Spine deformity最新文献

Background: Scheuermann kyphosis (SK) is a spinal deformity characterized by exaggerated kyphosis, frequently requiring surgical correction. Selection of the lowest instrumented vertebra (LIV) is critical in optimizing outcomes, with options including the stable sagittal vertebra (SSV) and first lordotic vertebra (FLV). This systematic review evaluates the clinico-radiological outcomes and complications associated with SSV and FLV as LIVs.

Methods: A systematic review were conducted following PRISMA guidelines. Seven studies comprising 311 patients (142 in the SSV group and 169 in the FLV group) were included. Outcomes analyzed included pre- and postoperative radiographic parameters (kyphosis, lumbar lordosis, sagittal balance), correction rates, incidence of distal junctional kyphosis (DJK), and revision surgery for DJK. Statistical analysis used Review Manager 5.4 with heterogeneity assessed using I² and Q tests. Evidence quality was evaluated using the GRADE framework.

Results: Pre- and postoperative kyphosis was significantly higher in the SSV group, while lumbar lordosis and sagittal balance were comparable. Although the correction rates were similar between groups, the incidence of DJK was significantly higher in the FLV group (OR 0.20, p = 0.04). Sensitivity analysis revealed that after removing the most heterogeneous study, the difference in DJK incidence was no longer statistically significant. Revision surgeries for DJK remained significantly higher in the FLV group (OR 0.26, p = 0.01).

Conclusion: Fusion to SSV may reduce the incidence of DJK and revision surgery compared to FLV, with comparable radiological outcomes. However, these findings were sensitive to study heterogeneity, and the significance of DJK difference disappeared after sensitivity analysis, highlighting the need for further prospective studies with larger sample sizes to strengthen the evidence.

Purpose: To demonstrate the utility of routine preoperative magnetic resonance imaging (MRI) in detecting neural axis abnormalities in presumed adolescent idiopathic scoliosis (AIS) patients.

Methods: A retrospective analysis of pediatric patients who underwent posterior spinal instrumentation and fusion (PSIF) for presumed AIS at a single institution over 14 years. Patients with syndromic, congenital, or neuromuscular scoliosis were excluded. MRI findings, history and exam findings, and neurosurgery consultation/intervention were documented.

Results: Among 233 patients with presumed AIS who underwent routine preoperative MRI, 24 (10.3%) had positive findings, including Arnold-Chiari malformations, syringomyelia, and tethered cords. Five patients (2.1%) required neurosurgical intervention before PSIF; only one exhibited an atypical curve pattern before MRI. The remaining cases did not alter surgical plans but required consultation with neurosurgery.

Conclusion: Routine MRI in presumed AIS patients identified neural axis abnormalities in a subset of patients who otherwise lacked neurological indicators. These findings support the consideration of preoperative MRI in AIS management to optimize surgical planning and patient safety.

Background: Accurate assessment of spinopelvic alignment is essential for managing adult spinal deformities. This study validates the Brainlab Elements Spine Planning software for automated measurement of spinopelvic parameters, comparing it with manual methods.

Methods: Spinopelvic parameters were measured manually and with the software in 21 patients with degenerative spinal disease, including instrumented and non-instrumented spines. Accuracy, intraobserver, and interobserver reliability were evaluated using Bland-Altman plots and intraclass correlation coefficients (ICCs). Measurement times were also compared.

Results: The software showed high reliability (ICC = 1), while manual measurements ranged from fair to excellent reliability (ICC 0.44-0.99). Bland-Altman plots indicated strong agreement between automated and manual measurements, though variability was noted for certain parameters. Automated measurements were significantly faster, averaging 62 s versus 227 s in manual measurements (p < 0.001), though 76.2% of cases had at least one parameter that could not be measured automatically, most frequently the sagittal vertical axis (SVA) and several coronal parameters.

Conclusion: The Brainlab Elements software provides accurate, reproducible, and time-efficient spinopelvic measurements for parameters it successfully captures. However, frequent failures in assessing SVA and coronal plane parameters automatically suggest that further refinement of the software is necessary.

Purpose: The United States (US) adult population's baseline knowledge and perceptions of adult spinal deformity (ASD) are unknown. This study employs crowdsourcing to evaluate public perceptions regarding ASD.

Methods: This is a survey-based study comprising a representative sample. A multiple-choice survey was administered through the CloudResearch platform and participants were matched for age, sex, and other demographics to reflect the current US census.

Results: 1000 participants were included with a mean age of 45.3 ± 16.1 years. Respondents ≥ 65 years old were significantly more likely to never have been screened for scoliosis compared to the 18-64 cohort (62% vs. 38%; p < 0.05). The majority of respondents (54%) correctly responded that X-ray is the typical diagnostic tool. Primary treatment modalities thought most useful by participants were physical therapy (80%) followed by spinal braces (66%). In terms of surgical treatment, 61% stated that fusion surgery was the typical treatment whereas 51% felt that motion-preserving surgery with disc replacement was a viable treatment option. Participants were most likely to identify orthopedic surgeons (81%) as most likely to treat ASD, followed by physical therapists (75%). The majority (80%) believed that surgery was effective treatment and only 4% believed that surgery was ineffective. Respondents ≥ 65 years old were significantly more likely to rely on primary-care referral (95% vs. 89%; p < 0.05) for selecting a surgeon and less likely to rely on health insurance, hospital name, and social media. The majority of respondents (73%) expected to return to baseline after surgery with only some minor limitations. Only 2% of respondents thought that the rate of any complication or likelihood of reoperation was ≥ 50%.

Conclusion: This study is the first of its kind to utilize an online crowd-sourced survey to comprehensively investigate perceptions of ASD and demonstrates a trend toward significantly lower scoliosis screening rates in respondents > 65 years old. While awareness was relatively high in domains, such as symptoms, diagnosis, and treatment, common misconceptions persisted regarding disease pathophysiology, expected recovery, complications, and pain; areas where perceptions underestimated risks compared with published outcomes. These findings highlight important knowledge gaps that may influence care-seeking behavior, referral patterns, and expectation management, demonstrating the need for targeted educational initiatives.

Introduction: Growing construct expansion surgeries in the setting of early-onset scoliosis (EOS) involve surgeon's feel to determine the optimal amount of distraction force to maximize correction and spinal length gained without compromising anchor integrity. Growing construct designs may require different amounts of distraction force to lengthen the spine or chest wall depending on the device used and various patient factors. Understanding these variations could guide appropriate force levels for the rational design for next-generation remote/external distraction devices and ultimately patient/deformity-specific lengthening forces.

Aim/objectives: The purpose of this study was to determine distraction force levels for expansion events in traditional growing rods (TGRs) and vertical expandable prosthetic titanium rib (VEPTR) constructs across patients with various anchor attachment points and etiologies of EOS.

Methods: With IRB approval, two different distraction devices (VEPTR distractor and TGR/rod distractor) were outfitted with electronic strain gauges to measure distraction force. Force data were recorded at a rate of 40 Hz during each surgery via a laptop connected to a PowerLab 8/35 data acquisition system. After each surgery, the distractor was validated on a custom calibration device. The data collected were then analyzed to determine the maximum force and average force during every distraction.

Results: From February 2019 to June 2023, a total of 146 in vivo distractions were collected on 52 patients with VEPTRs and 28 in vivo distractions were collected on 9 patients with traditional growing rods. TGR procedures required significantly higher forces than VEPTR (437.89 N vs 349.10 N, p < 0.001).

Conclusion: Modification of two different distraction devices with electronic strain gauges identified differences in distraction force between traditional growing rods and VEPTR constructs during expansion surgeries in children with EOS. Our findings highlight that implant type and potentially other factors may play significant roles in the amount of force required for lengthening the spine and chest wall. Current market implant technology (MCGR maximum force of 187 N) is likely underpowered compared to traditional technology across all construct types and disease classifications. These insights should inform the development of next-generation remote lengthening construct design.

Purpose: Though the use of anabolic bone agents has proven effective in adult spinal deformity (ASD) surgery, prescription and approval of these medications remains a challenge. In osteopenic/osteoporotic patients undergoing ASD surgery, we sought to determine the impact of a bone optimization clinic on: (1) prescription patterns of anabolic agents, (2) mechanical complications, and (3) reoperation.

Methods: A retrospective cohort study (2009-23) was performed for osteopenic/osteoporotic patients undergoing ASD surgery with ≥ 2-year follow-up. The study period was binarized into before/after a bone optimization clinic was established (2009-19 vs. 2020-23). The primary outcomes were: (1) use of anabolic agents prior to surgery (Teriparatide, Abaloparatide, and Romosozumab-aqqg), (2) mechanical complications, and (3) reoperation. Multivariable regression controlling for age, sex, body mass index, and operative time was performed.

Results: Of 126 patients (mean age 68 ± 10yrs; 86% female) undergoing ASD surgery with osteopenia (80%) or osteoporosis (20%), 91 (72%) were before the bone optimization clinic and 35 (28%) were after. Similar rates of osteoporosis in both groups were seen (pre-21% vs. post-17%, p = 0.638). After the bone optimization clinic, more patients received preoperative anabolic therapy (54% vs. 23%, p < 0.001) and for a longer duration (98 ± 156 vs. 40 ± 109 days, p = 0.027). Overall mechanical complications decreased significantly (49% vs 81%, p < 0.001) as did reoperation for mechanical complications (6% vs. 44%, p < 0.001). Multivariable regression showed that a bone optimization clinic independently improved the use of preoperative anabolic agents (OR = 5.3, 95%CI:2.1-13.4, p < 0.001) and reduced the risk of mechanical complications (OR = 0.2 95%CI:0.1-0.5, p < 0.001) and reoperation for mechanical complications (OR = 0.1, 95%CI:0.1-0.4, p < 0.001).

Conclusion: In osteopenic/osteoporotic patients undergoing ASD surgery, a bone optimization clinic was independently associated with increased prescription rates and duration of anabolic bone agents, reduced mechanical complications, and reduced reoperation for mechanical complications.

Background: Adolescent Idiopathic Scoliosis (AIS) affects over 1% of adolescents and is often diagnosed during a sensitive developmental period, with repeated radiographs, potentially increasing cancer risk. Previous studies have suggested an association between scoliosis and breast cancer, but have been limited by small cohorts, lack of matched controls, and incomplete registry data. The aim of this study, therefore, was to assess the hazard ratio (HR) of cancer among women with scoliosis compared to age-matched controls using nationwide registry data.

Methods: This observational cohort study included all Danish women born 1967-1977 with a scoliosis diagnosis (ICD-8 735.0/735.2 or ICD-10 DM411), and four age-matched controls per case, identified through national health registers. Cancer outcomes were obtained from the Danish National Cancer Register, and Cox regression was used to estimate HRs, with time at risk beginning at age 12.

Results: Among 6,217 women (1,238 (20% with scoliosis), the mean follow-up time was approximately 38 years. The HR (95% CI) for any cancer was 1.06 [0.85-1.31]. For breast cancer, HR was 1.25 [0.86-1.80], while HR for carcinoma in situ (CIS) of the breast was 13.62 [3.75-49.50]. Among 12 cases of ovarian cancer, the HR was 2.91 [0.92-9.18]. This study could not, however, discriminate between idiopathic and non-idiopathic scoliosis.

Conclusion: Women with scoliosis showed a significantly increased HR for CIS of the breast, and a non-significant trend toward increased risk of invasive breast and gynecologic cancers. Findings support further investigation into genetic or developmental links between scoliosis and cancer risk.

Key points: Women with scoliosis are at a higher risk of getting cancer, namely of the breast. Pregnancy did not appear to have a protective effect.

Purpose: Posterior spinal fusion (PSF) for scoliosis correction can be associated with substantial blood loss. Accurately characterizing risk factors and identifying strategies for minimizing blood loss are important for operative planning. Previous literature utilizes estimated blood loss (EBL), which may underestimate bleeding, and are limited in their usage of new anti-fibrinolytic medications and electrocautery technology. We sought to investigate blood loss difference in adolescent idiopathic scoliosis (AIS) and neuromuscular scoliosis (NMS) utilizing both EBL and calculated blood loss (CBL) based on height, weight, and hemoglobin values.

Methods: Retrospective review was conducted of children who underwent PSF for scoliosis correction from 2013 to 2021. EBL was determined from estimated intraoperative blood loss and measured postoperative drain output. CBL was computed as described by Foss et al. All values were further normalized based on vertebral levels fused and patient weight.

Results: Final cohort included 224 children with AIS and 76 with NMS. EBL significantly underestimated blood loss compared to CBL (882.2 ± 447.1 cc vs. 1315.0 ± 375.1 cc, P < 0.001 in AIS; 1132.9 ± 562.1 cc vs. 1455.2 ± 482.7 cc, P < 0.001 in NMS). CBL in patients with NMS was significantly higher than those with AIS (1455.2 ± 482.7 cc vs. 1215.0 ± 375.1 cc, P < 0.001). Per-level CBL, however, was lower in the NMS cohort, particularly in patients requiring fusion to pelvis.

Conclusion: EBL significantly underestimates blood loss compared to CBL. Patients with NMS have significantly greater blood loss than AIS. These differences appear to be driven by the extent of fusion. Updated guidelines would be valuable for more accurate determination of when to cross-match blood products prior to PSF for pediatric scoliosis.

Level of evidence: IV-Case series, diagnostic.