Risser Sign Research Articles

Evaluation of the effectiveness of soft braces on idiopathic scoliosis: A review of literature

Background: Various treatment approaches are used for subjects with idiopathic scoliosis, however using a brace is one of the most common approaches in this regard. The braces used for idiopathic scoliosis can be divided into soft and rigid braces. SpineCor brace is mostly recommended for subjects who refused to use rigid braces. However, it is not well understood whether soft braces are as effective as rigid braces to control scoliosis curve progression or not. Therefore, this study aimed to evaluate the effectiveness of soft braces used for idiopathic scoliotic curves compared to other available braces. Method: A search was done in databases including PubMed, Google Scholar, ISI Web of Knowledge, Ebsco, Embasco, and Scopus. Keywords of the soft brace, SpineCor were used in combination with scoliosis. The quality of the selected studies was evaluated by use of the Down and Black tool, which is a reliable method to evaluate the quality of the studies. Results: Based on the aforementioned keywords, 52 studies were achieved. After reviewing the title and abstract of each study 11 papers were selected for final analysis. Eight studies were on the evaluation of the effectiveness of the SpineCor brace on scoliosis. There were three studies on the comparison of the SpineCor with other available rigid braces. Conclusion: The results of selected studies confirmed that the SpineCor brace can be used to control the progression of idiopathic scoliosis. However, its effectiveness is limited to the curves with a severity of fewer than 30° and for the patients with Risser signs 0–3. The effectiveness of SpineCor is not comparable with a rigid brace, especially for the curve above 40°. SpineCor stabilizes the spine with high compliance and with significant improvement in posture, rib hump, lumbar predominance, and muscle contraction.

Higher Baseline Serum Myokine of FSTL1 May Serve as a Potential Predictive Biomarker for Successful Brace Treatment in Girls With Adolescent Idiopathic Scoliosis.

A retrospective case-control study. This study aimed to investigate whether myokine, which is related to exercise and muscle mass, could serve as a biomarker for predicting bracing outcomes. Several risk factors have been documented to be associated with bracing failure in patients with adolescent idiopathic scoliosis (AIS). However, serum biomarkers have not been extensively explored. Skeletally immature females with AIS, without previous histories of bracing or surgery, were included. Peripheral blood was collected at the time of the bracing prescription. Baseline serum concentrations of 8 myokines [apelin, fractalkine, brain-derived neurotrophic factor, erythropoietin, osteonectin, fatty-acid-binding protein 3, follistatin-like 1 (FSTL1), and musclin] were measured by multiplex assays. Patients were followed up until weaned from bracing and then designated as a "failure" (defined as Cobb angle progression >5°) or "success." A logistic regression analysis was performed that accounted for serum myokines and skeletal maturity. We included 117 patients, with 27 in the failure group. Patients in the failure group had lower initial Risser sign and lower baseline serum levels of myokines, including FSTL1 (2217.3 ± 617.0 vs . 1369.3 ± 704.9, P = 0.002), apelin [116.5 (12.0, 335.9) vs . 83.5 (10.5, 221.1), P = 0.016], fractalkine (979.6 ± 457.8 vs . 743.8 ± 456.1, P = 0.020), and musclin [211.3 (16.3, 370.3) vs . 67.8 (15.5, 325.6), P = 0.049]. Following adjusted analysis, serum FSTL1 [odds ratio = 10.460; (2.213-49.453)] was determined to be predictive of bracing effectiveness. Patients who failed AIS bracing had significantly lower mean baseline levels of FSTL1 than those who achieved success. FSTL1 may serve as a biomarker that can inform outcomes after bracing.

Does Progesterone Affect Perioperative Blood Loss during Posterior Spinal Fusion Surgeries in Female Patients with Adolescent Idiopathic Scoliosis? A Retrospective Study.

Menstruation is considered a contraindication for elective surgery for higher operative blood loss. Progesterone is often used to postpone menstruation to avoid surgery during menstruation. This study aimed to explore whether using progesterone to postpone menstruation affects perioperative blood loss and complications in female patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion (PSF) surgery. A retrospective study was performed for female patients diagnosed with AIS who underwent PSF surgery between March 2013 and January 2021. Patients scheduled to undergo PSF surgery from 2 days before menstruation to 3 days after menstruation were treated with progesterone preoperatively. The patients were divided into two groups according to progesterone use (progesterone injection group; control group). Demographic and surgical data including intraoperative blood loss (IBL), normalized blood loss (NBL), total blood loss (TBL), transfusion rate, perioperative complications, postoperative drainage time, postoperative hospital stay, and preoperative coagulation function data were collected. A total of 206 patients were included in the study. Among them, the progesterone injection group included 41 patients, with an average age of 14.8 years. While the control group included 165 patients, with an average age of 14.9 years. The two groups were matched for age, height, weight, operation time, Risser sign, correction rate, mean curve Cobb angle, bending Cobb angle, number of internal fixations, and number of fused levels (all P > 0.05). Regarding coagulation function, no significant differences were found in thrombin time, activated partial thromboplastin time, fibrinogen, prothrombin time, and platelet count between the two groups (all P > 0.05). IBL, NBL, and TBL were higher in progesterone injection group; however, the difference was nonsignificant (all P > 0.05). Transfusion rate, perioperative complications, postoperative drainage time, and postoperative hospital stay were not statistically different between groups (all P > 0.05). Intramuscular injection of progesterone to avoid menstruation during PSF surgery did not affect perioperative blood loss and complications in AIS patients. It may be a safe method for AIS patients to avoid menstrual problems affecting the operation time and receive PSF surgery as scheduled.

Substantial mismatch of skeletal maturity assessment between Risser sign and Simplified Skeletal Maturity Scale/Thumb Ossification Composite Index in patients with adolescent idiopathic scoliosis.

Recently, hand skeletal maturity systems such as the Simplified Skeletal Maturity Scale (SSMS) or Thumb Ossification Composite Index (TOCI) have been introduced to attempt to prospectively predict the occurrence of peak height velocity (PHV) in adolescents. This study aims to compare the frequency of the mismatch in estimation of HV between Risser sign (RS) and SSMS/TOCI stages in adolescent idiopathic scoliosis (AIS) patients. One hundred thirty-three female patients with AIS were included. The mean age of the patients was 13.1years. A whole spine and hand X-rays were obtained to establish skeletal maturity stage according to RS, SSMS, and TOCI systems. A mismatch resulting in overestimation (MOE) with RS compared to SSMS/TOCI was defined as the combination of RS 3-4/SSMS 3-5 or RS 3-4/TOCI 4-6, whereas a mismatch resulting in underestimation (MUE) with RS and SSMS/TOCI was defined as RS 0-1/SSMS 6-8 or RS 0-1/TOCI 7-8. Height velocity (HV) was compared between MOE/non-MOE and MUE/non-MUE groups. Between RS and SSMS, the rates of the MOE and MUE groups were 4.3% and 1.7%, respectively. Between RS and TOCI, rates were 2.8% and 1.7%, respectively. With the combination of RS and SSMS stages, an estimate of HV of 5.6cm/year in the MOE group was significantly larger than that of 2.7cm/year in the non-MOE group, and 3.7cm/year in the MUE group was significantly smaller than 6.9cm/year in the non-MUE group. Likewise, with the combination of RS and TOCI stages, an estimate of HV of 5.8cm/year in the MOE group was significantly greater that of 2.7cm/year in the non-MOE group, and 3.7cm/year in the MUE group was significantly smaller than 6.9cm/year in the non-MUE group. These findings support the use of SSMS/TOCI as the standard for assessing HV and skeletal maturity in patients with AIS.

Anterior Vertebral Body Tethering Compared with Posterior Spinal Fusion for Major Thoracic Curves: A Retrospective Comparison by the Harms Study Group.

Anterior vertebral body tethering (AVBT) is an alternative to posterior spinal fusion (PSF) for the surgical treatment of scoliosis. The present study utilized a large, multicenter database and propensity matching to compare outcomes of AVBT to PSF in patients with idiopathic scoliosis. Patients with thoracic idiopathic scoliosis who underwent AVBT with a minimum 2-year follow-up retrospectively underwent 2 methods of propensity-guided matching to PSF patients from an idiopathic scoliosis registry. Radiographic, clinical, and Scoliosis Research Society 22-Item Questionnaire (SRS-22) data were compared preoperatively and at the ≥2-year follow-up. A total of 237 AVBT patients were matched with 237 PSF patients. In the AVBT group, the mean age was 12.1 ± 1.6 years, the mean follow-up was 2.2 ± 0.5 years, 84% of patients were female, and 79% of patients had a Risser sign of 0 or 1, compared with 13.4 ± 1.4 years, 2.3 ± 0.5 years, 84% female, and 43% Risser 0 or 1 in the PSF group. The AVBT group was younger (p < 0.001), had a smaller mean thoracic curve preoperatively (48 ± 9°; range, 30° to 74°; compared with 53 ± 8°; range, 40° to 78° in the PSF group; p < 0.001), and had less initial correction (41% ± 16% correction to 28° ± 9° compared with 70% ± 11% correction to 16° ± 6° in the PSF group; p < 0.001). Thoracic deformity at the time of the latest follow-up was 27° ± 12° (range, 1° to 61°) for AVBT compared with 20° ± 7° (range, 3° to 42°) for PSF (p < 0.001). A total of 76% of AVBT patients had a thoracic curve of <35° at the latest follow-up compared with 97.4% of PSF patients (p < 0.001). A residual curve of >50° was present in 7 AVBT patients (3%), 3 of whom underwent subsequent PSF, and in 0 PSF patients (0%). Forty-six subsequent procedures were performed in 38 AVBT patients (16%), including 17 conversions to PSF and 16 revisions for excessive correction, compared with 4 revision procedures in 3 PSF patients (1.3%; p < 0.01). AVBT patients had lower median preoperative SRS-22 mental-health component scores (p < 0.01) and less improvement in the pain and self-image scores between preoperatively and the ≥2-year follow-up (p < 0.05). In the more strictly matched analysis (n = 108 each), 10% of patients in the AVBT group and 2% of patients in the PSF group required a subsequent surgical procedure. At a mean follow-up of 2.2 years, 76% of thoracic idiopathic scoliosis patients who underwent AVBT had a residual curve of <35° compared with 97.4% of patients who underwent PSF. A total of 16% of cases in the AVBT group required a subsequent surgical procedure compared with 1.3% in the PSF group. An additional 4 cases (1.3%) in the AVBT group had a residual curve of >50° that may require revision or conversion to PSF. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The Sanders Maturity Scale for skeletal maturity assessment in idiopathic scoliosis

Introduction. Skeletal maturity assessment in Idiopathic Scoliosis (IS) is used for the evaluation of deformation progression risk, as well as selecting a method of treatment. The Sanders Maturity Scale (SMS) is based on the ossification of phalanges, metacarpal bones and radius rated on AP radiograms of the left hand. Aim. This retrospective study aimed to compare SMS to other skeletal maturity assessment methods used in daily practice. Materials and methods. We included 39 female patients with IS (50 series of radiograms) with a mean age of 13.4, ranging from 10.3 to 17.3. Each series of radiograms was evaluated by three observers with different experience. Skeletal maturity was assessed using the Sanders Maturity Scale (SMS), Risser sign, Greulich and Pyle (GP) atlas, as well as the closure of the triradiate cartilage. Results. The majority of patients, 17 out of 50 (34 %) were classified as type 3 (adolescent rapid – early). Intra-observer and inter-observer reliability for the SMS was very good (Krippendorff’s alpha &gt;0.95). The GP and Risser method showed good reliability, whereas the triradiate cartilage closure assessment showed lower reliability. The Risser 0 grade corresponded with as many as four Sanders stages, 16 out of 20 (80 %) were rated Sanders 3. All radiograms with open triradiate cartilage (7/50, 14 %) were rated Sanders 2 or 3; they all received a Risser 0 grading. Conclusions. The SMS proved to have a very good intra-observer and inter-observer reliability, it is easy to be used by physicians and does not require an atlas. The SMS enhances the assessment of skeletal maturity of IS patients by providing additional stages in the early phase of growth (Risser 0).

Pulmonary Parameters in Adolescents with Severe Thoracic Idiopathic Scoliosis: Comparison Girls versus Boys.

The study compared pulmonary parameters, registered at the preoperative examination, in adolescent boys versus girls, both with severe thoracic idiopathic scoliosis. Thirty consecutive boys and 30 consecutive girls with Lenke 1 or 3 type, in the age range 14–18 years, with a Cobb angle of >50° and Risser sign ≥ 3 were enrolled. Corrected body height was used to calculate pulmonary parameters according to the Global Lung Function (GLI 2012) reference values. Significantly higher values of the calculated predicted pulmonary parameters and the upper and lower limit of normal (ULN and LLN), as well as significantly higher absolute values of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), were observed in boys than girls; however, the registered FVC and FEV1, expressed as percentages of the predicted values, tended to be lower in boys. The FEV1 z-score difference between boys and girls may suggest a need for more intensive preoperative pulmonary rehabilitation in boys.

Predictive Parameters for Chêneau Brace Efficacy in Patients with Adolescent Idiopathic Scoliosis.

Retrospective consecutive cohort study. For patients with mild to moderate adolescent idiopathic scoliosis (AIS), bracing is the standard therapy to prevent progression of deformity. Still, not all patients benefit from treatment in the same way. Therefore, predictive parameters are needed to determine if patients are likely to benefit from brace therapy. Fourty-five AIS patients treated with a Chêneau brace were evaluated retrospectively. Inclusion criteria were based on SRS-criteria. Whole spine X-rays were performed pre-brace, in-brace, and at least 6months after termination of brace treatment. Gender, age, Risser's sign, vertebral rotation determined by Nash and Moe grading system, in-brace correction and in-brace time per day were parameters evaluated. Treatment success and failure groups were compared to determine possible predictive parameters for successful brace treatment. Chêneau brace treatment was successful preventing curve progression in 69%. We found significant differences between success and failure group concerning age (14 ± .22 vs 12.4 ± .4; P < .001) and Risser's sign (1.71 ± .16 vs .5 ± .17; P < .001) at beginning of brace treatment. Most significantly, initial in-brace curve correction was correlated with successful outcome after brace treatment (r = .64 (P < .001)). As one of few studies adhering to the criteria defined by the Scoliosis Research Society our study shows reliable predictive parameters for Chêneau brace treatment success in patients with AIS. Data shown in this paper will help to differentiate AIS patients who are likely to benefit from adequate bracing therapy from those who could rather benefit from early surgical treatment.

The Effects of Short- and Long-Term Spinal Brace Use with and without Exercise on Spine, Balance, and Gait in Adolescents with Idiopathic Scoliosis

Background and Objectives: Adolescent idiopathic scoliosis (AIS) is a prevalent spinal disorder in adolescents. Previous studies have shown biomechanical changes of the gait in the lower limb of AIS patients. To minimize the progression of scoliotic curvature, a spinal brace is used, which has been shown to be efficient. Usually, a brace is worn strictly for 20–22 h every day. To our knowledge, no study has assessed the short- and long-term effects of spinal brace use with or without an exercise program (6 months) to improve clinical and biomechanical parameters. The aim of our study was to verify the effects of short- and long-term spinal brace use, with or without an exercise program on the spine, body balance, and plantar load distribution during gait in AIS. Materials and Methods: A prospective randomized study was conducted with intention-to-treat analysis in forty-five adolescents diagnosed with AIS undergoing conservative treatment at a center specialized in spinal rehabilitation. Adolescents were evaluated at two stages of intervention: (1) spinal orthopedic brace, with acute use 24 h/day (n = 22) and (2) spinal orthopedic brace, with acute use between 15–18 h/day associated with a specific rehabilitation exercise protocol for six consecutive months (six months and 12 total sessions, n = 23). The evaluated parameters were: spine pain, using a visual analog scale (VAS); Cobb angle measurement using radiograph exams, as well as the Risser sign; and static balance and plantar pressure of the feet during gait, carried out using a pressure platform. Results: AIS patients showed significant improvements in the main scoliotic curvature, with a 12-degree reduction in Cobb angle pre- and post-short-term immediate use of spinal brace and a 5.3 degree correction after six months of spinal brace use in combination with specific exercises (long term). In addition, short- and long-term brace use with an exercise program showed a significant increase in anteroposterior and mediolateral balance and a reduction in plantar overload on the heel during gait, with an effect size between moderate and high. Conclusions: Intervention via the short- or long-term use of a spinal brace combined with specific exercises in adolescents with idiopathic scoliosis proved to be effective for correcting scoliotic curvature. In addition, intervention also showed improvements to the antero-posterior and mediolateral body balance and a reduction in the plantar load on the rearfoot region during gait, demonstrating effective mechanical action on the spine.

Earlier appearance of Risser sign on ultrasound versus radiograph in adolescent idiopathic scoliosis.

ObjectiveThe usefulness of ultrasound in the detailed assessment of the Risser sign is still unclear. The purpose of this study was to analyze the usefulness of ultrasound for determining the Risser sign compared with that determined by conventional radiography by each Risser grade.Materials and MethodsEighty-eight iliac crests from 44 adolescent patients who visited the scoliosis clinic with Risser grades 0-4 were evaluated. The ultrasound probe was placed vertically on the iliac crest and the point where iliac apophysis ossification ended was marked. The length of ossification relative to the length of the iliac crest was calculated.ResultsAgreement between radiographic and ultrasound images were found in 58/86 iliac crests (67%). Kappa value was 0.565. Agreement between the two methods with regard to Risser grade was 53% for grade 0, 43% for grade 1, 47% for grade 2, 88% for grade 3, and 90% for grade 4. With additional analysis by integrating grades into two groups, the agreement rate was 47.7% and the Kappa value was 0.288 in the grade 0-2 group, and 88% and 0.703 in grades 3-4 group, respectively. In cases of disagreements, 93% of the iliac crests were judged as having higher Risser grades by ultrasound than by radiograph.ConclusionRisser sign evaluation by ultrasound demonstrated a higher agreement rate in grades 3 and 4, whereas less agreement was found in grades 0-2. In the majority of cases with disagreement, ultrasound showed a higher grade than radiography, suggesting that ossification can be detected earlier with ultrasound than with radiography.

An Integrated Comprehensive Tailor-Made Rehabilitation Conservative Treatment For Idiopathic Adolescent Scoliosis

Scoliosis is an abnormal lateral curvature of the spine associated with or without rotation of the vertebrae. Scoliosis is not just a cosmetic problem, but it has impact on many aspects of a person’s quality of life. One’s can experience pain, posture, respiratory, psychosocial problems. In This case report we would like to demonstrated an integrated comprehensive, tailor-made rehabilitation treatment for adolescent scoliosis. The patient is a 15-year-old female with complaints of scoliosis and back pain. Her first menarche was when she was 11 years old. No medical Problem was found. She loved to hang out with her friends and family but since her back hump getting worse, she ashamed of herself and sometimes refused to meet them or cover it with thick layer clothes. The pain in scale of 6 has been present for 1 year. She is unhappy with her body alignment and posture. From physical examination we found The Adam forward bend test was positive. From the x-ray before treatment showed the cobb angle was 20. Pelvic tilt (+), Risser sign 3-4, with Scoliosis C Curve. She can easily do her activities without feeling easily tired nor dyspnoea. She was prescribed a tailor-made Boston brace, physical exercise, heating modality, psychosocial intervention. After 12 weeks of therapy and bracing there was an improvement in posture, minimal pain (3-4), and she became more confidence and happy. The spine malalignment and the curvature can compress spinal disks, irritate nerve, strain joints, tighten muscles and it leads to pain. Because of this spine malalignment can affect posture it can leads to a psychosocial problem. Since the cobb angle was 20 degrees, no full maturation found, it is indicated for Brace prescription, to correct posture and prevent progressivity of curve angle. A proper exercise with heating modality can decrease muscle spasm and pain, maintain flexibility and strengthen spine/core muscle. The earlier diagnosis and treatment of an adolescent scoliosis can give so much different; it depends on the maturation and the cobb angle. In this comprehensive treatment needs a support not only from the patient but also from her society.

Vertebral body tethering compared to posterior spinal fusion for skeletally immature adolescent idiopathic scoliosis patients: preliminary results from a matched case–control study

Direct comparisons between vertebral body tethering (VBT) and posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS)are limited. We aimed to evaluate 2-year results of VBT and PSF to report comparative outcomes. 26 prospectively enrolled VBT patients were matched 1:1 by age, gender, Risser sign and major curve magnitude with PSF patients. At a minimum 2-year follow-up, surgical results and radiographic outcomes were reviewed. Operative time, anesthesia time, blood loss, and length of stay were significantly lower in the VBT group (< 0.001, p = 0.003, p < 0.001, p < 0.001, respectively). The major curve at 2years was corrected by 46% in the VBT group vs. 66% in the PSF (p = 0.0004). Success following VBT, defined as no fusion surgery and Cobb angle < 35° at the 2-year follow-up, was seen in 20 VBT patients (77%) (p = 0.0003) and correlated with mean Cobb angle of < 35° on 3-month imaging. 12 VBT patients (46%) showed curve improvement over time, and those patients had significantly lower mean Cobb angle on the 3-month radiograph than non-modulators (23° vs 31°, p = 0.014). At 2years, cord breakage occurred in five patients (19%). By 2years, three VBT patients developed complications (2 pleural effusion and 1 overcorrection needing return to OR). In contrast to PSF, growth continued at T1-T12 (mean 13mm) and over the instrumented levels (mean 10mm) following VBT, compared to no growth over instrumented segments in the fusion cohort (p = 0.011, p = 0.0001). In Sanders stages 3 and 4 patients treated in the USA, Cobb angle < 35° on 3-month imaging was associated with success at the 2-year follow-up. Curve correction was superior in the PSF group with 96% achieving curve correction to < 35° vs. 77% of the VBT patients. Cord breakage was noted in 19% of VBT patients at the 2-year follow-up. Three patients developed complications in both the VBT and PSF cohorts. Level II (prospective study with matched retrospective comparison group).

Evaluation of In-brace Correction in Individuals with Adolescent Idiopathic Scoliosis: A Retrospective and Descriptive Study

Introductions: Achieving maximum correction at the beginning of brace treatment in AIS is the only factor that can be controlled by the bracing provider if we have a better understanding of the prognostics and factors associated with achieving in-brace correction. The aim of this present study was to evaluate in-brace correction in a cohort of AIS patients who were treated by full-time bracing with plastic moulded thoraco-lumbo-sacral spinal orthosis (TLSO).&#x0D; Methods: This study was a retrospective descriptive study. We collected data from medical records of individuals with AIS who receiving full-time braces treatment from Orthotic Clinic, King Chulalongkorn Memorial Hospital. Demographic data included age, gender, weight, height, and body mass index (BMI). Cobb angle, Risser sign, and curve type were determined using pre and post-brace standing posteroanterior (PA) radiographs. Correlation analysis was performed to investigate in-brace correction with associated factors. &#x0D; Results: We included 91 patients' data and radiographic images with AIS, with seven (7.69%) boys and 84 (92.31%). The overall mean Cobb angle was 32.9 ± 8.5º, and during brace treatment, it was 22.5 ± 11.5º. There was a significant mean difference in the mean Cobb angle before and in-brace (p &lt; 0.001). The overall mean in-brace correction in the study was 34.1 ± 22.7%. Initial Cobb angle and BMI were found to be significantly negatively associated with in-brace correction with a Pearson coefficient of -0.49 and -0.24, respectively.&#x0D; Conclusion: The mean of first in-brace correction TLSO was 34.1% from the initial Cobb angle. No difference in in-brace correction across curve types in our study. There was a significant Cobb angle changed before and in-brace radiograph. We found that in-brace correction was significantly associated with initial Cobb angle and BMI.&#x0D; Keywords: Adolescent Idiopathic Scoliosis, in-brace correction, bracing

An Analysis of the Risk Factors for Adding-on Phenomena After Posterior Hemivertebral Resection and Pedicle Screw Fixation for the Treatment of Congenital Scoliosis Caused by Hemivertebral Malformation.

ObjectiveTo retrospectively analyze the risk factors for adding-on phenomena (AOP) after posterior hemivertebral resection (PHR) and pedicle screw fixation for the treatment of congenital scoliosis (CS) caused by hemivertebral (HV) malformation.MethodsPatients with CS who underwent surgery and were followed up for more than five years were included in this study. The d general data, such as gender, age, HV segment, Risser sign, and triangular cartilage, postoperative complications, and imaging data at different periods, including the standard anteroposterior and lateral x-rays of the total spine were collected.ResultsIn total, 58 patients were included in this study, of which 10 experienced AOP and 48 did not. The results of the single-factor analysis showed that there were statistically significant differences between the patients with AOP and those without in terms of the HV direction, lowest instrumented vertebra (LIV)–upper instrumented vertebra (UIV) (P < 0.05), and postoperative trunk shift (P < 0.05). The results of the logistic regression analysis showed that the HV direction and the postoperative trunk displacement distance were the main risk factors for postoperative AOP. The area under the receiver operating characteristic curve was 0.842 (P < 0.001). The best cut-off value of the adding-on index as an indicator of the occurrence of AOP after surgery was 0.67. When the adding-on index was >0.67, the incidence of postoperative AOP was 90.0%, and the non-occurrence rate was 22.9%.ConclusionPHR and pedicle screw fixation is an effective way to treat HV malformation in CS. The HV direction, LIV–UIV, and postoperative TS are risk factors for AOP in patients with CS treated with PHR and pedicle screw fixation. The adding-on index has a high degree of accuracy for the prediction of the occurrence of AOP after PHR and pedicle screw fixation.

TLSO: The Effect of Spinal Translation on Initial Coronal Curve Correction, Lateral Trunk Shift, and Coronal Balance in Adolescent Idiopathic Scoliosis

ABSTRACT Introduction Adolescent idiopathic scoliosis is often treated orthotically with thoracic lumbar sacral orthoses (TLSOs). The goal of these TLSOs is to improve the scoliotic curve during wear to prevent further curve progression. To achieve this in-orthosis curve improvement, clinicians often apply corrective modifications to a 3D model of the patient's trunk through computer-aided design (CAD) software, which are fabricated into the TLSO. Modifications often include laterally shifting certain portions of the orthosis to apply corrective forces to the scoliotic curve. The amount and magnitude of the shifting applied are loosely based on clinical experience and patient characteristics, but the decision is somewhat arbitrary. The purpose of this study is to determine any existing correlation between applied coronal translation (shift) through CAD modifications of TLSOs and resulting coronal curve correction in female subjects with idiopathic scoliosis. Materials and Methods Female subjects with idiopathic scoliosis who were prescribed a TLSO were included in this study. Demographic and clinical data were collected from medical records on age, sex, hours of TLSO wear, body mass index (BMI), and Risser sign. Radiographic Cobb angle, data regarding curve flexibility, and the amount of coronal translation used during the CAD modification process were recorded. Differences in the primary scoliotic curve were then assessed based on initial x-rays and in-orthosis x-rays to calculate the change in Cobb angle, apical vertebra translation (AVT), coronal balance (CB), and thoracic trunk shift (TTS). Results Seventeen participants were included in the study. Average measured curve flexibility was 59.64%, and applied coronal translation to the CAD model ranged from 3 to 19 mm. Average Cobb angle improvement from the initial x-ray to the first in-orthosis x-ray was 23.57%, which was statistically significant (P &lt; 0.01). Average improvement of AVT was 6.52 mm, which was statistically significant (P &lt; 0.05). CB improved by an average of 5.29 mm, and TTS improved by an average of 2.33 mm, neither of which was found to be a statistically significant improvement. No correlation was found between applied shifting in CAD modifications and Cobb angle improvement, AVT improvement, CB improvement, or TTS improvement. Conclusions These results do not support the hypothesis that greater applied lateral shifting in TLSO CAD modifications leads to greater coronal scoliotic curve correction. Orthotists are not able to predict in-orthosis coronal curve correction based on CAD modifications, spinal flexibility, and BMI alone. Additional factors play a role in the complexity of AIS treatment.

Anterior versus posterior approach in Lenke type 1 adolescent idiopathic scoliosis: a comparison of long-term follow-up outcomes.

BackgroundAfter surgical treatment of adolescent idiopathic scoliosis (AIS), doctors should not only focus on the short-term surgical effect, but also pay special attention to whether the patients can live normally in the long-term. This work compared the long-term effects of thoracoscopy-assisted anterior spinal fusion (ASF) and posterior spinal fusion (PSF) in AIS.MethodsTwenty-two patients underwent thoracoscopy-assisted ASF, and twenty-three patients underwent PSF from 2004 to 2009 were involved , including 14 males and 31 females with an average age of 14.8±2.6 years, and all patients suffered from only Lenke type 1 AIS. The mean follow-up time was 102 months, the radiographic parameters and operation time, hospitalization time, fusion segments and estimated blood loss were evaluated. Comparisons between groups were made such as Cobb’s angle, thoracic kyphosis, the instrumented levels, curve correction, preoperative parameters, SF-36/SRS-22 questionnaire scores, and pulmonary function.ResultsThere was no significant difference in age, gender, Risser sign and follow-up period between two groups. The instrumentation level had an average of 6 in the thoracoscopy-assisted ASF group and 9.7 in the PSF group (P<0.001). The average correction rate of the main curve was 67.4% in ASF group versus 79.2% in PSF group (P>0.05). The postoperative thoracic kyphosis was 16.2°±3.9° in ASF group and 25.6°±4.4° in PSF group (P=0.023). Patients had momentous advancement in self-image, vitality and mental health in the SRS-22 and SF-36 questionnaires. Compared to preoperatively, the pulmonary function of both groups was satisfactorily improved at the final follow-up.ConclusionsSince there was no statistically significant difference in the general conditions of the two groups selected for this study, so we finally concluded that thoracoscopy-assisted ASF had a satisfactory correction rate, famous long-term radiography outcomes and desirable pulmonary function results. However, compared to PSF, it has a longer operation time, a more complicated surgical procedure and a weaker three-dimensional correction effect, and PSF has affirmative long-term outcomes, fewer complications, and satisfactory sagittal balance, all of which make PSF the standard operation to treat AIS.

Supine correction index as a predictor for brace outcome in adolescent idiopathic scoliosis.

AimsThe aim of this study was to assess the ability of morphological spinal parameters to predict the outcome of bracing in patients with adolescent idiopathic scoliosis (AIS) and to establish a novel supine correction index (SCI) for guiding bracing treatment.MethodsPatients with AIS to be treated by bracing were prospectively recruited between December 2016 and 2018, and were followed until brace removal. In all, 207 patients with a mean age at recruitment of 12.8 years (SD 1.2) were enrolled. Cobb angles, supine flexibility, and the rate of in-brace correction were measured and used to predict curve progression at the end of follow-up. The SCI was defined as the ratio between correction rate and flexibility. Receiver operating characteristic (ROC) curve analysis was carried out to assess the optimal thresholds for flexibility, correction rate, and SCI in predicting a higher risk of progression, defined by a change in Cobb angle of ≥ 5° or the need for surgery.ResultsThe baseline Cobb angles were similar (p = 0.374) in patients whose curves progressed (32.7° (SD 10.7)) and in those whose curves remained stable (31.4° (SD 6.1)). High supine flexibility (odds ratio (OR) 0.947 (95% CI 0.910 to 0.984); p = 0.006) and correction rate (OR 0.926 (95% CI 0.890 to 0.964); p < 0.001) predicted a lower incidence of progression after adjusting for Cobb angle, Risser sign, curve type, menarche status, distal radius and ulna grading, and brace compliance. ROC curve analysis identified a cut-off of 18.1% for flexibility (sensitivity 0.682, specificity 0.704) and a cut-off of 28.8% for correction rate (sensitivity 0.773, specificity 0.691) in predicting a lower risk of curve progression. A SCI of greater than 1.21 predicted a lower risk of progression (OR 0.4 (95% CI 0.251 to 0.955); sensitivity 0.583, specificity 0.591; p = 0.036).ConclusionA higher supine flexibility (18.1%) and correction rate (28.8%), and a SCI of greater than 1.21 predicted a lower risk of progression. These novel parameters can be used as a guide to optimize the outcome of bracing.Cite this article: Bone Joint J 2022;104-B(4):495–503.

Initial In-Brace Correction: Can the Evaluation of Cobb Angle Be the Only Parameter Predictive of the Outcome of Brace Treatment in Patients with Adolescent Idiopathic Scoliosis?

Background: Patients with a better initial in-brace correction could show a higher probability of a successful outcome. However, no one has investigated whether parameters can affect the outcomes. The aim of this retrospective study was to evaluate if the initial correction rate (ICR) could be predictive of the bracing outcome and to determine the role of some mechanical and biological parameters in ICR. Methods: The study population comprised 449 patients who met the inclusion criteria. Curve correction > 10° Cobb defines brace treatment success. Success and failure groups were compared in terms of the Risser sign, initial Cobb angle, initial Perdriolle value and ICR. Results: ICR significantly correlates with initial Perdriolle. The success group had a significantly lower value of Pedriolle and initial Cobb angles, Risser sign and ICR than the failure group. The ICR and lower Risser were significantly associated with the brace treatment outcome. This seems particularly suitable for positivity prediction (Predicting value VP+: 87%). Conclusions: This study confirms that immediate in-brace correction can foretell the brace treatment outcome. Patients with a low Risser sign and a high rate of in-brace correction showed a bracing success of 87%. A correlation between rotation and in-brace correction confirms that rotation is among the parameters that influence the deformed spine reaction to corrective actions the most.

Effects of Core Stabilization Exercises on Pulmonary Function, Respiratory Muscle Strength, Peripheral Muscle Strength, Functional Capacity, and Perceived Appearance in Children With Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial.

The aim of the study was to investigate the effects of core stabilization exercises on pulmonary function, respiratory muscle strength, peripheral muscle strength, walking capacity, and perceived appearance in children with adolescent idiopathic scoliosis. This is an evaluator-blinded, randomized controlled trial. A total of 30 patients were randomly allocated to either a training group (n = 15, age = 13.8 ± 2.8 yrs, Cobb angle = 19.3 ± 6 degrees, Risser sign: n(1) = 1; n(2-4) = 14) or a control group (n = 15, age = 15.8 ± 3.4 yrs, Cobb angle = 20.8 ± 7.9 degrees, Risser sign: n(1) = 1; n(2-4) = 14). The training group received core stabilization exercises in addition to the traditional scoliosis exercises for 8 wks. The control group only received the traditional scoliosis exercises for 8 wks. Spirometry, maximal inspiratory and expiratory pressures, 6-min walking test, peripheral muscle strength, and the Walter Reed Visual Assessment Scale were assessed at the beginning and end of the study. The training group showed statistically significant improvements in maximal inspiratory pressure, maximum expiratory pressure, and Walter Reed Visual Assessment Scale score (respectively, mean changes = 17.4 ± 5.2 cmH2O; 10.6 ± 4.3 cmH2O; 2.4 ± 1.6), which were significantly larger compared with the control group (P < 0.05). Core stabilization exercises given in addition to the traditional scoliosis exercise can improve respiratory muscle strength and perceived appearance in patients with adolescent idiopathic scoliosis. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to: (1) Determine the evaluation methods required for scoliosis patients; (2) Evaluate respiratory parameters in scoliosis patients; and (3) Plan and implement an exercise program for scoliosis patients. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Video-Assisted Thoracoscopy for Vertebral Body Tethering of Juvenile and Adolescent Idiopathic Scoliosis: Tips and Tricks of Surgical Multidisciplinary Management.

VATS (video assisted thoracoscopic surgery) is routinely and successfully performed in minor and major complex thoracic procedures. This technique has been recently introduced for the treatment of severe forms of idiopathic scoliosis (IS) with the aim to repair the deformity, reduce morbidity and to prevent its progression in patients with skeletal immaturity. This study aims to present VATS in anterior vertebral body tethering (AVBT) approach to support the pediatric orthopedic surgeons during vertebral body fixation. Surgical and anesthesiologic tips and tricks are reported to assure a safe procedure. The study includes preadolescents with IS and a grade of scoliosis >40° that had a high probability of deterioration due to remaining growth (December 2018 to April 2021). Skeletal immaturity of enrolled patients was assessed by Sanders classification and Risser sign. Patients had a Risser score between 0 and 1 and a Sanders score >2 and <5. AVBT technique using VATS was performed by a senior pediatric surgeon assisting the pediatric orthopedic surgeon. Twenty-three patients have been submitted to VATS AVBT in the period of study (age range 9–14 years). The patients had a classified deformity Lenke 1A or B convex right and all types of curves were treated. In all patients, the vertebrae submitted to tethering surgery ranged from D5 to D12; mean curve correction was 43%. Three postoperative complications occurred: one late postoperative bleeding requiring a chest tube positioning on 12th postoperative day; one screw dislodged and needed to be removed; one child showed worsening of the scoliosis and needed a posterior arthrodesis. Initial results of VATS AVBT in growing patients with spinal deformities are encouraging. An appropriate selection of patients and a pediatric dedicated multidisciplinary surgical approach decrease intraoperative complications, time of operation and postoperative sequelae and guarantee an optimal outcome.