首页 > 最新文献

Spine deformity最新文献

英文 中文
Analysis of the hemivertebra resection strategy in adolescent and young adult congenital scoliosis caused by double hemivertebrae. 双半椎体所致青少年先天性脊柱侧凸半椎体切除策略分析。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-02 DOI: 10.1007/s43390-024-01026-3
Jie Zhou, Song Li, Yitong Zhu, Kai Sun, Zhen Liu, Zezhang Zhu, Yong Qiu, Saihu Mao

Purpose: This study is to conduct a retrospective review of the selective resection strategies, their immediate efficacy and prognosis, using double hemivertebrae (DHV) as illustrative cases.

Methods: A total of 59 adolescent and young adult patients with DHV were enrolled from 2009 to 2021. They were categorized into sagittal kyphosis group (SKG), coronal takeoff group (CTG) and balanced group (BG). The selective resection strategies for each group were reviewed.

Results: Nineteen patients presented ipsilateral DHV, including 15 cases of continuous type (interval ≤ 3 vertebrae) and 4 cases of skipping type (interval ≥ 4 vertebrae), while 40 patients presented bilateral DHV, including 25 cases of continuous type and 15 cases of skipping type. The proportions of patients with 0, 1 and 2 HV resections were 26%, 58% and 16% in the ipsilateral group, and 45%, 48% and 7% in the bilateral group, respectively. The rate of HV resection in the SKG, CTG and BG was 77%, 61%, 33%, respectively. Kyphosis was the primary indicator for HV resection (60%), followed by coronal takeoff effect (21%) and coronal segmental scoliosis (19%). Significant curve progression due to misresection or mis-preservation of HV was recorded as 1.7% and 3.4%, respectively.

Conclusions: Kyphosis, coronal cervicothoracic or lumbosacral takeoff caused by hemivertebrae are primary indicators for selective hemivertebrectomy. For balanced DHV, the necessity of hemivertebrectomy is relatively low. Misresection or mis-preservation of HV may cause iatrogenic coronal imbalance and secondary severe curve progression.

目的:本研究以双半椎体(DHV)为例,回顾性分析选择性切除策略及其即时疗效和预后。方法:2009 - 2021年共入组59例DHV青少年和青壮年患者。分为矢状面后凸组(SKG)、冠状面起飞组(CTG)和平衡组(BG)。回顾了各组的选择性切除策略。结果:同侧DHV 19例,其中连续型(间隔≤3个椎体)15例,跳跃型(间隔≥4个椎体)4例;双侧DHV 40例,其中连续型25例,跳跃型15例。同侧切除0、1、2个HV的患者比例分别为26%、58%、16%,双侧组分别为45%、48%、7%。SKG、CTG和BG的HV切除率分别为77%、61%和33%。后凸是HV切除术的主要指标(60%),其次是冠状剥离效果(21%)和冠状节段性脊柱侧凸(19%)。由于HV切除不当或保存不当导致的显著曲线进展分别为1.7%和3.4%。结论:半椎体引起的后凸、冠状颈胸或腰骶段脱位是选择性半椎体切除术的主要指标。对于平衡DHV,半椎体切除的必要性相对较低。错误切除或错误保存HV可能导致医源性冠状动脉不平衡和继发严重的弯曲进展。
{"title":"Analysis of the hemivertebra resection strategy in adolescent and young adult congenital scoliosis caused by double hemivertebrae.","authors":"Jie Zhou, Song Li, Yitong Zhu, Kai Sun, Zhen Liu, Zezhang Zhu, Yong Qiu, Saihu Mao","doi":"10.1007/s43390-024-01026-3","DOIUrl":"https://doi.org/10.1007/s43390-024-01026-3","url":null,"abstract":"<p><strong>Purpose: </strong>This study is to conduct a retrospective review of the selective resection strategies, their immediate efficacy and prognosis, using double hemivertebrae (DHV) as illustrative cases.</p><p><strong>Methods: </strong>A total of 59 adolescent and young adult patients with DHV were enrolled from 2009 to 2021. They were categorized into sagittal kyphosis group (SKG), coronal takeoff group (CTG) and balanced group (BG). The selective resection strategies for each group were reviewed.</p><p><strong>Results: </strong>Nineteen patients presented ipsilateral DHV, including 15 cases of continuous type (interval ≤ 3 vertebrae) and 4 cases of skipping type (interval ≥ 4 vertebrae), while 40 patients presented bilateral DHV, including 25 cases of continuous type and 15 cases of skipping type. The proportions of patients with 0, 1 and 2 HV resections were 26%, 58% and 16% in the ipsilateral group, and 45%, 48% and 7% in the bilateral group, respectively. The rate of HV resection in the SKG, CTG and BG was 77%, 61%, 33%, respectively. Kyphosis was the primary indicator for HV resection (60%), followed by coronal takeoff effect (21%) and coronal segmental scoliosis (19%). Significant curve progression due to misresection or mis-preservation of HV was recorded as 1.7% and 3.4%, respectively.</p><p><strong>Conclusions: </strong>Kyphosis, coronal cervicothoracic or lumbosacral takeoff caused by hemivertebrae are primary indicators for selective hemivertebrectomy. For balanced DHV, the necessity of hemivertebrectomy is relatively low. Misresection or mis-preservation of HV may cause iatrogenic coronal imbalance and secondary severe curve progression.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pulmonary function in patients with adolescent idiopathic scoliosis: an explorative study of a wearable smart shirt as a measurement instrument. 青少年特发性脊柱侧凸患者的肺功能:可穿戴智能衬衫作为测量工具的探索性研究。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2024-07-31 DOI: 10.1007/s43390-024-00938-4
N Te Hennepe, V L J M Steegh, M H Pouw, J Roukema, M De Kleuver, M L Van Hooff

Purpose: Adolescent idiopathic scoliosis (AIS) presents various challenges, including respiratory symptoms that impact pulmonary function. This study aims to explore the feasibility of using a smart shirt for continuous monitoring of lung volumes and heart rate during routine activities in AIS patients.

Methods: A single-center exploratory feasibility study was conducted with AIS patients aged 16-22 years with a thoracic curvature of ≥ 30 degrees and absence of respiratory comorbidities. A smart shirt was utilized to continuously monitor cardiopulmonary parameters during mild exercise, which included a standardized walking route with the ascent of multiple stairs.

Results: Five participants completed the study. Baseline spirometry measurements showed a range of values for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC ratio. During mild exercise, participants exhibited variability in tidal volume, heart rate, breathing rate, and minute ventilation, with increases observed during stair climbing. Breathlessness levels also varied throughout the activity but did not correlate with the measured lung volumes. Overall, the use of the smart shirt for assessing pulmonary function in AIS patients was deemed feasible and well tolerated by participants during the test activities.

Conclusion: The study confirms the feasibility of using a smart shirt for continuous measurement of cardiopulmonary parameters in AIS patients during daily activities. Incongruities between spirometry results and perceived dyspnea exists, which questions the nature of the perceived dyspnea. Further research is needed to validate these findings and explore the impact of AIS characteristics on measurement accuracy.

目的:青少年特发性脊柱侧弯症(AIS)带来了各种挑战,包括影响肺功能的呼吸道症状。本研究旨在探讨使用智能衬衫对 AIS 患者在日常活动中的肺容量和心率进行连续监测的可行性:方法:对年龄在 16-22 岁、胸廓弧度≥ 30 度且无呼吸系统合并症的 AIS 患者进行了一项单中心探索性可行性研究。在轻微运动过程中,利用智能衬衫对心肺参数进行连续监测,其中包括上多级楼梯的标准化步行路线:结果:五名参与者完成了研究。基线肺活量测量结果显示,受迫肺活量(FVC)、1 秒内受迫呼气容积(FEV1)和 FEV1/FVC 比值范围不一。在轻微运动时,参与者的潮气量、心率、呼吸频率和分钟通气量都会出现变化,爬楼梯时会增加。在整个运动过程中,呼吸困难程度也各不相同,但与测得的肺活量无关。总之,使用智能衬衫评估 AIS 患者的肺功能是可行的,参与者在测试活动中也能很好地耐受:该研究证实了使用智能衬衫在日常活动中连续测量 AIS 患者心肺功能参数的可行性。肺活量测量结果与感觉到的呼吸困难之间存在不一致,这对感觉到的呼吸困难的性质提出了质疑。需要进一步研究来验证这些发现,并探索 AIS 特征对测量准确性的影响。
{"title":"Pulmonary function in patients with adolescent idiopathic scoliosis: an explorative study of a wearable smart shirt as a measurement instrument.","authors":"N Te Hennepe, V L J M Steegh, M H Pouw, J Roukema, M De Kleuver, M L Van Hooff","doi":"10.1007/s43390-024-00938-4","DOIUrl":"10.1007/s43390-024-00938-4","url":null,"abstract":"<p><strong>Purpose: </strong>Adolescent idiopathic scoliosis (AIS) presents various challenges, including respiratory symptoms that impact pulmonary function. This study aims to explore the feasibility of using a smart shirt for continuous monitoring of lung volumes and heart rate during routine activities in AIS patients.</p><p><strong>Methods: </strong>A single-center exploratory feasibility study was conducted with AIS patients aged 16-22 years with a thoracic curvature of ≥ 30 degrees and absence of respiratory comorbidities. A smart shirt was utilized to continuously monitor cardiopulmonary parameters during mild exercise, which included a standardized walking route with the ascent of multiple stairs.</p><p><strong>Results: </strong>Five participants completed the study. Baseline spirometry measurements showed a range of values for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV<sub>1</sub>), and FEV<sub>1</sub>/FVC ratio. During mild exercise, participants exhibited variability in tidal volume, heart rate, breathing rate, and minute ventilation, with increases observed during stair climbing. Breathlessness levels also varied throughout the activity but did not correlate with the measured lung volumes. Overall, the use of the smart shirt for assessing pulmonary function in AIS patients was deemed feasible and well tolerated by participants during the test activities.</p><p><strong>Conclusion: </strong>The study confirms the feasibility of using a smart shirt for continuous measurement of cardiopulmonary parameters in AIS patients during daily activities. Incongruities between spirometry results and perceived dyspnea exists, which questions the nature of the perceived dyspnea. Further research is needed to validate these findings and explore the impact of AIS characteristics on measurement accuracy.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"101-110"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Five days of inpatient scoliosis-specific exercises improve preoperative spinal flexibility and facilitate curve correction of patients with rigid idiopathic scoliosis. 为期五天的脊柱侧凸专用住院锻炼可改善僵硬型特发性脊柱侧凸患者术前的脊柱柔韧性,促进曲线矫正。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2024-09-26 DOI: 10.1007/s43390-024-00965-1
Yunli Fan, Michael K T To, Guan-Ming Kuang, Nan Lou, Feng Zhu, Huiren Tao, Guangshuo Li, Eric H K Yeung, Kenneth M C Cheung, Jason P Y Cheung

Preoperative spine flexibility plays a key role in the intraoperative treatment course of severe scoliosis. In this cohort study, we examined the effects of 5 day inpatient scoliosis-specific exercise (SSE) on the spinal flexibility of patients with adolescent idiopathic scoliosis before surgery. A total of 65 patients were analyzed. These patients were divided into a prospective cohort (n = 43, age: 15 ± 1.6 years, 36 girls and 7 boys, Lenke class 1 and 2, Cobb angle: 64 ± 11°) who underwent spinal fusion in 2020, and a retrospective cohort (n = 22, age: 15 ± 1.5 years, 17 girls and 5 boys, Lenke class 1 or 2, Cobb angle: 63 ± 10°), who underwent surgery between 2018 and 2019 and did not receive preoperative SSE. Rigid scoliosis was defined as a reduction of less than 50% in Cobb angle between the preoperative fulcrum bending and initial standing curve magnitude. In the prospective cohort, 21 patients (Cobb angle: 65 ± 11°) presented with rigid thoracic scoliosis (pre-SSE fulcrum bending: 40 ± 9°, 39% reduction), and therefore received 5-day SSE to improve their preoperative spinal flexibility (SSE group), whereas 22 patients (Cobb angle: 63 ± 12°) presented with flexible thoracic scoliosis (pre-SSE fulcrum bending: 27 ± 8°, 58% reduction), and therefore underwent surgery without preoperative SSE (non-SSE group). For patients who received 5-day preoperative SSE for 4 h every day, the International Schroth Three-Dimensional Scoliosis Therapy technique was implemented with an inpatient model. After 5 days of SSE, improvements in Cobb angle with post-SSE fulcrum-bending radiography (23 ± 7°, 66% reduction) and pulmonary function (forced expiratory volume in 1 s/forced expiratory volume: 87% before SSE and 92% after SSE, p < 0.01) were observed. At the postoperative day 5, the degree of scoliosis had reduced from 44 ± 6.6° to 22 ± 6° in the SSE group, which is 1° less than the Cobb angle obtained on post-SSE fulcrum-bending radiography. In the non-SSE group, the degree of scoliosis decreased to 26 ± 5.7°. In the retrospective cohort, the degree of scoliosis decreased to 35 ± 5°, with the group also having higher postoperative pain (Visual Analog Scale score = 7, range = 5-10) and an extended hospitalization duration (11 ± 3 days). At 2-year follow-up, curve correction was found to be maintained without adding-on or proximal junctional kyphosis. Compared with the non-SSE group, the SSE group exhibited a greater curve correction (66%) with a shorter hospitalization duration (5 ± 1 days) and a lower degree of postoperative pain (Visual Analog Scale score = 4, range = 3-8). Taken together, our findings indicate that 5 day SSE improves preoperative spinal flexibility and facilitates curve correction.

术前脊柱柔韧性在严重脊柱侧凸的术中治疗过程中起着关键作用。在这项队列研究中,我们考察了住院5天的脊柱侧弯专项锻炼(SSE)对青少年特发性脊柱侧弯患者术前脊柱柔韧性的影响。共对 65 名患者进行了分析。这些患者分为前瞻性队列(n = 43,年龄:15 ± 1.6 岁,36 名女孩和 7 名男孩,伦克分级 1 级和 2 级,Cobb 角:64 ± 11°)和回顾性队列(n = 22,年龄:15 ± 1.5 岁,17 名女孩和 5 名男孩,伦克分级 1 级或 2 级,Cobb 角:63 ± 10°),前瞻性队列的患者在 2020 年接受了脊柱融合术,回顾性队列的患者在 2018 年至 2019 年期间接受了手术,术前未接受 SSE。刚性脊柱侧弯的定义是:术前支点弯曲与初始站立曲线幅度之间的 Cobb 角减小小于 50%。在前瞻性队列中,21 名患者(Cobb 角:65 ± 11°)为刚性胸椎脊柱侧弯(SSE 前支点弯曲:40 ± 9°,减少 39%),因此接受了为期 5 天的 SSE 以改善其术前脊柱灵活性(SSE 组),而 22 名患者(Cobb 角:63 ± 12°)为柔性胸椎脊柱侧弯(SSE 组),因此接受了为期 5 天的 SSE 以改善其术前脊柱灵活性(SSE 组):22名患者(Cobb角:63 ± 12°)表现为柔性胸椎侧弯(SSE前支点弯曲:27 ± 8°,减少58%),因此在术前未接受SSE手术(非SSE组)。对于术前接受为期5天、每天4小时SSE治疗的患者,采用住院模式实施国际施罗特三维脊柱侧弯治疗技术。经过5天的SSE治疗后,患者的Cobb角(SSE后支点弯曲射线照相术显示为23 ± 7°,减少了66%)和肺功能(1秒内用力呼气量/用力呼气量:SSE前为87%,SSE后为92%,P<0.05)均有所改善。
{"title":"Five days of inpatient scoliosis-specific exercises improve preoperative spinal flexibility and facilitate curve correction of patients with rigid idiopathic scoliosis.","authors":"Yunli Fan, Michael K T To, Guan-Ming Kuang, Nan Lou, Feng Zhu, Huiren Tao, Guangshuo Li, Eric H K Yeung, Kenneth M C Cheung, Jason P Y Cheung","doi":"10.1007/s43390-024-00965-1","DOIUrl":"10.1007/s43390-024-00965-1","url":null,"abstract":"<p><p>Preoperative spine flexibility plays a key role in the intraoperative treatment course of severe scoliosis. In this cohort study, we examined the effects of 5 day inpatient scoliosis-specific exercise (SSE) on the spinal flexibility of patients with adolescent idiopathic scoliosis before surgery. A total of 65 patients were analyzed. These patients were divided into a prospective cohort (n = 43, age: 15 ± 1.6 years, 36 girls and 7 boys, Lenke class 1 and 2, Cobb angle: 64 ± 11°) who underwent spinal fusion in 2020, and a retrospective cohort (n = 22, age: 15 ± 1.5 years, 17 girls and 5 boys, Lenke class 1 or 2, Cobb angle: 63 ± 10°), who underwent surgery between 2018 and 2019 and did not receive preoperative SSE. Rigid scoliosis was defined as a reduction of less than 50% in Cobb angle between the preoperative fulcrum bending and initial standing curve magnitude. In the prospective cohort, 21 patients (Cobb angle: 65 ± 11°) presented with rigid thoracic scoliosis (pre-SSE fulcrum bending: 40 ± 9°, 39% reduction), and therefore received 5-day SSE to improve their preoperative spinal flexibility (SSE group), whereas 22 patients (Cobb angle: 63 ± 12°) presented with flexible thoracic scoliosis (pre-SSE fulcrum bending: 27 ± 8°, 58% reduction), and therefore underwent surgery without preoperative SSE (non-SSE group). For patients who received 5-day preoperative SSE for 4 h every day, the International Schroth Three-Dimensional Scoliosis Therapy technique was implemented with an inpatient model. After 5 days of SSE, improvements in Cobb angle with post-SSE fulcrum-bending radiography (23 ± 7°, 66% reduction) and pulmonary function (forced expiratory volume in 1 s/forced expiratory volume: 87% before SSE and 92% after SSE, p < 0.01) were observed. At the postoperative day 5, the degree of scoliosis had reduced from 44 ± 6.6° to 22 ± 6° in the SSE group, which is 1° less than the Cobb angle obtained on post-SSE fulcrum-bending radiography. In the non-SSE group, the degree of scoliosis decreased to 26 ± 5.7°. In the retrospective cohort, the degree of scoliosis decreased to 35 ± 5°, with the group also having higher postoperative pain (Visual Analog Scale score = 7, range = 5-10) and an extended hospitalization duration (11 ± 3 days). At 2-year follow-up, curve correction was found to be maintained without adding-on or proximal junctional kyphosis. Compared with the non-SSE group, the SSE group exhibited a greater curve correction (66%) with a shorter hospitalization duration (5 ± 1 days) and a lower degree of postoperative pain (Visual Analog Scale score = 4, range = 3-8). Taken together, our findings indicate that 5 day SSE improves preoperative spinal flexibility and facilitates curve correction.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"165-175"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The two missing founding members of the Scoliosis Research Society. 两位失踪的脊柱侧凸研究会的创始成员。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1007/s43390-024-01013-8
George H Thompson
{"title":"The two missing founding members of the Scoliosis Research Society.","authors":"George H Thompson","doi":"10.1007/s43390-024-01013-8","DOIUrl":"10.1007/s43390-024-01013-8","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"5-6"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Deep learning in Cobb angle automated measurement on X-rays: a systematic review and meta-analysis. 深度学习在 X 射线柯布角自动测量中的应用:系统综述与荟萃分析。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2024-09-25 DOI: 10.1007/s43390-024-00954-4
Yuanpeng Zhu, Xiangjie Yin, Zefu Chen, Haoran Zhang, Kexin Xu, Jianguo Zhang, Nan Wu

Purpose: This study aims to provide an overview of different deep learning algorithms (DLAs), identify the limitations, and summarize potential solutions to improve the performance of DLAs.

Methods: We reviewed eligible studies on DLAs for automated Cobb angle estimation on X-rays and conducted a meta-analysis. A systematic literature search was conducted in six databases up until September 2023. Our meta-analysis included an evaluation of reported circular mean absolute error (CMAE) from the studies, as well as a subgroup analysis of implementation strategies. Risk of bias was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). This study was registered in PROSPERO prior to initiation (CRD42023403057).

Results: We identified 120 articles from our systematic search (n = 3022), eventually including 50 studies in the systematic review and 17 studies in the meta-analysis. The overall estimate for CMAE was 2.99 (95% CI 2.61-3.38), with high heterogeneity (94%, p < 0.01). Segmentation-based methods showed greater accuracy (p < 0.01), with a CMAE of 2.40 (95% CI 1.85-2.95), compared to landmark-based methods, which had a CMAE of 3.31 (95% CI 2.89-3.72).

Conclusions: According to our limited meta-analysis results, DLAs have shown relatively high accuracy for automated Cobb angle measurement. In terms of CMAE, segmentation-based methods may perform better than landmark-based methods. We also summarized potential ways to improve model design in future studies. It is important to follow quality guidelines when reporting on DLAs.

目的:本研究旨在概述不同的深度学习算法(DLA),找出其局限性,并总结提高 DLA 性能的潜在解决方案:我们审查了符合条件的关于在 X 光片上自动估算 Cobb 角度的 DLA 的研究,并进行了荟萃分析。截至 2023 年 9 月,我们在六个数据库中进行了系统的文献检索。我们的荟萃分析包括对研究报告的圆平均绝对误差(CMAE)进行评估,以及对实施策略进行分组分析。偏倚风险采用修订后的《诊断准确性研究质量评估》(QUADAS-2)进行评估。本研究在启动前已在 PROSPERO 注册(CRD42023403057):我们从系统检索中确定了 120 篇文章(n = 3022),最终将 50 项研究纳入系统综述,17 项研究纳入荟萃分析。CMAE的总体估计值为2.99(95% CI为2.61-3.38),异质性较高(94%,P 结论:CMAE的总体估计值为2.99(95% CI为2.61-3.38):根据我们有限的荟萃分析结果,DLA 对自动 Cobb 角测量的准确性相对较高。就 CMAE 而言,基于分割的方法可能比基于地标的方法表现更好。我们还总结了在未来研究中改进模型设计的潜在方法。在报告 DLA 时,遵循质量指南非常重要。
{"title":"Deep learning in Cobb angle automated measurement on X-rays: a systematic review and meta-analysis.","authors":"Yuanpeng Zhu, Xiangjie Yin, Zefu Chen, Haoran Zhang, Kexin Xu, Jianguo Zhang, Nan Wu","doi":"10.1007/s43390-024-00954-4","DOIUrl":"10.1007/s43390-024-00954-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to provide an overview of different deep learning algorithms (DLAs), identify the limitations, and summarize potential solutions to improve the performance of DLAs.</p><p><strong>Methods: </strong>We reviewed eligible studies on DLAs for automated Cobb angle estimation on X-rays and conducted a meta-analysis. A systematic literature search was conducted in six databases up until September 2023. Our meta-analysis included an evaluation of reported circular mean absolute error (CMAE) from the studies, as well as a subgroup analysis of implementation strategies. Risk of bias was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). This study was registered in PROSPERO prior to initiation (CRD42023403057).</p><p><strong>Results: </strong>We identified 120 articles from our systematic search (n = 3022), eventually including 50 studies in the systematic review and 17 studies in the meta-analysis. The overall estimate for CMAE was 2.99 (95% CI 2.61-3.38), with high heterogeneity (94%, p < 0.01). Segmentation-based methods showed greater accuracy (p < 0.01), with a CMAE of 2.40 (95% CI 1.85-2.95), compared to landmark-based methods, which had a CMAE of 3.31 (95% CI 2.89-3.72).</p><p><strong>Conclusions: </strong>According to our limited meta-analysis results, DLAs have shown relatively high accuracy for automated Cobb angle measurement. In terms of CMAE, segmentation-based methods may perform better than landmark-based methods. We also summarized potential ways to improve model design in future studies. It is important to follow quality guidelines when reporting on DLAs.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"19-27"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Machine learning identifies clusters of the normal adolescent spine based on sagittal balance. 机器学习根据矢状平衡识别正常青少年脊柱群。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2024-08-21 DOI: 10.1007/s43390-024-00952-6
Dion G Birhiray, Srikhar V Chilukuri, Caleb C Witsken, Maggie Wang, Jacob P Scioscia, Martin Gehrchen, Lorenzo R Deveza, Benny Dahl

Purpose: This study applied a machine learning semi-supervised clustering approach to radiographs of adolescent sagittal spines from a single pediatric institution to identify patterns of sagittal alignment in the normal adolescent spine. We sought to explore the inherent variability found in adolescent sagittal alignment using machine learning to remove bias and determine whether clusters of sagittal alignment exist.

Methods: Multiple semi-supervised machine learning clustering algorithms were applied to 111 normal adolescent sagittal spines. Sagittal parameters for resultant clusters were determined.

Results: Machine learning analysis found that the spines did cluster into distinct groups with an optimal number of clusters ranging from 3 to 5. We performed an analysis on both 3 and 5-cluster groups. The 3-cluster groups analysis found good consistency between methods with 96 of 111, while the analysis of 5-cluster groups found consistency with 105 of 111 spines. When assessing for differences in sagittal parameters between the groups for both analyses, there were differences in T4-12 TK, L1-S1 LL, SS, SVA, PI-LL mismatch, and TPA. However, the only parameter that was statistically different for all groups was SVA.

Conclusions: Based on machine learning, the adolescent sagittal spine alignments do cluster into distinct groups. While there were distinguishing features with TK and LL, the most important parameter distinguishing these groups was SVA. Further studies may help to understand these findings in relation to spinal deformities.

目的:本研究对来自一家儿科机构的青少年矢状脊柱X光片采用机器学习半监督聚类方法,以确定正常青少年脊柱的矢状对齐模式。我们试图利用机器学习来消除偏差,并确定是否存在矢状排列集群,从而探索青少年矢状排列的内在可变性:方法:将多种半监督机器学习聚类算法应用于 111 个正常青少年矢状脊柱。结果:机器学习分析发现,脊柱的矢状面对齐度较低,而脊柱的矢状面对齐度较高:结果:机器学习分析发现,脊柱确实聚类成不同的组,最佳聚类数为 3 至 5 个。我们对 3 簇和 5 簇进行了分析。3 簇分组分析发现,111 个脊柱中有 96 个与 3 簇分组分析结果一致,而 5 簇分组分析发现,111 个脊柱中有 105 个与 5 簇分组分析结果一致。在评估两组分析的矢状面参数差异时,T4-12 TK、L1-S1 LL、SS、SVA、PI-LL 错位和 TPA 存在差异。然而,所有组别中唯一存在统计学差异的参数是 SVA:结论:基于机器学习,青少年矢状脊柱排列确实分为不同的组别。虽然 TK 和 LL 有不同的特征,但区分这些组别的最重要参数是 SVA。进一步的研究可能有助于理解这些发现与脊柱畸形的关系。
{"title":"Machine learning identifies clusters of the normal adolescent spine based on sagittal balance.","authors":"Dion G Birhiray, Srikhar V Chilukuri, Caleb C Witsken, Maggie Wang, Jacob P Scioscia, Martin Gehrchen, Lorenzo R Deveza, Benny Dahl","doi":"10.1007/s43390-024-00952-6","DOIUrl":"10.1007/s43390-024-00952-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study applied a machine learning semi-supervised clustering approach to radiographs of adolescent sagittal spines from a single pediatric institution to identify patterns of sagittal alignment in the normal adolescent spine. We sought to explore the inherent variability found in adolescent sagittal alignment using machine learning to remove bias and determine whether clusters of sagittal alignment exist.</p><p><strong>Methods: </strong>Multiple semi-supervised machine learning clustering algorithms were applied to 111 normal adolescent sagittal spines. Sagittal parameters for resultant clusters were determined.</p><p><strong>Results: </strong>Machine learning analysis found that the spines did cluster into distinct groups with an optimal number of clusters ranging from 3 to 5. We performed an analysis on both 3 and 5-cluster groups. The 3-cluster groups analysis found good consistency between methods with 96 of 111, while the analysis of 5-cluster groups found consistency with 105 of 111 spines. When assessing for differences in sagittal parameters between the groups for both analyses, there were differences in T4-12 TK, L1-S1 LL, SS, SVA, PI-LL mismatch, and TPA. However, the only parameter that was statistically different for all groups was SVA.</p><p><strong>Conclusions: </strong>Based on machine learning, the adolescent sagittal spine alignments do cluster into distinct groups. While there were distinguishing features with TK and LL, the most important parameter distinguishing these groups was SVA. Further studies may help to understand these findings in relation to spinal deformities.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"89-99"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
High inpatient-opioid consumption predicts extended length of hospital stay in patients undergoing spinal fusion for adolescent idiopathic scoliosis. 青少年特发性脊柱侧凸脊柱融合术患者住院期间阿片类药物消耗量大,预示住院时间延长。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2024-09-25 DOI: 10.1007/s43390-024-00960-6
Mani Ratnesh S Sandhu, Samuel Craft, Benjamin C Reeves, Sumaiya Sayeed, Astrid C Hengartner, Dominick A Tuason, Michael DiLuna, Aladine A Elsamadicy

Objectives: Opioids are common medications used following spine surgery. However, few studies have assessed the impact of increased inpatient-opioid consumption on outcomes following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The aim of this study was to determine the impact of increased inpatient-opioid consumption on hospital length of stay (LOS) following PSF for AIS.

Methods: A retrospective cohort study was performed using the Premier Healthcare Database (2016-2017). Adolescent patients (11-17 years old) who underwent PSF for AIS, identified using ICD-10-CM coding, were stratified by inpatient MME (morphine milligram equivalent) consumption into Low (< 25th percentile for the cohort), Medium (25-75th percentile), and High (> 75th percentile) cohorts. Demographics, comorbidities, intraoperative procedures, perioperative adverse events (AEs), length of hospital stay (LOS), non-routine discharge rates, cost of admission, and 30-day readmission rates were assessed. A logistic multivariate regression analysis was performed to determine the association between inpatient MME consumption and extended LOS.

Results: Of the 1042 study patients, 260 (24.9%) had Low-MME consumption, 523 (50.2%) had Medium-MME consumption, and 259 (24.9%) had High-MME consumption. A greater proportion of patients in the High cohort identified as non-Hispanic white (Low: 46.5% vs Medium: 61.4% vs High: 65.3%, p < 0.001), while the proportion of patients reporting any comorbidity did not vary across the cohorts (p = 0.940). The number of post-operative AEs experienced also did not vary across the cohorts (p = 0.629). A greater proportion of patients in the High cohort had an extended LOS (Low: 6.5% vs Medium: 8.6% vs High: 19.7%, p < 0.001), while a greater proportion of patients in the Low cohort had an increased cost of admission (Low: 33.1% vs Medium: 20.3% vs High: 26.6%, p < 0.001). The High cohort had increased 30-day readmission rates relative to the Low and Medium cohorts (Low: 0.8% vs Medium: 0.2% vs High: 1.5%, p = 0.049). Non-routine discharge rates did not vary among the cohorts (p = 0.441). On multivariate analysis, High-MME consumption was significantly associated with extended LOS, while Medium-MME consumption was not [Medium: aOR: 1.48, CI (0.83, 2.74), p = 0.193; High: aOR: 4.43, CI (2.47, 8.31), p < 0.001].

Conclusions: Our study showed that high post-operative-MME consumption was significantly associated with extended LOS in patients undergoing PSF for AIS. In light of these findings, changes to existing protocols that decrease the reliance on opioids for post-operative analgesia are merited to improve patient outcomes and reduce health-care expenditures.

目的:阿片类药物是脊柱手术后的常用药物。然而,很少有研究评估住院患者阿片类药物用量增加对青少年特发性脊柱侧弯症(AIS)后路脊柱融合术(PSF)术后疗效的影响。本研究旨在确定青少年特发性脊柱侧凸后路融合术后住院患者阿片类药物用量增加对住院时间(LOS)的影响:使用 Premier Healthcare 数据库(2016-2017 年)进行了一项回顾性队列研究。使用 ICD-10-CM 编码识别了因 AIS 而接受 PSF 治疗的青少年患者(11-17 岁),并根据住院患者的 MME(吗啡毫克当量)消耗量将其分为低(第 75 百分位数)队列。对人口统计学、合并症、术中程序、围手术期不良事件(AEs)、住院时间(LOS)、非正常出院率、入院费用和 30 天再入院率进行了评估。为确定住院患者MME消耗量与延长住院时间之间的关系,进行了逻辑多变量回归分析:在1042名研究患者中,260人(24.9%)的MME消耗量较低,523人(50.2%)的MME消耗量中等,259人(24.9%)的MME消耗量较高。高水平组群中有更大比例的患者被认定为非西班牙裔白人(低水平:46.5% vs 中等水平:61.4% vs 高水平:65.3%,P 结论:我们的研究表明,在因 AIS 而接受 PSF 治疗的患者中,术后 MME 消耗量高与 LOS 延长有很大关系。鉴于这些研究结果,有必要改变现有方案,减少术后镇痛对阿片类药物的依赖,以改善患者预后并减少医疗支出。
{"title":"High inpatient-opioid consumption predicts extended length of hospital stay in patients undergoing spinal fusion for adolescent idiopathic scoliosis.","authors":"Mani Ratnesh S Sandhu, Samuel Craft, Benjamin C Reeves, Sumaiya Sayeed, Astrid C Hengartner, Dominick A Tuason, Michael DiLuna, Aladine A Elsamadicy","doi":"10.1007/s43390-024-00960-6","DOIUrl":"10.1007/s43390-024-00960-6","url":null,"abstract":"<p><strong>Objectives: </strong>Opioids are common medications used following spine surgery. However, few studies have assessed the impact of increased inpatient-opioid consumption on outcomes following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The aim of this study was to determine the impact of increased inpatient-opioid consumption on hospital length of stay (LOS) following PSF for AIS.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using the Premier Healthcare Database (2016-2017). Adolescent patients (11-17 years old) who underwent PSF for AIS, identified using ICD-10-CM coding, were stratified by inpatient MME (morphine milligram equivalent) consumption into Low (< 25th percentile for the cohort), Medium (25-75th percentile), and High (> 75th percentile) cohorts. Demographics, comorbidities, intraoperative procedures, perioperative adverse events (AEs), length of hospital stay (LOS), non-routine discharge rates, cost of admission, and 30-day readmission rates were assessed. A logistic multivariate regression analysis was performed to determine the association between inpatient MME consumption and extended LOS.</p><p><strong>Results: </strong>Of the 1042 study patients, 260 (24.9%) had Low-MME consumption, 523 (50.2%) had Medium-MME consumption, and 259 (24.9%) had High-MME consumption. A greater proportion of patients in the High cohort identified as non-Hispanic white (Low: 46.5% vs Medium: 61.4% vs High: 65.3%, p < 0.001), while the proportion of patients reporting any comorbidity did not vary across the cohorts (p = 0.940). The number of post-operative AEs experienced also did not vary across the cohorts (p = 0.629). A greater proportion of patients in the High cohort had an extended LOS (Low: 6.5% vs Medium: 8.6% vs High: 19.7%, p < 0.001), while a greater proportion of patients in the Low cohort had an increased cost of admission (Low: 33.1% vs Medium: 20.3% vs High: 26.6%, p < 0.001). The High cohort had increased 30-day readmission rates relative to the Low and Medium cohorts (Low: 0.8% vs Medium: 0.2% vs High: 1.5%, p = 0.049). Non-routine discharge rates did not vary among the cohorts (p = 0.441). On multivariate analysis, High-MME consumption was significantly associated with extended LOS, while Medium-MME consumption was not [Medium: aOR: 1.48, CI (0.83, 2.74), p = 0.193; High: aOR: 4.43, CI (2.47, 8.31), p < 0.001].</p><p><strong>Conclusions: </strong>Our study showed that high post-operative-MME consumption was significantly associated with extended LOS in patients undergoing PSF for AIS. In light of these findings, changes to existing protocols that decrease the reliance on opioids for post-operative analgesia are merited to improve patient outcomes and reduce health-care expenditures.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"111-121"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Does an improvement in cord-level intraoperative neuromonitoring data lead to a reduced risk for postoperative neurologic deficit in spine deformity surgery? 脊柱畸形手术术中脊髓水平神经监测数据的改善是否会降低术后神经功能缺损的风险?
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2024-08-08 DOI: 10.1007/s43390-024-00944-6
Nathan J Lee, Lawrence G Lenke, Mitchell Yeary, Alexandra Dionne, Chidebelum Nnake, Michael Fields, Matthew Simhon, Ted Shi, Varun Arvind, Anastasia Ferraro, Matthew Cooney, Erik Lewerenz, Justin L Reyes, Steven Roth, Chun Wai Hung, Justin K Scheer, Thomas Zervos, Earl D Thuet, Joseph M Lombardi, Zeeshan M Sardar, Ronald A Lehman, Fthimnir M Hassan

Purpose: To determine if an improvement in cord-level intraoperative neuromonitoring (IONM) data following data loss results in a reduced risk for new postoperative motor deficit in pediatric and adult spinal deformity surgery.

Methods: A consecutive series of 1106 patients underwent spine surgery from 2015 to 2023 by a single surgeon. Cord alerts were defined by Somatosensory-Evoked Potentials (SSEP; warning criteria: 10% increase in latency or > 50% loss in amplitude) and Motor-Evoked Potentials (MEP; warning criteria: 75% loss in amplitude without return to acceptable limits after stimulation up 100 V above baseline level). Timing of IONM loss and recovery, interventions, and baseline/postoperative day 1 (POD1) lower extremity motor scores were analyzed.

Results: IONM Cord loss was noted in 4.8% (53/11,06) of patients and 34% (18/53) with cord alerts had a POD1 deficit compared to preoperative motor exam. MEP and SSEP loss attributed to 98.1% (52/53) and 39.6% (21/53) of cord alerts, respectively. Abnormal descending neurogenic-evoked potential (DNEP) was seen in 85.7% (12/14) and detected 91.7% (11/12) with POD1 deficit. Abnormal wake-up test (WUT) was seen in 38.5% (5/13) and detected 100% (5/5) with POD1 deficit. Most cord alerts occurred during a three-column osteotomy (N = 23/53, 43%); decompression (N = 12), compression (N = 7), exposure (N = 4), and rod placement (N = 14). Interventions were performed in all 53 patients with cord loss and included removing rods/less correction (N = 11), increasing mean arterial pressure alone (N = 10), and further decompression with three-column osteotomy (N = 9). After intervention, IONM data improved in 45(84.9%) patients (Full improvement: N = 28; Partial improvement: 17). For those with full and partial IONM improvement, the POD1 deficit was 10.7% (3/28) and 41.2% (7/17), respectively. For those without any IONM improvement (15.1%, 8/53), 100% (8/8) had a POD1 deficit, P < 0.001.

Conclusion: A full or partial improvement in IONM data loss after intraoperative intervention was significantly associated with a lower risk for POD1 deficit with an absolute risk reduction of 89.3% and 58.8%, respectively. All patients without IONM improvement had a POD1 neurologic deficit.

目的:确定在数据丢失后改善脊髓水平术中神经监测(IONM)数据是否会降低小儿和成人脊柱畸形手术中术后出现新运动障碍的风险:方法:2015年至2023年期间,一名外科医生连续为1106名患者实施了脊柱手术。脊髓警报由躯体感觉诱发电位(SSEP;警告标准:潜伏期增加 10%或振幅损失大于 50%)和运动诱发电位(MEP;警告标准:振幅损失 75%,且未恢复)定义:振幅损失 75% 且在刺激电压高于基线水平 100 V 后未恢复到可接受范围)。对 IONM 丧失和恢复的时间、干预措施和基线/术后第 1 天 (POD1) 下肢运动评分进行了分析:结果:与术前运动检查相比,4.8%(53/11,06)的患者出现了 IONM 脊髓缺失,34%(18/53)的患者出现了 POD1 脊髓缺失。98.1%(52/53)和 39.6%(21/53)的脊髓警报分别归因于 MEP 和 SSEP 缺失。85.7%(12/14)的患者出现降神经源性诱发电位(DNEP)异常,91.7%(11/12)的患者出现 POD1 缺失。38.5%(5/13)的唤醒试验(WUT)异常,100%(5/5)的唤醒试验(WUT)检测出 POD1 缺失。大多数脊髓警报发生在三柱截骨术期间(23/53,43%);减压(12)、压迫(7)、暴露(4)和杆置入(14)。对所有53名脊髓缺失患者进行了干预,包括移除杆/减少矫正(11人)、单独增加平均动脉压(10人)以及通过三柱截骨术进一步减压(9人)。干预后,45 例(84.9%)患者的 IONM 数据得到改善(完全改善:28 例;部分改善:17 例)。在IONM完全改善和部分改善的患者中,POD1缺损率分别为10.7%(3/28)和41.2%(7/17)。在 IONM 未得到任何改善的患者中(15.1%,8/53),100%(8/8)的 POD1 均为不足,P 结论:术中干预后 IONM 数据丢失的完全或部分改善与 POD1 缺失风险的降低显著相关,绝对风险分别降低了 89.3% 和 58.8%。所有 IONM 无改善的患者均出现 POD1 神经功能缺损。
{"title":"Does an improvement in cord-level intraoperative neuromonitoring data lead to a reduced risk for postoperative neurologic deficit in spine deformity surgery?","authors":"Nathan J Lee, Lawrence G Lenke, Mitchell Yeary, Alexandra Dionne, Chidebelum Nnake, Michael Fields, Matthew Simhon, Ted Shi, Varun Arvind, Anastasia Ferraro, Matthew Cooney, Erik Lewerenz, Justin L Reyes, Steven Roth, Chun Wai Hung, Justin K Scheer, Thomas Zervos, Earl D Thuet, Joseph M Lombardi, Zeeshan M Sardar, Ronald A Lehman, Fthimnir M Hassan","doi":"10.1007/s43390-024-00944-6","DOIUrl":"10.1007/s43390-024-00944-6","url":null,"abstract":"<p><strong>Purpose: </strong>To determine if an improvement in cord-level intraoperative neuromonitoring (IONM) data following data loss results in a reduced risk for new postoperative motor deficit in pediatric and adult spinal deformity surgery.</p><p><strong>Methods: </strong>A consecutive series of 1106 patients underwent spine surgery from 2015 to 2023 by a single surgeon. Cord alerts were defined by Somatosensory-Evoked Potentials (SSEP; warning criteria: 10% increase in latency or > 50% loss in amplitude) and Motor-Evoked Potentials (MEP; warning criteria: 75% loss in amplitude without return to acceptable limits after stimulation up 100 V above baseline level). Timing of IONM loss and recovery, interventions, and baseline/postoperative day 1 (POD1) lower extremity motor scores were analyzed.</p><p><strong>Results: </strong>IONM Cord loss was noted in 4.8% (53/11,06) of patients and 34% (18/53) with cord alerts had a POD1 deficit compared to preoperative motor exam. MEP and SSEP loss attributed to 98.1% (52/53) and 39.6% (21/53) of cord alerts, respectively. Abnormal descending neurogenic-evoked potential (DNEP) was seen in 85.7% (12/14) and detected 91.7% (11/12) with POD1 deficit. Abnormal wake-up test (WUT) was seen in 38.5% (5/13) and detected 100% (5/5) with POD1 deficit. Most cord alerts occurred during a three-column osteotomy (N = 23/53, 43%); decompression (N = 12), compression (N = 7), exposure (N = 4), and rod placement (N = 14). Interventions were performed in all 53 patients with cord loss and included removing rods/less correction (N = 11), increasing mean arterial pressure alone (N = 10), and further decompression with three-column osteotomy (N = 9). After intervention, IONM data improved in 45(84.9%) patients (Full improvement: N = 28; Partial improvement: 17). For those with full and partial IONM improvement, the POD1 deficit was 10.7% (3/28) and 41.2% (7/17), respectively. For those without any IONM improvement (15.1%, 8/53), 100% (8/8) had a POD1 deficit, P < 0.001.</p><p><strong>Conclusion: </strong>A full or partial improvement in IONM data loss after intraoperative intervention was significantly associated with a lower risk for POD1 deficit with an absolute risk reduction of 89.3% and 58.8%, respectively. All patients without IONM improvement had a POD1 neurologic deficit.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"261-272"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141907662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Associations of overweight status with spinal curve correction and complications in patients undergoing vertebral body tethering: a multicenter retrospective review. 椎体系带术患者超重状况与脊柱曲线矫正及并发症的关系:多中心回顾性研究。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2024-08-19 DOI: 10.1007/s43390-024-00942-8
William ElNemer, Daniel Badin, Shyam J Kurian, Stefan Parent, Firoz Miyanji, Daniel Hoernschemeyer, Ahmet Alanay, Paul D Sponseller

Purpose: Our purpose was to determine associations between body mass index (BMI) category and outcomes of vertebral body tethering (VBT), a non-fusion treatment for adolescent idiopathic scoliosis (AIS) and juvenile idiopathic scoliosis (JIS).

Methods: Using a multicenter database, we identified patients with AIS or JIS who underwent VBT from 2012 to 2018 and had minimum 2-year follow-up (median, 3.0 [interquartile range 2.2, 3.8]). BMI percentiles were used to classify patients as overweight (≥ 85th percentile) or non-overweight (< 85th percentile). Univariate and multivariate regressions assessed associations between complication rates and curve correction between groups, controlling for sex, triradiate cartilage closure, and preoperative curve magnitude.

Results: Of 271 patients, 48 (18%) were overweight. Complication rates did not differ between groups. Factors associated with less correction from preoperative to first postoperative-erect imaging were overweight (β = - 10, p < 0.001), male sex (β = - 8.8 p < 0.01), closed triradiate cartilage (β = 6.0, p = 0.01), and smaller preoperative curve (β = 0.3, p < 0.01). Factors associated with a larger curve at latest follow-up were overweight (β = 4.0, p = 0.02) and larger preoperative curve (β = 0.5, p < 0.001), but tether breakage did not differ between groups (p = 0.31).

Conclusion: In patients who were overweight, VBT was associated with less curve correction at first erect imaging and larger final curve. However, complications and curve correction during the modulation phase were not different from those of non-overweight patients. These findings suggest that surgeons should expect less correction with VBT in patients who are overweight but similar correction over time.

Level of evidence: Prognostic, Level III.

目的:我们的目的是确定身体质量指数(BMI)类别与椎体系带术(VBT)结果之间的关联,椎体系带术是一种治疗青少年特发性脊柱侧凸(AIS)和幼年特发性脊柱侧凸(JIS)的非融合治疗方法:通过多中心数据库,我们确定了2012年至2018年期间接受VBT治疗且随访至少2年的AIS或JIS患者(中位数为3.0[四分位距为2.2,3.8])。BMI百分位数用于将患者分为超重(≥第85百分位数)和非超重(结果:在 271 名患者中,48 人(18%)超重。两组患者的并发症发生率没有差异。从术前到术后首次直立成像的矫正率较低的相关因素是超重(β = - 10,p 结论:在超重患者中,VT 波形的矫正率较低:对于超重患者,VBT 与首次直立造影时曲线矫正较少和最终曲线较大有关。然而,在调节阶段的并发症和曲线矫正与非超重患者没有区别。这些研究结果表明,外科医生在对超重患者进行 VBT 治疗时,应尽量减少对曲线的矫正,但随着时间的推移,矫正效果会相似:预后,III 级。
{"title":"Associations of overweight status with spinal curve correction and complications in patients undergoing vertebral body tethering: a multicenter retrospective review.","authors":"William ElNemer, Daniel Badin, Shyam J Kurian, Stefan Parent, Firoz Miyanji, Daniel Hoernschemeyer, Ahmet Alanay, Paul D Sponseller","doi":"10.1007/s43390-024-00942-8","DOIUrl":"10.1007/s43390-024-00942-8","url":null,"abstract":"<p><strong>Purpose: </strong>Our purpose was to determine associations between body mass index (BMI) category and outcomes of vertebral body tethering (VBT), a non-fusion treatment for adolescent idiopathic scoliosis (AIS) and juvenile idiopathic scoliosis (JIS).</p><p><strong>Methods: </strong>Using a multicenter database, we identified patients with AIS or JIS who underwent VBT from 2012 to 2018 and had minimum 2-year follow-up (median, 3.0 [interquartile range 2.2, 3.8]). BMI percentiles were used to classify patients as overweight (≥ 85th percentile) or non-overweight (< 85th percentile). Univariate and multivariate regressions assessed associations between complication rates and curve correction between groups, controlling for sex, triradiate cartilage closure, and preoperative curve magnitude.</p><p><strong>Results: </strong>Of 271 patients, 48 (18%) were overweight. Complication rates did not differ between groups. Factors associated with less correction from preoperative to first postoperative-erect imaging were overweight (β = - 10, p < 0.001), male sex (β = - 8.8 p < 0.01), closed triradiate cartilage (β = 6.0, p = 0.01), and smaller preoperative curve (β = 0.3, p < 0.01). Factors associated with a larger curve at latest follow-up were overweight (β = 4.0, p = 0.02) and larger preoperative curve (β = 0.5, p < 0.001), but tether breakage did not differ between groups (p = 0.31).</p><p><strong>Conclusion: </strong>In patients who were overweight, VBT was associated with less curve correction at first erect imaging and larger final curve. However, complications and curve correction during the modulation phase were not different from those of non-overweight patients. These findings suggest that surgeons should expect less correction with VBT in patients who are overweight but similar correction over time.</p><p><strong>Level of evidence: </strong>Prognostic, Level III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"145-152"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating the impact of multiple sclerosis on 2 year postoperative outcomes following long fusion for adult spinal deformity: a propensity score-matched analysis. 评估多发性硬化症对成人脊柱畸形长融合术后两年疗效的影响:倾向得分匹配分析。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2024-09-27 DOI: 10.1007/s43390-024-00956-2
Neil V Shah, Ryan Kong, Chibuokem P Ikwuazom, George A Beyer, Hallie A Tiburzi, Frank A Segreto, Juhayer S Alam, Adam J Wolfert, Daniel Alsoof, Renaud Lafage, Peter G Passias, Frank J Schwab, Alan H Daniels, Virginie Lafage, Carl B Paulino, Bassel G Diebo

Study design: Retrospective cohort study.

Purpose: The impact of neuromuscular disorders such as multiple sclerosis (MS) on outcomes following long segment fusion is underreported. This study evaluates the impact of MS on two-year (2Y) postoperative complications and revisions following ≥ 4-level fusion for adult spinal deformity (ASD).

Methods: Patients undergoing ≥ 4-level fusion for ASD were identified from a statewide database. Patients with a baseline diagnosis of MS were also identified. Patients with infectious/traumatic/neoplastic indications were excluded. Subjects were 1:1 propensity score-matched (MS to no-MS) based on age, sex and race and compared for rates of 2Y postoperative complications and reoperations. Logistic regression models were utilized to determine risk factors for adverse outcomes at 2Y.

Results: 86 patients were included overall (n = 43 per group). Age, sex, and race were comparable between groups (p > 0.05). MS patients incurred higher charges for their surgical visit ($125,906 vs. $84,006, p = 0.007) with similar LOS (8.1 vs. 5.3 days, p > 0.05). MS patients experienced comparable rates of overall medical complications (30.1% vs. 25.6%) and surgical complications (34.9% vs. 30.2%); p > 0.05. MS patients had similar rates of 2Y revisions (16.3% vs. 9.3%, p = 0.333). MS was not associated with medical, surgical, or overall complications or revisions at minimum 2Y follow-up.

Conclusion: Patients with MS experienced similar postoperative course compared to those without MS following ≥ 4-level fusion for ASD. This data supports the findings of multiple previously published case series' that long segment fusions for ASD can be performed relatively safely in patients with MS.

研究设计目的:多发性硬化症(MS)等神经肌肉疾病对长节段融合术后疗效的影响未得到充分报道。本研究评估了MS对成人脊柱畸形(ASD)≥4级融合术后两年(2Y)并发症和翻修的影响:方法:从全州范围的数据库中筛选出因 ASD 而接受≥ 4 级融合术的患者。同时还确定了基线诊断为多发性硬化症的患者。排除感染性/创伤性/肿瘤性适应症患者。根据年龄、性别和种族对受试者进行1:1倾向评分匹配(多发性硬化与非多发性硬化),并比较术后2年并发症和再次手术的发生率。利用逻辑回归模型确定2年后不良后果的风险因素:共纳入 86 名患者(每组 43 人)。各组患者的年龄、性别和种族具有可比性(P > 0.05)。多发性硬化症患者的手术费用较高(125,906 美元对 84,006 美元,P = 0.007),但住院时间相似(8.1 天对 5.3 天,P > 0.05)。多发性硬化症患者的总体内科并发症发生率(30.1% 对 25.6%)和外科并发症发生率(34.9% 对 30.2%)相当;P > 0.05。MS患者的2年翻修率相似(16.3% vs. 9.3%,P = 0.333)。在至少2年的随访中,MS与内科、外科或整体并发症或翻修无关:结论:与非MS患者相比,MS患者在进行≥4级ASD融合术后经历了相似的术后过程。这一数据支持了之前发表的多个病例系列的研究结果,即MS患者可以相对安全地进行ASD长节段融合术。
{"title":"Evaluating the impact of multiple sclerosis on 2 year postoperative outcomes following long fusion for adult spinal deformity: a propensity score-matched analysis.","authors":"Neil V Shah, Ryan Kong, Chibuokem P Ikwuazom, George A Beyer, Hallie A Tiburzi, Frank A Segreto, Juhayer S Alam, Adam J Wolfert, Daniel Alsoof, Renaud Lafage, Peter G Passias, Frank J Schwab, Alan H Daniels, Virginie Lafage, Carl B Paulino, Bassel G Diebo","doi":"10.1007/s43390-024-00956-2","DOIUrl":"10.1007/s43390-024-00956-2","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>The impact of neuromuscular disorders such as multiple sclerosis (MS) on outcomes following long segment fusion is underreported. This study evaluates the impact of MS on two-year (2Y) postoperative complications and revisions following ≥ 4-level fusion for adult spinal deformity (ASD).</p><p><strong>Methods: </strong>Patients undergoing ≥ 4-level fusion for ASD were identified from a statewide database. Patients with a baseline diagnosis of MS were also identified. Patients with infectious/traumatic/neoplastic indications were excluded. Subjects were 1:1 propensity score-matched (MS to no-MS) based on age, sex and race and compared for rates of 2Y postoperative complications and reoperations. Logistic regression models were utilized to determine risk factors for adverse outcomes at 2Y.</p><p><strong>Results: </strong>86 patients were included overall (n = 43 per group). Age, sex, and race were comparable between groups (p > 0.05). MS patients incurred higher charges for their surgical visit ($125,906 vs. $84,006, p = 0.007) with similar LOS (8.1 vs. 5.3 days, p > 0.05). MS patients experienced comparable rates of overall medical complications (30.1% vs. 25.6%) and surgical complications (34.9% vs. 30.2%); p > 0.05. MS patients had similar rates of 2Y revisions (16.3% vs. 9.3%, p = 0.333). MS was not associated with medical, surgical, or overall complications or revisions at minimum 2Y follow-up.</p><p><strong>Conclusion: </strong>Patients with MS experienced similar postoperative course compared to those without MS following ≥ 4-level fusion for ASD. This data supports the findings of multiple previously published case series' that long segment fusions for ASD can be performed relatively safely in patients with MS.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"287-291"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Spine deformity
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1