Spine deformity最新文献

Introduction: The impact of spondylolysis and isthmic spondylolisthesis on intervertebral disc health in pediatric patients remains poorly understood. The purpose of this study was to characterize intervertebral disc degeneration in pediatric patients with spondylolysis and spondylolisthesis.

Methods: This was a single-center retrospective cohort study. Patients were included if they were 1) under 18 years of age, 2) diagnosed with lumbar spondylolysis or isthmic spondylolisthesis based on computed tomography imaging, and 3) had magnetic resonance imaging of the lumbar spine with T2 sequence. Disc degeneration was graded using the Pfirrmann grading system at the level of the spondylolysis/listhesis. Disc degeneration at L4/5 and L5/S1 was graded in a control patient population of pediatric patients that received an abdominal MRI with a T2 sequence. Disc degeneration was reported as proportions within 4 groups: 1) patients with spondylolysis, 2) patients with grade 1 spondylolisthesis, 3) patients with grade 2-4 spondylolisthesis, and 4) the control group. Descriptive statistics, Chi-square test, and multivariable logistic regression analysis was used for analysis.

Results: A total of 87 patients were included in this study. There were 67 patients with spondylolysis or spondylolisthesis with a mean age of 14.9 ± 1.9 years and 49.3% (n = 33) were female. 62.7% (n = 42) had isolated spondylolysis, 20.9% (n = 14) had grade 1 spondylolisthesis, and 16.5% (n = 11) had grade 2-4 spondylolisthesis. There were 20 control patients with a mean age of 14.7 ± 2.1 years and 50.0% (n = 10) were female. In the control population, at 40 intervertebral discs, there was no disc degeneration in 92.5% (n = 37/40) and disc degeneration in 7.5% (n = 3/40). Compared to the control group, patients with spondylolysis (p = 0.04), grade 1 spondylolisthesis (p < 0.001), and grade 2-4 spondylolisthesis (p < 0.001) had higher rates of disc degeneration. The rates of disc degeneration at the level of the pathology for patients with spondylolysis, grade 1 spondylolisthesis, and grade 2-4 spondylolisthesis were 23.8%, 64.3%, and 100.0%, respectively. In the multivariable logistic regression analysis, presence of spondylolysis (OR 4.06, p = 0.04) and spondylolisthesis (OR 49.2, p < 0.001) were associated with higher odds of disc degeneration. Age was not associated with odds of disc degeneration (p = 0.652).

Conclusion: Intervertebral disc degeneration is common at the level of pathology in pediatric patients with lumbar spondylolysis and spondylolisthesis, with increasing severity of disc degeneration associated with increasing spondylolisthesis.

Purpose: To investigate the rate and risk factors for reoperation following a short-segment fusion strategy for congenital scoliosis (CS).

Methods: CS patients treated with posterior fusion were identified and stratified by history of revision surgery. Demographic and pre- and postoperative radiographic data were compared to determine the risk factors for reoperation.

Results: Thirty-five patients (mean age 5.0 years; mean follow-up 7.6 years) underwent an average of 3.5 levels fused. Index procedures were performed in the thoracic (49%), thoracolumbar (29%), lumbar (17%), and lumbosacral (6%) regions. Eighteen (51%) patients underwent reoperation at a mean of 5.2 years. Preoperative curve magnitude was significantly lower in patients who did not require reoperation (34.2° vs 66.7°, p < 0.001), with preoperative curves ≥ 45° having a 94% reoperation rate compared to 6% in curves < 45°. Preoperative curve magnitude strongly predicted reoperation (AUC 0.99, 95% CI 0.97-1.00), with 45° as the optimal cutoff (94.4% sensitivity, 94.1% specificity). Larger pre- and postoperative compensatory curves and constructs that did not span both end vertebrae were also risk factors for reoperation (p < 0.05). In multivariate analysis, only greater preoperative curve magnitude retained significance for reoperation (p = 0.028).

Conclusions: Although short-segment fusion for CS resulted in a 51% reoperation rate, stabilization for 6.2 years with this staged strategy allowed for growth and delayed additional surgery to a later, optimal age. Risk factors for reoperation included preoperative curves ≥ 45° and constructs failing to span both end vertebrae.

Level of evidence: III.

Purpose: To quantitatively evaluate three-dimensional spatial changes in the thoracic aorta before and after posterior spinal correction in patients with Lenke types 1 and 2 adolescent idiopathic scoliosis (AIS), and to assess the relationship between spinal realignment and aortic morphology using advanced 3D reconstruction techniques.

Methods: This retrospective study included 31 patients with either Lenke type 1 or 2 AIS who underwent posterior spinal fusion using pedicle screw instrumentation. Pre- and postoperative computed tomography scans were used to construct 3D models of the vertebrae and thoracic aorta. Curvature indices-including the vertebral curvature index (CI) and aortic tortuosity index (TI)-and transverse-plane parameters including aorta-vertebral angle (α), vertebral rotation angle (γ), and spatial distances between aorta and vertebrae were measured.

Results: Posterior correction significantly reduced CI (from 10.0 to 3.4%) and TI (from 13.6 to 6.5%) (both p < 0.001). The aorta underwent a measurable anteromedial shift, most prominently at thoracic levels T6-T10, which was reflected by decreased α and γ values. Changes in TI strongly correlated with changes in CI (r = 0.806, p < 0.001), indicating that vertebral realignment directly influenced aortic morphology.

Conclusion: Posterior spinal fusion in AIS patients induces significant three-dimensional changes in the thoracic aorta, including straightening and medial displacement. These findings highlight the need for comprehensive vascular evaluation and surgical planning to ensure safe pedicle screw placement, particularly in anatomically vulnerable regions.

Purpose: To assess if vertebral location within posterior VBT construct affected the overall vertebral growth rate, % growth modulation, and to determine if the proximal and distal physes within each tethered disk space responded similarly to tethering.

Methods: Six hyper-kyphotic swine underwent multi-level posterior compressive tethering. Pulsed fluorochrome labeling was performed. Growth rates, % growth modulation, physeal zonal thicknesses, vertebral epiphyseal ossification, location of central nucleus pulposis, and vertebral shape by location within tether construct were measured.

Results: Mean growth rates were similar throughout the vertebral levels studied and no significant difference was found between tethered or adjacent levels. However, the mean thickness of tethered physes was thinner than the adjacent uninstrumented physes (621 ± 36 μm vs 728 ± 52 μm, p = 0.001, adj p = 0.004) and this difference appeared to be primarily due to differences in the proliferative zone. The most proximal instrumented vertebral level, that corresponded anatomically to the 2nd and 3rd most distal thoracic level), had the greatest % growth modulation (55 ± 17%) compared to other instrumented levels (p = 0.0001, adj p value 0.004). No significant differences in growth rate, physeal thickness, or % growth modulation were found between the distal and proximal vertebral physes within each tethered disk. Adjacent level junctional kyphosis was observed through the significant reversal (negative) growth modulation at levels outside the construct (p < 0.0001, adj p value 0.004).

Conclusion: Mean vertebral growth was not significantly inhibited by a posterior tether. Despite uniform tensioning throughout each construct, the most proximal tethered level experienced the most growth modulation indicating that growth may not be modulated the same at each level within a construct. Additionally, asymmetric vertebral growth may contribute to junctional kyphosis in the growing spine.

Purpose: Describe implanted programmable device (IPD)-related complications after spine surgery in patients with early-onset scoliosis (EOS).

Methods: A descriptive study was conducted with patient data from a multicenter database. Eligibility criteria were: (1) diagnosis of EOS requiring spine deformity surgery, (2) presence of IPD(s), and (3) ≥ 2-year follow-up after index procedure. Each complication was categorized as related or not related to the IPD.

Results: 100 patients met eligibility criteria. Most either had a ventriculo-peritoneal shunt (VPS, n = 53) or an intrathecal baclofen pump (ITBP, n = 38); the remaining patients had a vagal nerve stimulator (n = 9), cochlear implant (n = 5), or a pacemaker (n = 1). A total of 55 patients experienced one or more complications of any type, but only seven experienced IPD-related complications (n = 4 IPD-related infections, n = 3 IPD-related malfunction). All complications occurred in patients with VPS or ITBP. Of the seven IPD-related complications, only two complications (one IPD-related infection and one IPD-related malfunction) occurred in the first 90 days following index spine surgery. All IPD-related complications required unplanned operations to resolve the complication.

Conclusion: Although post-operative complications were common for patients with IPDs who underwent spine deformity surgery, IPD-related complications were rare and most occurred later than 90 days after the index procedure. Further, the IPD-related complications did not appear to be related to potential electromagnetic fields created during surgery or magnetic lengthening. These findings suggest that, inherently, the presence of an IPD may not increase the risk of IPD-related complications (e.g., device malfunction) for patients with EOS who undergo spine deformity surgery.

Clinical trials registration: Not applicable.

Introduction: Unplanned hospital readmissions remain one of the largest causes for increased episode of care and adverse events. These readmissions are especially significant in posterior spinal fusion (PSF) for idiopathic adolescent scoliosis (AIS). Therefore, this study aimed to 1) determine the overall 90-day PSF readmission rate; 2) report the timing of readmission post-discharge; and 3) identify the most frequent causes of 90-day readmissions (i.e., medical- or orthopedic-related).

Methods: A cohort of 657 consecutive patients undergoing PSF for AIS between January 1, 2010 and February 28, 2021 were selected. Readmissions were examined manually for determination of primary cause and verification. Two-tailed t tests and chi-squared/Fisher tests were utilized with logistic regressions for individual variables.

Results: The 90-day readmission rate was 6.24% or 41 patients with most of the readmissions being in the first 6 weeks with 3.5% medical and 2.74% orthopedic readmissions. Wound infections (44%), normal physiological events (27%), and postoperative pain (17%) were the three top orthopedic readmission causes while gastrointestinal (45%), pulmonary (13%), and neurologic (13%) causes were the top three medical reasons. There was no difference between the rates of ICU admission (p = 0.573) or length of readmission stay (p = 0.201). However, orthopedic readmissions were significantly more likely to be treated operatively (p < 0.001) and more likely to receive transfusions (p = 0.030). Regression analysis found that decreased length of stay (p = 0.031) and less levels fused (p = 0.039) were associated with decreased risks for readmission while age (p = 0.126), BMI (p = 0.312), race (p = 0.13), preoperative Cobb's Angle (p = 0.197), OR Time (p = 0.156), autograft use (p = 0.092, and sex (p = 0.271) had no effect.

Conclusion: Most readmissions after PSF for scoliosis occur in the first 6 weeks postoperative with wound infections and gastrointestinal issues being the leading factors for orthopedic and medical readmission respectively. Length of stay and number of levels fused were associated with risks for unplanned hospital readmissions within 90 days.

Purpose: Vertebral body tethering (VBT) is a scoliosis correction technique that purportedly leverages spinal growth modulation to correct curves over time. Therefore, measures of skeletal maturity such as Risser and Sanders stages are often used in VBT patient selection. VBT in skeletally mature patients is sometimes seen as controversial or less predictable due to their limited remaining growth. This study compares VBT outcomes in Risser 0-2 vs. 3-5 and Sanders 1-4 vs. 5-8 patients.

Methods: Single institution retrospective review of 138 post-VBT patients with minimum 2-year follow-up. Patients were grouped by preop Risser and Sanders stages. Independent t-tests (alpha = 0.05) and Fisher's exact test were used for analysis of outcomes.

Results: No significant differences were observed in BMI, number of levels instrumented, preop major curve magnitude, preop major curve flexibility, estimated blood loss (EBL), % correction at first erect (FE), % correction at 2-year follow-up, or reoperation rates, complication rates, or cord breakage rates between the skeletally mature and immature patients. Operative time was shorter in Sanders 5-8 patients compared to Sanders 1-4 patients (p = 0.0478). Length of hospital stay was slightly shorter in Risser 3-5 patients (p = 0.0080), with no difference between Sanders groups.

Conclusion: At our center, Risser and Sanders stages did not significantly affect most VBT outcomes. Curve correction, reoperation rates, and complication rates were similar, suggesting that VBT can achieve comparable 2-year outcomes across a spectrum of skeletal maturity. However, given the shorter follow-up for the more skeletally mature patients, it remains possible that they may encounter issues such as cord breakage or require reoperation/fusion at rates similar to the less mature patients with longer follow-up. Larger studies are needed to determine the required degree of growth remaining for successful long-term outcomes and explore other factors associated with long-term success following VBT.

Purpose: Surgical correction of adolescent idiopathic scoliosis (AIS) involves correction of coronal plane deformity to establish coronal and sagittal balance. Posterior column osteotomies (PCOs) are frequently employed but have been associated with complications. We hypothesize that utilization of a novel geometry rod construct will achieve comparable coronal and sagittal correction in AIS surgery regardless of whether PCOs are performed.

Methods: A single-arm, prospective, multi-center study was completed to evaluate the primary curve and thoracic kyphosis (TK) correction in Lenke 1 and 2 AIS subjects as a function of rod stiffness. Baseline, initial postoperative, and 2-year postoperative radiographs were used. Results from pooled literature were used for comparison.

Results: Fifty-five patients were included; 22 had PCOs (PCO group) and 33 did not (NPCO group). There were no differences between cohorts in terms of baseline demographics or radiographic features. Between the NPCO and PCO cohorts, no differences were seen in preoperative primary Cobb (58.0 vs 61.6, p = 0.1427), Flexibility (%) (41.4 vs 36.8, p = 0.2453), ultimate post-op primary curve size (17.0 vs 17.1, p = 0.9501) or degree of correction (pre-post, %) (70.6 vs 72.2, p = 0.4806). Those with PCOs had increased blood loss (NPCO: %EBV: 13.5, 543.0 cc, PCO: %EBV: 17.8, 717.6 cc, p = 0.0260), transfusion volume (NPCO: 171.7 mL, PCO: 429.9 mL, p = 0.0009), and surgical time (NPCO: 266.2 min, PCO: 297.1 min, p = 0.0434). Compared to previously published literature (LIT), our cohort had slightly higher average preoperative TK (Study = 21.5°, LIT: 19.8°, z = 0.1041) and postoperative TK (Study All = 23.4°, LIT = 21.7°, z = 0.0399 and Study PCO 24.7°, z = 0.0237).

Conclusions: In our cohort, curves treated using a novel rod with increased rigidity, comparable corrections were achieved regardless of whether PCO was performed. We noted a higher intraoperative EBL and longer operative times when PCOs were utilized.

Level of evidence: II.