Showing papers on "Cobb angle published in 2008"
TL;DR: The PJK group demonstrated a significant increase in proximal junctional angle at 8 weeks, between 2 years postoperation and ultimate postoperation, and in thoracic kyphosis (T5–T12) at ultimate follow-up, and the SRS outcome instrument was not adversely affected by PJK, except when PJK exceeded 20°.
Abstract: Study Design. A retrospective study. Objective. To analyze time-dependent change of, prevalence of, and risk factors for proximal junctional kyphosis (PJK) in adult spinal deformity after long (≥5 vertebrae) segmental posterior spinal instrumented fusion with a minimum 5-year postoperative follow-up. of Background Data. No study has focused on time-dependent long-term proximal junctional change in adult spinal deformity after segmental posterior spinal instrumented fusion with minimum 5-year follow-up. Methods. Clinical and radiographic data of 161 (140 women/21 men) adult spinal deformity patients with minimum 5-year follow-up (average 7.8 years, range 5-19.8 years) treated with long posterior spinal instrumentation and fusion were analyzed. Radiographic measurements included sagittal Cobb angle at the proximal junction on preoperative, 8-weeks postoperation, 2-year postoperation, and ultimate follow-up (a5 years). Postoperative SRS outcome scores were also evaluated. Results. The prevalence of PJK at 7.8 years postoperation was 39% (62/161 patients). The PJK group (n = 62) demonstrated a significant increase in proximal junctional angle at 8 weeks (59%), between 2 years postoperation and ultimate postoperation (35%), and in thoracic kyphosis (T5-T12) at ultimate follow-up (P = 0.001). However, the sagittal vertical axis change at ultimate follow-up did not correlate with PJK (P = 0.53). Older age at surgery >55 years (vs. ≤55 years) and combined anterior and posterior spinal fusion (vs. posterior only) demonstrated significantly higher PJK prevalence (P = 0.001, 0.041, respectively). The SRS outcome scores did not demonstrate significant differences with the exception of the self-image domain when PJK exceeded 20°. Conclusion. The prevalence of PJK at 7.8 years postoperation was 39%. PJK progressed significantly within 8 weeks postoperation (59%) and between 2 years postoperation and ultimate follow-up (35%). Older age at surgery (>55 years) and combined anterior and posterior spinal fusion were identified as risk factors for developing PJK. The SRS outcome instrument was not adversely affected by PJK, except when PJK exceeded 20°.
349 citations
TL;DR: A combination of 3 MIS techniques allows for correction of lumbar degenerative scoliosis with less blood loss and morbidity than for open correction.
Abstract: Study design Prospective evaluation of 12 patients undergoing surgery for lumbar degenerative scoliosis. Objective To assess the feasibility of minimally invasive spine surgery (MIS) techniques in the correction of lumbar degenerative deformity. Summary of background data Patient age, comorbidities, and blood loss may be limiting factors when considering surgical correction of lumbar degenerative scoliosis. MIS may allow for significantly less blood loss and tissue disruption than open surgery. Methods Twelve patients underwent circumferential fusion. The age range of these patients was 50 to 85 years (mean of 72.8 y). Of the 12 patients, 7 were men and 5 were women. All patients underwent direct lateral transpsoas approach for discectomy and fusion with polyetheretherketone cage and rh-BMP2. All fusions to the sacrum included L5-S1 fusion with the Trans1 Axial Lumbar Interbody Fusion technique. Posteriorly, multilevel percutaneous screws were inserted using the CD Horizon Longitude system. Radiographs, visual analog scores (VAS), and treatment intensity scores (TIS) were assessed preoperatively and at last postoperative visit. Operative times and estimated blood loss were recorded. Results Mean number of segments operated on was 3.64 (range: 2 to 8 segments). Mean blood loss for anterior procedures (transpsoas discectomy/fusion and in some cases L5-S1 interbody fusion) was 163.89 mL (SD 105.41) and for posterior percutaneous pedicle screw fixation (and in some cases L5-S1 interbody fusion) was 93.33 mL (SD 101.43). Mean surgical time for anterior procedures was 4.01 hours (SD 1.88) and for posterior procedures was 3.99 hours (SD 1.19). Mean Cobb angle preoperatively was 18.93 degrees (SD 10.48) and postoperatively was 6.19 degrees (SD 7.20). Mean preoperative VAS score was 7.1; mean preoperative TIS score was 56.0. At mean follow-up of 75.5 days, mean VAS was 4.8; TIS was 28.0. Conclusions A combination of 3 MIS techniques allows for correction of lumbar degenerative scoliosis. Multisegment correction can be performed with less blood loss and morbidity than for open correction.
258 citations
TL;DR: For patients with severe Cobb angle and rotatory subluxation, long fusion should be carried out to minimize adjacent segment disease and spinal osteotomy is an alternative technique to be considered.
Abstract: The extent of fusion for degenerative lumbar scoliosis has not yet been determined. The purpose of this study was to compare the results of short fusion versus long fusion for degenerative lumbar scoliosis. Fifty patients (mean age 65.5 ± 5.1 years) undergoing decompression and fusion with pedicle screw instrumentation were evaluated. Short fusion was defined as fusion within the deformity, not exceeding the end vertebra. Long fusion was defined as fusion extended above the upper end vertebra. The lower end vertebra was included in the fusion in all the patients. The short fusion group included 28 patients and the long fusion group included 22 patients. Patients’ age and number of medical co-morbidities were similar in both the groups. The number of levels fused was 3.1 ± 0.9 segments in the short fusion group and 6.5 ± 1.5 in the long fusion group. Before surgery, the average Cobb angle was 16.3° (range 11–28°) in the short fusion group and 21.7° (range 12–33°) in the long fusion group. The correction of the Cobb angle averaged 39% in the short fusion group and 72% in the long fusion group with a statistical difference (P = 0.001). Coronal imbalance improved significantly in the long fusion group more than in the short fusion group (P = 0.03). The correction of lateral listhesis was better in the long fusion group (P = 0.02). However, there was no difference in the correction of lumbar lordosis and sagittal imbalance between the two groups. Ten of the 50 patients had additional posterolateral lumbar interbody fusion at L4-5 or L5-S1. The interbody fusion had a positive influence in improving lumbar lordosis, but was ineffective at restoring sagittal imbalance. Early perioperative complications were likely to develop in the long fusion group. Late complications included adjacent segment disease, loosening of screws, and pseudarthrosis. Adjacent segment disease developed in ten patients in the short fusion group, and in five patients in the long fusion group. In the short fusion group, adjacent segment disease occurred proximally in all of the ten patients. Loosening of distal screws developed in three patients, and pseudarthrosis at L5-S1 in one patient in the long fusion group. Reoperation was performed in four patients in the long fusion group and three patients in the short fusion group. In conclusion, short fusion is sufficient for patients with small Cobb angle and good spinal balance. For patients with severe Cobb angle and rotatory subluxation, long fusion should be carried out to minimize adjacent segment disease. For patients who have severe sagittal imbalance, spinal osteotomy is an alternative technique to be considered. As long fusion is likely to increase early perioperative complications, great care should be taken for high-risk patients to avoid complications.
156 citations
TL;DR: Better insight into the clinical suitability of rotation measurement methods currently available is presented, along with a discussion of critical concerns that should be addressed in future studies and development of new methods.
Abstract: Current research has provided a more comprehensive understanding of Adolescent Idiopathic Scoliosis (AIS) as a three-dimensional spinal deformity, encompassing both lateral and rotational components. Apart from quantifying curve severity using the Cobb angle, vertebral rotation has become increasingly prominent in the study of scoliosis. It demonstrates significance in both preoperative and postoperative assessment, providing better appreciation of the impact of bracing or surgical interventions. In the past, the need for computer resources, digitizers and custom software limited studies of rotation to research performed after a patient left the scoliosis clinic. With advanced technology, however, rotation measurements are now more feasible. While numerous vertebral rotation measurement methods have been developed and tested, thorough comparisons of these are still relatively unexplored. This review discusses the advantages and disadvantages of six common measurement techniques based on technology most pertinent in clinical settings: radiography (Cobb, Nash-Moe, Perdriolle and Stokes' method) and computer tomography (CT) imaging (Aaro-Dahlborn and Ho's method). Better insight into the clinical suitability of rotation measurement methods currently available is presented, along with a discussion of critical concerns that should be addressed in future studies and development of new methods.
131 citations
TL;DR: These data confirm the effectiveness of exercises in patients with scoliosis who are at high risk of progression and compared with non-adapted exercises, a specific and personalized treatment (SEAS) appears to be more effective.
Abstract: Objective To compare the effect of Scientific Exercises Approach to Scoliosis (SEAS) exercises with "usual care" rehabilitation programmes in terms of the avoidance of brace prescription and prevention of curve progression in adolescent idiopathic scoliosis. Design Prospective controlled cohort observational study. Patients Seventy-four consecutive outpatients with adolescent idiopathic scoliosis, mean 15 degrees (standard deviation 6) Cobb angle, 12.4 (standard deviation 2.2) years old, at risk of bracing who had not been treated previously. Methods Thirty-five patients were included in the SEAS exercises group and 39 in the usual physiotherapy group. The primary outcome included the number of braced patients, Cobb angle and the angle of trunk rotation. Results There were 6.1% braced patients in the SEAS exercises group vs 25.0% in the usual physiotherapy group. Failures of treatment in the worst-case analysis were 11.5% and 30.8%, respectively. In both cases the differences were statistically significant. Cobb angle improved in the SEAS exercises group, but worsened in the usual physiotherapy group. In the SEAS exercises group, 23.5% of patients improved and 11.8% worsened, while in the usual physiotherapy group 11.1% improved and 13.9% worsened. Conclusion These data confirm the effectiveness of exercises in patients with scoliosis who are at high risk of progression. Compared with non-adapted exercises, a specific and personalized treatment (SEAS) appears to be more effective.
106 citations
TL;DR: The spine surgery simulator S3 has proven its technical feasibility and clinical relevance to assist in the preoperative planning of instrumentation strategies for the correction of scoliotic deformities.
Abstract: Study design Proof of concept of a spine surgery simulator (S3) for the assessment of scoliosis instrumentation configuration strategies. Objective To develop and assess a surgeon-friendly spine surgery simulator that predicts the correction of a scoliotic spine as a function of the patient characteristics and instrumentation variables. Summary of background data There is currently no clinical tool sufficiently user-friendly, reliable and refined for the preoperative planning and prediction of correction using different instrumentation configurations. Methods A kinetic model using flexible mechanisms has been developed to represent patient-specific spine geometry and flexibility, and to simulate individual substeps of correction with an instrumentation system. The surgeon-friendly simulator interface allows interactive specification of the instrumentation components, surgical correction maneuvers and display of simulation results. Results The simulations of spinal instrumentation procedures of 10 scoliotic cases agreed well with postoperative results and the expected behavior of the instrumented spine (average Cobb angle differences of 3.5 degrees to 4.6 degrees in the frontal plane and of 3.6 degrees to 4.7 degrees in the sagittal plane). Forces generated at the implant-vertebra link were mostly below reported pull-out values, with more important values at the extremities of the instrumentation. Conclusion The spine surgery simulator S3 has proven its technical feasibility and clinical relevance to assist in the preoperative planning of instrumentation strategies for the correction of scoliotic deformities.
94 citations
TL;DR: Although the preoperative lordosis (or kyphosis) of the FSU could not always be maintained during the follow-up period, the overall sagittal balance of the cervical spine was usually preserved and preserved in 86% of cases at the final follow up.
Abstract: The object of this study is to review the early clinical results and radiographic outcomes following insertion of the Bryan Cervical Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN), together with its effect on maintaining sagittal alignment of the functional spinal unit (FSU) and overall sagittal balance of the cervical spine for the treatment of single-level or two-level symptomatic disc disease. Forty-seven patients with symptomatic single or two-level cervical disc disease who received the Bryan Cervical Artificial Disc were reviewed prospectively. A total of 55 Bryan disc were placed in 47 patients. A single-level procedure was performed in 39 patients and a two-level procedure in the other eight. Radiographic and clinical assessments were made preoperatively and at 1.5, 3, 6, 9, 12, and 18 and up to 33 months postoperatively. Mean follow-up duration was 24 months, ranging from 13 to 33 months. Periods were categorized as early follow up (1.5–3 months) and late follow up (6–33 months). The visual analogue scale (VAS), neck disability index(NDI), Odom’s criteria were used to assess pain and clinical outcomes. Static and dynamic radiographs were measured by hand and computer to determine the range of motion (ROM), the angle of the functional segmental unit (FSU), and the overall cervical alignment (C2–7 Cobb angle). With all of these data, we evaluated the change of the preoperative lordosis (or kyphosis) of the FSU and Overall sagittal balance of the cervical spine during the follow-up period. There was a statistically significant improvement in the VAS score from 7.0 ± 2.6 to 2.0 ± 1.5 (paired-t test, P = 0.000), and in the NDI from 21.5 ± 5.5 to 4.5 ± 3.9 (paired-t test P = 0.000). All of the patients were satisfied with the surgical results by Odom’s criteria. The postoperative ROM of the implanted level was preserved without significant difference from preoperative ROM of the operated level. Only 36% of patients with a preoperative lordotic sagittal orientation of the FSU were able to maintain lordosis following surgery. However, the overall sagittal alignment of the cervical spine was preserved in 86% of cases at the final follow up. Interestingly, preoperatively kyphotic FSU resulted in lordotic FSU in 13% of patients during the late follow-up, and preoperatively kyphotic overall cervical alignment resulted in lordosis in 33% of the patients postoperatively. Clinical results are encouraging, with significant improvement seen in the Bryan Cervical Artificial disc. The Bryan disc preserves motion of the FSU. Although the preoperative lordosis (or kyphosis) of the FSU could not always be maintained during the follow-up period, the overall sagittal balance of the cervical spine was usually preserved.
93 citations
TL;DR: Basic knowledge and recent innovation of surgical treatment for scoliosis will be described, with a focus on anterior instrumentation for the thoracic curve.
Abstract: In this review, basic knowledge and recent innovation of surgical treatment for scoliosis will be described. Surgical treatment for scoliosis is indicated, in general, for the curve exceeding 45 or 50 degrees by the Cobb's method on the ground that: 1) Curves larger than 50 degrees progress even after skeletal maturity. 2) Curves of greater magnitude cause loss of pulmonary function, and much larger curves cause respiratory failure. 3) Larger the curve progress, more difficult to treat with surgery. Posterior fusion with instrumentation has been a standard of the surgical treatment for scoliosis. In modern instrumentation systems, more anchors are used to connect the rod and the spine, resulting in better correction and less frequent implant failures. Segmental pedicle screw constructs or hybrid constructs using pedicle screws, hooks, and wires are the trend of today. Anterior instrumentation surgery had been a choice of treatment for the thoracolumbar and lumbar scoliosis because better correction can be obtained with shorter fusion levels. Recently, superiority of anterior surgery for the thoracolumbar and lumbar scoliosis has been lost. Initial enthusiasm for anterior instrumentation for the thoracic curve using video assisted thoracoscopic surgery technique has faded out. Various attempts are being made with use of fusionless surgery. To control growth, epiphysiodesis on the convex side of the deformity with or without instrumentation is a technique to provide gradual progressive correction and to arrest the deterioration of the curves. To avoid fusion for skeletally immature children with spinal cord injury or myelodysplasia, vertebral wedge ostetomies are performed for the treatment of progressive paralytic scoliosis. For right thoracic curve with idiopathic scoliosis, multiple vertebral wedge osteotomies without fusion are performed. To provide correction and maintain it during the growing years while allowing spinal growth for early onset scoliosis, technique of instrumentation without fusion or with limited fusion using dual rod instrumentation has been developed. To increase the volume of the thorax in thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis, vertical expandable prosthetic titanium ribs has been developed.
85 citations
TL;DR: The frequency of asymmetric lung perfusion and ventilation among children with congenital or infantile thoracic scoliosis before surgical treatment and the relationship between Cobb angle and asymmetry of lung function are described are described.
85 citations
TL;DR: The treatment of fixed cervical kyphosis with myelopathy using circumferential spinal osteotomies and instrumented reconstruction is technically demanding; however, restoration and maintenance of a neutral or lordotic cervical profile and excellent clinical outcomes are achievable.
Abstract: Study design A retrospective clinical study. Objective To investigate clinical and radiographic outcomes following the surgical treatment of fixed cervical kyphosis with myelopathy. Summary of background data To our knowledge, a study specifically addressing the surgical treatment of fixed cervical sagittal deformity has never before been published. Methods Sixteen patients treated surgically for fixed cervical kyphosis and myelopathy were followed for a mean of 4.5 years (range, 25-112 months). The study group consisted of 9 males and 7 females, with an average age of 52 years (range, 31-78 years). The principal etiologies of cervical deformity were prior laminectomy (63%), advanced spondylosis (19%), infection (6%), neuromuscular disease (6%), and metabolic disease (renal osteodystrophy) (6%). All patients were clinically evaluated by the Nurick classification and Odom criteria both before surgery and at the time of most recent follow-up. Radiographic analysis was performed using thin-cut CT scans, dynamic radiographs, and 14 x 36-inch scoliosis films. Results The mean preoperative cervical Cobb angle as measured from the C2-C7 was +38 degrees and improved to -10 degrees at final follow-up, yielding an average correction of 48 degrees . The mean number of anterior and posterior segments fused was 4.8 (range, 2-6) and 7.2 (range, 3-14), respectively. The mean Nurick score improved from 2.4 before surgery to 1.5 at the time of follow-up. According to Odom criteria, outcomes were as follows: excellent (38%), good (50%), fair (6%), and poor (6%). At the time of most recent follow-up, solid bony arthrodesis and maintenance of correction occurred in all patients; however, revision was required in one patient. Conclusion The treatment of fixed cervical kyphosis with myelopathy using circumferential spinal osteotomies and instrumented reconstruction is technically demanding; however, restoration and maintenance of a neutral or lordotic cervical profile and excellent clinical outcomes are achievable.
81 citations
TL;DR: Simultaneous translation on 2 rods provides a better correction of thoracic kyphosis than the sequential approximation by CR on patients with preoperative hypokyphosis.
Abstract: Study Design. A retrospective comparison of radiographic results for 2 consecutive series of patients treated for adolescent idiopathic scoliosis (AIS) by posterior instrumentations with thoracic screws using 2 methods of reduction: sequential approximation by cantilever reduction (CR) and simultaneous translation technique on 2 rods (ST2R). Objective. To compare correction of thoracic hypokyphosis and coronal radiographic results between the 2 methods of reduction. of Background Data. Publications concerning AIS confirm the moderate correction of thoracic hypokyphosis by posterior instrumentation with hooks and also with pedicle screws. Methods. Forty-four patients with AIS (Lenke type 1, 2, 3) underwent a posterior spinal fusion and instrumentation (CR series: 21 patients - ST2R series: 23 patients). Three groups of preoperative kyphosis were generated: 12 patients with severe hypokyphosis (≤10°) (5 in CR series and 7 in ST2R series); 12 patients with mild hypokyphosis (10-20°) (5 and 7 patients, respectively) and 20 with normal kyphosis (>20°) (11 and 9 patients, respectively). Thoracic kyphosis (T4-T12) and Cobb angle measurements of major and minor curves were evaluated by an independent observer. The minimum follow-up was 2 years. Results. At final follow-up, regarding patients with a severe preoperative hypokyphosis, the mean gain was 14° in the CR series (8° preoperative-22° postoperative) and 27° in the ST2R series (3-30°) (P = 0.018). Concerning patients with mild hypokyphosis, the mean gains were, respectively, 8° (17-25°) and 18° (16-34°) (P = 0.052). After surgery, 3 patients of CR series had hypokyphosis whereas the patients of the ST2R series all had normal kyphosis. In coronal plane, the mean correction of scoliosis was similar for both groups (75% vs. 69%; P = 0.177). Conclusion. Simultaneous translation on 2 rods provides a better correction of thoracic kyphosis than the sequential approximation by CR on patients with preoperative hypokyphosis. This surgical technique restores normal thoracic kyphosis in all cases.
TL;DR: The validity and safety of a new strategy using fulcrum bending (FB) radiographs and the inherent flexibility of the curve to select fusion levels for King type 2 and 3 curves is established and this strategy takes into account the power of modern instrumentation.
Abstract: Study design A prospective study of 50 consecutive patients undergoing selective thoracic fusion for idiopathic scoliosis with minimum 2 year follow-up. Objective We aim to establish the validity and safety of a new strategy using fulcrum bending (FB) radiographs and the inherent flexibility of the curve to select fusion levels for King type 2 and 3 curves (Lenke 1a, 1b, and 1c). The purpose of this new strategy is to preserve motion segments compared to the traditional method of selecting fusion levels. Summary of background data The aim of fusion in idiopathic scoliosis is to achieve a balanced spine with the shortest fusion preserving motion segments particularly in the lumbar spine. Conventional strategies for choosing fusion levels have been based on the standing radiographs and have not taken into account the flexibility of the curve. Methods We followed 50 consecutive patients who underwent selective thoracic fusion for King 2 and 3 curves (Lenke 1a, 1b, and 1c). The fusion levels were chosen based on our new strategy using the FB radiograph. Twenty-five patients were fused using a hook system and 25 with a hybrid system of hooks and screws. All patients were observed until skeletal maturity and a minimum of 2 years. The curve correction, trunk shift, radiographic shoulder height, list were recorded at the preoperative stage, postoperative stage, and final follow-up. Results The patients had an average age of 15.4 years. The average preoperative Cobb angle was 55.4 degrees and final follow-up Cobb angle for the primary curve was 24.1 degrees, with no difference between the 2 groups. With the new strategy, we were able to save levels in 31 patients (62%), compared to the conventional method of selecting the lowest instrumented vertebra. There was a statistically significant difference in the correction of the fusion mass Cobb angle between the hook and hybrid groups. There was significant improvement in the trunk shift after surgery. Ninety-six percent of patients had balanced or minimally imbalanced shoulders at final follow-up. Three patients had tilting of the vertebra below the fusion mass into the primary curve that did not progress at skeletal maturity. Conclusion The new objective strategy for determining fusion levels using FB radiographs is safe and effective. With considering the flexibility of the curve, we are able to save levels distally in over 60% of patients. This strategy takes into account the power of modern instrumentation.
TL;DR: The findings confirm the SRS instrument has excellent discriminate validity in the adult population and appears to be disease-specific in the domains of pain, appearance and activity in adult spinal deformity patients who have not had prior surgery.
Abstract: Study design Prospective, observational study Objective To further validate the Scoliosis Research Society (SRS) instrument by comparing scores of adult deformity patients with no prior history of spine surgery to the scores of normal adult volunteers in age-gender matched groups Summary of background data Efforts have been made to validate the SRS questionnaire in adolescent and adult deformity patients An important psychometric attribute of any quality of life tool is its ability to discriminate between subjects with and without the condition of interest Discriminate validity of the SRS questionnaire has not been established in the primary (no prior surgical treatment) adult deformity population Methods The SRS questionnaire was issued prospectively to 935 primary adult deformity patients with a diagnosis of idiopathic or de novo scoliosis and minimum Cobb angle of 30 degrees (average Cobb angle: 54 degrees; range: 30 degrees-132 degrees) Five hundred forty-three patients were treated nonsurgically while 392 patients underwent surgical intervention Baseline SRS scores of the deformity population were compared to 1222 volunteers with no history of spine disease randomly sampled from the US population Analysis between the 2 populations was broken down into 6 age-gender groups: male/female; 20-40, 41-60, 61-80 years of age Results SRS domain scores of the deformity subgroups demonstrated significant statistical differences from their corresponding age-gender matched normative group The only exceptions were the mental health domain in the older males, 61-80 years of age The average SRS subscore for each age-gender subgroup was less than the tenth percentile in the corresponding normative population, indicating substantial limitations in these patients Conclusion Our findings confirm the SRS instrument has excellent discriminate validity in the adult population It appears to be disease-specific in the domains of pain, appearance and activity in adult spinal deformity patients who have not had prior surgery
TL;DR: The retrospectively evaluated and compared the results of PS instrumentation and the Hybrid System, the latter consists of pedicle screws, sublaminar wire and hooks, and found that the PS system has a stronger effect on vertebral bodies, thereby providing better AV de-rotation.
Abstract: The expectations of both the patient and surgeon have been greatly revised in the last 10 years with the introduction of pedicle screws (PS) in spinal surgery. In this study, we have retrospectively evaluated and compared the results of PS instrumentation and the Hybrid System (HS), the latter consists of pedicle screws, sublaminar wire and hooks. The mean follow-up period was 60.1 months (range: 49–94 months) for the patients of the HS group and 29.3 months (range: 24–35 months) for those of the PS group. In the HS group, pedicle screws were used at the thoracolumbar junction and lumbar vertebra, the bilateral pediculotransverse claw hook configuration was used at the cranial end of the instrumentation, sublaminar wire was used on the concave side of the apical region and the compressive hook was used on the convex side. In the PS group, PS were used on the concave sides at all levels and on the convex side of the cranial and caudal end of instrumentation, in the transition zone and at the apex. The two groups were comparable for variables such as mean age, preoperative Cobb angle, thoracic kyphosis angle, lordosis angle, coronal balance, flexibility of the curve, apical vertebra rotation (AVR), apical vertebra rotation (AVT) and the number of vertebrae included in the fusion (p > 0.05). The parameters of values of correction, ratio of correction loss, AV derotation, AVT correction ratio, amount of blood loss, operation time, postoperative global coronal and sagittal balance, thoracic kyphosis angle and lumbar lordosis angle were measured at the last follow-up and used for comparing the HS and PS groups. There was no statistically significant difference between the groups for correction ratio, postoperative coronal balance, postoperative thoracic kyphosis and lumbar lordosis angle, operation time, amount of blood loss and number of fixation points (p > 0.05) The difference for the ratio of correction loss, AV derotation angle and the AVT correction ratio at the last follow-up visit and for the total follow-up period between the groups was found to be statistically significant (p 0.05) between the groups in terms of correction rate, postoperative coronal and sagittal balance, operation time, blood loss and number of fixation points. This may indicate that anchor points are more important than the use – or not – of screws. Correction durability and AV de-rotation was better with PS instrumentation, while AVT was better corrected by HS instrumentation (p < 0.05). We propose that the reason for the better correction of AVT with HS instrumentation is the forceful translation offered by the sublaminar wire at the apical region, while the reason for the better correction durability of the PS instrumentation may be due to the fact that multiple pedicle screws which afford three-column control are better at maintaining the correction and preventing late deterioration.
TL;DR: The prevalence of scoliosis in children with Prader–Willi syndrome is high (37.5%) and increased with age (infants and juveniles, ∼30%; adolescents, 80); the type ofScoliosis is affected by age and trunkLBM/BSA ratio.
Abstract: Background: The reported prevalence of scoliosis in children with Prader–Willi syndrome varies from 15% to 86%. Objective: To study the prevalence of scoliosis and the effects of age, gender, body mass index (BMI), total lean body mass (LBM), LBM of the trunk (trunkLBM) and genotype. Design: Radiographs were taken, length and weight were measured (BMI standard deviation scores (BMI SDS) and body surface area (BSA)), and dual energy x -ray absorptiometry was performed, measuring LBM and trunkLBM. Patients: 96 children, median (interquartile range) age 4.8 years (2.1 to 7.5), were included in a multicentre study. None received growth hormone treatment. Main outcome measures: Two types of scoliosis were identified: (1) long C-curve type scoliosis (LCS) and (2) idiopathic scoliosis (IS). Children were divided into age categories (infants, 0–3 years; juveniles, 3–10 years; adolescents, 10–16 years). Results: The prevalence of scoliosis was 37.5% and increased with age (infants and juveniles, ∼30%; adolescents, 80%); 44% of children with scoliosis had a Cobb angle above 20°. Children with scoliosis were significantly older than those without. Children with LCS were younger and more hypotonic than those with IS: median (interquartile range) age 4.4 years (1.7–5.9) vs 11.1 years (6.5–12.1) (p = 0.002) and trunkLBM/BSA ratio 7080 (6745–7571) vs 7830 (6932–8157) (p = 0.043). Conclusions: The prevalence of scoliosis in children with Prader–Willi syndrome is high (37.5%). Many children with scoliosis (13%) had undergone brace treatment or surgery. The type of scoliosis is affected by age and trunkLBM/BSA ratio.
TL;DR: The results suggest that different observers will obtain similar measurements when viewing the same image, but care should be taken when interpreting images printed on 2 unstitched films.
Abstract: STUDY DESIGN This study is a reliability analysis of coronal Cobb angle measurements in adolescent idiopathic scoliosis obtained by multiple observers. OBJECTIVE We sought to quantify and compare the interobserver reliability of conventional radiographs and 3 methods of digital radiography. SUMMARY OF BACKGROUND DATA The use of digital radiography for the evaluation of adolescent idiopathic scoliosis is being widely adopted. Previous studies comparing manual and computer-based measurements have found excellent intraobserver reliability for both techniques. Interobserver reliability of computer-based measurements on digital radiographs has not been compared with manual measurements on conventional radiographs. Other commonly used forms of output of digital radiography have not been studied. METHODS Preoperative standing posteroanterior full-length spine radiographs from 40 patients with adolescent idiopathic scoliosis were examined by 4 observers. Patients were divided into 2 groups of 20 patients. In 1 group, radiographs were obtained by conventional technique. In the other group, radiographs were obtained using a digital radiography system. Three types of output of the identical image obtained by a digital radiography system were examined, including computer-based image, printing of the image fitted onto a single film, or printing of the image onto 2 unstitched films. The Cobb angle, upper vertebra, and lower vertebra of the major curve were measured by each observer. Interobserver reliability for each technique was calculated by intraclass correlation coefficient and interobserver variance. RESULTS Interobserver reliability as described by intraclass correlation coefficient and interobserver variance was excellent (0.93-0.98) for measurements made on conventional, computer-based, and fitted printed radiographs. The intraclass correlation coefficient was good (0.87) in measurements obtained on radiographs printed on 2 unstitched films. CONCLUSION Measurements made on conventional and digital radiographs using manual and computer-based techniques have similar good to excellent interobserver reliability. Interobserver reliability was lower for digital radiographs when printed onto 2 unstitched films. The results suggest that different observers will obtain similar measurements when viewing the same image, but care should be taken when interpreting images printed on 2 unstitched films.
TL;DR: Data failed to demonstrate the curve type, the Cobb angle, the angle of trunk rotation or the curve progression factor to be related to the hip joint asymmetrical range of motion, but suggested a "torsional offset" of muscles patterns of activation around the spine in adolescent girls with structural idiopathic scoliosis during gait.
Abstract: In patients with structural idiopathic scoliosis the body asymmetries involve the pelvis and the lower limbs; they are included in many theories debating the pathogenesis of idiopathic scoliosis. Hip joint range of motion was studied in 158 adolescent girls, aged 10–18 years (mean 14.2 ± 2.0) with structural idiopathic scoliosis of 20–83° of Cobb angle (mean 43.0° ± 14.5°) and compared to 57 controls, sex and age matched. Hip range of rotation was examined in prone position, the pelvis level controlled with an inclinometer; hip adduction was tested in five different positions. In girls with structural scoliosis the symmetry of hip rotation was less frequent (p = 0.0047), the difference between left and right hip range of internal rotation was significantly higher (p = 0.0013), and the static rotational offset of the pelvis, calculated from the mid-points of rotation, revealed significantly greater (p = 0.0092) than in healthy controls. The detected asymmetries comprised no limitation of hip range of motion, but a transposition of the sector of motion, mainly towards internal rotation in one hip and external rotation in the opposite hip. The data failed to demonstrate the curve type, the Cobb angle, the angle of trunk rotation or the curve progression factor to be related to the hip joint asymmetrical range of motion. Numerous asymmetries around the hip were detected, most of them were expressed equally in scoliotics and in controls. Pathogenic implications concern producing a "torsional offset" of muscles patterns of activation around the spine in adolescent girls with structural idiopathic scoliosis during gait.
TL;DR: Custom software to increase automation of the Cobb angle measurement from posteroanterior radiographs was developed using active shape models and was reliable for moderate-sized curves, and did detect vertebrae in larger curves with a modified training set of larger curves.
Abstract: Choosing the most suitable treatment for scoliosis relies heavily on accurate and reproducible Cobb angle measurement from successive radiographs. The objective is to reduce variability of Cobb angle measurement by reducing user intervention and bias. Custom software to increase automation of the Cobb angle measurement from posteroanterior radiographs was developed using active shape models. Validity and reliability of the automated system against a manual and semiautomated measurement method was conducted by two examiners each performing measurements on three occasions from a test set (N = 22). A training set (N = 47) of radiographs representative of curves seen in a scoliosis clinic was used to train the software to recognize vertebrae from T4 to L4. Images with a maximum Cobb angle between 20° and 50°, excluding surgical cases, were selected for training and test sets. Automated Cobb angles were calculated using best-fit slopes of the detected vertebrae endplates. Intraclass correlation coefficient (ICC) and standard error of measurement (SEM) showed high intraexaminer (ICC > 0.90, SEM 2°–3°) and interexaminer (ICC > 0.82, SEM 2°–4°), but poor intermethod reliability (ICC = 0.30, SEM 8°–9°). The automated method underestimated large curves. The reliability improved (ICC = 0.70, SEM 4°–5°) with exclusion of the four largest curves (>40°) in the test set. The automated method was reliable for moderate-sized curves, and did detect vertebrae in larger curves with a modified training set of larger curves.
TL;DR: The rigid primary stability with pedicle screws allowed early mobilisation of the patients, which helped to avoid pulmonary complications, and the average percentage of predicted forced vital capacity was 55% preoperatively and decreased to 44% at the last follow-up.
Abstract: This report describes the spinal fixation with pedicle-screw-alone constructs for the posterior correction of scoliosis in patients suffering from Duchene muscular dystrophy (DMD). Twenty consecutive patients were prospectively followed up for an average of 5.2 years (min 2 years). All patients were instrumented from T3/T4 to the pelvis. Pelvic fixation was done with iliac screws similar to Galveston technique. The combination of L5 pedicle screws and iliac screws provided a stable caudal foundation. An average of 16 pedicle screws was used per patient. The mean total blood loss was 3.7 l, stay at the intensive care unit was 77 h and hospital stay was 19 days. Rigid stabilisation allowed immediate mobilisation of the patient in the wheel chair. Cobb angle improved 77% from 44° to 10°, pelvic tilt improved 65% from 14° to 3°. Lumbar lordosis improved significantly from 20° to 49°, thoracic kyphosis remained unchanged. No problems related to iliac fixation, no pseudarthrosis or implant failures were observed. The average percentage of predicted forced vital capacity (%FVC) of the patients was 55% (22–94%) preoperatively and decreased to 44% at the last follow-up. There were no pulmonary complications. One patient with a known cardiomyopathy died intraoperatively due to a sudden cardiac arrest. The rigid primary stability with pedicle screws allowed early mobilisation of the patients, which helped to avoid pulmonary complications.
TL;DR: The findings suggest that patients receiving ITB experience a natural progression of scoliosis similar to the natural history reported in the literature.
Abstract: Background Intrathecal baclofen (ITB) is an effective treatment of spasticity in patients with cerebral palsy. However, several recent reports have raised concerns that the treatment may be associated with a rapid progression of scoliosis. The objective of this study was to further examine the effect of ITB treatment on the progression of scoliosis in patients with cerebral palsy. Methods Spastic cerebral palsy patients who were ITB candidates were followed radiographically. Baseline Cobb angles of the primary curve were measured during the period of ITB pump insertion and at the most recent follow-up visit. Each patient was matched with a control patient by the diagnosis of cerebral palsy, age, sex, topographic involvement, and initial Cobb angle. The mean rate of change in Cobb angle was compared between ITB and control patients using paired t test. A multiple linear regression model was used to examine the difference, controlling for age, sex, topographic involvement, and initial Cobb angle. Results Fifty ITB patients and 50 controls were included in the analysis. There was no statistically significant difference between the mean change in Cobb angle in ITB patients (6.6 degrees per year) compared with the matched control patients (5.0 degrees per year, P = 0.39). The results from the multiple regression analysis also failed to show a statistically significant difference (0.92 degrees per year difference between ITB patients and controls, P = 0.56). Conclusions The progression of scoliosis in cerebral palsy patients with ITB treatment is not significantly different from those without ITB treatment. The findings suggest that patients receiving ITB experience a natural progression of scoliosis similar to the natural history reported in the literature. Level of evidence Level III.
TL;DR: Pedicle screw constructs in the apical levels demonstrated the best coronal correction, smallest loss of correction, and greatest amount of apical vertebral translation correction of the major Cobb angle compared with the other constructs without neurologic complications.
Abstract: Study design A retrospective comparative study. Objective To compare the efficacy and safety of several different anchors in the apical levels of scoliotic curves > or = 100 degrees using radiographic outcomes and clinical complications. Summary of background data To the best of our knowledge, no reports have compared various anchors at the apical level for correction of scoliosis curves > or = 100 degrees. Methods Sixty-eight scoliosis patients (44 neuromuscular, 21 idiopathic, and 3 congenital) with major curves > or = 100 degrees (mean, 112.7 degrees; range, 100 degrees -159 degrees ) who underwent segmental spinal instrumentation and fusion with different anchors in the apical level were analyzed. All patients had a minimum 2-year follow-up (mean, 4.0 years; range, 2.0-10.5) and were divided into Group W (sublaminar wires n = 26), Group H (hooks n = 18), Group A (anterior vertebral screws n = 7), and Group PS (pedicle screws n = 17) based on the type of apical anchor used. Radiographic parameters and complications were investigated. Results The 4 groups did not demonstrate any significant differences in gender, age at surgery, preoperative major Cobb angle, or curve flexibility (all P > 0.05). However, the PS group demonstrated a shorter follow-up period compared with the other 3 groups (P 0.05), 6 cases (8.8%) of implant failure (4 in Group W, 2 in Group H; P > 0.05). Despite one (1.5%) intraoperative neurologic complication (differences among groups, P > 0.05), there was no permanent neurologic deficit. Conclusion All 4 constructs were able to achieve and maintain acceptable correction safely without permanent neurologic deficit and all demonstrated acceptable implant failure rate. Pedicle screw constructs in the apical levels demonstrated the best coronal correction, smallest loss of correction, and greatest amount of apical vertebral translation correction of the major Cobb angle compared with the other constructs without neurologic complications.
TL;DR: It is found that the bilateral approach had a greater advantage in the reduction of kyphosis and the loss of reduction was less than the unilateral approach for the treatment of osteoporotic vertebral compression fractures.
Abstract: This study analyses the radiological and clinical results according to the two techniques of unilateral and bilateral balloon kyphoplasty in osteoporotic vertebral compression fractures. Fifty-two patients with osteoporotic vertebral compression fractures occurring at the thoracolumbar junction were enrolled in this study. All patients were classified into two groups; group I was treated with a unilateral approach and group II with a bilateral approach. The Cobb angle was measured each time to evaluate the kyphotic angle during the pre- and post-operative periods and at last follow-up, and a 10-point visual analog scale for pain was recorded at the same time. We found that the bilateral approach had a greater advantage in the reduction of kyphosis and the loss of reduction was less than the unilateral approach for the treatment of osteoporotic vertebral compression fractures.
TL;DR: Posterior segmental spinal instrumentation and fusion without anterior apical release of lumbar curves in adult scoliosis demonstrated better total SRS outcome scores and no differences in radiographic parameters without differences in clinical complications.
Abstract: STUDY DESIGN A retrospective study. OBJECTIVES To analyze radiographic and functional outcomes after posterior segmental spinal instrumentation and fusion (PSSIF) with and without an anterior apical release of the lumbar curve in adult scoliosis patients. SUMMARY OF BACKGROUND DATA No comparison study on PSSIF of adult lumbar scoliosis with apical release versus without has been published. METHODS Forty-eight adult patients with lumbar scoliosis (average age at surgery 49.6 years, average follow-up 3.7 years) who underwent PSSIF were analyzed with respect to radiographic change, perioperative and postoperative complications, and Scoliosis Research Society (SRS) outcome scores. Twenty-three patients underwent an anterior apical release of the lumbar curve via a thoracoabdominal approach followed by PSSIF (Group I). The remaining 25 patients underwent a PSSIF of the lumbar curve followed by anterior column support at the lumbosacral region through an anterior paramedian retroperitoneal or posterior transforaminal approach (Group II). RESULTS Before surgery, Group I showed a somewhat larger lumbar major Cobb angle (63.2 degrees vs. 55.9 degrees , P = 0.07), and both groups demonstrated significant differences in lumbar curve flexibility (26.9% vs. 37.2%, P = 0.02) and thoracolumbar kyphosis (27.0 degrees vs. 15.0 degrees , P = 0.03). After surgery, at the ultimate follow-up, there were no significant differences in major Cobb angle, C7 plumbline to the center sacral vertical line (P = 0.17), C7 plumbline to the posterior superior endplate of S1 (P = 0.44), and sagittal Cobb angles at the proximal junction (P = 0.57), T10-L2 (P = 0.24) and T12-S1 (P = 0.51). There were 4 pseudarthroses in Group I and one in Group II (P = 0.02). Postoperative total normalized SRS outcome scores at ultimate follow-up were significantly higher in Group II (69% vs. 79%, P = 0.01). CONCLUSION Posterior segmental spinal instrumentation and fusion without anterior apical release of lumbar curves in adult scoliosis demonstrated better total SRS outcome scores and no differences in radiographic parameters without differences in clinical complications. However, the use of BMP in some of these patients (44%) may have also contributed to these differences.
TL;DR: The results demonstrate that systematic exercising is probably not associated with the development of AIS, and actively participating in sports activities doesn’t seem to affect the degree of the main scoliotic curve either.
Abstract: Study design Cross-sectional observational study Objective Evaluation and comparison of the prevalence of adolescent idiopathic scoliosis (AIS) among 2 groups of patients (athletes and nonathletes) to determine whether athletic activities are related to the development of AIS Summary of background data The potential association between AIS and exercising remains uncertain The latter has often been considered as a therapeutic means and a causative factor of the former Methods A group of 2387 adolescents (boys: 1177, girls: 1210, mean age: 134 years) was evaluated All completed a questionnaire concerning personal, somatometric, and secondary sex characteristics, type, duration and character of daily-performed physical activities, and existing cases of AIS among relatives Patients were classified into 2 groups according to their answers; "athletes" and "nonathletes" The groups were comparable as far as age, height, weight, onset of menstruation, family history of scoliosis, and side of handedness were concerned Children underwent physical examination by 3 orthopedic surgeons who were unaware of their level of athletic activities Children considered, by all, to be suspicious of suffering from scoliosis, underwent further radiographic evaluation Results In 99 cases (athletes: 48, nonathletes: 51), AIS was radiographically confirmed (Cobb angle >10 degrees) No statistically significant difference was found between athlete and nonathlete adolescents (P = 0842), athlete and nonathlete boys (P = 0757), and athlete and nonathlete girls (P = 0705), as far as the prevalence of AIS was concerned The mean value of the Cobb angle of the main scoliotic curve was not statistically different between male athletes and nonathletes (P = 045) and female athletes and nonathletes (P = 0707) With the Cobb threshold reset at 20 degrees, no statistically significant differences were detected either Conclusion Our results demonstrate that systematic exercising is probably not associated with the development of AIS Actively participating in sports activities doesn't seem to affect the degree of the main scoliotic curve either
TL;DR: There is no evidence to support the premise that this result is correlated with improved pulmonary function or reduced pain, and for most patients, a reduced magnitude of spinal curvature can be achieved through one or more spinal fusion surgeries.
Abstract: Purpose. To evaluate the hypothesis that spinal fusion surgery is an effective method to address spinal deformity-associated clinical problems, including magnitude of curvature (Cobb angle), pulmonary dysfunction, and pain.Method. A systematic review was carried out using Science Citation Index (SCI) Expanded (1900 – present), Social Sciences Citation Index (1956 – present), Arts and Humanities Citation Index (1965 – present), Medline (1950 – present) and PubMed Central databases (1887 – present) to access information regarding efficacy of spine surgery in preventing or improving the health and function of patients diagnosed with scoliosis in adolescence.Results. Since 1950, more than 12,600 articles on scoliosis have been published, and nearly 50% (5721) focus on methods, rationale, outcome, and complications of surgical intervention. Among these, 82 articles have documented outcome for groups of ≥10 patients, treated for adolescent idiopathic scoliosis, and followed for at least 2 years after treatment....
TL;DR: Video rasterstereography is a reliable method in the three-dimensional evaluation of spinal deformities and constitutes a valuable additional tool to the clinical examination and can reduce the number of radiographs.
Abstract: QUESTION Video rasterstereography is a method for back surface measurement comprising automatic back surface reconstruction and shape analysis. Aim of this prospective study was to determine the accuracy of this method in comparison to the conventional frontal and lateral standing radiographs. METHOD 95 patients with idiopathic scoliosis or scoliotic postural abnormalities and 18 patients with thoracic hyperkyphosis and Scheuermann's disease were investigated. The Cobb angles, the sagittal profile and apical vertebral rotation as well as pelvic obliquity and trunk decompensation were measured. The analysis was carried out by two independent observers. RESULTS The root mean square (r.m.s.) deviation of the Cobb angle in the cases of idiopathic scoliosis ranged between 7 degrees and 8 degrees. In video rasterstereography there were no false negative results and two false positive results concerning differentiation between structural scoliosis and scoliotic postural abnormality. The r.m.s. deviation of apical vertebral rotation averaged 7.9 degrees and for pelvic obliquity respectively trunk imbalance 0.65 cm respectively 1.07 cm. The thoracic hyperkyphosis in Scheuermann's disease showed a r.m.s. deviation of 5.6 degrees. CONCLUSIONS Video rasterstereography is a reliable method in the three-dimensional evaluation of spinal deformities and constitutes a valuable additional tool to the clinical examination and can reduce the number of radiographs.
TL;DR: Scoliotic deformities are significantly reduced in supine position by a lordotic fulcrum force on the thoracolumbar junction, which may have consequences on bracing techniques.
Abstract: STUDY DESIGN: A prospective radiographic study was conducted. OBJECTIVE: To support our hypothesis that correction of the scoliosis may benefit from a lordotic fulcrum force in the sagittal plane on the thoracolumbar spine. SUMMARY OF BACKGROUND DATA: Adolescent idiopathic scoliosis is an important spinal deformity. Correction can be achieved with limited options by current bracing techniques. Lateral bending radiographs are used to assess flexibility and predict treatment outcome. The corrective potential of a lordotic fulcrum force in the sagittal plane has not been addressed. METHODS: Anterioposterior spine radiographs of patients with a double major curve pattern scoliosis were obtained in 2 groups of patients. In group A radiographs in 3 positions: standing, and supine with and without fulcrum (n = 12), and group B radiographs in 2 positions (n = 28): standing, and supine with lordotic fulcrum. Cobb angles were determined and evaluated statistically. The sagittal contour of the thoracolumbar junction in standing position was measured. RESULTS: In group A with the patients lying supine a correction of the Cobb angle was obtained at the thoracic level of 15.4% and the lumbar level of 27.5% (P < 0.001). Adding in supine position a lordotic fulcrum on the thoracolumbar junction resulted in a coupled further correction at the thoracic level of 15.7% and lumbar 18.1% (P < 0.001). Comparing in group A the thoracic and lumbar curvatures in standing position with that on a lordotic fulcrum in supine position revealed a total reduction of 31% and 45.6%, respectively. For the independent group B this reduction in 1 step is 38% and 44.4%, respectively. CONCLUSION: Scoliotic deformities are significantly reduced in supine position by a lordotic fulcrum force on the thoracolumbar junction. These findings may have consequences on bracing techniques.
TL;DR: Thoracoscopic anterior instrumentation for main thoracic idiopathic scoliosis results in five-year outcomes comparable with those reported previously for open anterior and posterior techniques.
Abstract: Background The surgical outcomes in patients with scoliosis at two years following anterior thoracoscopic spinal instrumentation and fusion have been reported. The purpose of this study was to evaluate the results at five years. Methods A consecutive series of forty-one patients with major thoracic scoliosis treated with anterior thoracoscopic spinal instrumentation was evaluated at regular intervals. Prospectively collected data included patient demographics, radiographic measurements, clinical deformity measures, pulmonary function, an assessment of intervertebral fusion, and the scores on the Scoliosis Research Society (SRS-24) outcomes instrument. Perioperative and postoperative complications were recorded. Patient data for the preoperative, two-year, and five-year postoperative time points were compared. In addition, a univariate analysis compared selected two-year radiographic, pulmonary function, and SRS-24 data of the study cohort and those of the patients lost to follow-up. Results Twenty-five (61%) of the original forty-one patients had five-year follow-up data and were included in the analysis. Between the two-year and five-year follow-up visits, no significant changes were observed with regard to the average percent correction of the major Cobb angle (56% +/- 11% and 52% +/- 14%, respectively), average total lung capacity as a percent of the predicted value (95% +/- 14% and 91% +/- 10%), and the average total SRS-24 score (4.2 +/- 0.4 and 4.1 +/- 0.7). Radiographic evaluation of intervertebral fusion at five years revealed convincing evidence of a fusion with remodeling and trabeculae present at 151 (97%) of the 155 instrumented motion segments. No postoperative infections or clinically relevant neurovascular complications were observed. Rod failure occurred in three patients, and three patients required a surgical revision with posterior spinal instrumentation and fusion. Conclusions Thoracoscopic anterior instrumentation for main thoracic idiopathic scoliosis results in five-year outcomes comparable with those reported previously for open anterior and posterior techniques. The radiographic findings, pulmonary function, and clinical measures remain stable between the two and five-year follow-up time points. Thoracoscopic instrumentation provides a viable alternative to treat spinal deformity; however, the risks of pseudarthrosis, hardware failure, and surgical revision should be considered along with the advantages of limited muscular dissection and improved scar appearance. Level of evidence Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
TL;DR: The results show that radiographic presentations including atypical curve patterns, atypICAL features in typical curve pattern, and a normal to hyperkyphotic thoracic spine may suggest the need for a preoperative magnetic resonance imaging.
Abstract: Background: Few radiographic guidelines are available to assist clinicians in deciding when to order magnetic resonance imaging in patients with a normal history and physical examination. Most of the recent reports on the radiographic characteristics of scoliosis are limited by a small number of patients and a shortage of large curves. The association between radiological features and the severity of scoliosis has little been elaborated. The purpose of this study is to further explore the radiological presentations in relation to curve severity in scoliosis associated with Chiari malformation and syringomyelia. Methods: A total of 87 children and adolescents were divided into 3 groups: group 1 (10 degrees ≤ Cobb angle ≤ 30 degrees), group 2 (30 degrees 60 degrees). Curves were classified into typical and atypical patterns in the coronal plane, and the sagittal profile was measured. Cerebellar tonsillar descent or syrinx patterns in relation to curve severity and the frequency of atypical curves were also investigated. Results: The frequency of atypical curve patterns from groups 1 to 3 was 46.2%, 45.2%, and 40.7%, respectively. A total of 65.3% of patients with typical curve patterns had atypical features in all of the 3 groups. There was a significant difference of kyphotic angle among the 3 groups showing that the larger curves tended to have greater thoracic kyphosis. Both the degree of cerebellar tonsillar descent and syrinx patterns had no correlation with the curve severity or the frequency of atypical curves. Conclusions: These results show that radiographic presentations including atypical curve patterns, atypical features in typical curve patterns, and a normal to hyperkyphotic thoracic spine may suggest the need for a preoperative magnetic resonance imaging. Kyphosis may be indicative of progressive scoliosis. There is no evidence to suggest that the degree of cerebellar tonsillar descent and syrinx patterns have an effect on the progress of scoliosis and the frequency of atypical curves. Level of Evidence: Systematic review 2 of Level III studies.
TL;DR: The outcomes of this study show that selective anterior thoracolumbar or lumbar fusion with solid rod instrumentation is effective for surgical correction of AIS with Lenke type 5 curve.
Abstract: According to Lenke classification of adolescent idiopathic scoliosis (AIS), patients with type 5 curve in which the structural major curve is thoracolumbar or lumbar curve with nonstructural proximal thoracic and main thoracic curves, could be surgically treated with selective anterior thoracolumbar or lumbar (TL/L) fusion. This study retrospectively analyzed the radiographies of selective anterior TL/L fusion in 35 cases of AIS with Lenke type 5 curve. Segmental fixation with a single rigid rod through anterior thoracoabdominal approach was applied in all patients. Measurements of scoliosis curve in preoperative, immediate postoperative and follow-up radiographies were analyzed. The average follow up time was 36 months (24–42 months). The average preoperative Cobb angle of the TL/L curve was 45.6° and improved into 9.7° immediate postoperatively, with 79.7% curve correction. In addition, the minor thoracic curve decreased from 29.7° preoperatively to 17.6° postoperatively, with a spontaneous correction of 41.5%. During the follow-up, a loss of 4.6° correction was found and the average Cobb angle of TL/L increased to 14.4°. Also, the minor thoracic curve increased to average 20.1° with a loss of 2.4° correction. Trunk shift deteriorated slightly immediate postoperatively and improved at the follow-up. The lowest instrumented vertebra (LIV) tilt was improved significantly and maintained its results at the follow-up. During the follow-up, the coronal disc angle immediately above the upper instrumented vertebra (UIVDA) and below the LIV (LIVDA) aggravated, while the sagittal contours of T5–T12 and T10–L2 were well maintained. The lumbar lordosis of L1–S1 and the sagittal Cobb angle of the instrumented segments were reduced slightly postoperatively and at the follow-up. There were no major complications or pseudarthrosis. The outcomes of this study show that selective anterior thoracolumbar or lumbar fusion with solid rod instrumentation is effective for surgical correction of AIS with Lenke type 5 curve. The TL/L curve, minor thoracic curve, and LIV title can be improved significantly, with good maintenance of sagittal contour. However, the UIVDA and LIVDA aggravate postoperatively when the trunk rebalances itself during follow-up. The degeneration of LIV disc warrants longer-term follow-up.