Spine deformity最新文献

Purpose: To biomechanically compare screw strains above and below a vertebral column resection (VCR) during segmental compression (SC) and cantilever bending (CB) performed via traditional methods and a novel, construct-to-construct accessory rod ("rail") technique.

Methods: Eight cadaveric torsos underwent a VCR with 25⁰ kyphosis at T8 with pedicle screws implanted three levels above and below the VCR (T5-7; T9-11). Four screws (T6, T7, T9, T10) were instrumented with strain gauges to capture screw strains during SC and CB. Both deformity corrective maneuvers were performed over a traditional construct (central rod) and over a construct-to-construct accessory ("rail") rod. Real-time screw strains were collected and peak strains were compared between corrective techniques.

Results: Strains in screws closest to the VCR were significantly less during "rail" compression compared to traditional SC (T7: p = 0.015). Maximum screw strains were significantly lower during "rail" SC and CB compared to traditional SC (T6: p = 0.037; T7: p = 0.015) and CB (T6: p = 0.018; T9: p < 0.001). Total screw strain was more evenly distributed over all screws during "rail" compression and CB compared to traditional techniques, which concentrated strain at individual screws adjacent to the VCR.

Conclusions: Performing segmental compression and cantilever bending across a lateral accessory construct-to-construct ("rail") rod resulted in significantly lower strain on individual pedicle screws adjacent to a thoracic VCR compared to traditional SC and CB. As such, the "rail" may lessen risk of screw pull-out and screw plough during maneuvers to correct spinal deformities across a VCR.

Purpose: Screening for adolescent idiopathic scoliosis (AIS) using the Adam Forward Bending Test (AFBT) remains controversial, resulting in the discontinuation of scoliosis screening in the Netherlands. This study aims to validate the Scolioscope, a simplified version of the Scoliometer, for detecting scoliosis in a home setting.

Methods: A validation study was conducted at the orthopedic outpatient clinic of Erasmus Medical Center Sophia Children's Hospital in Rotterdam, the Netherlands. Patients aged 9-18 years with or without AIS and capable of performing the AFBT were included. The Scolioscope measurement of the parents was compared with the Scoliometer measured by an orthopedic surgeon. After unsatisfactory results with the initial Scolioscope version, a revised version was developed and tested.

Results: Among 100 patients included in the study, 79 had scoliosis. The revised version of the Scolioscope demonstrated a positive predictive value of 97%, a negative predictive value of 89%, sensitivity of 94%, and specificity of 94%. Parental measurements showed no variation, with an intra-observer reliability kappa value of 1.

Conclusion: The Scolioscope demonstrates high diagnostic accuracy and precision, making it suitable for use in at-home scoliosis screening programs.

Purpose: Proximal fixation in adolescent idiopathic scoliosis (AIS) surgery is a matter of discussion. All screw (AS) constructs provide better coronal correction than hybrid constructs, but high thoracic pedicle screw placement can be challenging. This study investigated whether an AS-construct provides better correction than a proximal double hook-claw (PH) construct.

Methods: AIS patients undergoing posterior spinal fusion (PSF) were randomized to AS-construct or PH-construct from 2016 to 2020 with a two-year follow-up. Primary outcome is the main thoracic (MT) Cobb angle correction after two years. Secondary outcomes are thoracic kyphosis (TK), proximal junctional angle (PJA), proximal thoracic (PT) Cobb angle, SRS-22r, and complications after two years.

Results: 60 patients (30 AS, 30 PH) were included. No baseline differences were found. Preoperative MT Cobb angle was 62° ± 11° (AS) vs. 65° ± 12° (PH). There was no statistical difference in MT Cobb angle after two years: 25° ± 9° (AS) vs. 27° ± 7° (PH) (p = 0.247). No difference in PT Cobb angle was found: 20° ± 9° (AS) vs. 21° ± 9° (PH) and TK: 23° ± 9° (AS) vs. 22° ± 7° (PH). SRS-22r improved in both groups with no statistical difference: 3.9 ± 0.5 to 4.3 ± 0.5 (AS) vs. 3.7 ± 0.5 to 4.3 ± 0.5 (PH). There were 13 complications (ten patients) in AS group and 17 (13 patients) in PH group, including 1 major complication in each group (deep wound infection).

Conclusion: AS-construct does not provide better coronal Cobb correction after two years after surgery. A PH-construct is a reliable and safe option for proximal fixation AIS patients. TRN: NTR-NL5552 (2016).

Trial registration: Overview of medical research in the Netherlands (OMON): NL-OMON43852.

Purpose: To measure the effects of posterior vertebral tethering (pVBT) on disc pressure and the effect of tether tension on growth modulation in the hyperkyphotic swine model, and to use computational modeling to predict growth modulation in scenarios unable to be tested in the animal model.

Methods: Swine were divided into non-operative control, single-level apical pVBT, or multi-level posterior pVBT groups. Pulsed fluorochrome labeling was used to measure regional vertebral growth rates, digital radiographs to assess changes in vertebral alignment, and pressure transducers to measure intervertebral disc pressures. Finite element analysis (FEA) was performed to simulate tether-mediated disc space correction.

Results: Kyphotic swine had significantly greater angular kyphosis than control swine at 11- and 13-weeks, and deformities increased from 2 to 5 months of age. At 2-weeks post-operative, high-tension single level tethering resulted in significantly greater growth modulation than low-tension (53 ± 43% vs - 1 ± 15%, p = 0.03) or non-operative controls (p = 0.01), however, at 2-4 weeks, growth modulation was normalized between the low and high tensioned cohorts (14 ± 11% vs 10 ± 10%, p = 0.6). The FEA predicted that growth plate stress distributions worsen as the average disc height post-realignment is decreased.

Conclusion: Increased tether tension results in more effective early growth modulation in the young flexible spine without increasing disc pressure, however, these tension-related benefits are transitory as growth modulation becomes load-independent with time. Computational modeling predicted that in the less flexible spine, vertebral growth may be arrested rather than modulated.

Purpose: Sagittal spinopelvic alignment (SPA) is originally calculated by the algebraic expression pelvic incidence-lumbar lordosis (PI-LL), heralded numerous clinically relevant radiographic measures of spine alignment, e.g., T4-L1-pelvic angle. SPA malalignment compromises spine fusion outcomes and quality of life of typically aging persons. This study investigated gait and SPA of patients with cerebral palsy (CP) using multiple sagittal radiographic measures.

Methods: Twenty-three patients, mean age 35 years with CP at GMFCS I-II were included. Radiographic measures included C2PA, T4PA, L1PA. PI-LL and T4-L1PA mismatch were defined as > 10°/ < - 10° and > 4°/ < - 4°, respectively. Trunk, pelvis, hips, and knees kinematics were obtained. Statistical parameter mapping (SPM) assessed kinematic differences throughout the gait cycle. Multivariable linear regression assessed the relationship between gait and radiographic parameters.

Results: Fourteen and eleven patients (60.9% and 47.8%) presented with PI-LL and T4-L1PA mismatch, respectively. PI-LL mismatched patients demonstrated significantly lower knee flexion during gait. T4-L1PA mismatched patients demonstrated increased anterior pelvic tilt, hip flexion, and decreased knee flexion during gait, which was consistent with SPM analysis. Multivariable linear regression showed T4-L1PA, C2PA, and anterior pelvic tilt were associated with knee flexion.

Conclusion: This is the first study to evaluate SPA parameters and gait kinematics in patients with CP. This observational and preliminary data suggested that SPA and knee flexion in gait may be associated. Whether the variations in gait patterns are coping mechanisms or the cause for SPA malalignment requires clarification. The implications of SPA malalignment on the quality of life of this population warrant further investigations.

Purpose: To investigate whether socioeconomic factors may predict brace adherence and curve magnitude in adolescent idiopathic scoliosis (AIS).

Methods: Patients with adolescent idiopathic scoliosis (AIS) who received a Boston Brace 3D (BB3D) thoracic-lumbar-sacral orthosis (TLSO) from January 2014 to October 2019 at a single center were reviewed. Brace adherence was objectively measured using temperature sensors embedded in orthotics. Brace wear was reported at 4 to 6 weeks (weaning period), 6 months, 12 months, 18 months, and 24 months since the first brace fitting. We abstracted demographic and socioeconomic variables including age, sex, race, ethnicity, median household income, insurance status, and pre-existing mental health conditions. Linear mixed-effect modeling was used to determine changes in adherence and curve magnitude at each visit.

Results: Among 62 patients (84% female, 63% White, 11% publicly insured), average adherence peaked at 6 months (79%) and declined to 64% by 24 months. Our findings suggest that males, on average, had 16% lower adherence to bracing compared to females (p = 0.035). Age at the pre-brace visit was found to be a statistically significant predictor of curve change at the 24-month follow-up, with each 1-year age difference associated with a three-degree increase in curve magnitude (p = 0.006). Other sociodemographic variables were not significantly associated with adherence or curve change.

Conclusion: Despite declining adherence over time, curve magnitude remained stable in most patients, aligning with bracing success criteria. Gender may predict brace adherence, while age may predict curve progression. Analysis of sociodemographic factors in this limited cohort suggests potential disparities in non-operative management that warrant further investigation in more diverse populations. Such insights may inform targeted counseling strategies to optimize long-term outcomes.

Purpose: To assess potential disparities in care for non-ambulatory children with cerebral palsy (CP) and associated neuromuscular scoliosis treated at a quaternary pediatric hospital.

Methods: This retrospective cohort study included non-ambulatory children CP who received spinal deformity surgery between 01/2012 and 12/2022. Demographic, clinical, and radiographic data were collected. Relationships between demographic factors and clinical/radiographic data were assessed using Fisher's Exact Test, Wilcoxon Rank-Sum test, Kruskal-Wallis one-way ANOVA, and linear regression models.

Results: Of 502 children identified, 328 met eligibility criteria. The mean age of the sample was 9.8 ± 4.0 years, 59% were male. On presentation, the average major coronal curve magnitude was 46 ± 23˚. Most (70%) were White, 13% were Black, 6% were Hispanic or Latino, and the remaining participants were Asian, Pacific Islander, Native American, Alaska Native, or declined to answer. Most spoke English (89%). Just under half (45%) had both government and commercial insurance and 24% had only government insurance. Black compared to White race (p = .03), government compared to commercial insurance (p = .02), and farther distance from hospital (p < .001) were associated with larger curve magnitudes at presentation, after adjustment for covariates. Non-English language (p = .002) was associated with longer time from surgical recommendation to surgery, after adjustment for covariates.

Conclusions: Health disparities were identified related to ethnicity, race, preferred language, and geographical distance from the hospital for children with CP and neuromuscular scoliosis. These findings highlight the need for development of standardized criteria for surveillance, imaging, and referral to reduce health disparities for this specific population.