Scoliosis Patients Research Articles

Changes in trunk appearance following surgical correction of adolescent idiopathic scoliosis.

To assess the postoperative appearance of the trunk in surgically treated scoliosis patients after a 2 year follow-up using reliable indices and compare the results with 6-month follow-up. Forty-six Adolescent Idiopathic Scoliosis (AIS) patients (female; preop mean age 14.4 ± 2.4years) who underwent a posterior spinal fusion from 2009 to 2018 were included in this study. All had Lenke 1A thoracic curves, with surface topography taken preoperatively, 6months and 2years postoperatively. To assess spinal deformity, we measured the proximal thoracic, main thoracic and thoracolumbar/lumbar Cobb angles in the frontal plane from spinal X-rays and inclinometer angles in the thoracic and lumbar regions. To assess trunk deformity, Back Surface Rotation (BSR) and Trunk Lateral Shift (TLS) were computed along the trunk. We analysed the effect of age, height, weight, Cobb angle, length of follow-up, and surgical technique. We also compared correction rates (CRs) of the spinal and trunk measurements after 6months and 2years. Good spinal correction was achieved, with Cobb angles decreasing in the whole cohort. CRs for TLS and BSR were positive (denoting improvement) for 76% and 48% of patients, respectively, after 2years. Compared with 6months, the mean TLS CR increased while there was no improvement for BSR on average. We found no significant association after 2years between truncal index CRs and clinical variables (age, height, weight, preoperative Cobb angles) or surgical technique. However, there were significant correlations between the CRs of TLS and the main thoracic Cobb angle (r = 0.35), and between the CRs of BSR and thoracic inclinometer angle. Although more than 55% of the TLS was corrected after 2years of follow-up, the BSR remained stable over time and the persistence of rib hump on the back surface could be observed. III.

Finite element method-based study for spinal vibration characteristics of the scoliosis and kyphosis lumbar spine to whole-body vibration under a compressive follower preload

Purpose To analyze the dynamic response of the lumbosacral vertebrae structure of a scoliosis spine and a kyphosis spine under whole-body vibration. Methods Typical Lenke4 (kyphosis) and Lenke3 (scoliosis) spinal columns were used as research objects. A finite element model of the lumbosacral vertebrae segment was established and validated based on CT scanning images. Modal, harmonic response, and transient dynamic analyses were performed on the lumbar-sacral scoliosis model using the finite element software abaqus. Results The first four resonance frequencies of kyphosis spine extracted from modal analysis were 0.86, 1.45, 8.51, and 55.71 Hz. The first four resonance frequencies of scoliosis spine extracted from modal analysis were 0.76, 1.45, 10.51, and 63.82 Hz. The scoliosis spine had the maximum resonance amplitude in the transverse direction, while the kyphosis spine had the maximum resonance amplitude in the anteroposterior direction. The dynamic response in transient analysis exhibited periodic response over time at all levels. Conclusion The scoliosis and kyphosis deformity of the spine significantly complicates the vibration response in the scoliosis and kyphosis areas at the top of the spine. Scoliosis and kyphosis patients are more likely to experience vibrational spinal diseases than healthy people. Besides, applying vertical cyclic loads on a malformed spine may cause further rotation of scoliosis and kyphosis deformities.

Unsupervised local center of mass based scoliosis spinal segmentation and Cobb angle measurement.

Scoliosis is a medical condition in which a person's spine has an abnormal curvature and Cobb angle is a measurement used to evaluate the severity of a spinal curvature. Presently, automatic Existing Cobb angle measurement techniques require huge dataset, time-consuming, and needs significant effort. So, it is important to develop an unsupervised method for the measurement of Cobb angle with good accuracy. In this work, an unsupervised local center of mass (LCM) technique is proposed to segment the spine region and further novel Cobb angle measurement method is proposed for accurate measurement. Validation of the proposed method was carried out on 2D X-ray images from the Saudi Arabian population. Segmentation results were compared with GMM-Based Hidden Markov Random Field (GMM-HMRF) segmentation method based on sensitivity, specificity, and dice score. Based on the findings, it can be observed that our proposed segmentation method provides an overall accuracy of 97.3% whereas GMM-HMRF has an accuracy of 89.19%. Also, the proposed method has a higher dice score of 0.54 compared to GMM-HMRF. To further evaluate the effectiveness of the approach in the Cobb angle measurement, the results were compared with Senior Scoliosis Surgeon at Multispecialty Hospital in Saudi Arabia. The findings indicated that the segmentation of the scoliotic spine was nearly flawless, and the Cobb angle measurements obtained through manual examination by the expert and the algorithm were nearly identical, with a discrepancy of only ± 3 degrees. Our proposed method can pave the way for accurate spinal segmentation and Cobb angle measurement among scoliosis patients by reducing observers' variability.

Prediction of postoperative curve correction based on the supine radiographs for adult idiopathic scoliosis patients

BACKGROUND CONTEXTPreoperative supine radiographs are mandatory in the new adult idiopathic scoliosis (AdIS) classification. Supine radiographs are easily reproducible and highly predictive of side bending radiographs. However, few studies evaluated the use of supine radiographs in predicting postoperative curve correction after posterior spinal fusion (PSF) in AdIS. PURPOSETo investigate the use of supine and side bending (SB) radiographs in predicting postoperative curve correction in AdIS patients who underwent PSF. STUDY DESIGNRetrospective study. PATIENT SAMPLEA total of 93 AdIS patients who underwent PSF between 2022 and 2023 were included. OUTCOME MEASURESDemographic data were age, gender, height, weight, body mass index (BMI), Risser grade, Lenke curve types and Cobb angles. Main outcome measures were preoperative and immediate postoperative Cobb angle (proximal thoracic [PT], main thoracic [MT] and thoracolumbar/lumbar [TL/L] curves), Supine Cobb angle and Flexibility rate (PT, MT and TL/L), and Correction rate (PT, MT and TL/L). METHODSCorrelation study was performed between Supine Cobb angle vs postoperative Cobb angle for PT, MT and TL/L curves. A predictive formula was derived from the correlation plots. RESULTSA total of 93 subjects were included in our study with a median age of 24.7 years and comprised of 80 females (86.0%). Preoperative Supine Cobb angle (r=0.835, r=0.881, r=0.767, p<.001) and preoperative SB Cobb angle (r=0.815, r=0.872, r=0.801, p<.001) showed similar strong positive correlation with postoperative PT, MT and TL/L Cobb angle, but preoperative Supine Cobb angle had slightly stronger correlation in PT and MT, whereas preoperative SB Cobb angle had stronger correlation in TL/L curve. Using the derived predictive formulae, there was a significant, strong, positive correlation between the predicted value and actual value of postoperative standing Cobb angle, (r=0.852, p<.001), with 71.0% of the patients had predicted postoperative Cobb angle from the supine radiographs within 5° of the actual value. CONCLUSIONBoth supine radiographs and side bending radiographs had strong predictability of the postoperative Cobb angle for PT, MT and TL/L curves. In 71.0% of patients, the actual postoperative Cobb angle was within 5° of the predicted postoperative Cobb angle using the predictive formulae.

Do Caregivers and Patients With Early-Onset Scoliosis Share the Same Perspective on Health-Related Quality of Life? A Comparison of 24-item Early-Onset Scoliosis Questionnaire and 22-item Scoliosis Research Society Questionnaire Scores.

The 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) is validated in patients with early onset scoliosis (EOS) aged 0 to 18 years and the 22-item Scoliosis Research Society (SRS-22) questionnaire is validated in idiopathic scoliosis patients 10 years and older. EOSQ-24 is completed by the caregiver and SRS-22 is completed by the patient. A prior study comparing patient-reported outcome measures completed by older pediatric patients and their parents showed a low level of agreement. Our purpose was to compare EOSQ-24 and SRS-22 scores completed at the same time point and at subsequent time points, in patients aged 5 to 18 years with idiopathic or congenital EOS without developmental delay. This was a multicenter retrospective study. We identified pairs of EOSQ-24 and SRS-22 completed on the same day or within 6 months. Some patients had multiple pairs of surveys over time. EOSQ-24 and SRS-22 questions were matched and domain scores for Pain, Function, Mental Health, and Satisfaction were compared. Patients with a change in treatment between surveys were excluded. Pearson correlation coefficients ( r ) were used to compare domain scores, with r ≥0.7 indicating a strong relationship. There were 228 patient-caregiver dyads who completed 411 pairs of EOSQ-24 and SRS-22 on the same day. A strong correlation was found only for the Pain domain ( r =0.77). Function, Mental Health, and Satisfaction domains had positive but not strong correlations ( r = 0.58, r = 0.50, r = 0.41, respectively). Subanalysis based on age also showed a strong correlation only for Pain. There were 76 patient-caregiver dyads who completed 134 pairs of surveys with SRS-22 completed within 6 months after an EOSQ-24. All domains demonstrated a positive but not strong correlation, with Pain showing the highest correlation ( r = 0.64). EOSQ-24 and SRS-22 had a strong correlation only for Pain when completed at the same time point. EOSQ-24 and SRS-22 completed within 6 months lacked a strong correlation for all domains. Our findings suggest that parents and children with EOS may not share the same perspective on their health. Self-reported questionnaires should be used when possible to assess health-related quality of life in older children and adolescents with EOS who are developmentally neurotypical. Level III-diagnostic.

Functional and Radiological Outcomes of All-Posterior Surgical Correction of Dystrophic Curves in Patients with Neurofibromatosis Type 1.

A retrospective cohort study. To determine outcomes following all-posterior surgery using computed tomography navigation, hybrid stabilization, and multiple anchor point techniques in patients with neurofibromatosis type 1 (NF-1) and dystrophic scoliosis. Previous studies favored antero-posterior fusion as the most reliable method; however, approaching the spine anteriorly was fraught with significant complications. With the advent of computer assisted navigation and multiple anchor point method, posterior only approach is reporting successful outcomes. This study included patients who underwent all-posterior surgical deformity correction for dystrophic NF-1 curves. Coronal and sagittal Cobbs angles, apical rotation, and the presence of dystrophic features were evaluated before surgery. Postoperatively, sagittal, coronal, and axial correction, implant position, and implant densities were evaluated. The decline in curve correction and implant-related complications were evaluated at follow-up. Clinical outcomes were evaluated using the Scoliosis Research Society-22 revised index. This study involved 50 patients with a mean age of 13.6 years and a mean follow-up duration of 5.52 years. With a mean coronal flexibility of 18.7%, the mean apical vertebral rotation (AVR), preoperative coronal Cobb angle, and sagittal kyphosis were 27.4°, 64.01°, and 47.70°, respectively. The postoperative mean coronal Cobb angle was 30.17° (p <0.05), and the sagittal kyphosis angle was 25.4° (p <0.05). The average AVR correction rate was 41.3%. The correction remained significant at the final mean follow-up, with a coronal Cobb angle of 34.14° and sagittal kyphosis of 25.02° (p <0.05). The average implant density was 1.41, with 46% of patients having a high implant density (HID). The HID had a markedly higher mean curve correction (29.30° vs. 38.05°, p <0.05) and a lower mean loss of correction (5.7° vs. 3.8°, p <0.05). Utilizing computer-assisted navigation, hybrid instrumentation, and multiple anchor point technique and attaining high implant densities, this study demonstrates successful outcomes following posterior-only surgical correction of dystrophic scoliosis in patients with NF-1.

The effect of antibiotic-impregnated calcium sulfate beads and Medical Optimization Clinic attendance on the acute surgical site infection rate in high-risk pediatric neuromuscular and syndromic scoliosis patients.

Neuromuscular and syndromic (NMS) scoliosis patients are at higher risk of acute surgical site infections (SSIs). Despite following POSNA's endorsed consensus-based guidelines for SSI prevention, our institutional rates of acute SSI have varied dramatically. This variability drove simultaneous strategies to lower SSI rates: the creation of a preoperative Medical Optimization Clinic (MOC) and use of antibiotic-impregnated (Abx-I) calcium sulfate beads. Patients undergoing index PSF at a single institution between 2016 and 2022 were retrospectively reviewed. Patients with ≥ 2 risk factors were included: (1) BMI < 18.5 or > 25; (2) incontinence; (3) instrumentation to pelvis; (4) non-verbal; (5) GMFCS IV/V. SSI was defined as deep infection within 90days. We compared patients who attended MOC and received Abx-I (MOC + Abx-I) to those receiving neither intervention (control) nor a single intervention. 282 patients were included. The overall infection rate was 4.26%. Higher GMFCS (p = 0.0147), non-verbal status (p = 0.0048), and longer fusions (p = 0.0298) were independently associated with infection rate. Despite the MOC + Abx-I group having larger Cobb angles (88° ± 26°), higher GMFCS levels (4.5 ± 0.9), ASA class (3 ± 0.4), and more frequent instrumentation to the pelvis (85%), they had the lowest infection rate (2.13%) when compared to the control (4.2%) or single intervention groups (5.7%, 4.6%) (p = 0.9). The study examined the modern infection rate of NMS patients following the implementation of two interventions: MOC and Abx-I. Despite having higher risk factors (curves (88°), GMFCS level (4.5), ASA class (3), higher % instrumentation to the pelvis (85%)), the patients treated with both interventions demonstrated the lowest infection rate (2.13%).

Intrawound Vancomycin Powder Reduces Delayed Deep Surgical Site Infections Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

Retrospective. Evaluate whether the use of vancomycin powder (VP) placed in the surgical site prior to wound closure prevents delayed deep surgical site infections (DDI). DDI after posterior spinal fusion (PSF) in adolescent idiopathic scoliosis (AIS) patients remains a significant major complication. The use of VP to prevent acute surgical site infection has been reported but the impact on DDI is unknown. AIS patients treated over the past 20 years with PSF/instrumentation from a large muti-center registry were reviewed. Patients were divided into two groups: intraoperative vancomycin powder placed in the wound (VP) or no antibiotics placed in the wound (NVP). DDI was defined as an infection that occurred >90 days after surgery and required surgical intervention in the operating room. Patients who developed a DDI had secondary verification of VP use or not. Chi square and Kaplan-Meier (K-M) survivorship analyses were used to compare demographics and incident rate of DDI between groups. 4145 cases met inclusion for this study. A total of 43 DDI cases were identified (1.0%). The incidence of DDI for the VP group was 0.2% (4/2111), and 1.9% (39/2034) in the NVP group (P<0.001). Given the difference in follow-up for the 2 groups a Cumulative Survival and Kaplan-Meier analysis revealed the VP group had significantly better "survival" (no DDI) than the NVP group (P<0.001). DDIs are significant, adverse events that can greatly complicate patient recovery after PSF for AIS, including rehospitalization. This study found that patients who received VP intraoperatively were 10 times less likely to develop a DDI than those who did not receive VP. Although other advances/changes in surgical techniques may contribute to the significant decrease in infections found in the more recent VP cohort, VP should be considered as a prophylactic measure.

Aborted AIS spinal fusion due to persistent loss of IONM: which patients are at greatest risk?

Determine peri-operative risk factors predictive for prematurely stopping surgery prior to completion of deformity correction due to intra-operative neuromonitoring changes. A single institution retrospective review of adolescent idiopathic scoliosis (AIS) patients that underwent spinal fusion for curves greater than 70°. Cases aborted due to persistent loss of IONM were compared to completed cases. Demographic, radiographic, neurologic, and surgical information was reviewed. There were 453 total cases. Nine (9/453: (2%)) cases were aborted due to persistent loss of IONM, and 4 (4/453; (0.88%)) awoke with a neurologic deficit. Comparing to the 444 completed cases, pre-operative risk factors associated with case abortion were older age (15.3 vs. 13.8 years; p = 0.02), sex (male) (66.7% vs. 20.3%, p = 0.004), and larger cobb angles (87.6° vs. 79.2°; p = 0.01). Being male increased the risk of case abortion: 7.9X. Intraoperative risk factors associated with case abortion were combined anterior/posterior approach (ASF/PSF) (44.4% vs. 7.2%; p = 0.003) and increased index procedure EBL (1127 vs. 769mL; p = 0.043). ASF/PSF increased the risk: 10.3X. Four (4/9;44%) of the aborted cases awoke with neurologic deficit. Motor strength returned at 2.3days (0-18). Aborted cases returned to the OR after 12.6 ± 7.0days (1-23) which was related to time to regain motor strength. Pre-operative risk factors for AIS case abortion due to persistent loss of IOMN are older age, males, with larger Cobb angles. Intraoperative risk factors are combined ASF/PSF and increased index procedure EBL. Independent risk factors were sex (male) and ASF/PSF which increased the risk 7.9X and 10.3X, respectively.

Physiotherapeutic Scoliosis-Specific Exercises (PSSE-Schroth) can reduce the risk for progression during early growth in curves below 25°: prospective control study.

The main treatment aim in mild scoliosis is to prevent progression and if possible, to avoid bracing. Physiotherapeutic Scoliosis Specific Exercises (PSSE) are curve pattern specific exercises, based on 3D self-correction and activities of daily living training. The objective of this study was to evaluate the efficacy of PSSE - Schroth, as an exclusive treatment, during the riskiest period of rapid growth. Prospective control study. Outpatient treatment. Adolescents with scoliosis. One hundred and sixty-three patients (148 girls,15 boys; mean age 12.6 years, Risser sign 1.1, thoracic (Th) Cobb angle 20.8° and lumbar/thoracolumbar (L/TL) Cobb angle 20.7°) performed PSSE - Schroth exercises in our clinic. They were asked to regularly attend supervised sessions and to follow a home-program at least 5 times per week. Our inclusion criteria were Cobb angle 15°-25°, Risser 0-2 and angle trunk rotation (ATR) >5°, measured by scoliometer. The outcome parameters were the Cobb angle before and after the intervention (improvement or progression were defined as angle difference more than 5°) and the number of patients that finally needed a brace. Average follow-up time was 29.4 months. Control group was consisted of 58 patients (54 girls, 4 boys; mean age 13.1 years, Risser sign 0-2, Th Cobb 19.4°, L/TL Cobb 19.2°), that were retrospectively analyzed and performed general or no exercises. Compliance was self-reported. Statistical analysis was performed by paired t-test. For PSSE - Schroth group, 103 patients (63.2%) remained stable, 39 (23.9%) improved and 21 (12.9%) worsened. The success rate (87.1%) was significantly higher compared to Control group (P=0.002), where 15 subjects (25.9%) were stable and 43 (74.1%) worsened. Similarly, 16 patients (9.8%) from PSSE - Schroth group finally needed a brace, while 39 (67.2%) from control group (P=0.01). PSSE - Schroth reduced the risk of progression in Adolescent Idiopathic Scoliosis (AIS) patients, during early growth. Our results are in accordance with the recently published literature, showing the effectiveness of PSSE and their superiority compared to general exercises or natural history. Scoliosis specific exercises can be the first step of scoliosis treatment in mild curves, to avoid progression and bracing.

Development, validity and reliability of patient perception of scoliosis-specific physiotherapy (physio-is) questionnaire

Purpose To develop a questionnaire for adolescent idiopathic scoliosis (AIS) patients undergoing physiotherapeutic scoliosis-specific exercises (PSSE) and to evaluate its content validity, structural validity, and reliability. Methodology Seven PSSE treatment experts checked the content validity of the Patient’s Perception of Scoliosis-Specific Physiotherapy Questionnaire (Physio-IS). For each Physio-IS item, the content validity indexes must be ≥ 90%. Regarding structural validity and reliability 52 adolescents (ages 10–17) with AIS completed the questionnaire. Structural validity was assessed through exploratory factor analysis. Reliability was verified through internal consistency. Results Physio-IS content was validated in three evaluation rounds, obtaining 100% expert agreement. About structural validity we identified four domains (cumulative explained variance = 68.2%): (1) specific knowledge (seven questions on understanding their scoliosis condition); (2) social repercussion (five questions about social relationship implications); (3) pain (two questions about scoliosis-associated pain); and (4) associated concern (apprehension/expectations regarding the future). The Physio-IS demonstrated very good internal consistency (Cronbach’s alpha = 0.76–0.92). Conclusion The Physio-IS is a valid and reliable tool for assessing AIS patients undergoing PSSE and helping physiotherapists identify aspects requiring more attention, thus facilitating intervention strategies, as knowing the patient’s perception of their condition or treatment is fundamental to AIS treatment success.

Development and validation of AI-based automatic measurement of coronal Cobb angles in degenerative scoliosis using sagittal lumbar MRI

ObjectivesSeverity of degenerative scoliosis (DS) is assessed by measuring the Cobb angle on anteroposterior radiographs. However, MRI images are often available to study the degenerative spine. This retrospective study aims to develop and evaluate the reliability of a novel automatic method that measures coronal Cobb angles on lumbar MRI in DS patients.Materials and methodsVertebrae and intervertebral discs were automatically segmented using a 3D AI algorithm, trained on 447 lumbar MRI series. The segmentations were used to calculate all possible angles between the vertebral endplates, with the largest being the Cobb angle. The results were validated with 50 high-resolution sagittal lumbar MRI scans of DS patients, in which three experienced readers measured the Cobb angle. Reliability was determined using the intraclass correlation coefficient (ICC).ResultsThe ICCs between the readers ranged from 0.90 (95% CI 0.83–0.94) to 0.93 (95% CI 0.88–0.96). The ICC between the maximum angle found by the algorithm and the average manually measured Cobb angles was 0.83 (95% CI 0.71–0.90). In 9 out of the 50 cases (18%), all readers agreed on both vertebral levels for Cobb angle measurement. When using the algorithm to extract the angles at the vertebral levels chosen by the readers, the ICCs ranged from 0.92 (95% CI 0.87–0.96) to 0.97 (95% CI 0.94–0.98).ConclusionThe Cobb angle can be accurately measured on MRI using the newly developed algorithm in patients with DS. The readers failed to consistently choose the same vertebral level for Cobb angle measurement, whereas the automatic approach ensures the maximum angle is consistently measured.Clinical relevance statementOur AI-based algorithm offers reliable Cobb angle measurement on routine MRI for degenerative scoliosis patients, potentially reducing the reliance on conventional radiographs, ensuring consistent assessments, and therefore improving patient care.Key Points• While often available, MRI images are rarely utilized to determine the severity of degenerative scoliosis.• The presented MRI Cobb angle algorithm is more reliable than humans in patients with degenerative scoliosis.• Radiographic imaging for Cobb angle measurements is mitigated when lumbar MRI images are available.Graphical

Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: a systematic review and meta-analysis.

The objective of this meta-analysis was to determine the incidence of disc degeneration in patients with surgically treated adolescent idiopathic scoliosis (AIS) and identify the associated risk factors. PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched. The outcomes of interest were the incidence of disc degeneration, SRS-22, and radiological risk factors. The lower instrumented vertebra (LIV) was also evaluated. Fixed effects were used if there was no evidence of heterogeneity. Statistical analysis was performed using Review Manager. A meta-analysis was conducted including nine studies with a total of 565 patients. The analysis revealed that the global incidence of intervertebral disc degeneration in patients with surgically treated AIS patients was 24.78% (95% CI 16.59-32.98%) 10years after surgery, which significantly increased to 32.32% (95% CI 21.16-43.47% at an average of 13.8years after surgery. Among patients with significant degenerative disc changes, the SRS-22 functional, self-image, and satisfaction domains showed significantly worse results (MD - 0.25, 95% CI - 0.44 to - 0.05; MD - 0.50, 95% CI - 0.75 to - 0.25; and MD - 0.34, 95% CI - 0.66 to - 0.03, respectively). Furthermore, instrumentation at or above the L3 level was associated with a lower incidence of intervertebral disc degeneration compared to instrumentation below the L3 level (OR 0.25, 95% CI 0.10-0.64). It was also found that the preoperative and final follow-up lumbar curve magnitudes (MD 8.11, 95% CI 3.82-12.41) as well as preoperative and final follow-up lumbar lordosis (MD 0.42, 95% CI - 3.81 to 4.65) were associated with adjacent disc degeneration. This meta-analysis demonstrated that the incidence of intervertebral disc degeneration significantly increased with long-term follow-up using fusion techniques, reaching up to 32% when patients were 28years of age. Incomplete correction of deformity and fusion of levels below L3, were identified as negative prognostic factors. Furthermore, patients with disc degeneration showed worse functional outcomes.

Novel Screw Placement Method for Extremely Small Lumbar Pedicles in Scoliosis.

Study Design: Consecutive case series. Objective: To propose a screw placement method in patients with extremely small lumbar pedicles (ESLPs) (<2 mm) to maintain screw density and correction power, without relying on the O-arm navigation system. Summary of Background Data: In scoliosis surgery, ESLPs can hinder probe passage, resulting in exclusion or substitution of the pedicle screws with a hook. Screw density affects correction power, making it necessary to maximize the number of screw placements, especially in the lumbar curve. Limited studies provide technical guidelines for screw placement in patients with ESLPs, independent of the O-arm navigation system. Methods: We enrolled 19 patients who underwent scoliosis correction surgery using our novel screw placement method for ESLPs. Clinical, radiological, and surgical parameters were assessed. After posterior exposure of the spine, the C-arm fluoroscope was rotated to obtain a true posterior-anterior view and both pedicles were symmetrically visualized. An imaginary pedicle outline was presumed based on the elliptical or linear shadow from the pedicle. The screw entry point was established at a 2 (or 10) o'clock position in the presumed pedicle outline. After adjusting the gear-shift convergence, both cortices of the transverse process were penetrated and the tip was advanced towards the lateral vertebral body wall, where an extrapedicular screw was placed with tricortical fixation. Results: Out of 90 lumbar screws in 19 patients, 33 screws were inserted using our novel method, without correction loss or complications during an average follow-up period of 28.44 months, except radiological loosening of one screw. Conclusions: Our new extrapedicular screw placement method into the vertebral body provides an easy, accurate, and safe alternative for scoliosis patients with ESLPs without relying on the O-arm navigation system. Surgeons must consider utilizing this method to enhance correction power in scoliosis surgery, regardless of the small size of the lumbar pedicle.

Does the addition of convex uniplanar screws in hybrid constructs improve 3D surgical correction in thoracic adolescent idiopathic scoliosis posterior fusion?

Hybrid techniques using thoracic sublaminar bands have proved their efficacy in adolescent idiopathic scoliosis posterior fusion, but clinical axial correction sometimes remained disappointing. One solution found was "the frame technique" and the second alternative was the replacement of the convex sublaminar bands by periapical uniplanar screws. The goal of this study was to compare clinical and radiological outcomes of both techniques in a consecutive cohort of adolescent idiopathic scoliosis patients. All patients undergoing primary posterior fusion for thoracic adolescent idiopathic scoliosis between January 2017 and March 2020 were included. Two groups were compared: Group 1 with thoracic sublaminar bands only and Group 2 with periapical uniplanar screws. All patients underwent standing stereoradiographs. The main frontal, sagittal, and axial (apical vertebra rotation) radiological parameters of interest were analyzed. Functional outcomes were assessed using the Scoliosis Research Society 30 score. A total of 147 adolescents were included (Group 1, n = 73 and Group 2, n = 74 patients). In the frontal plane, a greater reduction index was observed in Group 2 (68% versus 62%, p < 0.001) as well as a better apical axial correction (67.8% versus 46.6%, p = 0.03). The number of thoracoplasty performed was reduced (6.7% versus 20.5%, p = 0.02) in Group 2, with a significant decrease in the rate of mechanical complication. No significant loss of correction was observed during follow-up in any of the group. The adjunction of convex uniplanar screws at the periapical levels improved the three-dimensional surgical correction of thoracic adolescent idiopathic scoliosis treated with hybrid constructs. level III, retrospective comparative study.

Limited Intervention in Adult Scoliosis-A Systematic Review.

Adult scoliosis is traditionally treated with long-segment fusion, which provides strong radiographic correction and significant improvements in health-related quality of life but comes at a high morbidity cost. This systematic review seeks to examine the literature behind limited interventions in adult scoliosis patients and examine the best approaches to treatment. This is a MEDLINE- and PubMed-based literature search that ultimately included 49 articles with a total of 21,836 subjects. Our search found that long-segment interventions had strong radiographic corrections but also resulted in high perioperative morbidity. Limited interventions were best suited to patients with compensated deformity, with decompression best for neurologic symptoms and fusion needed to treat neurological symptoms secondary to up-down stenosis and to provide stability across unstable segments. Decompression can consist of discectomy, laminotomy, and/or foraminotomy, all of which are shown to provide symptomatic relief of neurologic pain. Short-segment fusion has been shown to provide improvements in patient outcomes, albeit with higher rates of adjacent segment disease and concerns for correctional loss. Interbody devices can provide decompression without posterior element manipulation. Future directions include short-segment fusion in uncompensated deformity and dynamic stabilization constructs. Limited interventions can provide symptomatic relief to adult spine deformity patients, with indications mostly in patients with balanced deformities and neurological pain.

Pedicle Dysplasia in Proximal Thoracic Adolescent Idiopathic Scoliosis Curves: What are We Missing and What are its Possible Surgical Implications? An Observational Retrospective Study on 104 Patients.

Retrospective cohort study. To assess if pedicle dysplasia is present in proximal thoracic (PT), both structural and nonstructural, compared to main thoracic (MT) curves; and to assess if it is predictive of radiographic outcomes at minimum 2years of follow-up. A retrospective review of surgically-treated Adolescent Idiopathic Scoliosis (AIS) patients with Lenke 1-2-3-4 curves was performed. On preoperative CT-scan, at the apical vertebra, pedicle width on the concavity (PWc) and on the convexity (PWv) and Pedicle Dysplasia Index (PDI, defined as PWc/PWv) were measured. Preoperative and last follow-up (at least 2years) x-rays were reviewed. 104 patients meeting the inclusion criteria were divided into Structural-PT (S-PT) and Nonstructural-PT (NS-PT) groups based on Lenke criteria. PWc (P < .001). And PDI (P < .001 for S-PT, P = .004 for NS-PT) were significantly smaller in the PT than in MT curves for both groups. PT-PWc significantly correlated with follow-up PT Cobb for both groups (P < .001 and P = .015 respectively). PT-PDI significantly correlated with follow-up PT-Cobb (P < .001), CA (P < .040) and T1 tilt (P < .002), only for NS-PT group. NS-PT patients with PWc PT <1mm had higher RSHD (P = .021) and T1 tilt (P = .025) at follow-up. NS-PT patients with PDI PT <.3 had higher RSHD (P < .001), CA (P = .002) and T1 tilt (P = .003) at follow-up. S-PT and NS-PT curves show significant pedicle dysplasia on the concavity. Pedicle dysplasia significantly correlated with shoulder balance at follow-up, for NS-PT patterns. Patients with a PWc <1mm or PDI <.30 are at particular risk of postoperative shoulder imbalance.

Pelvic Fixation Technique Using the Ilio-Sacral Screw for 173 Neuromuscular Scoliosis Patients.

Pelvic fixation remains one of the main challenging issues in non-ambulatory neuromuscular scoliosis (NMS) patients, between clinical effectiveness and a high complication rate. The objective of this multicenter and retrospective study was to evaluate the outcomes of a technique that was applied to treat 173 NMS patients. The technique is not well-known but promising; it uses the ilio-sacral screw, combined with either the posterior spinal fusion or fusionless bipolar technique, with a minimum follow-up of two years. The mean operative age of the patients was 13 ± 7 years. The mean preoperative main coronal curve was 64° and improved by a mean of -39° postoperatively. The mean preoperative pelvic obliquity was 23°, which improved by a mean of -14° postoperatively. No decrease in the frontal or sagittal correction was observed during the last follow-up. The sitting posture improved in all cases. Twenty-nine patients (17%) had a postoperative infection: twenty-six were treated with local debridement and antibiotics, and three required hardware removal. Fourteen mechanical complications (8%) occurred: screw malposition (n = 6), skin prominence (n = 1), and connector failure (n = 1). This type of surgery is associated with a high risk for infection. Comorbidities, rather than the surgery itself, were the main risk factors that led to complications. The ilio-sacral screw was reliable and effective in correcting pelvic obliquity in NMS patients. The introduction of intraoperative navigation should minimize the risk of screw misplacement and facilitate revision or primary fixation.

Clinical characteristics and anaesthetic management of severe scoliosis patients with spinal muscular atrophy: case series

Introduction and importance: There is no expert consensus or guidance on perioperative anaesthesia management for spinal surgery of spinal muscular atrophy (SMA) patients with severe scoliosis (Cobb≧90°). We provide a comprehensive summary of the perioperative characteristics observed in patients with SMA and propose an optimized perioperative management strategy for anaesthesia. Methods: This study is a retrospective single-centre research. Twenty-six SMA patients with severe scoliosis underwent posterior spinal fusion surgery from September 2019 to September 2022 were enroled. The main outcomes were to show the patients’ characteristics in anaesthesia, intra- and post-operative periods. Outcomes: Nineteen patients underwent awake transnasal/transairway intubation. The median anaesthesia time of 25 patients treated under total intravenous anaesthesia was 425 min. After operation, the Cobb angle and correction rate in the coronal plane were median 54.0° and 54.4%. The length of mechanical ventilation with endotracheal intubation in ICU was median 17.5 h in 8 patients. The ICU length of stay of postoperative hospital was median 19 days. Postoperative pneumonia developed in nine patients, atelectasis in two patients, and pleural effusion in six patients. All patients did not need special oxygen therapy after discharge. Conclusion: Multidisciplinary consultation, lung-protective ventilation strategy, appropriate anaesthetic drugs and reasonable blood transfusion scheme and postoperative monitoring were important in anaesthesia, intraoperative and postoperative periods in the patients of severe scoliosis with spinal muscular atrophy.

Analysis of duration of different stages of surgery in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) patients: comparison between severe versus non-severe AIS.

Prolonged surgical duration in severe adolescent idiopathic scoliosis (AIS) patients is associated with increased blood loss and perioperative complications. The aim of this study was to compare the duration of each stage of posterior spinal fusion (PSF) in severe AIS (Cobb angle ≥ 90°) with non-severe AIS patients. This analysis will identify the most time-consuming stage of PSF and help surgeons formulate strategies to shorten operative time. Retrospective study whereby 90 AIS patients (Lenke type 2, 3, 4, and 6) who underwent PSF from 2019 to 2023 were recruited. Twenty-five severe AIS patients were categorized in Gp1 and 65 non-severe AIS patientsin Gp2. Propensity score matching (PSM) with one-to-one with nearest neighbor matching (match tolerance 0.05) was performed. Outcomes measured via operation duration of each stage of surgery, blood loss, number of screws, fusion levels and screw density. Twenty-five patients from each group were matched. Total operative time was significantly higher in Gp1 (168.2 ± 30.8 vs. 133.3 ± 24.0min, p < 0.001). The lengthiest stage was screw insertion which took 58.5 ± 13.4min in Gp1 and 44.7 ± 13.7min in Gp2 (p = 0.001). Screw insertion contributed 39.5% of the overall increased surgical duration in Gp1. Intraoperative blood loss (1022.2 ± 412.5 vs. 714.2 ± 206.7mL, p = 0.002), number of screws (17.1 ± 1.5 vs. 15.5 ± 1.1, p < 0.001) and fusion level (13.1 ± 0.9 vs. 12.5 ± 1.0, p = 0.026) were significantly higher in Gp1. Screw insertion was the most time-consuming stage of PSF and was significantly longer in severe AIS. Adjunct technologies such as CT-guided navigation and robotic-assisted navigation should be considered to reduce screw insertion time in severe AIS.