Spine deformity最新文献

Spinal scoliosis, a prevalent spinal deformity impacting both physical and mental well-being, has a significant genetic component, though the exact pathogenic mechanisms remain elusive. This review offers a comprehensive exploration of current research on embryonic spinal development, focusing on the genetic and biological intricacies governing axial elongation and straightening. Zebrafish, a vital model in developmental biology, takes a prominent role in understanding spinal scoliosis. Insights from zebrafish studies illustrate genetic and physiological aspects, including notochord development and cerebrospinal fluid dynamics, revealing the anomalies contributing to scoliosis. In this review, we acknowledge existing challenges, such as deciphering the unique dynamics of human spinal development, variations in physiological curvature, and disparities in cerebrospinal fluid circulation. Further, we emphasize the need for caution when extrapolating findings to humans and for future research to bridge current knowledge gaps. We hope that this review will be a beneficial frame of reference for the guidance of future studies on animal models and genetic research for spinal scoliosis.

Purpose: To assess the radiological outcomes and complications focusing on distal junctional failure (DJF) of adult spinal deformity patients who underwent thoracolumbar fixation with the use of offset sublaminar hooks (OSH) distally.

Methods: Retrospective review of a prospective, multicenter adult spinal deformity database (2 sites). Inclusion criteria were age of at least 18 years, presence of a spinal deformity with thoraco-lumbar instrumentation ending distally with OSH (pelvis excluded), with minimum 2 years of follow-up. Demographic data, spinopelvic parameters, functional outcomes and complications were collected. Data was analyzed using descriptive statistics. Statistical significance was set to p < 0.05.

Results: 32 patients met the inclusion criteria, with the main etiologies being Scheuermann kyphosis and post-traumatic kyphosis. There was a significant correction of thoracic or thoraco-lumbar kyphosis (from 83° to 45° in case of posterior column osteotomy, p < 0.001, and from 49° to 11° in case of a three-column osteotomy, p < 0.001). DJF occurred in 9.3% of the patients including 1 patient who presented distal hook dislodgement and 2 patients who presented a compression fracture below the lowest instrumented vertebra. Oswestry Disability Index score improved in the majority of the patients (from 34.3 to 18.1, p < 0.05).

Conclusions: This is the first paper to propose offset sublaminar hook as a safe and efficient tool for protection of the distal end of the construct in kyphotic ASD surgery when not going down to the pelvis. It showed satisfactory radiological and clinical outcome with an acceptable rate of complications and no distal junctional failure that required revision surgery.

Purpose: To evaluate the impact of different positions of adolescent idiopathic scoliosis (AIS) patients and examiners on the angle of trunk rotation (ATR) measured during the forward bending test (FBT) with Scoliometer.

Methods: Adolescents who had come to the hospital for outpatient were recruited. Considering the location of the subject and the examiner, four postural combinations of ATR were measured. After measuring ATR, the subject underwent radiographic measurements for diagnosis of AIS. Mann-Whitney test was used for the inter-group reliability test in two examiners, and the Kruskal-Wallis test was used to measure intra-group differences in ATR for the four positions. The receiver operating characteristic curve and area under the curve were used to evaluate the diagnostic performance of ATR in AIS measured by different postures. Preplanned sensitivity analyses of the primary outcome were performed by subgroup.

Results: Of the 63 participants suspected of having AIS included, there was no statistically significant difference (P > 0.05) observed between ATR measurements taken in different postures. Only the measurements taken by the examiner from behind the subject demonstrated diagnostic capability for AIS (AUC = 0.73 for both feet together and apart, $P<0.05$ ). There was no statistically significant difference ( $P=0.989)$ in diagnostic ability between the subjects who stood with feet together or apart. The sensitivity analysis supports the robustness of the conclusions ( $P>0.05)$ .

Conclusion: When the examiner measured from behind the subject, AIS can be effectively diagnosed, regardless of whether the subject is standing on feet apart or feet together. There is no difference in diagnostic ability in ATR between the two forward bending positions.

Level of evidence: Level III.

Purpose: This study aimed to investigate sex-related differences in demographics, radiography, and perioperative complications in adult spinal deformity (ASD) surgeries.

Methods: This retrospective cohort, single-center study enrolled patients who underwent long-instrumented fusion from the thoracic spine to the ilium for ASD, with a minimum follow-up of 2 years. The incidence of preoperative comorbidities, perioperative complications, and postoperative mechanical complications was analyzed.

Results: Of the 323 patients, ASD was more common in females (85.8%). The T-score in female patients was lower than that in male patients (-1.6 ± 1.1 vs.- 0.8 ± 1.0, p = 0.02). Male patients demonstrated lower rates of degenerative kyphoscoliosis (83.4% vs. 65.2%, p = 0.004) but higher rates of neuromuscular disease (7.6% vs. 21.7%, p = 0.003) than female patients. Male patients exhibited higher prevalence of cardiovascular disease (4.0% vs. 13.5%, p = 0.034) and hemodialysis (2.5% vs. 10.8%, p = 0.035). Additionally, male patients had a higher Charlson Comorbidity Index than female patients (0.8 ± 1.1 vs. 1.4 ± 1.1, p = 0.001). Moreover, male patients showed higher perioperative complications in surgical site infection (5.1% vs. 15.2%, p = 0.018). However, the incidence of proximal junctional failure (43.3% vs. 39.1%, p = 0.595) and rod fracture (27.8% vs. 26.1%, p = 0.81) was not different.

Conclusions: Male patients with ASD demonstrated frequent pathology of neuromuscular disease, preoperative comorbidities, and surgical site infection, necessitating careful preoperative checkups and intraoperative care.

Purpose: The purpose of this study was to compare the LIV selection in 'tweener' patients treated with MCGR or PSF.

Methods: A multicenter pediatric spine database was queried for ambulatory patients ages 8-11 years treated by MCGR or PSF with at least 2-year follow-up. The relationship between the LIV and preoperative spinal height, curve magnitude, and implant type were assessed. The relationship between the touched vertebrae (TV), the last substantially touched vertebrae (LSTV), the stable vertebrae (SV), and the LIV were evaluated.

Results: One hundred and fifty-nine patients met inclusion criteria. Preoperative curve magnitude was similar between groups (MCGR 68 ± 19.0° vs. PSF 66 ± 17.2°, p = 0.6). Preoperative curve magnitude was associated with LIV, as larger curves were associated with a more caudal LIV (p = 0.0004). Distribution of the LIV was more varied in PSF compared to MCGR. L3 was the LIV in 43% of MCGR patients compared to 27% of PSF patients. A thoracic LIV was more common in the PSF group (PSF 13% vs. MCGR 1.2%, p = 0.0038). The LIV was cephalad to the SV in 68% of PSF compared to 48% of MCGR patients (p = 0.02).

Conclusion: The majority of LIV selection in 'tweener' patients was at L3 or below regardless of surgical strategy, likely driven by curve magnitude. However, 'tweener' patients treated with PSF had more cephalad LIV selections compared to patients treated with MCGR. Potential LIV differences should be considered when selecting MCGR vs. PSF in 'tweener' patients.

Level of evidence: III.

Purpose: To investigate the adoption and sustained use of telehealth for managing early-onset scoliosis (EOS) during and after the COVID-19 pandemic.

Methods: A 35-question anonymous survey was emailed to 191 physician members of an international pediatric spine research group.

Results: Ninety seven clinicians completed the survey (51%). Of the 78% who reported that they currently use telehealth for EOS patients, 44% do so rarely; 21% do not use telehealth at all for EOS patients. Pre-pandemic, 37% used telehealth, increasing to 93% during the pandemic, with 40% using telehealth for most visits and 33% for a quarter of visits (p < 0.001). Post-pandemic usage was significantly higher than pre-pandemic levels (p < 0.001). Bracing was the favored treatment to monitor via telehealth (61% of respondents). Minor curves and initial post-op visits were ranked as the most suitable for remote care (77% of respondents). Geography and transport issues were the most cited drivers of telehealth (71% and 57% of respondents, respectively). No specific subset of EOS was particularly suitable for telehealth. The most common exam techniques used via telehealth included back inspection (88%), observing gait/posture (58%), and Adams test (46%).

Conclusion: The COVID-19 pandemic saw a significant increase in telehealth services for EOS patients (p < 0.001). While most patients returned to in-person visits post-pandemic, a significant number continued to use telehealth, especially when compared to pre-pandemic (p < 0.001). This persistent use, particularly for patients treated with bracing and to monitor minor curves, highlights the opportunity to optimize EOS care by strategically blending telemedicine with conventional clinic visits.

Purpose: Screening for adolescent idiopathic scoliosis (AIS) currently relies on clinical evaluations by trained practitioners, most commonly using a scoliometer. Modern structured light 3D scanning can generate high-quality 3D representations of surface anatomy using a mobile device. We hypothesized that a mobile-based 3D scanning system would provide accurate deformity assessments compared to a scoliometer.

Methods: Between August 2020 and June 2022, patients 10-18 years being evaluated for AIS in our clinic with a scoliosis radiograph obtained within 30 days of clinic evaluation and no history of spinal surgery were enrolled. Patients had 3D scans taken in the upright and forward bend positions, and the largest angle of trunk rotation (ATR) was measured by a scoliometer. Image processing software was used to analyze trunk shift (TS), coronal balance (CB), and clavicle angle (CL) in the upright position and the largest ATR in the forward bend position. 3D and scoliometer measurements were correlated to major curve magnitude. Multiple logistic regression models were created based on 3D and scoliometer measurements, controlling for demographic covariates.

Results: Two hundred and fifty-eight patients were included in this study. Mean coronal major curve magnitude was 25.7° (range 0-100), and 59% had a thoracic major curve. There were good-to-excellent correlations between 3D and radiographic measures of TS, CB, and CL (r = 0.79, rs = 0.80, and r = 0.64, respectively, p < 0.001). Correlations between 3D and radiographic measures of largest lumbar and thoracic ATR also demonstrated good correlations (r = 0.64 for both, p < 0.001). Using Akaike's Information Criterion (AIC), a multivariable logistic regression model based on 3D scanning outperformed a scoliometer model.

Conclusions: Mobile device-based 3D scanning of TS, CB, and TS identifies clinically relevant scoliotic deformity and is more predictive of radiographic curve magnitude than scoliometer in this population. This new modality may facilitate scoliosis screening by decreasing the need for trained personnel or dedicated equipment and clinical space to perform screening tests.

Level of evidence: II.

Purpose: Implant density for posterior spinal fusion in AIS remains controversial. As limited data exist to guide surgeons, we aimed to evaluate the effect of implant density on radiographic and patient reported outcomes (PROMs).

Methods: This is a retrospective review of prospectively collected multicenter data. Radiographic, perioperative, and PROMs were compared for patients treated with high-density (> 1.8) and moderate-density (≤ 1.8-1.4) screw constructs. Patients were stratified according to the Lenke classification.

Results: 1865 patients met inclusion criteria: 1225 high-density and 640 moderate-density screw construct patients. The groups had similar mean age (14.7 vs 14.6, p > 0.05) and sex (81.5% vs 79.5% female, p > 0.05). There were similar radiographic outcomes between groups [final curve magnitude (19° vs 19°, p = 0.540)] with only small differences in the percent correction for Lenke 2 curves (66% vs 61%, p = 0.001) producing a 1° difference in curve correction (19° vs 20°, p = 0.001) in the high-density group at 2 years. Excluding thoracoplasty patients, 2-year rib rotation was similar between the two groups (4.5° vs 6.3°, p < 0.05). The mean time to follow-up was shorter in the high-density group (4.5 vs 5 years, p < 0.001), but no statistically significant differences in the two-year SRS-22 scores.

Conclusion: Patients treated with both high and moderate-density constructs had similar SRS scores and radiographic results at 2-year follow-up. High-density constructs produced marginally better axial, sagittal, and coronal correction. However, these differences are small and not clinically meaningful with no difference in PROMs in curves ≤ 70°. The use of a moderate-density construct should be considered for routine AIS surgery.

Level of evidence: III.

Study design: Retrospective study.

Purpose: We aimed to investigate the clinical impact and risk factors for residual T1 tilt in patients with adolescent idiopathic scoliosis (AIS).

Methods: We retrospectively analyzed data of patients with AIS and Lenke type 1 curves who underwent posterior fusion. Residual T1 tilt was defined as T1 tilt > 5° at 2 years postoperatively. Patients were classified based on the presence of residual T1 tilt: residual T1 tilt ( +) and residual T1 tilt (-) groups. Radiographic parameters and clinical outcomes were compared between the two groups.

Results: Among 128 patients, 44 (34.4%) had residual T1 tilt. The residual T1 tilt ( +) group had a significantly greater preoperative proximal thoracic (PT) curve, greater preoperative T1 tilt, and main thoracic (MT) curve correction rate than the residual T1 tilt (-) group. Shoulder imbalance and neck tilt rates at 2 years postoperatively were significantly higher in the residual T1 tilt ( +) group. The residual T1 tilt ( +) group had a significantly worse postoperative self-image score. Multivariate analysis identified the preoperative PT curve magnitude as an independent risk factor for residual T1 tilt. Receiver operating characteristic curve analysis identified a preoperative PT curve cutoff value of 26.5°.

Conclusion: Achieving horizontalization of T1 tilt is vital to improve the self-image of patients with Lenke type 1 AIS. The study highlights the clinical impact of T1 tilt and identifies the preoperative PT curve magnitude as a significant independent risk factor.

Level of evidence: Level 4.

Purpose: To determine the efficacy of bilateral rib-to-pelvis distraction instrumentation for the growth-friendly surgical treatment of congenital kyphosis in children with myelomeningocele.

Methods: The clinical courses of nine children (five males, four females), mean age 4.3 years (range 1.4 years-10.0 years), with myelomeningocele and congenital kyphosis treated by the rib-to-pelvis surgical method were studied. Radiographic measurements established the extent of deformity corrections, spinal elongation and growth, and rib levels. Surgical complications were categorized as wound or instrumentation related.

Results: The mean follow-up was 5.2 years (range, 2.4 years-10.4 years). Following the index procedure, a mean of seven procedures (range, 4-20), or 1.2 procedures per year, were performed on each child. The mean preoperative, postoperative, and final follow-up kyphotic deformity was 139° (range, 93°-180°), 86°(range, 45°-150°) and 98° (range, 50°-176°) respectively. Eight children lost some of the initial correction and the two youngest lost all correction. Six children were converted to spine-based procedures. The mean growth for the cohort was 0.6 cm/year (range, -1.2 cm-1.9 cm). Twenty-two complications occurred in eight children-14 in the three youngest children. In two children the procedure was abandoned due to ulceration over the gibbus after 2.8 years and 5.6 years of treatment.

Conclusion: The bilateral rib-to-pelvis surgical procedure produced modest deformity correction and spinal growth, and prevented deformity progression. It delayed but did not eliminate the need for spine-based deformity correction, and was associated with the significant morbidity of distraction-based growth-friendly spinal surgery. The rib-based technique may have a role in a child with myelomeningocele kyphosis when surgical intervention is required in the very young.