Spine deformity最新文献

Purpose: Advances in operative and recovery protocols such as the rapid recovery pathway (RRP) in the last decade have shortened inpatient stays for adolescent idiopathic scoliosis (AIS). This study aimed to evaluate the impact of these national trends on length of stay (LOS), complication rates, and costs in patients with AIS undergoing posterior spinal fusion (PSF) using a large, nationally representative dataset.

Methods: A retrospective review of 10,081 patients requiring PSF for AIS was conducted using the Healthcare Cost and Utilization Project's (HCUP) Kids' Inpatient Database (KID) in the latest available year prior to the popularity of protocols like RRP (2012) and most recently (2019). Patients and complications were identified via ICD-9 and ICD-10 codes. Multivariate linear and logistic regression analyses were performed to assess the impact of year of surgery while adjusting for demographic variables.

Results: Average LOS decreased in 2019 vs. 2012 (3.9 days vs. 5.4 days, p < 0.001), year of surgery (β = -1.4 days, p < 0.001), and absence of complications (β = -2.8 days, p < 0.001) were the largest predictors of LOS. Overall complication rates declined from 12.8% to 6.5% (p < 0.001). Year of surgery showed significantly increased charges after inflation adjustment (β = $12,452.6, p < 0.001), though other demographic variables demonstrated larger impact on cost.

Conclusions: More recent surgical year resulted in reduced hospital stays with fewer complications and without substantial increases in cost. These findings support continued adoption and refinement of operative and recovery protocols in pediatric spine surgery.

Purpose: One factor that may lead to the development of early-onset scoliosis (EOS) is chest wall procedures during infancy, which are common for patients with Trisomy 21 requiring cardiothoracic intervention involving thoracotomies. Studies examining scoliosis incidence in patients with prior thoracotomy demonstrate a wide incidence range. Our study aimed to assess if scoliosis prevalence is higher in patients with Trisomy 21 who underwent prior thoracotomy compared to patients who underwent sternotomy for congenital heart disease repair.

Methods: An IRB-approved, single-center retrospective review included patients aged 9 years or older with Trisomy 21 who underwent prior cardiothoracic surgery. Exclusion criteria included other trisomy diagnoses, no cardiothoracic surgical history, unavailable operative records, and ages 0-8 years. Medical chart review examined demographics, surgical details, and scoliosis diagnosis and management. Statistical analyses included chi-square, z test, one-way ANOVA, and descriptive statistics.

Results: Of 301 total patients, 12.6% were eventually diagnosed with scoliosis (n = 38). Common cardiothoracic procedures included atrioventricular canal repair (n = 141/301, 46.8%) and ventricular septal defect repair (n = 67/301, 22.3%). Thoracotomies were required in 7.0% (n = 21/301) at a median age of 1 month (IQR:0-15), most commonly for patent ductus arteriosus ligation (n = 8/21, 38.0%). Among thoracotomy patients, 28.6% developed scoliosis (n = 6/21), compared to 11.4% of sternotomy patients (n = 32/280) (p = 0.023). Among all patients with scoliosis (n = 38), 36.8% required intervention in the form of non-operative (i.e. bracing) or surgical treatment due to curve presentation and/or progression (n = 14); and 13.2% ultimately required spinal fusion (n = 5).

Conclusion: Our study demonstrates that trisomy 21 patients requiring early CT intervention have greater scoliosis prevalence following thoracotomy than sternotomy. While the prevalence is greater in the thoracotomy group, the evidence suggests both cohorts must closely be monitored for spinal deformity development to intervene early and prevent progression to an operative magnitude scoliosis.

Introduction: Posterior segmental instrumented fusion (PSIF) is considered the gold standard surgical treatment for adolescent idiopathic scoliosis (AIS), as it leads to immediate deformity correction and predictable long-term outcomes. Extended inpatient length of stay (LOS) following this intervention has been associated with greater morbidity, healthcare cost, and reoperation rates. Therefore, there is a growing impetus to reduce LOS through previously described accelerated discharge protocols. However, there is a paucity of literature characterizing perioperative factors associated with extended LOS in patients undergoing PSIF for AIS. Additionally, it remains unclear whether postoperative patient-reported outcomes are superior in patients with shorter LOS after AIS surgery.

Methods: A single institution's longitudinally maintained database was queried from a large academic medical center to identify patients with AIS who underwent PSIF by a single fellowship-trained pediatric spine surgeon between 2019 and 2024. Perioperative factors including age, sex, height, weight, race, ethnicity, insurance plan, language spoken at home, Risser stage, curve magnitude, training level of first assistant, intraoperative time, levels fused, navigation assistance, estimated blood loss, and Scoliosis Research Society (SRS) scores were assessed to determine potential associations with extended LOS.

Results: Of the 118 AIS patients who underwent PSIF, the mean LOS was 3.1 ± 0.8. Perioperative factors associated with longer LOS included only greater levels fused (p = 0.023). Longer LOS was associated with higher postoperative SRS mental health scores (p = 0.022), with a trend toward greater satisfaction (p = 0.055) and pain (p = 0.072) scores after adjustment for baseline values. No other perioperative factors or specific SRS domains were associated with LOS (p > 0.05 for all).

Conclusion: Greater number of levels (more than 11 segments) fused in surgery was associated with longer length of stay for AIS patients who underwent PSIF. With growing focus on minimizing inpatient LOS duration following PSIF for AIS patients, our findings of higher postoperative patient-reported SRS scores after longer inpatient stay may warrant prospective analysis and should be further considered in the perioperative care of AIS patients.

Level of evidence: Level III.

Purpose: Chiari I Malformation (CIM) is occasionally associated with scoliosis, especially in the presence of syringomyelia (SyM). While posterior fossa decompression (PFD) is often performed before spinal fusion, its impact on scoliosis progression remains unclear. Some studies report curve stabilization or improvement, while others show continued progression. This systematic review and meta-analysis aim to evaluate whether PFD influences CIM patients' scoliosis outcomes and identify predictive factors for curve behavior, improving multidisciplinary surgical management.

Methods: A systematic literature search was conducted in PubMed, Cochrane, Embase, Medline, Scopus, and Web of Science up to June 2025, following PRISMA guidelines. Inclusion criteria included pediatric patients (< 19 years) diagnosed with CIM who underwent PFD as the first treatment and had concurrent scoliosis (major curve angle > 10°). Data from 11 retrospective studies comprising 380 patients were analyzed. Pooled proportions of improvement, stability, and progression were calculated using random-effects models. Subgroup analyses were performed for duroplasty, and metaregression explored predictors, including age at surgery and baseline Cobb angle.

Results: The mean age at PFD was 10.3 years, with a mean preoperative curve of 37°. Syringomyelia was present in 92.6% of patients. After PFD, 55% (95% CI 46-63%) of curves improved or stabilized, while 45% (95% CI 37-54%) progressed. In the duroplasty subgroup (6 studies, 189 patients), success and progression rates were similar to the overall cohort (54% vs. 46%). Syrinx improvement was observed in 94% (95% CI 82-98%), with higher rates in duroplasty cases (97%). Metaregression demonstrated that older age at surgery (OR per year = 1.24, 95% CI 1.10-1.39; p < 0.001) and greater baseline Cobb angle (OR per + 5° = 0.79, 95% CI 0.65-0.96; p = 0.012) were independent predictors of scoliosis progression. Ultimately, 37.8% of patients required spinal fusion.

Conclusion: This meta-analysis suggests that PFD is associated with scoliosis improvement in nearly half of pediatric patients with CIM, but a significant proportion still experiences curve progression. Younger age at surgery and lower preoperative major curve angle are associated with better outcomes. Future prospective studies with standardized criteria and extended follow-up periods are needed to refine treatment strategies.

Purpose: This systematic review and meta-analysis aim to investigate the prevalence of cardiac abnormalities in patients with idiopathic scoliosis.

Methods: A systematic search on PubMed, Embase, Scopus, and Web of Science was conducted, covering studies published from their inception up to February 2024. Peer-reviewed studies that used echocardiograms to screen for cardiac abnormalities were included. Nine thousand five hundred fifty-four cases met the inclusion criteria and were included in the final data synthesis. A meta-analysis was performed to calculate the pooled prevalence of cardiac abnormalities and a 95% confidence interval (CI). Results were divided into subgroups to reveal the prevalence of each cardiac abnormality for further consideration.

Results: 7.5% had cardiac abnormalities. Valvular diseases are the most common cardiac abnormalities. Tricuspid regurgitation (TR) is the most prevalent, accounting for 24.4% of cases. This is followed by mitral regurgitation (MR) at 17%, mitral valve prolapse (MVP) at 8%, aortic regurgitation (AR) at 3.8%, and pulmonary insufficiency at 1.9%. In addition, other valvular diseases collectively make up 22% of the findings. Congenital heart diseases (CHD) were also included in the results, with atrial septal defect (ASD) being the most prominent at 1.5%, followed by ventricular septal defect (VSD) at 1.4%, and other CHD comprising 2.5%. Pulmonary hypertension accounts for a substantial portion of the results, representing 16.8%. A dilated aortic root and pericardial effusion were observed in 2.4% and 0.9% of cases, respectively.

Conclusion: Cardiovascular abnormalities are prevalent in patients with idiopathic scoliosis. This highlights the need for thorough cardiovascular screening of these patients before surgical intervention.

Background: Severe adolescent idiopathic scoliosis (AIS) may be associated with cardiopulmonary issues, including previously undiagnosed congenital cardiac anomalies, valvular disease, and pulmonary hypertension. Many centers routinely refer patients with coronal Cobb angles ≥ 70° for pre-operative cardiology evaluation prior to posterior spinal fusion (PSF). The clinical utility of this practice remains uncertain.

Methods: A retrospective review was conducted of AIS patients undergoing PSF at a single pediatric orthopedic center from 2017 to 2024. All patients received pre-operative anesthesia evaluations including history, auscultation, and electrocardiogram (EKG). Cardiology referral was made for patients with Cobb angles ≥ 70° or for those with cardiac symptoms, murmurs, or EKG abnormalities. Data collected included cardiology referral status, echocardiogram (TTE) findings, need for intervention or follow-up, surgical delays, and perioperative cardiac complications. Comparative analysis was performed between patients with Cobb angles ≥ 70° and < 70°.

Results: Of 151 patients (mean age 14.5 years [range 11-20] 75% female), 51 had Cobb angles ≥ 70°. These patients were more likely to report cardiac symptoms (20% vs. 3%, p = 0.0012) and have murmurs (10% vs. 1%, p = 0.017). 35 patients with Cobb ≥ 70° patients were referred to cardiology, and 17 underwent TTE. Nine had abnormal but largely benign findings; only three required follow-ups. No patient in either group experienced surgical delays or perioperative cardiac complications.

Conclusions: Although AIS patients with Cobb angles ≥ 70° demonstrate higher rates of symptoms and murmurs, routine cardiology referral based on Cobb angle alone rarely uncovers clinically significant findings or impacts surgical timing. A targeted referral strategy incorporating symptoms, exam findings, and EKG abnormalities may optimize patient safety while reducing unnecessary testing and cost.

Purpose: In many centers, extra bone graft or bone substitute is used in routine surgery for adolescent idiopathic scoliosis (AIS). We examined the existing evidence to determine whether local bone graft (LBG) alone is sufficient.

Methods: We performed the literature search through PubMed and Web of Science, using the search terms "scoliosis" and "bone graft." The inclusion criteria were primary posterior AIS surgery, the use of LBG exclusively, and segmental placement of anchors. Studies that provided a control group were added to the meta-analysis. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool and version 2 of the Risk of Bias tool for randomized trials (RoB 2) was used. The inverse variance method and the random effects model meta-analysis were chosen.

Results: Six studies involving 549 patients were eligible. One study reported occasional use of posterior column osteotomy. Adding bone graft did not reduce the occurrence of pseudoarthrosis (odds ratio 0.94; 95% confidence interval 0.40-2.22; p = 0.89; I² = 0). Although not significant, the direction of effect was in favor of LBG alone (intervention group). Two studies reported Scoliosis Research Society Scores, which were similar in both groups.

Conclusions: LBG can be used alone in AIS patients with posterior segmental instrumentation. Extra material may not be needed in routine cases.