Spine deformity最新文献

Purpose: Comparison of the clinical outcomes of halo-gravity traction (HGT) and halo-pelvic traction (HPT) was performed in the treatment of patients with severe rigid spinal deformity, with the aim of elucidating the clinical value of HGT and HPT in managing such deformities and providing evidence-based recommendations for surgical treatment planning.

Methods: A retrospective study was conducted of 20 patients treated at two large tertiary hospitals (2019-2022). All underwent posterior osteotomy correction and were categorized into HGT (n = 14) and HPT (n = 6) groups. Key parameters analyzed included radiographic measures (Cobb angles), pulmonary function tests (before and after traction/surgery), and intraoperative metrics such as blood loss, surgery duration, and osteotomy grade. Health-related quality of life was evaluated using the SRS-22 questionnaire.

Results: Baseline characteristics were comparable between groups. Compared to the HPT group, the HGT group showed significantly lower correction rates in both coronal and sagittal Cobb angles (P < 0.01), longer surgical duration, greater intraoperative blood loss, and higher osteotomy grade (P < 0.05). Improvements in FVC% and FEV1% were significantly smaller in the HGT group (P < 0.001). While both groups showed postoperative gains in SRS-22r scores, the differences between them were not statistically significant. No neurological complications occurred in either group; one case of iliac pin breakage in the HPT group was managed successfully without impacting the surgical outcome.

Conclusion: Both HGT and HPT were feasible and safe in the preoperative management of patients with severe rigid spinal deformity. In this limited cohort, HPT was associated with greater angular correction, improved pulmonary function, and reduced intraoperative complexity compared to HGT. While these findings are encouraging, larger prospective studies are warranted to validate the long-term efficacy and safety of HPT and to better inform clinical decision-making in high-risk spinal deformity cases.

Purpose: The complex relationship between spine deformity and self-image is incompletely understood. This study aims to evaluate how age affects self-image in idiopathic scoliosis.

Methods: Single-center study of adult (AdIS) and adolescent (AIS) idiopathic scoliosis patients treated with posterior spinal fusion (PSF). Preoperative and two-year postoperative patient-reported, radiographic, and perioperative outcomes were compared. Patients were grouped according to age, AIS (< 1 8 years), young adults (yAdIS, 18-40 years) and older adults (oAdIS, > 40 years).

Results: 176 patients were included, 54 AIS (ave. 15.8 years), 47 yAdIS (mean 25.2 years), and 74 oAdIS (mean 56.5 years). Preoperative curve magnitude was similar between groups (p = 0.0863). Postoperative, AIS and yAdIS had similar curves, but smaller than oAdIS (p = 0.0104) with similar corrections (p = 0.6476). AIS had lower EBL (p < 0.0001), shorter OR times (p < 0.0001), fewer levels (p < 0.0001) and pelvic instrumentation (p < 0.0001). AIS had greater preoperative self-image scores (3.5 vs. 3.1 vs. 2.5, p < 0.0001) with no difference seen postoperative (4.4 vs. 4.3 vs. 4.2, p = 0.1230). However, the greatest improvement was observed in oAdIS patients (p < 0.0001). Independent predictors of self-image scores varied by age and included anxiety/depression (β = - 1.057), BMI (β = 0.033), and postoperative CVA (β = - 0.021) for AIS; anxiety/depression (β = - 0.513) and curve correction (β = 0.0143) in yAdIS; and postoperative pelvic tilt (β = - 0.028, p = 0.0037) for oAdIS.

Conclusion: AIS patients had the highest preoperative self-image scores, followed by yAdIS and then oAdIS. However, the greatest improvement was observed in the older patients, despite more surgical morbidity. Mental health diagnoses were associated with worse self-image scores in AIS and yAdIS, though not oAdIS.

Study design: Retrospective case-series OBJECTIVE: The purpose of this study is to validate novel radiographic measures, specifically Rib-2 height (R2H) and T1-Rib-2 Change (T1R2C), as predictors of postoperative shoulder balance following adolescent idiopathic scoliosis (AIS) surgery. Shoulder balance following posterior spinal fusion (PSF) in AIS continues to be important for optimal aesthetic outcomes and patient satisfaction. Using currently accepted radiographic measures intraoperatively (e.g., T1-tilt) for the achievement of shoulder balance remains a challenge. Power analysis determined 28 patients were needed to achieve 80% power with an effect size Pearson's r = 0.5.

Methods: AIS patients who underwent PSFs were retrospectively identified when no further deformity correction was completed after the last intraoperative long-cassette radiograph. Traditional radiographic measures were completed. For intra-op patients, a reference vertical was used for all measurements. All measures were Pearson correlated with radiographic shoulder height (RSH) 6 weeks post-op (6wk) and 2y.

Results: There were 29 patients (26 female, 90%) whose mean age at surgery was 14.1 years. The mean RSH changed from -14.9mm pre-op to 5.4mm 2y post-op (p =1.9e-6). T1R2C and R2H demonstrated strong positive correlations pre-op (T1R2C r=0.7, p =0.0001) / (R2H r=0.6, p =0.001) to post-op (T1R2C r=0.8, p =2.23e-7) / (R2H r=0.6, p =2e-4). All radiographic variables showed significant correlations with RSH pre-op to post-op (p<0.001). Intraoperative R2H had intermediate associations with RSH at 6wks (r=0.48, p=0.018) and 2y post-op (r=0.4, p =0.04). Intra-op T1R2C and remaining coronal measurements showed no correlation with RSH. Linear regression models show a significant predictive relationship between RSH at 2y and intra-op R2H. The model was not improved when corroborated with intra-op T1R2C.

Conclusion: R2H was a significant predictor of RSH pre-op to post-op and intra-op to post-op, performing better than T1R2C and other radiographic measures. R2H could be used as an objective radiographic measurement tool to plan surgery and during surgery to optimize shoulder balance following PSF including T1-Rib-2 Change.

Introduction: Anterior vertebral body tethering (AVBT) has recently been utilized as a surgical alternative to posterior spinal fusion for a subset of pediatric scoliosis patients. Indications for AVBT are evolving and, while early results have been promising, there is a paucity of literature examining the behavior of the lumbar curve after exclusive tether of the thoracic region. It was hypothesized that thoracic tether leads to a spontaneous decrease in the un-instrumented lumbar curve.

Methods: The study population consisted of 166 patients with idiopathic scoliosis enrolled in the Pediatric Spine Study Group registry undergoing thoracic tether with a minimum of two-year follow-up. Exclusion criteria included: patients with non-idiopathic scoliosis, patients with prior spine surgery, and patients instrumented below L1.

Results: Overall curve correction was notable, with mean pre-op, immediate post-op, and two-year follow-up angles of 51.3°, 29.7°, and 30.3° respectively for the thoracic curve and 32.7°, 22.9°, and 24.1° respectively for the un-instrumented lumbar curve. Overall, 124 subjects (74.7%) had a decrease in lumbar curve > 5° immediately post-op. Over a two-year follow-up period, 32 subjects (19%) had a continued decrease in lumbar curve > 5°, 91 subjects (54%) had minimal change, and 43 subjects (26%) had an increase in lumbar curve > 5°. In a subgroup analysis of 36 subjects with a decrease in thoracic curve > 5° from post-op to two-year follow-up, 11 subjects (31%) had a concomitant decrease in lumbar curve with only 5 (14%) showing an increase in lumbar curve > 5°. The changes in lumbar curve from pre-op to post-op and from post-op to two-year follow-up were found to be associated with changes in the thoracic curve for the same periods (rho = 0.603, p < 0.001; rho = 0.413, p < 0.001 respectively). When considering Lenke lumbar modifiers, the un-instrumented lumbar curve corrected an average of 35%, 27%, and 20% following surgery and 27%, 30%, and 17% at two-year follow-ups for A, B, and C curves respectively (p < .001 for all data points compared to pre-op).

Conclusion: Lumbar curves tended to mirror the behavior of the maximal thoracic curve in terms of correction or decompensation both during surgery and during the two-year follow-up. Furthermore, un-instrumented lumbar curves with a Lenke C modifier tended to achieve a lower percentage correction. These data provide clearer insights into the response of the lumbar curve following thoracic tethering and the effect of growth modulation.

Purpose: The efficacy of bracing for juvenile idiopathic scoliosis (JIS) remains controversial. Although full-time bracing is standard for curves > 25°, part-time bracing for smaller curves (< 25°) may prevent progression. This study evaluates the effectiveness of part-time bracing compared to observation in JIS patients with 15-24° curves, hypothesizing that part-time bracing reduces curve progression and the need for full-time bracing.

Methods: This retrospective cohort study reviewed skeletally immature JIS patients (4-10 years old) with 15-24° curves. Patients underwent either observation or part-time bracing (8-12 h/day). Minimum two-year outcomes included: (1) curve change (> 5°), (2) progression to > 25° requiring full-time bracing, and (3) prescription for full-time bracing.

Results: Eighty-three patients (59% observed, 41% braced) were analyzed. The braced cohort demonstrated slightly higher baseline curves (+ 1.6°, p = 0.01). By final follow-up, braced patients improved by 3.2° (p = 0.05), while the observed cohort worsened by 3.4° (p = 0.05). More braced patients improved > 5° (69% vs. 21%, p < 0.001), whereas more observed patients progressed > 5° (54% vs. 11%, p < 0.001) and to > 25° (54% vs. 20%, p = 0.002). Full-time bracing was prescribed for 63% of observed patients but only 17% of braced patients (p < 0.001).

Conclusion: Part-time bracing not only prevents curve progression, but also frequently leads to improved curve magnitude in JIS patients with smaller curves, minimizing the need for full-time bracing.

Purpose: Shoulder balance is an important parameter while assessing the scoliosis deformity from a patient as well as clinician's perspective following the treatment. While there is uniform consensus about the importance of shoulder balance in scoliosis patients, what constitutes shoulder symmetry is still debatable. The aim of the study was to evaluate radiographic and clinical parameters both for medial and lateral components of shoulder balance.

Methods: A prospective database of scoliosis was reviewed. Patient demographics and radiological parameters, including radiographic shoulder height, clavicle angle, T1 tilt, first-rib angle, coracoid height difference, and clavicle rib intersection distance, were recorded. Shoulder angle, axillary angle, neck trapezius angle, lateral and medial shoulder height, axillary height, and neck height were recorded for clinical parameters by two independent observers. SRS-22r score was used for patient-reported outcome measure.

Results: 57 patients (AIS = 31, EOS = 26) were recruited. Intra-observer and inter-observer reliability was excellent for both radiographic and clinical parameters. Most of the radiological parameter had poor-to-moderate correlation with clinical parameters except Radiological Shoulder Height with Lateral Shoulder Height (r = 0.6, p < 0.05) and First Rib Angle with Medial Shoulder Height (r = 0.6, p < 0.05) having strong corelations. On comparing EOS and AIS patients for radiographic and clinical parameters correlation, no significant difference was found between two groups. First rib angle, neck trapezial angle, and neck height were significantly higher in medial shoulder imbalance group, while coracoid angle, radiological shoulder height, coracoid height difference, and shoulder angle were significantly higher in lateral shoulder imbalance group.

Conclusions: The results indicated that radiographic parameters could only partially reflect the clinical appearance of shoulders. In surgical planning of deformity correction, both medial and lateral components of shoulder balance should be taken into consideration for both radiological and clinical parameters. Level of Evidence Diagnostic study, Level III.

Purpose: To evaluate the long-term cancer risks associated with AIS, focusing on the roles of genetic predispositions and radiation exposure.

Methods: A comprehensive systematic search was conducted on August 5, 2024, across PubMed, EMBASE, Scopus, Cochrane Libraries, and CINAHL, covering studies from 1947 onward. Human studies on patients with scoliosis diagnosed before age 20 were included. For cancer assessment, both risk, incidence and mortality were included. Studies were excluded if they focused solely on congenital or secondary scoliosis. Screening and quality assessment were conducted using Covidence. The first author performed the initial screening, while the first and second authors conducted full-text assessments and quality assessment collaboratively, with an agreement score of 0.83.

Results: Seven studies from the USA, Australia, Denmark and The Netherlands were identified. Notable findings included elevated breast cancer risks among US cohorts, linked to historical radiographic practices that delivered higher radiation doses. None of the included studies assessed genetic etiologies of cancer. Risk of bias in the studies were generally attributed to selection bias and underreporting of characteristics and confounding variables. While most studies included either showed a tendency or a significant association towards an association between scoliosis and risk of cancer, it was mainly based on data before 1990 with exposure to radiation several orders of magnitude larger than modern standards. These changes could be a major factor in the risk of cancer identified in historical cohorts.

Conclusion: This review highlights the importance of continued research, including the effect of modern examination techniques, such as EOS, MRI on rates of cancer in modern populations.

Purpose: A subset of adult spinal deformity (ASD) patients undergoing corrective surgery receive a disproportionate level of medical resources and incur greater costs. We examined the characteristics of such super-utilizers of health care resources among ASD patients.

Methods: This prospective, multicenter study analyzed data from ASD patients with > 4 levels of spinal fusion and a minimum 2-year follow-up. Index and total episode-of-care (EOC) costs in 2022 US dollars were calculated using average itemized direct costs obtained from administrative hospital records. Patients with total 2-year EOC cost > 90th percentile were considered super-utilizers, the characteristics of which we identified through a multivariate generalized logistic model.

Results: Of 1299 eligible patients, mean age was 60 years, 73% were female and 92% were Caucasian. Super-utilizers were older (+2.1 years; p = 0.012), had greater depression (34.2 vs 25.7%; p = 0.03), increased frailty (p = 0.009) comorbidities (p = 0.005), higher reoperation rates (54.4 vs 15.0%; p < 0.001), hospital length of stay (+ 3 days; p < 0.0001), higher surgical invasiveness (+28.6; p < 0.001), more vertebrae fused (+ 3; p < 0.0001); interbody fusions (80 vs 55%; p < 0.0001), bone morphogenetic protein (BMP) use (87.3 vs 69.4%; p = 0.0001), operative time (+91 min; p < 0.0001), and blood loss (+620 mL; p < 0.0001) compared to other ASD patients. Index cost was 65% (p < 0.0001), and cost/quality-adjusted life-year was three times higher among super-utilizers.

Conclusion: ASD patients with depression who undergo more complex or revision spinal surgical procedures are more likely to be super-utilizers. Identifying likely super-utilizers within the ASD population may enable targeted interventions and preoperative planning to reduce unnecessary costs, while improving patient outcomes.

Background: S2 Alar-Iliac (S2AI) screw placement is a common method to achieve stable lumbosacral fixation in the setting of multilevel fusion constructs. Differences in pelvic morphology between males and females can result in a more medial screw starting point in males. This can affect the ability to easily connect the pelvic screw to the rest of the construct. The purpose of this study is to assess the impact of sex and pelvic anatomy on the location of S2AI screw placement and lumbosacral rod alignment in the coronal plane.

Methods: Consecutive cases with S2AI screw placement were identified. Radiographic measurements included the distance between the posterior superior iliac spine (PSIS) on preoperative computed tomography (CT) imaging, distance between S2AI screw heads, and rod-to-rod angles.

Results: Females exhibited significantly greater distance between PSIS compared to males, reflecting sex-based anatomical differences in pelvic structure (p < 0.01). Average rod-to-rod angles were significantly more convergent distally in males than in females (p < 0.05). No significant differences were observed between freehand and stereotactic navigation techniques for rod-to-rod angles or screw distances. PSIS distance was a strong predictor of both rod-to-rod angle (β = 3.3, p < 0.01) and screw distances (β = 0.3, p < 0.01). When evaluating sex and technique as predictors, only sex was significant for PSIS distance (p < 0.01) and rod-to-rod angle (p < 0.05).

Conclusions: The placement of S2AI screws demonstrate sex-based anatomical differences in the location of S2AI screw placement. These anatomical differences should be taken into account in preoperative planning.