Spine deformity最新文献

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: Various risk factors for curve progression during brace treatment in adolescents with idiopathic scoliosis (AIS) have been identified. However, curve-type-specific risk factors remain unclear. We aimed to identify risk factors for curve progression by curve type.

Methods: At our hospital, we analyzed 211 patients with AIS (200 females, 11 males). X-rays were obtained before and immediately after brace application. Patients were categorized into those requiring surgery during follow-up (Surgery group) and those avoiding surgery (Avoidance group). Univariate and multivariate analyses identified risk factors for curve progression. Subgroup analysis was performed based on curve type.

Results: Among all cases, 163 (77.3%) avoided surgery. In the univariate analysis, the Surgery group was significantly younger (p = 0.008), had a lower BMI (p < 0.001), a lower TOCI grade (p < 0.001), a lower Risser classification (p < 0.001), included more premenarcheal individuals (p < 0.001), had larger pre- and post-brace Cobb angles (p < 0.001), and fewer thoracolumbar/lumbar curves (p = 0.002) than the Avoidance group. Multivariate analysis showed that a lower TOCI grade (p = 0.005), thoracic curve type (p < 0.001), a larger post-brace Cobb angle (p = 0.001), and greater post-brace apical vertebral translation (AVT) (p = 0.006) were significant risk factors for requiring surgery. In both thoracic (N = 101) and thoracolumbar/lumbar curves (N = 110), the Surgery group had significantly larger pre- and post-brace Cobb angles (p < 0.001/p < 0.001 and p = 0.005/p < 0.001, respectively), and larger pre- and post-brace AVT (p = 0.049/p = 0.004 and p < 0.001/p < 0.001) than the Avoidance group.

Conclusion: In both thoracic and thoracolumbar/lumbar curves, reduction in the Cobb angle and AVT at the time of brace application is crucial for successful AIS management.

Introduction: There is a paucity of data on the use, efficacy, and safety of antifibrinolytic agents (AF) in patients with neuromuscular scoliosis undergoing growth-friendly instrumentation. Previous studies have shown mixed results of AF agents in young patients with neuromuscular conditions, and other authors have expressed concerns regarding adverse effects in this medically fragile population. The purpose of this study was to investigate the rate of use of AF agents for growth-friendly surgery in patients with neuromuscular scoliosis, and assess its impact on blood loss and transfusion requirements.

Methods: This is a retrospective cohort study of patients from a multicenter spine study group with neuromuscular scoliosis that underwent an index growth-friendly procedure. Patients with a history of venous thromboembolism and those undergoing revision surgery or lengthening surgery were excluded. Perioperative data were collected including patient demographics, type of instrumentation, use and type of AF agent, estimated blood loss (EBL), use and volume of cell saver, and intraoperative blood transfusion. Univariate statistics were used to determine differences.

Results: This study included 335 patients with a mean age of 7 years (SD: 2.6). Of these patients, 176 patients were managed with VEPTR/TGR instrumentation and 159 patients were managed with MCGR instrumentation. AF agents were used in 36% of index cases. In cases with AF use, TXA was the most frequently used agent (TXA:68%, ACA:21%). The use of AF increased over the study period from less than 10% before 2010 to 75% in 2020 (R² = 0.31). There was no statistical difference in EBL between patients who received AF agents compared to patients that did not receive AF agents (AF = 184.9 ml, no AF = 103 ml, p = 0.23). In addition, there was no difference in cell saver volume (AF = 127 ml, no AF = 145 ml, p = 0.88). The overall rate of intraoperative blood transfusion was low (8.5%). In this cohort, there was no significant difference in transfusion rates between groups (AF = 7.6%, no AF = 8.7%, p = 0.7). There was a high rate of postoperative blood transfusion (51.4%) in this cohort; however, there was no significant difference in postoperative transfusion rates between groups (AF = 62.1%, no AF = 50.5%, p = 0.62).

Conclusion: AF agents are being used for patients undergoing growth-friendly procedures with TXA being the most commonly used AF. However, there is no significant difference in EBL, cell saver volume, and intraoperative or postoperative transfusion rates between patients that do or do not receive AF agents for these procedures. Additional studies are needed to validate these results, as well as determine their efficacy, safety, and value in this medically fragile group.

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: 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.

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.

Purpose: Halo traction is frequently initiated in severe scoliosis or kyphosis prior to fusion surgery to achieve partial correction, improve surgical tolerance, and reduce neurologic risk from excessive intraoperative correction. Halo-gravity and halo-femoral traction are the most common modalities. Despite efficacy, traction carries risks, such as pin-site infection, skin breakdown, and neurologic complications. This systematic review aimed to categorize, quantify, and analyze complications of preoperative halo traction in pediatric patients across all spinal deformity etiologies, while identifying demographic and clinical trends.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, 28 publications were included. Two reviewers independently extracted demographic, clinical, and complication data. Complication burden was summarized as incidence rates (events per patient-day) and pooled with random effects meta-analysis (REML estimator, inverse-variance weighting). Pooled estimates were back-transformed to events per 100 patient-days with Knapp-Hartung confidence intervals.

Results: Across 777 patients (mean age 15.4 years, mean traction duration 62 days), the overall complication rate was 0.39 per 100 patient-days (≈1 per 256 patient-days). Implant-related complications, particularly pin-site infections, were most common (0.29 per 100 patient-days), whereas neurologic and systemic events were rare. Longer traction duration was associated with reduced incidence of complications per patient-day in traction (IRR, 0.98 per additional day; p = 0.0096), while no associations were identified with sex, age, or initial Cobb angle.

Conclusion: Halo traction is relatively safe, but associated with frequent implant-related morbidity across ages and deformity types. Vigilance and standardized protocols, particularly during the early phase of treatment, remain critical to minimizing risk.

Purpose: Bracing is the mainstay of treatment for growing adolescents affected by idiopathic scoliosis with curves between 25° and 45°. Previous randomized trials and prospective studies have indicated that duration of bracing is an important factor in preventing curve progression. We aimed to compare actual in brace time to prescribed time.

Methods: We prospectively collected heat sensor data to assess bracing adherence. We aimed to assess brace prescription versus actual wear time and if any demographic or curve factors affected this relationship.

Results: We identified 104 patients with minimum 6-month follow-up brace heat sensor data. Average brace prescription was 16.5 h/day, and wear time, as indicated by heat sensor, was 12.9 h. This constituted 3.6 less hours worn than prescribed (2.4-4.3; p < 0.001). Thoracic curves had decreased brace wear versus target compared to thoracolumbar/lumbar (T/L) curves. Curve magnitude was positively associated with total brace wear average, but was not associated with adherence versus target brace wear. Diminishing returns in brace wear times were noted with prescriptions over 16 h.

Conclusion: Brace adherence averages 3.6 h less than prescribed or 78.2% of the original prescribed time. Patients with larger curves were prescribed longer brace wear but did not have better adherence versus target. Thoracic curves had less adherence compared to T/L curves. The only modifiable independent risk factor we were able to determine for greater brace wear was prescribed hours. This information can be used to counsel patients during bracing treatment.

Introduction: In idiopathic scoliosis, the psychological and social effects of bracing can be difficult, thus clinicians sometimes recommend a brace holiday when the curve drops below 25°. While the Scoliosis Research Society has reached a consensus on bracing indications and duration, there is little evidence regarding outcomes from taking a break from bracing prior to skeletal maturity. We hypothesized there would be no relationship between taking a brace holiday and final primary curve.

Materials and methods: A retrospective cohort study at a single institution was performed for idiopathic scoliosis patients treated with a brace whose primary curve corrected to below 25° from 2016 to 2022. Objective bracing compliance I-button data was collected on patients aged 3 - 18 years old at the time of brace presentation. Patients with neuromuscular and syndromic etiologies of scoliosis and those ineligible for a brace holiday were excluded. Univariate analyses were performed as appropriate.

Results: 34 patients met inclusion criteria. Of these, 16 received a brace holiday (18 did not). At most recent follow up, primary curve size did not differ between those who received a brace holiday (23.1 ± 12.6°) and those who did not (21.7 ± 6.1°) (p = 0.772). Brace holidays lasted on average 17.8 ± 10.7 months, occurring at a mean age 10.6 ± 1.5 years in patients with a mean primary curve of 14.9 ± 3.6° at the beginning of the holiday. The mean age for patients who resumed bracing (n = 12) was 12.0 ± 0.9 years, at a mean primary curve of 29.3 ± 4.1°, with a most recent mean primary curve of 26.4 ± 12.4°.

Conclusion: This study demonstrates that select younger patients who take a brace holiday may not have clinically relevant differences in final primary curve magnitude compared to standard-of-care adolescents. This work offers evidence that can be valuable in the productive dialogue with families on the risks and benefits of a brace holiday.

Level of evidence: III.

Purpose: To examine the prevalence and association of mental health symptoms, social factors, and healthcare experiences in individuals diagnosed with Scheuermann's disease (SD).

Methods: We analyzed self-reported data from the Scheuermann's Disease Fund (SDF) CoRDS registry from September 2021 to March 2025, which included 168 patients. Of these patients, 106 self-reported a Cobb angle. Participants completed a 196-item questionnaire covering demographics, curve severity, mental health domains of anxiety, depression, PTSD, and social isolation, healthcare experiences, and social factors. Statistical analyses, including descriptives and chi-square tests (α = 0.05), were conducted with IBM SPSS Statistics v30.

Results: Patients diagnosed with SD in these specific cohort were between the ages of 11-20 (59.5%), 21-40 (28.0%), and > 41 (12.5%) years, with thoracic kyphosis Cobb angle < 60º (15.1%), 61-80° (40.6%) or 81° and above (44.3%). Patients often reported pain (73.2%), with 37.3% reporting severe pain or worse. In total, 46.1% reported anxiety, 45.2% reported depression, 9.6% reported PTSD, and 63.0% reported social isolation. Depression was associated with chronic pain (r = 0.27, p < 0.001), and anxiety was correlated with social isolation (r = 0.26, p = 0.001). Over 72.0% of the patients felt misunderstood, and 65.1% lacked mental health referrals to receive appropriate counseling. Patients expressed that they did not believe their physician could understand or treat their condition, with 52.6% visiting at least two to four doctors before finding adequate care that met their unique needs.

Conclusions: SD imposes substantial mental health burden, with many patients experiencing anxiety, depression, or feelings of social isolation. Many patients reported challenges in finding specialty care. These findings suggest the need for further research to determine whether earlier diagnosis and integrated care could improve outcomes.