Spine deformity最新文献

Purpose: To assess the complementary value of transverse plane descriptors (orientation of the regional planes of deformation (ORPD) and local apical vertebral rotations (AVR)) integrated into the new modular three-tiered, four-modifier SRS-Lenke-Aubin 3D classification, relative to conventional 2D radiographic parameters and current Lenke 2D classification in adolescent idiopathic scoliosis (AIS).

Methods: Transverse plane deformities of 285 surgically treated AIS cases reconstructed in 3D were quantified using ORPD and AVR, independently assessed for the proximal thoracic (PT), main thoracic (MT), and thoracolumbar/lumbar (TL/L) regions. Correlation analyses evaluated relationships between standard 2D parameters (Cobb angles, thoracic kyphosis (TK), lumbar lordosis (LL)) and transverse plane indices (ORPD, AVR). The distribution of ORPD and AVR subclasses was examined, as well as the associations between conventional Lenke lumbar and thoracic sagittal profile modifiers, and their corresponding 3D transverse plane modifiers. Complementary analyses also included 3D displacement of the apex relative to the end-vertebrae line (DAEVL).

Results: Nearly all ORPD-AVR subclass combinations were observed across regions, confirming the system's ability to capture diverse deformity patterns. ORPD and AVR were independent in PT and MT but correlated in TL/L (r = 0.69). Cobb angle correlated moderately with ORPD in MT (r = 0.43) and strongly in TL/L (r = 0.67), while correlations with AVR were moderate in MT (r = 0.50) and TL/L (r = 0.59). TK correlated negatively with MT ORPD (r = -0.58), whereas LL showed no association with TL/L ORPD. DAEVL correlated strongly with Cobb across all regions but only weakly to moderately with ORPD. Associations between Lenke 2D modifiers and ORPD were strong in TL/L (V = 0.59) and moderate in MT (V = 0.37). Multivariate models showed that Cobb and TK explained ~ 44% of MT ORPD variance, while > 55% of ORPD variability across regions remained unexplained by 2D parameters.

Conclusions: ORPD and AVR provide complementary, region-specific 3D information beyond conventional 2D measures and Lenke modifiers. Their integration into the SRS-Lenke-Aubin 3D classification enhances dimensional completeness while preserving usability, laying the groundwork for future outcome-based evaluations.

Purpose: Mental health disorders (MHD) represent a growing concern in the pediatric population. This study aims to evaluate whether the presence of a mental health disorder influences perioperative and postoperative outcomes in patients with adolescent idiopathic scoliosis (AIS) undergoing surgery.

Methods: Using the TriNetX collaborative network, a retrospective cohort study was conducted including pediatric patients aged 18 and under who underwent surgery for AIS. Patients were divided based on the presence or absence of a preoperative DSM-5 psychiatric diagnosis. 1:1 propensity score matching was applied to balance covariates. Statistical analyses on primary outcomes were performed.

Results: PSM included 913 patients per cohort. MHD patients had higher odds of wound dehiscence at 3 months (OR 1.92; 95% CI 1.08-3.43), 6 months (OR 1.93; 95% CI 1.10-3.39), 1 year (OR 1.85; 95% CI 1.07-3.17), and 2 years (OR 1.74; 95% CI 1.04-2.91). They also had increased risk of implant mechanical breakdown at 1 year (OR 2.65; 95% CI 1.27-5.52) and 2 years (OR 2.41; 95% CI 1.28-4.53). Similarly, they also had higher readmission at 3 months (OR 1.45; 95% CI 1.03-2.04), and ED visits at 2 years (OR 1.31; 95% CI 1.03-1.66). Following Holm-Bonferroni correction, the only outcome that remained significant was mechanical breakdown at 1 year (OR 2.65; 95% CI 1.27-5.52; p = 0.049) and 2 years (OR 2.41; 95% CI 1.28-4.53; p = 0.035).

Conclusions: Mental health disorders in AIS patients were associated with higher rates of postoperative complications, with only mechanical failure remaining significant after correction. These findings suggest that preoperative mental health disorders may be an important factor in recovery and surgical outcomes. Further research is needed to better understand these associations and to develop targeted perioperative strategies to optimize care for this population.

Purpose: This study aimed to identify sagittal misalignment patterns in adolescent idiopathic scoliosis (AIS) by measuring sagittal segmental slope angles of the lower cervical, upper and lower thoracic, and upper and lower lumbar segments relative to the global horizontal line, as well as sagittal deviations of C4, T7, and L3 from the sagittal central sacral line on lateral radiographs of AIS patients. This study also examined the sagittal pathomechanics of AIS, including compensatory mechanisms underlying these misalignment patterns.

Methods: A retrospective radiographic analysis was conducted using standing full-spine lateral radiographs from 100 AIS patients randomly selected from a scoliosis clinic database. Five sagittal segmental radiographic spinal alignment parameters (RSAPs) and three sagittal deviational angles (SDAs) were measured. Radiographs were classified into distinct sagittal misalignment types based on combinations of SDA values and sagittal segmental RSAP measurements. Statistical analyses were performed to confirm the distinctiveness of each type.

Results:  Seven sagittal misalignment types were identified, ranging from near-normal alignment to patterns involving mixed combinations of of the following features: pronounced posterior tilting of the thoracic spine with excessive posterior decompensation of the superior segments; thoracic hypokyphosis with or without cervical decompensation; vertical straightening of the upper lumbar segments, lower thoracic segments, or both; and lumbar hyperlordosis with pronounced anterior tilt of the lower lumbar segment. These profiles reflect regional responses-anterior displacement or compensatory hyperextension-to increased extension moments.

Conclusion:  AIS sagittal misalignment is driven by increased extension moments and compensatory hyperextension, with regional responses governed by facet joint orientation. Recognizing these mechanisms supports universal 3D biomechanical principles for orthotic design, enhancing sagittal correction and overall treatment outcomes.

Purpose: Surgical treatment for ASD is complex and associated with significant perioperative risks. Despite advancements in surgical techniques and perioperative care, complications remain common. This study aims to develop a predictive model of 30-day mortality in patients undergoing surgery for ASD using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2014 to 2022.

Methods: Patients included were aged ≥ 18 years undergoing ASD surgeries were included. Major complications were defined as deep surgical site infection (SSI), organ space SSI, wound dehiscence, prolonged ventilation ≥ 48 h, pulmonary embolism, cerebrovascular accident, renal failure, myocardial infarction, cardiac arrest, bleeding requiring transfusion, sepsis, septic shock, pneumonia, and unplanned reintubation. The primary outcome of interest was 30-day mortality. Categorical variables were analyzed using the Pearson χ² test, and continuous variables were analyzed using the Mann-Whitney U test.

Results: The study cohort included 2471 adults. The overall mortality rate within 30 days of 0.5% (13/2471). Patients who experienced mortality were significantly more likely to present with COPD (30.8% vs. 3.5%, p < 0.001), chronic heart failure (CHF; 23.1% vs. 0.9%, p < 0.001), and chronic steroid use (23.1% vs. 4.6%, p = 0.031). The median hospital stay was twice as long in the mortality group (12 vs. 6 days). Independent predictors of mortality included COPD (OR: 7.48; 95% CI: 1.06-52.95; p = 0.044), CHF (OR: 32.73; 95% CI: 3.11-344.81; p = 0.004), chronic steroid use (OR: 11.42; 95% CI: 1.58-82.60; p = 0.016), unplanned intubation (OR: 58.66; 95% CI: 10.66-322.86; p < 0.001), septic shock (OR: 15.41; 95% CI: 1.51-157.56; p = 0.021), and renal insufficiency (OR: 32.55; 95% CI: 3.57-296.84; p = 0.002). The model demonstrated excellent predictive performance for mortality, with an area under the ROC curve (AUC) of 0.987 (95% CI: 0.961-0.999).

Conclusion: Our analysis of 2471 patients from the ACS-NSQIP database highlights the significant role of key preoperative and postoperative factors, such as COPD, CHF, and septic shock, in predicting 30-day mortality. These findings emphasize the importance of integrating these predictors into preoperative assessments and decision-making processes to better stratify risk and guide personalized interventions.

Introduction: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis entails notable bleeding and transfusion risk, yet optimal tranexamic acid dosing remains undefined. We conducted a network meta-analysis (NMA) comparing high dose, low dose, and no-TXA regimens in this setting.

Methods: We conducted a PROSPERO-registered NMA (CRD420251033929) of RCTs in AIS patients undergoing PSF. PubMed, CINAHL, EMBASE, reference lists, and grey literature were searched for trials comparing high dose (20-50 mg/kg load; 10-20 mg/kg/h infusion), low dose (10 mg/kg load; 1 mg/kg/h infusion), or no TXA. Outcomes were pooled using a random-effects model to produce mean differences for continuous data and relative risks for binary data.

Results: Five RCTs (n = 475) were included. Patients had a frequency-weighted average (FWA) (SD) age of 15.1 (1.5) years, preoperative Cobb angle of 58.0 (7.9)°, 10.4 (1.3) levels fused, and operative time of 186.9 (62.0) minutes. They were allocated to high-dose TXA (n = 184), low-dose TXA (n = 144), or no-TXA (n = 147) arms. The FWA total EBL was 787.3 (261.5) mL in the high-dose group, 705.3 (219.0) mL in the low-dose group, and 1016.3 (492.2) mL in controls. There was no significant difference in EBL between high- vs low-dose TXA (MD -98.3 mL [-646.9, 426.2]). In the NMA, high-dose TXA reduced total EBL by 319 mL (95% CI -818 to 133) and low-dose by 219 mL (95% CI -764 to 294) versus no TXA-an 81% probability that no TXA was worst strategy-though neither comparison reached statistical significance. When compared per fused level, High- and low-dose TXA reduced EBL per level by 38.2 mL (MD -38.2 [-86.3, 6.1]) and 29.5 mL (MD -29.5 [-85.2, 27.3]) versus no TXA, respectively, without statistical significance; however, the no-TXA arm had an 87% probability of being worst for EBL by level. The FWA EBL per level was 78.9 ± 6.3 mL, 78.2 ± 7.2 mL, and 116.3 ± 17.8 mL for high-dose, low-dose, and no-TXA groups (very low certainty). When compared by operative time, high and lowdose TXA reduced EBL per hour by 81.0 mL/h (MD -81.0 [-250.0, 80.5]) and 60.2 mL/h (MD -60.2 [-285.0, 160.0]) versus no TXA, respectively, with no statistical significance. FWA EBL per hour was 273.8 ± 112.6 mL/h, 315.4 ± 133.6 mL/h, and 249.8 ± 150.2 mL/h for high dose, low dose, and no TXA (very low certainty). Both TXA arms had no complications vs. one uncontrolled bleed in the no-TXA group (0.7%).

Conclusion: High and low dose TXA in AIS PSF yielded modest, non-significant reductions in total blood loss and per-level EBL. No thromboembolic, neurologic, or renal complications occurred among, underscoring its safety. These results support a case-by-case approach to TXA use and highlight the need for larger, standardized RCTs to confirm its clinical value.

Introduction: The natural history of growth-friendly graduates treated with growing instrumentation but no final fusion is unknown. Two previous reports exist with one analyzing 30 growin g rod patients with no definitive fusion and another including 10 patients with growing rod removal, but no comprehensive data exist in the literature.

Methods: A multi-center database was queried for patients treated with TGR or VEPTR and at least 2 years of follow-up from their index procedure. Patients met inclusion criteria if they had not undergone a final fusion procedure but had completed planned interventions for early onset scoliosis and had sufficient follow-up. Kaplan-Meier analysis was performed to model rates of UPROR and complications in patients with retained and removed implants over time.

Results: Of 233 included patients, definitive treatment was implant maintenance in 203 (87%) and removal in 30 (13%). Patients with retained implants experienced 10 (5%) UPRORs and 41 (20%) complications after final lengthening. Patients with removed implants had 0 UPRORs and 10 (33%) complications after implant removal. Patients with available pre-definitive and follow-up measurements and whose implants were removed increased by a mean 14.3° of coronal curvature compared to 19.0° in those who retained implants at mean 3.8 and 3.7 year follow-up, respectively.

Conclusion: Growth-friendly graduates without final fusion demonstrate low rates of UPROR and complications following definitive lengthening or implant removal. However, those who undergo implant removal are more likely to experience complications. Coronal curve magnitude was moderately maintained in both cohorts, suggesting that avoidance of definitive fusion may be viable for some patients.

Purpose: The purpose of this study is to determine the trends in use of magnetically controlled growing rods (MCGRs) over time for the treatment of scoliosis.

Methods: All patients treated with MCGRs were identified through a multi-center pediatric spine database from 2014 to 2021. MCGR use over time was analyzed with respect to individual variables within the dataset including demographics, etiology, primary vs conversion surgeries, and major curve magnitude.

Results: A total of 1,404 patients treated with MCGRs were identified. MCGR usage grew quickly until 2017 and then steadily declined through 2021. There was minimal variation over time with respect to patients' age and weight. MCGR as the index implant as opposed to revision surgery increased from 67% in 2014 to 99% in 2021. Initially, MCGR utilization was consistent across scoliosis etiologies; however, over time, it grew among neuromuscular patients while decreasing among other etiologies. MCGR use decreased over time for curves with magnitude < 60 degrees, with a corresponding rise in curves > 80 degrees.

Conclusion: Use of MCGRs expanded quickly after initial FDA approval in 2014 with broad indications. Over time, the indications for use of MCGRs have steadily evolved. In recent years, a higher proportion of them are used in neuromuscular scoliosis and larger curves in contrast to declining use in smaller curves.

Level of evidence: III.

Purpose: To compare direct costs associated with anterior spinal instrumented fusions (ASIF) and posterior spinal instrumented fusions (PSIF) for thoracolumbar adolescent idiopathic scoliosis (AIS).

Methods: A retrospective analysis was conducted of adolescents (ages 10-18 years) who underwent ASIF or PSIF for thoracolumbar AIS by a single surgeon. Demographics, clinical and surgical details, and inpatient post-operative outcomes were analyzed. Direct costs were obtained from medical billing data, including supplies, instrumentation, operating room services, room and board, and ICU admissions.

Results: 17 patients (13 girls; average age 15.3 ± 1.9 years) met inclusion criteria and were analyzed. There were no significant differences in age, major thoracolumbar Cobb angle, or thoracic Cobb angle between groups. PSIF had significantly more instrumented levels (6 ± 0.9 v. 5 levels; p < 0.01) and shorter operative times (308 ± 25.6 min vs. 447 ± 39.2 min; p < 0.01). ASIF incurred higher total costs ($72,174 ± $19,550 v. $66,552 ± $14,019; p = 0.04) and direct costs ($40,161 ± $3,668 v. $34,469 ± $7,846; p = 0.04), largely due to more ICU admissions and greater hospital lengths of stay (LOS). Excluding 2 ASIF patients with prolonged hospitalizations, direct costs between ASIF ($39,990 ± $3,855) and PSIF ($34,469 ± $7,846) were not statistically different (p > 0.05).

Conclusions: While ASIF had significantly greater direct costs due to more postoperative ICU admissions and longer hospital LOS, exclusion of outliers resulted in similar average direct costs between approaches. ASIF saved one treated level on average. Number of implants, operating room services, ICU admissions and LOS are the principal drivers of cost.

Purpose: Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare neurodevelopmental disorder marked by the absence of horizontal eye movement and gradual progressive scoliosis during childhood. Here, we report two biological siblings that presented with a shared diagnosis; however, the curves are in opposite directions and one presents with dextrocardia.

Methods: Two siblings presented with acute scoliosis and conjugate absence of horizontal gaze. The diagnosis was confirmed based on characteristic clinical presentation, congenital absence of horizontal gaze, and supportive radiographic imaging. Both patients were followed from early infancy through skeletal maturity with radiographs and clinical evaluations. Curve progression, response to conservative measures, and indications for surgical intervention were documented.

Results: Both patients developed progressive thoracic scoliosis despite early casting and bracing, with curves exceeding 70° by early adolescence ultimately requiring an anterior and posterior spinal fusion and instrumentation (PSFI). Postoperatively, both patients demonstrated stable spinal alignment and achieved satisfactory correction with long-term follow-up. Interestingly, evaluation of the radiographs demonstrates opposite convex thoracic curve patterns, each with an apex at T9, one with a left thoracic curve and an associated dextrocardia and the other with a right thoracic curve and normal left-sided heart position.

Conclusion: This report provides rare long-term data spanning more than a decade with a unique phenotypic presentation among siblings. It is notable for their opposing curve directions-one right-sided and one left-sided with the presence of conjugate dextrocardia in the left thoracic scoliosis. These findings may suggest an underlying influence of asymmetric cardiothoracic development or potential link of blood supply pattern on spinal curve direction. Recognition of this unique phenomenon might offer new insight into the etiology of scoliosis in HGPPS and warrants further investigation into the developmental factors contributing to curve morphology.