Vertebral Rotation Research Articles

Correlation of transverse rotation of the spine using surface topography and 3D reconstructive radiography in children with idiopathic scoliosis.

The relationship between axial surface rotation (ASR) measured by surface topography (ST) and axial vertebral rotation (AVR) measured by radiography in the transverse plane is not well defined. This study aimed to: (1) quantify ASR and AVR patterns and their magnitudes from T1 to L5; (2) determine the correlation or agreement between the ASR and AVR; and (3) investigate the relationship between axial rotation differences (ASR-AVR) and major Cobb angle. This is a retrospective study evaluating patients (age 8-18) with IS or spinal asymmetry with both radiographic and ST measurements. Demographics, descriptive analysis, and correlations and agreements between ASR and AVR were evaluated. A piecewise linear regression model was further created to relate rotational differences to Cobb angle. Fifty-two subjects met inclusion criteria. Mean age was 14.1 ± 1.7 and 39 (75%) were female. Looking at patterns, AVR had maximal rotation at T8, while ASR had maximal rotation at T11 (r = 0.35, P = .006). Cobb angle was 24.1° ± 13.3° with AVR of - 1° ± 4.6° and scoliotic angle was 20.9° ± 11.5° with ASR of -2.3° ± 6.6°. (ASR-AVR) vs Cobb angle was found to be very weakly correlated with a curve of less than 38.8° (r = 0.15, P = .001). Our preliminary findings support that ASR measured by ST has a weak correlation with estimation of AVR by 3D radiographic reconstruction. This correlation may further help us to understand the application of transverse rotation in some clinical scenarios such as specific casting manipulation, padding mechanism in brace, and surgical correction of rib deformity.

Does the addition of convex uniplanar screws in hybrid constructs improve 3D surgical correction in thoracic adolescent idiopathic scoliosis posterior fusion?

Hybrid techniques using thoracic sublaminar bands have proved their efficacy in adolescent idiopathic scoliosis posterior fusion, but clinical axial correction sometimes remained disappointing. One solution found was "the frame technique" and the second alternative was the replacement of the convex sublaminar bands by periapical uniplanar screws. The goal of this study was to compare clinical and radiological outcomes of both techniques in a consecutive cohort of adolescent idiopathic scoliosis patients. All patients undergoing primary posterior fusion for thoracic adolescent idiopathic scoliosis between January 2017 and March 2020 were included. Two groups were compared: Group 1 with thoracic sublaminar bands only and Group 2 with periapical uniplanar screws. All patients underwent standing stereoradiographs. The main frontal, sagittal, and axial (apical vertebra rotation) radiological parameters of interest were analyzed. Functional outcomes were assessed using the Scoliosis Research Society 30 score. A total of 147 adolescents were included (Group 1, n = 73 and Group 2, n = 74 patients). In the frontal plane, a greater reduction index was observed in Group 2 (68% versus 62%, p < 0.001) as well as a better apical axial correction (67.8% versus 46.6%, p = 0.03). The number of thoracoplasty performed was reduced (6.7% versus 20.5%, p = 0.02) in Group 2, with a significant decrease in the rate of mechanical complication. No significant loss of correction was observed during follow-up in any of the group. The adjunction of convex uniplanar screws at the periapical levels improved the three-dimensional surgical correction of thoracic adolescent idiopathic scoliosis treated with hybrid constructs. level III, retrospective comparative study.

3D analysis of the preoperative deformity in AIS can be used to guide surgical treatment decisions for selective thoracic fusion.

To identify 3D measures of scoliosis from preoperative imaging that are associated with optimal radiographic outcomes after selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS). Subjects with primary thoracic curves (Lenke 1-4, B or C modifiers) fused selectively (L1 or above) who had preoperative 3D reconstructions and minimum 2 years of follow-up were included. An optimal outcome at 2 years was defined as having 4 of 5 parameters previously defined in the literature: (1) lumbar curve < 26º, (2) deformity flexibility quotient < 4, (3) C7-CSVL < 2cm, (4) lumbar prominence < 5º and (5) trunk shift < 1.5cm. Univariate and CART analyses were performed to identify preoperative variables associated with achieving an optimal outcome 2 years postoperatively. Ninety-nine (88F, 11M) patients met inclusion. Mean age was 15 ± 2years. Fifty-one subjects (52%) had an optimal outcome. Seven preoperative deformity measures representing smaller thoracolumbar/lumbar deformity in the optimal group were found to be significant on univariate analysis. CART analysis identified the following variables associated with optimal outcomes: difference in apical rotation > 30° = 27% optimal outcomes, difference in apical rotation ≤ 30° and coronal vertebral wedging of lumbar apex > 3° = 46% optimal outcomes, and difference in apical rotation ≤ 30° and coronal vertebral wedging of lumbar apex ≤ 3° = 80% optimal outcomes (p < 0.05). Optimal outcomes after STF were associated with a preoperative difference in apical vertebral rotation in the axial plane less than 30° between thoracic and lumbar curves as well as coronal plane vertebral wedging of the lumbar apical vertebra less than 3°.

Deletion of a conserved genomic region associated with adolescent idiopathic scoliosis leads to vertebral rotation in mice.

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis, in which spinal curvature develops in adolescence, and 90% of patients are female. Scoliosis is a debilitating disease that often requires bracing or surgery in severe cases. AIS affects 2%-5.2% of the population; however, the biological origin of the disease remains poorly understood. In this study, we aimed to determine the function of a highly conserved genomic region previously linked to AIS using a mouse model generated by CRISPR-CAS9 gene editing to knockout this area of the genome to understand better its contribution to AIS, which we named AIS_CRMΔ. We also investigated the upstream factors that regulate the activity of this enhancer in vivo, whether the spatial expression of the LBX1 protein would change with the loss of AIS-CRM function, and whether any phenotype would arise after deletion of this region. We found a significant increase in mRNA expression in the developing neural tube at E10.5, and E12.5, for not only Lbx1 but also other neighboring genes. Adult knockout mice showed vertebral rotation and proprioceptive deficits, also observed in human AIS patients. In conclusion, our study sheds light on the elusive biological origins of AIS, by targeting and investigating a highly conserved genomic region linked to AIS in humans. These findings provide valuable insights into the function of the investigated region and contribute to our understanding of the underlying causes of this debilitating disease.

Intraobserver and Interobserver Reliability of Pelvic Obliquity Measurement Methods in Patients With Idiopathic Scoliosis.

Despite the importance of the assessment of pelvic obliquity, especially in the planning of surgery, there is no consensus on the pelvic obliquity measurements. The purpose of this study is to assess the intraobserver and interobserver reliability of 4 different pelvic obliquity measuring methods in patients with idiopathic scoliosis (IS): the Osebold, O'Brien, Maloney, and Allen&Ferguson methods. A retrospective cohort of 85 posteroanterior full-spine radiographs in the standing position of patients with IS involving the pelvic obliquity was evaluated by a team of 3 raters. The same researcher recorded the curve magnitude, apical vertebral rotation, Risser grade, curve pattern, and femoral head height difference. The pelvic obliquity angle was measured using the Osebold, O'Brien, Maloney, and Allen&Ferguson methods. The same graders were asked to regrade the same radiographs after at least 1 month. The Osebold method showed the highest interobserver reliability with an ICC of 0.994 and 0.983. The Allen&Ferguson method had the lowest reliability with an ICC of 0.911 and 0.934, but all of the methods were considered having excellent reliability. The Osebold method also showed the highest intraobserver reliability, ranging from 0.909 to 0.997. The Allen&Ferguson method had the lowest intraobserver reliability, with a range of 0.741 to 0.960. Also, all observers preferred the Osebold Method. The observers reported that the Allen&Ferguson method was considered the most time-consuming method, while the least time-consuming method was specified as the Osebold method. To the best of our knowledge, this study is the first to evaluate the intraobserver and interobserver reliability of pelvic obliquity among common measurement methods in patients with idiopathic scoliosis. All methods were evaluated as having excellent to good reliability in this study, but the Osebold method is the most reliable method of measuring pelvic obliquity on a frontal view radiograph in idiopathic scoliosis. The Osebold method is easier to use as it requires only the iliac crests to be visualized. Level III-Retrospective cohort study.

Automatic Vertebral Rotation Angle Measurement of 3D Vertebrae Based on an Improved Transformer Network.

The measurement of vertebral rotation angles serves as a crucial parameter in spinal assessments, particularly in understanding conditions such as idiopathic scoliosis. Historically, these angles were calculated from 2D CT images. However, such 2D techniques fail to comprehensively capture the intricate three-dimensional deformities inherent in spinal curvatures. To overcome the limitations of manual measurements and 2D imaging, we introduce an entirely automated approach for quantifying vertebral rotation angles using a three-dimensional vertebral model. Our method involves refining a point cloud segmentation network based on a transformer architecture. This enhanced network segments the three-dimensional vertebral point cloud, allowing for accurate measurement of vertebral rotation angles. In contrast to conventional network methodologies, our approach exhibits notable improvements in segmenting vertebral datasets. To validate our approach, we compare our automated measurements with angles derived from prevalent manual labeling techniques. The analysis, conducted through Bland-Altman plots and the corresponding intraclass correlation coefficient results, indicates significant agreement between our automated measurement method and manual measurements. The observed high intraclass correlation coefficients (ranging from 0.980 to 0.993) further underscore the reliability of our automated measurement process. Consequently, our proposed method demonstrates substantial potential for clinical applications, showcasing its capacity to provide accurate and efficient vertebral rotation angle measurements.

The Comparison of Posterior Intervertebral Release Combined with Posterior Column Osteotomy and Posterior Column Osteotomy Alone for the Treatment of Moderate-to-Severe Rigid Scoliosis: A Prospective Controlled Study.

There is no consensus on the treatment of moderate-to-severe rigid scoliosis. Anterior release and three-column osteotomy are excessively traumatic, whereas posterior column osteotomy (PCO) alone results in poor outcomes. An emerging surgical technique, posterior intervertebral release (PR), can release the rigid spine from the posterior approach. This study was performed to compare the multi-segment apical convex PR combined with PCO and PCO alone in patients with moderate-to-severe rigid scoliosis. From June 2021 to June 2022, this prospective study of moderate-to-severe (Cobb: 70-90°) rigid scoliosis (flexibility of main curve <25%) involved two groups defined by surgical procedure: the PR group, the patients undergoing PR combined with PCO; and the PCO group, the patients undergoing PCO alone. Follow-up was at least 12 months. Radiographic results mainly included main curve Cobb, correction of per PR/PCO segment, apical vertebra rotation (AVR) and apical vertebra translation (AVT). Demographics, surgical data, complications were also recorded. Student's independent samples t test and Pearson's chi-square test were used to compare the differences between groups. Forty patients with an average age of 16.65 years were included (PR group, n = 20; PCO group, n = 20). The main curves averaged 77.56° ± 5.86° versus 78.02° ± 5.72° preoperatively and 20.07° ± 6.73° versus 33.58° ± 5.76° (p < 0.001) at the last follow-up in the PR and PCO groups, respectively. The mean correction rates were 74.30% and 56.84%, respectively (p < 0.001). The average coronal curve correction was 13.49° per release segment, which was significantly higher than the PCO correction of 6.20° (p < 0.001). The correction of apical vertebra rotation and translation in the main thoracic curve was significantly better in the PR group than in the PCO group (p < 0.05). Several minor complications in the two groups improved after conservative treatment. The multi-segment apical convex PR combined with PCO offers more advantages than PCO alone in the treatment of patients with moderate-to-severe rigid scoliosis. Owing to its excellent corrective effect and few complications, this is a high benefit-risk ratio surgical strategy for rigid scoliosis.

Ab. No. 36 Integrated Effect of 3d Schroth Method and Cellular Rhythm Therapy on 4-D Postural Analysis in an Individual With Idiopathic Structural Scoliosis- Single Case Study

Introduction: The study attempts to widen the horizons of physiotherapy profession by promoting insights towards the advanced non-invasive treatment approaches for the management of Idiopathic Structural Scoliosis and aims to investigate the combined effect of 3D Schroth Method (spinal corrective exercise program) and Cellular Rhythm Therapy on 4D Postural Analysis in an individual with Idiopathic Structural Scoliosis Methods: An 18-year-old male diagnosed with idiopathic scoliosis for 4 years. He had thoracic levoscoliosis and lumbar dextroscoliosis with a baseline Cobb’s angle of 35º. Physical findings were uneven shoulder heights, slight right scapular winging, prominent left hip, and increased space between left elbow and trunk due to trunk deviation towards the right side. The patient intervened with Cellular Rhythm Therapy for 20 minutes followed by 3D Schroth Method exercises for 20 minutes. The treatment was given for a total of 30 days (5 sessions per week). Pre and Post interventional objective assessment was done using 4D postural analysis and subjective assessment was done using the Italian Spine-Related Quality of Life (ISYQOL) questionnaire at day 0 and day 30. Result: Significant change was found in lumbar lordosis angle (46º -31º), sagittal imbalance (6º - 2º), pelvic torsion (4º- 2º), vertebral rotation (17º -13º), apical deviation (49º - 21º), lumbar lordosis depth (32º- 30º) and in Cobb’s angle from 35º to 29º, along with difference in Italian Spine-Related Quality of Life (ISYQOL) questionnaire from 37% to 39%. Conclusion: According to the study’s findings, 3D Schroth Method and Cellular Rhythm Therapy can be an effective treatment for patients with Scoliosis. Implications: This combinational approach anticipates a useful reference guide for future management of Idiopathic Structural scoliosis.

Application of the Six-Minute Walk Test in Assessment of the Cardiopulmonary Function of Children With Idiopathic Scoliosis.

A retrospective observational study. To assess whether the six-minute walk test (6MWT) can predict cardiopulmonary function in children with idiopathic scoliosis (IS) as an alternative to the cardiopulmonary exercise test (CPET). Cardiopulmonary functional impairment in the setting of IS is a common health problem. A simple and convenient assessment method is needed. We recruited 65 children (eight male, 57 female) aged 10.70 to 14.84 years old with IS. Radiographic characteristics of the cohort were measured, including Risser's sign and Cobb angle. We measured cardiopulmonary exercise tolerance using both the 6MWT and CPET and their corresponding indicators, including six-minute walking distance (6MWD) and peak oxygen uptake (peak VO 2 ), respectively. Pearson correlation analysis was used to determine the relationship between 6MWT indicators and IS parameters. Linear regression models were used to explore the relationship between 6MWT and CPET response indicators. Over a third of the cohort (35.4%) had a Risser's sign grade of 0, with 21.5% in grade 2 and 3, respectively. The cohort's mean Cobb angle was 26.02°. 6MWD was significantly positively correlated with Risser's sign ( R =0.258; P =0.038) and change in respiratory rate positively correlated with vertebral rotation ( R =0.264; P =0.034). 6MWD positively correlated with peak VO 2 , peak VO 2 /heart rate (HR), and metabolic equivalents, and negatively correlated with the ventilation equivalent of the carbon dioxide slope (VE/VCO 2 slope) ( P <0.05). These four CPET indicators were found to be predicted from 6MWD in the linear regression model ( P <0.05). CPET response indicators, especially peak VO 2 , can be predicted using 6MWD, among other factors. The 6MWT can therefore be used to rapidly and efficiently predict the cardiorespiratory tolerance of children with IS. 3.

Inter-Specimen Analysis of Diverse Finite Element Models of the Lumbar Spine.

Over the past few decades, there has been a growing popularity in utilizing finite element analysis to study the spine. However, most current studies tend to use one specimen for their models. This research aimed to validate multiple finite element models by comparing them with data from in vivo experiments and other existing finite element studies. Additionally, this study sought to analyze the data based on the gender and age of the specimens. For this study, eight lumbar spine (L2-L5) finite element models were developed. These models were then subjected to finite element analysis to simulate the six fundamental motions. CT scans were obtained from a total of eight individuals, four males and four females, ranging in age from forty-four (44) to seventy-three (73) years old. The CT scans were preprocessed and used to construct finite element models that accurately emulated the motions of flexion, extension, lateral bending, and axial rotation. Preloads and moments were applied to the models to replicate physiological loading conditions. This study focused on analyzing various parameters such as vertebral rotation, facet forces, and intradiscal pressure in all loading directions. The obtained data were then compared with the results of other finite element analyses and in vivo experimental measurements found in the existing literature to ensure their validity. This study successfully validated the intervertebral rotation, intradiscal pressure, and facet force results by comparing them with previous research findings. Notably, this study concluded that gender did not have a significant impact on the results. However, the results did highlight the importance of age as a critical variable when modeling the lumbar spine.

A finite element method study of the effect of vibration on the dynamic biomechanical response of the lumbar spine

BackgroundStudies focusing on lumbar spine biomechanics are very limited, and the mechanism of the effect of vibration on lumbar spine biodynamics is unclear. To provide guidance and reference for lumbar spine biodynamics research and vibration safety assessment, this study aims to investigate the effects of different vibrations on lumbar spine biodynamics. MethodsA validated finite element model of the lumbosacral spine was utilized. The model incorporated a 40 kg mass on the upper side and a 400 N follower preload. As a comparison, another model without a coupled mass was also employed. A sinusoidal acceleration with an amplitude of 1 m/s2 and a frequency of 5 Hz was applied to the upper and lower sides of the model respectively. FindingsWhen the coupled mass point is not introduced: in the case of upper-side excitation, the lumbar spine shows a significantly larger response in the x-direction than in the z-direction, while in the case of lower-side excitation, the lumbar spine experiences rigid body displacement in the z-direction without any movement, deformation, rotation, or stress changes in the x-direction. When the coupled mass point is introduced: both upper and lower-side excitations result in significant differences in z-directional displacement, with relatively small differences in vertebral rotation angle, disc deformation, and stress. Under upper excitation, low-frequency oscillations occur in the x-direction. In both types of excitations, the anterior-posterior deformation of the L2-L3 and L4-L5 intervertebral discs is greater than the vertical deformation. The peak (maximum) disc stress exceeds the average stress and stress amplitude across the entire disc. Regardless of the excitation type, the stress distribution within the disc at the moment of peak displacement remains nearly identical, with the maximum stress consistently localized on the anterior side of the L4-L5 disc. InterpretationAccurately simulating lumbar spine biodynamics requires the inclusion of the upper body mass in the lumbosacral spine model. The physiological curvature of the lumbar spine could escalate the risk of lumbar spine vibration injuries. It is more instructive to apply local high stress in the disc as a lumbar spine vibration safety evaluation parameter.

Sex-based differences in clinical and radiological presentation of patients with degenerative lumbar scoliosis: a cross-sectional study

BackgroundTo evaluate the sex-based differences in clinical and radiological presentation of patients with degenerative lumbar scoliosis (DLS) and to explore whether the difference is helpful in investigating the etiology and progression of DLS.MethodA retrospective review of 199 patients (41 males, 158 females) with DLS was included. Patient demographics including age, gender, bone mineral density were collected. Back and leg pain was assessed by visual analog scale, and general physical condition was assessed by Oswestry Disability Index. Cobb’s angle was measured, and direction of scoliosis, position of the superior, inferior and apex vertebrae, number of vertebrae included in the scoliosis, rotation of apex vertebrae (Nash-Mo index), translation of apex vertebrae were recorded. Sagittal longitudinal axis, thoracolumbar kyphosis, lumbar lordosis (LL), pelvic incidence angle (PI), sacral slope, apex of lumbar lordosis and coronal balance distance were measured by whole spine lateral radiographs, and type of coronal imbalance was evaluated in all patients. Fat infiltration rate (FIR) of the paraspinal muscles at the vertebral apex was measured by MRI.ResultCompared to female patients, male patients showed more back and leg pain on clinical presentation and smaller Cobb angle, less parietal rotation, larger LL, smaller PI-LL and lower paravertebral muscle FIR on radiologic features.ConclusionGender differences do exist in DLS patients with regard to clinical and radiological presentation, low back pain was more pronounced in male patients, and scoliosis was more severe in female patients based on this cross-sectional study.

Dual Growing Rods and the Apical Control Technique for Treating Congenital Early-Onset Scoliosis: Lessons Learned.

Congenital early-onset scoliosis (CEOS) is characterized by a spectrum of vertebral anomalies, including formation failures and segmentation failures at the apex segment, which makes CEOS different from other etiologies of early-onset scoliosis. To date, studies on patients who have graduated from CEOS treatment using traditional dual growing rods (TDGR) have been scarce, and the preliminary results of TDGR with or without the apical control technique (ACT) have varied. We therefore compared the final outcomes of patients with CEOS who graduated from TDGR with or without the ACT. A retrospective study of patients with CEOS who had graduated from TDGR treatment performed from 2007 to 2020 was conducted. Graduation included final fusion or observation after reaching skeletal maturity. Patients were divided into the ACT-TDGR group (apical vertebrectomy and/or hemivertebrectomy with short fusion and TDGR) and the TDGR-only group. Demographic characteristics, radiographic data, patient-reported clinical outcomes, pulmonary function, and complications were analyzed. A total of 41 patients with CEOS were enrolled: 13 in the ACT-TDGR group and 28 in the TDGR-only group. The lengthening intervals were longer in the ACT-TDGR group (mean [and standard deviation], 1.26 ± 0.66 years) than in the TDGR-only group (0.80 ± 0.27 years). The preoperative main curve was larger in the ACT-TDGR group (80.53° ± 19.50°) than in the TDGR-only group (64.11° ± 17.50°). The residual curve was comparable between groups (26.31° ± 12.82° in the ACT-TDGR group compared with 27.76° ± 15.0° in the TDGR group) at the latest follow-up. The changes in apical vertebral rotation and thoracic rotation were significantly larger in the ACT-TDGR group. Patients had comparable T1-12 and T1-S1 heights, pulmonary function, and 22-item Scoliosis Research Society (SRS-22) scores at the latest follow-up. The mean number of mechanical-related complications per patient was lower in the ACT-TDGR group (0.77 ± 0.73) than in the TDGR-only group (1.54 ± 1.43). Seventeen patients underwent final fusion. In this small-scale study, we observed that both ACT-TDGR and TDGR-only could correct the deformity while allowing for spinal growth in patients with CEOS. ACT-TDGR yielded better correction in severe cases and did not have a deleterious effect on spinal height. A large number of cases will be needed to validate the clinical value of the ACT. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Ultrasound-assisted lumbar puncture with a horizontal and perpendicular paramedian approach based on positioning in patients with abnormal spinal anatomy: a case report and technical description

BackgroundThe use of ultrasound has been reported to be beneficial in challenging neuraxial procedures. The angled probe is responsible for the main limitations of previous ultrasound-assisted techniques. We developed a novel technique for challenging lumbar puncture, aiming to locate the needle entry point which allowed for a horizontal and perpendicular needle trajectory and thereby addressed the drawbacks of earlier ultrasound-assisted techniques.Case presentationPatient 1 was an adult patient with severe scoliosis who underwent a series of intrathecal injections of nusinersen. The preprocedural ultrasound scan revealed a cephalad probe’s angulation (relative to the edge of the bed) in the paramedian sagittal oblique view, and then the probe was rotated 90° into a transverse plane and we noted that a rocking maneuver was required to obtain normalized views. Then the shoulders were moved forward to eliminate the need for cephalad angulation of the probe. The degree of rocking was translated to a lateral offset from the midline of the spine through an imaginary lumbar puncture’s triangle model, and a needle entry point was marked. The spinal needle was advanced through this marking-point without craniocaudal and lateromedial angulation, and first-pass success was achieved in all eight lumbar punctures. Patient 2 was an elderly patient with ankylosing spondylitis who underwent spinal anesthesia for transurethral resection of the prostate. The patient was positioned anteriorly obliquely to create a vertebral rotation that eliminated medial angulation in the paramedian approach. The procedure succeeded on the first pass.ConclusionsThis ultrasound-assisted paramedian approach with a horizontal and perpendicular needle trajectory may be a promising technique that can help circumvent challenging anatomy. Larger case series and prospective studies are warranted to define its superiority to alternative approaches of lumbar puncture for patients with difficulties.

A Novel Multiple Screw Distraction Reducer System in the Treatment of Scoliosis with a Severe Rib Hump.

The treatment of scoliosis with a severe rib hump remains a major challenge. Traditional vertebral rotation techniques are not satisfactory, and thoracoplasty has many pulmonary complications that limit its application. A novel surgical device, the multiple screw distraction reducer (MSDR) system, provides longitudinal distraction during the corrective operation while at the same time providing lateral translation and axial derotation, which may facilitate the correction of a rib hump. This study was performed to investigate the effectiveness of the MSDR system for adolescent idiopathic scoliosis (AIS) with a severe rib hump. This was a case-matched study of patients with retrospectively collected data from our hospital between January 2017 and December 2021. Sixty-eight patients who underwent one-stage posterior pedicle screw-instrumented spinal fusion were matched by the Cobb angle of the main curve and rib hump. All patients underwent a minimum of 2 years of follow-up. The patients were divided into two groups: the MSDR group (using the MSDR system, n = 34) and the DVR group (using direct vertebral derotation, n = 34). The patients were evaluated for the height of the rib hump, deformity correction, complications, and SRS-30 scores. The unpaired Student's t-test and Pearson's χ2 -test were used to compare the outcome measures between the two groups. Multiple linear regression analysis was used to examine the variables that affected the correction of a rib hump. The rib hump was 30.21 ± 6.21 mm versus 29.35 ± 6.52 mm (p = 0.583) preoperatively and 9.18 ± 4.06 mm versus 13.82 ± 5.54 mm (p < 0.001) at the last follow-up in the MSDR and DVR groups, respectively. The correction rates were 70.83% and 53.56%, respectively (p < 0.001). Preoperatively, the main thoracic curve was 58.43° ± 7.97° and 57.84° ± 6.32° (p = 0.736) and was corrected to 10.92° ± 5.47° and 19.14° ± 5.32° (p < 0.001) at last follow-up in the MSDR and DVR group, respectively. Thoracic kyphosis was restored from 18.24° ± 5.19° and 17.98° ± 5.28° (p = 0.836) in the MSDR and DVR group to 24.59° ± 4.41° and 19.32° ± 4.96° (p < 0.001), respectively. Correction of apical vertebra rotation and translation in the main thoracic curve were significantly better in the MSDR group than in the DVR group (p < 0.05). There was no significant difference in the Lenke type, implant density, estimated blood loss, or follow-up duration between the two groups, whereas the operation time in the DVR group was significantly less than that in the MSDR group. There were only two minor pulmonary complications in the MSDR group. At the last follow-up, the MSDR group scored higher in terms of appearance and satisfaction (p < 0.05). The MSDR system, enabling better coronal alignment, thoracic kyphosis, and axial derotation, could be a safe and effective technique for severe rib hump correction in AIS.

Evaluation of Chêneau brace in the treatment of thoracic and lumbar adolescent idiopathic scoliosis with apical vertebral rotation.

Adolescent idiopathic scoliosis (AIS) is a common structural disorder of the spine in adolescents, often associated with structural deformities in both coronal and axial positions. Apical vertex rotation (AVR) is one of the main indicators of axial deformity in patients with scoliosis. Currently, there are few studies on the impact of AVR in the treatment of AIS. This study examined the influence of different AVR on AIS after brace treatment. Data were collected from 106 AIS participants aged 11-16 years from the orthopedic outpatient clinic of the Second Hospital of Lanzhou University. Two orthopaedic professionals measured the Cobb angle, AVR and spinal mid-line offset before and after brace treatment, and descriptive and linear correlation analyses were used to determine the correlation between AVR and AIS measured parameters. (1) In AIS volunteers with the same AVR, the treatment effect of AIS with lumbar predominant curvature was higher than that of AIS with thoracic predominant curvature. The treatment effect tended to decrease with increasing AVR. (2) Spinal mid-line deviation was associated with AVR. For patients with AIS with I and II degrees of AVR, the treatment effect of spinal mid-line offset after bracing is better. For AIS patients with AVR III degrees and above, the degree of correction of spinal mid-line offset decreases with the continuous correction of Cobb angle. The efficacy of AIS was found to be related to the severity of AVR. The efficacy of AIS with predominantly lumbar curvature was significantly higher than that of AIS with predominantly thoracic curvature. The efficacy of treatment of mid-line spinal deviation also decreased with increasing AVR.

Relationship between Fusion Mass Shift and Postoperative Distal Adding-on in Lenke 1 Adolescent Idiopathic Scoliosis after Selective Thoracic Fusion.

This is a retrospective cohort study. This study aims to investigate the risk factors for postoperative distal adding-on in Lenke 1 adolescent idiopathic scoliosis (AIS) and validate the relationship between fusion mass shift (FMS) and postoperative distal adding-on. Postoperative distal curve adding-on is one of the complications in AIS. FMS has been proposed to prevent postoperative distal adding-on, which requires further validation from different institutions. This study included 60 patients with Lenke 1 AIS who underwent selective thoracic fusion surgery. Coronal spinal alignment parameters were analyzed preoperatively, postoperatively, and at the final follow-up. The postoperative FMS was divided into two groups: the balanced group (FMS ≤20 mm) and the unbalanced group (FMS >20 mm). An independent t-test was used to compare quantitative data between groups, and a chi-square test was used for qualitative data. Furthermore, binary logistic regression and receiver operating characteristics curve analyses were used to identify the risk factors for postoperative distal adding-on in AIS. At 2-year follow-up, the unbalanced group was more likely to have adding-on (17 of 24 patients) than the balanced group (six of 36 patients; p<0.001). Twenty-three patients with distal adding-on had significantly greater preoperative and postoperative lower instrumented vertebrae (LIV) rotation, FMS, and FMS angle (FMSA) than those without postoperative distal adding-on. Binary logistic regression analysis selected three independent risk factors for adding-on incidence after surgery: FMS (odds ratio [OR], 1.115; 95% confidence interval [CI], 1.049-1.185; p<0.001), FMSA (OR, 1.590; 95% CI, 1.225-2.064; p<0.001), and postoperative LIV rotation (OR, 6.581; 95% CI, 2.280-19.000; p<0.001). Achieving a balanced fusion mass intraoperatively is important to avoid postoperative distal adding-on, with FMS of <20 mm and FMS angle of <4.5°. Furthermore, correcting LIV rotation helps to decrease the incidence of postoperative distal addingon.

Automatic axial vertebral rotation estimation on radiographs for adolescent idiopathic scoliosis by deep learning

PurposeAdolescent idiopathic scoliosis (AIS) is a three-dimensional spine deformity governed by lateral curvature and axial vertebral rotation (AVR). Estimating AVR is important for treatment decisions and the prediction of AIS progression. However, manual AVR measurements have intra-observer and inter-observer errors, and therefore this paper proposes an automatic AVR measurement method to address the low precision issue of manual measurement. MethodWe develop an improved feature extraction module for vertebral landmark detection and pedicle segmentation. The improved coordinate convolution layer combined Polarized Self-Attention mechanism is applied in the feature extraction module to help the High-resolution Network to extract coordinate information. Based on vertebral landmark detection and pedicle segmentation, we propose an automatic AVR measurement algorithm to estimate the AVR. ResultsThe mean radial error (MRE) of vertebral landmark detection is 2.70 mm pixels, and the dice coefficient of pedicle segmentation is 72.45%. Compared with the original model, the MRE decreases by 2.13 mm, and the dice coefficient improves by 4.61%. For the AVR measurement results, the testing set contains 37 spine radiographs, including 481 vertebrae and 962 AVR measurements (481 vertebrae by two observers). The average measurement error is lower than 5°, which is within the standard of clinical measurement error. ConclusionThe results demonstrate that the proposed network performs well in vertebral landmark detection and pedicle segmentation, and the proposed AVR measurement is adopted for clinic diagnosis of AIS. SignificanceOur method achieves automatic AVR measurement, reducing the error introduced by manual measurement and improving the efficiency of orthopedists.

Rotational Changes Following Use of Direct Vertebral Rotation in Adolescent Idiopathic Scoliosis: A Long-Term Radiographic and Computed Tomography Evaluation.

A retrospective cohort study. To evaluate long-term rotational changes in the vertebrae of patients with adolescent idiopathic scoliosis (AIS) who underwent direct vertebral rotation (DVR). DVR using thoracic pedicle screws, a rotational corrective maneuver used in the surgical treatment of AIS, was introduced in 2004. Although DVR is considered to be the main axial corrective maneuver, the long-term rotational changes of vertebrae following this treatment are not well understood. A total of 135 vertebrae that underwent DVR using thoracic pedicle screws with a minimum five-year follow-up were retrospectively assessed for the vertebral rotation angle. The vertebral rotation of the apical vertebra (AV) and distal end vertebra (EV) was evaluated using the Nash-Moe scale, the rotational angle to the sacrum (RAsac), and the Aaro and Dahlborn method. The Student t test (paired means) was used for continuous variables, and the χ 2 test was used for categorical variables, as appropriate. A comparison of two and three groups used a one-way repeated measures analysis of variance, and the post hoc analysis used the Bonferroni test. The mean Nash-Moe scale of distal EV showed statistically significant differences between preoperative and postoperative values ( P =0.034) and no statistically significant difference between postoperative and last follow-up values ( P =1.000). The last follow-up RAsac of AV did not differ significantly from the preoperative RAsac of AV ( P =0.515). The last follow-up RAsac of distal EV was significantly lower than the preoperative RAsac of distal EV ( P =0.001). The Pearson correlation analysis showed that the last follow-up RAsac of distal EV was correlated with the Cobb angle of the main curve ( r =0.459, P =0.004), loss of correction ( r =0.541, P =0.001), and lowest instrumented vertebra tilt angle ( r =0.504, P =0.001). The rotation regression phenomenon in AV and rotation maintenance in distal EV were observed after DVR over an average 10-year follow-up. These findings suggest that the DVR in the surgical treatment of AIS has a positive long-term effect on the stabilization of distal EV from the point of view of axial rotation. 4.

Rod Rotation with Outrigger Is Substantial for Correcting Apical Hypokyphosis in Patients with Adolescent Idiopathic Scoliosis: Novel Outrigger Device for Concave Rod Rotation

The apical hypokyphosis of scoliotic patients is thought to lead to decreased lung capacity and cause shortness of breath. Additionally, concave rod curve reduction is a problem in the correction of apical hypokyphosis in posterior spinal fusion surgery in adolescent idiopathic scoliosis (AIS). We investigated the contributions of rod rotation (RR) with an outrigger device, followed by differential rod contouring (DRC) with the outrigger attached to the concave rod, designed to prevent concave rod curve-flattening. We analyzed and compared the results of segmental pedicle screw fixation without the outrigger in 41 AIS patients with thoracic curves (Lenke type I, 25; type II, 16) to those corrected using the outrigger in 36 patients (Lenke type I, 24; type II,12). The changes in the Cobb angle, apical kyphosis of five vertebrae, thoracic kyphosis (TK, T4–12), correction rate, correction angle of apical vertebral rotation, spinal penetration index (SPi), and rib hump index (RHi) before and after surgery were measured, and the contribution of the outrigger was analyzed. The mean scoliosis correction rates without and with the outrigger were 72.1° and 75.6°, respectively (p = 0.03). Kyphosis of the five apical vertebrae and TK were significantly greater in the surgery with the outrigger (p = 0.002). Significantly greater improvements in SPi and RHi were also noted in the surgery with the outrigger (p &lt; 0.05). The use of concave RR and convex DRC with the outrigger appear to be advantageous for correcting apical hypokyphosis, followed by the subsequent formation of TK. As a result, breathing problems are less likely to occur during daily life because of improvements in SPi and RHi.