Scoliosis Research Society Scores Research Articles

Effects of a Long-Term Supervised Schroth Exercise Program on the Severity of Scoliosis and Quality of Life in Individuals with Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial Study

Background and Objectives: Adolescent Idiopathic Scoliosis (AIS) affects individuals aged 10–18 years and is characterized by spinal deformity, three-dimensional axis deformation, and vertebral rotation. Schroth method exercises and braces have been shown to reduce the Cobb angle and halt spinal deformity progression. The aim of this study was to investigate the impact of a 12-month, supervised Schroth exercise program on scoliosis severity and quality of life in adolescents with AIS. Materials and Methods: Eighty adolescents with AIS (aged 10–17 years) were prescribed a brace and were divided into two groups. The intervention group followed a supervised Schroth exercise program three times a week for 12 months in addition to wearing a brace. The control group used only the brace. Outcomes included the Cobb angle of the main curvature and the sum of curves using radiography, the maximum angle of trunk rotation (ATR maximum, using a scoliometer), and quality of life with the Scoliosis Research Society-22 (SRS-22) questionnaire. Evaluations were conducted at baseline, after 12 months, and 6 months post-intervention. A multivariate analysis of covariance (MANCOVA) was used for statistical analysis (p-Value < 0.05). Results: The intervention group showed statistically significant improvement compared to the control group in the 12th month in Cobb angle (mean differences, 95% CI: −3.65 (−5.81, −1.53), p-Value < 0.001, Cohen’s d = 0.30), ATR maximum (mean differences, 95% CI: −3.05 (−3.86, −2.23), p-Value < 0.001, Cohen’s d = 0.74), and SRS-22 score (mean differences, 95% CI: 0.87 (0.60, 1.13), p-Value < 0.001, Cohen’s d = 0.58). Differences in ATR maximum and SRS-22 score remained significant at the 18-month measurement. No significant differences were found between groups in the sum of curves (p-Value > 0.05). Conclusions: A 12-month supervised Schroth exercise program in AIS patients undergoing brace treatment significantly improves scoliosis severity (Cobb angle and ATR maximum) and quality of life. Improvements were greater than those in shorter-duration studies, suggesting a linear dose–response relationship. Further clinical studies are needed to clarify the impact of long-term Schroth programs.

Scientific Exercise Approach to Scoliosis in Adolescents With Mild Idiopathic Scoliosis: A Controlled Clinical Trial

ObjectiveThis study aimed to investigate the effectiveness of Scientific Exercise Approach to Scoliosis (SEAS) protocol for patients with mild adolescent idiopathic scoliosis (AIS). Method(A controlled clinical trial) This preliminary study included 32 patients with AIS, aged 10 to 16 years, with Cobb angles ranging from 12° to 25°. The participants were divided into 2 groups: the SEAS group (n = 21) and standard care (n = 11). We assessed Cobb angles via radiographs, axial trunk rotation using the Adams test, spinal deformity from various perspectives with the Spinal Appearance Questionnaire (SAQ), and health-related quality of life with the Scoliosis Research Society-22 (SRS-22) questionnaire, both before and after 1 year of treatment. ResultsRepeated measure-ANOVA revealed significant group x time interactions for various parameters: Cobb angle (F1,30 = 35.757; P < .001), axial trunk rotation (F1,30 = 39.595; P < .001), SAQ appearance domain for the physiotherapist (F1,30 = 53.943; P < .001), SAQ appearance (F1,30 = 14.054; P = .001), expectations (F1,30 = 9.103; P = .005) domains, the total score (F1,30 = 23.574; P < .001) for the child, and the SAQ appearance domain for the parent (F1,29 = 5.412; P = .027). There were no significant differences in SRS-22 scores between the 2 groups. The success rates for the SEAS group and the standard care group were 100% and 72.7%, respectively. ConclusionAfter 1 year, the group of patients with mild AIS who received the SEAS method showed greater improvements in the Cobb angle, axial trunk rotation, and spinal appearance than those who received standard care. This preliminary study suggests that larger trials should be completed.

Spinal deformity surgery in Scheuermann's kyphosis versus adolescent idiopathic scoliosis: meta-analysis of complications and clinical outcomes.

Surgical management of adolescent idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) may be associated with several complications including extended length of stay and unplanned reoperations. Several studies have previously compared postoperative complications and functional outcomes for AIS and SK patients with mixed results. However, a meta-analysis compiling the literature on this topic is lacking. Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1-20) were accessed and explored until April 2024. The extracted data consisted of complications (overall and surgical-site infections [SSI]), readmissions, reoperations, and Scoliosis Research Society-22 (SRS-22) score. Mean differences (MD) with 95% CI were used for continuous data and odds ratio (OR) was utilized for dichotomous data were calculated across studies. Seven retrospective articles were included in the meta-analysis, including 4866 patients, with 399 in the SK group and 4467 in the AIS group. SK patients were found to have statistically significantly higher rates of overall complications (OR = 5.41; 95% CI 3.69-7.93, p < .001), SSI (OR = 11.30; 95% CI 6.14-20.82, p < .001), readmissions (OR = 2.81; 95% CI 1.21-6.53, p = 0.02), and reoperations (OR = 7.40; 95% CI 4.76-11.51, p < .001) than AIS patients. However, they had similar SRS-22 scores postoperatively (MD = -0.06; 95% CI -0.16 to 0.04, p = 0.26) despite the SK group having lower SRS-22 scores preoperatively (MD = -0.30; 95% CI -0.42 to -0.18, p < .001). In this meta-analysis of studies comparing spinal deformity surgery outcomes in AIS and SK patients, SK was associated with more complications, readmissions, and reoperations. SK did have equivalent SRS-22 scores postoperatively to AIS patients, highlighting the benefit of surgical treatment despite higher complication rates. This data may help inform healthcare institutions, payors, and quality monitoring organizations who examine outcomes of pediatric and adult spinal deformity surgery.

Risk of coronal imbalance after posterior surgery for adolescent idiopathic scoliosis of type Lenke5C

Purpose To investigate the incidence, risk factors, and clinical impact of persistent coronal imbalance (PCI) in Lenke5C adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF). Methods We analyzed the medical records of 112 Lenke5C AIS patients. They were grouped into PCI (+) group and PCI (–) group according to the occurrence of PCI at 2 years after surgery. Coronal and sagittal parameters were measured and compared between both groups preoperatively, immediately postoperatively, and 2 years postoperatively. Scoliosis Research Society-22 (SRS-22) score was used to evaluate clinical outcomes. Results Of the 112 patients, 12 had coronal imbalance persisting 2 years after surgery. Logistic regression analysis indicated risk factors including older age [odds ratio (OR) = 1.841, 95% confidence interval (CI) = 1.147–2.132, p = .001], lower preoperative flexibility main thoracic (MT) curve (OR = 1.308, 95% CI = 1.041–2.015, p = .016), greater preoperative apical vertebral translation (AVT) of the thoracolumbar/lumbar (TL/L) curve (AVT-TL/L) (OR = 2.291, 95% CI = 1.120–4.719, p = .001), larger preoperative lowest instrumented vertebra tilt (LIV lilt) (OR = 2.141, 95% CI = 1.491–3.651, p = .011), and postoperative immediate coronal imbalance (OR = 5.512, 95% CI = 4.531–6.891, p = .001). The satisfaction and total score of the SRS-22 scale in the PCI (+) group were lower than those in the PCI (–) group at 2 years after surgery (p <.05). Conclusions We found a 10.7% incidence of PCI in patients with Lenke5C AIS undergoing PSF. PCI adversely affects clinical outcomes. Risk factors of PCI included older age, reduced preoperative MT curve flexibility, increased preoperative AVT in the TL/L curve, greater preoperative LIV tilt, and immediate postoperative coronal imbalance.

Curve progression following selective and nonselective spinal fusion for adolescent idiopathic scoliosis: are selective fusions stable?

The purpose of this study is to compare postoperative outcomes between selective and non-selective fusions longitudinally over the first five postoperative years. Patient parameters were retrieved from a multicenter, prospective, database. Patients with Lenke 1-6, B and C deformities were included. Patients were stratified into 2 groups: selective fusion (SF), if the last instrumented vertebra (LIV) was at or cranial to the lumbar apex, or non-selective fusion (NSF). Differences in coronal and sagittal radiographic outcomes were assessed with generalized linear models (GLMs) at 1-, 2- and 5- year postoperative outcomes. Five-year postoperative categorical radiographic outcomes, flexibility, scoliosis research society scores (SRS), and reoperation rates were compared between groups. Matched cohorts were created for subgroup analysis. 416 (SF:261, NF:155) patients, including 353 females were included in this study. The mean preoperative thoracic and lumbar Cobb angles were 57.3 ± 8.9 and 45.3 ± 8.0, respectively. GLMs demonstrated greater postoperative coronal deformity in the SF group (p < 0.01); however, the difference between groups did not change overtime (p > 0.05) indicating a relatively stable postoperative deformity correction. The SF group had a greater incidence of lumbar Cobb ≥ 26 degrees (p < 0.01). The NSF group demonstrated worse forward and lateral flexibility at 5-year postoperative outcome (p < 0.05). There was no difference in postoperative SRS scores between the SF and NSF groups. Reoperation rates were similar between groups. Selective fusion results in greater coronal plane deformity; however, this deformity does not progress significantly over time compared to non-selective fusion. Selective spinal fusion may be a beneficial option for a larger subset of patients than previously identified. III.

Complications and health-related quality of life following lumbosacral hemivertebra resection and short segmental fusion: a retrospective cohort study

Previous literature has provided descriptions of postoperative complications. However, these studies have included heterogeneous cohorts of hemivertebra patients undergoing different surgical methods and addressing deformities at various locations. To assess independent risk factors for complications following lumbosacral hemivertebra (LSHV) resection and to further explored the potential association between complications and health-related quality of life (HRQOL). Retrospective cohort study. We retrospectively analyzed consecutive patients who underwent LSHV resection and short segment fusion at our institution between 2010 and 2022. In the current study, the outcome measure were complications and HRQOL. Between 2010 and 2022, a total of 64 consecutive patients with LSHV underwent hemivertebra resection. The diagnostic criteria for LSHV were delineated that the hemivertebra resides caudal to L5 and beyond. Electronic patient record and radiographic data were reviewed retrospectively in our electronic database. According to complications, the patients were divided into with and without complications, and further stratified as neurological, mechanical, and infectious complications. HRQOL outcomes were collected preoperatively, 3 months postoperatively, and at last follow-up using the Scoliosis Research Society-22 (SRS-22) questionnaire. Multivariate logistic regression models were used to determine independent risk factors affecting complications. A total of 64 patients were enrolled in this study for at least 2-year follow-up. The mean follow-up was 7.3±4.2 years. In the coronal plane, the mean main curve was corrected from 27.3° preoperatively to 8.0° postoperatively, and 9.3° at last follow-up. Global spine balance was significantly improved after surgery, and kept stable during the follow-up. In all, 18 complications were recorded in 15 (23.4%) patients. In the multivariate logistic regression model, 3 independent risk factors for complication were screened out, including age (OR=1.16, 95% CI 1.01-1.34, p=.042), anterior reconstruction (OR=3.40, 95% CI 1.03-11.2, p=.045), and preoperative CB (OR=1.06, 95% CI 1.00-1.12, p=.036). The mean SRS-22 total and domain scores for the entire cohort showed improvement at last follow-up. However, in the noncomplication group, the improvements in SRS-22 scores were more substantial. Postoperative neurological and mechanical complications are common medical events following LSHV resection. The age, anterior column reconstruction, and preoperative coronal balance were the independent risk factors. Compared to the noncomplication group, the improvements in HRQOL are blunted in the complication group.

Comparison of Surgical Burden, Radiographic and Clinical Outcomes According to the Severity of Baseline Sagittal Imbalance in Adult Spinal Deformity Patients.

To determine the clinical impact of the baseline sagittal imbalance severity in patients with adult spinal deformity (ASD). We retrospectively reviewed patients who underwent ≥ 5-level fusion including the pelvis, for ASD with a ≥ 2-year follow-up. Using the Scoliosis Research Society-Schwab classification system, patients were classified into 3 groups according to the severity of the preoperative sagittal imbalance: mild, moderate, and severe. Postoperative clinical and radiographic results were compared among the 3 groups. A total of 259 patients were finally included. There were 42, 62, and 155 patients in the mild, moderate, and severe groups, respectively. The perioperative surgical burden was greatest in the severe group. Postoperatively, this group also showed the largest pelvic incidence minus lumbar lordosis mismatch, suggesting a tendency towards undercorrection. No statistically significant differences were observed in proximal junctional kyphosis, proximal junctional failure, or rod fractures among the groups. Visual analogue scale for back pain and Scoliosis Research Society-22 scores were similar across groups. However, severe group's last follow-up Oswestry Disability Index (ODI) scores significantly lower than those of the severe group. Patients with severe sagittal imbalance were treated with more invasive surgical methods along with increased the perioperative surgical burden. All patients exhibited significant radiological and clinical improvements after surgery. However, regarding ODI, the severe group demonstrated slightly worse clinical outcomes than the other groups, probably due to relatively higher proportion of undercorrection. Therefore, more rigorous correction is necessary to achieve optimal sagittal alignment specifically in patients with severe baseline sagittal imbalance.

Outcome of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society outcome questionnaire

Background Adolescent idiopathic scoliosis (AIS) is a structural deformity of the spine. Posterior deformity correction represents the gold standard of the surgical treatment of AIS. The fixation technique was shifted from hybrid fixation to the all pedicle screw construct, which could produce superior deformity correction. Patient-oriented outcome questionnaires have become an important measure of the success of surgical correction. This study was conducted to assess the outcome of all pedicle screw constructs in treating AIS using the Scoliosis Research Society (SRS)-24 outcome questionnaire. Patients and methods Seventy-nine AIS patients were included with a minimum 2-year follow-up. Clinical and radiographic measurements were evaluated at preoperative, postoperative, and final follow-up periods. Complications and results of the SRS-24 questionnaire were analyzed. Sex, Lenke classification, levels of the lowest instrumented vertebra, curve magnitude, and percentage of curve correction were correlated with the SRS-24 questionnaire results. Results There were 59 females and 20 males. The mean age of the patients was 14.2 ± 2.5 years. According to Lenke classification, the majority of the curves were type 1 (57 patients), followed by type 5 (11 patients), type 2 (six patients), type 3 (three patients), type 6 (two patients), and no type 4. The mean preoperative major curve Cobb angle was 59.3 ± 9.045° and the mean postoperative Cobb angle was 5.82 ± 5.932°. The average score for SRS-24 was 4.17. The mean preoperative pain score was 3.29, which improved to 4.30 after at least 2 years of follow-up (P˂0.005). Statistically significant improvement was seen in the general self-image, function from back condition, and level of activity. After surgery, the mean score for self-image was 4.19, and for function was 3.55. The postoperative function was the lowest, while the postoperative satisfaction score was the best of all domains, with a mean score of 4.55. About 90% of patients were satisfied with the results of their surgical correction. Magnitude of curve and amount of correction did not significantly alter the SRS scores. Conclusion All pedicle screw construct is an efficient and safe method in AIS correction. The surgical treatment in our AIS patients has resulted in a perceived benefit in all domains of SRS-24 questionnaire.

A Comparison of the Effects of Supervised versus Home Schroth Exercise Programs with Adolescent Idiopathic Scoliosis.

(1) Background: Schroth exercise can reduce the deformity of the spine and improve the life quality and the body image of patients with adolescent idiopathic scoliosis (AIS). (2) Methods: The study began with 49 participants, aged 10-16 years old, who were diagnosed with AIS. At the end of the study, 37 patients were randomly assigned to either the Supervised (n = 19) or Home-Based Schroth Exercise Group (n = 18) and completed the study. Both groups were treated for seven days a week over twelve weeks. For all patients, body rotation measurements were performed with a scoliometer, surface asymmetry analysis was carried out using an Artec Eva 3D scanner, health-related quality of life was evaluated by the Scoliosis Research Society-22 (SRS-22) questionnaire, and the perception of the cosmetic deformity was assessed by the Walter Reed Visual Assessment Scale (WRVAS). All the measurements were repeated before and after the 12-week treatment. (3) Results: Post-treatment scoliometric measurements showed a significant decrease in body rotation in both groups (p < 0.05). Similarly, both groups observed significant positive changes in SRS-22 and WRVAS scores (p < 005). RMS values were statistically significant in both groups; the difference was only statistically significant in the thoracic anterior arm subparameter (p < 0.05). (4) Conclusion: The Schroth exercise for both groups with AIS improved body symmetry, quality of life, and body image.

Progressive coronal caudal curve after corrective osteotomies for congenital cervicothoracic scoliosis: incidence and predictors.

Postoperative progressive coronal caudal curve (PCC) was characterized by a postoperative de novo caudal S-curve ≥ 20° following congenital cervicothoracic scoliosis (CTS) corrective osteotomies, and at least 20° greater than the preoperative measurement, while the incidence was uncertain and the pathogenesis was equivocal. The objective of this study was to investigate the morbidity and potential factors contributing to PCC following CTS surgery. This study reviewed 72 CTS patients between 2005 and 2021. Patients were categorized into two groups according to the absence or presence of PCC at last follow-up, namely the nonprogressive curve group (NPC-group) and the progressive curve group (PC-group). Demographics, radiographic data and the Scoliosis Research Society-22 (SRS-22) questionnaire results were reviewed. Multivariate linear regression analyses were utilized to determine possible predictors for PCC. PCC was observed in 11 (15%) of the total 72 patients. Compared with the NPC-group, the PC-group exhibited greater postoperative residual local curve (24.0 ± 9.7° vs. 9.1 ± 4.4°, P < 0.001), upper instrumented vertebra (UIV) tilt (16.9 ± 7.4° vs. 6.2 ± 3.7°, P < 0.001), T1 tilt (14.3 ± 9.4° vs. 6.6 ± 3.9°, P = 0.022) and neck tilt (10.1 ± 6.7° vs. 3.7 ± 2.5, P = 0.009). The multivariable linear regression demonstrated that the larger postoperative UIV tilt, residual local curve and neck tilt were associated with PCC. In addition, patients with PCC showed lower SRS-22 scores in terms of pain, mental health, self-image and satisfaction (P < 0.05). The morbidity of PCC was 15% in CTS patients who underwent corrective osteotomies. Greater residual local curve, postoperative UIV tilt and neck tilt were identified as predictors for PCC.

Prospectively Collected Comparison of Outcomes Between Surgically and Conservatively Treated Patients With Adolescent Idiopathic Scoliosis.

Retrospective review of a prospectively collected multicenter registry. To evaluate health-related quality of life (HRQOL) measures in an operative cohort of patients (OP) and compare them with a matched nonoperative cohort (NON). Historically, the surgical outcomes of adolescent idiopathic scoliosis (AIS) have been radiographically evaluated. However, the importance of HRQOL measures and their impact on surgical outcomes are increasingly being understood. We identified 90 NON patients with curves in the operative range who were observed for at least two years. These patients were matched with an OP cohort of 689 patients. All patients completed the Scoliosis Research Society-22 (SRS-22) questionnaire at the initial evaluation and at a minimum of two-year follow-up. Subgroup comparisons were based on curve type: primary thoracic (Th), primary thoracolumbar/lumbar (TL/L), and double major (DM) curves. The preoperative major curves in the Th, TL/L, and DM OP subgroups averaged 50.4°, 45.4°, and 51.5°, respectively, and 49.4°, 43.7°, and 48.9° in the NON cohort ( P >0.05). At two years postoperatively, the major curve in the Th, TL/L, and DM OP subgroups improved to 19.0°, 19.2°, and 19.3°, respectively, compared with the progression to 51.3°, 44.5°, and 49.7° in the NON group at two-year follow-up ( P <0.05). The SRS-22 self-image, mental health, satisfaction, and total scores at the two-year follow-up were significantly better in all OP subgroups ( P <0.001) but remained largely unchanged in the NON group. A significant percentage of patients ( P <0.001) in the OP cohort reported better SRS-22 scores at the two-year follow-up in the self-image, mental health, and satisfaction domains than the NON group at two years. Surgically treated patients with AIS have improved HRQOL outcomes in several domains compared with age-matched and curve magnitude-matched nonoperatively treated patients at two-year follow-up.

Bilateral Distal Femoral Osteotomy for Valgus Knee Deformity May Result in Improved Patient-Reported Outcome Scores

Background: The lateral opening wedge distal femoral osteotomy (DFO) is an effective treatment for genu valgum to improve mechanical alignment, decrease lateral compartment loads, and decrease the risk of knee osteoarthritis. Multiple studies have utilized outcome scores assessing functional changes related to pain and joint stability, with a focus solely on knee pain and functional outcomes. Questions/purposes: The primary aim of this study was to evaluate patient-reported outcome measures (PROMs) that assessed knee function, pain, patient’s perception of body image, and limb deformity-related quality of life, both preoperatively and at least 1-year postoperatively. Methods: In a retrospective review of nontraumatic genu valgum patients who underwent bilateral DFO, preoperative and postoperative radiographs were evaluated. Routinely collected preoperative and 1-year postoperative PROMs scores were analyzed, using the Knee Injury and Osteoarthritis Outcome Score Jr. (KOOS-JR) and the Limb Deformity-Modified Scoliosis Research Society (LD-SRS) score, in 72 limbs (36 patients): 7 men (19.44%) and 29 women (80.56%) with an average age of 35.34 ± 13.57 years. The mean follow-up time was 36.85 ± 24.43 months. Results: Overall mechanical axis deviation, lateral distal femoral angle, and mechanical axis alignment angle were significantly improved after DFO in all patients. Both PROMs also improved significantly from preoperative to postoperative scores: LD-SRS (3.10 ± 0.56 vs 4.19 ± 0.44, respectively) and KOOS-JR (63.02 ± 19.25 vs 78.06 ± 16.29, respectively). Conclusion: This retrospective review suggests that bilateral lateral opening-wedge DFOs in patients with symptomatic valgus knee deformity may be associated with improved overall knee health, limb deformity-related quality of life, and patients’ body image. Further study is needed.

Correlation analysis of surgical outcomes and spino-pelvic parameters in patients with degenerative lumbar scoliosis.

The study aims to analyze factors that affect the postoperative health-related quality of life (HRQOL) of degenerative lumbar scoliosis (DLS) patients and explore the appropriate pelvic incidence minus lumbar lordosis (PI-LL) value for Chinese DLS patients. DLS patients who met the inclusion and exclusion criteria were included in this study. General information, spino-pelvic parameters, and HRQOL were collected. Correlation analysis was used to explore the spino-pelvic parameters that affect the postoperative HRQOL. Thresholds of each parameter were obtained using the receiver operating characteristic (ROC) curve. Regardless of the effect of age, DLS patients were classified into three groups according to the SRS-Schwab classification: group 0 means PI-LL < 10°, group+means PI-LL = 10-20°, and group ++ means PI-LL > 20°. Postoperative HRQOL was analyzed using variance methods. The ROC curve was used to measure the appropriate PI-LL threshold. When considering the effect of age, the patients with Oswestry Disability Index (ODI) < 75% percentile were considered to have a satisfactory clinical outcome, which was drawn to an equation between PI-LL, age, and PI by multiple linear regression equation. A total of 71 patients were included. Compared with the control group, there were significant differences in both postoperative ODI and Scoliosis Research Society 22 (SRS-22) scores when the postoperative Cobb angle ≤11°, postoperative lumbar lordosis index (LLI) > 0.8, postoperative sagittal vertical axis (SVA) ≤ 5 cm, postoperative T1 pelvic angle (TPA) ≤ 16° and postoperative global tilt (GT) ≤ 22°, respectively. Regardless of the effect of age, there was a statistical difference in postoperative HRQOL between group 0 and group ++. The PI-LL threshold derived from the ROC curve was 14.4°. Compared with the PI-LL > 14° group, the PI-LL ≤ 14° group achieved a lower postoperative ODI score and a higher postoperative SRS-22 score. Considering the influence of age, the equation for ideal PI-LL was PI-LL = 0.52age + 0.38PI-39.4 (R = 0.509, p = 0.001). PI-LL was an important parameter that affects the postoperative HRQOL of DLS patients. Sufficient LL should be restored during the operation (LL ≥ PI-14°). The appropriate PI-LL value was affected by age. Smaller LL needed to be restored as the age increased.

Clinical study of the Cobb+1 to Cobb fusion strategy for Lenke 5C adolescent idiopathic scoliosis patients with the lower lumbar apex

Objective: To investigate the indications and surgical outcome of Cobb+1 to Cobb fusion strategy in Lenke 5C adolescent idiopathic scoliosis (AIS) patients with the lower lumbar apex. Methods: The clinical data of Lenke 5C AIS patients treated in Nanjing Drum Tower Hospital from August 2015 to December 2018 were retrospectively analyzed. The patients were followed-up for at least 2 years after surgery and treated with selective Cobb+1 to Cobb fusion strategy. The patients were divided into the normal lumbar apex group (apex location of the main curve was between T12 and L1) and the lower lumbar apex group (apex location of the main curve was below the disc of L1/L2). The occurrence of proximal decompensation in the two groups was compared. In addition, according to whether the patients had proximal decompensation at the last follow-up, the patients in the lower lumbar apex group were further divided into proximal decompensation group and non-decompensation group. The radiographic parameters and Scoliosis Research Society-22 (SRS-22) scores of the two groups were compared. Results: A total of 52 patients (19 cases in the normal lumbar apex group and 33 cases in the lower lumbar apex group), aged (15.3±1.6) years, were followed up for 2-5 (3.2±1.2) years. Six patients (6/19) in the normal lumbar apex group and 5 cases (15.2%) in the lower lumbar apex group showed proximal decompensation during follow-up, and the incidence was significantly higher in the normal lumbar apex group (P=0.034). Within the lower lumbar apex group, the patients with proximal decompensation (n=5) showed similar Risser grade, baseline thoracic Cobb angle, and main Cobb angle as those without proximal decompensation(n=28), and the differences were all not statistically significant (all P>0.05). However, the baseline thoracic/lumbar apical vertebra translation (AVT) ratio was significantly larger in patients with proximal decompensation (0.6±0.2 vs 0.4±0.2, P=0.042), but the postoperative upper instrumented vertebra (UIV) tilt angle was similar (4.5°±2.3° vs 6.2°±3.4°, P=0.312). Conclusion: Cobb+1 to Cobb fusion strategy, selecting UIV at 1 level above upper end vertebra (UEV), could be performed in Lenke 5C patients with the lower lumbar apex location. In addition, UIV could be selected at UEV+1 in patients with small baseline thoracic curve.

Adolescent Perception of Stiffness After Spinal Fusion Surgery.

Posterior spinal instrumented fusion (PSIF) is a treatment option for adolescent spinal deformity. PSIF leads to loss of spinal segment motion. It is unclear the extent to which spinal stiffness is perceived by adolescent patients after fusion. Focus groups of adolescents between ages 11 and 21 years who underwent PSIF for spinal deformity were performed. Focus groups were evaluated for common themes, and a 36-question survey was designed. Survey responses were analyzed relative to last instrumented vertebra (LIV) and Scoliosis Research Society-22 (SRS-22) scores. Five focus groups were held with 18 patients in total. Three main themes were identified by participants: 56% identified difficulty bending forward, 44% identified difficulty hunching while sitting, and 56% identified difficulty with twisting motions. Patients with more distal LIV reported significant more difficulty with self-care/grooming (P = .014) and chores (P < .001). SRS-22 function/activity scores correlated well with survey categories in self-care/grooming (r = .61; P = .049) and recreation (r = .69; P = .019). Focus groups suggest that spinal stiffness is frequently perceived and leads to alteration in daily tasks in adolescents after spinal fusion.

Dual Growing Rods and the Apical Control Technique for Treating Congenital Early-Onset Scoliosis: Lessons Learned.

Congenital early-onset scoliosis (CEOS) is characterized by a spectrum of vertebral anomalies, including formation failures and segmentation failures at the apex segment, which makes CEOS different from other etiologies of early-onset scoliosis. To date, studies on patients who have graduated from CEOS treatment using traditional dual growing rods (TDGR) have been scarce, and the preliminary results of TDGR with or without the apical control technique (ACT) have varied. We therefore compared the final outcomes of patients with CEOS who graduated from TDGR with or without the ACT. A retrospective study of patients with CEOS who had graduated from TDGR treatment performed from 2007 to 2020 was conducted. Graduation included final fusion or observation after reaching skeletal maturity. Patients were divided into the ACT-TDGR group (apical vertebrectomy and/or hemivertebrectomy with short fusion and TDGR) and the TDGR-only group. Demographic characteristics, radiographic data, patient-reported clinical outcomes, pulmonary function, and complications were analyzed. A total of 41 patients with CEOS were enrolled: 13 in the ACT-TDGR group and 28 in the TDGR-only group. The lengthening intervals were longer in the ACT-TDGR group (mean [and standard deviation], 1.26 ± 0.66 years) than in the TDGR-only group (0.80 ± 0.27 years). The preoperative main curve was larger in the ACT-TDGR group (80.53° ± 19.50°) than in the TDGR-only group (64.11° ± 17.50°). The residual curve was comparable between groups (26.31° ± 12.82° in the ACT-TDGR group compared with 27.76° ± 15.0° in the TDGR group) at the latest follow-up. The changes in apical vertebral rotation and thoracic rotation were significantly larger in the ACT-TDGR group. Patients had comparable T1-12 and T1-S1 heights, pulmonary function, and 22-item Scoliosis Research Society (SRS-22) scores at the latest follow-up. The mean number of mechanical-related complications per patient was lower in the ACT-TDGR group (0.77 ± 0.73) than in the TDGR-only group (1.54 ± 1.43). Seventeen patients underwent final fusion. In this small-scale study, we observed that both ACT-TDGR and TDGR-only could correct the deformity while allowing for spinal growth in patients with CEOS. ACT-TDGR yielded better correction in severe cases and did not have a deleterious effect on spinal height. A large number of cases will be needed to validate the clinical value of the ACT. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Preceding neurosurgery is not needed for presumed adolescent idiopathic scoliosis with syringomyelia: a 10-year longitudinal comparative study.

One-stage scoliosis correction surgery is safe for adolescent idiopathic scoliosis (AIS), but it is not yet known whether it is safe for presumed AIS (PAIS). This study sought to investigate the safety and efficacy of one-stage scoliosis correction surgery for PAIS associated with syringomyelia from multiple perspectives by conducting an analysis of 10-year consecutive cases. A retrospective study of all consecutive cases of patients diagnosed with PAIS associated with syringomyelia or AIS from January 2011 to January 2020 was performed. The main radiographic parameters and clinical function scores before, immediately after, and at the last follow-up were collected or measured. Three-dimensional (3D) models of spinal canal length were generated, refined, measured, and compared between the PAIS and AIS groups. In total, 318 patients with AIS and 47 patients with PAIS associated with syringomyelia were included in the study. There were no significant differences between the two groups in terms of changes in the Cobb angle of the main curve (MC), thoracic kyphosis (TK), coronal balance (CB), sagittal vertical axis (SVA), Oswestry disability index (ODI), Scoliosis Research Society-22 (SRS-22) score, cervical and thoracolumbar spinal canal length, and whole spinal canal length before and after the surgery (P>0.05). The changes in the thoracolumbar and whole spinal canal length were significantly positively correlated with the improvement rate of the MC (P<0.05), but were not significantly correlated with the improvement rate of TK, the SRS-22 score, and the ODI (P>0.05). In relation to the main radiologic parameters, clinical function scores, and 3D biomechanics, one-stage posterior correction surgery was found to be safe and effective for patients with PAIS associated with syringomyelia.

Signficant Femoral Version Abnormalities and Patient-Reported Quality of Life.

The purpose of this study was to determine how the Limb Deformity-Modified Scoliosis Research Society (LD-SRS) and Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire scores differ between patients with femoral version abnormalities and healthy control subjects. A retrospective database review identified patients with femoral version abnormalities between December 2018 and September 2022. A total of 21 adult patients scheduled for femoral derotational osteotomy and 33 control subjects were included. All individuals completed the LD-SRS and PROMIS questionnaires. Patients with femoral version abnormalities reported significantly worse scores than control subjects on all LD-SRS and PROMIS domains: LD-SRS (Total [3.46 ± 0.66 vs. 4.58 ± 0.37, P < 0.001]; Function/Activity [3.48 ± 0.83 vs. 4.44 ± 0.4, P < 0.001]; Mental Health [3.41 ± 0.96 vs. 4.3 ± 0.73, P < 0.001]; Pain [3.55 ± 0.9 vs. 4.81 ± 0.31, P < 0.001]; and Self-Image/Appearance [3.37 ± 0.79 vs. 4.75 ± 0.43, P < 0.001]) and PROMIS (Function [41.6 ± 7.58 vs. 60.0 ± 7.28, P < 0.001]; Pain Intensity [45.85 ± 8.04 vs. 33.7 ± 4.89, P < 0.001]; Pain Interference [56.78 ± 9.63 vs. 42.8 ± 6.6, P < 0.001]; Global Mental Health [47.97 ± 9.68 vs. 55.3 ± 7.81, P = 0.004]; and Global Physical Health [45.23 ± 7.49 vs. 58.2 ± 7.07, P < 0.001]). Patients with femoral version abnormalities reported markedly worse quality of life as measured on the LD-SRS and PROMIS scores compared with healthy control subjects. The combination of these two surveys effectively captures the multifaceted quality-of-life-deficit individuals with excessive femoral version may experience.

Gravity Line-Hip Axis Offset as a Guide for Global Alignment to Prevent Recurrent Proximal Junctional Kyphosis/Failure.

Proximal junctional kyphosis/failure (PJK/F) is a potentially serious complication after adult spinal deformity (ASD) corrective surgery. Recurrent PJK/F is especially troublesome, necessitating fusion extension and occasionally resulting in irreversible neurological deficits. The gravity line (GL) offers valuable insights into global sagittal balance. This study aims to examine the postoperative GL-hip axis (GL-HA) offset as a critical risk factor for recurrent PJK/F. We retrospectively reviewed patients with ASD who had undergone revision surgery for initial PJK/F at a single academic center. Patients were categorized into 2 groups: nonrecurrent PJK/F group and recurrent PJK/F group. Demographics, surgical characteristics, preoperative and postoperative parameters of spinopelvic and global alignment, and the Scoliosis Research Society-22 scores were assessed. We examined these measures for differences and correlations with recurrent PJK/F. Our study included 32 patients without recurrent PJK/F and 28 patients with recurrent PJK/F. No significant differences were observed in baseline demographics, operative characteristics, or Scoliosis Research Society-22 scores before and after surgery. Importantly, using a cutoff of -52.6 mm from logistic regression, there were considerable differences and correlations with recurrent PJK/F in the postoperative GL-HA offset, leading to an odds ratio of 7.0 (95% CI: 1.94-25.25, P = .003). Postoperative GL-HA offset serves as a considerable risk factor for recurrent PJK/F in patients with ASD who have undergone revision surgery. Overcorrection, with GL-HA offset less than -5 cm, is associated with recurrent PJK/F. The instrumented spine tends to align the GL near the HA, even at the cost of proximal junction.

Clinical and Economic Impact of Proximal Junctional Kyphosis on Pediatric and Adult Spinal Deformity Patients.

The common goal of pediatric and adult spinal reconstructive procedures is to minimize long-term risk of disability, pain, and mortality. A common complication that has proved particularly problematic in the adult spinal deformity population and that has been an area of increased research and clinical focus is proximal junctional kyphosis (PJK). The incidence of PJK ranges from 10%-40% based on criteria used to define the condition. Clinically, PJK complication is associated with increased pain, decreased self-image and Scoliosis Research Society scores, and severe neurological injuries affecting the patient's quality of life. Economically, direct costs of PJK complication-associated revision surgery ranges from $20,000 to $120,000, which places an enormous burden on patients, providers, and payers. To mitigate the risk of PJK occurrence postoperatively, it is paramount to develop consistent guidelines in defining and classifying PJK in addition to extensive preoperative planning and risk stratification that is patient specific. This article will provide an overview on the clinical and economic impact of PJK in pediatric and adult spine deformity patients with an emphasis on the role of patient factors and predictive analytics, challenges in developing a consistent PJK classification, and current treatment and prevention strategies.