Severe Idiopathic Scoliosis Research Articles

Prediction of the risks of developing clinically significant frontal imbalance in surgical treatment of severe forms of idiopathic scoliosis with a primary thoracic scoliotic curve

Objective. To create a multifactorial model for predicting the risks of developing clinically significant frontal imbalance in surgical treatment of severe idiopathic scoliosis based on the identification of predictors influencing the main clinical parameters of trunk asymmetry.Material and Methods. The results of surgical treatment of 288 patients with severe forms of idiopathic scoliosis with a primary thoracic scoliotic curve of types 1, 2, 3 according to Lenke (mean 97.6° ± 15.5° according to Cobb) who underwent surgery in 1999–2019 using posterior segmental instrumentation with hook, hybrid and transpedicular fixation, were analyzed. There were 243 female (84.4 %) and 45 male patients (15.6 %). The average age of patients at the time of surgery was 15.3 [10–39] years. The average postoperative follow-up period was 3.5 [2.0–19.5] years. The analysis included clinical and radiological data obtained in the preoperative, postoperative and late postoperative periods. Predictors of the occurrence of frontal imbalance (the distance from the plumb line to the navel and intergluteal fold more than 15 mm, the tilt of the shoulder girdles more than 5° and the tilt of the scapula more than 15°) were identified by building single- and multivariate logistic regression models.Results. In the total cohort, 41 (14.2 %) patients with clinically significant frontal imbalance were identified, including 10 (3,0 %) – with an increase in the distance from the plumb line to the umbilicus of more than 15 mm, 12 (4.2 %) – with an increase in the distance from the plumb line to the intergluteal fold of more than 15 mm, 8 (2.8 %) – with a shoulder girdle tilt of more than 5°, and 11 (3.8 %) – with a scapular tilt of more than 15°. A significant predictor of the risk of developing frontal imbalance was determined as postoperative thoracic scoliotic curve of more than 63°. Multiplicative predictors of the risk of frontal imbalance were identified: postoperative increase in the distance from the plumb line to the umbilicus by more than 15 mm and a tilt of the shoulder girdles by more than 5° with a sensitivity of 88.9 % and 100.0 %, and a specificity of 89.5 % and 100.0 %, respectively (p < 0.001).Conclusion. Identification of multiplicative predictors of the risk of frontal imbalance allows predicting the risk of increasing the distance from the plumb line to the navel by more than 15 mm and the risk of shoulder girdle tilt by more than 5°. To eliminate the risk of frontal imbalance, it is necessary to strive for maximum correction of the thoracic scoliotic curve. When planning surgical treatment using transpedicular fixation for the correction of severe thoracic scoliosis, it is necessary to take into account the patient’s gender and the presence of concomitant neurosurgical, cardiological and pulmonological pathology to prevent shoulder girdle imbalance.

Radiological and Pulmonary Results of Surgical Treatment of Severe Idiopathic Scoliosis Using Preoperative Halo Gravity Traction Compared with Less Invasive Temporary Internal Distraction in Staged Surgery in Adolescents.

Background: Severe and rigid scoliosis represents a type of spinal deformity characterized by a Cobb angle exceeding 90° and a flexibility of less than 30%. Halo spinal traction remains the established standard for managing severe scoliosis, although alternative approaches such as temporary internal distraction rods and staged surgical correction exist. The primary objective of this investigation was to compare two cohorts of patients treated using these distinct methods to ascertain any divergences in terms of surgical and radiological outcomes, pulmonary function (PF), and quality of life (QoL). Methods: This study encompassed a total of 62 pediatric patients meeting the specified criteria, which included severe idiopathic scoliosis (major Cobb curve >90) and flexibility <30%. Group 1 (G1) underwent surgical intervention involving preoperative Halo gravity traction (HGT) succeeded by posterior spinal fusion (PSF). On the other hand, Group 2 (G2) underwent a two-stage procedure starting with a less invasive temporary internal distraction technique (LITID) prior to PSF. The radiological outcomes, PF, and QoL were documented and assessed over a monitoring period ranging from 2 to 5 years. Results: The average preoperative major curves (MCs) measured 124° and 122° in G1 and G2, respectively (p < 0.426). Initial flexibility, as observed in preoperative bending films, ranged from 18% in G1 to 21% in G2 (p < 0.001). Following the ultimate surgical intervention, the MCs were corrected to 45° and 37.4° in G1 and G2, respectively (p < 0.001). The percentage correction of the MCs was higher in G2 (63% vs. 70% in G1 and G2, respectively), with significant between-group disparities (p < 0.001). The mean preoperative thoracic kyphoses (TKs) were 96.5° in G1 and 92° in G2 (p = 0.782), which were rectified to 45.8° in G1 and 36.2° in G2 (p < 0.001), equating to correction rates of 55% and 60% in the respective groups. Initially, G2 exhibited lower values for the percentage of predicted lung volume (FVC) and predicted FEV1 compared with G1 (49% and 58% vs. 54.5% and 60.8%; N.S.). Nonetheless, both groups demonstrated enhancements in their FVC and FEV1 values over the follow-up period. Conclusions: The surgical management of severe and untreated spinal curvatures in the pediatric and adolescent population can be considered safe, with a tolerable incidence of minor complications. LITID emerges as a method offering improved QoL and pulmonary function, achieving notably substantial average corrections in deformity by 70% in the coronal plane and 60% in the sagittal plane, alongside a mean increase in trunk height of 10.8 cm. Furthermore, a typical reduction of 76% in rib humps and enhancements in respiratory function, as indicated by improvements in 1 s predicted forced expiratory volume (by 25-56%) and forced vital capacity (by 35-65%), were achieved, leading to a clinically and statistically significant enhancement in QoL when evaluated using SRS-22r, without resorting to more radical, high-risk procedures.

Prevalence and plasma exosome-derive microRNA diagnostic biomarker screening of adolescent idiopathic scoliosis in Yunnan Province, China.

Idiopathic scoliosis significantly affects the physical and mental health of children and adolescents, with varying prevalence rates in different regions. The occurrence of idiopathic scoliosis is associated with genetic regulation and biochemical factors, but the changes in exosome-derived miRNA profiles among idiopathic scoliosis patients remain unclear. This study aimed to determine the prevalence of idiopathic scoliosis in Yunnan Province, China, and identify key exosome-derived miRNAs in idiopathic scoliosis through a cohort study. From January 2018 to December 2020, a cross-sectional study on idiopathic scoliosis in children and adolescents was conducted in Yunnan Province. A total of 84,460 students from 13 cities and counties in Yunnan Province participated in a scoliosis screening program, with ages ranging from 7 to 19 years. After confirmation through screening and imaging results, patients with severe idiopathic scoliosis and normal control individuals were selected using propensity matching. Subsequently, plasma exosome-derived miRNA sequencing and RT-qPCR validation were performed separately. Based on the validation results, diagnostic performance analysis and target gene prediction were conducted for differential plasma exosome-derived miRNAs. The overall prevalence of idiopathic scoliosis in children and adolescents in Yunnan Province was 1.10%, with a prevalence of 0.87% in males and 1.32% in females. The peak prevalence was observed at age 13. Among patients diagnosed with idiopathic scoliosis, approximately 12.8% had severe cases, and there were more cases of double curvature than of single curvature, with thoracolumbar curvature being the most common in the single-curvature group. Sequencing of plasma exosome-derived miRNAs associated with idiopathic scoliosis revealed 56 upregulated and 153 downregulated miRNAs. Further validation analysis confirmed that hsa-miR-27a-5p, hsa-miR-539-5p, and hsa-miR-1246 have potential diagnostic value. We gained insights into the epidemiological characteristics of idiopathic scoliosis in Yunnan Province and conducted further analysis of plasma exosome-derived miRNA changes in patients with severe idiopathic scoliosis. This study has provided new insights for the prevention and diagnosis of idiopathic scoliosis, paving the way for exploring clinical biomarkers and molecular regulatory mechanisms. However, further validation and elucidation of the detailed biological mechanisms underlying these findings will be required in the future.

Consistent anatomical relationships of pedicle, lamina, and superior articulating process in severe idiopathic scoliosis allow for safe freehand pedicle screw placement: A proof-of-concept technical study.

Transpedicular screw placement has superior pullout strength compared to alternative forms of spinal fusion and is often performed in deformity correction surgery with navigation for optimal accuracy and reliability. Freehand technique for pedicle screws minimizes operation time and radiation exposure without fluoroscopy but is not widely adopted given the challenge of difficult anatomical corridors and accurate placement, especially in idiopathic scoliosis and advanced deformity. We used a computer-generated model to assess a proof-of-concept and anatomical feasibility of a freehand screw technique in severe scoliosis. Three-dimensional (3D) reconstructions of vertebra from a sample of two male patients with severe idiopathic scoliosis deformity (1 thoracic and 1 lumbar) with Cobb angles of 100° were used for planned placement of 17 levels of thoracolumbar (6.5 mm × 45 mm) pedicle screws. 3D reconstruction of each vertebra was created and measurements of screw entries and trajectories were reproduced with a 3D slicer software image computing platform. Accurate transpedicular screw placement is possible with anatomical landmarks based on the 3D reconstructed vertebral levels. A series of 5 figures were assembled to demonstrate sagittal, coronal, and axial planes and key anatomical landmarks and trajectories of thoracic and lumbar freehand pedicle screws in severe idiopathic scoliosis. Anatomical landmarks for freehand transpedicular screw placement (between pedicle, lamina, and superior articulating process) are constant and reliable in severe idiopathic scoliosis as evidenced by 3D computer modeling. Preoperative computed tomography modeling may assist appropriate screw entry and trajectory based on anatomical landmarks for spine surgeons, and guide freehand technique for screw placement in adolescent idiopathic scoliosis.

Three-stage correction of severe idiopathic scoliosis with limited skeletal traction during a humanitarian surgical mission: illustrative case.

Underprivileged and underserved patients from developing countries often present late with advanced, untreated spinal deformities. We report a three-stage all-posterior approach using limited skeletal traction with Gardner-Wells tongs (GWTs) for the management of severe idiopathic scoliosis during a humanitarian surgical mission trip. A 17-year-old high-school female was previously diagnosed with juvenile idiopathic scoliosis (diagnosed at age 8) and progressed to a severe 135° kyphoscoliosis. Procedural stage 1 involved spinal instrumentation and posterior releases via posterior column osteotomies from T3 to L4. She then underwent 7 days of skeletal traction with GWTs in the intensive care unit as stage 2. In stage 3, rod engagement, posterior spinal fusion, and partial T10 vertebral column resection were performed. There were no changes in intraoperative neuromonitoring during either surgery and she woke up neurologically intact after both stages of the surgical procedure. Skeletal traction with GWTs is a viable alternative to traditional halo-gravity traction in settings with limited resources. Three-stage spinal deformity correction using limited skeletal traction is a feasible and effective approach for managing severe scoliosis during humanitarian surgical mission trips.

The machine-vision image guided surgery system reduces fluoroscopy time, ionizing radiation and intraoperative blood loss in posterior spinal fusion for scoliosis

PurposeTo determine if the novel 3D Machine-Vision Image Guided Surgery (MvIGS) (FLASH™) system can reduce intraoperative radiation exposure, while improving surgical outcomes when compared to 2D fluoroscopic navigation.MethodsClinical and radiographic records of 128 patients (≤ 18 years of age) who underwent posterior spinal fusion (PSF), utilising either MvIGS or 2D fluoroscopy, for severe idiopathic scoliosis were retrospectively reviewed. Operative time was analysed using the cumulative sum (CUSUM) method to evaluate the learning curve for MvIGS.ResultsBetween 2017 and 2021, 64 patients underwent PSF using pedicle screws with 2D fluoroscopy and another 64 with the MvIGS. Age, gender, BMI, and scoliosis aetiology were comparable between the two groups. The CUSUM method estimated that the MvIGS learning curve with respect to operative time was 9 cases. This curve consisted of 2 phases: Phase 1 comprises the first 9 cases and Phase 2 the remaining 55 cases. Compared to 2D fluoroscopy, MvIGS reduced intraoperative fluoroscopy time, radiation exposure, estimated blood loss and length of stay by 53%, 62% 44%, and 21% respectively. Scoliosis curve correction was 4% higher in the MvIGS group, without any increase in operative time.ConclusionMvIGS for screw insertion in PSF contributed to a significant reduction in intraoperative radiation exposure and fluoroscopy time, as well as blood loss and length of stay. The real-time feedback and ability to visualize the pedicle in 3D with MvIGS enabled greater curve correction without increasing the operative time.

Longer Brace Duration Is Associated with Lower Stress Levels and Better Quality of Life in Adolescents with Idiopathic Scoliosis.

Physical and psychological health concerns have been raised due to either spine deformity or orthotic treatment in adolescents with idiopathic scoliosis. To determine whether orthotic bracing duration affects psychological stress and health-related quality of life, a sample of 46 patients (8M, 38F, aged 11-17 years, regularly treated with bracing) with moderate or moderate to severe idiopathic scoliosis were separated into two groups based on whether their treatment duration was up to six months or longer. The brace-related levels of stress and quality of life were investigated in both groups by using the Bad Sobernheim Stress Questionnaire and the Italian Spine Youth Quality of Life, respectively. The questionnaire scores were categorized as low, mean, and high. Our statistical analysis considered the proportion of patients falling into the three categories and the difference in crude score rates between the two groups. Values were considered significant at p < 0.05. The proportion of patients with brace-related stress and impaired quality of life was significantly lower in the group treated longer compared to the group that had only received treatment for up to six months (chi-square test, p < 0.0001). Overall, mean ± SD BSSQ scored 8.72 ± 4.91 and 12.89 ± 4.65 in group 1 and group 2, respectively (Mann-Whitney U test, p = 0.008), while ISYQoL scored 19.94 ± 8.21 and 16.07 ± 6.12, respectively. We argue that the differences could depend on both the physical and psychological adaptation patients make to their brace and that more support should be provided to patients when they start to wear their brace.

Health-related quality of life of adult, non-surgically treated patients with idiopathic scoliosis and curves above 45°: a cross-sectional study at an average follow-up of 30years.

Previous studies on the natural history of moderate to severe idiopathic scoliosis show contradictory results. Some studies reported an increased incidence of back pain and disability in severe curves, while other studies reported no difference in health-related quality of life (HRQoL) compared to age-matched adult controls. None of these studies addressed HRQoL using currently recommended and validated questionnaires. To examine the long-term HRQoL in non-surgically treated adult idiopathic scoliosis patients with a curve of 45° or higher. In this retrospective cohort study, all patients were retrospectively identified in the hospital's scoliosis database. Patients (1) with idiopathic scoliosis; (2) born before 1981 (to ensure 25-year follow-up after skeletal maturity); (3) with a curve of 45° or more by Cobb's method at the end of growth; and (4) no spinal surgical treatment were selected. Patients received digital questionnaires of the Short Form-36, Scoliosis Research Society-22, Oswestry Disability Index and Numeric Rating Scale. Outcomes of the SF-36 were compared with a national reference cohort. Additional measures with questions regarding choice of education and occupation were used. Forty-eight of 79 (61%) eligible patients completed the questionnaires, at an average follow-up time of 29.9 ± 7.7years. Their average age was 51.9 ± 8.0, and median Cobb angle at adolescence was 48.5°. Five of the eight SF-36 subdomains were significantly lower in the scoliosis group compared to the nationwide cohort: physical functioning (73 vs 83, p = 0.011), social functioning (75 vs 84, p = 0.022), role physical functioning (63 vs 76, p = 0.002), role emotional functioning (73 vs 82, p = 0.032), and vitality (56 vs 69, p = < 0.001). The scoliosis-specific SRS-22r score of the patients was 3.7 ± 0.7 on a 0-5 scale. The mean NRS score for pain of all patients was 4.9 ± 3.2, and eight patients (17%) reported a NRS of 0 and 31 (65%) a NRS above 3. At the Oswestry Disability Index, 79% of the patients reported minimal disabilities. Thirty-three patients (69%) reported that their scoliosis had influenced their choice of education. Fifteen patients (31%) reported that their scoliosis had influenced their choice of work. Patients with idiopathic scoliosis and curves of 45° or higher have reduced HRQoL. Although many patients experience back pain, the disability reported on the ODI was limited. Scoliosis had noteworthy effect on choice of education.

Intervertebral Foramen - A Gateway to Epidural Space in Severe Lumbar Scoliosis.

We describe cases in which a preoperative computed tomography was used to guide the placement of an epidural catheter through the defect in the intervertebral foramina in patients with severe lumbar scoliosis. We demonstrate the adroitness with which epidural catheters were inserted through the intervertebral foramina. Computed tomography scan illustrates and plots the needle path creating a 3-dimensional image of the vertebral body rotation, needle trajectory, and the distance from the skin to the intervertebral foramina. Severe scoliosis is defined as a lateral curvature (Cobb's angle) of more than 50 degrees. It was proposed in severe idiopathic scoliosis that interventional pain management techniques are managed with fluoroscopic imaging or an alternative form. However, after a computed tomography evaluation of the scoliotic spine, we assumed that the intervertebral foraminal anatomy would facilitate a safe and efficient epidural needle and subsequent catheter positioning in severe scoliotic patients.

The Efficacy of a Posterior Approach to Surgical Correction for Neglected Idiopathic Scoliosis: A Comparative Analysis According to Health-Related Quality of Life, Pulmonary Function, Back Pain and Sexual Function

This study aimed to evaluate the treatment outcomes of severe idiopathic scoliosis (IS) and hypothesized that surgical treatment would have a superior impact on the health-related quality of life (HRQoL), pulmonary function (PF), back pain, and sexual function. We retrospectively reviewed 195 consecutive patients with IS classified into severe (SG) and moderate groups (MG) with a minimum follow-up of two years. The mean preoperative curve was 131° and 60° in the SG and MG, respectively. The mean preoperative flexibility in the bending films averaged between 22% in the SG and 41% in the MG. After definitive surgery, the main curve was corrected to 61° and 18° in the SG and MG, respectively. The mean preoperative thoracic kyphosis was 83° in the SG and 25° in the MG, which was corrected to 35° in the SG and 25° in the MG. At baseline, the percentage of predicted lung volume (FVC) was significantly lower in the SG than that in the MG (51.2% vs. 83%). The baseline percentage of the predicted FEV1 values was also significantly lower in the SG than in the MG (60.8% vs. 77%). During the two-year follow-up, the percentage of predicted FVC showed significant improvement in the SG (69.9%) (p < 0.001), and the percentage of predicted FEV1 values during the follow-up improved significantly in the SG (76.9%) (p < 0.001) compared with the MG (81%), with no statistical difference observed during the two-year follow-up. The SRS-22r showed a clinically and statistically significant improvement in the preoperative results to those of the final follow-up (p < 0.001). Surgical treatment of severe scoliosis can be safe. It provided a mean correction of the deformity for 59% of patients and significantly improved respiratory function, with the percentage of predicted forced expiratory volume in 1 s improving by 60% and the forced vital capacity improving by 50%, resulting in clinically and statistically significant improvements in the SRS-22r, HRQoL outcome scores, and back pain (reduced from 36% to 8%), as well as improved sexual function. The planned surgical treatment can achieve a very significant deformity correction with a minimal risk of complications. The surgical treatment has a superior impact on the quality of life patients with severe spinal deformities and significantly improves function in every sphere of life.

Pre-operative spirometry evaluation in adolescent girls with severe idiopathic scoliosis

Introduction. Pulmonary impairment may be observed in patients with severe idiopathic scoliosis (IS). The aim of the study was to analyze spirometry parameters and identify the pulmonary status of patients prior to scoliosis surgery. Materials and methods. Ninety-two adolescent girls with IS, aged 10-18 underwent a spirometry examination and radiographic evaluation. The body height loss was calculated from Stokes’ formula. The values of the pulmonary parameters were interpreted against the measured versus the corrected body height. Results. The mean thoracic Cobb angle was 68.3°, range 50°-89°. A restrictive pattern was observed in over 40% of patients. The use of reference values calculated for corrected body height decreased the number of patients presenting pulmonary parameters within the normal range (48.9% versus 56.5%) and increased the number of patients with a possible restrictive pattern (42.4% versus 32.6%). Airway obstruction was observed in 10.9% of patients when measured body height was used versus 8.7% of patients while corrected body height was used. Conclusions. More than half of patients with severe thoracic idiopathic scoliosis present pulmonary impairment, mainly of a restrictive pattern. The calculations of reference values from the corrected body height as a substitute for the measured one may influence the interpretation of the spirometry examination results.

Association of LBX1 Gene Methylation Level with Disease Severity in Patients with Idiopathic Scoliosis: Study on Deep Paravertebral Muscles.

Idiopathic scoliosis (IS) is a multifactorial disease with a genetic background. The association of Ladybird Homeobox 1 (LBX1) polymorphisms with IS has been proven in multiple studies. However, the epigenetic mechanisms have not been evaluated. This study aimed to evaluate the LBX1 methylation level in deep paravertebral muscles in order to analyze its association with IS occurrence and/or IS severity. Fifty-seven IS patients and twenty non-IS patients were examined for the paravertebral muscles’ methylation level of the LBX1 promoter region. There was no significant difference in methylation level within paravertebral muscles between patients vs. controls, except for one CpG site. The comparison of the paravertebral muscles’ LBX1 promoter region methylation level between patients with a major curve angle of ≤70° vs. >70° revealed significantly higher methylation levels in 17 of 23 analyzed CpG sequences at the convex side of the curvature in patients with a major curve angle of >70° for the reverse strand promoter region. The association between LBX1 promoter methylation and IS severity was demonstrated. In patients with severe IS, the deep paravertebral muscles show an asymmetric LBX1 promoter region methylation level, higher at the convex scoliosis side, which reveals the role of locally acting factors in IS progression.

The Role of Bending Films in the Lowest Instrumented Vertebra Selection in Adolescent Idiopathic Scoliosis Lenke Type 1A,B Based on Asymmetrical Disc Loading and Decompensation

Patients with severe adolescent idiopathic scoliosis (AIS) require instrumented spinal fusion surgery. The range of instrumented vertebra is still questioned, especially the selection of the lowest instrumented vertebra (LIV). This single institution retrospective consecutive study is to provide real-world data on outcomes. The study aims to assess whether bending films can determine the LIV. The method of determination of the lower tilted vertebra (LTV) is presented. The selection of the LTV was identified on standing PA (LTVs) and on bending X-rays (LTVb). Group A is a reference group, with less flexible curves. Groups B and C contained patients with more flexible curves. Group B covered patients with instrumentation ending at the LTVs and group C with shorter instrumentation ending at LTVb. The disc angle below the LIV was monitored for postoperative decompensation. Sixty-eight subjects with AIS Lenke 1A and 1B types underwent selective fusion. The decompensation criteria of the unfused disc below the fusion were determined as a wedging disk of &gt;5° of the Cobb angle. The patients were monitored during the postoperative period with 5.8 years average followup (minimum of 2 years). The rate of decompensation was comparable in groups A and B (31% and 33%, respectively). In contrast, the rate of decompensation was doubled in group C (60%). Caudal fusion shortening in more flexible curves according to bending films is associated with the first free disc asymmetry, which leads to decompensation below the fusion. This method should be considered in addition to other LIV selection criteria.

Outcomes of Definitive Spine Fusion Using All-pedicle-Screw Constructs in Skeletally Immature Patients Aged 8 to 10 Years With Severe Idiopathic Early-Onset Scoliosis.

The choice between growth-sparing techniques or definitive spine fusion for severe idiopathic early-onset scoliosis (IEOS) in skeletally immature patients aged 8 to 10 years represents a challenging dilemma. Although growth-sparing techniques show high complication rates in severe IEOS, the outcomes of definitive fusion in borderline skeletally immature patients with severe IEOS have not been investigated. We aimed to investigate the outcomes of early definitive fusion using all-pedicle-screw constructs in skeletally immature patients aged 8 to 10 years with severe IEOS. The inclusion criteria were as follows: IEOS, age 8 years or above, major coronal curve ≥90 degrees, thoracic height >18 cm, no history of previous spine surgery, no intraspinal anomalies and at least 3 years of postoperative follow-up. Patients underwent instrumented spinal fusion with all-pedicle-screw constructs and multiple Ponte osteotomies. All patients completed the Scoliosis Research Society 22 revision (Arabic version) questionnaire and Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S) preoperatively and at the last follow-up. Fifty-five patients (24 males, 31 females; mean age: 8.96 y; range: 8 to 10 y) with severe IEOS met the inclusion criteria (mean follow-up period: 4.1±0.6 y; range: 3 to 5 y). The mean major coronal Cobb angle improved significantly (P<0.001) from 107±12.5 degrees to 26.8±6.8 degrees. Mean thoracic kyphosis improved significantly (P<0.001) from 57.2±15.8 degrees to 31.2±4.4 degrees. The loss of correction at the latest follow-up was nonsignificant. The total Scoliosis Research Society 22 revision (SRS-22r) score improved significantly from 2.5±1 to 4.3±0.7. The mean BIDQ-S score improved significantly from 4.1±0.3 to 1.6±0.3. The immediate postoperative gains in the mean thoracic height (T1-T12) and spinal height (T1-S1) were 14.9% and 19.6%, respectively, and the overall height increase at the latest follow-up was 17.8% and 23.8%, respectively. One patient underwent revision for implant failure (rod breakage). Early definitive fusion for skeletally immature patients with severe IEOS yielded excellent correction with major improvements in patient quality of life. Severe IEOS poses a significant risk, but definitive fusion can potentially mitigate that risk in patients aged 8 to 10 years.

Особенности опорной функции стоп у детей с тяжелыми формами идиопатического сколиоза до и после хирургического лечения

Background Idiopathic scoliosis in children can cause noticeable changes in the musculoskeletal system including the feet and the relationship between spinal deformity and impaired biomechanics of the feet is important to learn in the case. The purpose was to explore plantographic characteristics of feet in children with severe idiopathic scoliosis before and after surgical correction of the curve using transpedicular spinal systems. Material and methods Foot support indices were measured in 18 children aged 14-17 years with grades III and IV idiopathic scoliosis Lenke types I, III, V and VI. The results were compared with plantographic findings of 18 healthy children. Results The medial index m was within normal limits with a double-support load in patients with idiopathic scoliosis before spinal surgery. The rest of the indices were significantly reduced irrespective of the extent of the foot load. Double-support load tests showed a pathologically strong correlation between the medial and median support indices m ~ s. The spring function of the foot arches was intact. The frontal balance of the spine correlated with the foot support indices. Patients developed no foot rigidity at 9–10 days of surgery and showed an increased asymmetry in the arches of the contralateral feet and an abnormal increase in the relationship between the foot support indices m, s and t with no correlation between the frontal balance of the spine and the plantographic characteristics. Conclusion Children with severe idiopathic scoliosis were shown to develop impaired biomechanics of the feet with decreased contact area between the feet and the support surface, and a pathological increase in the functional relationship of the arches. Impaired biomechanics of the feet appeared to aggravate at a short term following correction of spinal deformity.

3D ultrasound navigation system for screw insertion in posterior spine surgery: a phantom study.

Posterior spinal fusion surgery is required to correct severe idiopathic scoliosis. The surgery involves insertion of screws which requires high accuracy to prevent neurologic damage to the spinal cord. Although conventional CT navigation can reduce this risk, 3D-ultrasound-based navigation could achieve this without added ionizing radiation and usage of expensive and bulky equipment. This study aimed to evaluate the accuracy of a 3D ultrasound navigation system for posterior spine surgery. A custom 3D ultrasound (3DUS) with model-to-surface registration algorithm was developed and integrated into a 3D navigation environment. A CT scan of an adolescent spine (T3-T11) was segmented and 3D printed for experiments. A probe with reflective markers was placed in vertebral pedicles 684 times in varying levels, positions in the capture space and orientation of vertebra, and the entrypoint and trajectory accuracies were measured. Among 684 probe placements in vertebral levels T3 to T11 in the phantom spine, 95.5% were within 1mm and 5° of accuracy, with an average accuracy of 0.4 ± 0.4mm and 2.1 ± 0.9°, requiring 8.8s to process. Accuracies were statistically significantly affected by vertebral orientation and position in the capture volume, though this was still within the targeted accuracies of 1mm and 5°. This preliminary ultrasound-based navigation system is accurate and fast enough for guiding placement of pedicle screws into the spine in posterior fusion surgery. The current results are limited to phantom spines, and future study in animal or human cadavers is needed to investigate soft tissue effects on registration accuracy.

Features of postural control in children with severe forms of idiopathic scoliosis

Objective. The study of postural stability in children with severe degrees of idiopathic scoliosis and assessment of body balance disorders after surgical correction of spinal deformity.&#x0D; Material and methods. The study of 18 patients aged 1417 years with idiopathic scoliosis of the IIIIV degree with localization of the main arc according to Lenke I, III, V and VI was conducted. The vertical balance of the body was evaluated using a stabilometric platform MBN "Biomechanica" (LLC "MBN", Moscow) before and 910 days after the surgical correction of spinal deformity using transpedicular spinal systems. The results were compared with a stabilometric survey of 18 healthy children.&#x0D; Results. In patients with idiopathic scoliosis before surgery, a decrease in the stability of the vertical balance of the body, manifested by pronounced deviations from the nominal values of the stabilometric parameters, was revealed. The correlation analysis showed a pathologically strong relationship between the length L, the area S and the amplitude of fluctuations of the pressure center A in patients statokinesiograms compared to the group of healthy children.&#x0D; In the immediate postoperative period, the postural control system disorders are aggravated in patients.&#x0D; Conclusions. In children with severe idiopathic scoliosis, violations of the postural control system were revealed, which led to the formation of a suboptimal motor stereotype due to dysfunction of sensorimotor integration.

Comparing Health-related Quality of Life of Lenke 1–2, and Lenke 5–6 Severe AIS Adolescent Idiopathic Scoliosis Patients 2 Years after Surgery Using SRS-22 Questionnaire

Comparing Health-related Quality of Life of Lenke 1–2, and Lenke 5–6 Severe AIS Adolescent Idiopathic Scoliosis Patients 2 Years after Surgery Using SRS-22 Questionnaire

Development of a Shared Decision-Making Tool for Adolescents With Scoliosis to Decide Between Observation Versus Fusion Surgery.

Adolescent patients with moderate to severe idiopathic scoliosis who have completed their skeletal growth face a significant choice in their treatment path: watchful waiting or spinal fusion. Shared decision making (SDM) assists patients and clinicians to find treatments that make intellectual, practical and emotional sense. Our objective was to develop a tool that supports SDM for patients with scoliosis and their families. We used a user-centered design approach that included collaboration between patients, surgeons and SDM experts, observation of clinician encounters, and literature review. We focused on adolescent idiopathic scoliosis patients 13 or more years of age with less than 1 year of growth remaining (Risser stage 3 or greater) and curves between 40 and 65 degrees. We included 22 patients, and collected 22 video recordings. From these videos, we identified salient patient priorities for decision making including treatment benefits, surgical complications, pain, scheduling and recovery, and cost. For each theme, we conducted a focused review to obtain the best estimate of effect. Then, an expert SDM designer developed an electronic prototype called Scoliosis Choice. The initial prototype of the scoliosis SDM was finalized and is currently being field tested in clinic. Scoliosis Choice may help patients and surgeons better understand the potential risks and benefits of spinal fusion vs. observation for scoliosis treatment and improve validated measures of quality in patient-parent-surgeon communication.

Cost-Utility Analysis of Anterior Vertebral Body Tethering versus Spinal Fusion in Idiopathic Scoliosis from a US Integrated Healthcare Delivery System Perspective

PurposeAnterior vertebral body tethering (VBT) is a non-fusion, minimally invasive, growth-modulating procedure with some early positive clinical outcomes reported in pediatric patients with idiopathic scoliosis (IS). VBT offers potential health-related quality of life (HRQoL) benefits over spinal fusion in allowing patients to retain a greater range of motion after surgery. We conducted an early cost-utility analysis (CUA) to compare VBT with fusion as a first-choice surgical treatment for skeletally immature patients (age >10 years) with moderate to severe IS, who have failed nonoperative management, from a US integrated healthcare delivery system perspective.Patients and MethodsThe CUA uses a Markov state transition model, capturing a 15-year period following index surgery. Transition probabilities, including revision risk and subsequent fusion, were based on published surgical outcomes and an ongoing VBT observational study (NCT02897453). Patients were assigned utilities derived from published patient-reported outcomes (PROs; SRS-22r mapped to EQ-5D) following fusion and the above VBT study. Index and revision procedure costs were included. Probabilistic (PSA) and deterministic sensitivity analyses (DSA) were performed.ResultsVBT was associated with higher costs but also higher quality-adjusted life years (QALYs) than fusion (incremental costs: $45,546; QALYs gained: 0.54). The subsequent incremental cost-effectiveness ratio for VBT vs fusion was $84,391/QALY gained. Mean PSA results were similar to the base case, indicating that results were generally robust to uncertainty. The DSA indicated that results were most sensitive to variations in utility values.ConclusionThis is the first CUA comparing VBT with fusion in pediatric patients with IS and suggests that VBT may be a cost-effective alternative to fusion in the US, given recommended willingness-to-pay thresholds ($100,000–$150,000). The results rely on HRQoL benefits for VBT compared with fusion. For improved model accuracy, further analyses with longer-term PROs for VBT, and comparative effectiveness studies, would be needed.