Scoliosis Research Society Questionnaire Research Articles

The Coronal and Sagittal Parameters before and after Posterior Spinal Fusion with all Pedicle Screw Construct in Adolescent Idiopathic Scoliosis (AIS) Patients and Comparing their Health-Related Outcomes Through SRS-22 Questionnaire

Background: Sagittal balance in severe androgen insensitivity syndrome (AIS) patient has been difficult to study due to problems with imaging technique. Abnormal sagittal profiles have been frequently observed in AIS patients presenting as cervical kyphosis, thoracic hypokyphosis, and positive sagittal vertical axis (SVA) off set. The significance of these changes is not understood in these patients. The purpose of this study is to assess the sagittal profile of AIS patients before and after surgery. Subjects and Methods: Changes in curve correction in both coronal and sagittal planes before and after surgery. Curve type, Cobb angles, sagittal parameters, and fusion level were analyzed with conventional parameters. Patient outcomes were measured using mobile device friendly Scoliosis Research Society-22 questionnaire online. Results: Fourteen patients were recruited. Average age was 16 years (13–36). Postoperation and final follow-up Cobb angles were reduced to 27°, 26°, and 16° and 29°, 28°, and 16°, respectively. In the sagittal plane, the Cobb angles pre- and postoperation and final follow-up are as follows: Cervical lordosis (36.7, 39.1, and 41.9), thoracic kyphosis (33.1, 35.8, and 39.1), lumbar lordosis (51.1, 45.2, and 54.2), SVA (1.3, 1.6, and 0), pelvic tilt (19, 21, and 18), sacral slope (47, 46, and 55), and pelvic tilt (43.7, 45, and 43.5). “Function”, “satisfaction,” and “mean” were significantly improved over the period, particularly between the last seen visit and before surgery. Conclusions: Abnormal coronal and sagittal parameters and their changes after surgery are reported in AIS patients. Patients expressed significant improvements in their function abilities and satisfied with clinical management, as well as their general quality of life.

Effect of core-based exercise in people with scoliosis: A systematic review and meta-analysis

Objective: To systematically assess the effectiveness of core-based exercise for correcting a spinal deformity and improving quality of life in people with scoliosis. Data sources: The PubMed, Embase, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Science databases were searched from inception up to September 30, 2020. Methods: Clinical controlled trials were eligible if they compared the effectiveness of core-based exercise to other nonsurgical interventions in people with scoliosis. The revised Cochrane risk of bias assessment tool for randomized trials and the methodological index for non-randomized studies scale were used to assess the risk of bias. The outcomes included the Cobb angle, the angle of trunk rotation and quality of life. RevMan 5.3 was used, and intergroup differences were determined by calculating mean differences (MD) and 95% confidence intervals (CIs). Results: After screening 1348 studies, nine studies with 325 participants met the inclusion criteria. The exercise group had significantly lower Cobb angles (MD = −2.08, 95% CI: −3.89 to −0.28, P = 0.02) and significantly better quality of life as measured by the Scoliosis Research Society-22 questionnaire (MD = 0.25, 95% CI: 0.02 to 0.49, P = 0.03) than the control groups. However, no significant difference was observed regarding the angle of trunk rotation between groups (MD = −0.69, 95% CI: −2.61 to 1.22, P = 0.48). Furthermore, no serious adverse events were reported. The overall quality of evidence ranged from low to very low. Conclusion: Core-based exercise may have a beneficial role in reducing the Cobb angle and improving quality of life in people with scoliosis in the short term. PROSPERO registration number: CRD42020160509 (Available at http://www.crd.york.ac.uk/prospero/)

Using Satellite Rod Technique in Patients with Severe Kyphoscoliosis Undergoing Three-Column Osteotomy: A Minimum of 2 Years' Follow-up.

ObjectiveTo introduce the satellite rod technique utilized in severe spinal deformity after three‐column osteotomy (3CO) and to evaluate the radiographic and clinical outcomes at 2‐year follow‐up, further discussing its utilization in this particular cohort.MethodsA total of 32 (19 females and 13 males) with an average age of 32.9 ± 18.3 years from December 2012 to March 2016 were retrospectively reviewed. Radiographic measurements were performed on standing full‐spine anteroposterior and lateral radiographs preoperatively, postoperatively, and at last follow‐up. The coronal parameters including Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL‐CSVL), as well as the sagittal parameters including global kyphosis (GK) and sagittal vertical axis (SVA) were measured at three time points. The Scoliosis Research Society‐22 questionnaire (SRS‐22) was fulfilled preoperatively and at each follow‐up. Paired t test would be used to determine whether there was a significant difference between time points.ResultsA total of 32 patients were enrolled in this study with mean age of 32.9 ± 18.3 (range, 12 to 66) years old. Twenty patients underwent pedicle subluxation osteotomy (PSO) and 12 patients underwent vertebral column resection (VCR). The pathogenesis of this cohort included neuromuscular scoliosis (11 cases), congenital kyphoscoliosis (seven with hemivertebrae and five with segmentation failure), degenerative spinal deformity (five cases), and thoracolumbar tuberculosis with angular kyphosis (four cases). The post‐operative Cobb angle decreased significantly from 49.1° ± 28.0° to 19.0° ± 16.7° with a correction rate of 65.2% ± 21.8%. At final follow‐up, the average Cobb angle was 19.4° ± 16.9° and no obvious loss of correction was found. The preoperative, postoperative, and last follow‐up C7PL‐CSVL were 23.9 ± 14.5 mm, 15.7 ± 11.1 mm, and 12.1 ± 7.4 mm, respectively. Significant postoperative improvement was attained while there was no change observed at last follow‐up. Postoperative GK significantly improved from 73.8° ± 28.1° to 23.2° ± 11.7° with the correction rate of 66.0% ± 17.9%. SVA decreased significantly from 42.9 ± 33.9 mm to 24.1 ± 21.1 mm. The average GK and SVA at final follow‐up were 22.7° ± 10.1° and 23.5 ± 21.1 mm, respectively and no obvious loss of correction was observed of them during follow‐up. In addition, no change or loss of motor or somatosensory evoked potential occurred during surgery. During the follow‐up, two malposition screws and one rod breakage were found.ConclusionThe satellite rod used in patients with severe kyphoscoliosis undergoing 3CO could yield favorable radiological and clinical outcomes. With the utilization of this technique, the coronal and sagittal balance could be well‐maintained during follow‐up.

Reliability and validity of Turkish version of the Scoliosis Japanese Questionnaire- 27 in patients with adolescent idiopathic scoliosis

BackgroundThe aim of this study was to evaluate the reliability and validity of an adapted Turkish version of the Scoliosis Japanese Questionnaire- 27 (SJ- 27). MethodsTranslation and retranslation of the English version of the SJ- 27 was conducted, and all steps of the cross-cultural adaptation process were performed. The Turkish version of the SJ- 27, the Scoliosis Research Society-22 (SRS- 22) questionnaire and the Short Form-36 (SF- 36) were performed to 139 patients with AIS. Reliability was assessed using the test–retest method (Pearson's correlation coefficient); internal consistency was analyzed using Cronbach's alpha. Validity was assessed by correlating the SJ- 27 with the SRS- 22 questionnaire and SF- 36. ResultsThe mean Cobb angles were 23.2 ± 8.3° and 19 ± 5.9° for thoracic and lumbar regions, respectively. The SJ- 27 showed excellent test/retest reliability with an Intraclass correlation coefficient of 0.99. Internal consistency of the SJ- 27 was found to be very good (Cronbach's alpha = 0.991). The SJ- 27 demonstrated very good construct validity with the SRS- 22 total score (r = 0.61). The similar domains of the SJ- 27 and SF- 36 questionnaire was correlated also in the study. ConclusionsThe Turkish version of the SJ- 27 to measure health related quality of life in adolescent idiopathic scoliosis was found to have very good validity, excellent reliability, and high internal consistency.

Residual lumbar curvature that developed during adolescence accelerates intervertebral disc degeneration in adulthood.

To elucidate the influence of spinal deformity in adolescent idiopathic scoliosis (AIS) on lumbar intervertebral disc (IVD) degeneration in adulthood using magnetic resonance imaging (MRI). A total of 102 patients (8 men, 94 women; mean age, 31.4years) who had developed idiopathic scoliosis at the age of 10-18years and underwent preoperative lumbar spine MRI at the age of ≥ 20 were included in the study. Twenty volunteers (3 men, 17 women; mean age, 33.6years) without scoliosis were assessed as controls. We divided the adult scoliosis patients into two groups: Group A consisted of patients with lumbar modifier A, and Group BC consisted of those with modifiers B and C. IVD degeneration from L1/2 to L5/S1 was assessed by MRI. The Scoliosis Research Society-22 (SRS-22) patient questionnaire was used in the patients' clinical assessment. There were 40 patients in the Group A and 62 in the Group BC. Compared to the control groups, significant IVD degeneration was observed at L2/3 and L3/4 in Group A, and at all levels except for L5/S1 in Group BC. The proportion of degenerated IVDs patients (Grades 1c and 2) was significantly higher in Group BC than those in Group A at L3/L4 and L4/L5. Furthermore, the severity of IVD degeneration was significantly greater in the group BC than in the group A at all levels, except for L5/S1, especially in patients aged > 30years. The mean scores of all subdomains in the SRS-22 questionnaire were comparable between the two groups. Our study showed that the residual lumbar curvature from AIS may have accelerated IVD degeneration in adulthood, especially in patients aged > 30years. III.

Radiographic and clinical evidence: osteoarthritic knee can change surgical result for lumbar degenerative disease patient undergone surgery for 3-year follow-up: a retrospective comparative clinical study

BackgroundThere is a paucity of reports clarifying the implication of knee osteoarthritis (OA) on spinal sagittal alignment of patients undergone surgery for lumbar spine. This study aimed to analyze how osteoarthritic knee affects radiographic and clinical results of degenerative lumbar disease patients undergone lumbar fusion.MethodsWe retrospectively reviewed the medical records and radiographs of 74 consecutive degenerative lumbar disease patients who underwent posterior instrumentation and fusion surgery between May 2016 and June 2017 and were followed up for minimum 3 years postoperatively. The patients were divided into 2 groups according to the severity of knee OA by Kellgren-Lawrence grading (KLG) scale (group I, KLG 1 or 2 [n = 39]; group II, KLG 3 or 4 [n = 35]). Patient demographic data, comorbidities, spinal sagittal parameters and clinical scores were extracted and compared at preoperative, postoperative 1 month and the ultimate follow-up between the groups. In radiographic assessment, sagittal alignment parameters and sagittal balance were used. In clinical assessment, the scores of Oswestry disability index (ODI) and Scoliosis Research Society questionnaire (SRS-22) were used. For the frequency analysis of categorical variables across the groups, chi-square test was used and student t tests was used to compare the differences of continuous variables.ResultsIn radiographic assessment, TLK (thoracolumbar kyphosis), LL (lumbar lordosis), PT (pelvic tilt), C7 SVA (sagittal vertical axis) in both groups improved significantly after surgery (p < 0.05). However, LL, PT, C7SVA improved at postoperative 1 month in the group II were not maintained at the ultimate postoperative follow-up. In clinical assessment, preoperative Oswestry disability index (ODI, %) and all SRS-22 subscores of the group I and II were not different (p > 0.05). There were significant differences between the groups at the ultimate follow-up in ODI (− 25.6 vs − 12.1, p < 0.001), SRS total score (%) (28 vs 20, p = 0.037), function subscore (1.4 vs 0.7, p = 0.016), and satisfaction subscore (1.6 vs 0.6, p < 0.001).ConclusionOsteoarthritic knee with KLG 3 or 4 have a negative influence on maintaining postoperative spinal sagittal alignment, balance, and the clinical outcomes achieved immediately by posterior instrumentation and fusion for lumbar degenerative disease.Trial registrationThis study was retrospectively registered with approval by the institutional review board (IRB) of our institution (approval number: 2018–11-007).

Analyse des changements réciproques dans les profils cervicaux supérieurs après fusion vertébrale postérieure avec la technique de dérotation simultanée à double tige pour la scoliose idiopathique de l’adolescent

BackgroundThe relationship between postoperative change of cervical lordotic alignment and restoration of thoracic kyphosis with adolescent idiopathic scoliosis (AIS) is still controversial. We investigated reciprocal changes in the sagittal profiles of the upper and middle-lower cervical spinal segments after posterior spinal fusion with the simultaneous double rod rotation technique (SDRRT) for AIS. HypothesisOcciput-C2 and C2-C7 sagittal profiles of patients with AIS could change significantly after surgical adequate increase of thoracic kyphosis with SDRRT. Patients and methodsTwenty-seven consecutive patients with AIS treated with the SDRRT were retrospectively reviewed. We investigated the following parameters preoperatively, postoperatively, and at the 2-year follow-up: the Cobb angles of main thoracic curves; C7 sagittal vertical axis; thoracic kyphosis (TK) from T5 to T12; lumbar lordosis from L1 to S1; chin-brow vertical angle; McGregor's slope; occiput to C2 Cobb angle (O-C2angle); C2-C7 Cobb angle (C2-C7angle); T1-slope; and C2-C7 sagittal vertical axis. Additionally, the Scoliosis Research Society questionnaire was completed preoperatively and at the 2-year follow-up. Patients were categorised according to preoperative TK (T5-T12) into hypokyphotic (TK<20°) and normo-hyperkyphotic (TK ≥20°) groups. To assess the effect of corrective surgery on sagittal profiles, we investigated correlations among the changes in sagittal parameters. ResultsThe mean preoperative TK was 6.1±3.7° in the hypokyphotic group and 23.5±4.7° in the normo-hyperkyphotic group (p<0.001), which was significantly improved postoperatively (22.3±4.4° and 26.1±2.6°, respectively; p=0.02) and at the 2-year follow-up (23.0±6.3° and 26.8±5.0°, respectively; p=0.04). The mean preoperative C2-C7angle reflected kyphosis (7.4±9.8°) in the hypokyphotic group, and, in contrast, lordosis (−8.8°±6.8°) in the normo-hyperkyphotic group (p<0.001), which improved toward greater lordosis postoperatively (−3.7±5.8° and −14.8±5.1°, respectively; p<0.001) and at the 2-year follow-up (−5.1±4.4° and −15.3±6.4°, respectively; p<0.001). On the other hand, the mean preoperative O-C2angle was −20.5±6.5° in the hypokyphotic group and −13.1±2.8° in the normo-hyperkyphotic group (p=0.002), which was significantly changed postoperatively (−12.6±6.4° and −7.7±4.3°, respectively; p=0.04) and at the 2-year follow-up (−13.1±6.3° and −7.9±4.3°, respectively; p=0.04). ΔC2-C7 was negatively correlated with ΔT5-T12 (r=−0.298) and ΔO-C2angle (r=−0.332). DiscussionLordotic reciprocal alignment changes in the C2-C7angle can occur after adequate restoration of TK. The O-C2angle compensates the C2-C7angle for a maintained horizontal gaze. O-C2 and C2-C7 sagittal profiles of patients with AIS changed significantly after corrective surgery with SDRRT. Level of evidenceIV, Case-series.

Long-Term Follow-up of Posterior Selective Thoracolumbar/Lumbar Fusion in Patients With Lenke 5C Adolescent Idiopathic Scoliosis: An Analysis of 10-Year Outcomes.

Study Design:Retrospective study.Objective:The aim of this study was to assess long-term radiographic and clinical outcomes in Lenke 5C adolescent idiopathic scoliosis (AIS) patients after posterior selective fusion.Methods:Lenke 5C AIS patients who underwent posterior selective thoracolumbar/lumbar (TL/L) fusion in our hospital from January 2007 to January 2010 were recruited. Radiographic parameters were measured preoperatively and at the 3-month, 1-year, 2-year, 5-year, and 10-year follow-ups. The SRS-22 (Scoliosis Research Society) questionnaire was used to assess the clinical outcomes.Results:We included 37 patients who underwent posterior selective TL/L fusion surgery in our study, and the mean follow-up time was 11.26 ± 0.85 years. The average preoperative Cobb angles of the thoracic and TL/L curves were 24.0 ± 9.0° and 45.4 ± 6.3°, respectively, which were corrected to 12.2° and 12.4° at the 3-month follow-up postoperatively, with correction losses of 2.2° and 1.5° at the 10-year follow-up. In the sagittal plane, the degree of thoracic kyphosis (TK) gradually increased over the follow-up period. The proximal junctional angle (PJA) also gradually increased from 6.7 ± 4.6 to 13.7 ± 5.6 during the follow-up period. For the clinical outcomes, correction surgery improved the SRS-22 scores in each domain, especially in the self-image domain.Conclusions:Posterior selective TL/L fusion can effectively correct spinal deformities, leading to stable outcomes for 10 years postoperatively. During the follow-up period, the degree of TK presented an increasing trend that remained almost constant after the 1-year follow-up. Moreover, the variation in the PJA was highly significant in the postoperative period, and it showed an increasing trend until the 2-year follow-up.

39. Critical analysis of anterior/posterior staged vs same day surgery in patients undergoing identical corrective surgery for adult spinal deformity

BACKGROUND CONTEXT Surgical intervention aimed at addressing adult spinal deformity (ASD) is an invasive and complex procedure that surgeons often elect to perform anterior/posterior (A/P) on different days. Literature on the effect of the interval between procedures on outcomes is limited. PURPOSE Identifying optimal interval of time between A/P staged surgeries during same hospitalization. STUDY DESIGN/SETTING Retrospective cohort study of a prospective multicenter database of ASD patients. PATIENT SAMPLE A total of 176 propensity score matched A/P ASD patients. OUTCOME MEASURES Health-related quality of life (HRQL) measures including Oswestry Disability Index (ODI), Scoliosis Research Society Questionnaire (SRS22); SF-36, EBL, LOS. METHODS Op patients who met ASD database criteria (>18yrs, scoliosis ≥20°, SVA ≥5cm, PT ≥25° and/or TK >60°), had a A/P fusion to the pelvis and had complete radiographic and HRQL data at baseline (BL) and 2Y were included. Propensity score match for levels fused, number of interbodies, interbody approach, number of osteotomies, baseline frailty, ODI, CCI, revisions, SVA, PI-LL, and UIV isolated a matched cohort of A/P same day and staged surgical patients. All patients underwent both A/P procedures during same admission. Posterior-only procedures were excluded. Patients that underwent a staged (not same day) corrective procedure were further stratified into percentiles of days between staging: (1) 25th percentile (2 days); (2) 50th percentile (3 days); (3) 75th percentile (5 days). Means comparison tests assessed differences in baseline demographic, clinical data, and intervals of staging. RESULTS A total of 176 propensity score matched patients (63.0yrs, 80% F, 29.2 kg/m2) were isolated. Radiographically at baseline, patients presented with: PT (26.8±10.0), PI-LL (24.5±18.7), SVA (96.1±78.7). The median interval between A/P staged procedures was 3.0 days±2.6. Staged patients had significantly greater overall operative time (628 min vs 501 min) and lower ICU stays postoperatively (p CONCLUSIONS In the closest matched cohort known to date of A/P staged and same day surgery patients, staged procedures were shown to result in significant improvement radiographically, reduced ICU stays, and superior patient reported outcomes. An interval of three days between A/P staged procedures was associated with increased improvement in GAP proportionality even after adjusting for institution and surgeon. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Minimally invasive surgery versus standard posterior approach for Lenke Type 1-4 adolescent idiopathic scoliosis: a multicenter, retrospective study.

To compare the safety and efficacy of posterior minimally invasive surgery (MIS) to standard posterior spinal fusion (PSF) surgery for Lenke Type 1-4 adolescent idiopathic scoliosis (AIS). This multicenter retrospective study enrolled 112 patients with Lenke Type 1-4 AIS who treated with MIS (n = 64) or PSF (n = 48) between March 2007 and January 2015. Coronal and sagittal parameters were evaluated before surgery, immediately after surgery, and at the last follow-up. Operative time, level of fusion, intraoperative blood loss, blood transfusion, and intraoperative radiation exposure were recorded. 22-item Scoliosis Research Society questionnaire (SRS-22) was applied for assessment of life quality. The accuracy of pedicle screw placement was assessed according to postoperative computed tomography images, and the complications were collected in follow-up period. The baseline characteristics of 2 groups were matched. There was no significant difference between 2 groups in terms of radiographic parameters immediately after surgery and at the last follow-up. The MIS group had significantly longer operative time, more level of fusion, less intraoperative blood loss, and lower blood transfusion rate (p < 0.001). The evaluation of pain using SRS-22 showed significantly lower score in MIS group (p < 0.05). No significant difference was found between 2 groups in terms of accuracy of pedicle screw placement and complications. Posterior MIS is a safe and effective alternative to standard open approach for Lenke Type 1-4 AIS patients with curves < 70° and reasonable flexibility. Mid-term results showed MIS had the advantages of less blood loss and pain with more fusion segments.

Health Mindset Correlates with Health-Related Quality of Life Assessment in Adolescents with Idiopathic Scoliosis

PURPOSE Mindset theory describes two different categories: “fixed”, in which a particular personal characteristic is seen as unchangeable, and “growth”, in which the characteristic is viewed as malleable and subject to improvement. Recently, the concept of mindset has been applied to the study of health beliefs and how they influence wellness behaviors. The Scoliosis Research Society Questionnaire (SRS-30) is a specific instrument to measure health-related quality of life in patients with scoliosis. The purpose of this study is to evaluate how health mindset correlates with an adolescent’s health-related …

Surgical Scoliosis Correction in Chiari-I Malformation with Syringomyelia Versus Idiopathic Syringomyelia.

Both patients with Chiari-I malformation (CIM) with syringomyelia and those with idiopathic syringomyelia (ISm) have a syrinx and can have scoliosis as well. However, there is no literature regarding differences between CIM and ISm in terms of radiographic outcomes and surgical complications after posterior fusion, to our knowledge. The aim of the present study was to compare radiographic features, clinical outcomes, and surgical complications after posterior spinal fusion between patients with CIM-associated scoliosis and those with ISm-associated scoliosis. One hundred and twenty patients with syringomyelia-associated scoliosis were retrospectively analyzed. Twenty-one patients with scoliosis secondary to CIM were enrolled and matched by sex, age, and the Cobb angle of the scoliotic curve with 21 patients with scoliosis secondary to ISm. All patients underwent 1-stage posterior fusion surgery. Coronal and sagittal radiographic parameters were evaluated before surgery, immediately after surgery, and at the final follow-up (at least 2 years). We also collected data regarding syringeal features, neurological deficits, intraoperative neuromonitoring, and complications. Sex, age, preoperative coronal/sagittal scoliosis parameters, and neurological deficits were similar between the matched CIM and ISm groups. On average, the CIM group had a longer syrinx (12.3 ± 3.6 versus 8.9 ± 4.5 vertebral levels, p = 0.010) than the ISm group. The CIM and ISm groups showed similar correction rates for primary curves (70.9% ± 10.6% versus 69.5% ± 16.3%, p = 0.739). There were no significant differences in coronal/sagittal correction, intraoperative neuromonitoring abnormalities, surgical complications, or Scoliosis Research Society-22 questionnaire scores between the 2 groups. Despite matched demographic and scoliotic coronal parameters, patients with CIM had longer syrinxes compared with patients with ISm. One-stage posterior fusion achieved comparable clinical and radiographic outcomes for both CIM- and ISm-associated scoliosis without significant differences in neurological complications. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Associations between three-dimensional measurements of the spinal deformity and preoperative SRS-22 scores in patients undergoing surgery for major thoracic adolescent idiopathic scoliosis.

Retrospective study. To analyze the relationships between three-dimensional (3D) measurements of spinal deformity and Scoliosis Research Society-22 (SRS-22) scores in preoperative patients with major thoracic adolescent idiopathic scoliosis (AIS). Previous studies reported 2D measurements were not or only weakly correlated with preoperative SRS-22 scores. However, 2D measures do not always accurately represent the 3D deformity. A multicenter prospective registry of surgically treated AIS patients was reviewed for patients with right major thoracic AIS (Lenke type 1-4) who underwent biplanar radiography and completed the SRS-22 questionnaire preoperatively. For the 3D measurements, two reference frames were utilized: global (gravity/patient-based) and local (vertebra/disc-based). To obtain regional measurements, the individual segments in the appropriate reference plane were summed between the levels of interest. Patients were divided into two groups for each SRS-22 domain according to their scores: low (< 4) and high (≥ 4) score groups. Group differences and correlations with SRS-22 scores were analyzed with p < 0.01 as the threshold for significance. There were 405 eligible patients (mean age, 14.4years). The mean 3D thoracic curve was 59° (45°-115°). The only significant group difference of 3D measurements occurred in the local lumbar lordosis (LL) with a small mean difference (-3.4°, p = 0.008) in the mental health domain. In the correlation analyses, global and local thoracic kyphosis (TK) and TK/LL ratio demonstrated significant, but weak, correlations with function and total scores (|r|< 0.2, p < 0.01). 3D measurements of scoliosis severity have only weak associations with preoperative SRS-22 scores, which might indicate a limit to the discriminative capacity of the SRS-22 within surgical range major thoracic AIS curves. Interestingly, the sagittal plane was the principle 3D plane in which significant correlations existed. II, prognostic.

Body Awareness and its Relation to Quality of Life in Individuals with Idiopathic Scoliosis.

An individual's body awareness depends on the integration of bodily signals from both inside and outside the body. The etiology of idiopathic scoliosis includes a variety of somatosensorial and biomechanical alterations that may affect an individual's body awareness. In this study, we investigated body awareness and its relation to quality of life among individuals with idiopathic scoliosis. We studied 96 participants with scoliosis and 71 healthy control participants. We evaluated both participant groups' body awareness using the Awareness-Body-Chart, and we assessed the quality of life of those with scoliosis using the Scoliosis Research Society-22 (SRS-22) questionnaire. The overall body awareness score and the body awareness values for the face, cervical/lumbar region, back, shoulder, upper arm, lower arm/elbow, hand, genital area, thigh/hip, lower leg, and foot were all found to be significantly lower among the participants with scoliosis than among healthy participants. Among participants with scoliosis, the body awareness value for the back region was positively correlated with pain, body image, mental health, and overall quality of life scores on the SRS-22, whereas the pain score on the Awareness-Body-Chart was negatively correlated with the function/activity, pain, mental health, and overall scores for the SRS-22. This study showed that participants with idiopathic scoliosis have poorer body awareness than control participants without scoliosis, and body awareness among participants with scoliosis was correlated with their self-reports of pain, body image, function, and mental health. These findings highlight the particular importance of body awareness to quality of life for individuals with scoliosis.

Analysis of reciprocal changes in upper cervical profiles after posterior spinal fusion with the simultaneous double rod rotation technique for adolescent idiopathic scoliosis

BackgroundThe relationship between postoperative change of cervical lordotic alignment and restoration of thoracic kyphosis with adolescent idiopathic scoliosis (AIS) is still controversial. We investigated reciprocal changes in the sagittal profiles of the upper and middle-lower cervical spinal segments after posterior spinal fusion with the simultaneous double rod rotation technique (SDRRT) for AIS. HypothesisOcciput-C2 and C2-C7 sagittal profiles of patients with AIS could change significantly after surgical adequate increase of thoracic kyphosis with SDRRT. Patients and methodsTwenty-seven consecutive patients with AIS treated with the SDRRT were retrospectively reviewed. We investigated the following parameters preoperatively, postoperatively, and at the 2-year follow-up: the Cobb angles of main thoracic curves; C7 sagittal vertical axis; thoracic kyphosis (TK) from T5 to T12; lumbar lordosis from L1 to S1; chin-brow vertical angle; McGregor's slope; occiput to C2 Cobb angle (O-C2angle); C2-C7 Cobb angle (C2-C7angle); T1-slope; and C2-C7 sagittal vertical axis. Additionally, the Scoliosis Research Society questionnaire was completed preoperatively and at the 2-year follow-up. Patients were categorized according to preoperative TK (T5-T12) into hypokyphotic (TK<20°) and normo-hyperkyphotic (TK≧20°) groups. To assess the effect of corrective surgery on sagittal profiles, we investigated correlations among the changes in sagittal parameters. ResultsThe mean preoperative TK was 6.1±3.7° in the Hypokyphotic group and 23.5±4.7° in the Normo-hyperkyphotic group (p<0.001), which was significantly improved postoperatively (22.3±4.4° and 26.1±2.6°, respectively; p=0.02) and at the 2-year follow-up (23.0±6.3° and 26.8±5.0°, respectively; p=0.04). The mean preoperative C2-C7angle reflected kyphosis (7.4±9.8°) in the Hypokyphotic group, and, in contrast, lordosis (−8.8±6.8°) in the Normo-hyperkyphotic group (p<0.001), which improved toward greater lordosis postoperatively (−3.7±5.8° and −14.8±5.1°, respectively; p<0.001) and at the 2-year follow-up (−5.1±4.4° and −15.3±6.4°, respectively; p<0.001). On the other hand, the mean preoperative O-C2angle was −20.5±6.5° in the Hypokyphotic group and −13.1±2.8° in the Normo-hyperkyphotic group (p=0.002), which was significantly changed postoperatively (−12.6±6.4° and −7.7±4.3°, respectively; p=0.04) and at the 2-year follow-up (−13.1±6.3° and −7.9±4.3°, respectively; p=0.04). ΔC2-C7 was negatively correlated with ΔT5-T12 (r=−0.298) and ΔO-C2angle (r=−0.332). DiscussionLordotic reciprocal alignment changes in the C2-C7angle can occur after adequate restoration of TK. The O-C2angle compensates the C2-C7angle for a maintained horizontal gaze. O-C2 and C2-C7 sagittal profiles of patients with AIS changed significantly after corrective surgery with SDRRT. Level of evidenceIV, Case-series.

Prospective Comparison of Patient-selected Operative Versus Nonoperative Treatment of Scheuermann Kyphosis

Scheuermann kyphosis (SK) can be managed operatively or nonoperatively. Few studies compare the effect of operative versus nonoperative treatment on patient health-related quality of life. We compare 2-year radiographic and the Scoliosis Research Society-22 questionnaire (SRS-22) results of patients who self-selected either conservative or surgical treatment. Single institution review of prospectively collected data for patients presenting with SK from 2006 to 2014. Forty-five of 55 patients returned for 2-year follow-up. Patients were divided into operative (n=27) or nonoperative (n=18) groups based upon their self-selected method of treatment. Radiographic data and SRS-22 scores were collected at initial presentation and 2-year follow-up. Operatively treated patients had larger initial sagittal Cobb angles and lower SRS-22 scores in the pain and appearance domains. Two years postoperatively, surgically treated patients had smaller Cobb angles and improved scores in these SRS-22 domains. Nonoperatively treated patients did not deteriorate over time. Patients who elect to receive operative treatment for SK have improved radiographic and SRS-22 parameters at 2-year follow-up compared with patients who elect nonoperative treatment. Not surprisingly, patients selecting surgical treatment had greater sagittal Cobb angles and greater levels of pain and dissatisfaction with their appearance. However, at 2-year follow-up, surgical patients experience greater (and significant) change on all parameters; exhibiting smaller Cobb angles, less pain, and greater satisfaction with their outcomes. Nonoperatively treated patients do not deteriorate over 2 years. Level II-prognostic study.

Outcome of 24 Weeks of Combined Schroth and Pilates Exercises on Cobb Angle, Angle of Trunk Rotation, Chest Expansion, Flexibility and Quality of Life in Adolescents with Idiopathic Scoliosis.

BackgroundThis study aimed to quantify the outcomes of combining Schroth and Pilates exercises on the Cobb angle, angle of trunk rotation (ATR), chest expansion, flexibility (trunk flexion), and quality of life (QoL) in adolescents with mild and moderate idiopathic scoliosis.Material/MethodsSixty-nine adolescents with idiopathic scoliosis aged 10–17 years, presenting with a Cobb angle of 10–45º were enrolled in this study. The treatment protocol, including selected exercises from Schroth and Pilates methods, was performed over 24 weeks and consisted of 2 periods of 2-week treatment regimens performed daily for 60 minutes. Each of treatment periods was then followed by the same home program treatment for 10 weeks. Cobb angle (x-rays), ATR (Scoliometer), chest expansion (cm), trunk flexion (cm, distance between C7 to S2 with measuring tape), and QoL (SRS-22r Scoliosis Research Society Questionnaire) were assessed pre-treatment, at 12 week, and at 24 weeks.ResultsSignificant improvements (P<0.05) were found in both groups of patients wearing and not wearing a brace for Cobb angle (from 21.97±4.99° to 18.11±6.39°; from 14.19±3.11° to 11.66±2.73°), angle of trunk rotation (from 7.19±1.36° to 5.36±1.66°; from 4.72±1.04° to 3.58±0.94°), chest expansion (from 2.56±0.84 cm to 3.46±0.72 cm; from 2.57±0.87 cm to 3.52±0.72 cm), trunk flexion (from 9.55±1.95 cm to 14.33±2.40 cm; from 9.82±2.61 cm to 13.98±2.18 cm) and QoL (from 3.50±0.27 to 3.82±0.2; from 3.42±0.24 to 3.78±0.23) respectively.ConclusionsThis study showed that combined exercises provided benefit on the Cobb angle, ATR, chest expansion, trunk flexion and QoL in adolescents with mild and moderate idiopathic scoliosis.

What level of symptoms are patients with adult spinal deformity prepared to live with? A cross-sectional analysis of the 12-month follow-up data from 1043 patients.

Previous studies suggest that a meaningful and easily understood measure of treatment outcome may be the proportion of patients who are in a "patient acceptable symptom state" (PASS). We sought to quantify the score equivalent to PASS for different outcome instruments, in patients with adult spinal deformity (ASD). We analysed the following 12-month questionnaire data from the European Spine Study Group (ESSG): Oswestry Disability Index (ODI; 0-100); Numeric Rating Scales (NRS; 0-10) for back/leg pain; Scoliosis Research Society (SRS) questionnaire; and an item "if you had to spend the rest of your life with the symptoms you have now, how would you feel about it?" (5-point scale, dichotomised with top 2 responses "somewhat satisfied/very satisfied" being considered PASS+, everything else PASS-). Receiver operating characteristics (ROC) analyses indicated the cut-off scores equivalent to PASS+. Out of 1043 patients (599 operative, 444 non-operative; 51 ± 19years; 84% women), 42% reported being PASS+ at 12 months' follow-up. The ROC areas under the curve were 0.71-0.84 (highest for SRS subscore), suggesting the questionnaire scores discriminated well between PASS+ and PASS-. The scores corresponding to PASS+ were > 3.5 for the SRS subscore (> 3.3-3.8 for SRS subdomains); ≤ 18 for ODI; and ≤ 3 for NRS pain. There were slight differences in cut-offs for subgroups of age, treatment type, aetiology, baseline symptoms, and sex. Most interventions for ASD improve patients' complaints but do not totally eliminate them. Reporting the percentage achieving a score equivalent to an "acceptable state" may represent a more stringent and discerning target for denoting treatment success in ASD. These slides can be retrieved under Electronic Supplementary Material.

Reliability and Validity of the Turkish Version of the Body Image Disturbance Questionnaire-Scoliosis.

It is cross-cultural adaptation and validation of the Body Image Disturbances Questionnaire. The purpose of the study was to adopt the English version of the Body Image Disturbance Questionnaire-Scoliosis (BIDQ-S) into Turkish language. BIDQ-S is originally adopted from BIDQ scale which is designed to be used for healthy subjects in order to assess concerns and distress about physical appearance, and impairment on daily functioning. However, there is no culturally adopted and validated BIDQ-S for the Turkish population. Translation and back translation method was used to guide the translation process of the BIDQ-S from English to Turkish. In order to determine and confirm the factor structure of the Turkish BIDQ-S exploratory and confirmatory factor analysis were performed. Convergent validity of the Turkish BIDQ-S- was determined by calculating the correlations of BIDQ-S, and the factors emerged, with the indicators of subjective well-being which consists of three components: positive affect (PA), negative affect (NA), and satisfaction with life (SWL) and of health related quality of life measured by Scoliosis Research Society Questionnaire (SRS-22). The data from the present study demonstrated that different from the original, German and Chinese versions two factor solutions were found. The Turkish BIDQ-S also showed satisfactory internal consistency value with Cronbach α equals to 0.88 construct validity. In conclusion, current study shows that Turkish BIDQ-S is a valid and reliable questionnaire for assessing the body image concerns in patients with scoliosis in Turkish population. 4.

Introduction of the Novel Radiographic Line (L5-Kyphosis Apex Line) Intended to Evaluate Scheuermann's Disease and Postural Kyphosis Progression on Standard Lateral X-Rays.

Study DesignCross-sectional and follow-up nested study.PurposeTo assess the reliability of the L5-kyphosis apex line (L5-KAL) evaluation and determine the association between changes in L5-KAL, changes in radiological parameters, and changes in clinical symptoms.Overview of LiteratureScheuermann’s disease is the most common cause of hyperkyphosis of the thoracolumbar and thoracic spine during adolescence. Scheuermann’s disease patients usually show compensatory hyperlordosis of the lumbar spine, which is usually flexible, and express an anterior translation of the lumbar section. The L5-KAL was developed on the basis of our clinical experience, displaying the horizontal distance between the thoracic and lumbar curves.MethodsIn the cross-sectional segment, 150 initial lateral X-rays of patients with Scheuermann’s disease and postural kyphosis were analyzed, and 80 additional X-rays were analyzed in the follow-up segment. The data taken from the X-rays of the whole spinal column included the thoracic kyphosis angle, the C7 plumb line, and the L5-KAL. Clinical data included a numerical rating scale of self-perceived body image, pain, and a Scoliosis Research Society-22 questionnaire (SRS-22).ResultsSignificant positive associations were observed in a cross-sectional study between the L5-KAL and thoracic kyphosis, lumbar lordosis, C7 line, and self-perceived body image. In the follow-up nested study, in a mixed analysis of variance, the main effect of time was significant for the L5-KAL, kyphotic deformity and SRS-22, which indicated a change in these parameters after treatment of Scheuermann’s disease patients. Significant positive associations were observed between the changes in L5-KAL and the changes in thoracic kyphosis.ConclusionsOur evidence suggests that the L5-KAL can serve as an indicator of the thoracic curve change in Scheuermann’s disease and postural kyphosis patients and should be considered in clinical practice.