Spine deformity最新文献

Purpose: This study aimed to investigate the effect of 3D rapid prototyping(3DRP) curve-specific scoliosis model in pedicle screws placement, and contrast it with standard free-hand techniques.

Methods: A retrospective review on scoliosis patients operated on by a single surgeon from 2014 to 2018 identified 48 patients with curve-specific models manufactured by 3DRP and used intra-operatively for guidance of instrumentation. They were age and gender-matched to 48 scoliosis patients in whom pedicle screws were placed following the standard free-hand technique. Screw position was determined on CT by a grading system as Grade 0 (no violation), Grade 1 (< 2 mm perforation), Grade 2 (< 4 mm perforation), or Grade 3 (> 4 mm perforation).

Results: 1485 screws (686 in the 3DRP group vs. 799 in the control group) were analyzed. Patients in the 3DRP group had higher Cobb angles and more challenging deformity. Although the overall percentages of critical perforations (those with risk of complications) were comparable between the two groups, the distribution of screw perforation were different. Screws in the 3DRP group were less likely to be critical both medially and laterally, and more likely to be critical anteriorly. Furthermore, laterally and anteriorly, the difference between them were largely due to a difference in Grade 2 perforation, whereas medially, the difference resulted from a higher percentage of both Grade 2 and Grade 3 perforation.

Conclusion: 3DRP scoliosis model represents an affordable and accessible approach to reduce medial pedicle screw perforation with high risk of complications in the thoracic and lumbar spine.

The incidence of spine-related pathologies is expected to increase in developed countries due to ongoing fundamental demographic shifts toward an older population. These changes present significant challenges to public health, as healthcare systems worldwide must confront the burden of musculoskeletal aging and its related consequences. Here, we synthesize current knowledge on the biologic mechanisms underlying musculoskeletal aging, focusing on the implications for the aging spine. The complexity of the aging process, characterized by a convoluted interplay between genetic, environmental, and lifestyle factors, necessitates a comprehensive understanding of the biologic processes and reliable methods of surveying biologic states to inform effective diagnostic, predictive, and prognostic strategies. Biomarkers emerge as invaluable tools in this domain, offering insights into the early detection, risk assessment, and targeted intervention for age-related musculoskeletal decline. This review highlights various biomarker types including diagnostic, predictive, and prognostic, and explores their distinct roles in enhancing our understanding of musculoskeletal aging. Navigating the interconnected landscape of cellular senescence, sarcopenia, osteoporosis, and frailty, this review underscores the critical importance of developing personalized care approaches for the aging population. By identifying and integrating functional biomarkers, researchers and clinicians can elucidate the underlying mechanisms and devise tailored strategies to alleviate the musculoskeletal decline associated with the aging process. We envision an "active surveillance" future where biomarkers of musculoskeletal aging are integrated into clinical practice, empowering clinicians to make proactive, data-driven decisions that improve spine health for older adults.

Purpose: To evaluate the concurrent validity of 3 Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric metrics (Mobility, Pain Interference, and Anxiety) in Early Onset Scoliosis (EOS) by using the 24-item EOS Questionnaire (EOSQ-24) as an anchor.

Methods: We retrospectively reviewed PRO data of children with EOS from April 2021 to June 2023. PROMIS Pain Interference, Mobility, Anxiety, and EOSQ-24 were simultaneously completed. Comparisons were made according to each EOSQ-24 domain with Pearson correlations. Correlations above 0.7 indicate a strong relationship, 0.4 to 0.69 indicate a moderate relationship, and 0.1 to 0.39 indicate a weak relationship.

Results: 236 children (84 boys, 152 girls) ages 10.4 ± 3.5 years (range: 5-19 years) with curves averaging 39° ± 22° were included. The strongest correlations between the 3 PROMIS metrics and each EOSQ-24 domain were between Mobility and EOSQ-24 Physical function (r = 0.75, p < 0.001), Pain Interference and EOSQ-24 Pain/discomfort (r = -0.68, p < 0.001), and Anxiety and EOSQ-24 Emotion (r = -0.51, p < 0.001). The weakest correlations between all 3 PROMIS metrics and each EOSQ-24 domain were for General health (r ≤ 0.35, p < 0.001), Financial impact (r ≤ 0.36, p < 0.001), and Pulmonary function (r ≤ 0.39, p < 0.001).

Conclusion: The 3 PROMIS metrics (Mobility, Pain Interference, Anxiety) demonstrate moderate to strong validity with the related EOSQ-24 domains (Physical function, Pain/discomfort, Emotion). The weak associations between EOS-specific concerns demonstrate diverging constructs. This study supports the use of the EOSQ-24 given the adequate associations with the appropriate domains while highlighting the value of other EOSQ domains.

Purpose: To evaluate the biomechanical performance of a novel Bezier surface-smoothed transition rod, and to compare it to conventional and stepped rods, focusing on correction capability, spinal stabilization, instrumentation and spinal loading related to risk of proximal junctional kyphosis (PJK).

Methods: A spine finite element model with patient-specific 3D spinal geometry (severe sagittal imbalance from thoracolumbar kyphosis) was used. Surgical instrumentation with five rod types was simulated: (1) constant 6.0 mm diameter, (2) stepped 6.0 mm-5.0 mm diameter, (3) Bezier 6.0 mm-5.5 mm-5.0 mm diameter, (4) constant 5.5 mm diameter, and (5) Bezier 5.5 mm-5.0 mm-4.75 mm diameter. Gravitational forces and flexion movements were simulated to compare load transfer between the spine and instrumentation.

Results: All rod configurations achieved equivalent sagittal correction. Load distribution analysis showed that Bezier rods provided smoother load transitions and better offloading of proximal segments compared to constant diameter rods. The highest moment sustained by the segment adjacent to the instrumentation was observed with the constant 6 mm rod (9N.m), while the Bezier 5.5-5-4.75 mm rod showed the lowest moment (7.5Nm), indicating reduced stress of 16% on the upper adjacent vertebrae. Similarly, the Bezier rods were more effective in offloading pedicle screws up to 45% with respect to the stiffer rod construct, potentially reducing the risk of PJK.

Conclusions: The simulation analysis demonstrates Bezier rods offer promising biomechanical benefits particularly in load distribution and stress reduction at adjacent levels of long thoracolumbar instrumentation. Future efforts will focus on clinical validation and optimization of patient-specific designs.

Purpose: Using patient-reported questionnaires (PROs), the impact of adolescent idiopathic scoliosis (AIS) on psychosocial well-being domains of Self-Image, Self-Esteem, Mental Health and Peer Relationships, and the interplay between these domains, physical function and clinical measures was investigated.

Methods: 95 patients from a convenience cohort with AIS completed questionnaires (SRS-22r, SAQ, PODCI, PROMIS, and Harter's Self-Perception Profile), and clinical data were collected. PRO scores analyses included descriptive statistics, unpaired t-test comparing typical peers and correlations. Scores on PRO domains for the lowest interquartile groups (LowIQR) were compared with the Remaining Cohorts (RC) using t tests, and differences were evaluated using Cohen's d statistic.

Results: The entire study cohort reported psychosocial well-being similar to their AIS and typical peers. Scores on PsychoSocial Self-Image measures and PODCI Happiness, a mental health domain, and physical function measures of PODCI Transfer&Mobility and Sports&Physical Function were worse than typical population. Curve severity and clinical measures were not linked to PRO scores. For LowIQR patients, scores were statistically worse than the RCs in many domains with effect sizes indicating clinically noticeable differences. Patients in LowIQRgroups reported scores below typical peers on Mental Health, Self-Esteem and global self-image measures, while RC did not.

Conclusions: This research enhances the clinical utility of PROs for assessing psychosocial well-being in patients with AIS by establishing thresholds for identification of patients reporting scores worse than their AIS peers. Interventions targeting psychosocial well-being may help mitigate the potential negative impact of scoliosis on adolescents.

Introduction: Management of early onset scoliosis (EOS) patients can require growth-friendly surgery to manage spinal deformity in children too immature for a definitive fusion. There is limited literature on outcomes for patients with failed growing constructs requiring removal of implants (ROI).

Methods: We studied EOS patients from an international registry undergoing removal of growth-friendly implants, comparing early re-implantation (within 12 months of ROI) to observation-only. We examined demographic data and radiographic measurements with a significance level of p < 0.05.

Results: Sixty-four patients met the inclusion criteria for radiographic analysis: 53 had early re-implantation and 11 were observed. There were no significant differences between the groups in age at index, ROI, or etiology. Pre-ROI, observation and re-implantation groups had similar coronal Cobb angles (55° vs 47°, p = 0.35) and similar time from index procedure to ROI. However, at two years post-ROI, the observation group had a larger coronal Cobb angle than the re-implantation (81° vs 53°, p = 0.003). In the re-implantation group, 16 (30%) patients progressed ≥ 5° vs 7 (64%) in the observation group (p = 0.04). The re-implantation group had a smaller difference in major Cobb angle between post-ROI and two years post-ROI (-2° vs 12°, p = 0.01). The re-implantation group had no significant progression in the major Cobb angle at two years post-ROI compared to immediate post-ROI (55° vs 53°, p = 0.36), while the observation group increased by about 13° (68° vs 81°, p = 0.03), resulting in a total increase of more than 25° from pre-ROI.

Conclusion: Our interim data strongly suggest that promptly replacing removed implants stabilizes curves in this population of EOS patients. Timely re-implantation should be a priority, when possible, to enhance outcomes, despite technical challenges for some patients.

Background: Long-level pedicle screw placement involves repetitive, forceful rotational movements that increase the risk of musculoskeletal pain and disorders in spine surgeons. Full power-assisted pedicle screw insertion may mitigate these risks, but its efficacy and safety compared to manual techniques remain underexplored. Understanding these differences is crucial for optimizing surgical practices and improving outcomes.

Objective: To systematically evaluate the outcomes of full power-assisted versus manual pedicle screw insertion in paediatric spine surgery, focusing on operative time and complications.

Methods: A systematic review of English-language literature published up to September 2024 was conducted using the search criteria ("Pedicle Screws"[Mesh]) and (power), adhering to PRISMA guidelines. Studies comparing full power-assisted and manual pedicle screw insertion were included.

Results: Of 2,559 patients, 1,715 underwent full power-assisted insertion (65.7% female, mean age 14.3 years, mean follow-up 20.8 months), and 844 underwent manual insertion (67.9% female, mean age 14.5 years, mean follow-up 26.9 months). Operative times were comparable (248 vs. 251.4 min, p = 0.69), as were screw breach rates (0.49% vs. 1.42%, p = 0.23). However, manual insertion was associated with a significantly higher rate of other complications compared to full power-assisted techniques (0.077% vs. 0.022%, p = 0.03).

Conclusion: Full power-assisted pedicle screw insertion is as efficient and accurate as manual techniques, with fewer complications in pedicle screw placement surgery. These findings support the use of power assistance to enhance surgical safety. Further research should validate these results in diverse patient populations and long-term follow-up.

Background: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is associated with severe postoperative pain leading to prolonged hospital stay and increased analgesic requirements. This meta-analysis aims to evaluate the efficacy of the erector spinae plane block (ESPB) in reducing postoperative pain and opioid consumption in AIS patients undergoing PSF.

Methods: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The following databases were searched: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL).

Results: Five studies involving a total of 352 patients were included, with 167 in the ESPB group and 185 in the control group. ESPB significantly reduced postoperative pain scores during the initial 24 postoperative hours (SMD = -1.58; CI -2.98 to -0.18; P = 0.03). Opioid consumption was significantly lower both intraoperatively (SMD = -3.72; CI -5.91 to -1.53; P = 0.0009) and postoperatively (SMD = -3.22; CI -5.14 to -1.30; P = 0.001). Rescue analgesia was required less frequently in the ESPB group (OR = 0.15; CI 0.08 to 0.29; P < 0.00001), and the time to first rescue analgesia was significantly longer (SMD = 2.95; CI 0.61 to 5.28; P = 0.01). Secondary outcomes, including incidence of opioid-related side effects, time to ambulation, length of hospital stay, and percentage change in motor-evoked potentials, were comparable between the ESPB and control groups.

Conclusion: Our findings suggest that the erector spinae plane block (ESPB) in PSF for AIS is effective in reducing postoperative pain up to 24 h postoperatively and results in lower overall opioid consumption without a significant increase in complications.