Spine deformity最新文献

Purpose: Early onset scoliosis (EOS) has traditionally been an indication for MRI because of its association with neural axis abnormalities (NAAs). Because these abnormalities are often clinically silent and concerns regarding sedation in young children are growing, routine MRI for EOS is debated. This study investigates the current practices of EOS MRI screening among surgeons in the Pediatric Spine Study Group (PSSG).

Methods: A survey assessing EOS MRI practices was distributed to the PSSG. The survey presented scenarios that varied in age, curve size, and diagnosis and asked which scenarios would indicate an MRI. Respondents also ranked age, curve progression, etiology, and need for sedation by level of importance when considering to order MRI.

Results: Age and curve progression were ranked as the most important factors when deciding to order MRI. For all non-congenital scoliosis, increased age and curve size were associated with increased rates of MRI among respondents. For idiopathic EOS, more than 60% of respondents would order MRI for patients with curve magnitudes of 45° regardless of age. All respondents would order MRI for congenital EOS before surgery and for EOS caused by neurofibromatosis. For EOS secondary to cerebral palsy, 61% of respondents would order an MRI, and 34% believe that EOS and Prader-Willi syndrome require MRI.

Conclusion: Our results indicate that the MRI screening practices for EOS vary greatly between physicians, as expected. Future research on the prevalence of NAAs in EOS and the clinical outcomes of routine MRI is needed to inform which MRI practices should be standard.

Purpose: Treating idiopathic Early Onset Scoliosis (idiopathic EOS) is challenging due to ongoing growth and extensive follow-ups. While bracing is effective for Adolescent Idiopathic Scoliosis (AIS), its value for children under 10 remains debated. This systematic review and meta-analysis evaluates the effectiveness of spinal bracing in idiopathic EOS, followed to skeletal maturity.

Methods: We searched Ovid Medline and Web of Science until November 1st, 2023. Studies included idiopathic EOS patients between the ages of 3 and 10 (corresponding to Juvenile Idiopathic Scoliosis), followed to skeletal maturity, with no more than 25% initiating bracing after age 11. The primary outcome was the percentage undergoing scoliosis surgery. Pooled outcomes were calculated using a random effects model and 95% confidence intervals.

Results: Out of 417 studies, 15 met the inclusion criteria, encompassing 868 patients. All were observational with a high risk of bias. The pooled percentage of patients undergoing surgery was 40% (95% CI 27-55%). The percentage of patients with a 5-degree progression or more and those progressing beyond 45 degrees were 44% (95% CI 24-66%) and 33% (95% CI 17-54%), respectively. Factors including larger initial Cobb angles, younger age, smaller in-brace correction, and poor compliance were identified as progression risk factors.

Conclusions: Bracing may prevent progression to surgery in idiopathic EOS when initiated early, but progression and surgery are still more common compared to adolescents. This is the first systematic review and meta-analysis looking at the success of bracing in idiopathic EOS, followed up to skeletal maturity. The high bias and variability of included studies limit the strength of these conclusions, highlighting the need for high-quality research with innovative trial designs.

Level of evidence: IV (systematic review of level IV studies).

Purpose: To determine the prevalence of scoliosis in patients who have undergone surgical repair of CDH and attempt to assess the aetiology of scoliosis in affected cases.

Methods: A prospectively collected database of patients with CDH treated in a single centre between 1997 and 2023 was reviewed. Cases with adequate records who continued to reside locally having survived beyond age 2 and > 2 years following CDH repair were included. Congenital spinal abnormalities and scoliosis were diagnosed from imaging studies. In those who developed scoliosis, medical notes were reviewed to assess the aetiology of scoliosis and its treatment.

Results: 145 patients (92 male) who had undergone CDH repair were included. The median age at CDH repair was at 4 days. The mean time from CDH repair to this study was 14.1 years (2.0-26.2). 15 developed scoliosis (10.3%). In 8 cases, the scoliosis was considered a reflection of multisystem abnormalities including congenital vertebral anomalies in 3 cases (2%). In the 7 remaining cases the scoliosis had no obvious cause. Of those with scoliosis, to date, 3 have had surgical treatment with 1 awaiting surgery, 7 have not required scoliosis treatment and 4 have died.

Conclusions: Scoliosis is relatively common in those who have undergone CDH repair, typically presenting before age 10 years. Scoliosis when present was commonly part of a multisystem issue, with congenital vertebral anomalies rare. There appears no strong association between use of synthetic patch and scoliosis. Few children undergoing CDH repair will require treatment of a scoliosis.

Purpose: Clinical trials have studied the effects of curve magnitude and flexibility, age, and skeletal immaturity on the outcomes of VBT. No studies have assessed the effect of Lenke curve type on the outcomes of VBT. This study compares outcomes in patients who underwent VBT with Lenke type 1, 3, 5, and 6 curves.

Methods: Single center retrospective review of patients undergoing mini-open thoracoscopic-assisted two row vertebral body tethering (2RVBT) for the correction of AIS with a minimum 2-year follow-up were included. Patients were grouped by Lenke type, which yielded 4 groups; types 1, 3, 5, or 6. Analysis included preoperative demographic parameters, as well as radiographic and clinical outcome measures.

Results: 156 2RVBT (Lenke 1, N = 61; Lenke 3, N = 35; Lenke 5, N = 37; Lenke 6, N = 23) patients met inclusion criteria. The mean preoperative apex Cobb angle in the Lenke type 1, 3, 5, and 6 groups were 50.2 ± 9.1, 50.5 ± 10.1, 45.0 ± 8.6, and 49.0 ± 10.8, respectively. This corrected to 21.2 ± 10.2, 19.2 ± 8.5, 13.6 ± 7.2, 18.5 ± 8.3 in Lenke type 1, 3, 5, and 6 groups, respectively, demonstrating that Lenke type 5 saw greatest correction following 2RVBT. With regards to revision recommendation following tether breakage, Lenke type 3 curves were most frequently indicated for fusion, whereas Lenke type 1 curves were most frequently not indicated for revision surgery.

Conclusion: Lenke type 5 curves are the most amenable to correction via 2RVBT, as evident by their lower post-operative apex Cobb angles and lowest rate of recommendation for revision to posterior spinal fusion.

Purpose: Adolescent idiopathic scoliosis surgery (AIS) is often associated with high costs and significant recovery challenges. Enhanced recovery after surgery (ERAS) protocols aim to improve outcomes, reducing hospital stays and complications compared to traditional (TD) pathways. This study evaluates the impact of ERAS protocols on AIS treatment.

Methods: Following PRISMA guidelines, a systematic review identified 30 studies (n = 15,954 patients). Search terms included "ERAS," "adolescent idiopathic scoliosis," and "posterior spinal fusion." Outcomes assessed included surgical metrics, recovery milestones, complications, and pain. A meta-analysis was performed, and the risk of bias was evaluated using the MINORS score.

Results: ERAS patients (n = 5582) had shorter surgical durations (- 23 min, p = 0.08) and reduced blood loss (- 126 mL, p = 0.033) compared to TD patients (n = 7916). Recovery milestones improved, including earlier ambulation (- 37.4 h, p < 0.0001), patient-controlled analgesia discontinuation (- 1.1 days, p < 0.0001), catheter removal (- 0.75 days, p < 0.001), and shorter hospital stays (- 1.7 days, p < 0.0001). Complications were lower in the ERAS group (4% vs. 8%, p = 0.0074), while wound-related complications and 30-day readmission rates were comparable. Pain scores were significantly reduced from surgery day to postoperative day 2 (p < 0.0181).

Conclusion: ERAS protocols improve recovery and reduce complications in AIS surgery, with shorter hospital stays and enhanced patient outcomes. These findings support broader implementation and further randomized trials to evaluate long-term benefits and patient satisfaction.

Purpose: To determine patient-reported clinical status in a cohort of patients operated on during adolescence for adolescent idiopathic scoliosis (AIS) using Cotrel-Dubousset instrumentation after a minimum follow-up (FU) of 25 years.

Methods: Multicentric cross-sectional observational study. We assessed the clinical status of patients using the lumbar-pain numeric rating scale (NRS), ODI, SRS-22r, SF-36, and EQ-5D-5L. For NRS and SRS-22r, the reported "Patient Acceptable Symptom State" (PASS +) was used as a reference for normality. Further, normative data were used for SF-36 and EQ-5D-5L.

Results: Out of 226 eligible patients, 152 (67% of the total; 87% female) were included (mean FU = 29.6 years). The mean age at FU was 45.1 years (SD3.4; range 36-55). The PASS + status was achieved by 56.7% of patients on the SRS-22 subtotal score, 56% of patients in the NRS and 56.8% in the ODI questionnaire achieving PASS + state. Significant differences were found between the normative values for the SF-36 and EQ-5D-5L scores, but the magnitude of the differences was not clinically relevant. Clinically significant differences were found for SF-36 bodily pain (43.0 vs. 50.0; p < 0.001), SF-36 PCS (42.8 vs. 50.0; p = 0.0001) and EQ-5D-5L pain score, with the scoliotic population having 4.1 times more risk of severe/extreme pain than their peers.

Conclusions: Thirty years after surgery, AIS patients have more pain and worse physical functioning than their peers. However, the differences are not clinically relevant except for pain and physical activity. Further, on average, the former are in good clinical condition, although surgery has not normalized their lives.

Purpose: Non-fusion surgical options for pediatric scoliosis management such as vertebral body tethering (VBT) offer an alternative to spinal fusion. With this study, we aim to evaluate the postoperative outcomes in boys versus girls who have undergone VBT. Our hypothesis is that girls and boys will have similar outcomes by 2-year follow-up.

Methods: This study employed a review of retrospective data for patients who underwent VBT at 10 sites between 2011 and 2020. Patients were stratified based on gender. All patients had preoperative and 2-year follow-up and were evaluated for curve correction, complications, surgery metrics, and patient reported outcomes.

Results: 328 patients were included in this study: 277 girls and 51 boys. Mean age at surgery was 12.2 years for girls and 13.4 years for boys. Mean preoperative curve magnitude and curve flexibility was similar between both groups. Compared to girls, boys were older, heavier and taller at the time of surgery; BMI was not different between the groups. Skeletal maturity was not different preoperatively or at 2 years. There were no significant differences for mean operative time, mean estimated blood loss, or levels instrumented. Postoperative stay was longer in the girls averaging 4.5 days compared to 3.9 days for the boys (p = 0.026). There were no statistically significant differences between boys and girls for the curve magnitude at final follow-up (28° vs 25° thoracic, 21° both groups lumbar) or percent correction (45% vs 38% thoracic, 38% vs 31% lumbar) at 2-year follow-up. Overall, 98 girls (35%) experienced medical or surgical complications compared to 18 boys (39%) (p = 0.599). Boys experienced higher rates of tether breakage at latest follow-up (33% vs. 17%, p = 0.008) and more loss of correction > 10° (10% vs. 3%, p = 0.03). Rates of reoperation were 15.9% in the girls and 15.7% in the boys (p = 0.972).

Conclusion: Our study found that boys on average had higher body weight than girls and also higher rates of tether cord breakage and loss of correction. Despite these differences, curve correction, modulation, and reoperation rates were similar in both groups. Further work is needed to determine the relative impact of patient gender and weight on incidence of tether breakage.

Purpose: Delayed metal hypersensitivity reactions can cause complications in spine surgery. Currently, there is no information on the prevalence of metal hypersensitivity in pediatric patients undergoing spine surgery. The objective of this study is to determine the prevalence of metal hypersensitivity in pediatric patients undergoing spinal instrumentation.

Methods: Retrospective chart review of patients who underwent spinal instrumentation with or without fusion at a single institution, from January 1, 2014, to December 31, 2020, was performed. Patients were pre-screened for history of allergic diseases, including previous reaction to metals, prior to surgery. Patch metal allergy testing (PMAT) for metal hypersensitivity was also performed.

Results: Of the 796 pediatric patients who underwent spinal instrumentation procedures from 2014 to 2020, 118 (15%) screened positive for metal hypersensitivity. However, the number of patients with documented evidence of metal hypersensitivity diminished to 26 (3%) after PMAT verification. Nickel hypersensitivity was most prevalent, with 20 patients (16.9% of positive screening; 2.5% of all instrumented patients) demonstrating positive skin patch tests. The other most prevalent metal hypersensitivities included cobalt in 9 patients (7.6%; 1.1%), manganese in 3 patients (2.5%; 0.4%), and copper in 1 patient (0.8%; 0.1%). with a number needed to treat (NNT) of 5.

Conclusions: This study suggests that routine pre-operative PMAT is not necessary in all pediatric spine patients yet should be considered if patients report a history of prior metal hypersensitivity reactions.

Purpose: To compare health-related quality-of-life (HRQOL) between children with hyperkyphosis and idiopathic scoliosis using 9-item Oswestry Disability Index (ODI-9) and Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference, Mobility, and Anxiety.

Methods: Children with hyperkyphosis, idiopathic scoliosis, and controls with no structural diagnosis ages 10-18 years who completed the PROMIS Pediatric Pain Interference, Mobility, and Anxiety domains were retrospectively evaluated from April 2021 to June 2023. Comparisons were made between hyperkyphosis, idiopathic scoliosis, and control groups. Within the hyperkyphosis group, comparisons were made between Scheuermann kyphosis and postural kyphosis subgroups.

Results: 304 children with hyperkyphosis, 1134 with idiopathic scoliosis, and 1493 controls were included. Children with hyperkyphosis had increased age, male sex, BMI percentile, Spanish than English speakers, and public insurance type. They also had worse ODI-9, PROMIS Pain Interference and Mobility scores which remained significant after multivariate regression analysis included age, sex, BMI percentile, language, insurance type, and race/ethnicity (p < 0.01). The Scheuermann kyphosis (n = 67) subgroup had increased age, male sex, area deprivation index (ADI), BMI percentile, concern by their appearance, and worse PROMIS Pain Interference and Mobility scores than the postural kyphosis (n = 237) subgroup. However, Scheuermann kyphosis subgroup score differences did not remain significant after considering age, sex, ADI, and BMI percentile.

Conclusion: Children with hyperkyphosis (both Scheuermann and postural kyphosis subtypes) have worse HRQOL scores than their peers with idiopathic scoliosis. Worse ODI-9, PROMIS Pain Interference and Mobility scores remained significant only in the hyperkyphosis group as a whole after adjusting for confounding variables, but not between hyperkyphosis subgroups.