Spinal Correction Research Articles

Clinical application of a classification based on crucial curvature of coronal imbalance in degenerative lumbar scoliosis

Objective: To present efficacy of clinical application of a classification based on crucial curvature of coronal imbalance in degenerative lumbar scoliosis (DLS). Methods: A case series study. Clinical data of 61 cases (8 males, 53 females) who underwent posterior correction surgery for DLS from January 2019 to January 2021 were retrospectively analyzed. The mean age was (71.7±6.2) years (ranged 60-82 years). According to the direction of C7 plumb line (C7PL) deviated from central sacral vertical line (CSVL) and orientation of L4 coronal tilt, the author determined which one was the crucial curve. If C7PL deviated from CSVL in the same direction as concave side of the thoracolumbar curve and L4 coronally tilts opposite direction of C7PL deviates from CSVL, then the crucial curve was thoracolumbar curve (type 1). On the contrary, if C7PL deviated from CSVL in the same direction as concave side of the lumbosacral curve and L4 coronally tilts consist with direction of C7PL deviates from CSVL, then the crucial curve was lumbosacral curve (type 2). According to absolute value of coronal balance distance (|CBD|), each type of patients was divided into two groups, respectively, namely coronal balance (CB) (|CBD|≤3 cm) and coronal imbalance (CIB) (|CBD|>3 cm). Changes of Cobb angles of thoracolumbar curve and lumbosacral curve and CBD were recorded and analyzed. Results: The rate of preoperative CIB was 55.7% (34/61) in all the patients. Of the patients, 23 cases were classified as type 1 and 38 cases as type 2. The rate of preoperative CIB was 34.8% (8/23) in type 1 patients and 68.4% (26/38) in type 2. The rate of postoperative CIB was 27.9% (17/61) in all the patients, with 13.0% (3/23) in type 1 and 36.8% (14/38) in type 2. The |CBD| of CB group in type 1 patients decreased from (2.6±1.4) cm before the operation to (1.5±1.0) cm after (P=0.015); and the correction rate of thoracolumbar curve (68.8%±18.4%) was significantly higher than that of lumbosacral curve (34.5%±23.9%) (P=0.005). The |CBD| of CB group in type 2 patients decreased from (2.6±3.0) cm before the operation to (1.6±1.2) cm after (P=0.027); the correction rate of lumbosacral curve (71.3%±18.6%) was higher than that of thoracolumbar curve (57.3%±21.1%), but the difference was not statistically significant (P=0.546). There was no significant difference in |CBD| of CIB group in type 2 patients before and after the operation (P=0.222); the correction rate of lumbosacral curve (38.3%±14.8%) was significantly lower than that of thoracolumbar curve (53.6%±16.0%) (P=0.001). There was a correlation between the change of CBD (3.8±1.5) cm and the difference in correction rate between thoracolumbar and lumbosacral curve (32.3%±19.6%) in CB group in type 1 patients after surgery (r=0.904, P<0.001). There was a correlation between the change of CBD (1.9±2.2) cm and the difference in correction rate between lumbosacral and thoracolumbar curve (14.0%±26.2%) in CB group in type 2 patients after surgery (r=0.960, P<0.001). Conclusion: Clinical application of a classification based on crucial curvature of coronal imbalance in DLS is satisfactory, and its combination with matching correction can effectively prevent the occurrence of coronal imbalance after spinal correction surgery.

The effect of dexmedetomidine on wake-up test quality when muscle relaxants are not used: A randomized control trial.

Stagnara wake-up test is a simple reproducible neuromonitoring method during spinal surgery which replaces the evoked potential monitoring in the absence of neuromonitoring facilities. Dexmedetomidine (DEX) effect on the intraoperative wake-up test is still unclear. The present study was conducted to evaluate the effectiveness of DEX on the quality of wake-up test during spinal correction surgery. A randomized controlled study was carried out over 62 patients randomized into two equal groups planned for elective minimally invasive corrective spine surgery. Instead of atracurium administration in the control group, patients in the experimental group were administered titrated continuous intravenous infusion of DEX at a dose of 0.2-0.7 μg/kg/hour. Lidocaine 2% spray around the vocal cords was done in both the groups to facilitate toleration of the endotracheal tube. The DEX group showed statistically significant longer duration and better quality of the wake-up test. Statistically significant better haemodynamic state, a lower amount of intraoperative sedatives and higher amount of intraoperative analgesics were also evident in the DEX group. The postoperative Ramsay sedation scale was significantly lower in the DEX group just after extubation. The DEX use has shown an improving effect on the wake-up test quality, with slightly prolonged wake-up time. The present work supports the use of DEX as an adjuvant drug alleviating the need for the neuromuscular blockade, inducing a better haemodynamic profile, exhibiting better sedation and improving the awakening condition.

Analysis of the relationship between spinal alignment and retrocrural space area in adult spinal deformity surgery: Potential risk factors for acute celiac artery compression syndrome

PurposeThis study was designed to reveal the association between spinal parameters and RCS area in patients with adult spinal deformities treated with spinal correction surgery. We hypothesized that reduction of the retrocrural space (RCS) area is related to thoracolumbar alignment, which may cause acute celiac artery compression syndrome (ACACS). MethodsEighty-nine patients (age: 68.4 ± 7.6 years; sex: 7 male/82 female) with ASD treated by spinal correction surgery were enrolled. Preoperative and postoperative spinal parameters were measured, and the differences between these parameters were calculated. Postoperative T12 translation was measured and RCS area was evaluated using reconstructed computed tomography. The change of RCS area after surgery was defined as ΔRCS. Patients were divided into increased and decreased RCS groups by the ΔRCS value, and spinal parameters were compared between groups. The correlation between spinal parameters and ΔRCS was calculated. ResultsThe patients in the decreased RCS group had greater anterior T12 translation than those in the increased RCS group (p < 0.001). T12 translation was significantly correlated with ΔRCS (β = −0.31, p = 0.017). There were no correlations between ΔRCS and other spinal parameters. ConclusionThoracolumbar alignment was associated with RCS area. Consistent with the hypothesis, overcorrection of the thoracolumbar junction was associated with reduced RCS area and might be one risk factor for ACACS.

The impact of spinal fusion of adolescent idiopathic scoliosis in Salah (Islamic Prayer) movement: a retrospective case-control study.

Corrective spine surgery is widely accepted for treating severe adolescent idiopathic scoliosis (AIS). Postoperative spinal range of motion (ROM) could be affected after such surgery. In certain populations, such as Muslims, this ROM change can impact daily life, as it may affect the five-times-a-day prayer (Salah). This study aims to assess the influence of spinal fusion (SF) in Adolescent Idiopathic Scoliosis (AIS) during the daily Islamic prayer (Salah). SF-AIS patients were videoed while performing Salah prayer. The kinematic documentation was assessed and compared to Salah movements of a control group of age-matched Muslim AIS patients, who had not had surgery. The prayer quality changes were subjectively classified into improved, no change/remained, and worsened, according to the Global Perceived Effect (GPE). Functional outcome and pain were assessed by the Scoliosis Research Society Questionnaire Version 30 (SRS-30). Thirty-nine women and five men (mean age±SD: 14.8±2.3 years) met the inclusion criteria, and unoperated AIS patients were used as control (twenty-two women, mean age±SD: 15.32±1.43 years). The prostrations ROM of the SF-AIS group differed significantly from the control group (p<0.05). The GPE of the prayer movement showed improvement in 36.4%, no change in 59.1%, and worsening in 4.5% of the SF-AIS patients. The worsened group had a significantly lower bowing ROM and higher prostrations ROM compared to all groups of prayer quality changes (p<0.05). SRS-30 scores showed good outcomes (function 4.0±0.2, pain 4.2±0.5), along with the overall bowing ROM and prostrations ROM (84.2±12.0° and 53.4±9.6°, respectively). Moreover, a significant moderate positive correlation between the bowing ROM and pain (r=0.417, p=0.007) was also found. Spinal fusion positively affects AIS Islamic patients in maintaining their daily Salah movement, ROM and prayer quality. Prayer quality assessment should be given extra attention as an adjuvant of the SRS-30 questionnaire to evaluate Muslim patients.

Is Minimally Invasive Bipolar Technique a Better Alternative to Long Fusion for Adult Neuromuscular Scoliosis?

Prospective cohort study. To report the results for an alternative technique based on minimally invasive fusion-less surgery. This approach is original in that it corrects deformities by proximal and distal fixation, with reliable pelvic fixation through the use of iliosacral screws on osteoporotic bones. Adult cerebral palsy patients requiring spinal correction surgery were included prospectively between 2015 and 2019. The technique involved the use of a double-rod construct anchored proximally by four clawed hooks and distally by iliosacral screws, in a minimally invasive approach. Cobb angle and pelvic obliquity were measured before and after initial surgery and at final follow-up. Complications and functional results were reviewed. This group (P) was compared with a second group (R) of patients who underwent surgery between 2005 and 2015, for whom data were collected retrospectively. Thirty-one patients were included in group P, and 15 in group R. The two groups were comparable for demographic data and deformity. At most recent follow-up (3years for group P [2-6] and 5years for group R [2-16]), neither correction nor surgical complications differed between the two groups. However, group P had 50% less blood loss and a lower medical complication rate than group R. Our results confirm the effectiveness of this minimally invasive technique for neuromuscular scoliosis in adults. The results were similar to those obtained with the usual techniques, but with fewer medical complications. Confirmation of these results is now required for a longer follow-up period.

Return to Sport after Adolescent Idiopathic Scoliosis (AIS) Correction Surgery: A Retrospective Data Analysis.

Sports are relevant to younger populations in society. Adolescent idiopathic scoliosis (AIS) patients who undergo surgical correction of the spine are often intensively involved in sports. For that, returning to the sport is often an important concern for the patients and their families. To the best of our knowledge, there is still a lack of scientific data indicating established recommendations about the time of returning to sport activities after surgical spinal correction. The aim of this study was to investigate (1) when AIS patients return to athletic activities after a posterior fusion, and (2) if they change their activities postoperatively. Furthermore, another question was (3) if the length of the performed posterior fusion or (4) fusion to the lower lumbar spine could have an influence on the rates or time of returning to sport activities postoperatively. Data collection was performed using questionnaires assessing patients' contentment and athletic activity. Athletic activities were categorized into three categories: (1) contact, (2) contact/non-contact and (3) non-contact sports. The intensity of exercised sports, the time of returning to the sport and changes in sport habits were documented. Radiographs were evaluated pre- and postoperatively to determine the Cobb angle and the length of the posterior fusion via the identification of the upper (UIV) and lower instrumented vertebra (LIV). Stratification analysis due to the fusion length was performed to answer a hypothetical question. This retrospective survery of 113 AIS patients treated with a posterior fusion revealed that, on average, returning to sport activities required 8 months of postoperative rest. The preoperative to postoperative rate of patients participating in sport activities increased from 88 (78%) to 94 (89%). Furthermore, postoperatively, a relevant shift of exercised activities from contact to non-contact sports was noted. Further subanalysis revealed that only 33 subjects were able to return to exactly the same athletic activities as before surgery (10 months postoperatively). The assessment of radiographs revealed that in this study group, the length of the performed posterior fusion and fusions to the lower lumbar spine had no influence on the time of return to athletic activities. The results of this study might shed some light on postoperative recommendations for sport activities after AIS treatment with a posterior fusion and may be beneficial for surgeons treating patients.

Scoliosis and Kyphosis Prevalence in Turner Syndrome: A Retrospective Review at a Pediatric Tertiary Care Medical Center.

The prevalence of major coronal and sagittal spinal curves (scoliosis and kyphosis) in Turner syndrome (TS) is not well established due to limited reporting. The relationship between growth hormone (GH) therapy and its effect on TS spinal curve incidence is also not well established. A retrospective chart review of 306 TS patients from 2007 to 2021 evaluated major coronal and sagittal spinal curves, progression of the curve, and treatment with GH. Statistical significance (defined as P <0.05) between curvature rates and curve progression was compared between GH-treated patients and non-GH-treated patients using a χ 2 or Fisher exact test when appropriate. Thirty-seven of 306 (12%) TS patients had a radiographically relevant spinal deformity. Twenty-seven of 37 (73%) had mild; 4 of 37 (11%) had moderate, and 6 of 37 (16%) had severe curves. Of those with severe, 4 underwent spinal fusion, 1 was treated with bracing, and 1 was braced before a cardiovascular-related death. Regarding GH use among TS patients, 190 of 306 (62%) used GH versus 116 of 306 (38%) who did not. Of those with a spinal curve, 24 of 37 (65%) used GH compared with 13 of 37 (35%) who did not. On univariate analysis, GH therapy was not a risk factor for the diagnosis of a major spinal curve, a more severe degree of the curve at the time of diagnosis, or spinal curve progression ( P >0.05 for all). This is the largest single institution retrospective review of a TS cohort known to the authors assessing spinal curve prevalence and relation to GH treatment and demonstrates a TS spinal curve rate of 12% (37/306). Four of six (11%) TS patients with a severe curve underwent corrective spine fusion. There was no relationship between the use of GH and the presence of a spinal curve or curve progression. Further study is warranted to determine risk factors for curve progression. Level III. This retrospective case series serves to review and address the prevalence of spinal deformity in TS patients and whether GH impacts worsening deformity.

Mobility Analysis of the Lumbar Spine with a Dynamic Spine-Correction Device.

According to data, 60-70% of the world's population experience low-back pain (LBP) at least once during their lifetime, often at a young or middle age. Those affected are at risk of having worse quality of life, more missed days at work, and higher medical care costs. We present a new rehabilitation method that helps collect and analyze data on an ongoing basis and offers a more personalized therapeutic approach. This method involves assessing lumbar spine rotation (L1-L5) during torso movement using an innovative dynamic spine correction (DSC) device designed for postural neuromuscular reeducation in LBP. Spinal mobility was tested in 54 patients (aged 18 to 40 years) without LBP. Measurements were made with 12-bit rotary position sensors (AS5304) of the DSC device. During exercise, the mean lumbar spine rotation to the right was greater (4.78° ± 2.24°) than that to the left (2.99° ± 1.44°; p < 0.001). Similarly, the maximum rotation to the right was greater (11.35° ± 3.33°) than that to the left (7.42° ± 1.44°; p < 0.0001). The measurements obtained in the study can serve as a reference for future therapeutic use of the device.

Comparative Evaluation of Effectiveness of Pelvic Floor Strengthening and Myokinetic Active Release of Trigger Points in Reducing Dysmenorrhea

Background and Aim Dysmenorrhea is a dull abdominal pain that may radiate to lower back and thigh beginning approximately two days before menstruation. Pelvic floor strengthening is favorable in reducing dysmenorrhea. Alteration in muscle function due to hormonal imbalance can also cause dysmenorrhea. Lower rectus abdominis trigger points TrPs deactivation relieves dysmenorrhea. Restoring correct spine mobility by deactivating quadratus lumborum trigger points may improve dysmenorrhea. Gluteus medius commonly develops satellite triggers in response to active quadratus lumborum triggers. Myokinetic active release technique can be effectively used to treat TrPs. This study aimed to find if myokinetic active release of TrPs of rectus abdominis gluteus medius and quadratus lumborum is better than pelvic floor muscle strengthening in reducing dysmenorrhea.Methods This experimental trial was done in research lab of Department of Physiotherapy SBSPGI Dehradun. This experimental study comprised of 40 subjects randomly divided into two groups namely Group 1 and Group 2. Each group consisted of 20 subjects. Subjects in Group 1 were prescribed pelvic floor muscle strengthening and those in Group 2 were prescribed myokinetic active release of triggers points. Pre-and post-treatment visual analogue scale VAS scores were recorded and analyzed. Paired t test was used for within the group and unpaired t test was used for between the group comparisons.Results The results showed both the treatment protocols to be significantly effective p lt0.0001 but on comparison of data between the groups Group 2 was found to be better.Conclusion Both the techniques were found to be effective in treating dysmenorrhea however myokinetic active release was observed to be superior.

Effects of Posterior Spinal Correction and Fusion on Postural Stability in Patients with Adolescent Idiopathic Scoliosis

The present study aimed to assess the effects of posterior spinal correction and fusion on postural stability in patients with adolescent idiopathic scoliosis (AIS). The study included 41 female patients with AIS at our institution. All patients performed three 10 s single-leg standing trials on a force plate. The center of pressure (COP) was measured preoperatively, and at 1 week and 6 months postoperatively. The postural stability parameters were absolute minimum time-to-boundary (TTB), mean of the minimum TTB, mean COP velocity, standard deviation, range, and 95% confidence ellipse area. One-way repeated analysis of variance or Friedman test was applied to the postural stability parameters. Multiple comparisons were performed using the Bonferroni correction. The absolute minimum TTB and the mean minimum TTB showed a significant increase 6 months post-operation as compared to preoperatively and 1 week postoperatively. The COP velocity significantly decreased at 6 months post-operation compared to preoperatively and 1 week postoperatively. These changes in postural stability indicate that spinal correction and fusion can be considered to improve postural stability during single-leg standing tests in the postoperative period.

Quantitative evaluation of correlation between lumbosacral lordosis and pelvic incidence in standing position among asymptomatic Asian adults: a prospective study

The determination of lumbopelvic alignment is essential for planning adult spinal deformity surgery and for ensuring favorable surgical outcomes. This prospective study investigated the correlation between the lumbar section of lumbar spine lordosis and increasing pelvic incidence in 324 Asian adults with a mean age of 55 ± 13 years (range: 20–80 years), comprising 115 male and 209 female volunteers. Participants were divided into three groups based on pelvic incidence (G1, G2, and G3 had pelvic incidence of < 45°, 45–55°, and ≥ 55°, respectively). We determined that distal and proximal lumbar lordosis contributed differentially to the increase in pelvic incidence, whereas the lordosis ratio of the L3–L4 and L4–L5 segments mostly remained constant. The mean contribution ratio of the segmental lordosis from L1 to S1 was as follows: L1–L2, 2.3%; L2–L3, 11.7%; L3–L4, 18.1%; L4–L5, 25.2%; and L5–S1, 42.7%. Pelvic incidence had a stronger correlation with proximal lumbar lordosis than did distal lumbar lordosis. The ratios of proximal lumbar lordosis to distal lumbar lordosis were 37.8% in G1, 45.8% in G2, and 55.9% in G3. These findings serve as a reference for future lumbar spine correction or fusion surgery for Asian adults.

Semiautomated intraoperative measurement of Cobb angle and coronal C7 plumb line using deep learning and computer vision for scoliosis correction: a feasibility study.

Scoliosis is a degenerative disease with a 3D deformity in the alignment of the spinal column. Surgical spinal correction outcomes are heavily dependent on the surgeon's expertise and use of visual cues because of time requirements, lack of automation, and radiation exposure associated with current intraoperative measurement techniques. In this study, the authors sought to validate a novel, nonradiographic, and semiautomated device that measures spinal alignment intraoperatively using deep learning and computer vision. To obtain spinal alignment metrics intraoperatively, the surgeon placed 3D-printed markers made of acrylonitrile butadiene styrene (ABS) plastic at designated locations in the surgical field. With the high-definition camera of the device, the surgeon can take an image of the markers in the surgical field. Images are processed through a computer vision model that detects the location of the markers and calculates the Cobb angle and coronal plumb line. The marker detection model was trained on 100 images and tested on 130 images of the ABS markers in various conditions. To verify the Cobb angle calculation, 50 models of angle templates from 0° to 180° in 3.6735° increments were created for testing. To verify the plumb line calculation, 21 models of plumb line measurements from -10 to +10 cm in increments of 1 cm were created for testing. A validation study was performed on a scoliotic cadaver model, and the radiographic calculations for Cobb angle and plumb line were compared with the device's calculations. The area under the curve for the marker detection model was 0.979 for Cobb angle white, 0.791 for Cobb angle black, and 1 for the plumb line model. The average absolute difference between expected and measured Cobb angles on the verification models was 1.726° ± 1.259°, within the clinical acceptable error of 5°. The average absolute difference between the expected and measured plumb lines on the verification models was 0.415 ± 0.255 cm. For the cadaver validation study, the differences between the radiographic and device calculations for the Cobb angle and plumb line were 2.78° and 0.29 cm, respectively. The authors developed and validated a nonradiographic, semiautomated device that utilizes deep learning and computer vision to measure spinal metrics intraoperatively.

Linear parameters of the thoracic vertebrae in adults in the second period of adulthood

The aim of the study is to identify age, gender and somato-typological features of the linear parameters of the thoracic vertebrae in adults of the second period of adulthood using X-ray computed tomography. Material and methods. The study included 34 patients of both sexes (17 men, 17 women) in the second period of adulthood. The focus of research was the thoracic vertebrae; for their morphometry, computed tomograms of the chest organs of the patients were studied. The average, the largest and smallest values of the length and width of the bodies of 1–12 thoracic vertebrae in the axial plane were determined; the correlation between the obtained sizes and the chest width index according to V.N. Shevkunenko, the value of the subcostal angle, the Haller index and the age of the patients were evaluated. Gender differences in the studied parameters were also specified. Results. It has been found that the age-related variability of the linear parameters of the vertebral bodies is characterized by a decreased length and width of the thoracic vertebral bodies in older people. Smaller values of the length and width of the vertebral bodies present sex differences in the linear parameters of the thoracic vertebral bodies in women compared to men. The constitutional features of the linear parameters of the thoracic vertebrae bodies were determined: wider and longer bodies of the vertebrae are typical for people having a brachymorphic constitution, smaller values of these quantitative parameters of the vertebral bodies are typical for patients having a dolichomorphic constitution. Conclusion. The obtained data on the age, sex and constitutional features of the structure of the thoracic vertebrae are of practical significance for the interpretation of intravital methods of spine investigation and for optimizing surgical and technical methods of spinal correction.

Proximal junctional kyphosis is a compensation for post-operative negative C2-FH in ASD patients: a cross-sectional study

BackgroundRecent studies have found that C2-FH is close to 0 cm in both standing and sitting position for asymptomatic adults. We hypothesize that the thoracic spine may compensate with PJK when the immediate post-operative C2-FH was not ideally restored in adult spinal deformity (ASD).MethodsThe inclusion criteria were as follows: ASD patients over 45 years old; Cobb angle > 30°; with posterior spinal correction surgery; at least 2 years follow-up. C2-FH was defined as the distance between the femoral heads to the C2 vertical line. All participants were divided into two groups according to the occurrence of PJK at the last follow-up: PJK group and non-PJK group.Results68 ASD patients, with a minimum follow-up of 2.5 years, were included. PJK was found in 24 patients (35.3%) while the rest 44 patients remained no sagittal malalignment. Immediately post-operative C2-FH showed significant difference between PJK group and non-PJK group (p = 0.015). However, at the last follow-up, C2-FH showed no significant difference between PJK and non-PJK group and the mean value of C2-FH in both groups was approximately − 1 cm, indicating that ASD patients could develop various compensatory mechanisms to maintain sagittal global balance. The AUC was 0.84 (95%CI 0.68–0.97), indicating the well effectiveness of ROC curve and cut-off value in predicting occurrence of PJK in ASD patients. Based on the ROC curve, the optimal cut-off value of C2-FH as indicators for occurrence of PJK was − 42.3 mm.ConclusionImmediate postoperative negative global malalignment (C2-FH < − 42.3 mm) may predict proximal junctional kyphosis in ASD patients. The normal value of C2-FH, − 1 cm, may be the target of global sagittal compensation, and PJK is a compensatory mechanism.Trial registration: 2021-LCYJ-DBZ-05, 2021.07, Retrospective study.

Dual-Rod Instrumentation Via the Anterior Approach for Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis

Background: Posterior spinal fusion with pedicle screw instrumentation is currently the standard technique for spinal surgery. However, the anterior approach remains useful for thoracolumbar and lumbar (TL/L) lesions, such as in adolescent idiopathic scoliosis (AIS) 1–4 and spinal injuries 5,6 . We previously documented that long-term radiographic findings and clinical measures were satisfactory in patients with TL/L AIS treated with anterior dual-rod instrumentation 1 . Description: This surgical technique is indicated for single TL/L (Lenke 5) curves and is performed with use of extrapleural retroperitoneal approaches. The extrapleural cavity is connected to the retroperitoneal space by diaphragmatic transection. The lateral aspect of the vertebral bodies is exposed by retracting the psoas major muscle posteriorly from the intervertebral discs. Segmental vascular bundles are divided with coagulation and/or ligation. Care should be taken to reflect the psoas in its entirety and avoid an intramuscular approach to prevent bleeding injury to nerves, including the femoral, ilioinguinal, and genitofemoral nerves, as well as ureteral injury. After the intervertebral discs and cartilage plates are removed to the vertebral end plates, 2 screws are inserted in each vertebral body through a vertebral staple 1,4 . The anterior rod is then placed in the screw heads and rotated anteriorly, providing 3-dimensional correction of kyphotic deformities with lordosis production 1,4 . After the posterior rod is applied in the same manner as the anterior rod, compression forces are applied between the screws to correct scoliosis 1,4 . The compression force is first applied to the posterior rod so that kyphosis can be corrected more effectively 1,4 . Alternatives: Posterior pedicle screw instrumentation techniques are widely utilized for TL/L AIS curve correction. However, anterior techniques have frequently also been applied to the curve. Dwyer et al. 7 first reported the use of anterior spinal fusion (ASF) with a single braided cable connecting vertebral screws for the treatment of TL/L AIS, and Zielke et al. 8 modified that procedure by replacing the cable with a threaded rod. Although these instrumentation techniques and other single anterior rod techniques such as the Texas Scottish Rite Hospital System effectively correct scoliosis in the coronal plane and improve vertebral derotation 1,9 , poor sagittal and rotational plane deformity correction, implant weakness, and high incidence of pseudarthrosis remain unresolved issues 1 . Rationale: The fundamental advantages of the anterior approach in dual-rod instrumentation are the ability to achieve 3-dimensional correction with extremely low rates of pseudarthrosis and implant failure 1,10–12 . Furthermore, the fusion is expected to include fewer motion segments than with posterior systems (usually 1 level less distally and proximally). However, low skeletal maturity and a TL/L to thoracic Cobb ratio of &lt;1.25 appeared to be important factors for postoperative curve progression of the thoracic coronal deformity following ASF for the treatment of Lenke 5 curves 1,13 . In addition, subjacent disc wedging may occur when the subjacent disc is nearly parallel before surgery 1,14 . Expected Outcomes: The described technique is expected to provide 3-dimensional spinal correction. In a previous study, 30 patients with Lenke 5 AIS were followed for a mean of 17 years 1 . The mean TL/L Cobb angle correction rate and correction loss were 79.8% and 3.4°, respectively, at the time of the latest follow-up 1 . The average percent of predicted forced vital capacity and of forced expiratory volume in 1 second were 91.8% and 81.8%, respectively 1 . The average total score on the Scoliosis Research Society-30 outcome instrument was 4.21. No instrumentation failure, pseudarthrosis, or clinically relevant neurovascular complications were observed 1 . Important Tips: This technique is applicable to Lenke 5 AIS curves. However, the anterior approach can also be utilized for other TL/L lesions.The anterior procedure is accomplished via extrapleural retroperitoneal approaches with diaphragmatic transection.Care should be taken to reflect the psoas in its entirety and avoid an intramuscular approach to prevent bleeding and nerve and ureteral injuries. Acronyms &amp; Abbreviations: SRS-30 = Scoliosis Research Society-30

Predicting Health-Related Quality of Life Outcomes Following Major Scoliosis Surgery in Adolescents: A Latent Class Growth Analysis.

Prospective cohort study. To identify patient trajectories of recovery defined by change in health-related quality of life (HRQOL) following surgery for adolescent idiopathic scoliosis (AIS). To explore possible predictors of trajectory membership. Adolescent patients scheduled to undergo spinal fusion for AIS were enrolled in the Post-Operative Recovery following Spinal Correction: Home Experience (PORSCHE) study. Responses to the Pediatric Quality of Life Inventory-version 4 (PedsQL-4.0) were collected prior to surgery and 4 to 6 weeks, 3, 6, and 12months post-operatively. Latent class growth analyses identified patient subgroups based on their unique trajectories of physical health (PH) and psychosocial health (PSH) outcomes using the PedsQL-4.0 subscale scores. Predictors included demographic, clinical, and psychosocial factors. Data from up to 190 patients were included (87.4% female; mean±SD age = 14.6 ± 1.9years). Three trajectory subgroups were identified for PH and 4 trajectories were found for PSH, with a majority of patients scoring within the established range of healthy adolescents 12months post-surgery. Increased child and parent pain catastrophizing, child trait anxiety and previous hospitalizations were associated with poorer PH outcomes, whereas increased child and parent pain catastrophizing, child state and trait anxiety, and parent state and trait anxiety were associated with poorer PSH trajectories. The PH and PSH trajectories identified in this study and the factors associated with their membership may inform surgical decision-making for AIS while facilitating patient and family counselling regarding peri-operative recovery and expectations.

Dynamics of functional changes in the spinal column in scoliosis in children in the use of adaptive physical activity techniques

Objective . To evaluate the effectiveness of spinal correction in scoliosis in children in the process of adaptive physical activity (APA). Materials and methods . A study conducted at the Republican Research Center for Radiation Medicine and Human Ecology involved 60 children with scoliosis of varying severity. A course of spinal correction by APA means, forms, and techniques was performed. Results . The conducted study on the use of the scoliosis correction course has showed the effectiveness of the applied means and techniques. It has been proved that children undergoing the developed course in contrast to children undergoing the generally accepted course, reveal a significant improvement in almost all indicators of the positions of the spinal column, namely: lateral deviation of the spine axis (p=0.028), thoracic kyphosis (p&lt;0.001), pelvic tilt (p=0.049), rotation of the left superficial plane (p=0.045). At the trend level, an improvement in the following indicators was noted: lumbar lordosis (p=0.086), rotation of the right superficial plane (p=0.064), lateral deviation to the right (p=0.096). Conclusion . It has been proved that the performed spinal correction course in children with scoliosis in the process of APA is effective.

The impact of spinal fusion of adolescent idiopathic scoliosis in Salah (Islamic Prayer) movement: a case-control study

Background: Corrective spine surgery is widely accepted for treating severe adolescent idiopathic scoliosis (AIS). Postoperative spinal range of motion (ROM) could be affected after such surgery. In certain populations, such as Muslims, this ROM change can impact daily life, as it may affect the five-times-a-day prayer (Salah). This study aims to assess the influence of spinal fusion (SF) in Adolescent Idiopathic Scoliosis (AIS) during the daily Islamic prayer (Salah). Methods: SF-AIS patients were videoed while performing Salah prayer. The kinematic documentation was assessed and compared to Salah movements of a control group of age-matched Muslim AIS patients, who had not had surgery. The prayer quality changes were subjectively classified into improved, no change/remained, and worsened, according to the Global Perceived Effect (GPE). Functional outcome and pain were assessed by the Scoliosis Research Society Questionnaire Version 30 (SRS-30). Results: Thirty-nine women and five men (mean age±SD: 14.8±2.3 years) met the inclusion criteria, and unoperated AIS patients were used as control (twenty-two women, mean age±SD: 15.32±1.43 years). The prostrations ROM of the SF-AIS group differed significantly from the control group (p&lt;0.05). The GPE of the prayer movement showed improvement in 36.4%, no change in 59.1%, and worsening in 4.5% of the SF-AIS patients. The worsened group had a significantly lower bowing ROM and higher prostrations ROM compared to all groups of prayer quality changes (p&lt;0.05). SRS-30 scores showed good outcomes (function 4.0±0.2, pain 4.2±0.5), along with the overall bowing ROM and prostrations ROM (84.2±12.0o and 53.4±9.6o, respectively). Moreover, a significant moderate positive correlation between the bowing ROM and pain (r=0.417, p=0.007) was also found. Conclusion: Spinal fusion positively affects AIS Islamic patients in maintaining their daily Salah movement, ROM and prayer quality. Prayer quality assessment should be given extra attention as an adjuvant of the SRS-30 questionnaire to evaluate Muslim patients.

Anxiety as a Risk Factor for Postoperative Delirium in Elective Spine Deformity Surgeries: A National Database Study.

IntroductionGeneralized anxiety disorder has become one of the most prevalent mental health disorders in the United States. In addition, postoperative delirium has been shown to increase hospital stay, increase mortality, and increased healthcare costs. Few studies have looked at the prevalence of postoperative delirium in patients diagnosed with anxiety undergoing elective spinal deformity procedures. The purpose of this study was to determine if anxiety is a risk factor for postoperative delirium in elective spinal deformity surgeries.MethodsThe authors performed a retrospective analysis using the TriNetX Research Database. Patients diagnosed with kyphosis or lordosis who then underwent elective spinal correction surgeries were identified. This group was then separated based on the diagnosis of a generalized anxiety disorder before the operation versus no diagnosis. Propensity score adjustment, based on mental disorders and other risk factors, was then used to match cohorts on baseline demographics and characteristics. Analysis was performed on the primary outcome of postoperative delirium, with secondary outcomes of upper respiratory tract infections, surgical site infections, sepsis, ventilator dependence, convulsions, stroke, emergency department visits, myocardial infarction, pulmonary embolism, and urinary retention within 30 days after surgery.ResultsOur search included 1,211 patients with a diagnosis of anxiety and 8,055 patients without anxiety. After propensity score matching, 996 patients remained in each cohort. Statistical analysis showed significant outcomes between the matched cohorts in the anxiety group for postoperative delirium (OR 2.788; 1.587-4.899) and convulsions (OR 1.615; 1.006-2.592). All other outcomes were not significant after propensity score matching.ConclusionThese results showed generalized anxiety disorder is a risk factor for postoperative delirium and convulsions after elective spine surgery. Further research is necessary on the effects of mental health disorders on postoperative delirium and other outcomes to better understand the risks in this population.

All Pedicle Screw versus Hybrid Hook-Screw Instrumentation in the Treatment of Thoracic Adolescent Idiopathic Scoliosis (AIS): A Prospective Comparative Cohort Study.

Background: Posterior spinal correction and fusion remains the most common surgical treatment in AIS. Surgeons currently favour all pedicle screw (AS) correction techniques with alternative implants being less utilised. The purpose of this study was to assess whether a hybrid hook–screw (HS) construct could achieve similar outcomes. Methods: A single centre, prospective cohort study was conducted. Patients with moderate and severe thoracic AIS (Lenke 1) were included. Clinical and radiological results of a standardised hybrid HS technique were compared with those obtained with an AS construct. All patients had a minimum 2-year follow-up. Results: 160 patients were included in this series (80 patients/group). The HS group had significantly reduced surgical time, blood loss and implant density. Both techniques achieved ≥75% scoliosis correction. The HS group was superior in restoring thoracic kyphosis and global sagittal balance with an average 31% increase in kyphosis compared to 10% with the AS group (p < 0.001). There was significant improvement in SRS-22 scores at 2 years postoperative (p < 0.001) in both groups. There were no neurological or visceral complications related to instrumentation, no detected non-union and no reoperations. The HS implant cost was significantly lower than that of AS, with a mean instrumentation saving of almost £2000/patient. Conclusion: A standardised hybrid HS technique achieved excellent correction of thoracic scoliosis, high patient satisfaction and low complication rates in patients with thoracic AIS. These results were comparable to the AS group. The HS technique achieved better correction of thoracic kyphosis and sagittal balance than the AS technique, together with reduced surgical time, blood loss and implant cost.