Spine deformity最新文献

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.

Purpose: The current body of literature has examined both pediatric and adult patients in concert with respect to single- versus dual-surgeon treatment of spinal deformity; however, to our knowledge, pediatric and adult outcomes have not yet been reported independently. We hypothesize that the favorable outcomes seen in pediatric spine deformity with a dual-surgeon approach may also extend to adult spinal deformity patients.

Methods: Databases were searched for studies involving surgeries around spinal deformities and the use of dual or single surgeons. For both dual- and single-surgeon group, details on rates of complications, operating room times, lengths of stay, blood loss, rates of transfusion, and reoperation rates were recorded. Categorical variables were reported in pooled odds ratio (OR) and continuous variables were reported in standardized mean difference (SMD). Alpha value of less than 0.05 was considered significant.

Results: In adults, the dual-surgeon approach was associated with decreased risk of complications (OR = 0.31, 95% CI, 0.21-0.46; p < 0.01). In pediatrics, the dual-surgeon approach was associated with a decreased length of stay (SMD = -0.93 days, 95% CI: -1.25 - -0.61; p < 0.01) and operating time (SMD = -82.20 min, 95% CI: -114.28 - -51.32; p < 0.01).

Conclusion: The results of this study demonstrated statistically significant decrease in length of stay and operative duration with a dual-surgeon team in pediatric patients. In adults, a dual-surgeon team had correlated with a significant decreased rate of complications. There exists a lack of sufficient adult data to determine differences in operative duration, length of stay, and blood loss. Further investigation may utilize larger datasets to better understand the impacts of the dual-surgeon approach for both adult and pediatric populations.

Purpose: To compare radiographic outcomes, patient-reported outcomes (PROs), and complications between L5 and sacropelvic fixation as the lowest instrumented vertebra (LIV) in long-segment fusion for adult spinal deformity (ASD).

Methods: Following PRISMA 2020 guidelines, PubMed, Web of Science, Scopus, and Embase were searched for studies comparing L5 vs. pelvic fixation in ASD. Studies with Newcastle-Ottawa Scale (NOS) ≥ 7 were included. Extracted data included demographics, radiographic parameters [pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA)], complications, and PROs [Scoliosis Research Society (SRS) and Oswestry Disability Index (OD)]. Meta-analysis used standardized mean differences (SMD) and odds ratios (OR). Heterogeneity was assessed with I², and publication bias with Egger's test.

Results: Nine studies (1196 patients; mean age 67.5 years; mean follow-up 36.5 months) were included. Pelvic fixation achieved better sagittal correction: lower PT (SMD 0.88, p = 0.005), higher LL (SMD - 0.76, p < 0.001), and lower SVA (SMD 0.82, p = 0.016). PROs were similar at baseline and follow-up (all p > 0.05). L5 fixation had shorter operative time (SMD - 0.78, p = 0.005) but higher distal junctional failure (DJF) risk (OR 2.62, p = 0.002). Predictors of DJF with L5 LIV included older age, extensive fusion, high pelvic incidence, facet degeneration, and poor baseline sagittal balance.

Conclusions: Pelvic fixation provides superior sagittal correction with comparable PROs and overall complications, while L5 fixation carries a 2.6-fold higher DJF risk. LIV selection must be individualized; pelvic fixation is strongly recommended for patients with advanced age (> 66 years), high pelvic incidence (> 52°), or severe sagittal malalignment to mitigate mechanical failure. PROSPERO ID Number: CRD420251129518.

Scoliosis, the most common spinal deformity in adolescents, requires frequent radiographic follow-up, exposing patients to cumulative ionizing radiation with potential long-term risks. In response, recent efforts have explored radiation-free alternatives for Cobb angle estimation, but most fail to meet the clinical threshold of a minimum significant change of 5°. In this study, we aimed to develop and internally validate a fully automated method for predicting Cobb angle using 3D surface topography (ST) data and a linear regression model (LRM). Principal component analysis was used to reduce the dimensionality of the ST data, and several machine learning models were compared, including neural networks, XGBoost and Stacking. The LRM showed the best performance in the test set, with a mean absolute error (MAE) of 3.97°, a root Mean square error (RMSE) of 4.70°, and a strong correlation with the ground truth (r = 0.91). Residual analysis confirmed normality and homoscedasticity, supporting the robustness of the model. Importantly, the MAE fell below the clinically significant threshold of 5°, indicating the model's ability to detect minimal but critical changes in spinal curvature. These results outperform most previous non-radiographic methods and suggest that a simple, interpretable LRM, combined with open-source tools and ST data, offers a viable and scalable solution for non-invasive scoliosis monitoring. If externally validated, this method could reduce reliance on x-rays, thereby reducing radiation exposure while maintaining assessment accuracy.

Background: The 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) is a condition-specific instrument to assess health-related quality of life in children with early-onset scoliosis (EOS). Previous studies have raised concerns regarding ceiling effects, i.e. clustering of scores at the upper limit, which may reduce the ability of the EOSQ-24 to detect clinical improvements.

Methods: A structured review of published clinical studies reporting EOSQ-24 scores was performed. Data were standardized to a 0-100 scale. For each domain weighted mean scores, standard deviations (SD), and ceiling effect percentages were calculated. A ceiling effect ≥ 15% was considered significant.

Results: Data from 16 studies were included. Significant ceiling effects were observed in the following domains: pulmonary function (28%), physical function (25%), overall satisfaction (22%), transfer (20%), financial burden (22%), daily living (18%), fatigue/energy level (18%), and emotion (16%). Lower ceiling effects were noted in general health, pain/discomfort, parental burden, and child/parent satisfaction domains.

Conclusions: Eight of EOSQ-24 domains exhibit marked ceiling effects, potentially limiting responsiveness to treatment effects in patients with high baseline function. These findings support consideration of revised scoring strategies or adjunctive measures in EOS outcome assessment. The presence of marked ceiling effect should be noted as a limitation in studies. Objective pulmonary function testing should be implemented in future studies.