Spine deformity最新文献

Purpose: The current body of literature has examined both pediatric and adult patients in concert with respect to single- versus dual-surgeon treatment of spinal deformity; however, to our knowledge, pediatric and adult outcomes have not yet been reported independently. We hypothesize that the favorable outcomes seen in pediatric spine deformity with a dual-surgeon approach may also extend to adult spinal deformity patients.

Methods: Databases were searched for studies involving surgeries around spinal deformities and the use of dual or single surgeons. For both dual- and single-surgeon group, details on rates of complications, operating room times, lengths of stay, blood loss, rates of transfusion, and reoperation rates were recorded. Categorical variables were reported in pooled odds ratio (OR) and continuous variables were reported in standardized mean difference (SMD). Alpha value of less than 0.05 was considered significant.

Results: In adults, the dual-surgeon approach was associated with decreased risk of complications (OR = 0.31, 95% CI, 0.21-0.46; p < 0.01). In pediatrics, the dual-surgeon approach was associated with a decreased length of stay (SMD = -0.93 days, 95% CI: -1.25 - -0.61; p < 0.01) and operating time (SMD = -82.20 min, 95% CI: -114.28 - -51.32; p < 0.01).

Conclusion: The results of this study demonstrated statistically significant decrease in length of stay and operative duration with a dual-surgeon team in pediatric patients. In adults, a dual-surgeon team had correlated with a significant decreased rate of complications. There exists a lack of sufficient adult data to determine differences in operative duration, length of stay, and blood loss. Further investigation may utilize larger datasets to better understand the impacts of the dual-surgeon approach for both adult and pediatric populations.

Purpose: To compare radiographic outcomes, patient-reported outcomes (PROs), and complications between L5 and sacropelvic fixation as the lowest instrumented vertebra (LIV) in long-segment fusion for adult spinal deformity (ASD).

Methods: Following PRISMA 2020 guidelines, PubMed, Web of Science, Scopus, and Embase were searched for studies comparing L5 vs. pelvic fixation in ASD. Studies with Newcastle-Ottawa Scale (NOS) ≥ 7 were included. Extracted data included demographics, radiographic parameters [pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA)], complications, and PROs [Scoliosis Research Society (SRS) and Oswestry Disability Index (OD)]. Meta-analysis used standardized mean differences (SMD) and odds ratios (OR). Heterogeneity was assessed with I², and publication bias with Egger's test.

Results: Nine studies (1196 patients; mean age 67.5 years; mean follow-up 36.5 months) were included. Pelvic fixation achieved better sagittal correction: lower PT (SMD 0.88, p = 0.005), higher LL (SMD - 0.76, p < 0.001), and lower SVA (SMD 0.82, p = 0.016). PROs were similar at baseline and follow-up (all p > 0.05). L5 fixation had shorter operative time (SMD - 0.78, p = 0.005) but higher distal junctional failure (DJF) risk (OR 2.62, p = 0.002). Predictors of DJF with L5 LIV included older age, extensive fusion, high pelvic incidence, facet degeneration, and poor baseline sagittal balance.

Conclusions: Pelvic fixation provides superior sagittal correction with comparable PROs and overall complications, while L5 fixation carries a 2.6-fold higher DJF risk. LIV selection must be individualized; pelvic fixation is strongly recommended for patients with advanced age (> 66 years), high pelvic incidence (> 52°), or severe sagittal malalignment to mitigate mechanical failure. PROSPERO ID Number: CRD420251129518.

Scoliosis, the most common spinal deformity in adolescents, requires frequent radiographic follow-up, exposing patients to cumulative ionizing radiation with potential long-term risks. In response, recent efforts have explored radiation-free alternatives for Cobb angle estimation, but most fail to meet the clinical threshold of a minimum significant change of 5°. In this study, we aimed to develop and internally validate a fully automated method for predicting Cobb angle using 3D surface topography (ST) data and a linear regression model (LRM). Principal component analysis was used to reduce the dimensionality of the ST data, and several machine learning models were compared, including neural networks, XGBoost and Stacking. The LRM showed the best performance in the test set, with a mean absolute error (MAE) of 3.97°, a root Mean square error (RMSE) of 4.70°, and a strong correlation with the ground truth (r = 0.91). Residual analysis confirmed normality and homoscedasticity, supporting the robustness of the model. Importantly, the MAE fell below the clinically significant threshold of 5°, indicating the model's ability to detect minimal but critical changes in spinal curvature. These results outperform most previous non-radiographic methods and suggest that a simple, interpretable LRM, combined with open-source tools and ST data, offers a viable and scalable solution for non-invasive scoliosis monitoring. If externally validated, this method could reduce reliance on x-rays, thereby reducing radiation exposure while maintaining assessment accuracy.

Background: The 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) is a condition-specific instrument to assess health-related quality of life in children with early-onset scoliosis (EOS). Previous studies have raised concerns regarding ceiling effects, i.e. clustering of scores at the upper limit, which may reduce the ability of the EOSQ-24 to detect clinical improvements.

Methods: A structured review of published clinical studies reporting EOSQ-24 scores was performed. Data were standardized to a 0-100 scale. For each domain weighted mean scores, standard deviations (SD), and ceiling effect percentages were calculated. A ceiling effect ≥ 15% was considered significant.

Results: Data from 16 studies were included. Significant ceiling effects were observed in the following domains: pulmonary function (28%), physical function (25%), overall satisfaction (22%), transfer (20%), financial burden (22%), daily living (18%), fatigue/energy level (18%), and emotion (16%). Lower ceiling effects were noted in general health, pain/discomfort, parental burden, and child/parent satisfaction domains.

Conclusions: Eight of EOSQ-24 domains exhibit marked ceiling effects, potentially limiting responsiveness to treatment effects in patients with high baseline function. These findings support consideration of revised scoring strategies or adjunctive measures in EOS outcome assessment. The presence of marked ceiling effect should be noted as a limitation in studies. Objective pulmonary function testing should be implemented in future studies.

Purpose: Radiation-free tools, such as scoliometers, ultrasound, and Moiré topography, have been explored for monitoring Adolescent Idiopathic Scoliosis (AIS), but none have replaced the need for serial spinal radiographs. This study aimed to evaluate the accuracy and criterion validity of a new AI-powered digital health application using 3D surface topography to predict Cobb angles, with the goal of reducing radiation exposure and enabling home-based curve monitoring.

Methods: In a single-center observational study, 125 patients with confirmed or suspected scoliosis underwent smartphone-based 3D surface-topography scans in standing and forward-bending positions. Poor-quality scans (n = 20) were excluded. Radiographic Cobb angles were used as the gold standard. After random allocation, 79 scans formed the training set and 26 formed the validation set; external data (142 controls, 188 scoliosis patients) were added to strengthen training, and 25 controls were added to the test set. Accuracy was expressed as mean absolute error (MAE) and correlation with radiographs. Criterion validity was assessed by sensitivity, specificity, and AUC at clinically meaningful thresholds (10°, 25°, and 40°).

Results: Across 51 test scans (AIS + controls), the algorithm showed a strong correlation with radiographs (r = 0.922, 95% CI 0.866-0.955) and an MAE of 5.9° (95% CI 4.5-7.3). In AIS-only curves of 10-50°, the MAE was 6.4° (95% CI 4.4-8.3). At 10°, sensitivity was 0.962, specificity was 0.960, and AUC was 0.978. At 25°, sensitivity was 0.706, specificity was 0.853, and AUC was 0.917. At 40°, sensitivity was 0.667, specificity was 1.000, and AUC was 1.000.

Conclusion: This AI-driven 3D surface topography demonstrated high validity for non-radiographic Cobb angle prediction, particularly in mild-to-moderate AIS. It supports safer, more frequent, home-based monitoring, though refinements are needed for severe curves and patients with a higher BMI.

Background: Pediatric spinal deformities frequently require surgical correction, and precise preoperative planning is essential to ensure optimal outcomes and minimize complications. A key aspect of planning involves assessing pedicle morphology to determine appropriate screw sizing. This systematic review examines whether magnetic resonance imaging (MRI) can serve as a reliable, radiation-free alternative to computed tomography (CT). While MRI shows promising potential, current evidence presents mixed results regarding its accuracy and clinical applicability compared to CT.

Methods: Following PRISMA guidelines, a systematic review was performed. Literature from Medline, Scopus, Embase, and the Cochrane Library, up to August 2025, was analyzed. Search terms included "scoliosis," "pediatric deformity," "pedicle morphology," "pedicle dimension," "magnetic resonance imaging," and "computed tomography." The extracted data included study details, patient demographics, scoliosis etiology, radiographic techniques, pedicle measurement methods, and outcomes of MRI-CT comparison. Risk of bias was assessed using the MINORS tool.

Results: Of 319 identified studies, 6 met the inclusion criteria (n = 428 patients). A total of 12,633 pedicles were analyzed across the studies, with MRI and CT used for preoperative assessment. MRI showed good concordance with CT for most measurements though accuracy decreased for more severe pedicle abnormalities. MRI was generally reliable for preoperative planning but had limitations, especially for pedicle sizing.

Conclusion: While MRI offers a radiation-free alternative for preoperative assessment of pedicle morphology in pediatric spinal deformity surgery, current evidence is limited to retrospective studies and shows variable accuracy, particularly in severe or complex cases. CT generally remains more reliable for precise pedicle evaluation and continues to represent the standard of care. Future advancements in MRI technology may help improve its accuracy and expand its role in clinical practice, but stronger prospective evidence is needed before it can be considered a full substitute for CT.

Purpose: To evaluate the growth modulation and corrective effects of a novel polyetheretherketone spring rib plate (PEEK-SRP) implant in a porcine model of early-onset thoracic scoliosis (EOS).

Methods: 15 one-month-old pigs underwent thoracic nerve transection to induce right thoracic scoliosis. After 1.5 months of curve progression, animals were assigned to 3 groups: Untreated Group (UG, n = 6): Observed without intervention; Treated Group (TG, n = 6): PEEK-SRP implanted at three ribs on the convex apical levels; and Sham Group (SG, n = 3): Underwent the same surgical procedures as TG without the PEEK plate implantation. Radiographic and CT-based assessments were performed to evaluate Cobb angle, apical vertebral rotation (AVR), rib hump index (RHI), vertebra-rib angle difference (RVAD), thoracic volume, and spinal growth over 2.5 months.

Results: Baseline curves averaged 43.7 ± 9.4° with no group differences. At 2.5 months, the Cobb angle decreased by 17.5% (41.8° ± 11° to 34.5° ± 14.6°) in TG, compared with progression of 27.6% (54° ± 15.9° to 68.9° ± 16.8°) in UG (p = 0.0036) and 72% (35.4° ± 11.7° to 60.9° ± 5.9°) in SG (p = 0.0223). The PEEK-SRP reduced AVR by 87.3% (p < 0.0104), RHI by 79.4% (p < 0.0340), and improved RVAD by 15.2% (p < 0.0489) compared with controls. TG also demonstrated a 44% increase in convex thoracic area and an 86.8% increase in convex thoracic width compared to UG (p < 0.0005). Spine growth rate (9.6 ± 2.4 mm/week in UG, 12.7 ± 4.6 mm/week in TG, and 9.4 ± 0.4 mm/week in SG) was not different among the three groups (p = 0.1844).

Conclusion: The PEEK-SRP system provided effective apical control, rib cage remodeling, and spinal correction while preserving thoracic growth in a porcine EOS model. This transverse load-sharing, non-fusion strategy directly targets rib-spine deformity and shows promise as a growth-friendly treatment for EOS.

Key points: 1. The PEEK-SRP system offers a novel, non-fusion strategy for treating early-onset thoracic scoliosis by targeting rib cage deformities at the curve apex. 2. Unlike traditional growing rods, which are longitudinal load-bearing devices with high complication rates and no apical control, the PEEK-SRP system functions as a transverse load-sharing implant that directly modulates rib-spine growth. 3. In a porcine EOS model, PEEK-SRP implantation significantly reduced spinal curvature, apical vertebral rotation, and rib hump deformity, while increasing thoracic volume. 4. The implant preserved spinal growth and flexibility, confirming its role as a growth-friendly corrective system. 5. This study supports the clinical potential of PEEK-SRP for children with moderate progressive scoliosis, offering segmental correction without compromising thoracic development.

Purpose: To assess the complementary value of transverse plane descriptors (orientation of the regional planes of deformation (ORPD) and local apical vertebral rotations (AVR)) integrated into the new modular three-tiered, four-modifier SRS-Lenke-Aubin 3D classification, relative to conventional 2D radiographic parameters and current Lenke 2D classification in adolescent idiopathic scoliosis (AIS).

Methods: Transverse plane deformities of 285 surgically treated AIS cases reconstructed in 3D were quantified using ORPD and AVR, independently assessed for the proximal thoracic (PT), main thoracic (MT), and thoracolumbar/lumbar (TL/L) regions. Correlation analyses evaluated relationships between standard 2D parameters (Cobb angles, thoracic kyphosis (TK), lumbar lordosis (LL)) and transverse plane indices (ORPD, AVR). The distribution of ORPD and AVR subclasses was examined, as well as the associations between conventional Lenke lumbar and thoracic sagittal profile modifiers, and their corresponding 3D transverse plane modifiers. Complementary analyses also included 3D displacement of the apex relative to the end-vertebrae line (DAEVL).

Results: Nearly all ORPD-AVR subclass combinations were observed across regions, confirming the system's ability to capture diverse deformity patterns. ORPD and AVR were independent in PT and MT but correlated in TL/L (r = 0.69). Cobb angle correlated moderately with ORPD in MT (r = 0.43) and strongly in TL/L (r = 0.67), while correlations with AVR were moderate in MT (r = 0.50) and TL/L (r = 0.59). TK correlated negatively with MT ORPD (r = -0.58), whereas LL showed no association with TL/L ORPD. DAEVL correlated strongly with Cobb across all regions but only weakly to moderately with ORPD. Associations between Lenke 2D modifiers and ORPD were strong in TL/L (V = 0.59) and moderate in MT (V = 0.37). Multivariate models showed that Cobb and TK explained ~ 44% of MT ORPD variance, while > 55% of ORPD variability across regions remained unexplained by 2D parameters.

Conclusions: ORPD and AVR provide complementary, region-specific 3D information beyond conventional 2D measures and Lenke modifiers. Their integration into the SRS-Lenke-Aubin 3D classification enhances dimensional completeness while preserving usability, laying the groundwork for future outcome-based evaluations.