Spine deformity最新文献

Purpose: To present our experience using Shilla Growth Guidance System (SGGS) technology with a solid pelvic foundation in patients with severe early-onset neuromuscular spine deformity.

Methods: The surgical procedure involved a solid instrumented fusion from L5 to the pelvis with iliac screws, with minimal dissection of the spine from L4 to T4, leaving the longitudinal para-spinal muscles intact. Alternating SGGS screws were sequentially placed from L4 to T4 with fluoroscopy and/or computer navigation. This retrospective study from two institutions included surgeries performed by three surgeons. The primary outcomes were the number of revision surgeries and the complication rate; T1-S1 height increase was a secondary outcome.

Results: For 34 patients, the average age at the initial surgery was 5.9 years and the follow-up was 10 years for surviving patients. Eleven patients were tracheostomy- and ventilator-dependent. The average total number of surgeries/patients was 2.3. The revision surgery rate was 53% (45 revision surgeries in 18 patients, average of 2.5 revision surgeries/patient). 20 patients (59%) had a major complication (modified Clavien-Sink-Dindo classification 3a-5). Nine (26%) had a deep surgical-site (SSI) infection requiring irrigation, debridement, and implant exchange. Thirteen patients died at an average age of 10.7 years, average 4.7 years post-operative, a 38% 10-year mortality and representing the frail nature of this population. Ten of these 13 (77%) deceased patients had no additional surgery after their index surgery, which was one of the major goals of the procedure. Nine of the 34 patients (26%) had a final fusion. The T1-S1 height increased by a mean of 6.7 cm (p < 0.01).

Conclusions: SGGS with a solid pelvic foundation is an option for addressing severe spinal deformity for patients with early-onset neuromuscular scoliosis who are too immature for a definitive fusion. For 47% of these patients, only the initial surgical procedure was necessary, thus avoiding serial surgical or clinic lengthening procedures. However, the revision rate of 53% and complication rate of 59% demonstrates the high risks of this procedure in this extremely frail population.

Purpose: Adult spinal deformity (ASD) is a chronic musculoskeletal condition characterized by abnormal spinal curvature and adverse psychological well-being. However, the mental health burden of ASD remains poorly characterized. This retrospective cross-sectional cohort study compared the prevalence and odds of mental health conditions in the ASD population to a matched general population cohort using the nationally representative All of Us Research Program.

Methods: ASD patients (n = 6531) were identified using ICD-9/10. Using 1:1 nearest neighbor propensity matching without replacement (caliper = 0.05), 6396 ASD patients were matched to 6396 general population controls. Logistic regression was performed to compute odds ratios (OR) and 95% confidence-intervals (CI) for mental health outcomes.

Results: After matching, mean age was 58.0 and 76% were female. Compared to the general population, ASD patients had higher unadjusted rates of depression (37.6% vs. 11.3%), anxiety (41.6% vs. 12.1%), post-traumatic stress disorder (PTSD) (7.2% vs. 2.2%), bipolar disorder (7.1% vs. 2.1%), schizophrenia/psychosis (2.4% vs. 0.9%), substance use disorders (24.3% vs. 9.7%), eating disorders (1.4% vs. 0.4%), and attention-deficit hyperactivity disorder (ADHD) (5.3% vs. 1.4%). On logistic regression, ASD patients had higher odds of depression (OR = 2.06, CI = 1.90-2.23, P < 0.001), anxiety (OR = 2.24, CI = 2.07-2.43, P < 0.001), and ADHD (OR = 2.87, CI = 2.32-3.54, P < 0.001). ASD patients also exhibited significantly elevated odds for eating disorders, bipolar disorder, PTSD, and substance use disorder (P < 0.05).

Conclusions: ASD patients in the United States have a substantially elevated mental health burden than the general populace. Routine mental health screenings and psychological assessments can be beneficial for this vulnerable population.

Purpose: Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional (3D) spinal deformity, with transverse plane rotational components increasingly targeted by modern surgical techniques. Yet, clinical evaluation remains predominantly based on 2D radiographic parameters, including the widely used Lenke classification. In response, the 3D Classification Task Force of the Scoliosis Research Society (SRS) developed a comprehensive, clinically relevant classification system that remains intuitive, reproducible, and readily applicable by spine surgeons. This manuscript introduces the proposed SRS-Lenke-Aubin 3D classification and evaluates its ability to provide a structured and clinically meaningful 3D characterization of spinal deformities in AIS.

Methods: To maintain continuity with standard clinical practices, the system builds upon the established Lenke classification and introduces two complementary 3D descriptors: the orientation of the regional plane of deformation (ORPD) and the apical vertebral rotation (AVR). These indices capture transverse plane deformities at the regional and local levels, respectively. Each was independently assessed for the proximal thoracic (PT), main thoracic (MT), and thoracolumbar/lumbar (TL/L) regions using calibrated 3D reconstructions from biplanar radiographs. A population-representative cohort of 285 AIS surgical cases was used to evaluate the system. ORPD and AVR values were translated into categorical modifiers using predefined clinical thresholds.

Results: The new SRS-Lenke-Aubin 3D AIS classification adds two transverse plane modifiers per spinal region-the ORPD and AVR-yielding a modular 3-tiered, 4-modifier system: Curve type (1-6), Lumbar spine modifier (A, B, C), Thoracic sagittal profile modifier (-, N, +), Transverse plane regional modifier (ORPD: 1-3) and Transverse plane local modifier (AVR: s, m, l). A broad range of ORPD × AVR combinations was observed across the cohort, reflecting the system's ability to capture transverse plane heterogeneity. Notably, similar coronal curve types often exhibited divergent transverse morphologies, underscoring the added value of these 3D descriptors in identifying clinically relevant variation.

Conclusions: The SRS-Lenke-Aubin 3D classification enriches the existing Lenke framework by incorporating practical transverse plane descriptors compatible with standard imaging workflows. This system offers a clinically meaningful step toward more complete 3D characterization of AIS, with potential applications in improving surgical planning, assessing outcomes, and supporting future integration with automated 3D tools.

Purpose: Advances in operative and recovery protocols such as the rapid recovery pathway (RRP) in the last decade have shortened inpatient stays for adolescent idiopathic scoliosis (AIS). This study aimed to evaluate the impact of these national trends on length of stay (LOS), complication rates, and costs in patients with AIS undergoing posterior spinal fusion (PSF) using a large, nationally representative dataset.

Methods: A retrospective review of 10,081 patients requiring PSF for AIS was conducted using the Healthcare Cost and Utilization Project's (HCUP) Kids' Inpatient Database (KID) in the latest available year prior to the popularity of protocols like RRP (2012) and most recently (2019). Patients and complications were identified via ICD-9 and ICD-10 codes. Multivariate linear and logistic regression analyses were performed to assess the impact of year of surgery while adjusting for demographic variables.

Results: Average LOS decreased in 2019 vs. 2012 (3.9 days vs. 5.4 days, p < 0.001), year of surgery (β = -1.4 days, p < 0.001), and absence of complications (β = -2.8 days, p < 0.001) were the largest predictors of LOS. Overall complication rates declined from 12.8% to 6.5% (p < 0.001). Year of surgery showed significantly increased charges after inflation adjustment (β = $12,452.6, p < 0.001), though other demographic variables demonstrated larger impact on cost.

Conclusions: More recent surgical year resulted in reduced hospital stays with fewer complications and without substantial increases in cost. These findings support continued adoption and refinement of operative and recovery protocols in pediatric spine surgery.

Purpose: One factor that may lead to the development of early-onset scoliosis (EOS) is chest wall procedures during infancy, which are common for patients with Trisomy 21 requiring cardiothoracic intervention involving thoracotomies. Studies examining scoliosis incidence in patients with prior thoracotomy demonstrate a wide incidence range. Our study aimed to assess if scoliosis prevalence is higher in patients with Trisomy 21 who underwent prior thoracotomy compared to patients who underwent sternotomy for congenital heart disease repair.

Methods: An IRB-approved, single-center retrospective review included patients aged 9 years or older with Trisomy 21 who underwent prior cardiothoracic surgery. Exclusion criteria included other trisomy diagnoses, no cardiothoracic surgical history, unavailable operative records, and ages 0-8 years. Medical chart review examined demographics, surgical details, and scoliosis diagnosis and management. Statistical analyses included chi-square, z test, one-way ANOVA, and descriptive statistics.

Results: Of 301 total patients, 12.6% were eventually diagnosed with scoliosis (n = 38). Common cardiothoracic procedures included atrioventricular canal repair (n = 141/301, 46.8%) and ventricular septal defect repair (n = 67/301, 22.3%). Thoracotomies were required in 7.0% (n = 21/301) at a median age of 1 month (IQR:0-15), most commonly for patent ductus arteriosus ligation (n = 8/21, 38.0%). Among thoracotomy patients, 28.6% developed scoliosis (n = 6/21), compared to 11.4% of sternotomy patients (n = 32/280) (p = 0.023). Among all patients with scoliosis (n = 38), 36.8% required intervention in the form of non-operative (i.e. bracing) or surgical treatment due to curve presentation and/or progression (n = 14); and 13.2% ultimately required spinal fusion (n = 5).

Conclusion: Our study demonstrates that trisomy 21 patients requiring early CT intervention have greater scoliosis prevalence following thoracotomy than sternotomy. While the prevalence is greater in the thoracotomy group, the evidence suggests both cohorts must closely be monitored for spinal deformity development to intervene early and prevent progression to an operative magnitude scoliosis.

Introduction: Posterior segmental instrumented fusion (PSIF) is considered the gold standard surgical treatment for adolescent idiopathic scoliosis (AIS), as it leads to immediate deformity correction and predictable long-term outcomes. Extended inpatient length of stay (LOS) following this intervention has been associated with greater morbidity, healthcare cost, and reoperation rates. Therefore, there is a growing impetus to reduce LOS through previously described accelerated discharge protocols. However, there is a paucity of literature characterizing perioperative factors associated with extended LOS in patients undergoing PSIF for AIS. Additionally, it remains unclear whether postoperative patient-reported outcomes are superior in patients with shorter LOS after AIS surgery.

Methods: A single institution's longitudinally maintained database was queried from a large academic medical center to identify patients with AIS who underwent PSIF by a single fellowship-trained pediatric spine surgeon between 2019 and 2024. Perioperative factors including age, sex, height, weight, race, ethnicity, insurance plan, language spoken at home, Risser stage, curve magnitude, training level of first assistant, intraoperative time, levels fused, navigation assistance, estimated blood loss, and Scoliosis Research Society (SRS) scores were assessed to determine potential associations with extended LOS.

Results: Of the 118 AIS patients who underwent PSIF, the mean LOS was 3.1 ± 0.8. Perioperative factors associated with longer LOS included only greater levels fused (p = 0.023). Longer LOS was associated with higher postoperative SRS mental health scores (p = 0.022), with a trend toward greater satisfaction (p = 0.055) and pain (p = 0.072) scores after adjustment for baseline values. No other perioperative factors or specific SRS domains were associated with LOS (p > 0.05 for all).

Conclusion: Greater number of levels (more than 11 segments) fused in surgery was associated with longer length of stay for AIS patients who underwent PSIF. With growing focus on minimizing inpatient LOS duration following PSIF for AIS patients, our findings of higher postoperative patient-reported SRS scores after longer inpatient stay may warrant prospective analysis and should be further considered in the perioperative care of AIS patients.

Level of evidence: Level III.

Purpose: Chiari I Malformation (CIM) is occasionally associated with scoliosis, especially in the presence of syringomyelia (SyM). While posterior fossa decompression (PFD) is often performed before spinal fusion, its impact on scoliosis progression remains unclear. Some studies report curve stabilization or improvement, while others show continued progression. This systematic review and meta-analysis aim to evaluate whether PFD influences CIM patients' scoliosis outcomes and identify predictive factors for curve behavior, improving multidisciplinary surgical management.

Methods: A systematic literature search was conducted in PubMed, Cochrane, Embase, Medline, Scopus, and Web of Science up to June 2025, following PRISMA guidelines. Inclusion criteria included pediatric patients (< 19 years) diagnosed with CIM who underwent PFD as the first treatment and had concurrent scoliosis (major curve angle > 10°). Data from 11 retrospective studies comprising 380 patients were analyzed. Pooled proportions of improvement, stability, and progression were calculated using random-effects models. Subgroup analyses were performed for duroplasty, and metaregression explored predictors, including age at surgery and baseline Cobb angle.

Results: The mean age at PFD was 10.3 years, with a mean preoperative curve of 37°. Syringomyelia was present in 92.6% of patients. After PFD, 55% (95% CI 46-63%) of curves improved or stabilized, while 45% (95% CI 37-54%) progressed. In the duroplasty subgroup (6 studies, 189 patients), success and progression rates were similar to the overall cohort (54% vs. 46%). Syrinx improvement was observed in 94% (95% CI 82-98%), with higher rates in duroplasty cases (97%). Metaregression demonstrated that older age at surgery (OR per year = 1.24, 95% CI 1.10-1.39; p < 0.001) and greater baseline Cobb angle (OR per + 5° = 0.79, 95% CI 0.65-0.96; p = 0.012) were independent predictors of scoliosis progression. Ultimately, 37.8% of patients required spinal fusion.

Conclusion: This meta-analysis suggests that PFD is associated with scoliosis improvement in nearly half of pediatric patients with CIM, but a significant proportion still experiences curve progression. Younger age at surgery and lower preoperative major curve angle are associated with better outcomes. Future prospective studies with standardized criteria and extended follow-up periods are needed to refine treatment strategies.

Purpose: This systematic review and meta-analysis aim to investigate the prevalence of cardiac abnormalities in patients with idiopathic scoliosis.

Methods: A systematic search on PubMed, Embase, Scopus, and Web of Science was conducted, covering studies published from their inception up to February 2024. Peer-reviewed studies that used echocardiograms to screen for cardiac abnormalities were included. Nine thousand five hundred fifty-four cases met the inclusion criteria and were included in the final data synthesis. A meta-analysis was performed to calculate the pooled prevalence of cardiac abnormalities and a 95% confidence interval (CI). Results were divided into subgroups to reveal the prevalence of each cardiac abnormality for further consideration.

Results: 7.5% had cardiac abnormalities. Valvular diseases are the most common cardiac abnormalities. Tricuspid regurgitation (TR) is the most prevalent, accounting for 24.4% of cases. This is followed by mitral regurgitation (MR) at 17%, mitral valve prolapse (MVP) at 8%, aortic regurgitation (AR) at 3.8%, and pulmonary insufficiency at 1.9%. In addition, other valvular diseases collectively make up 22% of the findings. Congenital heart diseases (CHD) were also included in the results, with atrial septal defect (ASD) being the most prominent at 1.5%, followed by ventricular septal defect (VSD) at 1.4%, and other CHD comprising 2.5%. Pulmonary hypertension accounts for a substantial portion of the results, representing 16.8%. A dilated aortic root and pericardial effusion were observed in 2.4% and 0.9% of cases, respectively.

Conclusion: Cardiovascular abnormalities are prevalent in patients with idiopathic scoliosis. This highlights the need for thorough cardiovascular screening of these patients before surgical intervention.

Background: Severe adolescent idiopathic scoliosis (AIS) may be associated with cardiopulmonary issues, including previously undiagnosed congenital cardiac anomalies, valvular disease, and pulmonary hypertension. Many centers routinely refer patients with coronal Cobb angles ≥ 70° for pre-operative cardiology evaluation prior to posterior spinal fusion (PSF). The clinical utility of this practice remains uncertain.

Methods: A retrospective review was conducted of AIS patients undergoing PSF at a single pediatric orthopedic center from 2017 to 2024. All patients received pre-operative anesthesia evaluations including history, auscultation, and electrocardiogram (EKG). Cardiology referral was made for patients with Cobb angles ≥ 70° or for those with cardiac symptoms, murmurs, or EKG abnormalities. Data collected included cardiology referral status, echocardiogram (TTE) findings, need for intervention or follow-up, surgical delays, and perioperative cardiac complications. Comparative analysis was performed between patients with Cobb angles ≥ 70° and < 70°.

Results: Of 151 patients (mean age 14.5 years [range 11-20] 75% female), 51 had Cobb angles ≥ 70°. These patients were more likely to report cardiac symptoms (20% vs. 3%, p = 0.0012) and have murmurs (10% vs. 1%, p = 0.017). 35 patients with Cobb ≥ 70° patients were referred to cardiology, and 17 underwent TTE. Nine had abnormal but largely benign findings; only three required follow-ups. No patient in either group experienced surgical delays or perioperative cardiac complications.

Conclusions: Although AIS patients with Cobb angles ≥ 70° demonstrate higher rates of symptoms and murmurs, routine cardiology referral based on Cobb angle alone rarely uncovers clinically significant findings or impacts surgical timing. A targeted referral strategy incorporating symptoms, exam findings, and EKG abnormalities may optimize patient safety while reducing unnecessary testing and cost.