities.

Role of growth modulation in the management of idiopathic scoliosis: A narrative review of literature

Scoliosis is a condition in which there is a lateral curve to the spine. The cause of scoliosis is unknown, but different aetiologies have been suggested, but mostly cause has been idiopathic in nature. Muscle spasms, cerebral palsy, Marfan syndrome, and tumours (neurofibromatosis) are some of the suggested aetiologies. Progressive adolescent idiopathic scoliosis (AIS) affects mainly girls and anterior spinal overgrowth during the second growth spurt appear to be a significant cause. The diagnosis of scoliosis is primarily a clinical suspicion followed by an AP and lateral X ray of spine in standing position. Measurement of the Cobb angle is the standard method of assessing the curvature in a quantitative manner. It is the angle between two lines, drawn perpendicular to the upper endplate of the first vertebra involved and the lower endplate of the last vertebra involved. Cobb angles are followed for both curves for those with two curves. Risser classification grades the skeletal maturity on X rays and is considered along with the Cobb angle to making a decision towards surgery. Indications for surgical correction of scoliosis is not clearly defined however, the treatment of scoliosis is based on the severity and progressive nature of the curve. Cobb angle above 40 degrees, rapidly progressing curve, major thoracic deformity affecting the function such as breathing and cosmetic reasons, are some of the indications for surgery. There are several modalities of surgical correction. Main method has been correction of the deformity and fixation with one or two rods and pedicle screws followed by bone grafting. Harrington rods were the primarily used system, but with time many spinal instrumentation systems and rods have been introduced to the market. Apart from using rods some have tried anterior vertebral body stapling and anterior vertebral body tethering for correction scoliosis using the principle of growth modulation.&#x0D; We conducted a systematic review to answer the question, 'What is the role of growth modulation in the management of idiopathic scoliosis?' All articles / publications published from 2010 May to 2019 October were used as research data. A health, related database (PubMed) was used for the search. Search criteria revealed 99 articles initially and 37 articles after filtered based on title reading. Then 18 articles were selected for the final analysis after being filtered manually by reading summary and abstracts of each article.

Comparative analysis of the results of surgical correction of idiopathic thoracic scoliosis in patients with active bone growth

Objective. To conduct a comparative analysis of surgical treatment results for idiopathic thoracic scoliosis in patients during active bone growth and to identify the most effective methods of scoliosis correction for the considered age group.Material and Methods. The results of surgical treatment of 343 patients aged 10–14 years with continued active growth and progressive idiopathic thoracic scoliosis were analyzed. The patients were operated on in 1998–2018 using five surgical techniques: hybrid fixation with and without anterior stage, transpedicular fixation, and laminar fixation with and without anterior stage.Results. Statistically significant deformity progression was observed in patients operated on using laminar (Group IV) and hybrid (Group I) fixation. An additional anterior stage (discectomy and interbody fusion) in combination with laminar fixation (Group V) does not prevent deformity progression after surgery. In patients who underwent hybrid fixation in combination with the anterior stage (Group II) or total transpedicular fixation (Group III), no statistically significant progression of scoliotic deformity was observed in the postoperative period. Patients operated on with total transpedicular fixation (Group III) show improvement in all domains of the SRS-24 questionnaire: no increase in pain throughout the entire follow-up period, higher assessment of appearance after surgery and satisfaction with the treatment result. In groups II and III, there was no negative dynamics of topographic parameters in the long-term period after treatment; the initial correction of the deformity was maintained throughout the entire postoperative follow-up.Conclusion. Total transpedicular fixation provides the best correction of scoliosis in the absence of progression in the long-term postoperative follow-up in children during the period of active bone growth (age 10–14 years). According to the survey data, patients operated on with total transpedicular fixation demonstrate improvement in the following domains: the absence of pain syndrome throughout the entire postoperative follow-up period, the highest assessment of appearance after surgery and satisfaction with the result of surgical treatment. Hybrid fixation in combination with the anterior stage and total transpedicular fixation ensure the absence of negative dynamics of topographic parameters in the long term after surgery with maintenance of the initial surgical correction of spinal deformity.

Treatment for an Adult Patient with Slowly Progressive Idiopathic Scoliosis Using a Unique Anterior Scoliosis Correction Technique: A Case Report

Adolescent idiopathic scoliosis (AIS) can continue to progress after skeletal maturity. Once the progression is severe, posterior spinal fusion (PSF) is the gold standard for surgical treatment. While effective in achieving curve correction, PSF is associated with many problems, including loss of spinal flexibility, uncorrected sagittal deformity, and adjacent segment disease. We present a case of a 50-year-old woman with a documented 38º thoracic curve as a late teen who experienced curve progression after skeletal maturity to &gt;70 ° and underwent Anterior Scoliosis Correction (ASC), a motion-preserving scoliosis correction surgery. Her progressive curve improved from 71º Lenke 1A main thoracic curve to 28°, with a 59% correction being maintained within 5° (33°) at 7 years. She also obtained a 50% correction of her compensatory lumbar curve and correction of hypokyphosis from 2.4° to 23° at 7 years. Along with improvement of her thoracic kyphosis, her lumbar lordosis decreased to a normal range of 60° from 70°, giving her better overall alignment. This case report suggests that motion preserving surgical treatment may be considered for some select adult patients with progressive scoliosis. Key Words: Progressive Scoliosis, Anterior Scoliosis Correction

Efficacy of Anterior Vertebral Body Tethering in Skeletally Mature Children with Adolescent Idiopathic Scoliosis: A Preliminary Report.

Anterior vertebral body tethering (AVBT) offers a dynamic fusionless correction option for children with adolescent idiopathic scoliosis (AIS). Few existing clinical studies evaluating novel AVBT in skeletally immature children have questioned the midterm efficacy with concerns of overcorrection and curve progression with remaining growth. The current study investigates the effect of this technique in skeletally mature children (Risser ≥ 4 and Sanders ≥ 7) with AIS with limited remaining growth potential. We evaluated skeletally mature children with AIS who underwent the AVBT technique for a single structural major curve between 40° and 80° with ≥50% flexibility on dynamic radiographs and a minimum of 1 year of follow-up. Pertinent clinical and radiographic data collected include skeletal maturity, curve type, Cobb angle, sagittal parameters, and a patient-reported outcome measure Scoliosis Research Society-22 (SRS-22) questionnaire. All 10 children were female with a mean age of 14.9 ± 2.7 years at the time of surgery. The mean follow-up was 24.1 ± 3.6 months. The mean Risser and Sanders scores were 4.2 ± 0.6 and 7.2 ± 0.6, respectively. Three patients had major thoracic curves, and 7 patients had thoracolumbar/lumbar curves. Cranial and caudal instrumented levels were T5 and L4. Mean preoperative Cobb's angle was 52.0° ± 11.6° and was corrected to 15.9° ± 6.8° on the first erect postoperative radiograph, with stabilization of corrected curve at the 1-year follow-up (mean Cobb's angle of 15.3° ± 8.7°). Mean preoperative and postoperative SRS-22 scores were 78.0 ± 3.2 and 92.5 ± 3.1, respectively (P < .01). No complications were noted until the last follow-up. Our preliminary experience with this novel AVBT as an alternative technique to fusion to stabilize progressive idiopathic scoliosis in skeletally mature children is promising. 4.

Anterior Vertebral Body Tethering: A Nonfusion Surgery for Idiopathic Scoliosis

Idiopathic scoliosis (IS) is a spinal deformity of unknown etiology, and it is the most common spinal deformity in the pediatric population. The treatment of IS is multifactorial but is determined in part by curve magnitude and remaining skeletal growth. The goal of nonoperative treatment of IS is to prevent curve progression during growth, but if curve magnitude continues to progress, the goal of operative treatment becomes curve correction and stabilization. The current gold standard of treatment for progressive IS is a posterior spinal fusion; however, anterior vertebral body tethering (AVBT) is a newer surgical technique which has emerged as a nonfusion option for the treatment of progressive IS in skeletally immature patients. Many recent clinical studies have garnered evidence that AVBT may be a viable treatment option and an alternative to posterior spinal fusion in patients with remaining growth.

Evaluation of the role of ventral interventions in the surgery of idiopathic scoliosis in patients with active bone growth

BACKGROUND: Today, the question of the tactics of surgical treatment of patients with idiopathic scoliosis during active bone growth, namely, the need for ventral interventions due to the emergence of modern dorsal instruments, remains open.&#x0D; AIM: This study aims to evaluate the role of ventral interventions in the surgical treatment of patients with progressive idiopathic scoliosis Lenke type 1, 2, 3 during the period of active bone growth.&#x0D; MATERIALS AND METHODS: The long-term results of operational correction 352 patients with thoracic idiopathic scoliosis aged from 10 to 14 years old operated in Novosibirsk Research Institute of Traumatology and Orthopedics n.a. Ya.L. Tsivyan from 1998 to 2018 using various methods and different instrumentation types.&#x0D; RESULTS: Among patients (352 people) aged 10 to 14 years with idiopathic thoracic scoliosis (Lenke type 1, 2, 3), statistically significant postoperative progression was observed in patients who underwent surgical deformity correction using laminar (hook) fixation. At the same time, additional ventral stage conduction could not prevent deformity progression in the postoperative period. In those groups where hybrid fixation was used combined with the ventral stage and total transpedicular fixation, no significant progression was observed in the postoperative period.&#x0D; CONCLUSION: Modern dorsal systems for transpedicular fixation narrow the indications for using additional mobilizing and stabilizing ventral interventions in the surgical treatment of progressive idiopathic scoliosis in patients with active bone growth. Total transpedicular fixation provides excellent main curve and anti-curvature arch correction in the absence of scoliotic deformity progression in the postoperative long-term follow-up.

Growing-rod Graduates With Idiopathic Early-onset Scoliosis Have Comparable Exercise Tolerance to Patients With Surgically Treated Adolescent Idiopathic Scoliosis.

Growing-rod (GR) treatment is the current standard for progressive idiopathic early-onset scoliosis (I-EOS) in young children. Despite good radiographic outcomes, the impact of scoliosis treatment on pulmonary functions is not well-defined in this patient population. The aim of this study was to evaluate pulmonary functions and exercise tolerance in I-EOS patients graduated from GR treatment and to compare them with age-matched, surgically treated adolescent idiopathic scoliosis (AIS) patients and healthy controls. Eight GR graduates with I-EOS with pulmonary function tests and complete radiographic results were compared with a group of 9 thoracic AIS patients at least 2 years out from posterior fusion. Both groups were also compared with a set of 10 healthy individuals. All subjects underwent cardiopulmonary exercise testing and spirometry to evaluate pulmonary function. Age, sex, height, arm span, weight, residual deformity, and level of instrumentation in GR and AIS patients were similar. In the GR group, forced vital capacity % and forced expiratory volume in 1 second % values were reduced compared with the healthy controls and AIS group (P<0.001, <0.001 and 0.036, 0.046, respectively). Breathing reserve index at lactate threshold (BRILT) was higher in GR and AIS patients (P=0.001 and 0.002, respectively), and was similar between GR and AIS patients (P=0.916). Heart rate at lactate threshold was higher in GR and AIS groups compared with controls (P<0.001 and 0.001, respectively). AIS and GR patients demonstrated reduced pulmonary reserve and exercise tolerance compared with their peers with no spinal deformity. However, exercise tolerance of I-EOS patients treated with the GR method was similar to that of operated AIS patients. These results suggest a positive impact of GR treatment in children with I-EOS. Level III-cross-sectional comparative study.

Chiropractic rehabilitation plus nighttime bracing for progressive adolescent idiopathic scoliosis: a case-controlled series.

Non-operative treatments for scoliosis include various types of scoliosis-specific exercise therapies, as well as dynamic and rigid spinal orthoses. Although there are many studies evaluating various types of bracing-only constructs for scoliosis treatment, few have evaluated bracing when combined with chiropractic care. The present study analyzed the data of 18 patients from the initiation a chiropractic rehabilitation program combined with nighttime bracing. Patients were managed through the end of growth, and results were compared to baseline. Their collective results were compared to a similar group of previously published patients who participated in the same chiropractic rehabilitation program, but did not perform concurrent bracing treatment. Patients initiating the combined chiropractic and bracing treatment achieved a correction of 6° or more 81% of the time, while the remaining 19% remained within 5° of their baseline measurements. The average curve improvement was 9.4°. This was compared to a correction rate of 51.7%, a stabilization rate of 38.3%, and a progression rate of 10% in the group performing chiropractic rehabilitation only.

A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data

BackgroundThere is a paucity of literature regarding the conservative management of adult scoliosis. The authors review and summarize the literature from 1967 to 2018 on the clinical outcomes of spinal brace/orthosis use in this subgroup of the population.MethodsCINAHL, Embase, CENTRAL, PubMed and PEDro were searched from database inception to the 30th of October, 2018. A combination of medical subject heading terms and keywords pertaining to three core concepts (adult, scoliosis, and braces/orthoses) were used in the search. Studies were included if A) clinical outcomes were collected from B) participants ≥18 years C) receiving spinal brace/orthosis treatment for D) primary degenerative (de novo) scoliosis or progressive idiopathic scoliosis. A step-wise screening process was employed which involved a title and abstract screen for relevancy followed by a full text eligibility appraisal by two authors. Data were extracted, and a risk of bias assessment was performed on the included cohort studies using the Newcastle-Ottawa Scale. Given the overall level and quality of the available evidence, conclusions were drawn based on a qualitative summary of the evidence.ResultsTen studies (four case reports and six cohort studies) were included which detailed the clinical outcomes of soft (2 studies) or rigid bracing (8 studies), used as a standalone therapy or in combination with physiotherapy/rehabilitation, in 339 adults with various types of scoliosis. Most studies included female participants only. Commonly reported outcomes were pain (7 studies), function (3 studies) and Cobb angles (3 studies), with follow-up times ranging from 2 days to 17 years. Brace wear prescriptions ranged from 2 to 23 h per day, and there was mixed brace-compliance reported. Most studies reported modest or significant reduction in pain and improvement in function at follow-up. There were mixed findings with regards to Cobb angle changes in response to bracing. Participants from one study noted discomfort associated with bracing. Each of the six cohort studies demonstrated a high risk of bias.ConclusionThere is evidence to suggest that spinal brace/orthosis treatment may have a positive short – medium term influence on pain and function in adults with either progressive primary (de novo) degenerative scoliosis or progressive idiopathic scoliosis. At this point in time the evidence is of low quality and has been focused primarily on female patients with thoracolumbar and lumbar curves. More granular statements regarding the efficacy of different brace types or manufacturers, or the effect of this therapy on different curve types cannot be determined based on the current literature. Properly constructed prospective trials are required to better understand the efficacy of bracing in adult scoliosis.

CHD7 gene polymorphisms in female patients with idiopathic scoliosis

BackgroundThe CHD7 (chromosome domain helicase DNA binding protein 7) gene has been associated with familial idiopathic scoliosis (IS) in families of European descent. The CHD7 single-nucleotide polymorphisms have never been studied in Polish Caucasian IS patients.MethodsThe aim of this study was to investigate the relationship of CHD7 gene polymorphisms with susceptibility to or progression of IS in Polish Caucasian females. The study group comprised 211 females who underwent clinical, radiological and genetic examination. The study group was analyzed in three subgroups according to: (1) Cobb angle (Cobb angle ≤30° vs. Cobb angle ≥35°), (2) age of diagnosis (adolescent IS vs. early-onset IS) and (3) rate of progression (non-progressive vs. slowly progressive vs. rapidly progressive IS). The control group comprised 83 females with no scoliosis and with a negative family history who underwent clinical and genetic examination. In total six CHD7 gene polymorphisms were examined. Three polymorphisms (rs1017861, rs13248429, and rs4738813) were examined by RFLP (restriction fragment length polymorphism) analysis, and three were quantified by Sanger sequencing (rs78874766, rs4738824, and rs74797613).ResultsIn rs13248429, rs78874766, and rs74797613 polymorphisms only the wild allele was present. The rs1017861 polymorphism demonstrated an association with IS susceptibility (p < 0.01). Two polymorphisms, rs1017861 and rs4738813, were associated with curve severity and progression rate (p < 0.05). None of the evaluated polymorphisms in CHD7 gene showed any association with the age of IS onset.ConclusionsThe polymorphism rs1017861 in CHD7 gene showed an association with IS susceptibility. Two polymorphisms (rs1017861 and rs4738813) were associated with curve severity and progression rate. None of the evaluated polymorphisms in CHD7 gene showed any association with the age of IS onset. Further evaluation of CHD7 gene should be considered as IS modifying factor.