Spine deformity最新文献

Background: Although the etiology of adolescent idiopathic scoliosis (AIS) remains largely elusive, it is widely recognized as a multifactorial condition shaped by both genetic predispositions and environmental influences. This review seeks to explore the intricate relationships between idiopathic scoliosis and its associated comorbidities, with the goal of advancing our understanding of this multifaceted disorder.

Methods: Primary studies involving human subjects diagnosed with idiopathic scoliosis and presenting comorbid conditions were included. Six online databases (AMED, CENTRAL, CINAHL, EMBASE, MEDLINE, and WOS) were systematically searched. Two reviewers independently screened citations and extracted data. Studies were categorized based on commonly examined diagnoses, and outcome measures were descriptively reported.

Results: Our search yielded 1185 citations, with 9 studies meeting the eligibility after screening. These studies examined comorbidities involving conditions like malocclusion, central precocious puberty (CPP), gingival diseases, malignant hematopoietic neoplasms (MHN), temporomandibular joint disorders (TMD), and functional gastrointestinal disorders (FGD). Significant associations were found between AIS and these multifactorial disorders, including dental anomalies (i.e., asymmetrical canine, midline deviations, crossbites, overbite, multiple malocclusion, gingivitis, distocclusion, asymmetric molar occlusion, maxillary overjet, crowding, and reverse chewing cycles), digestive issues (i.e., FGD), endocrine disruptions (i.e., CPP), musculoskeletal imbalances (i.e., reduced masseter muscle volume, higher Fonseca Anamnestic Index score, and greater Helkimo Clinical Dysfunction Index score), and oncological conditions (i.e., MHN).

Conclusion: We have presented the multifactorial and potential systemic nature of AIS by revealing its associations with comorbid conditions. These relationships may indicate shared genetic, hormonal, neuromuscular, and immunological pathways.

Purpose: Vertebral body tethering (VBT) is an emerging treatment option for idiopathic scoliosis, but routinely requires intraoperative placement of a chest tube (CT). Topical thrombin and injectable collagen have routinely been used as a hemostatic agent, but data are lacking on its use in VBT. Thus, we aim to investigate the impact of the topical hemostatic use on CT output and duration, and the subsequent rate of clinically-significant hemothorax and effusion after VBT.

Methods: Retrospective review was conducted on patients who underwent VBT at a single institution between 2015 and 2024. Patients were grouped to whether they were treated with FDA-approved, topically applied recombinant thrombin and injectable collagen intraoperatively. We hypothesized that there would be fewer thoracic and chest tube complications in the topical hemostatic group based on their 90-day perioperative outcomes.

Results: Out of 190 patients who underwent VBT, 92 received thrombin and injectable collagen intraoperatively while 98 did not. Mean age at surgery was 13 (range 9-17) years. Adjusting for chest tube size and number of instrumented levels, regression analysis showed significant decrease in CT output, CT duration, and the odds of developing clinically significant pleural effusion with the use of intraoperative topical hemostatic agents. Two cases of in-hospital hemothorax were found in the non-topical hemostatic group and none in the group with topical hemostatic.

Conclusions: Applying topical thrombin and injectable collagen during surgery decreases CT output and duration following VBT, as well as the odds of developing clinically significant pleural effusion. This may serve as an alternative to the use of 24-h intravenous hemostatic agent such as tranexamic acid.

Level of evidence: Level III-Retrospective Cohort Study.

Level of evidence: Level III-Retrospective Cohort Study.

Purpose: The aim of this study was to investigate whether developmental delay is a risk factor for postoperative complications following pediatric spinal fusion.

Methods: The American College of Surgeons National Surgical Quality Improvement Program Pediatric database was queried to retrospectively identify patients who had undergone spinal fusions between 2016 and 2021. The study population was divided into two distinct groups 1) Patients with developmental delay 2) who have no delay. T-tests for continuous variables and chi-square tests for categorical variables were used to identify differences in perioperative characteristics between the two groups. Multivariable logistic regression analysis assessed the effect of preoperative developmental delay on post-operative surgical outcomes.

Results: A total of 32,621 pediatric spinal fusion patients were identified, of which 7,637 had developmental delay and 24,984 had no delay. The developmental delay group had a higher rate of surgical complications and medical complications (5.38% vs 1.41%, p < 0.001). Developmental delay independently increased the risk for medical complications (OR: 1.099, 95% CI: (1.009-1.978), surgical complications (OR: 1.4833, 95% CI (1.197-1.838), extended hospital LOS (OR: 1.250, 95% CI (1.028-1.518), intensive care unit stay (OR: 1.333, 95% CI (1.227-1.446), and death (OR: 9.638, 95% CI: 2.150-68.700) following a multivariate logistic regression analysis.

Conclusion: Patients with developmental delay undergoing pediatric spinal fusion had an increased risk for surgical complications. The findings of this study serve as a valuable resource in aiding surgeons in preoperative risk assessment and in facilitating comprehensive discussions with patients and their caregivers.

Purpose: Patients increasingly rely on online resources to better understand their health conditions. ChatGPT could satisfy the demand for reliable and accessible online health education resources, yet few studies have applied this to pediatric orthopaedic counseling. This study quantifies the accuracy and comprehensibility of ChatGPT responses to frequently asked questions (FAQs) regarding scoliosis.

Methods: Twelve FAQs regarding scoliosis were compiled following a literature review, and ChatGPT Version 3.5 was utilized to answer them. The responses were analyzed for accuracy and clarity using the Mika et al. scoring system and modified DISCERN score in collaboration with two fellowship-trained pediatric orthopaedic surgeons. Readability was assessed using several published educational-level indices.

Results: The ChatGPT responses received a Mika et al. average of 2.4 (satisfactory requiring minimal to moderate clarification) and an averaged mean DISCERN score of 45.9. The estimated reading level necessary for comprehension ranged from 11^th grade to college graduate.

Conclusions: When prompted with 12 scoliosis FAQs, ChatGPT produces responses of satisfactory accuracy but require further clarification and are written at an inappropriately high reading level for the scoliosis patient population. Future research should explore strategies to verify the reliability of AI services for counseling on other pediatric orthopaedic conditions.

Purpose: To quantify the breast computed tomography (CT) parameters in IS patients. Patients' perceptions of their breast appearance before/after scoliosis surgery were also assessed with Breast-Q™ questionnaire.

Outcome measure: Concave/convex side breast volume difference (BVD), computed tomographic external breast appearance parameters (extraversion angle (EA), coverage angle (CA), axial breast height (ABH), nipple-to-sternum distance (NSD), thoracic rib cage parameter (inclination angle (IA)), and Breast Satisfaction and Psychosocial Well Being domains of Breast-Q Q™ questionnaires.

Methods: This was a prospective study of 50 IS patients recruited between June 2017 and December 2018 who had pre-operative CT scans available for review. Pre-operative radiological parameters as stated above were evaluated. Breast volume difference (BVD) was calculated using the formula: 100 * {(CC BV - CV BV)/[(CC BV + CV BV)/2]}. Breast-Q™ questionnaires were administered pre-operative and post-operatively. The percentage of patients who achieved the minimal clinically important difference (MCID) was reported.

Results: Thirty-three patients (66%) had significant BVD with the concave side larger in 52.0% of patients. BVD had significant correlation with ABH, NSD, CA, and EA. There was no significant correlation between pre-operative Cobb angle with BVD and IA. There was also no significant correlation between Tanner stage and the radiological parameters. Breast satisfaction and psychosocial well-being domains improved after surgery and the satisfaction with breast domain minimal clinically important difference (MCID) was achieved in 83.7% of patients, while the psychosocial well-being domain reached the MCID in 75.5% of patients (p < 0.001).

Conclusion: Scoliosis led to significant breast asymmetry among patients with smaller volume on the convex side. Changes in breast volume (BV) contributed significantly towards the external breast appearance. Patient's breast satisfaction and psychosocial well-being improved post-operatively and, in the majority, MCID was achieved.

Purpose: To determine whether patients with L5 spondylolysis have different lumbosacral anatomy compared to patients without L5 spondylolysis.

Methods: Computed tomography (CT) scans of pediatric patients with isolated L5 spondylolysis were identified and matched 1:4 (age, sex, BMI) to patients without spondylolysis. Sagittal parameters assessed included sacral slope angle, sacral table angle, L4-S1 and L5-S1 Cobb angles, the horizontal angle of the L5 pars interarticularis, the distances between the L4 inferior articular process (IAP) and the S1 superior articular process (SAP) and their respective individual distances to the L5 pars. Coronal parameters assessed included the percent subluxation of L4 IAP below the facet joint.

Results: 1084 CT scans were reviewed. 32 patients with isolated L5 spondylolysis were identified and matched to 122 patients without spondylolysis. The horizontal angle of the L5 pars was greater in spondylolysis patients (142.5 ± 10.2 vs. 119.9 ± 5.9, p < 0.05). There was less distance (mm) between L4 IAP and S1 SAP (11.3 ± 3.9 vs. 14.7 ± 2.9, p < 0.05) and less distance (mm) from both L4 IAP (2.6 ± 1.7 vs. 5.4 ± 2.2, p < 0.05) and S1 SAP (0.7 ± 0.4 vs. 1.5 ± 0.7, p < 0.05), respectively, to the L5 pars in the spondylolysis group. Pearson's analyses revealed that a larger horizontal angle of the L5 pars was strongly associated with spondylolysis (0.59).

Conclusion: Pediatric patients with L5 spondylolysis have a significantly more horizontal L5 pars that is closer to both the L4 IAP and S1 SAP.

Purpose: To compare patient-reported outcomes (PROs) in adult spinal deformity (ASD) patients reoperated within six months of their index surgery to patients without readmissions/reoperations and note any similarities/dissimilarities in activity and pain outcomes.

Methods: ASD patients who underwent spinal fusion at a single institution with minimum two years follow-up were included. Patients without readmissions/reoperations (No Reops) were compared to those requiring early reoperation resolved by six months post-index procedure (Early Reop) cohort. Outcomes included 2Y PROs, improvement, and MCID attainment. Question 22 from the SRS-22r, assessing likelihood of choosing the same treatment, was separately evaluated.

Results: 238 patients [211(89%) No Reops; 27(11%) Early Reop] were included. Early reoperations were associated with PJK/DJK (29.63%, n = 8), implant dislodgement (18.52%, n = 5), and pedicle/vertebral fracture (14.81%, n = 4). There was no difference in demographics, operative characteristics, baseline alignment, and preoperative PROs. PRO improvement was not significantly different for SRS Activity (p = 0.392), Pain (p = 0.291), Appearance (p = 0.179), Mental Health (p = 0.840), Satisfaction (p = 0.098), Total score (p = 0.152), and ODI (p = 0.564). MCID achievement was comparable for SRS Activity (p = 0.536), Pain (p = 0.115), Appearance (p = 0.269), Mental Health (p > 0.999), Satisfaction (p = 0.149), and ODI (p = 0.403). SRS total score MCID attainment was greater for No Reops Cohort (82% vs 70%, p = 0.048). In addition, a greater proportion of No Reop patients endorsed that they would choose the same operative management (86% vs 70%, p = 0.046) if they had to choose again.

Conclusion: Early reoperations within 6 months after ASD surgery that addresses the reason for the revision surgery do not adversely affect two-year functional and pain outcomes. However, only 70% would choose the same treatment again vs 86% of those who didn't undergo a reoperation with greater SRS22r total score MCID attainment among the No Reop cohort.

Purpose: The purpose was to compare outcomes in adolescent idiopathic scoliosis (AIS) patients with left vs. right main thoracic curves. A secondary purpose was to elucidate surgeon opinions between these two curve types and differences in surgical approach via a survey.

Methods: A multicenter database was utilized to identify AIS patients with left thoracic curves without significant MRI abnormalities from 1996 to 2018 receiving posterior spinal fusion. A 1:1 propensity match was performed to right thoracic curves. Differences between the curve groups were analyzed.

Results: Fifty patients had left thoracic curves. Curve direction had no impact on levels fused, surgical time, length of hospitalization, estimated blood loss, cell saver transfused, death, pain, pseudoarthrosis, reoperation, or infection rates. At two-years postoperatively, left curves had greater T2-T12 kyphosis (37 vs. 31°, p = .02), and variations in T1 tilt angle direction (30 vs. 39 left tilt, p = .04), EIV angulation (-2 vs. 5°, p < .01), EIV translation (0.6 vs. -0.2 cm, p = .03), and left shoulder elevation (12 in left curves vs. 25 in right curves, p = .01). There were no differences in correction rate, Cobb angle, lumbar curve, T12-S1 lordosis, shoulder height difference, or SRS 22 scores.

Conclusion: In AIS, there are no significant differences in surgical characteristics or outcomes between left and right-thoracic curves. Notably, curve direction does not influence correction rate, surgical time, levels fused, length of hospitalization, blood loss, pain, SRS 22 scores, or rates of reoperation, infection, or pseudoarthrosis. There are some variations in radiographic parameters postoperatively that are unlikely to be clinically significant.

Purpose: The purpose of this study was twofold: (1) to validate the predictive capabilities of the Scoliosis Assessment App using ST technology against X-ray "ground truth" in patients being evaluated for clinically significant scoliosis; and (2) to compare the diagnostic accuracy of the App versus the commonly used scoliometer tool.

Methods: A multicenter, prospective validation study was conducted among patients with known or suspected scoliosis. The App determined an Asymmetry Index to predict the likelihood of clinically significant disease (MCM ≥ 20°) as determined by X-ray. Outcomes included the sensitivity, specificity, and area under the receiver operating characteristic curve (ROC AUC) associated with the Apps prediction of clinically significant disease.

Results: Fifty-five patients were evaluated with a mean age of 13.6 ± 2.1 years. The App correctly classified 91% (50/55) of the patients compared to 69% (38/55) for the scoliometer. The sensitivity of the App was 96.4% (89.6-100% CI) versus 50% (28.1-71.9% CI) for the scoliometer (P < 0.05), while the specificity values were 85.2% (71.8-98.9% CI) and 88.9% (74.4-100% CI), respectively. ROC analysis indicated a statistically significant difference in accuracy (AUC) in favor of the App (95% versus 71%; P = 0.015).

Conclusion: The Scoliosis Assessment App using ST technology offers an accurate, accessible, and non-ionizing method of detecting clinically significant scoliosis, suggesting that the App can be used for detection and monitoring as an alternative to radiography and as a replacement for scoliometer without diminishing the standard of care. Further studies are required to assess variations of sensitivity in a large cohort of patients and clinical utility as an alternative to radiographs.

Purpose: Robotic-assisted spine surgery (RASS) has increased in prevalence over recent years, and while much work has been done to analyze differences in outcomes when compared to the freehand technique, little has been done to characterize the potential pitfalls associated with using robotics. This study's goal was to leverage expert opinion to develop a classification system of potential sources of error that may be encountered when using robotics in spine surgery. This not only provides practitioners, particularly those in the early stages of robotic adoption, with insight into possible sources of error but also provides the community at large with a more standardized language through which to communicate.

Methods: The Delphi method, which is a validated system of developing consensus, was utilized. The method employed an iterative presentation of classification categories that were then edited, removed, or elaborated upon during several rounds of discussion. Voting took place to accept or reject the individual classification categories with consensus defined as ≥ 80% agreement.

Results: After a three-round iterative survey and video conference Delphi process, followed by an in-person meeting at the Safety in Spine Surgery Summit, consensus was achieved on a classification system that includes four key types of potential sources of error in RASS as well as a list of the most commonly identified sources within each category. Initial sources of error that were considered included: cannula skidding/skive, penetration, screw misplacement, registration failure, and frame shift. After completion of the Delphi process, the final classification included four major types of pitfalls including: Reference/Navigation, Patient Factors, Technique, and Equipment Factors (available at https://safetyinspinesurgery.com/ ).

Conclusion: This work provides expert insight into potential sources of error in the setting of robotic spine surgery. The working group established four discrete categories while providing a standardized language to unify communication.