Spine deformity最新文献

Purpose: To evaluate the long-term cancer risks associated with AIS, focusing on the roles of genetic predispositions and radiation exposure.

Methods: A comprehensive systematic search was conducted on August 5, 2024, across PubMed, EMBASE, Scopus, Cochrane Libraries, and CINAHL, covering studies from 1947 onward. Human studies on patients with scoliosis diagnosed before age 20 were included. For cancer assessment, both risk, incidence and mortality were included. Studies were excluded if they focused solely on congenital or secondary scoliosis. Screening and quality assessment were conducted using Covidence. The first author performed the initial screening, while the first and second authors conducted full-text assessments and quality assessment collaboratively, with an agreement score of 0.83.

Results: Seven studies from the USA, Australia, Denmark and The Netherlands were identified. Notable findings included elevated breast cancer risks among US cohorts, linked to historical radiographic practices that delivered higher radiation doses. None of the included studies assessed genetic etiologies of cancer. Risk of bias in the studies were generally attributed to selection bias and underreporting of characteristics and confounding variables. While most studies included either showed a tendency or a significant association towards an association between scoliosis and risk of cancer, it was mainly based on data before 1990 with exposure to radiation several orders of magnitude larger than modern standards. These changes could be a major factor in the risk of cancer identified in historical cohorts.

Conclusion: This review highlights the importance of continued research, including the effect of modern examination techniques, such as EOS, MRI on rates of cancer in modern populations.

Purpose: A subset of adult spinal deformity (ASD) patients undergoing corrective surgery receive a disproportionate level of medical resources and incur greater costs. We examined the characteristics of such super-utilizers of health care resources among ASD patients.

Methods: This prospective, multicenter study analyzed data from ASD patients with > 4 levels of spinal fusion and a minimum 2-year follow-up. Index and total episode-of-care (EOC) costs in 2022 US dollars were calculated using average itemized direct costs obtained from administrative hospital records. Patients with total 2-year EOC cost > 90th percentile were considered super-utilizers, the characteristics of which we identified through a multivariate generalized logistic model.

Results: Of 1299 eligible patients, mean age was 60 years, 73% were female and 92% were Caucasian. Super-utilizers were older (+2.1 years; p = 0.012), had greater depression (34.2 vs 25.7%; p = 0.03), increased frailty (p = 0.009) comorbidities (p = 0.005), higher reoperation rates (54.4 vs 15.0%; p < 0.001), hospital length of stay (+ 3 days; p < 0.0001), higher surgical invasiveness (+28.6; p < 0.001), more vertebrae fused (+ 3; p < 0.0001); interbody fusions (80 vs 55%; p < 0.0001), bone morphogenetic protein (BMP) use (87.3 vs 69.4%; p = 0.0001), operative time (+91 min; p < 0.0001), and blood loss (+620 mL; p < 0.0001) compared to other ASD patients. Index cost was 65% (p < 0.0001), and cost/quality-adjusted life-year was three times higher among super-utilizers.

Conclusion: ASD patients with depression who undergo more complex or revision spinal surgical procedures are more likely to be super-utilizers. Identifying likely super-utilizers within the ASD population may enable targeted interventions and preoperative planning to reduce unnecessary costs, while improving patient outcomes.

Background: S2 Alar-Iliac (S2AI) screw placement is a common method to achieve stable lumbosacral fixation in the setting of multilevel fusion constructs. Differences in pelvic morphology between males and females can result in a more medial screw starting point in males. This can affect the ability to easily connect the pelvic screw to the rest of the construct. The purpose of this study is to assess the impact of sex and pelvic anatomy on the location of S2AI screw placement and lumbosacral rod alignment in the coronal plane.

Methods: Consecutive cases with S2AI screw placement were identified. Radiographic measurements included the distance between the posterior superior iliac spine (PSIS) on preoperative computed tomography (CT) imaging, distance between S2AI screw heads, and rod-to-rod angles.

Results: Females exhibited significantly greater distance between PSIS compared to males, reflecting sex-based anatomical differences in pelvic structure (p < 0.01). Average rod-to-rod angles were significantly more convergent distally in males than in females (p < 0.05). No significant differences were observed between freehand and stereotactic navigation techniques for rod-to-rod angles or screw distances. PSIS distance was a strong predictor of both rod-to-rod angle (β = 3.3, p < 0.01) and screw distances (β = 0.3, p < 0.01). When evaluating sex and technique as predictors, only sex was significant for PSIS distance (p < 0.01) and rod-to-rod angle (p < 0.05).

Conclusions: The placement of S2AI screws demonstrate sex-based anatomical differences in the location of S2AI screw placement. These anatomical differences should be taken into account in preoperative planning.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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