Spine deformity最新文献

Purpose: The etiology of early-onset scoliosis (EOS) has been shown to significantly influence baseline parent-reported health-related quality of life (HrQOL). In combining these etiology groups, we obligatorily lump together many disparate diagnoses, particularly true in the neuromuscular (NM) cohort. We sought to evaluate the influence of underlying neuromuscular diagnosis on the HrQOL at 5 years following surgery for EOS.

Methods: A retrospective review of a multi-center EOS database was performed. Children treated with primary distraction-based, growth-friendly instrumentation (GFI) for EOS with complete baseline, 2-year, and 5-year post-surgical EOSQs were included. Neuromuscular scoliosis patients, as classified by the C-EOS system, were isolated and subdivided by underlying diagnosis into 5 groups. EOSQ domains and composite HrQOL score at presentation, 2-year, and 5-year follow-up were compared across underlying diagnosis.

Results: A total of 65 neuromuscular EOS patients were identified (mean 7.6 ± 1.99 years of age, 50% female). Cerebral palsy was the most common underlying diagnosis (30%, N = 18), followed by spinal muscular atrophy (SMA, N = 16). There were differences in EOSQ domains with CP, SMA, and MD having significantly lower scores than Chiari/Syrinx patients at 2-year follow-up. Chiari/Syrinx patients demonstrated EOSQ scores statistically similar to idiopathic EOS patients at all time points (P > 0.05). CP patients were most likely to experience improvement in HrQOL at 5-year follow-up.

Conclusion: Underlying NM diagnosis has direct implications on treatment response following GFI for EOS. Cerebral palsy patients demonstrate the best improvement in HrQOL at 5 years following surgery while others actually deteriorate over time. Children with EOS related to Chiari and Syringomyelia had similar HrQOL scores to idiopathic EOS and may not be best suited for inclusion in NM cohorts when assessing HrQOL scores following treatment. Increasing population-based HrQOL data may allow further refinement and prognostication of neuromuscular diagnoses over time.

Introduction: Congenital lumbar kyphosis is present in about 15% of patients with myelomeningocele. Worsening of deformity with complications such as chronic skin ulcers and bone exposure is common. In patients under 8 years of age, treatment becomes even more challenging: in addition to resecting the apex of the kyphotic deformity, we should ideally stabilize the spine with fixation methods that do not interrupt the growth of the rib cage, associated with the challenging pelvic fixation in this population. The emergence of growth-friendly techniques has greatly benefited patients with early-onset deformity, allowing for correction and control of deviation without interrupting trunk growth, which is often already compromised in these patients. We describe the surgical technique and present preliminary clinical outcomes for a novel approach which combines self-sliding screws that allow for trunk growth with impaction of translumbosacral rods for distal fixation.

Methodology: Candidates for the technique were patients with myelomeningocele and congenital lumbar kyphosis, inability to assume supine position, and a history of skin ulcers, recurrent osteomyelitis and poor weight gain. They all lacked sensory or motor function below the level of the myelomeningocele. They underwent the same reconstruction technique after kyphectomy which combines self-sliding screws that allow for trunk growth with impaction of the translumbosacral rods for distal fixation.

Results: Case 1: Female; 4.5 years old at surgery; 5 year follow-up. 1 complication: loosening of one blocker. The child is doing well and did not require surgical revision. Mean growth per year: 9.5 mm. Case 2: Male; 7.4 Years old at surgery; 4 year follow-up. 1 complication: post-surgical infection which required 2 debridements in the operating room and prolonged antibiotic therapy. Mean growth per year: 6 mm. Case 3: Female; 5.5 Years old at surgery; 27 month follow-up. No complications reported so far. Mean growth per year: 9.42 mm. None of the cases showed signs of sacral osteolysis or rod migration.

Discussion / conclusion: To our knowledge, this is the first study that combines sliding screws with translumbosacral rod impaction. Although this technique has proven to be safe and effective, we are aware that the number of cases is limited and the follow-up is short. Further studies are necessary to confirm the method.

Background: To investigate the association between lumbar degenerative scoliosis and the dural sac cross-sectional area (DSCA), the lumbar canal anterior-posterior (LCAP) diameter, and the neural foraminal cross-sectional area (NFCA) in relation to facet joint tropism (FJT).

Methods: In a retrospective case-control study, we analyzed data from 160 patients referred for lumbar magnetic resonance imaging (MRI) between January 2020 and December 2022. Cobb's angle on anteroposterior lumbosacral X-ray is served to identify the presence of degenerative lumbar scoliosis-Cobb's angle exceeding 10 degrees-, and axial T2W MRI is implemented to evaluate facet joint angles and tropism-defined as a difference exceeding 10 degrees between the facet joint angles at each level-, DSCA, LCAP, and NFCA.

Results: FJT was much more common in patients with degenerative lumbar scoliosis (69%) than in controls (14%). The frequency of FJT also incremented with the increasing severity of the scoliotic curve. We observed that LCAP and NFCA were significantly smaller in cases with FJT. However, no statistically significant difference was found in DSCA related to FJT. Age and gender did not exhibit significant associations with degenerative lumbar scoliosis, and no correlation was detected between different Cobb's angle groups and age.

Conclusions: These findings underscore the importance of considering FJT as a potential contributing factor to degenerative lumbar scoliosis and may have implications for clinical diagnosis and management. Prospective research with larger and more diverse cohorts is needed to further investigate this complex relationship and its impact on lumbar spinal health.

Purpose: Few studies have investigated quality-of-life (QoL)-related outcome measures in adolescent idiopathic scoliosis (AIS) patients over long-term follow-up. We investigated whether patients with any given Lenke type improved relative to other types and whether selective fusions resulted in better QoL-related outcome measures.

Methods: We utilized the Harms Study Group database to select patients with AIS who underwent posterior spinal fusion (PSF) with Scoliosis Research Society questionnaire-22 revised (SRS-22r) scores at minimum 10-year follow-up. Characteristics and SRS-22r were quantified by Lenke type and compared using ANOVA and Tukey post hoc tests. Multivariate analyses were conducted to identify the predictive value of Lenke types on QoL-related outcomes. Sub-group analysis split cohorts into those who underwent selective vs. non-selective fusion(s).

Results: 110 patients were available at minimum 10-year follow-up. Types 3, 4, and 6 curves generally demonstrated lower SRS-22r scores both preoperatively and at long-term follow-up. Independent of Lenke type, total SRS-22r, along with self-image and satisfaction, showed consistent improvement relative to pre-op at 10-year follow-up, whereas pain, mental health, and general function showed a slight worsening. Sub-group analyses revealed no significant differences in SRS-22r scores between selective and non-selective fusion groups.

Conclusions: At 10-year follow-up, total SRS-22r, self-image, and satisfaction scores stayed consistently improved relative to preoperative status over time, while pain, general function, and mental health declined from 2 years onward. Increased age may play a role in enhancing self-image and satisfaction while worsening general function, pain, and mental health. Selectively vs. non-selectively fusing a patient should not hinge on fear of impacting patients' QoL-related measures, as our data suggest improvement in total SRS-22r, self-image, and satisfaction regardless.

Level of evidence: III.

Purpose: This study is to conduct a retrospective review of the selective resection strategies, their immediate efficacy and prognosis, using double hemivertebrae (DHV) as illustrative cases.

Methods: A total of 59 adolescent and young adult patients with DHV were enrolled from 2009 to 2021. They were categorized into sagittal kyphosis group (SKG), coronal takeoff group (CTG) and balanced group (BG). The selective resection strategies for each group were reviewed.

Results: Nineteen patients presented ipsilateral DHV, including 15 cases of continuous type (interval ≤ 3 vertebrae) and 4 cases of skipping type (interval ≥ 4 vertebrae), while 40 patients presented bilateral DHV, including 25 cases of continuous type and 15 cases of skipping type. The proportions of patients with 0, 1 and 2 HV resections were 26%, 58% and 16% in the ipsilateral group, and 45%, 48% and 7% in the bilateral group, respectively. The rate of HV resection in the SKG, CTG and BG was 77%, 61%, 33%, respectively. Kyphosis was the primary indicator for HV resection (60%), followed by coronal takeoff effect (21%) and coronal segmental scoliosis (19%). Significant curve progression due to misresection or mis-preservation of HV was recorded as 1.7% and 3.4%, respectively.

Conclusions: Kyphosis, coronal cervicothoracic or lumbosacral takeoff caused by hemivertebrae are primary indicators for selective hemivertebrectomy. For balanced DHV, the necessity of hemivertebrectomy is relatively low. Misresection or mis-preservation of HV may cause iatrogenic coronal imbalance and secondary severe curve progression.

Purpose: Adolescent idiopathic scoliosis (AIS) presents various challenges, including respiratory symptoms that impact pulmonary function. This study aims to explore the feasibility of using a smart shirt for continuous monitoring of lung volumes and heart rate during routine activities in AIS patients.

Methods: A single-center exploratory feasibility study was conducted with AIS patients aged 16-22 years with a thoracic curvature of ≥ 30 degrees and absence of respiratory comorbidities. A smart shirt was utilized to continuously monitor cardiopulmonary parameters during mild exercise, which included a standardized walking route with the ascent of multiple stairs.

Results: Five participants completed the study. Baseline spirometry measurements showed a range of values for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), and FEV₁/FVC ratio. During mild exercise, participants exhibited variability in tidal volume, heart rate, breathing rate, and minute ventilation, with increases observed during stair climbing. Breathlessness levels also varied throughout the activity but did not correlate with the measured lung volumes. Overall, the use of the smart shirt for assessing pulmonary function in AIS patients was deemed feasible and well tolerated by participants during the test activities.

Conclusion: The study confirms the feasibility of using a smart shirt for continuous measurement of cardiopulmonary parameters in AIS patients during daily activities. Incongruities between spirometry results and perceived dyspnea exists, which questions the nature of the perceived dyspnea. Further research is needed to validate these findings and explore the impact of AIS characteristics on measurement accuracy.

Preoperative spine flexibility plays a key role in the intraoperative treatment course of severe scoliosis. In this cohort study, we examined the effects of 5 day inpatient scoliosis-specific exercise (SSE) on the spinal flexibility of patients with adolescent idiopathic scoliosis before surgery. A total of 65 patients were analyzed. These patients were divided into a prospective cohort (n = 43, age: 15 ± 1.6 years, 36 girls and 7 boys, Lenke class 1 and 2, Cobb angle: 64 ± 11°) who underwent spinal fusion in 2020, and a retrospective cohort (n = 22, age: 15 ± 1.5 years, 17 girls and 5 boys, Lenke class 1 or 2, Cobb angle: 63 ± 10°), who underwent surgery between 2018 and 2019 and did not receive preoperative SSE. Rigid scoliosis was defined as a reduction of less than 50% in Cobb angle between the preoperative fulcrum bending and initial standing curve magnitude. In the prospective cohort, 21 patients (Cobb angle: 65 ± 11°) presented with rigid thoracic scoliosis (pre-SSE fulcrum bending: 40 ± 9°, 39% reduction), and therefore received 5-day SSE to improve their preoperative spinal flexibility (SSE group), whereas 22 patients (Cobb angle: 63 ± 12°) presented with flexible thoracic scoliosis (pre-SSE fulcrum bending: 27 ± 8°, 58% reduction), and therefore underwent surgery without preoperative SSE (non-SSE group). For patients who received 5-day preoperative SSE for 4 h every day, the International Schroth Three-Dimensional Scoliosis Therapy technique was implemented with an inpatient model. After 5 days of SSE, improvements in Cobb angle with post-SSE fulcrum-bending radiography (23 ± 7°, 66% reduction) and pulmonary function (forced expiratory volume in 1 s/forced expiratory volume: 87% before SSE and 92% after SSE, p < 0.01) were observed. At the postoperative day 5, the degree of scoliosis had reduced from 44 ± 6.6° to 22 ± 6° in the SSE group, which is 1° less than the Cobb angle obtained on post-SSE fulcrum-bending radiography. In the non-SSE group, the degree of scoliosis decreased to 26 ± 5.7°. In the retrospective cohort, the degree of scoliosis decreased to 35 ± 5°, with the group also having higher postoperative pain (Visual Analog Scale score = 7, range = 5-10) and an extended hospitalization duration (11 ± 3 days). At 2-year follow-up, curve correction was found to be maintained without adding-on or proximal junctional kyphosis. Compared with the non-SSE group, the SSE group exhibited a greater curve correction (66%) with a shorter hospitalization duration (5 ± 1 days) and a lower degree of postoperative pain (Visual Analog Scale score = 4, range = 3-8). Taken together, our findings indicate that 5 day SSE improves preoperative spinal flexibility and facilitates curve correction.

Purpose: This study aims to provide an overview of different deep learning algorithms (DLAs), identify the limitations, and summarize potential solutions to improve the performance of DLAs.

Methods: We reviewed eligible studies on DLAs for automated Cobb angle estimation on X-rays and conducted a meta-analysis. A systematic literature search was conducted in six databases up until September 2023. Our meta-analysis included an evaluation of reported circular mean absolute error (CMAE) from the studies, as well as a subgroup analysis of implementation strategies. Risk of bias was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). This study was registered in PROSPERO prior to initiation (CRD42023403057).

Results: We identified 120 articles from our systematic search (n = 3022), eventually including 50 studies in the systematic review and 17 studies in the meta-analysis. The overall estimate for CMAE was 2.99 (95% CI 2.61-3.38), with high heterogeneity (94%, p < 0.01). Segmentation-based methods showed greater accuracy (p < 0.01), with a CMAE of 2.40 (95% CI 1.85-2.95), compared to landmark-based methods, which had a CMAE of 3.31 (95% CI 2.89-3.72).

Conclusions: According to our limited meta-analysis results, DLAs have shown relatively high accuracy for automated Cobb angle measurement. In terms of CMAE, segmentation-based methods may perform better than landmark-based methods. We also summarized potential ways to improve model design in future studies. It is important to follow quality guidelines when reporting on DLAs.

Purpose: This study applied a machine learning semi-supervised clustering approach to radiographs of adolescent sagittal spines from a single pediatric institution to identify patterns of sagittal alignment in the normal adolescent spine. We sought to explore the inherent variability found in adolescent sagittal alignment using machine learning to remove bias and determine whether clusters of sagittal alignment exist.

Methods: Multiple semi-supervised machine learning clustering algorithms were applied to 111 normal adolescent sagittal spines. Sagittal parameters for resultant clusters were determined.

Results: Machine learning analysis found that the spines did cluster into distinct groups with an optimal number of clusters ranging from 3 to 5. We performed an analysis on both 3 and 5-cluster groups. The 3-cluster groups analysis found good consistency between methods with 96 of 111, while the analysis of 5-cluster groups found consistency with 105 of 111 spines. When assessing for differences in sagittal parameters between the groups for both analyses, there were differences in T4-12 TK, L1-S1 LL, SS, SVA, PI-LL mismatch, and TPA. However, the only parameter that was statistically different for all groups was SVA.

Conclusions: Based on machine learning, the adolescent sagittal spine alignments do cluster into distinct groups. While there were distinguishing features with TK and LL, the most important parameter distinguishing these groups was SVA. Further studies may help to understand these findings in relation to spinal deformities.