Treatment Of Idiopathic Scoliosis Research Articles

Transitional and spectrum-based care for idiopathic scoliosis.

The goal of this study is to discuss the transitional nature of idiopathic scoliosis and the variation in treatment and management across the spectrum of age presentation. This is a review article that discusses the evaluation, management, and classification of idiopathic scoliosis. The authors searched PubMed/MEDLINE, Google Scholar, and the Cochrane database for articles published up to April 2024. Keywords and MeSH terms relevant to the topic were used, including adolescent idiopathic scoliosis (AIS), adult idiopathic scoliosis (AdIS), adult degenerative scoliosis, young adult idiopathic scoliosis, early-onset scoliosis (EOS), classification, management, follow-up, outcomes, natural history, Cobb angle, and transitional care. Reference lists of selected articles were also searched to identify further articles. Inclusion criteria included English language articles that summarized any type of study design, including randomized controlled trials, observational studies, case-control/series, or metaanalysis, with study populations ranging from infants to > 50-year-old patients. Inter-reviewer disagreement on inclusion of particular articles was resolved through discussion. Related information was analyzed, and relevant concepts related to the transitional period dilemma have been discussed. Each idiopathic scoliosis case needs independent assessment with regard to the age, degree of the curve, and patient-specific presentation. An accurate prediction of the curve progression by considering the patient's remaining growth potential is paramount to the treatment strategy. The classification system for EOS, AIS Lenke classification, AdIS classification, and the Scoliosis Research Society-Schwab classification are important for reliable communication between surgeons treating deformities. Untreated progressive idiopathic scoliosis warrants multidisciplinary management during the transition from EOS stage to AIS and then to AdIS. Also, surgical treatment of untreated AIS transitioning to AdIS is specific and nuanced. AdIS needs to be differentiated from adult degenerative scoliosis because the latter is associated with multiple comorbidities and anatomical differences. Idiopathic scoliosis presents across the age spectrum with specific age-related decisions that transition into adulthood. Integrated models of both surgical and nonsurgical treatment of idiopathic scoliosis are warranted.

An Innovative Method for the Conservative Treatment of Idiopathic Scoliosis Using the GraviSpine Device According to the Concept of Spinal Reflex Balance.

Objectives: Conservative treatment of idiopathic scoliosis is more effective as a result of early diagnosis in conjunction with the use of specific physiotherapy and bracing techniques. Our aim was to investigate the effectiveness of specific physiotherapy developed according to the concept of spinal reflex balance using the GraviSpine device. This study is a retrospective analysis of prospectively collected data. Methods: A total of 199 patients aged 6-17 years, with a mean age of 11.26 ± 3.35 years, including 168 girls (84.4%) and 31 boys (15.6%), out of a total of 830 patients treated for IS at the Scoliosis Treatment Center in 2014-2019 were included in the assessment, which was conducted according to the inclusion and exclusion criteria. The study group was divided into three age groups. Group A subjects were 6-9 years old; group B, 10-12 years old; and group C, 13-17 years old. The mean follow-up time was 28.71 ± 10.98 months. Treatment outcomes were compared, based on changes in the Cobb angle and the angle of trunk rotation before and after treatment, both within the groups and with respect to sex and curvature location, using the Wilcoxon signed-rank test. Cobb angle changes in patients were classified as improvements, stabilizations, or deteriorations according to the SOSORT criteria. Results: A majority of patients improved or stabilized after treatment, with 67%, 71%, and 90% of subjects in groups A, B, and C, respectively, achieving these results. In group C (the oldest children), a statistically significant reduction of -1.84° ± 6.88° (6.31%) in the mean Cobb angle was achieved after treatment. With regard to sex, improvements and stabilizations accounted for 81% of cases in girls and 61% in boys, respectively. With respect to location, statistically significant reductions in the Cobb angle were noted for thoracic and thoracolumbar spines of -2.2° ± 7.54° (10.17%) p = 0.022 and -2.2° ± 6.58° (6.36%) p = 0.049, respectively. A significant reduction in the mean angle of trunk rotation was obtained in the group and in three curvature locations. Conclusions: Based on the presented research findings, the utilization of the GraviSpine device as an adjunct to specific PSSE (physiotherapeutic scoliosis-specific exercises) physiotherapy and bracing in the management of pediatric patients with mild to moderate scoliosis appears to enhance treatment efficacy.

The Efficacy of Night Bracing in the Treatment of Adolescent İdiopathic Scoliosis: A Systematic Review.

Background/Objectives: The effectiveness of night braces alone or in combination with other treatments for adolescent idiopathic scoliosis remains unclear. This systematic review study aimed to review and analyze the available literature to determine whether night braces are an effective treatment for idiopathic scoliosis. Methods: A total of 162 databases, including Cochrane Library (reviews, protocols, trials), Web of Science, PubMed, Medline, Scopus, PEDro, CINAHL (EBSCO), Ovid and Google Scholar, were searched for published articles from inception to February 2024. The available literature was screened by the following terms: "scoliosis and night-time brace", "scoliosis and night brace", "scoliosis and part-time bracing", "scoliosis and Providence" and "scoliosis and Charleston". Results: Twenty studies were included; only one study was a randomized controlled trial, and most of the studies were retrospectively designed. Providence, Charleston and Boston braces were used as night braces. The Cobb angle was evaluated in all studies, and Cobb angle change after treatment and surgical treatment rates were the parameters that were evaluated the most. In one study, the angle of trunk rotation, quality of life, perception of spinal appearance, and physical activity level were measured. In one study, sagittal plane assessments were performed in addition to the Cobb angle. Conclusions: The results of this review suggest that there is no evidence to support the use of night braces in the treatment of adolescent idiopathic scoliosis. Randomized controlled trials with a well-designed methodology are needed to determine the efficacy of night braces.

Spinal height for growth guidance treatment in early onset idiopathic scoliosis: analysis through final surgical treatment.

The growth guidance (GG) method for treatment of early onset scoliosis has as its primary goal the restoration of apical spinal alignment, facilitating normal spinal growth to achieve a suitable adult thoracic height. To evaluate whether GG surgical treatment achieves comparable thoracic and spinal height to distraction-based treatment (DBT) in idiopathic early onset scoliosis (I-EOS) patients. We hypothesized that GG would prove superior to DBT at the time of definitive fusion surgery. All I-EOS patients who underwent GG at a single center were reviewed. T1-L1 and T1-S1 heights were measured using the traditional coronal method as well as the Halifax sagittal spinal length (SSL) technique. The same measurements were obtained from a comparable control group obtained from a multi-center pediatric early onset scoliosis database who underwent treatment with traditional growing rods (TGR) or magnetically controlled growing rods (MCGR). Of the I-EOS patients who underwent GG 2004-2019, 15 patients underwent final fusion after GG completion, with a mean 5.5years of GG treatment prior to fusion (range 2.0-11.4years). Mean age at GG implantation was 8.4years (range 2.0-11.7years); 7 were male and 8 female. GG patients experienced a mean coronal thoracic height increase of 6.2cm during treatment through final fusion, and a mean coronal spinal height increase of 8.8cm. At the time of final fusion, GG patients achieved greater significant mean increases than DBT patients by 2.9cm in coronal thoracic height (p = 0.0023), 4.5cm in coronal spinal height (p = 0.001), and 4.0cm in SSL spinal height (p = 0.01). No GG patient concluded treatment with a thoracic height less than 18cm in either coronal or sagittal plane. Not only did 100% of GG patients reach minimum thoracic height of 18cm at time of final fusion, but GG also proved to be superior to distraction-based constructs in a comparison cohort on 3 of 4 spinal elongation measures. 3.

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

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

The Effectiveness of Early Rehabilitation in Limiting the Progression of Idiopathic Scoliosis.

Background: The purpose of this study was to assess specific rehabilitation methods' effectiveness in early idiopathic scoliosis (IS) development, focusing on lower limb functional inequality's role in scoliosis progression. Materials and Methods: This study comprised 812 patients aged 6-16 years at risk of developing idiopathic scoliosis (IS). The mean (SD) age was 10.66 (3.16) years. Patients were categorized into high- and medium-risk groups based on the angle of trunk rotation (ATR) size. Specific scoliosis physiotherapy was used, and the average follow-up period was 28.1 ± 14.5 months. Changes in ATR, Cobb angle, and functional length of the lower limbs pre- and post-treatment were statistically analyzed across three age groups (6-9, 10-12, and 13-16 years) and three scoliosis locations. Results: Significant effectiveness of early rehabilitation was observed in the high-risk group of children aged 6-9 years. In the medium-risk group, significant reductions in ATR were observed in both the 6-9 and 10-12 age groups across all three scoliosis locations. Additionally, there was a significant decrease in the Cobb angle in the thoracolumbar region and a significant reduction in lower limb inequality across all age groups and scoliosis locations. Conclusions: The early implementation of specific physiotherapy may enhance the efficacy of idiopathic scoliosis treatment by attenuating factors contributing to its progression.

Differences in spine growth potential for Sanders maturation stages 7A and 7B have implications for treatment of idiopathic scoliosis.

This study aimed to clarify the differences in spine and total body height growth and curve progression between Sanders maturation stage (SMS) 7A and 7B in patients with adolescent idiopathic scoliosis (AIS). This retrospective case-control study involving patients with AIS at SMS 7 evaluated the differential gains in the spine (T1-S1) and total body height and curve progression between SMS 7A and 7B. A validated formula was used to calculate the corrected height, accounting for height loss due to scoliosis. A multivariable non-linear and logistic regression model was applied to assess the distinct growth and curve progression patterns between the SMS 7 subtypes, adjusting for potential confounders. A total of 231 AIS patients (83% girls, mean age 13.9 ± 1.2years) were included, with follow-up averaging 3.0years. Patients at SMS 7A exhibited larger gains in spine height (9.9mm vs. 6.3mm) and total body height (19.8mm vs. 13.4mm) compared with SMS 7B. These findings remained consistent even after adjustments for curve magnitude. Non-linear regression models showed continued spine and total body height increases plateauing after 2years, significantly greater in SMS 7A. More SMS 7A patients had curve progression over 10°, with an adjusted odds ratio of 3.31. This study revealed that patients staged SMS 7A exhibited more spine and total body growth and a greater incidence of substantial curve progression than those at 7B. These findings imply that delaying brace discontinuation until reaching 7B could be beneficial, particularly for those with larger curves. Level III (Case-control study).

Growing Rod versus Posterior Spinal Fusion Treatment of Juvenile Idiopathic Scoliosis: Unique Characteristics and Surgical Outcomes.

Progressive spinal curvature in juvenile idiopathic scoliosis (JIS) is challenging to treat. When conservative management fails, treatments include growing rods (GRs) or posterior spinal fusion (PSF). The purpose of this study is to compare the patient characteristics and outcomes of GR and PSF treatment of JIS. We performed a retrospective review of demographic, radiographic, and surgical data for all JIS patients requiring surgical treatment between 2012 and 2020. Patients who underwent any GR treatment were compared to PSF patients. A total of 36 patients (13 GR, 23 PSF) were reviewed. PSF patients had a larger pre-operative spinal height (p = 0.002), but similar pre-operative major curve magnitudes (p = 0.558). PSF treatment resulted in similar change in the T1-S1 length (p = 0.002), but a greater correction of the curve magnitude (p < 0.055) compared to GR patients. Eight patients initially treated with GRs later underwent definitive PSF treatment. This subset of patients had a greater spinal height before PSF (p = 0.006), but similar immediate post-PSF T1-S1 lengths (p = 0.437) and smaller changes in spinal height from PSF (p = 0.020) than primary PSF patients. At final follow-up, patients who underwent primary PSF versus PSF after GR had similar spinal heights (p = 0.842). The surgical intervention chosen to manage progressive JIS often differs based on patient characteristics. While this choice may impact immediate outcomes, the outcomes at final follow up are similar.

Health-related Quality of Life (HRQOL) Outcomes of Selective/Nonselective Thoracic Fusion for Lenke 1C Adolescent Idiopathic Scoliosis (AIS) Patients with a Minimum 4-year Follow-up.

Both the selective thoracic fusion (STF) and nonselective thoracic fusion (NSTF) are treatments for Lenke 1C adolescent idiopathic scoliosis (AIS). To date, the impacts of the two surgical strategies on patients' long-term quality of life remain unclear. Therefore, the purpose of this study was to explore the long-term effects of STF/NSTF on the quality of life in Lenke 1C AIS patients through a 4-10-year follow-up. From January 2011 to April 2018, according to the inclusion and exclusion criteria, a retrospective single-center study of 75 surgical patients with Lenke 1C curves was performed (n = 75). They all underwent posterior fusion, and patients were divided into the selective thoracic fusion (STF) group (n = 42) and the nonselective thoracic fusion (NSTF) group (n = 33) based on their surgical approach. All participants received the survey of the visual analogue scale (VAS), SRS30, SF12, and Oswestry disability index (ODI) scales. Patients' gender, age, body mass index (BMI), surgical approach (STF/NSTF), surgical segments (UIV and LIV), follow-up time, complications, preoperative, postoperative, and last follow-up Cobb angles, and health-related quality of life (HRQOL) outcomes were collected, and analyzed through the Shapiro-Wilks test, Wilcoxon rank-sum test, t-test, and χ2 test. The mean follow-up of the entire cohort was 73 ± 5.6 months. The lumbar Cobb angle in the STF group improved from 31.8 ± 6.5° to 11.5 ± 5.1° after the operation and 10.3 ± 6.9° at the last follow-up. The postoperative correction rate of the lumbar curve was 63.8%, which increased to 67.7% at the last follow-up. In the NSTF group, the lumbar Cobb angle improved from 34.3 ± 11.3° to 4.3 ± 3.7° after the operation, and was 5.1 ± 3.1° at the last follow-up. The postoperative correction rate of the lumbar curve was 87.4%, and 85.1% at the last follow-up. At the last follow-up, the STF group had higher overall HRQOL scores than the NSTF group, and there were statistically differences between the different groups (STF/NSTF) in SRS-30-Mental health (p = 0.03), SRS-30-Satisfaction with management (p = 0.02), SRS-30-Pain (p = 0.03), ODI (p = 0.01), SF-12 PCS (p = 0.03), VAS back pain (p = 0.005) and VAS leg pain (p = 0.001). No statistically differences were found in SF12 MCS, SRS-30-Self-image/Appearance and SRS-30 Function/activity. After 4-10 years of follow-up, we found that the STF group achieved satisfactory correction results, and compared with the NSTF group, their overall HRQOL scores were higher, especially in terms of pain and satisfaction, where the STF group shows a significant advantage.

Correlation between physical activity and adolescent idiopathic scoliosis: a systematic review

BackgroundThe multifactorial aetiology of scoliosis is well known. Physical activity is considered both a treatment and causative factor for idiopathic scoliosis; however, evidence for a causal relationship between physical activity levels and idiopathic scoliosis in adolescents is conflicting. Therefore, we aimed to summarise the current evidence regarding the association between adolescent idiopathic scoliosis and physical activity and further to assess whether the relationship is dose dependent.MethodsPubMed, Cochrane, Scopus, and Web of Science databases were searched from 1991 to July 2022 using the following main keywords: adolescent idiopathic scoliosis, physical activity, and risk factors, supplemented with manual searches, secondary citations, and reference searches. The quality of the included literature was evaluated using the Scale for Reporting Observational Studies in Enhanced Epidemiology guidelines.ResultsEight studies were included in this review, of which six reported an association between adolescent idiopathic scoliosis and physical activity levels and two reported no association. One British study reported reduced physical function early in life as a new risk factor for scoliosis onset.ConclusionsPhysical activity is strongly associated with adolescent idiopathic scoliosis. Physical activity should be encouraged as it plays an important role in the prevention of adolescent idiopathic scoliosis. Further research is needed to determine the dose-dependent relationship between physical activity and prevention of adolescent idiopathic scoliosis.

Numerical modelling of an orthopedic brace with increased functional characteristics for the treatment of idiopathic scoliosis.

Orthotic braces play a key role in the correction of spinal deformities. The effectiveness of these devices depends on the design and distribution of corrective forces transmitted through the corset shell. The present study aimed to reduce the weight of the orthosis and improve its functionality while maintaining its corrective function. The distribution of corrective forces transmitted by the orthosis was evaluated using the finite element method (FEM). Areas of the orthosis, which had minimal impact on the overall stiffness, were identified and material from these areas was removed. The modified orthosis shell was subjected to minor adjustments to maintain its corrective stiffness. With the modifications made, a 39% reduction in the weight of the orthosis was achieved, while maintaining its corrective stiffness. This indicates that the corrective function was largely preserved. The study provides a novel approach to orthosis design demonstrating that optimizing the structure using the distribution of maximum principal stress trajectories can significantly improve the functionality of the brace. The proposed method offers potential advances in the design of various types of orthoses, contributing to developments in the field.

Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis: What Trade-Offs in Outcomes Are Acceptable for the Patient and Family?

Vertebral body tethering and other non-fusion techniques for the treatment of pediatric idiopathic scoliosis are increasing in popularity. There is limited physician consensus on this topic as the result of a paucity of published data regarding which patients most benefit from non-fusion strategies. Thus, much of the decision-making is left to patients and parents, who must select a treatment based on their goals and values and the information available from health-care providers, the internet, and social media. We sought to understand patient and family preferences regarding the attributes of fusion versus non-fusion surgery that drive these choices. Patients and families were recruited from 7 pediatric spine centers and were asked to complete a survey-based choice experiment that had been jointly developed with the U.S. Food and Drug Administration (FDA) to evaluate patient preferences. Choices between experimentally designed alternatives were analyzed to estimate the relative importance of outcomes and requirements associated with the choice options (attributes). The attributes included appearance, confidence in the planned correction, spinal motion, device failure, reoperation, and recovery period. The inclusion criteria were (1) an age of 10 to 21 years and (2) a diagnosis of adolescent idiopathic scoliosis in patients who were considering, or who had already undergone, treatment with fusion or non-fusion surgery. Preference weights were estimated from the expected changes in choice given changes in the attributes. A total of 344 respondents (124 patients, 92 parents, and 128 parent/patient dyads) completed the survey. One hundred and seventy-three patients were enrolled prior to surgery, and 171 were enrolled after surgery. Appearance and motion were found to be the most important drivers of choice. For the entire cohort, fusion was preferred over non-fusion. For patients who were considering surgery, the most important attributes were preservation of spinal motion and appearance. Patients and families seeking treatment for idiopathic scoliosis value appearance and preservation of spinal motion and, to a lesser extent, reoperation rates when considering fusion versus non-fusion surgery.

Assessing Idiopathic Scoliosis Knowledge Levels Among Malaysian Physiotherapists and Associating Their Clinical Experience

Physiotherapists play a significant role in the conservative management of idiopathic scoliosis (IS) patients. This study aimed to determine the level of knowledge on IS among practising physiotherapists and the association between years of clinical experience and the level of knowledge. A total of 63 physiotherapists responded to the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SORSOT) questionnaire. The findings demonstrated that the level of knowledge among the physiotherapists was poor, particularly regarding the prevalence, diagnosis, and treatment of IS. There was a significant association between years of clinical experience and the level of knowledge.

Primary correction results in the prediction of the basic scoliotic curves and postoperative progression in patients with youth idiopathic scoliosis of the thoracic localization surgical treatment

BACKGROUND: Predicting the results of the surgical treatment of idiopathic scoliosis is important, as the role of communication between the doctor and the patient increases in discussing possible outcomes of treatment and developing a plan for surgical intervention.&#x0D; AIM: To create a multivariate model for predicting the surgical results of juvenile idiopathic scoliosis based on the identification of predictors that affect the quantity of the main scoliotic curve primary correction and postoperative progression.&#x0D; MATERIALS AND METHODS: The surgical results of 922 patients with juvenile idiopathic thoracic scoliosis who underwent surgery from 1999 to 2019 were analyzed. The mean age was 14.6 1.2 years (men, 16.8%; women, 83.1%). The patients were divided into four groups according to the types of surgical interventions: group I included 247 patients (26.8%) who received correction using laminar fixation and anterior stage; group II, 450 patients (48.8%) who underwent correction using hybrid fixation; group III, 80 (8.7%) patients who had correction using hybrid fixation and anterior stage; and group IV, 145 (15.7%) patients who underwent correction with total transpedicular fixation. Clinical and radiological data were analyzed in the preoperative, postoperative, and late postoperative periods. Predictors of undercorrection and postoperative progression (loss of achieved correction) were identified by constructing univariate and multivariate logistic regression models.&#x0D; RESULTS: The greatest correction of the thoracic scoliotic curve (74.3%) was noted in group IV. In patients with spinal deformity of 80 and mobility of 25%, the smallest correction (44.8%) was noted in group III. Postoperative progression of 10 was observed in groups I and II. Multiplicative predictors of insufficient correction of the main scoliotic curve of 50% and postoperative progression of 10 were identified. The sensitivity and specificity to predict undercorrection were 75.2% and 82.6% and for postoperative progression were 68.6% and 66.8%, respectively (p 0.05).&#x0D; CONCLUSIONS: The identification of multiplicative predictors of insufficient correction and postoperative progression makes it possible to predict the risk of insufficient correction with an accuracy of 75% and the risk of postoperative progression with an accuracy of 68.6%. If transpedicular fixation to correct the main scoliotic curve is impossible, additional anterior intervention may be performed to prevent postoperative progression.

From PHQ-2 to SRS-22: how a depression screening tool relates to SRS scores in patients with adolescent idiopathic scoliosis.

The aim of our study was to determine the relationship between Patient Health Questionnaire (PHQ) scores-a simple, validated depression screening tool-and Scoliosis Research Society (SRS)-22 questionnaire scores in patients with idiopathic scoliosis (IS). IS patients screened for depression with the PHQ-2 who completed the SRS-22 over a 2-year period were reviewed. If PHQ-2 scores were positive (> 3), the more comprehensive PHQ-9 was administered. Median SRS-22 scores between positive and negative PHQ screens were compared. Nonparametric correlation between PHQ and SRS-22 Mental Health (MH) domain was performed. The ability of the MH domain to discriminate between patients with positive versus negative screens and patients with moderate-severe depression risk versus no-mild risk was evaluated with ROC analysis. 521 patients were included. Patients with + PHQ-2 screens had significantly lower total and individual domain SRS scores, especially within the MH domain (4.0 vs. 3.2). For those with moderate-severe depression risk, total and individual domain scores were also significantly lower (MH domain, 4.0 vs. 3.0, p < 0.05). A weak, but significant correlation was observed between the PHQ and MH domain scores (rho = 0.32, p < 0.001). A cut-off of ≥ 3.6 on the MH domain demonstrated sensitivity of 0.75 and specificity of 0.86 for identifying patients at no-mild risk for depression. Recognizing mental health conditions is critical to successful IS treatment as psychosocial conditions can negatively affect treatment outcomes. IS patients scoring < 3.6 on the SRS-22 MH domain should be considered for depression screening due to an increased risk of moderate-severe depression.

Early brace treatment for idiopathic scoliosis may change the paradigm to improve curves.

This study evaluated whetherearly brace treatment of curves < 25° decreased theprevalence of curve progression and surgery. In a retrospective review, patients with idiopathic scoliosis Risser stages 0 to 2 braced at < 25° were followed until brace discontinuation, skeletal maturity, or surgery. Patients with predominantly primary thoracolumbar/lumbar curves were prescribed nighttime braces (NTB) and thoracic curves were prescribed fulltime braces (FTB). Comparisons were made for TLSO type (NTB vs. FTB) and triradiate cartilage (TRC) status (open vs. closed) at brace prescription. 283 patients were included, 81% who were Risser stage 0 with curves averaging 21.8° ± 2.1° at brace prescription. The average curve change was 2.4° ± 11.2°. Curves improved ≥ 6° in 23% of patients. Patients who were not skeletally mature at brace discontinuation (n = 39) had lower Cobb angles (16.7° vs. 23.9°, p < 0.001), better curve improvement (-4.7° vs. 2.1°, p < 0.001), and were braced for a shorter period of time (1.8years vs. 2.3years, p = 0.011) than those who were skeletally mature at brace discontinuation (n = 239). Only 7% of patients in NTB and 8% of patients in FTB with open TRC required surgery. The numbers needed to treat to prevent surgery in patients in FTB with open TRC was calculated to be 4. Early brace treatment (Cobb < 25° and open TRC) may not only reduce curve progression and the need for surgical treatment but may also result in curve improvement, thus challenging the paradigm that the goal of bracing is merely to stop curve progression. 3-retrospective cohort study.

Posterior Vertebral Pedicular Tethering for the Treatment of Idiopathic Adolescent Scoliosis.

Over the last decade, there has been a new wave of interest in non-fusion techniques for the treatment of adolescent idiopathic scoliosis. These are not new techniques, as they were first published and presented in the late 1950s, using compression of the convexity or distraction of the concavity of the main curvature. More recently, anterior vertebral body tethering has raised great interest, as although it is a major procedure through the child's chest, it seems appropriate for the thoracic curves. The main objective of this article is to describe Posterior Vertebral Pedicular Tethering (PVPT) as a "new" technique performed as a less invasive spinal procedure for the treatment of certain thoracolumbar and lumbar scoliosis in growing adolescents. It is an alternative growth modulation technique appropriate for thoracolumbar and lumbar curvatures where we observe reduction of the three plane deformity of idiopathic scoliosis in adolescents.

Anesthetic Complications in Children Undergoing Mehta Spine Casting: A Case Series.

Elongation-derotation flexion casting, commonly referred to as Mehta casting, is a relatively new treatment for infantile idiopathic scoliosis. Surgeons have noted remarkable, sustained improvement in scoliosis following treatment with serial Mehta plaster casts. There is scant literature regarding anesthetic complications during Mehta cast placement. This case series examines 4 children who underwent Mehta casting at a single tertiary institution. Complications included endotracheal tube obstruction, hypothermia, pressure point injuries, and prolonged exposure to general anesthesia (GA) that potentially increases the risk of long-term neurodevelopmental delay.

Surgical treatment of adult scheuermann kyphosis and idiopathic scoliosis: A matched-controlled comparison

Surgical treatment of adult scheuermann kyphosis and idiopathic scoliosis: A matched-controlled comparison

Application of the Schroth Method in the Treatment of Idiopathic Scoliosis: A Systematic Review and Meta-Analysis.

(1) Background: Idiopathic scoliosis can be defined as a complex three-dimensional deformity of the spine and trunk, which occurs in basically healthy children. Schroth scoliosis-specific exercises have shown good results in reducing idiopathic scoliosis progression. This study aimed to critically evaluate the effect size of Schroth's method through a systematic review and meta-analysis. (2) Methods: Four databases were included in the search: PubMed, Cochrane Library, Web of Science, and Google Scholar. The following keywords were used: "Schroth exercise", "idiopathic scoliosis", "Cobb angle", "angle of trunk rotation", and "quality of life". Only articles written in English that met the following criteria were included in our study: subjects who had idiopathic scoliosis, the Schroth method was applied, and Cobb angle or angle of trunk rotation or quality of life as outcomes. (3) Results: Ten randomized controlled trials were included in this study. The effect size of the Schroth exercise ranged from almost moderate to large, for the outcomes used: Cobb angle (ES = -0.492, p ˂ 0.005); ATR (ES = -0.471, p = 0.013); QoL (ES = 1.087, p ˂ 0.001). (4) Conclusions: The current meta-analysis indicates that the Schroth method has a positive effect on subjects with idiopathic scoliosis.