Spine deformity最新文献

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: This study evaluated racial disparities in health perception, health literacy, and barriers to care in patients with adult spinal deformity (ASD).

Methods: We conducted a cross-sectional study using the National Institutes of Health All of Us survey database. Adult patients with spinal deformities were identified using ICD-9/10 codes and categorized by race: non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic or Latino (HL). Survey responses regarding demographics, socioeconomic status, health status, health perceptions, health literacy, and barriers to healthcare were compared between groups.

Results: In our cohort of 9271 patients, 69.7% were NHW, 15.7% were NHB, and 14.6% were HL. NHW patients reported the highest education, annual income, employment, married status, and home ownership (p < 0.001). HL patients reported both the highest and lowest fatigue (p < 0.001). NHB patients reported more pain (p < 0.001), while the HL cohort reported more emotional problems (p < 0.001). NHW patients accomplished more everyday activities (p < 0.001). HL patients had the worst self-perceptions of health (p < 0.001) and the least health literacy (p < 0.001). NHW patients were the least worried about paying for care (p < 0.001); however, they more often reported delaying prescriptions to save money (p = 0.041) and not being able to afford dental or specialist care (p < 0.001), deductibles (p = 0.003), or copays (p < 0.001). NHB patients experienced more transportation issues (p < 0.001), and HL patients experienced more issues with childcare or getting time off work (p < 0.001).

Conclusion: Our study points to racial disparities in self-perception of health, literacy, and barriers to care among ASD patients.

Purpose: This study compares the range of motion (ROM) in all three planes in patients with Scheuermann kyphosis (SK) to healthy controls using surface topographic (ST) scanning.

Methods: SK patients and healthy controls between 11-21 years old were recruited prospectively. Patients underwent ST scanning in maximal forward bend, twist to the right and left, and side-bend to the right and left. Sagittal, axial, and coronal ROM were computed using an automated pathway. An analysis of variance was used to determine significant differences in the ROM (coronal, axial, and sagittal) and asymmetry (coronal and axial) of SK patients versus controls. Scoliosis Research Society (SRS) 22r total, self-image, pain and function, as well as Patient-Reported Outcome Measurement Information System (PROMIS) mobility, physical activity and pain interference scores, and HSS Pedi-FABS were collected for all patients.

Results: 23 patients with SK and 98 controls were analyzed. SK group was 78.3% male with BMI of 24.1 kg/m², average thoracic kyphosis angle of 75.0°. Control group was 55.1% male with a BMI 20.9 kg/m². Compared to controls, patients with SK had 18.0° less sagittal, 12.0° less coronal ROM, and 15.5° less axial ROM. Controlling for age, sex, BMI, HSS Pedi-FABS did not change significance except for axial asymmetry index when controlling for sex. Patients with SK had lower SRS22r pain scores (4.1 vs. 4.4, p = 0.023), SRS22r self-image scores (3.5 vs. 4.5, p < 0.001) and SRS22r total scores (3.9 vs. 4.4, p < 0.001) compared to controls.

Conclusions: Patients with SK have reduced ROM in all three planes measured by ST, compared to controls. The restriction in motion is accompanied by lower SRS22r pain and total scores, indicating that motion may play an important role in a patient's quality of life. This study is limited by the lack of evaluation of extension when assessing sagittal range of motion, which has previously been documented to be compromised by SK.

Purpose: Vertebral Body Tethering (VBT) is a motion-preserving surgical technique for treating adolescent idiopathic scoliosis (AIS), particularly for thoracolumbar (TL) curves. While the technique has demonstrated potential benefits, its outcomes remain less predictable compared to posterior spinal fusion (PSF), with complications, such as tether breakages and revision surgeries. This study evaluates the impact of surgical experience and implant modifications on the outcomes of TL VBT for Lenke type 5 curves.

Methods: A retrospective analysis was performed on all consecutive AIS patients who underwent TL VBT from 2017 to 2022. The cohort was divided into three groups based on surgical technique and implant evolution: Group 1 (single-tether), Group 2 (double-tether), and Group 3 (advanced experience with 2nd generation implants). Radiographic outcomes, success rates (defined as a postoperative Cobb angle ≤ 30°), and complications were analysed at 1- and 2-year follow-ups.

Results: 30 patients were included. Average correction rates were 53.7%, 62.6%, 71.2% for groups 1, 2, and 3. Group 3 had a 100% success rate at 2 years, compared to 42.9% in Group 1 and 40% in Group 2 (P = 0.010). Early tether breakage rate (at 1 year) significantly correlated with experience (85.7% vs. 40% vs. 12.5%). Revision rate was 28.6% for Group 1 and 0 for groups 2 and 3.

Conclusions: These findings suggest that advanced surgical techniques and improved implants are key to achieving superior radiological outcomes and reducing revision rates.

Introduction: Adult spinal deformity surgery is frequently performed to address degenerative conditions and scoliosis, but postoperative complications such as proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common. These conditions can lead to neurological deficits and compromised surgical outcomes. This systematic review and meta-analysis aimed to evaluate the prevalence of neurological deficits associated with PJK and PJF.

Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. A comprehensive search was performed across multiple databases, including PubMed, Web of Science, Cochrane, Embase, and Scopus, with no language restrictions. Studies that reported neurological deficits following PJK or PJF after adult spinal deformity surgery were included. Data extraction and quality assessment were performed by two independent authors using NIH quality assessment tools. Meta-analysis was conducted using random-effect models, and heterogeneity was evaluated using I².

Results: Thirteen eligible studies were identified involving 2846 patients. Of these, 777 patients developed PJK or PJF, with 61 patients experiencing neurological deficits. The pooled prevalence of neurological deficits was 6.2% for PJF (95% CI: 0.062-0.192; p < 0.001) and 7.1% for PJK (95% CI: 0.027-0.115; p < 0.001). Heterogeneity amongst the studies was high for PJF (I² = 70.25%) and low for PJK (I² = 14.47%).

Conclusion: This study highlights the incidence of neurological deficits following PJK and PJF in adult spinal deformity surgeries. Future research should focus on identifying the risk factors and utilising evidence-based strategies that can improve postoperative care and reduce complication rates.

Objectives: The role of facet joint tropism (FJT) in degenerative spinal disorders such as disc herniation, spondylolisthesis, and lumbar canal stenosis is well-established. However, its association with adult spinal deformity (ASD) remains underexplored. Hence, we aim to study the correlation of FJT with spinopelvic parameters and lumbar paraspinal muscle morphology in ASD patients.

Materials and methods: We analysed 117 patients with ASD from 2021 to 2024. An absolute value difference (ΔFJA) of more than 10 degrees between the right- and left-facet joint angle (FJA) was defined as FJT. We considered patients with FJT at the apex vertebra as the FJT + group and with ASD but without FJT as the FJT- group.

Results: The mean ΔFJAs between the FJT + (n = 45) and FJT- (n = 45) were 17.14 and 5.38, respectively. For Cobb angle (CA) > 40˚ (n = 13), 84.6% (n = 11) belonged to the FJT + group. For CA 10-19˚(n = 28), 78.6% (n = 22) belonged to the FJT- group. Of the radiological parameters, differences in CA (p = 0.012), pelvic incidence (PI) (p = 0.031), grades of vertebral body rotation (VBR) (p = 0.022), facet joint osteoarthritis grades (FJOA) (p = 0.040) and cross-sectional area (CSA) of concave multifidus muscle (MF) (p = 0.010) were statistically significant between both the groups. The CSA of MF was decreased on the concave side (2.45 cm²) compared to the convex side (3.70 cm²) and was negatively correlated with ΔFJA (R² = 0.642, p = 0.020). The ΔFJA had significant positive correlation with CA (R² = 0.550, p = 0.010), PI (R² = 0.624, p = 0.030), grades of VBR (R² = 0.610, p = 0.007), and grades of FJOA (R² = 0.780, p = 0.005).

Conclusions: Patients with ASD and FJT exhibited greater Cobb angle, higher PI, higher grades of FJOA and VBR, and lower CSA of concave MF. However, the role of facet joint tropism in adult spinal deformity-whether causal or compensatory-warrants validation through longitudinal, long-term studies.

Level of evidence: Level III.

Purpose: The purpose of the study is to assess the MRI predictability of pedicle dimensions in AIS patients with curve magnitude more than 50° and to determine the influence of curve magnitude and vertebral rotation on MRI predictability.

Methods: The study included a comparative analysis of preoperative MRI (pMRI), and intraoperative CT (iCT) scan images of surgically corrected AIS patients with a curve magnitude of more than 50°. Bilateral T2-L4 pedicle levels were evaluated to measure the chord length and isthmic diameter in pMRI and iCT axial cuts. Vertebral rotation was assessed using the Nash and Moe method. Patients were categorised based on structural curve magnitude into group 1 (50°-70°), group 2 (71°-90°), and group 3 (> 90°).

Results: A total of 1860 pedicles in 62 patients were analysed. Comparison between iCT and pMRI measurements showed excellent reliability (ICC > 0.90) for pedicle diameter at all levels except the apical levels. Comparison based on curve magnitude revealed at the apical levels showed good correlation (ICC = 0.87) in Group 1, moderate correlation (ICC = 0.75) in Group 2 and poor reliability (ICC = 0.37) in Group 3. However, the pedicle length showed excellent reliability (ICC = 0.92) across all three groups. Moreover, MRI reliability for predicting vertebral dimensions decreased as the degree of rotation increased.

Conclusions: Both the curve magnitude and vertebral rotation significantly impact the MRI prediction of the pedicle dimensions, with predictability decreasing as the curve magnitude and vertebral rotation increase.

Purpose: The purpose of this study is to evaluate how 2-year postoperative SRS scores for patients with adolescent idiopathic scoliosis (AIS) who underwent spine fusion have evolved over time.

Methods: Single center, retrospective review of AIS patients who underwent fusion between 2002 and 2020. Patients were included if they completed SRS questionnaires preoperatively and 2-years postoperatively (21-49 months). The SRS has seven scoreable domains: Pain, Appearance, Activity, Mental Health, Subtotal (calculated with the four previous domains), Satisfaction, and Total Score. Domain score range from 1 to 5 (worst-best). Multivariable linear regressions were performed on 2-year SRS domain scores. The primary variable was calendar year of SRS completion, but variables also included: preoperative SRS scores, gender, race, age, and time since surgery (months). Subsequently multivariable linear regressions were performed for the change in SRS scores between preoperative and 2-year.

Results: Seven hundred eighty seven patients (83.7% female, age 14.3 ± 2.0) were included in this study. Of the variables included, preoperative SRS scores, gender, race, and time since surgery contributed significantly to the regression models. More recent calendar years for SRS completion were associated with worse Mental Health and Activity domain scores (coefficient = - 0.010, p = 0.0432; coefficient = - 0.007, p = 0.0340). Each additional year was associated with a ~ 0.01 decline in Mental Health and Activity scores. Regression analysis between preop and 2-year scores found that patients with more recent SRS completion years had greater improvements in Pain and Subtotal scores (coefficient = 0.014, p = 0.013, coefficient = 0.009, p = 0.023).

Conclusion: AIS patients undergoing spinal fusion in more recent years report worse HRQoL in the Activity and Mental Health domains postoperatively. However, Pain and Subtotal scores had greater improvements from preoperative to 2-year, suggesting a mitigating effect of surgery in the setting of declining preoperative scores.