Spine deformity最新文献

Objective: Scoliosis is primarily seen during adolescence and often causes significant concern among patients and their families when the deformity becomes noticeable. With technological advancements, patients frequently search the Internet for information regarding their disease's diagnosis, treatment, prognosis, and potential complications. This study aims to assess the quality of Google and ChatGPT responses to questions about scoliosis.

Methods: A search was conducted using Google with the keyword "scoliosis." The first ten questions listed under the "People Also Ask" (FAQs) section were recorded. Responses to these questions from ChatGPT and Google were evaluated using a four-level rating system: "Excellent response not requiring clarification," "satisfactory requiring minimal clarification," "satisfactory requiring moderate clarification," and "unsatisfactory requiring substantial clarification." Additionally, the sources of the responses were categorized as academic, commercial, medical practice, governmental, or social media.

Results: ChatGPT provided "excellent responses requiring no explanation" for 9 out of 10 questions (90%). In contrast, none of Google's responses were categorized as excellent; 50% were unsatisfactory, requiring substantial clarification; 40% were satisfactory, requiring moderate clarification, and 10% were satisfactory, requiring minimal clarification. ChatGPT sourced 60% of its responses from academic resources and 40% from medical practice websites. Conversely, Google did not use scholarly sources, with 50% of reactions derived from commercial websites, 30% from medical practice sources, and 20% from social media. When the agreement between the 4 raters, regardless of AI, was examined using Fleiss Multirater Kappa in the reliability analysis, a statistically significant (p < 0.001) moderate agreement (κ = 0.48) was found.

Conclusion: ChatGPT outperformed Google by providing more accurate, well-referenced responses and utilizing more credible academic sources. This suggests its potential as a more reliable tool for obtaining health-related information.

Purpose: This study aimed to identify independent risk factors for brace treatment failure, examine the correlation between initial in-brace Cobb angle and curve progression, and assess the relationships among age, curve type, initial in-brace Cobb angle, and treatment success.

Methods: Eighty consecutive patients (76 girls and 4 boys; mean age: 12.0 ± 1.2 years) commenced treatment with an underarm brace and were followed for a minimum of 2 years after brace initiation. Brace treatment failure was defined as a final Cobb angle of ≥ 50°, surgery, or curve progression ≥ 6°. A spinal surgeon evaluated standing long-cassette antero-posterior radiographs the pre-treatment, initial in-brace, and final follow-up time points. Multivariate analysis was conducted to classify patients into the bracing success and failure groups. We employed receiving operator characteristic analysis to determine cut-off values based on age and initial in-brace Cobb angle.

Results: The cohort of 80 patients were followed for a mean of 3.1 ± 1.2 years. Overall success rate was 62%, with 19 patients requiring surgery and 30 experiencing bracing failure. Bracing success cases exhibited significantly lower pre-treatment Cobb angle (29.1° vs. 31.7°; P = 0.038), lower initial in-brace Cobb angle (15.5° vs. 21.0°; P < 0.001), and higher in-brace correction rate (48.6% vs. 32.9%; P < 0.001). Multivariate analysis identified younger age (+ 1 year, odds ratio 0.44; P = 0.006) and higher initial in-brace Cobb angle (+ 10°, odds ratio 5.0; P = 0.009) as independent predictors of treatment failure, with cut-off values of 12 years and 16°, respectively.

Conclusion: For patients aged ≥ 12 years, controlling Cobb angle to < 16° at the initial underarm brace fitting may prevent significant curve progression and reduce the likelihood of surgery.

Purpose: Anterior vertebral body tethering (VBT) is a viable option for children with idiopathic scoliosis. Treating double major curves with bilateral VBT may allow patients to avoid spinal fusion while improving the coronal Cobb angle.

Methods: A single center retrospective study was conducted to identify all patients who underwent bilateral VBT (lowest instrumented vertebra L3 or 4) with minimum 2-year follow-up. Clinical and radiographic parameters were collected, including complications and reoperations. Statistical analysis was performed utilizing Students' t-test.

Results: Seventy-three patients (67 female, 91.8%) underwent bilateral VBT with mean follow-up of 4.2 ± 1.5 years. Preoperatively, all patients were skeletally immature (age 12.7 ± 1.2 years with a Sanders score of 3.3 ± 0.8 and Risser grade of 0.6 ± 0.8). The preoperative lumbar Cobb angle was 51.1° ± 7.9° which corrected to 20.7° ± 11.3° at most recent follow-up (p < 0.01) and the thoracic Cobb angle measured 52.3° ± 9.0° which corrected to 27.0° ± 11.3° (p < 0.01) at most recent follow-up. At latest follow-up, 51/73 (69.9%) had a thoracic Cobb angle <30°, 59/73 patients (80.8%) had a lumbar Cobb angle <30°, and 47/73 (64.4%) had both thoracic and lumbar Cobb angles <30°. 15 patients (20.5%) underwent 17 reoperations with overcorrection being the most common indication (8/17, 47.1%). Broken tethers led to reoperation in 3/17 instances (17.6%). Five patients (6.8%) eventually required posterior spinal fusion.

Conclusions: Bilateral VBT is a safe procedure and may be a viable option for patients with double curves, with the majority of curves measuring <30° at most recent follow-up. Surgeons can use these data to help patients and parents make informed decisions regarding treatment options.

Study design: This is a retrospective single-center study.

Purpose: The purpose is to investigate the incidence of distal junctional kyphosis (DJK) when fused proximal to the stable sagittal vertebra (SSV) in adolescent idiopathic scoliosis (AIS) patients undergoing selective thoracic fusion.

Methods: We retrospectively reviewed a consecutive cohort of surgically treated AIS patients with Lenke 1-2 A/B curves between 2011 and 2022 with a minimum of 2 years of follow-up. The SSV was defined as the vertebra bisected by the posterior sacral vertical line on long-standing sagittal radiographs. All patients underwent posterior pedicle screw instrumentation, and the decision of fusion level was at the surgeons' discretion. Distal junctional kyphosis was defined as ≥10° angulation between the lower instrumented vertebra (LIV) and the vertebra below the LIV (LIV + 1). Patients were stratified into Fusion proximal of SSV (Prox-SSV) and fusion including SSV (Incl-SSV). Multivariable backward regression was performed to identify predictors for DJK.

Results: A total of 196 patients were included, with 80 in the Prox-SSV group. The overall DJK rate was 3.6% (7/196), occurring in 6.3% (5/80) in the Prox-SSV group and 1.7% (2/116) in the Incl-SSV group, respectively (p = 0.125). Fusion proximal of SSV did not significantly increase DJK risk (Univariate OR 7.98, 95% CI 0.87-66.6; excluded in multivariable regression). Using SSV for LIV selection would extend the fusion by one level in 63.8%, two in 25.0%, and three in 11.2% of patients.

Conclusion: The overall risk of DJK is small in thoracic curves and fusion proximal to the SSV did not significantly increase the risk of DJK. Standardized use of SSV as LIV would result in a substantial extension of the fusion area with questionable benefits to the patients.

Purpose: To date, natural history studies on scoliosis development describe only curve progression but do not include its initiation. Around 50% of children with 22q11.2 Deletion Syndrome (22q11.2DS) develop a scoliosis. Longitudinal data from a large cohort of 22q11.2DS patients is available. This study aims to inventory the natural history of scoliosis development, starting before curve onset, in 22q11.2DS patients.

Methods: 22q11.2DS patients are biennially radiographically screened for scoliosis from age 6 to adulthood. All available radiographs were analyzed. Outcome measures were: skeletal maturity (modified Risser classification), coronal Cobb angles, curve angle fluctuation and treatment (bracing, surgery or no treatment). An evaluation was performed of scoliosis onset, risk of progression to > 30°, curve angle fluctuation and treatment.

Results: 722 full-spine standing radiographs of 292 patients were included. 116 (40%) of the patients developed a curve ≥ 10°, 44% of girls and 36% of boys. Thirteen (4%) progressed to a curve > 30° and seven (2%) required surgical treatment. In patients with radiographs before age 10, 49% already had a scoliosis. 22% of the patients already had a curve ≥ 10° at first visit. More fluctuation compared to a predicted trend line was seen in future scoliosis patients.

Conclusion: It appeared that many 22q11.2DS patients already have fluctuating spinal asymmetry before age 10, often without progression, and that only a subset develops a severe progressive deformity. This longitudinal dataset provides the opportunity for future risk-profiling to distinguish between stable versus progressive scoliosis for the 22q11.2DS population.

Purpose: Proximal junctional kyphosis (PJK) is a condition frequently encountered in children with early onset scoliosis (EOS) undergoing growth-friendly instrumentation (GFI). Previous studies have identified risk factors but have not compared the rate of PJK between children with connective tissue disease (CTD) and idiopathic EOS (iEOS).

Methods: Retrospective review of a multicenter spine database was performed. Patients with EOS undergoing GFI with a minimum of 5 years follow-up were identified and isolated to those with CTD (Marfan, Loeys-Dietz, Ehlers-Danlos, Soto, and Larsen) and idiopathic etiologies. PJK was defined as requiring revision surgery or as having > 10 degree change in proximal junctional angle (PJA). Surgical factors and implant variables were recorded. Radiographic parameters and complication development were compared between groups.

Results: A total of 253 children (mean 5.7 years, 57% female) were identified (CTD:49, iEOS:204). A total of 58 patients developed radiographic PJK (23%) with only 11 (18.9%, 4% of total cohort) undergoing revision surgery at 5 years following implantation. There were no identified surgical factors or radiographic variables associated with the development of PJK. In comparing the CTD and iEOS cohorts, there was no difference in PJK (CTD:26.5%, iEOS:22.1%; P = 0.5). Additionally, there were no significant differences between groups for preoperative or 5-year follow-up radiographic parameters, although there was a trend toward greater increase in PJA from post-implant to 5 years in CTD patients (CTD: 2.5 ± 13.8° vs - 0.01 ± 9.9; P = 0.08). CTD and iEOS patients gained similar thoracic heights, 26.6 ± 20.7 mm vs 26.9 ± 21.7 mm (P = 0.8). There was no difference in overall complication rate but CTD patients experienced a greater number of complications/patient (3.1 vs 2.0; P = 0.004).

Conclusion: PJK is a pervasive complication in EOS, occurring in 23% of patients undergoing GFI. Having an underlying CTD did not increase the risk of PJK development within 5 years of treatment.

Purpose: Implant-related complications can occur after the surgery for adolescent idiopathic scoliosis (AIS) and remain untreated for long periods until they become painful enough for intervention. This can result in a rigid deformity with vertebral fusion and disc degeneration within the scoliotic curve. This report aimed to emphasize the importance of early revision surgery illustrated in three unique cases.

Case description: The cases presented were as follows: a 48-year-old female who had experienced implant failure following posterior corrective fixation left untreated for 25 years; a 32-year-old female who had experienced implant failure following anterior corrective fixation left untreated for 16 years; and a 23-year-old male who had experienced pseudarthrosis following posterior corrective fixation and had been left untreated for 5 years following implant removal. All patients exhibited vertebral fusion and disc degeneration within the exacerbated major thoracolumbar/lumbar scoliotic curve as well as kyphotic deformity because of prolonged neglect after implant failure. In all cases, surgery required an anteroposterior combined procedure with anterior intervertebral release, posterior fusion mass osteotomy, and asymmetric pedicle subtraction osteotomy.

Conclusion: When implant failure occurs after AIS surgery, early surgical intervention can enable less extensive revision with reduced risk before stiffness and fusion of the bone mass develop. Regular long-term follow-up is therefore essential for early detection of implant failure. Moreover, when recommending revision surgery, it is critical to intervene at an appropriate time, ensuring that patients fully understand both the risks and benefits, including the psychological burden of residual deformity.

Purpose: To define anatomical landmarks on the vertebrae at each spinal level for surgeons to use intraoperatively as a guide for the placement of juxtapedicular screws in the setting of hypoplastic or absent pedicles.

Methods: Preoperative computed tomography (CT) of patients with adolescent idiopathic scoliosis (AIS) was analyzed for thoracic pedicles ≤ 3 mm wide, measured between the outer cortices at the isthmus, as these may require a juxtapedicular screw for safe placement. For these pedicles, a simulated juxtapedicular screw was placed into the vertebrae using image reconstruction software. The distance from the screw's insertion point was measured in the axial plane to the medial and lateral borders of the superior articular process (SAP) and to the posterior tip of the transverse process (TP), and in the sagittal plane to the junction of the SAP and TP. Screw trajectory angle was measured between the longitudinal axis of the screw and the sagittal and axial planes.

Results: Of 6324 pedicles, a total of 378 pedicles (6.0%) met inclusion. The average distance to the medial and lateral borders of the SAP was 14.7 ± 3.4 mm and 10.7 ± 5.4 mm, respectively; to the tip of the TP was 9.0 ± 3.9 mm, and to the TP/SAP junction 2.8 ± 1.6 mm. The average angle in the axial plane was 21.1 ± 4.4° and in the sagittal plane it was - 4.2 ± 3.6°.

Conclusions: Preoperative CT scans were used to map a safe starting point and trajectory for juxtapedicular screw placement in thoracic vertebrae. These findings can assist surgeons with thoracic pedicle screw placement.

Purpose: Magnetic controlled growing rods (MCGRs) are used to treat early-onset scoliosis when nonsurgical options fail, controlling curve progression and allowing for continued spinal growth. Recent reports of unplanned reoperations and mechanical failure of MCGRs have led to further research. This is a systematic review on the retrieval analysis of explanted MCGR rods. Understanding the failure mechanisms will shed light on the survivorship and complications associated with the implant.

Methods: A Medline and EMBASE database search was performed, looking at all variations in the terms "magnetic controlled growing rods" and the terms "retrieval/explant/metallosis" All published retrieval analysis studies of MCGR were included, and all clinical outcome studies, biomechanical testing studies, review articles, and case reports were excluded. Data were collected regarding the source, year, and aim of the study; number of patients and rods analysed; duration of implantation; and main findings and conclusions.

Results: Nine studies (454 rods) reported metallosis due to O-ring damage (67%), internal mechanism failure of locking pins (45%) and rod fracture (7%) in all MCGR generations. Actuator locking pin fractures reported in 174 rods (38.3%) continue to persist despite newer implant iterations. The pin fracture rates decreased from 52% in MAGEC 1.3 to 15% in MAGEC X.

Conclusions: MCGR failure is multifactorial, and metallosis is of significant concern because of the unknown long-term effects in patients. Early recognition and revision of existing rods in situ is essential, along with continued efforts to reduce mechanical failure in future iterations of MAGEC.

Levels of evidence: MCGR failure is multifactorial, and metallosis is of significant concern because of the unknown long-term effects in patients. Early recognition and revision of existing rods in situ is essential, along with continued efforts to reduce mechanical failure in future iterations of MAGEC. This systematic review provides Level III evidence on failure mechanisms in MCGR, as the results were obtained from Level III studies. The levels of evidence for all relevant references can be found in the reference section.

Level ii: [1-4].

Level iii: [5-34].

Level iv: [35-44].

Level v: [45-50].