Thoracolumbar Curves Research Articles

Asymmetric Pedicle Subtraction Osteotomy for Adult Spinal Deformity with Coronal Imbalance: Complications, Radiographic and Surgical Outcomes.

Asymmetric pedicle subtraction osteotomy (APSO) can be utilized for adult spinal deformity (ASD) with fixed coronal plane imbalance. There are few reports investigating outcomes following APSO and no series that include multiple revision cases. To detail our surgical technique and experience with APSO. All thoracolumbar ASD cases with a component of fixed, coronal plane deformity who underwent APSO from 2004 to 2016 at one institution were retrospectively reviewed. Preoperative and latest follow-up radiographic parameters and data on surgical outcomes and complications were obtained. Fourteen patients underwent APSO with mean follow-up of 37-mo. Ten (71.4%) were revision cases. APSO involved a mean 12-levels (range 7-25) and were associated with 3.0 L blood loss (range 1.2-4.5) and 457-min of operative time (range 283-540). Surgical complications were observed in 64.3%, including durotomy (35.7%), pleural injury (14.3%), persistent neurologic deficit (14.3%), rod fracture (7.1%), and painful iliac bolt requiring removal (7.1%). Medical complications were observed in 14.3%, comprising urosepsis and 2 cases of pneumonia. Two 90-d readmissions (14.3%) and 5 reoperations (4 patients, 28.6%) occurred. Mean thoracolumbar curve and coronal vertical axis improved from 31.5 to 16.4 degrees and 7.8 to 2.9 cm, respectively. PI-LL mismatch, mean sagittal vertical axis, and pelvic tilt improved from 40.0 to 27.9-degrees, 10.7 to 3.5-cm, and 34.4 to 28.3-degrees, respectively. The APSO, in both a revision and non-revision ASD population, provides excellent restoration of coronal balance-in addition to sagittal and pelvic parameters. Employment of APSO must be balanced with the associated surgical complication rate (64.3%).

Thoracolumbar curve and Cobb angle in determining spread of spinal anesthesia in Scoliosis. An observational prospective pilot study.

Background and Aims:Disparity in spread of spinal anesthesia is a known complication in scoliosis patients. Our primary aim was to compare this disparity based on Cobb Angle and thorocolumbar spine curvature. Secondary aim was to calculate the appropriate lateral angulation of the spinal needle from midline for successful lumbar puncture.Materials and Methods:All poliomyelitis patients with scoliosis posted for lower limb orthopedic contracture release surgeries were enrolled into Group A (Cobb Angle <50°), Group B (Cobb Angle >50°), and on thoracolumbar curve into Group R (Right), Group L (Left). Group A, B, R, and L were studied for bilateral spread of spinal anaesthesia. Lateral angle of the spinal needle from midline was noted with Goniometer in groups A and B. Statistical analysis was done using unpaired t test and Chi-square test.Results:Failures in subarachnoid block (SAB) (unilateral anaesthesia/inadequate/patchy block) was significant in Group B (P = 0.033). Segmental disparity in bilateral spread of spinal anaesthesia was significant in Group R with P value of 0.042. Approximate lateral angle for needle in Group A was (4.1 ± 2.45) and in Group B was (9.14 ± 2.45).Conclusions:The study showed that there was a strong correlation between right-sided thoracolumbar curve and the spread of spinal anesthesia

Three-Dimensional Analysis of Initial Brace Correction in the Setting of Adolescent Idiopathic Scoliosis.

The three-dimensional nature of adolescent idiopathic scoliosis (AIS) necessitates a tridimensional assessment and management. Bracing constitutes the mainstay conservative treatment for mild adolescent idiopathic scoliosis. In the literature hitherto, there has been uncertainty regarding the behavior of the spine, pelvis, and vertebral orientations in the context of bracing, especially in the transverse plane. This poses a challenge to healthcare providers, patients, and their families, as brace treatment, although not as invasive as surgery, is laden with medical and psychological complications and could be considered traumatizing. Hence, a thorough understanding of initial three-dimensional spinal behavior in the context of bracing is important. The purpose of this retrospective study was to investigate the immediate 3D impact of Chêneau-type brace. Thirty-eight patients with AIS undergoing Chêneau-type bracing were included. Patients were stratified according to their structural curve topography into thoracic, thoracolumbar, and lumbar groups. 3D reconstruction of the spine using a dedicated biplanar stereoradiography software with and without the brace was performed. The examined anthropometric radiographic measures were pre- to in-brace variations and differences of spinopelvic parameters and vertebral orientations in the coronal, sagittal, and transverse planes. The complex impact of the Chêneau-type brace on different curves in three planes was delineated. In the coronal plane, the Cobb angle was significantly decreased in all types of curves, and the coronal tilt correction was concentrated in specific segments. The impact of the brace in this study on the sagittal profile was variable, including the loss of thoracic kyphosis and lumbar lordosis. In the transverse plane, an axial vertebral rotation change and detorsion above the apex occurred in the thoracolumbar curves. The results from this exploratory study could shed some light on the initial 3D spinal behavior in the context of bracing and may be of beneficial for treating physicians and brace makers.

Risk factors for the development of persistent shoulder imbalance after surgical correction of idiopathic scoliosis

Objective . To assess risk factors for the imbalance of the shoulder girdle and to identify reproducible X-ray criteria for persistent shoulder imbalance after correction of idiopathic scoliosis. Material and Methods . A total of 94 patients with idiopathic scoliosis were included in the retrospective study. All patients underwent primary posterior correction of the deformity using pedicle screw instrumentation. Radiography of the spine throughout its length was performed before surgery, in the early postoperative and in the long-term (at least 12 months after surgery) periods. The shoulder imbalance was considered clinically significant with radiographic shoulder height difference more than 2 cm. Results . A significant decrease in the magnitude of all curves after surgery and in the long-term period was noted. The magnitude of the proximal curve decreased from 25.38° ± 15.89° to 14.51° ± 8.17° (p < 0.0001) and to 14.29° ± 8.25° (p = 0.24); the main thoracic curve from 59.33° ± 20.76° to 20.096° ± 9.89° (p < 0.0001) and to 20.87° ± 9.48° (p = 0.19); and thoracolumbar curve from 47,20° ± 15,99° to 15.69° ± 8.66° (p < 0.0001) and to 16.98° ± 7.6° (p = 0.01), respectively. The shoulder imbalance was recorded in 27 patients (28.72 %) after surgery and in 13 (13.83 %) – in the long-term period. In these patients, various Lenke types of deformity were presented. A correlation of the distal adding-on phenomenon with self-correction of the shoulder balance is revealed (r = 0.56; p < 0.005). Persistent shoulder imbalance correlated with presence of a structural proximal thoracic curve (p = 0.041642), residual proximal curve magnitude after surgery (r = 0.22; p = 0.03), and presence of a symptom of double rib hump on radiographs after surgery (r = 0.75; p ≤ 0.005). Conclusion . The most characteristic pattern of persistent shoulder imbalance is the presence of asymmetry in the proximal and main regions of the chest. This sign can be detected by intraoperative lateral radiography of the spine, which will allow the surgeon to take measures to eliminate this phenomenon and reduce the probability of persistent shoulder imbalance development.

Hypermobility Frequency in School Children: Relationship With Idiopathic Scoliosis, Age, Sex and Musculoskeletal Problems.

This study aims to assess the prevalence of generalized joint hypermobility (GJH) in school children in relation to scoliosis and to identify musculoskeletal problems. This cross-sectional study included 822 school children (413 males, 409 females; mean age 12.2±1.3 years; range, 10 and 15 years). Demographic characteristics of all children were recorded. The presence of GJH was assessed by the Beighton score (≥4 was considered joint hypermobility). Scoliosis screening consisted of forward bend test (FBT) and measurement of angle of trunk rotation (ATR). Positive FBT or ATR ≥5° was referred to a portable X-ray device. The presence of musculoskeletal complaints was determined by a questionnaire. Children's Body Mass Index (BMI) was 19.6±4.1. GJH was diagnosed in 151 subjects (18.4%). No significant association was detected between sex and hypermobility. Joint hypermobility was inversely correlated with age and BMI. Scoliosis was found in 43 subjects (5.2%) and all of them except one girl had mild scoliosis. The most common scoliosis pattern was a single left thoracolumbar curve. Seventy-three subjects (8.9%) had Cobb angle under 10°, with a potential for progression. Among subjects having GJH, the most common clinical finding was pes planus (34.3%) and the most common clinical symptom was ankle sprain (31.3%). Similar to that found in children from many countries, GJH is a common clinical condition in Turkish children. GJH should be assessed in the differential diagnosis of adolescents with musculoskeletal complaints for effective treatment and reducing morbidity. GJH should be considered in adolescents with scoliosis, which may be an important aspect in treatment.

24. Untreated adolescent idiopathic scoliosis in adulthood: how often do these patients require surgery?

BACKGROUND CONTEXT Weinstein and Ponsetti demonstrated that despite increased pain, adults with previously unoperated adolescent idiopathic scoliosis (AIS) typically lead normal functioning lives. The Oswestry Disability Index (ODI) is a validated questionnaire for assessing back disability with 0-20 indicating minimal disability. A score of >30 has been used in past FDA trials as an inclusion criterion for surgical studies. We predict that increasing ODI scores will correlate with age, curve size, curve location and progression to surgery. PURPOSE To analyze ODI scores in unoperated adults with AIS to better understand the natural history and its potential correlation with progression to surgery. STUDY DESIGN/SETTING Single center retrospective study. PATIENT SAMPLE A total of 249 patients (pts) identified and 214 pts with ODI scores available were analyzed. OUTCOME MEASURES ODI score with respect to age, curve size, and curve location. Surgical rates in adults with AIS. METHODS All unoperated adult (≥20yrs) AIS pts seen in a tertiary deformity clinic from 2008-2018 were reviewed. Demographics, curve size [thoracic (T) and thoracolumbar (TL)], comorbidities, and ODI were collected. ODI scores ≥20 and ≥30 were analyzed across 3 age groups: 20-39 yrs (G1), 40-59 yrs (G2), and ≥60 yrs (G3). Differences between categorical and continuous variables were analyzed. Subgroup analyses based on ODI score groups, T vs TL curves, and pts progressing to surgery with T ≥50° and/or TL ≥40° only were also analyzed. Significance was defined as p RESULTS A total of 249 consecutive AIS pts were seen by one author over 10 yrs. Two hundred fourteen pts had ODI scores and were included. Mean age was 41 yrs (84% female). ODI scores had positive correlations with age, BMI, and curve size (p CONCLUSIONS ODI scores positively correlated with age, BMI, and coronal Cobb in adults with AIS. Pts age 20-59 tended to have ODI scores lower than 30. Despite “surgical size” curves, few (10%) adults seeking evaluation for scoliosis went on to surgery and those who did reported higher ODI scores than their nonsurgical counterparts. Pediatric deformity surgeons can use this information when counseling skeletally mature AIS patients and their families regarding the need for surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Analysis of the interface pressure exerted by the Chêneau brace in patients with double-curve adolescent idiopathic scoliosis.

The Chêneau brace has proven its effectiveness in treating the adolescent idiopathic scoliosis patients. However, no studies reported on the analysis of interface pressure in double-curve adolescent idiopathic scoliosis patients. In this study, we evaluated the interface pressure of the Chêneau brace action in double-curve adolescent idiopathic scoliosis patient treatment. A total of 72 (60 girls and 12 boys) patients aged 10 years and above participated in the study. The F-Socket transducers (9811E) were used to evaluate the pressure on the right thoracic and left thoracolumbar curves between normal and maximum strap tension and variation in these interface pressures with other tasks. Each patient was asked to do nine different tasks corresponding to daily activities, and the interface pressures for each activity were recorded for both normal and maximum tension. The resultant mean peak pressure in double-curve adolescent idiopathic scoliosis was higher for right thoracic curves than left thoracolumbar curves in all tasks. The pressure significantly increased at the task of maximal inspiration (p < 0.0001) for both types of curves for normal and maximum tension. The degrees of correction for the thoracic and thoracolumbar curves were 23.2% and 34.5%, respectively, after 6 months of brace use (23 h per day). Hence, we could not find any substantial correlation between mean peak pressure in the standing position and degree of scoliosis correction for two curves having r = 0.158, p = 0.356 and r = -0.024, p = 0.889 values.

Scheuermann's Kyphosis: Diagnosis, Management, and Selecting Fusion Levels.

Scheuermann's kyphosis (SK) is a rigid structural deformity of the thoracic spine defined radiographically as three or more contiguous vertebrae with at least 5° of wedging anteriorly. Prevalence of the disease is thought to be between 0.4% and 10%. The true cause of SK remains unclear; however, various theories include growth irregularities, mechanical factors, genetic factors, and/or poor bone quality as the causes. Patients with mild disease (less than 70°) generally have a favorable prognosis with good clinical outcomes. Most patients with SK are successfully treated nonsurgically with observation, anti-inflammatory medications, and physical therapy. Surgical intervention is indicated in patients with greater than 70° to 75° thoracic curves, greater than 25° to 30° thoracolumbar curves, intractable pain, neurologic deficit, cardiopulmonary compromise, or poor cosmesis. Because of advances in posterior spinal instrumentation, surgery can typically be performed through a posterior-only approach. When surgical treatment is planned, appropriate selection of the upper- and lower-instrumented vertebrae is important to achieve a well-balanced spine, preserve motion segments, and reduce the risk of junctional kyphosis.

Effectiveness of school scoliosis screening and the importance of this method in measures to reduce morbidity in an Italian territory.

Although several procedures for treating scoliosis have been developed, the most effective treatment is still based on early detection. For early diagnosis of idiopathic scoliosis, many authors have proposed methods of school screening; however, there is still no standardized screening program. The aim of this study was to evaluate a school screening method and the prevalence and distribution of scoliosis in Italian school children, aged 9-14 years, and to determine if the screening method can reduce morbidity in an Italian territory. The screening program consisted of three steps: the first step was a clinical examination carried out by the school physician and two specialists. In the second step, doubtful cases (presence of a hump between the two sides of the torso, in the thoracic or thoracolumbar region, measured using a hump meter) were evaluated by an orthopedic specialist and subsequently controlled every 6 months either clinically or by radiographic examination. The third step was the classification of the scoliosis and procedures for treatment. All patients were scheduled for a follow-up program and were evaluated during the subsequent 3 years. Statistical analyses were performed with GraphPad Prism 6. A total of 8995 children were screened for scoliosis. Of these, 487 showed clinical signs of scoliosis, and 181 were referred for anteroposterior radiographs because of a positive result on the forward-bending test (hump>5 mm). No significant statistical difference was observed by the three clinical examiners. Of the 181 patients who were referred, 69 were radiographed, and the clinical diagnosis was confirmed in 94.2% of the cases. The prevalence of scoliosis (defined as a curve of ≥10°) was 0.76% (65 of 8995 children), and most of the curves (44; prevalence 67.69%) were small (<20°). The overall ratio of boys to girls was 1 : 3.3, but varied according to the magnitude of the curve (1 : 3 for curves of <20°, 1 : 3.25 for curves of 20-29°, and 1 : 4 for curves of ≥30°). Double curves were the most common type identified, followed by thoracolumbar curves; specifically, of the 65 children who had a curve, 21 (32.30%) had a double curve, 18 (27.6%) had a thoracolumbar curve, 17 (26.1%) had a lumbar curve, and nine (13.84%) had a thoracic curve. In the following 3 years, only four patients were found to have curves more than 20° and none more than 30°. Our results show that the school screening program was accurate and repeatable. Moreover, screening children for scoliosis using a simple test appears to be an effective means of early detection. Above all, the screening process effectively decreased morbidity in the territory at a negligible cost.

Midterm Results of Hemivertebrae Resection and Transpedicular Short Fusion in Patients Younger Than 5 Years: How Do Thoracolumbar and Lumbosacral Curves Compare?

Study DesignRetrospective case series with comparative analysis. ObjectiveTo analyze a consecutive cohort of very young patients operated for congenital scoliosis secondary to a single hemivertebra (HV) and compare thoracolumbar (TL) versus lumbosacral (LS) curve results. Summary of Background DataDespite the published successful results regarding early hemivertebra resection and short fusion for congenital hemivertebrae, literature lacks midterm results, especially in very young children. MethodsPatients under 5 years of age, operated by HV resection and transpedicular short fusion, with follow-up longer than 5 years, were included. Preoperative, postoperative (1-year), final radiographic parameters, and complications were recorded. Midterm results were analyzed and TL versus LS curves were compared. ResultsTwenty-three patients were included (14 TL and 9 LS HV). The mean age was 3.5 ± 1.7 years and the mean follow-up was 7.6 years (4.7–13.7). The mean preoperative Cobb angle (40.3° ± 6.7°), corrected 65% postoperatively and 50% at final follow-up. The compensatory cranial curve improved spontaneously from 25.3° ± 14.8° to 13.5° ± 12° and finally to 19.9° ± 10.7°. Preoperative coronal balance corrected postoperatively but worsened at the final follow-up. TL curves corrected more initially than LS curves (TL: −29°, 68%, vs. LS: −22°, 59%; p = .043); however, both groups lost correction at the final follow-up (TL: 4°, 56%, vs. LS: 7°, 39%; p = .186). The LS group had a larger preoperative compensatory curve, which corrected with surgery but lost more correction at the final follow-up (p = .046). Segmental kyphosis was especially corrected in the TL group (TL: −14° vs. LS: −2°, p = .018) and was maintained over time. ConclusionEarly hemivertebra resection and transpedicular short fusion allowed good coronal correction initially, which was difficult to maintain at midterm, especially at the LS junction. Sagittal plane correction was excellent in TL deformities and was maintained over time. Results were more challenging in the LS group compared with TL deformities. Guidance to avoid unwanted results is proposed. Level of EvidenceLevel III.

Evaluation of the efficacy of part-time versus full-time brace wear in subjects with adolescent idiopathic scoliosis (AIS): a review of literature

Background: Scoliosis is a musculoskeletal disorder that can be managed by wearing an orthosis full or part time. It is not well understood whether the effectiveness of part-time orthotic management of spinal curve progression is as efficacious as full-time wear. The aim of this review was to determine the efficiency of part-time bracing (with a focus on night-time braces), compared to full-time bracing. Moreover, the study aimed to determine which part-time brace demonstrated the most efficacy. Method: A literature review was conducted via a Medline search in PubMed, ISI Web of knowledge, Scopus, Ebsco, Embasco, and Google Scholar. Key words (part time, night braces) were used in combination with adolescent idiopathic scoliosis. The quality of the selected papers was evaluated based on the Downs and Black tool. Results: Fifty papers were found. Following application of inclusion and exclusion criteria based on titles and abstracts, 19 papers were selected for final analysis. These papers were divided into three categories: (1) evaluation of the efficacy of night braces on progression of scoliotic curve (seven papers); (2) Comparison of efficacy between night and full-time bracing (10 studies); and (3) three-dimensional modeling and finite element analysis of part-time bracing. Conclusions: The Providence brace appears to provide an effective treatment approach to influence curve progression in scoliotic patients. However, it should be emphasized that its maximal effect is for lumbar, lumbosacral, and thoracic curves with a low apex. It is recommended to use the Charleston Bending brace only for patients with a single scoliotic curve. The efficacy of full-time bracing for double curves, thoracolumbar curves, and curves more than 35 degrees indicates that more than just a night brace is necessary. However, it seems that there is no difference between the effects of part-time and full-time bracing for curves of smaller magnitude (less than 35 degrees).

Understanding Respiratory Restrictions as a Function of the Scoliotic Spinal Curve in Thoracic Insufficiency Syndrome: A 4D Dynamic MR Imaging Study.

Over the past 100 years, many procedures have been developed for correcting restrictive thoracic deformities which cause thoracic insufficiency syndrome. However, none of them have been assessed by a robust metric incorporating thoracic dynamics. In this paper, we investigate the relationship between radiographic spinal curve and lung volumes derived from thoracic dynamic magnetic resonance imaging (dMRI). Our central hypothesis is that different anteroposterior major spinal curve types induce different restrictions on the left and right lungs and their dynamics. Retrospectively, we included 25 consecutive patients with thoracic insufficiency syndrome (14 neuromuscular, 7 congenital, 4 other) who underwent vertical expandable prosthetic titanium rib surgery and received preimplantation and postimplantation thoracic dMRI for clinical care. We measured thoracic and lumbar major curves by the Cobb measurement method from anteroposterior radiographs and classified the curves as per Scoliosis Research Society (SRS)-defined curve types. From 4D dMRI images, we derived static volumes and tidal volumes of left and right lung, along with left and right chest wall and left and right diaphragm tidal volumes (excursions), and analyzed their association with curve type and major curve angles. Thoracic and lumbar major curve angles ranged from 0 to 136 and 0 to 116 degrees, respectively. A dramatic postoperative increase in chest wall and diaphragmatic excursion was seen qualitatively. All components of volume increased postoperatively by up to 533%, with a mean of 70%. As the major curve, main thoracic curve (MTC) was associated with higher tidal volumes (effect size range: 0.7 to 1.0) than thoracolumbar curve (TLC) in preoperative and postoperative situation. Neither MTC nor TLC showed any meaningful correlation between volumes and major curve angles preoperatively or postoperatively. Moderate correlations (0.65) were observed for specific conditions like volumes at end-inspiration or end-expiration. The relationships between component tidal volumes and the spinal curve type are complex and are beyond intuitive reasoning and guessing. TLC has a much greater influence on restricting chest wall and diaphragm tidal volumes than MTC. Major curve angles are not indicative of passive resting volumes or tidal volumes. Level II-diagnostic.

ADOLESCENT IDIOPATHIC SCOLIOSIS AND SIMILAR CONDITIONS: SHORT, APICAL, SINGLE OR MULTIPLE FIXATION

ABSTRACT Objective: To create a new instrumentation principle for the treatment of adolescent idiopathic scoliosis (AIS) and similar conditions. Methods: A new fixation format was created for the treatment of AIS using 3rd generation instrumentation in short, apical and single or multiple fixations. In patients presenting one scoliotic curve, one fixation is performed. In patients with two curves, two fixations are performed, and in those with three curves, three fixations are performed. To evaluate the new method, a retrospective study of 54 patients who had already undergone surgery for AIS and similar conditions using this innovation was conducted. Results: In this series, average corrections of 72% in the proximal curve, of 83% in the thoracic curve, and of 85% in the thoracolumbar curve were verified. Conclusions: It was concluded that the new fixation principle in the treatment of AIS and similar conditions using short, apical and multiple fixations presented excellent correction, better still in the curves that were more distal in relation to the spine. There was a significant statistical difference between the percentages of curvature correction. Level of Evidence III; Retrospective study.

Alternatives to spinal fusion surgery in pediatric deformity

The standard of care for skeletally immature patients with idiopathic scoliosis is bracing for moderate curves. The standard of care for both skeletally immature and mature patients who have more severe or progressive curves is spinal fusion. We present a summary of four currently used non-fusion surgical techniques as alternatives to bracing and spinal fusion. Vertebral body stapling (VBS) is suggested for patients between the ages of 8 and 13 yr for girls and younger than 15 yr for boys with at least one year of growth remaining (Risser 0-1, Sanders digital stage ≤4). Thoracic curves should measure 25-35 degrees and lumbar curves 25-45 degrees. For best results, the curves should be flexible, bending to &lt; 20 degrees. Correction with a cord/screw construct includes vertebral body tethering (VBT) and anterior scoliosis correction (ASC), which are most commonly being performed for skeletally immature patients (Risser 0-2, Sanders digital stage ≤4) with thoracic and lumbar curves between 30-70 degrees that bend to &lt; 30 degrees. The authors of this article have expanded the indications for treating adolescents with idiopathic scoliosis who are more mature (Risser &gt; 2) with ASC. One commercial product has received CE mark approval in Europe for ASC treatment in both skeletally immature and mature patients. A second product utilizing posterior dynamic concave distraction, also with CE mark approval in Europe, is indicated for patients who are 10-17 yr old with primary single main thoracic or thoracolumbar curves between 30-60 degrees that correct to ≤35 degrees on bending films.

Classifications in Brief: The Lenke Classification for Adolescent Idiopathic Scoliosis.

Classifications in Brief: The Lenke Classification for Adolescent Idiopathic Scoliosis.

Trunk asymmetry is associated with dominance preference: results from a cross-sectional study of 1029 children

BackgroundIn some studies, an association has been reported between laterality of the curve in scoliotic adolescents and hand dominance; however, additional studies have to be performed to confirm these findings. ObjectiveThe objective of this study is to evaluate the prevalence between trunk asymmetry and side dominance in hand, foot and visual laterality in adolescents. MethodsThis was a cross-sectional study secondary analysis. In total, 1029 children (491 females) were enrolled from the Secondary School of Brescia, Italy, with a mean age of 12 (SD=0.9 years). All subjects underwent a screening program divided into three phases: Phase 1, collection of demographic and clinical characteristics; Phase 2, spine evaluation with a plumb line and Bunnell Scoliometer; and Phase 3, evaluation of side dominance of the eye, hand and foot with a 4-item survey. ResultsOur data showed a prevalence of 0.43%, 1.01% and 0.87% for thoracic, thoracolumbar and lumbar curves, respectively, with a right-side dominance and a prevalence of 2.72%, 2.54% and 0.65% for thoracic, thoracolumbar and lumbar curves, respectively, with a left-side dominance. ConclusionThe left-side dominance could have a prevalence on trunk asymmetry in thoracic and thoraco-lumbar curves. Our study suggests that the clinical evaluation of trunk asymmetry should be associated with the evaluation of laterality.

Effect of an elongation bending derotation brace on the infantile or juvenile scoliosis

BackgroundA wide variety of braces are commercially available designed for the adolescent idiopathic scoliosis (AIS), but very few braces for infantile scoliosis (IS) or juvenile scoliosis (JS). The goals of this study were: 1) to briefly introduce an elongation bending derotation brace (EBDB) in the treatment of IS or JS; 2) to investigate changes of Cobb angles in the AP view of X-ray between in and out of the EBDB at 0, 3, 6, 9, and 12 months; 3) to compare differences of Cobb angles (out of brace) in 3, 6, 9, and12 month with the baseline; 4) to investigate changes (out of brace) in JS and IS groups separately.MethodsThirty-eight patients with IS or JS were recruited retrospectively for this study. Spinal manipulation was performed using a stockinet. This was done simultaneously with a surface topography scan. The procedure was done in the operating room for IS, or in a clinical setting for JS. The brace was edited and fabricated using CAD/CAM method. Radiographs were recorded in and out of bracing approximately every 3 months from baseline to 12 months. A linear mixed effects model was used to compare in and out of bracing, and out of brace Cobb angle change over the 12 month period.ResultsOverall, 37.5% of curves are corrected and 37.5% stabilized after 12 months (Thoracic curves 48% correction, 19% stabilization; thoracolumbar curves 33% correction, 56% stabilization and lumbar curves 29% correction, 50% stabilization). The juvenile group had 25.7% correction and 42.9% stabilization, while the infantile group had 50% correction and 32.1% stabilization. There was a significant Cobb angle in-brace reduction in the thoracic (11°), thoracolumbar (12°), and lumbar (12°) (p < 0.001). There was no statistically significant change in out of brace Cobb angle from baseline to month 12 (p > 0.05). No patients required surgery within the 12 month span.ConclusionsThis study describes a new clinical protocol in the development of the EBDB. Short-term results show brace is effective in preventing IS or JS curve progression over a 12 month span.

P 176 - Correlation of shoulder pain and postural abnormalities among adolescent swimmers

The purpose of this study was to compare the characteristics of scoliosis in Prader–Willi syndrome (PWS) patients versus idiopathic scoliosis (IS).We identified 193 PWS patients. Scoliosis was found in 58 PWS patients, 39 of whom were treated with GH. Fifty-five IS patients were consecutively selected from an outpatient clinic. We investigated 113 patients (58 PWS group, 55 IS group) followed for a minimum of 2 years. The mean age was 17.9 and 16.1 years, respectively. Deformity was measured using Lenke classification, Cobb angle, thoracic kyphosis at T2–5 and T5–12, lumbar lordosis at T12–S1, and sagittal alignment at the C7 plumb line. BMI was also recorded.According to the Lenke system, patients were classified as (PWS group/IS group): Type 1 (8/26), Type 2 (1/4), Type 3 (3/15), Type 4 (1/0), Type 5 (32/8), and Type 6 (13/2). The average Cobb angles were 32.6° in the PWS and 35.4° in the IS. No significant differences were found for the thoracic kyphosis (T2–5, T5–12), lumbar lordosis (T12–S1) or C7 plumb line between the two groups. BMI was increased in the PWS group not treated previously with GH as compared with the IS group and the PWS group with GH.Most PWS patients presented with lumbar or thoracolumbar curves (Type 5, 6), whereas IS patients typically had thoracic scoliosis (Type 1, 2, 3).

O 041 - Long-term outcome after hamstring lengthening in children with CP depends on preoperative hamstring length and velocity

Retrospective case series with comparative analysis.To analyze a consecutive cohort of very young patients operated for congenital scoliosis secondary to a single hemivertebra (HV) and compare thoracolumbar (TL) versus lumbosacral (LS) curve results.Despite the published successful results regarding early hemivertebra resection and short fusion for congenital hemivertebrae, literature lacks midterm results, especially in very young children.Patients under 5 years of age, operated by HV resection and transpedicular short fusion, with follow-up longer than 5 years, were included. Preoperative, postoperative (1-year), final radiographic parameters, and complications were recorded. Midterm results were analyzed and TL versus LS curves were compared.Twenty-three patients were included (14 TL and 9 LS HV). The mean age was 3.5 ± 1.7 years and the mean follow-up was 7.6 years (4.7–13.7). The mean preoperative Cobb angle (40.3° ± 6.7°), corrected 65% postoperatively and 50% at final follow-up. The compensatory cranial curve improved spontaneously from 25.3° ± 14.8° to 13.5° ± 12° and finally to 19.9° ± 10.7°. Preoperative coronal balance corrected postoperatively but worsened at the final follow-up. TL curves corrected more initially than LS curves (TL: −29°, 68%, vs. LS: −22°, 59%; p = .043); however, both groups lost correction at the final follow-up (TL: 4°, 56%, vs. LS: 7°, 39%; p = .186). The LS group had a larger preoperative compensatory curve, which corrected with surgery but lost more correction at the final follow-up (p = .046). Segmental kyphosis was especially corrected in the TL group (TL: −14° vs. LS: −2°, p = .018) and was maintained over time.Early hemivertebra resection and transpedicular short fusion allowed good coronal correction initially, which was difficult to maintain at midterm, especially at the LS junction. Sagittal plane correction was excellent in TL deformities and was maintained over time. Results were more challenging in the LS group compared with TL deformities. Guidance to avoid unwanted results is proposed.Level III.

Early discharge after posterior spinal fusion for adolescent idiopathic scoliosis is possible using an optimized postoperative pathway: a case-control study

Background: Patients with adolescent idiopathic scoliosis (AIS) are typically healthy and yet hospital stay after posterior spinal fusion (PSF) remains lengthy. Methods: A review of patients undergoing PSF for AIS by four pediatric orthopaedic surgeons was performed. Patients were divided based on their surgery occurring before or after the implementation of an accelerated discharge pathway (AD). Patients treated prior to the AD pathway were managed using a less standardized traditional (TD) pathway. Results: Four surgeons performed 99 PSF for AIS using the TD pathway and 81 PSF after implementation of the AD pathway. Length of stay was 20% shorter in patients managed under the AD pathway (3.29±0.61 days vs. 4.11±0.97 days, P&lt;0.0001) There was no difference in age, sex, preoperative main thoracic thoracolumbar curve magnitudes between groups. There was no difference in groups with regards to the use of osteotomies, number of levels fused, or total number of screws placed. Patients managed in the AD cohort had shorter surgical times (TD 4.55±0.9 hr vs. AD 4.19±1.11 hr, P=0.02) and lower estimated blood loss (TD 688±395 cc vs. AD 453±327 cc; P&lt;0.0001). Multivariate regression analysis revealed a 0.82 day reduction in length of stay when controlling for estimated blood loss and length of surgery. There was no statistical difference between groups with regards to any complications. Conclusions: The use of a coordinated discharge pathway helped to reduce length of stay in patients undergoing PSF for AIS without an increase in complications. This hospital stay of 3 days represents a dramatic decrease over previously published averages.