Self-image Scores Research Articles

Modified Thoracoplasty for Rib Hump Deformity in Scoliosis Patients: A Case-Control Study

Razorback deformity with stiff thoracic scoliosis creates a complex three-dimensional deformity. Posterior spinal fusion (PSF) and thoracoplasty (TP) can correct rib hump deformity and improve patient satisfaction. However, conventional thoracoplasty (CTP) may impair pulmonary function and increase complications. We present a modified thoracoplasty (MTP) technique for addressing rib hump deformity in stiff thoracic scoliosis patients, emphasizing its clinical efficacy and safety. This study included 44 patients with stiff thoracic scoliosis and razorback deformity who underwent surgery between January 2010 and May 2021. Patients were divided into PSF+MTP (n=27) and PSF (n=17) groups. Surgical parameters, complications, radiographic improvements, pulmonary function, and SRS-22 scores were evaluated preoperatively and at 3 months and 2 years postoperatively. There were no significant differences in baseline characteristics between the two groups, except for the rib hump height, which was higher in the PSF+MTP group. The PSF+MTP group showed superior correction of the thoracic curve and rib hump height compared to the PSF group, with significant improvements in self-image scores. No significant differences were observed in pulmonary function between the groups. The operative time was longer in the PSF+MTP group, but there were no significant differences in intraoperative blood loss, hospitalization costs, or major complications. Regression analysis indicated that the type of surgery, thoracic Cobb angle and preoperative self-image scores were significant predictors of postoperative self-image scores. MTP provides enhanced correction of thoracic curve and rib hump deformity without significantly increasing pulmonary function impairment or complication rates. It also improves patients' self-image, making it a valuable addition to PSF in treating stiff thoracic scoliosis with rib hump deformity.

Genital self-image and sexual function in Iranian women from pregnancy to postpartum: a cohort study.

Genital self-image is among the factors affecting women's sexual function. The present study aimed to determine changes in the genital self-image and its relationship with women's sexual function in the third trimester of pregnancy and postpartum. The participants of this prospective cohort study included 301 eligible pregnant women chosen through stratified random sampling with proportional allocation from comprehensive health centers in Gorgan, Iran. The Persian version of the 7-item Female Genital Self-Image Scale, the 6-item Female Sexual Function Index, and Depression Anxiety and Stress Scale 21 were filled in a self-report manner on 2 occasions: (1) 30 to 37weeks of pregnancy and (2) 12 to 16weeks (± 2weeks) postpartum. Finally, the data were analyzed using SPSS 24 software. Outcomes included Female Genital Self-Image Scale and Female Sexual Function Index changes from pregnancy to postpartum according to the childbirth mode. The mean age of participants was 29.66 ± 5.27 years. These values for the genital self-image scores of women during pregnancy (19.18 ± 3.25) and postpartum (19.43 ± 3.57) were not significantly different (P = .30). Also, this difference was not statistically significant regarding the mode of delivery in 2 groups of women with vaginal birth (P = .62) and cesarean section (P = .14). The mean Female Sexual Function Index scores during pregnancy (15.15 ± 6.73) and postpartum (17.52 ± 6.46) were significantly different (P = .001). In addition, this difference was significant in women with vaginal birth (P = .004) and cesarean section (P = .001). Clinicians should inform women/couples about changes in female sexual function and address genital self-image as a factor involved in female sexual function during pregnancy and postpartum.Strengths and Limitations: Because the participants of this study were women in the third trimester of pregnancy, the obtained results may not be generalized to pregnant women in the first and second trimesters of pregnancy or even to different postpartum periods (ie, midterm and long term). The results showed that the female genital self-image is not significantly different during pregnancy and postpartum, or with the mode of delivery. However, the female sexual function score in postpartum is higher than in pregnancy, regardless of the mode of delivery.

Type 3 bone-disc-bone osteotomy (grade 4+ osteotomy) combined with presurgical halo-pelvic traction: a safe and effective solution to correct severe angular-like kyphoscoliosis.

Treatment of severe angular-like kyphoscoliosis is a technically demanding surgical challenge and requires high-risk spinal osteotomy, such as vertebral column resection. Preoperative halo-pelvic traction is commonly used to decrease the curve magnitude. However, few studies have utilized the potent method of bone-disc-bone osteotomy, which could theoretically provide correction up to 60°. This study aimed to evaluate the safety and effectiveness of type 3 bone-disc-bone osteotomy combined with presurgical halo-pelvic traction to correct severe angular-like kyphoscoliosis. This was a retrospective cohort study. Patients with severe angular-like kyphoscoliosis who underwent presurgical halo-pelvic traction and type 3 bone-disc-bone osteotomy from January 2017 to December 2019 were consecutively reviewed. Patient demographics and clinical data were recorded. The coronal and sagittal Cobb angles were measured preoperation, post-traction, post-operation, and at the final follow-up. Complications were also recorded. Patients' health-related quality of life was evaluated by the Scoliosis Research Society 22 (SRS-22) questionnaire. Paired Student's t test and one-way analysis of variance were used for comparisons among different groups. Thirty patients (18 females and 12 males) with an average age of 20.2 years (range, 13-33 years) were included. The mean preoperative coronal and sagittal Cobb angles were 123.1°±16.4° (range, 90°-155°) and 120.3°±19.9° (range, 90°-156°), respectively. After 2.9±0.7 months (range, 2-4 months) of halo-pelvic traction, the coronal and sagittal Cobb angles decreased significantly to 81.9°±13.2° and 76.0°±12.6°, respectively. Postoperatively, the scoliotic and kyphotic angles further decreased to 42.4°±12.2° and 33.9°±8.8°, respectively. After a mean follow-up of 2.93±1.05 years, the correction rates were maintained at 64.3%±10.6% and 70.5%±6.3%, respectively. Nine patients experienced positive evoked potential events during surgery. Common complications after surgery included transient lower extremity weakness, pneumonia, and pleural effusion. The self-image scores were significantly improved from 2.66±0.27 to 3.36±0.23 compared to preoperation. This study proposes a novel strategy to correct severe angular-like spinal deformities. The combination of presurgical halo-pelvic traction and type 3 bone-disc-bone osteotomy (grade 4+ osteotomy) achieves substantial correction and satisfactory aesthetic outcomes without serious complications.

NATURAL HISTORY OF GRADE ONE LUMBOSACRAL ISTHMIC SPONDYLOLISTHESIS IN ADOLESCENT PATIENTS: LONG TERM FOLLOW-UP OF 299 PATIENTS TREATED CONSERVATIVELY

Purpose of the Study: The aim is to report the natural history, type of treatment received and quality of life improvement of adolescent patients with isthmic low-grade lumbosacral spondylolisthesis with a slip of less than 25%. Methods: The complete records of 299 prospective patients (127 males and 172 females) with isthmic low-grade lumbosacral spondylolisthesis referred to an orthopedic clinic were reviewed. Radiological parameters, Micheli scale, and quality of life measured by the SRS-22 questionnaire were measured at the first visit and a minimum 5-year follow-up. Results: The average follow-up time is 5.7 ± 1.4 years. The main complaint at the initial presentation was lower back pain in 107 patients, and three patients had lower back pain and lower limbs radiculopathy. Scoliosis was found in 38 patients in the initial radiograph. One-hundred-eighty-nine patients (63%) were asymptomatic at the time of presentation. At the last follow-up; SRS-22 were 4.21 ± 0.6, 4.21 ± 0.7, 4.31 ± 0.5, 4.21 ± 0.7, 4.2 ± 0.7 for total, pain, function, mental, and self-image scores, respectively. The patients with grade one lumbosacral spondylolisthesis with normal morphology of the sacrum had responded well to the nonsurgical treatment modalities. No patient has progressed during the follow-up, and no patient underwent surgical intervention for back pain. The slip percent was relatively lower in patients with low back pain. The average slip percentage was 15.5 ± 8.4 among the asymptomatic patients and 13 ± 9 among patients who presented with low back pain ([Formula: see text]-value = 0.009). Conclusion: Adolescent patients with grade one isthmic lumbosacral spondylolisthesis have very good prognosis with nonoperative modalities and they have an almost normal quality of life at the end of follow-up. A long follow-up in an outpatient clinic with X-Rays series might not be indicated for all patients with low-grade spondylolisthesis, specifically if the slip is less than 25%.

3D surface topographic measurements for idiopathic scoliosis are highly correlative to patient self-image questionnaires.

Adolescent idiopathic scoliosis (AIS) is a deformity of the spine that results in external asymmetry of the torso in the shoulder, waist, and rib hump. Several patient reported outcome measures (PROMS) including the Trunk Appearance Perception Scale (TAPS) and SRS-22r self-image domain are used to measure the patient's self-perception. The purpose of this study is to investigate the relationship between objective surface topographic measurements of the torso to subjective patient self-perception. 131 AISsubjects and 37 controls participated in this study. All subjects completed TAPS and SRS-22r PROMS followed by whole body 3d surface topographic scanning. An automated analysis pipeline was used to compute 57 measurements. Multivariate linear models were developed to predict TAPS and SRS-22r self-image using each unique combination of 3 parameters and leave one out validation where the best combinations were selected. Back surface rotation, waist crease vertical asymmetry and rib prominence volume were most predictive of TAPS. The final predicted TAPS values from leave one out cross validation was correlated to ground truth TAPS scores withan R value of 0.65. Back surface rotation, silhouette centroid deviation, and shoulder normal asymmetry were most predictive of SRS-22r self-image with a correlation of R = 0.48. Surface topographic measurements of the torso are correlated to TAPS and SRS-22r self-image scores in AIS patients and controls, with TAPS exhibiting a stronger relationship, better reflecting the patient's external asymmetries.

Effect of clinical and radiological parameters on the quality of life in adult patients with untreated adolescent idiopathic scoliosis: a cross-sectional study.

The aim of this study is to evaluate the factors that affect health-related quality of life (HRQoL) in untreated adolescent idiopathic scoliosis (AIS) patients in adulthood. We investigate the effect of clinical and radiological parameters on the SRS-22 results. A total of 286 untreated adolescent idiopathic scoliosis patients at adult age between April 2021 and April 2022 who were admitted to our clinic were included in the study. Rotational deformities were evaluated with a scoliometer. Cobb angles, coronal balance, clavicle angle, coronal pelvic tilt, trunk shift, and apical vertebral translation were measured in standing anteroposterior X-rays. The effect of each clinical and radiological parameter on SRS-22 results was evaluated. No correlation was found between gender, age, curve type, presence of gibbosity or diagnosis time, and SRS-22 scores. A negative correlation was found between the BMI of the patients and the self-image scores (r = - 0.246, p < 0.01) and function scores (r = - 0.193, p < 0.05). Main thoracic (MT) gibbosity negatively correlates with self-image and total SRS-22 scores. Also, negative correlations were found between lumbar/thoracolumbar (LTL) gibbosity, function, and pain scores. MT Cobb angle magnitude was negatively correlated with self-image, mental health, and total SRS-22 scores. There were negative correlations between clavicle angle and mental health score, coronal pelvic tilt and self-image score, and apical vertebral translation and pain score. BMI, MT gibbosity, LTL gibbosity, MT Cobb angle, clavicle angle, coronal pelvic tilt, and apical vertebral translation were negatively correlated with SRS-22 domains in untreated AIS patients in adulthood.

Benefit-risks analysis of thoracoplasty in adolescent idiopathic scoliosis treated by sublaminar bands

IntroductionCosmetic concerns are one of the main complaints of patients with adolescent idiopathic scoliosis (AIS). Several studies have shown a significant improvement in self-image scores after thoracoplasty. However, the effects of thoracoplasty on pulmonary function and clinical outcomes remain debated. The objective was to analyze the benefits and risks of thoracoplasty during AIS surgery using a hybrid construct with sublaminar bands. Material and methodsIn this monocentric prospective cohort study, 68 patients with thoracic AIS were consecutively included between 2016 and 2017. All patients had low-dose 3D radiographs. Surgical correction was performed via the posterior approach, using the posteromedial translation technique with a hybrid construct (thoracic sublaminar band and lumbar pedicle screws). A thoracoplasty was proposed in cases of severe rib hump (more than 3cm). Pulmonary function was assessed by pulmonary function tests (PFT) with forced vital capacity, forced expiratory volume in 1 second and total lung capacity). Radiographic parameters and PFT were compared between patients who had or had not had a thoracoplasty preoperatively and 2 years postoperatively. The SRS-22 score was collected at follow-up. ResultsThe average age was 15±3 years. Nineteen patients (27%) had a thoracoplasty. The demographic, radiographic and respiratory data of the 2 groups were comparable preoperatively. The correction was similar between the groups on sagittal and coronal views. At 2 years, the PFTs were comparable to those performed preoperatively and no difference was found between the groups. None of the 12 patients who had a pleural effusion had it drained. The total SRS-22 score and the cosmetic subscore were higher in the thoracoplasty group (p<0.03). DiscussionThe association of a thoracoplasty with AIS surgery improves the self-image of patients without altering the PFTs at 2 years postoperatively. Given the low morbidity of thoracoplasty, it seems reasonable to offer it to patients with severe rib hump and high cosmetic demands. Level of evidenceIII.

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

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

Does Size Matter? Genital Self-Image, Genital Size, Pornography Use and Openness Toward Cosmetic Genital Surgery in 3503 Swedish Men and Women

BackgroundDissatisfaction with the appearance and size of one's genitalia is a common issue, and the use of cosmetic genital surgery is increasing among people with normal genitalia. AimThis cross-sectional study aimed to investigate the distribution of genital self-image in a large sample of males and females, and whether selected factors could predict genital self-image. MethodsThree thousand five hundred three anonymous participants completed online questionnaires. Multiple linear regressions were used to identify the association between genital self-image and genital size (length of penis or protrusion of labia minora), consumption of sexually explicit material (SEM), sexual activity, avoidance and safety seeking behaviors, openness toward genital cosmetic surgery and age. OutcomesTotal scores on the Female and Male Genital Self Image Scale were used as the main outcome measures. ResultsOverall, 3.6% of females and 5.5% of males had a severely low genital self-image (defined as 2 SD below the mean) and 33.8% of all individuals reported dissatisfaction with the appearance of their genitalia, with 13.7% of females and 11.3% of males considering undergoing cosmetic genital surgery. Mean protrusion of labia minora and stretched flaccid penis length in the population was estimated to 0.76 cm (95% CI 0.63–0.89 cm) and 12.5 cm (95% CI 12.33–12.76 cm), respectively. A higher genital self-image score was predicted by having a larger penis or less protruding labia minora, but not by the degree of SEM consumption, although 93.6% of males and 57.5% of females had consumed SEM in the past three months. The degree of avoidance and safety seeking behaviors, sexual activity, and openness toward genital cosmetic surgery predicted a low genital self-image. Being older was associated with a better genital self-image in females. Clinical ImplicationsThe results show that a psychological intervention may be needed as an alternative to cosmetic genital surgery for people who are dissatisfied with the appearance of their genitals. Strengths and LimitationsThis is one of few available studies investigating the association between actual genital size and genital dissatisfaction. The vast sample size and high response rate are also strengths. Limitations include the cross-sectional design, and possible bias in the study sample due to self-selection. ConclusionOverall, a low genital self-image and dissatisfaction with one's genitalia is relatively common and is influenced not only by genital size, but also behaviors performed to alleviate worry about one's genitals.Hustad IB, Malmqvist K, Ivanova E, et al. Does Size Matter? Genital Self-Image, Genital Size, Pornography Use and Openness Toward Cosmetic Genital Surgery in 3503 Swedish Men and Women. J Sex Med 2022;19:1378–1386.

Adult Congenital Spine Deformity: Clinical Features and Motivations for Surgical Treatment.

There is scarce information available about adult congenital spine deformity (ACSD) in the literature, especially its impact after the pediatric age. The aim was to define ACSD characteristics and to establish the drivers for surgical intervention. Cross-sectional study of data collected in an adult deformity multicenter database. Only ACSD patients were included. Demographic and radiographic data, as well as patient-reported outcome measures, were assessed. Conservatively (C) vs surgically (S) treated patients were compared using Student t test, χ², and Mann-Whitney U test. Fifty-two patients were included. They were young adults (x = 37.7 years), mostly female (71%). Among them, 60% had single hemivertebrae (HV), 35% had multiple HV, and 5% had segmentation defects. Also, 75% had mainly coronal deformity (Cobb 62.5° ± 29.6) and 25% had sagittal deformity.Mean Oswestry Disability Index (ODI) was 29.6% ± 17 and mean Scoliosis Research Society 22-item survey (SRS-22) total score was 3.2 ± 0.8. Of note, mean SRS-22 self-image score was 2.8 ± 0.9 and 36-item Short Form Health Survey (SF-36) physical function score was 40.9 ± 11.Thirty patients were treated conservatively (C), whereas 22 patients underwent surgery (S). No differences were found regarding age, type or location of the deformity, comorbidities, or radiographic parameters. Operated patients had worse Core Outcome Measurement Index (COMI) back scores (C: 3.8 ± 2.4 vs S: 6.7 ± 2.4; P = 0.004); worse SRS-22 self-image (C: 3 ± 0.9 vs S: 2.5 ± 0.9; P = 0.047), and SRS-22 total scores (C: 3.4 ± 0.8 vs S: 2.9 ± 0.7; P = 0.01); worse SF-36 physical component summary (C: 43.3 ± 10.8 vs S: 36.7 ± 10.4; P = 0.048); and worse SF-36 physical role, function, and social function. Adult congenital deformity patients were mainly female young adults, with formation defects (HV), worried about their image and presenting some degree of functional impairment and pain. These symptoms were the essential drivers for surgery, rather than the radiographic deformity itself. One of the few studies describing the characteristics and clinical concerns of patients with congenital spinal deformities. 3.

Patient Satisfaction Following Minimally Invasive and Open Surgeries for Adult Spinal Deformity

Patient satisfaction has become an important variable in assessing outcomes after spine surgery. Although minimally invasive surgery (MIS) techniques have become popular owing to reduced perioperative complications compared with open deformity surgery, whether patient-reported postoperative satisfaction differ between the 2 surgical approaches is unclear. The aim of this study was to characterize postoperative patient-reported outcomes (PRO) in patients who underwent open surgery or MIS for adult spinal deformity (ASD). PRO scores were prospectively collected for patients undergoing deformity correction surgery between 2016 and 2018. Inclusion criteria were age >18 years, ASD, and completed PRO surveys. Patient demographic, clinical, and radiographic data and PRO survey responses were analyzed. A post hoc analysis comparing patients who were satisfied with their outcome and those who were unsatisfied was performed. Forty patients who underwent operative management of ASD (19 in the open surgery group and 21 in the MIS group) met the criteria for inclusion in this study. Patients in the MIS group reported higher mental health and self-image scores at 6 months; however, at the 12-month follow-up, both the open surgery and MIS groups reported minimal clinically important differences in back pain, leg pain, and functional status. Patient satisfaction scores did not differ based on surgical approach or intraoperative complications. PRO after open surgery and after MIS for ASD reflected successful outcomes with significant improvements in PRO survey scores but with subtle differences in the postoperative recovery process. The MIS group reported faster recovery with earlier improvement in self-image and mental health scores, which may stem from correction of smaller deformities. At the 12-month follow-up, postoperative satisfaction was high for the majority of patients in both groups.

Long-term follow-up of untreated Scheuermann's kyphosis.

Long-term cross-sectional study. To investigate the long-term effects of untreated Scheuermann's kyphosis on quality of life, and its relationship to radiographic parameters of spinal deformity. Previous studies reported reduced self-image, increased pain and impaired physical status. Little is known of the long-term impact of sagittal plane deformity in untreated SK. One hundred and thirteen consecutive untreated patients with SK were identified from a national service database prior to 2000, when surgery was not offered at this unit. 81 of these patients were available for evaluation; 66 (81%) consented to questionnaire and clinical evaluation, and 47 (58%) consented to additional radiological evaluation. Health-related quality of life (HRQoL) was compared to normative population values. Mean age was 45.1years (31-65), and mean follow-up was 27years (16-36). 57 patients had thoracic kyphosis and 9 had thoracolumbar deformity. SRS-22 and SF-36 scores were lower, and ODI was greater in patients with untreated SK compared to normative population values. Kyphosis progressed from mean 66° at skeletal maturity to 78° (p < 0.001) after mean follow-up of 27years. Long-term progression of untreated SK was 0.45°/year (n = 47). Multilinear regression showed good correlation between increasing SVA and worse ODI scores (r = 0.59; p = 0.001). Increasing SVA also correlated with worse function, pain and mental health scores reported by SRS-22, and with worse physical function and bodily pain scores reported by SF-36. Increasing CL correlated with worse SF-36 physical function scores. Increasing cSVA and increasing TK correlated with worse SRS-22 self-image scores. SRS-22 and SF-36 scores were lower, and ODI was greater in patients with untreated SK compared to normative data. Long-term progression of untreated SK was 0.45°/year (n = 47). Increasing SVA correlated with worse SF-36 physical function, SRS-22 function, SRS-22 pain and higher ODI scores. Total kyphosis (TK) and cSVA were independent predictors of low SRS self-image. III.

The Impact of Corrective Surgery on Health-Related Quality of Life Subclasses in Adult Scoliosis: Will Degree of Correction Prognosticate Degree of Improvement?

Objectives in scoliosis corrective surgery include restoration of normal sagittal and coronal parameters to achieve patient satisfaction. HRQLs improvements remain limited after corrective surgery.The aim of this study was to evaluate the HRQL subclass variability specific to the sagittal and coronal correction in adult scoliosis surgery. This multi-centre prospective analysis of consecutive adult spinal deformity (ASD) patients, from five European centres, only included multilevel instrumentation for scoliosis. d-(delta) values for each parameter represented pre to post-operative changes. Parameters included demographics, baseline, 1- and 2-year. HRQL outcomes (Oswestry disability index (ODI), Scoliosis Research Society (SRS)-22 and Short Form (SF36)), sagittal correction including relative spinopelvic alignment (dRSA) and coronal correction including major Cobb (dCobb) angles. A total of 353 patients reached 1-year and 2-year follow up. All HRQL total scores significantly improved postoperatively, including ODI, SRS-22 and SF36. HRQL subclasses which displayed persistent improvements correlated to dRSA included sex-life, self-image, fatigue, vitality, social functioning. The only HRQL subclass improvement that correlated with dCobb was self-image. Adult scoliosis surgery improves overall HRQL, having a minimal effect on each variable. Importantly, greater coronal deformity correction affects only greater self-image scores, whereas with greater sagittal correction there are many greater HRQL sub-class impacts. Correction and restoration of coronal balance is one of the surgical goals in adult scoliosis but the degree to which Cobb angle is corrected, apart from self-image, does not correlate with gains in sub-classes of HRQL. These results need to be taken into account when planning surgery.

Effect of Instrumentation Level on Mental Health Subscale of Scoliosis Research Society Outcomes Questionnaire in Adolescent Idiopathic Scoliosis.

IntroductionAdolescent idiopathic scoliosis (AIS) surgery aims to obtain a flexible and stable spine, correct axial rotation and halt curve progression by fusing the least number of motion segments. Longer fusions can improve deformity correction, but late decompensation and lumbar degeneration may occur. Even some daily issues can be problematic in some scoliosis patients. Reduction in mobility, segmental mobility adjacent to fusion, degeneration of junctional unfused levels and low-back pain (LBP) results in poor outcomes. It is reported that AIS patients have more mental and psychological problems including depression. Preoperative concerns due to deformity may continue postoperatively as instrumentation fuses motion segments. We wanted to present the relationship between the remaining mobile segments and Scoliosis Research Society-22r (SRS-22r) mental health (MH) scores of AIS patients.MethodsIt is a retrospective study of 110 posterior fusion AIS patients, age between 10 and 18 years, and followed-up for at least two years who filled SRS-22r forms both preoperatively and in postoperative second year (POY2). Patients are grouped according to the lowest instrumented vertebra (LIV) as LIV L5: group 1, LIV L4: group 2, LIV L3 and above: group 3.ResultsA statistically significant difference (SSD) was not found in preoperative and POY2 comparison of truncal shift (TTS), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal balance (SB) in group 1; SB in group 2, and LL in group 3 (p>0.05). SSD was found in all other radiologic measurements of groups and in all patients. No SSD was found in function and MH in group 1, in function and pain in group 2 and in pain in group 3 and all patients (p>0.05). SSD was found in the remaining SRS-22r subscales. There was an SSD between groups 1 and 2 in terms of instrumentation level (p=0.013). SSD was found between groups 1 and 2 in preoperative Cobb angle (p=0.016). SSD was found between groups 2 and 3 in POY2 Cobb angle (p=0.025). SSD was found between groups 2 and 3 in POY2 apical vertebral translation (p=0.01). There was no SSD in other radiological parameters (p>0.05).SSD was found between groups 1 and 2 (p=0.02) and between groups 1 and 3 (p=0.037) in terms of POY2 MH, but no SSD was found between groups 2 and 3 (p>0,05). There was no SSD in other preoperative or POY2 SRS-22r subscales (p>0.05).ConclusionMore distal LIV is associated with a reduction of mobility and SRS scores. The self-image scores of groups were not statistically different. However, in group 1, MH was significantly lower. With the improvement of body images, patients start to worry about mobility instead of cosmesis. Higher depression has been reported in AIS patients. In POY2, there was no SSD between groups in terms of pain, function and satisfaction in addition to the self-image score as indicated in the literature.We especially recommend that L5 LIV patients should receive psychiatric support in order to prevent anxiety, and inform and support them that they are not different in terms of pain, self-image and function scores compared to more proximal LIV patients, and also we recommend encouraging L5 LIV patients that POY2 SRS22-r pain, self-image, satisfaction, subtotal and total scores are improved. As reported in the literature which shows increased suicidal thoughts and depression in scoliosis patients; our findings regarding MH are important and considerable.

Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients

Current literature on surgical outcomes after gender affirming genital surgery is limited by small sample sizes from single-center studies. To use a community-based participatory research model to survey a large, heterogeneous cohort of transmasculine patients on phalloplasty and metoidioplasty outcomes. A peer-informed survey of transmasculine peoples' experience was constructed and administered between January and April 2020. Data collected included demographics, genital surgery history, pre- and postoperative genital sensation and function, and genital self-image. Of the 1,212 patients completing the survey, 129 patients underwent genital reconstruction surgery. Seventy-nine patients (61 percent) underwent phalloplasty only, 32 patients (25 percent) underwent metoidioplasty only, and 18 patients (14 percent) underwent metoidioplasty followed by phalloplasty. Patients reported 281 complications requiring 142 revisions. The most common complications were urethrocutaneous fistula (n = 51, 40 percent), urethral stricture (n = 41, 32 percent), and worsened mental health (n=25, 19 percent). The average erect neophallus after phalloplasty was 14.1 cm long vs 5.5 cm after metoidioplasty (P < .00001). Metoidioplasty patients report 4.8 out of 5 erogenous sensation, compared to 3.4 out of 5 for phalloplasty patients (P < .00001). Patients who underwent clitoris burial in addition to primary phalloplasty did not report change in erogenous sensation relative to primary phalloplasty patients without clitoris burial (P = .105). The average postoperative patient genital self-image score was 20.29 compared with 13.04 for preoperative patients (P < .00001) and 21.97 for a historical control of cisgender men (P=.0004). These results support anecdotal reports that complication rates following gender affirming genital reconstruction are higher than are commonly reported in the surgical literature. Patients undergoing clitoris burial in addition to primary phalloplasty did not report a change in erogenous sensation relative to those patients not undergoing clitoris burial. Postoperative patients report improved genital self-image relative to their preoperative counterparts, although self-image scores remain lower than cisgender males. These results are unique in that they are sourced from a large, heterogeneous group of transgender patients spanning 3 continents and dozens of surgical centers. The design of this study, following a community-based participatory research model, emphasizes patient-reported outcomes with focus on results most important to patients. Limitations include the recall and selection bias inherent to online surveys, and the inability to verify clinical data reported through the web-based questionnaire. Complication rates, including urethral compromise and worsened mental health, remain high for gender affirming penile reconstruction. Robinson IS, Blasdel G, Cohen O, etal. Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients. J Sex Med 2021;18:800-811.

The effects of thoracoplasty on immediate post-operative recovery in adolescent idiopathic scoliosis.

The purpose of this study was to evaluate differences in pain, opiate utilization and oxygen (O2) consumption during the immediate post-operative course for patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) with and without thoracoplasty. Patients aged 10-21years old that had undergone PSF for AIS were identified from 1/1/16-8/1/18. A cohort of patients that did not have a thoracoplasty group was used as a control group. A standardized pain protocol (rapid response pathway) was implemented on all patients. A retrospective chart review was performed. Pre-operative, operative and post-operative data and SRS scores were analyzed. Forty-six patients (38 girls, 8 boys) were included, 23 in each group. The average age was 15.2years (range 12.0-19.3) and BMI was 20.9 (range 13.1-37.6). Differences in visual analog scores, post-operative oxygen and narcotic consumption were not statistically significant on any POD. Total opiate utilization was 146.06 morphine milligram equivalents (MME) in the control group and 149.41 MME in the thoracoplasty group (p = 0.78). One-year SRS self-image scores were higher in the thoracoplasty group (4.24 vs 3.96) (p = 0.007). There was no difference in length of hospitalization (3.6 vs 3.5days), levels fused (12.9 vs 12.9) or blood loss (334.1 vs 413.5mL). There was one pleural effusion and no instances of intercostal neuralgia or pneumothorax in the thoracoplasty group. There is no increase in immediate post-operative pain, narcotic use or oxygen consumption when a thoracoplasty is performed with a PSF for AIS. Improved SRS self-image scores were seen after thoracoplasty.

Determining the association between the radiographic parameters and the SRS-22 scores in Chinese female patients with adolescent idiopathic scoliosis: does curve pattern matter?

Background: The Scoliosis Research Society (SRS)-22 outcomes have been shown to be correlated with radiographic parameter of adolescent idiopathic scoliosis (AIS). A recent study suggested that curve patterns might play a role in assessing the influence of deformity on patient’s reported outcomes. The aim of this study was to examine the relationship between radiographic parameters and SRS-22 questionnaire outcomes in female patients with adolescent AIS among the Chinese population based on five curve patterns. Patients and Methods: The radiographic data and SRS-22 questionnaires of 259 female AIS patients were reviewed. Radiographic measurements included: Cobb angle of the major curve, T1 tilt angle, apical vertebral rotation, apical vertebral translation (AVT), thoracic kyphosis, and lumbar lordosis. Curve patterns included single thoracic (T), single thoracolumbar/lumbar (TL), double thoracic (DT), double major (DM), and triple major (TM). The correlation between radiographic measurements and each domain in SRS-22 was determined by Pearson’s correlation coefficient. Results: The curve magnitude and AVT of the major curve were found to be significantly correlated with the self-image domain in all cases (Cobb angle: r = –0.426, p = 0.002; AVT: r = –0.281, p=0.006) and in all curve patterns except for TM. Compared to other groups, the TM group had a significantly larger major curve than the DT group and TL group (p ≤ 0.004). In TM group, the self-image scores were lower than TL group (p =0.018), and the function scores were lower than that in T, TL (p < 0.001) and DM groups (p =0.013). In the DT group, the T1 tilt was significantly correlated with the self-image domain (r = –0.376, p =0.004). In the T group, coronal curve magnitude was significantly correlated with function domain (r = −0.397, p < 0.001). Conclusion: Our findings suggested curve patterns should be considered in evaluating the correlations between radiographic parameters and SRS-22 outcomes in patients with AIS.

Clinical and radiological factors associated with postoperative shoulder imbalance and correlation with patient-reported outcomes following scoliosis surgery

BackgroundShoulder balance (SB) is an important cosmetic concern and is a determinant to assess outcomes following scoliosis surgery. Shoulder imbalance (SI) has been studied predominantly in idiopathic scoliosis with limited literature on other etiologies. PurposeTo assess SB following scoliosis surgery and correlate SRS-30 self-image scores with radiological shoulder imbalance SI. MethodsA retrospective analysis was performed for 43 patients undergoing scoliosis surgery with a minimum 2-year follow-up. Radiological SI was assessed by the coracoid height difference on whole spine standing radiographs at preoperative, 12-weeks postoperative and 2-year follow-up. The preoperative Cobb angle, postoperative Cobb angle and mean correction were recorded. The upper and lower end vertebrae (UEV/LEV), and instrumented vertebrae (UIV/LIV) were documented. The aetiology of scoliosis and functional outcomes based on the SRS-30 questionnaire were noted. ResultsThere were 19 males and 24 females with a mean age of 14.5 ± 4.7 years. The 12-week postoperative radiographs showed SI in 15 patients and residual SI in 7 patients at 2-year follow-up. SI was seen in four congenital scoliosis with segmentation or mixed anomalies in the proximal thoracic spine. Two idiopathic scoliosis (Lenke type 1 and type 3) showed SI where the UIV was T3 and T2 respectively. The mean preoperative SRS-30 score for patients with SB (N = 9) was 2.5 ± 0.72 and for SI (N = 34) was 3 ± 0.42 without significant difference (p > 0.5). The final mean SRS-30 self-image score for patients with SB was 3.7 ± 0.54 and for patients with SI was 3.7 ± 0.53 without significant difference (p > 0.05). ConclusionRadiological SI assessed by coracoid height difference was not associated with a significant difference in SRS 30 scores preoperatively and at 2 year follow up. SI was seen with congenital scoliosis associated with segmentation and mixed anomalies of the proximal thoracic spine.

Reliability and validity of the adapted Turkish version of the Spinal Appearance Questionnaire

The Spinal Appearance Questionnaire (SAQ), scoliosis specific quality of life questionnaire, was developed to assess the spinal appearance in adolescent idiopathic scoliosis (AIS) patients. The aim of this study is to evaluate the adaptation, validity, and reliability of the Turkish version of the Spinal Appearance Questionnaire (Tr-SAQ). Tr-SAQ and already validated Turkish SRS-22 were applied to 75AIS patients (56 females) twice within a 2-week interval for test-retest reliability. Validity of the Tr-SAQ was assessed with factor analysis, convergent validity, and discriminant validity. Convergent validity was evaluated by calculating Spearman correlation coefficients between Tr-SAQ and SRS-22 self-image domain. Internal consistency and intraclass correlation coefficient (ICC) were evaluated for the determination of reliability. Factor analysis indicated that Tr-SAQ had two factors as appearance (items 1-10) and expectations (items 12-15). Convergent validity test showed a significant negative correlation between the Tr-SAQ appearance score and SRS-22 self-image score (Spearman's r = - 0.6).Test-retest was conducted within a mean of 16.7 (range 14-28) days. Both ICC and Cronbach's α were found to be high (0.98, 0. 91, respectively). The correlations with the major curve magnitude were stronger for the Tr-SAQ Appearance (r = 0.7) and Tr-SAQ Total (r = 0.6) scores than the correlations between the SRS-22 self-image (r = - 0.5) and SRS-22 Total (r = - 0.4) scores. The Turkish version of the SAQ was reliable and valid for clinical use for AIS patients who are native speakers of Turkish. Level I- diagnostic studies.

HIV Stigma and Its Associations with Longitudinal Health Outcomes Among Persons Living with HIV with a History of Unhealthy Alcohol Use.

This study examined the demographic and clinical correlates of HIV stigma and evaluated how HIV stigma was associated with physical and mental health outcomes one year later in a primary-care based cohort of persons living with HIV (PLHIV; N = 584). HIV stigma was measured using a modified Berger HIV stigma scale, which includes four subscales: (1) personalized stigma; (2) disclosure concerns; (3) negative self-image; and (4) concerns around public attitudes towards PLHIV. Physical and mental health were assessed using the 12-item short form survey (SF-12). Compared to whites, African Americans were more likely to have higher personalized stigma scores (adjusted prevalence ratio [aPR] 1.54 [95% confidence interval 1.10-2.15]), disclosure concerns (aPR 1.40 [1.03-1.92]), and concerns with public attitudes about PLHIV (aPR 1.61 [1.11-2.34]). Hispanic/Latinx participants were more likely to have concerns around public attitudes towards PLHIV (aPR 1.50 [1.11-2.02]) than whites. Compared to men, women were more likely to have higher negative self-image scores (aPR 1.50 [1.08-2.08]). Higher stigma scores were associated with poorer subsequent self-reported physical and mental health functional status. Our findings highlight the substantial need for addressing HIV stigma, particularly among minority subgroups.