Treatment Of Adolescent Idiopathic Scoliosis Research Articles

Fifteen Years and 2530 Patients: The Evolution of Instrumentation, Surgical Strategies, and Outcomes in Adolescent Idiopathic Scoliosis in a Single Institution

Over the past decade, the surgical treatment of adolescent idiopathic scoliosis (AIS) has established new techniques to reduce curve severity and shifted to include the regular use of pedicle screws. Few studies have focused on this evolving trend in AIS correction surgery. In this study, we investigated how the operative approach, instrumentation, and surgical techniques have changed over the past 15 years and to quantify the related improvements in AIS surgical treatment. This is a retrospective review of a prospective AIS registry in a single center. Patient data were reviewed from January 2001 to December 2015. The age and surgical case distribution were recorded for each year. Trends in classification use, instrumentation types, levels of fusion, and surgical approaches were analyzed by year. The major Cobb angles and correction rates were compared between different instrumentations and surgical approaches. A total of 2530 patients with AIS (83.0% female) were included, with a mean age of 15.14 years. Most patients underwent surgery at 14 years of age (473 patients, 18.7%), followed by 15 years of age (468 patients, 18.5%). In our center, the classification of patients with AIS shifted from the King classification to the Lenke classification in 2005. The major baseline Cobb angle of the entire cohort averaged 50.99° and this mean Cobb angle decreased to 14.41° after surgery. The correction rates for the first 3 years (2001-2003) were less than 70%, whereas the correction rates for the rest of the years were all greater than 70%. In addition, significantly higher correction rates were observed in patients with Cobb angles <90° (72.93% vs. 55.61%, P < 0.001). A total of 218 anterior-only surgeries and 109 combined anteroposterior surgeries were performed; the remaining 2205 surgeries were performed with a posterior-only approach. The use of anterior-only and anteroposterior approaches trended to decrease after 2005. The correction rate of anterior-only approaches was significantly greater than posterior-only and anteroposterior approaches (77.86%, 72.51%, and 59.37%, respectively). In patients corrected with a posterior-only approach, the screw-hook hybrid construct was used in 342 patients, whereas the all-pedicle-screw construct was used in 1835 patients. The shift from hybrid to all-screw construct occurred in 2006. In patients with thoracic AIS, the correction rate was significantly higher in the all-screw group (73.26% vs. 67.76%; P < 0.001). Consistent improvement of major curve correction has been achieved by the spine community over 15 years. After stabilized coronal correction and fewer fusion levels, the next steps in this evolution are the restoration of sagittal profiles, especially the hypokyphosis seen in patients with Lenke 1, the posterior minimally invasive approach, and a fast-track return to activity.

Choice of Rods in Surgical Treatment of Adolescent Idiopathic Scoliosis: What Are the Clinical Implications of Biomechanical Properties? – A Review of the Literature

The surgical treatment of adolescent idiopathic scoliosis (AIS) involves 3-dimensional curve correction with multisegmental pedicle screws attached to contoured bilateral rods. The substantial corrective forces exert a high level of stress on the rods, and the ability of the rod to withstand these forces without undergoing permanent deformation relies on its biomechanical properties. These properties, in turn, are dependent on the material, diameter, and shape of the rod. The surgical treatment of AIS is characterized by the requirement for a special biomechanical profile that may differ substantially from what is needed for adult deformity surgery. This overview summarizes the current knowledge of rod biomechanics in frequently used rod constructs, with a particular focus on translational research between biomechanical studies and clinical applicability in AIS patients.

Trial Protocol: The use of mindfulness-based intervention for improving bracing compliance for adolescent idiopathic scoliosis patients: protocol for a randomised, controlled trial

Adolescent idiopathic scoliosis (AIS) is the most prevalent deforming orthopaedic condition; it causes significant disability when spinal curves progress beyond 45deg. Bracing is the primary treatment prescribed for adolescents with an immature skeleton who have spinal curves between 25 and 45deg. New evidence suggests that compliance with bracing significantly decreases the progression of high-risk curves to the threshold for surgery. Nonetheless, bracing is a stressful experience. Therefore, interventions that mediate health-related quality of life for AIS patients are of great interest. In the past few decades, numerous studies have documented the benefits of mindfulness training on chronic pain, stress management, anxiety and emotional disorders. Mindfulness might additionally provide AIS patients with psychosocial support. This study will investigate the effects of a mindfulness-based intervention on bracing compliance and quality of life among AIS patients with poor bracing compliance. The study also plans to evaluate if the mindfulness-based intervention effect is sustained after the intervention period. The potential mechanism by which mindfulness affects bracing compliance will be explored. Single-blind, two-arm, randomised, controlled trial. The study will recruit 120 AIS patients aged between 10 and 15 years with non-satisfactory bracing compliance. Patients who have previously practised or are currently practising meditation or mindful yoga or who cannot finish the whole intervention will be excluded. The study will take place at the Jockey Club School of Public Health and Primary Care building. Patients in the mindfulness-based intervention group will join weekly sessions for 8 weeks. This program is a short version of a mindfulness-based stress relaxation program to address the specific issues of AIS patients. Two to three experienced instructors will deliver the program. Control group patients will participate in an 8-week physiotherapy exercise program as recommended in the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) 2011 guideline. The primary outcome is the 6-month post-intervention total score of bracing compliance. Secondary measures are non-bracing-specific quality of life, bracing-specific quality of life, self-compassion, emotional regulation, mindful awareness and acceptance, self-efficacy, perception of stress, and general measure of health outcome. 120 participants will be assigned to either an intervention or control arm by simple randomisation, and the randomisation result will only be revealed once participants have confirmed availability to attend intervention classes. Clinicians of the scoliosis clinic and research staff will be blinded to the treatment allocation. ANCOVA will be conducted to compare the effect of mindfulness-based intervention versus physiotherapy exercise on the outcome measures. To investigate significant change over time, linear mixed models analyses will be conducted following the intention-to-treat principle. The R-package lavaan will be used to conduct structural equation modelling to study the potential mechanism of mindfulness. This will be the first psychosocial intervention study conducted on braced AIS patients with the aim of improving patients' bracing compliance and quality of life. The results from this study will potentially carry significant impact on future AIS treatment by emphasising psychosocial care for braced AIS patients.

Thoracoscopic Anterior Instrumentation and Fusion as a Treatment for Adolescent Idiopathic Scoliosis: A Systematic Review of the Literature

Study DesignA systematic review and meta-analysis on thoracoscopic anterior instrumentation and fusion as a treatment for adolescent idiopathic scoliosis (AIS). ObjectiveThe goal of this study is to determine the current status of thoracoscopic instrumentation and fusion as a treatment for AIS. Summary of Background DataTraditional surgical techniques for AIS have been open anterior thoracotomy with instrumentation and posterior spinal fusion and instrumentation. With the growing clinical interest in growth modulation surgeries, such as vertebral body tethering, there is a resurgence of interest in a thoracoscopic technique. MethodsThe most commonly used medical databases (PubMed, Medline, EMBASE, CINAHL, and the Cochrane library) were searched up to November 2016 using the search terms VATS, thoracoscopic scoliosis, and thoracoscopic scoliosis instrumentation. ResultsThirteen studies met the strict inclusion criteria. Five hundred thirty patients were reported: 81.7% females, with the majority diagnosed as AIS. The mean operative time was 371.5 minutes, mean blood loss of 502.85 mL, and mean hospital stay of 5.9 days. Mean preoperative curve magnitude was 52.9°; postoperative curve magnitude was 17.9°, with a correction of 62.7%. Number of levels instrumented was 6.3, pulmonary function tests returned to preoperative values by 2 years postoperation, and the complication rate was 21.3%. Compared to thoracotomy, VATS had similar complication rates, blood loss, operation theater time, curve correction, and number of fused levels. Compared to posterior fusion, VATS has higher complication rates and operation theater time. Blood loss and percentage correction were similar. VATS had a smaller number of fused segments. ConclusionsAdvantages include less invasive, excellent curve correction, few levels fused, good satisfaction, and no long-term effect on pulmonary function. Drawbacks are increased operative time and incidence of pulmonary complications. With appropriate surgeon training and careful patient selection, this technique offers an acceptable alternative to the more traditional procedures. Level of EvidenceLevel II.

Repeat Surgical Interventions Following “Definitive” Instrumentation and Fusion for Idiopathic Scoliosis: 25-Year Update*

Study DesignSingle-institution, retrospective review of prospectively collected data on pediatric patients with adolescent idiopathic scoliosis (AIS) undergoing spinal fusion with a minimum two-year follow-up. ObjectiveTo determine the rate of reoperation in AIS patients undergoing spine fusion from 2008 to 2012. Summary of Background DataRecent trends in the surgical treatment of AIS have included increased use of all–pedicle screw constructs, smaller implants, more posterior-only approaches, and improved correction techniques. MethodsA retrospective review of 467 patients undergoing spinal fusion from 2008 to 2012 was performed. Demographic, clinical, radiographic, and surgical data were collected prospectively on all patients for the index procedure and any reoperations. Data were compared to previously published cohorts of patients from the authors' institution who underwent spinal fusion for AIS between 1988 and 2007. ResultsThe rate of reoperation in this five-year cohort of patients was 9.9%. The most common indications for reoperation were infection (4.5%: 2.4% delayed infections and 2.1% acute infections), symptomatic implants (2.1%), and misplaced pedicle screws (1.7%). When compared to the 2003-2007 cohort, the rate of reoperation for acute infection and malpositioned pedicle screws increased significantly (p = .01 and p = .04), whereas the rate of reoperation for curve progression decreased (p = .01). Reoperations for acute infections and malpositioned pedicle screws also increased significantly (p = .047 and p = .042) compared with the 1988-2002 cohort, whereas the rate of reoperation for pseudarthrosis decreased (p = .002). ConclusionReoperation rates for AIS have not improved with more sophisticated implants and techniques, predominantly because of increased acute infections and malpositioned pedicle screws despite decreasing pseudarthrosis rates and curve progression. Level of EvidenceLevel II.

Brace Treatment for Adolescent Idiopathic Scoliosis.

In the past, numerous non-operative treatments for adolescent idiopathic scoliosis (AIS), including exercise, physical therapy, electrical stimulation, and brace treatment, have been tried to delay or prevent the curve progression. Of these, brace treatment is the only option that is widely accepted and has demonstrated the efficacy to alter the natural history of AIS. Recently, the importance of brace treatment for AIS has been increasing since the efficacy was objectively established by the BrAIST (Bracing in Adolescent Idiopathic Scoliosis Trial) study in 2013. This editorial article summarizes the current status of brace treatment in patients with AIS and discusses future prospects on the basis of our clinical experiences.

High Rate of Mismatch between Sanders and Risser Staging in Adolescent Idiopathic Scoliosis: Are Some Guiding Treatment With the Wrong Classification?

Purpose: Risser staging has traditionally been used as the primary markers of skeletal maturity utilized in decision making for treatment of adolescent idiopathic scoliosis (AIS). The authors believe Risser staging is an insensitive marker of growth compared to Sanders classification. The purpose of this study is to determine the incidence and factors associated with mismatch …

Influence of Derotation Connectors on 3D Surgical Correction of Adolescent Idiopathic Scoliosis.

Monocentric study comparing results of simultaneous translation on 2 rods (ST2R) with derotation connectors (prospective series) or without derotation connectors (retrospective series) in Adolescent Idiopathic Scoliosis (AIS) surgery. The objective of this study was to assess if derotation connectors influence axial, coronal, and sagittal results in AIS surgery. Conventional reduction techniques remain limited in their ability to reduce axial torsion. Direct vertebral derotation technique accomplishes partial axial derotation but decreases thoracic kyphosis. Monocentric study including AIS surgeries performed using ST2R technique with derotation connectors (group D+, n=44) or without derotation connectors (group D-, n=24). The axial intervertebral rotation was measured between apical and neutral vertebra on pre and postoperative computed tomography scan. T test was used to compare mean values. ANCOVA analyzed the influence of connectors and covariates on the primary outcome, which was the difference between preoperative and postoperative intervertebral rotation. The mean axial torsion gain in the D+ group was 23% (+3.84 degrees, 95% confidence interval, +1.95/+5.73). In the D- group, mean axial torsion increase of 4% (-0.42 degrees, 95% confidence interval, -1.19/+2.03). The result was significantly different between the 2 groups (P=0.005). The coronal correction of the main curve angle was 80% in the D+ group and 64% in the D- group (P=0.004). Kyphosis correction was similar between the 2 groups (P=0.3) with significant increase of thoracic kyphosis in the whole series (P=0.02) and no patients with postoperative hypokyphosis <10 degrees. Multivariate analysis confirmed the influence of derotation connectors on both axial and coronal correction (P<0.05). The use of derotation connectors in the surgical treatment of AIS significantly improved axial and coronal correction compared to nonuse of connectors without compromising the sagittal plane.

Computer-assisted design and finite element simulation of braces for the treatment of adolescent idiopathic scoliosis using a coronal plane radiograph and surface topography

BackgroundOrthopedic braces made by Computer-Aided Design and Manufacturing and numerical simulation were shown to improve spinal deformities correction in adolescent idiopathic scoliosis while using less material. Simulations with BraceSim (Rodin4D, Groupe Lagarrigue, Bordeaux, France) require a sagittal radiograph, not always available. The objective was to develop an innovative modeling method based on a single coronal radiograph and surface topography, and assess the effectiveness of braces designed with this approach. MethodsWith a patient coronal radiograph and a surface topography, the developed method allowed the 3D reconstruction of the spine, rib cage and pelvis using geometric models from a database and a free form deformation technique. The resulting 3D reconstruction converted into a finite element model was used to design and simulate the correction of a brace. The developed method was tested with data from ten scoliosis cases. The simulated correction was compared to analogous simulations performed with a 3D reconstruction built using two radiographs and surface topography (validated gold standard reference). FindingsThere was an average difference of 1.4°/1.7° for the thoracic/lumbar Cobb angle, and 2.6°/5.5° for the kyphosis/lordosis between the developed reconstruction method and the reference. The average difference of the simulated correction was 2.8°/2.4° for the thoracic/lumbar Cobb angles and 3.5°/5.4° the kyphosis/lordosis. InterpretationThis study showed the feasibility to design and simulate brace corrections based on a new modeling method with a single coronal radiograph and surface topography. This innovative method could be used to improve brace designs, at a lesser radiation dose for the patient.

Influence of Distal Fusion Level on Sagittal Spinopelvic and Spinal Parameters in the Surgical Management of Adolescent Idiopathic Scoliosis.

Study DesignRetrospective analysis of adolescent idiopathic scoliosis.PurposeThis study aimed to investigate the influence of distinct distal fusion levels on spinopelvic parameters in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior instrumentation and fusion surgery.Overview of LiteratureThe distal fusion level selection in treatment of AIS is the one of milestone to effect on surgical outcome. Most of the paper focused on the coronal deformity correction and balance. The literature have lack of knowledge about spinopelvic changing after surgical treatment and the relation with distal fusion level. We evaluate the spinopelvic and pelvic parameter alteration after fusion surgery in treatment of AIS.MethodsA total of 100 patients with AIS (88 females and 12 males) were retrospectively reviewed. Patients were assigned into the following three groups according to the distal fusion level: lumbar 2 (L2), lumbar 3 (L3), and lumbar 4 (L4). Using a lateral plane radiograph of the whole spine, spinopelvic angular parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were radiologically assessed.ResultsThe mean age was 15±2.4 years, and the mean follow-up period was 24.27±11.69 months. Regarding the lowest instrumented vertebra, patients were categorized as follows: 30 patients in L2 (group 1), 40 patients in L3 (group 2), and 30 patients in L4 (group 3). TK decreased from 36.60±13.30 degrees preoperatively to 26.00±7.3 degrees postoperatively in each group (p=0.001). LL decreased from 52.8±9.4 degrees preoperatively to 44.30±7.50 degrees postoperatively (p=0.001). Although PI showed no difference preoperatively among the groups, it was statistically higher postoperatively in group 3 than in the other groups (p<0.05). In addition, in group 2, PI decreased from 50.60±8.74 degrees preoperatively to 48.00±6.84 degrees postoperatively (p=0.027). SS decreased from 35.20±6.40 degrees preoperatively to 33.40±5.80 degrees postoperatively (p=0.08, p>0.05). However, mean SS was significantly higher in group 3 (p=0.042, p<0.05). PT decreased from 15.50±7.90 degrees preoperatively to 15.2±7.10 degrees postoperatively. The positive relationship (28.5%) between LL and PI measurements was statistically significant (r=0.285; p=0.004, p<0.01). Furthermore, the positive relationship (36.5%) between LL and SS measurements was statistically significant (r=0.365; p=0.001, p<0.01).ConclusionsWhen the distal instrumentation level in AIS surgery is below L3, a significant change in PT and SS (pelvic parameters) is anticipated.

An In Vitro Biomechanical Study on Ovine Rib Flexibility With Increasing Deconstruction—As an Alternative to Rib Resection for Costoplasty

Study DesignAn in vitro biomechanical study into the effect of rib deconstruction on the flexibility in ovine ribs, using three-point bending. ObjectiveTo examine the feasibility and possible effectiveness of a more conservative costoplasty using an in vitro animal model. Summary of Background DataCostoplasty remains useful in the treatment of adolescent idiopathic scoliosis, rib hump, and associated chest wall deformities. However, traditional costoplasty increases morbidity and blood loss. MethodsRibs 2–10 were dissected from four fresh half ovine rib cages. The ribs were randomly allocated to Groups 1 to 4. The ribs underwent deconstruction, 10 mm from the lateral tubercle and 30 mm long, according to their group: Group 1 = control; Group 2 = convex cortical bone removed; Group 3 = convex cortical and cancellous bone removed; Group 4 = all but the ventral cortex is removed. Flexibility was tested by loading the concave side of each rib while fixed at the rib head and equidistant from the center of the resected area. The ribs were deformed at 0.5 mm/s up to a maximum load of 9.99 kg or fracturing. Load was plotted against displacement to find the load/displacement coefficient for each group. Statistical analysis was by an analysis of variance with Tukey's honestly significant difference post hoc testing. ResultsThe load/displacement coefficients were as follows: Group 1 = 131.93 (±27.52) N/mm, Group 2 = 93.36 (±40.71) N/mm, Group 3 = 88.66 (±25.84) N/mm, and Group 4 = 29.69 (±29.11) N/mm. Group 4 was significantly less stiff than Groups 1, 2, and 3 (p < .01). No ribs in Groups 1, 2, and 4 fractured. Five of 8 ribs in Group 3 fractured during loading. ConclusionsDeconstructing the rib down to the concave side significantly increases the flexibility by approximately 4.5 times. Despite large removal of bone, it retains the ability to withstand 10 kg of load without fracture.

Manual therapy treatment for adolescent idiopathic scoliosis

BackgroundAdolescent idiopathic scoliosis (AIS) is a common orthopedic condition with a prevalence of 2%–3% in children aged 10–16 years. Conservative interventions remain controversial and are usually based on physical therapy exercises and treatments. Manual therapy techniques may also serve as adequate treatments for AIS due to their ability to improve range of motion and decrease muscle tone and pain. ObjectiveTo critically assess the current literature on the effectiveness of manual therapy methods used to treat AIS. MethodsPubMed, PEDro, BioMed Central, and Google Scholar databases were searched from inception until December 2016 using keywords associated with scoliosis and manual therapy. Criteria for inclusion were studies investigating the effect of manual therapy methods on AIS treatment. We analyzed all published material with an emphasis on randomized controlled trials (RCT). Trials of any methodological quality written in English were included in the review. Major findingsFourteen papers were reviewed, all presenting manual therapy treatments such as manipulation, mobilization, and soft tissue techniques used to treat AIS. All case studies showed a significant improvement, post-treatment, in most measured parameters. Observational studies showed mixed results. Only one RCT concluded manual therapy techniques were ineffective in improving trunk morphology and spine flexibility in AIS patients. ConclusionCase reports and small-scale clinical trials of poor methodological quality presented in this review did not allow us to draw a clear conclusion about the effectiveness of manual therapy in the treatment of AIS. On the other hand, they provide us a basis to assume that manual therapy techniques such as myofascial release and spinal manipulative techniques may potentially be effective in treating AIS in conjunction with other conservative treatments. Further high-quality studies are essential to determine the effectiveness of the different manual therapy techniques.

Effectiveness of Posture Correction Girdle as Conservative Treatment for Adolescent Idiopathic Scoliosis: a Preliminary Study

Orthopedic Research Online Journal Effectiveness of Posture Correction Girdle as Conservative Treatment for Adolescent Idiopathic Scoliosis: a Preliminary Study Queenie Fok1, Joanne Yip1*, Kit-lun Yick1, Sun-Pui Ng2 and Chi-Yung Tse3 1Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong 2Hong Kong Community College, The Hong Kong Polytechnic University, Hong Kong 3Centre for Orthopaedic Surgery, Hong Kong *Corresponding author: Joanne Yip, Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong Submission: December 13, 2017; Published: January 31, 2018 DOI: 10.31031/OPROJ.2018.01.000524 ISSN : 2576-8875Volume1 Issue5

Improvement in Scoliosis Research Society-22R Pain Scores After Surgery for Adolescent Idiopathic Scoliosis.

Longitudinal cohort. To investigate whether patients with painful adolescent idiopathic scoliosis experience pain relief with surgical treatment. Adolescent idiopathic scoliosis (AIS) was previously thought to be a painless condition, but recent studies have shown that a significant proportion of patients have pain. Little information is available regarding pain relief with surgical treatment for AIS. Patients enrolled in a prospective database of surgically treated AIS were divided into two groups based on their preoperative Scoliosis Research Society (SRS)-22R pain domain score. Patients with a preoperative pain domain score of 4 or more (N = 1005) were classified as nonpainful. If the preoperative pain domain score was less than 4 (N = 505), they were classified as painful. Demographics, SRS total and domain scores, and changes with treatment were compared for the two groups. The two groups had similar demographics and preoperative coronal curve magnitude. Patients with painful scoliosis experienced significant improvement in SRS-22R pain scores, from 3.29 preoperatively to 4.03 postoperatively (P < 0.000). Eighty-one percent of these patients reached the minimum clinically important difference threshold (0.20) for improvement in pain score. Painful scoliosis patients also had greater 2-year improvement in total and all domain scores than the nonpainful scoliosis patients (P < 0.000). Absolute values of SRS-22R total and domain scores were all greater at 2 years in the nonpainful group than the painful group. Patients with AIS with substantial back pain can be cautiously counseled to expect significant improvement in pain level with surgical correction of their deformity, even if curve progression is the primary indication for surgery. Although these patients achieve greater improvements in health-related quality of life compared with patients with mild or no pain, 2-year SRS-22R scores were still better in patients with mild or no pain preoperatively. 2.

Anterior versus Posterior Selective Fusion in Treating Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis of Radiologic Parameters.

To compare the clinical efficacy of anterior and posterior approaches for selective thoracic fusion (STF) and selective thoracolumbar/lumbar fusion (SLF) in treating adolescent idiopathic scoliosis (AIS). English-language literature on selective fusion treatment of AIS published before September 2016 was retrieved from the PubMed, Embase, Cochrane, and Google Scholar databases. Studies were manually selected for inclusion based on preset criteria. Relevant radiologic data were extracted, and a systematic review and meta-analysis were performed. Thirty-five eligible studies were included. The Cobb angles of the main thoracic and minor thoracolumbar/lumbar curves at the final follow-up were significantly and similarly corrected in the anterior and posterior STF groups. Anterior but not posterior STF was effective in correcting thoracic and thoracolumbar junctional hypokyphosis and in promoting sagittal balance, as determined by the relative position of the C7 plumb line. Similarly, in both the anterior and posterior SLF groups, the final Cobb angles of main thoracolumbar/lumbar and minor thoracic curves were significantly reduced compared with angles before surgery (P < 0.05). In contrast, posterior but not anterior SLF was effective in correcting lumbar hypolordosis and thoracic hypokyphosis. Both anterior and posterior SLF promoted coronal balance, with no effects on sagittal balance. Both anterior and posterior approaches are effective for treatment of AIS. Anterior is more effective than posterior STF in correcting thoracic and thoracolumbar junctional hypokyphosis and in restoring sagittal balance. Posterior is more effective than anterior SLF in correcting lumbar hypolordosis and thoracic hypokyphosis and in restoring the sagittal curvature.

Radiological Evaluation of Spinal Instrumentation as Treatment for Adolescent Idiopathic Scoliosis, a Single Saudi Center 5-Year Experience

Aim of the Study: The aim of this work is to radiologically evaluate the postoperative outcomes of spinal instrumentation performed as a treatment for Adolescent Idiopathic Scoliosis (AIS) on 5-year follow up basis, and to correlate with different clinical scenarios. Materials and Methods: One hundred (100) AIS consecutive patients treated with spinal instrumentation were included in this study. The study period was from 2012 to 2017. All patients had radiological evaluations including total spine x-rays, low dose CT scan using Orthopedic Metal Artifact Reduction (OMAR) software and MRI, after obtaining the informed consents and approval of the institution ethical board. Radiological evaluation included Cobb angle measurement assessed pre, postoperatively and at regular intervals within the 5-year period. Results: Of the 100 patients included, 24 were females and 76 were males. The average age at operation was 16.5 years. Sixty seven (67%) patients showed good correction and maintenance of the spinal curves where the mean Cobb angle was 68° preoperatively and 21° postoperatively, representing a correction rate of 74%. Thirty three (33%) patients showed complications including postoperative infection (13), surgical revision (4), pseudarthrosis (3), neurological deficits (5), screw loosening (7) and complete hardware failure (1); in whom the preoperative mean Cobb angle was 56° compared to the patients with no complications (p = 0.288). In males, there were postoperative complications in 27 out of 76 and in females 5 out of 24, (p = 0.027). The average duration of follow-up was 3.7 years for all cases. Conclusion: Five-year follow up of patients with AIS treated with spinal instrumentation demonstrates good improvement and maintenance of the corrected spinal curves in two thirds of patients, one third showed variable minor and major complications. Low dose CT scan with OMAR provided an effective modality for evaluation.

Brace treatment for adolescent idiopathic scoliosis

Brace treatment for adolescent idiopathic scoliosis

Post-Operative Adding-On in Adolescent Idiopathic Scoliosis, A Particular Etiology: Conflict Between the Upper Articular Process and the Instrumentation Material : A Case Report

The aim of surgical treatment of adolescent idiopathic scoliosis (AIS) is to achieve a balanced spine. Distal addingon is a postoperative phenomenon in AIS, which is characterized by a progressive correction loss. A 13-Year-old girl with AIS who underwent posterior arthrodesis showed aggravation of the disequilibrium under the last instrumented vertebra (LIV) 30 months post operatively and an increase of the lumbar curvature with no evident cause. Extension surgery was made and per operatively we noticed that the distal end of the arthrodesis was disengaged and that the left rod was conflicting with the upper left articular process of L2. Among the causes of adding-on we report in this article a particular etiology that consists in a conflict with the instrumentation material. This conflict has to be looked for postoperatively if an adding-on phenomenon is suspected in addition to a distally protruding rod, and could motivate a CT scan imaging for diagnosis.

Perceptive and Rehabilitative Muscle Recruitment Facilitation Secondary to the use of a Dynamic and Asymmetric Spine Brace in the treatment of Adolescent Idiopathic Scoliosis (AIS)

Perceptive and Rehabilitative Muscle Recruitment Facilitation Secondary to the use of a Dynamic and Asymmetric Spine Brace in the treatment of Adolescent Idiopathic Scoliosis (AIS)

The Role of Correction in the Conservative Treatment of Adolescent Idiopathic Scoliosis.

Introduction:Physiotherapeutic Scoliosis-Specific Exercises (PSSE) and bracing have been found to be effective in the stabilization of curves in patients with Adolescent Idiopathic Scoliosis (AIS). Yet, the difference among the many PSSEs and braces has not been studied. The present review attempts to investigate the role of curve correction in the outcome of treatment for PSSEs and braces.Material and Methods:A PubMed manual search has been conducted for studies on the role of correction in the effectiveness of PSSE and bracing. For the PSSEs, the key words used were “adolescent idiopathic scoliosis, correction, physiotherapy, physical therapy, exercise, and rehabilitation.” For bracing, the key words used were “adolescent idiopathic scoliosis, correction and brace”. Only papers that were published from 2001-2017 were included and reviewed, as there were very few relevant papers dating earlier than 2001.Results:The search found no studies on the role of correction on the effectiveness of different PSSEs. The effectiveness of different PSSEs might or might not be related to the magnitude of curve correction during the exercises. However, many studies showed a relationship between the magnitude of in-brace correction and the outcome of the brace treatment.Discussion:The role of correction on the effectiveness of PSSE has not been studied. In-brace correction, however, has been found to be associated with the outcome of brace treatment. An in-brace correction of < 10% was associated with an increased rate of failure of brace treatment, whereas an in-brace correction of >40-50% was associated with an increased rate of brace treatment success (i.e. stabilization or improvement of curves). Thus, in the treatment of AIS, patients should be advised to use highly corrective braces, in conjunction with PSSE since exercises have been found to help stabilize the curves during weaning of the brace. Presently, no specific PSSE can be recommended.Conclusion:Braces of high in-brace correction should be used in conjunction with PSSEs in the treatment of AIS. No specific PSSE can be recommended as comparison studies of the effectiveness of different PSSEs are not found at the time of this study.