Epidemiology of adolescent idiopathic scoliosis

Risk factors and foot biomechanical characteristics of idiopathic scoliosis: a cross-sectional study

Idiopathic scoliosis (IS) caused by an unknown etiology is prevalent in primary and secondary school students. Early detection and prevention are challenging because of the limited knowledge about controllable risk factors and imbalances in body mechanics. In this study, we examined the potential causative factors of IS and its correlation with foot mechanics among 7-14 year-old students in northern Jiangsu Province, China. Based on a stratified whole cluster sampling, 4387 students were examined, of whom of whom 165 were diagnosed with scoliosis. Through logistic regression analysis, the following risk factors were identified: age group, female gender, thinness, unsuitable desk and chair heights, heavy schoolbags, backpack carried on one shoulder, daily sedentary time ≥ 10 h, daily playing electronic products time ≥ 2 h, daily physical activity time < 1 h, sports programs with unilateral limb power, lumbar and back fatigue, unequal thickness of worn soles on both feet and flat foot. When compared to healthy people, IS patients exhibit foot biomechanics characterized by a diagonal distribution of bilateral weight-bearing and walking instability, as well as poor balance function if they have an abnormal foot type, as in the case of flat foot. Our study revealed that the detection rate of scoliosis in primary and secondary school students in northern Jiangsu Province, China, is relatively is on the high side, so it is necessary to strengthen education and screening, concentrate on female students, and provide guidance on how to develop a healthy lifestyle and learning habits. Assessment of plantar pressure distribution and postural symmetry is an effective means of predicting scoliosis. Plantar pressure analysis can serve as an additional tool for assessing the risk of scoliosis.

Posterior spinal fusion outcomes for moderate adolescent idiopathic scoliosis in boys and girls: should we counsel them the same?

PURPOSE

With this study, we aim to evaluate and compare the perioperative outcomes of PSF for girls and boys. We hypothesize that female patients will have better curve correction and lower rates of complications when compared to male patients.

METHODS

This study employed a retrospective review of AIS patients who underwent PSF at 23 sites between 2011 and 2021, limited to preoperative curves between 40 and 60° and stratified based on sex assigned at birth. All patients had preoperative and 2-year follow-up and were evaluated for correction, complications, surgery metrics, and patient reported outcomes.

RESULTS

1714 patients were included in this study: 1381 girls, 333 boys. At time of surgery, the mean age was 15.4 ± 2 years for girls and 16.4 ± 2 years for boys. Boys were significantly taller and heavier than the girls. The preoperative curve magnitude was equivalent (major Cobb 50° in girls and boys, p = 0.799). Boys and girls had median 10 levels instrumented [IQR 2] (p = 0.012). At 2-year follow-up, girls with primary thoracic curves had better coronal curve measurements (22° ± 7 vs 23° ± 8, p = 0.002) and percent correction (56% ± 14 vs 53% ± 16, p = 0.004). For primary lumbar curves, curve measurements and percent correction were not different. SRS scores for 2-year post-operative patient reported outcomes were not different in boys and girls. 191 girls experienced complications compared to 48 boys (14% of their cohorts, p = 0.31). 67 girls and 14 boys underwent reoperation (5% vs 4%, p = 0.61).

CONCLUSIONS

At 2 years following spinal fusion for AIS, boys and girls with moderate curves exhibit similar postoperative curve correction and SRS scores. Complication rates had no difference by patient sex.

Risk factor analysis for cardiac abnormalities in patients with idiopathic scoliosis

The proportion of cardiac abnormalities in patients with idiopathic scoliosis(IS) who required surgery is relatively high. However, the specific cause and underlying risk factors remain poorly elucidated. A retrospective study. To investigate the proportion of cardiac abnormalities in patients with IS and identify the related risk factors. Clinical and imaging data from 289 IS patients aged 6-18 years including 225 females and 64 males admitted to our center from January 2015 and March 2023 were analyzed. The records of echocardiography, spinal radiographs and magnetic resonance imaging were reviewed. Calculate the proportion of congenital heart disease and cardiac abnormalities related to heart valves in patients with IS, and screen the risk factors by multivariate analysis. Twelve patients (4.15%) had congenital heart disease, with atrial septal defect being the most common type (1.73%). Eighty-eight patients (30.45%) had cardiac abnormalities related to heart valves, with mild tricuspid regurgitation being the most common type (17.65%). There were no statistically significant differences in the proportion of congenital heart disease among groups based on gender(P = 0.096), age(6 ~ 10 vs. 11-18, P = 0.200), ethnicity(Han vs. Minority, P = 0.969), BMI grade(Emaciation vs. Normal vs. Overweight/Obesity, P = 0.512), altitude(< 2000 m vs. ≥ 2000 m, P = 0.078), main curvature location(Thoracic vs. Thoracolumbar vs. Lumbar, P = 0.326), severity of scoliosis(Deformed vs. Highly deformed, P = 0.841), main direction(P = 0.102), and chest aspect ratio(< 0.45 vs. ≥ 0.45, P = 0.341). The proportion of cardiac abnormalities related to heart valves was higher in males, patients with thoracolumbar IS, and patients with left-sided scoliosis (P < 0.05). Multivariate analysis showed that males and thoracolumbar scoliosis were risk factors for cardiac abnormalities related to heart valves in patients with IS (P < 0.05). Linear regression analysis showed that altitude had a weak correlation with IS combined with congenital heart disease (R²=0.018, P < 0.05). Among 289 patients with idiopathic scoliosis who required surgery, 4.15% had congenital heart disease, and 30.45% had cardiac abnormalities related to heart valves. Males and scoliosis in thoracolumbar were risk factors for cardiac abnormalities related to heart valves in patients with idiopathic scoliosis.

Outcomes and complications of vertebral body tethering by patient gender

PURPOSE

Non-fusion surgical options for pediatric scoliosis management such as vertebral body tethering (VBT) offer an alternative to spinal fusion. With this study, we aim to evaluate the postoperative outcomes in boys versus girls who have undergone VBT. Our hypothesis is that girls and boys will have similar outcomes by 2-year follow-up.

METHODS

This study employed a review of retrospective data for patients who underwent VBT at 10 sites between 2011 and 2020. Patients were stratified based on gender. All patients had preoperative and 2-year follow-up and were evaluated for curve correction, complications, surgery metrics, and patient reported outcomes.

RESULTS

328 patients were included in this study: 277 girls and 51 boys. Mean age at surgery was 12.2 years for girls and 13.4 years for boys. Mean preoperative curve magnitude and curve flexibility was similar between both groups. Compared to girls, boys were older, heavier and taller at the time of surgery; BMI was not different between the groups. Skeletal maturity was not different preoperatively or at 2 years. There were no significant differences for mean operative time, mean estimated blood loss, or levels instrumented. Postoperative stay was longer in the girls averaging 4.5 days compared to 3.9 days for the boys (p = 0.026). There were no statistically significant differences between boys and girls for the curve magnitude at final follow-up (28° vs 25° thoracic, 21° both groups lumbar) or percent correction (45% vs 38% thoracic, 38% vs 31% lumbar) at 2-year follow-up. Overall, 98 girls (35%) experienced medical or surgical complications compared to 18 boys (39%) (p = 0.599). Boys experienced higher rates of tether breakage at latest follow-up (33% vs. 17%, p = 0.008) and more loss of correction > 10° (10% vs. 3%, p = 0.03). Rates of reoperation were 15.9% in the girls and 15.7% in the boys (p = 0.972).

CONCLUSION

Our study found that boys on average had higher body weight than girls and also higher rates of tether cord breakage and loss of correction. Despite these differences, curve correction, modulation, and reoperation rates were similar in both groups. Further work is needed to determine the relative impact of patient gender and weight on incidence of tether breakage.

Selective Apical Convex Rod Derotation: A Fast and Secure Technique for the Correction of Adolescent Idiopathic Scoliosis-A Case Series of 38 Patients

BACKGROUND AND OBJECTIVES

We present a novel technique of selective apical convex rod derotation as an effective and safe maneuver for the correction of adolescent idiopathic scoliosis and give the clinical results of our patients. Adolescent idiopathic scoliosis is the three-dimensional deformity of the spine of more than 10° affecting children from 10 to 18 years. The gold standard for the correction of larger curves is posterior fusion. With the help of osteotomies, the spine becomes mobile and the ideal alignment can be achieved with correction maneuvers. Derotations from the concave side harvest numerous complications such as exacerbation of apical rotation, screw pullout, and implant failure.

METHODS

After the transpedicular screws are placed, a short titanium rod is put on the convex-side screws just covering the apex and the screw nuts are loosely tightened. The convex apical rod is held with 2 rod holders and derotation is applied to the rod and the convex spine is pulled toward the midline. After the desired correction is reached, a permanent rod is placed to the concave side and screw nuts are tightened.

RESULTS

A total of 38 patients have been included in this study. Preoperative median Cobb angle was 47.19°, postoperative Cobb angle was measured as 18.45°, and 1 year follow-up was 17.25°. Thoracic kyphosis values were 19.07°, 30.52°, and 33.05°, respectively. Lumbar lordosis were measured as 42.63°, 43°, and 45.75°, respectively.

CONCLUSION

Selective apical convex rod derotation is an effective treatment of adolescent idiopathic scoliosis with minimal risk for screw pullout, pedicular bursting, or hypokyphosis. Correction results are similar to classic correction maneuvers.

Longitudinal impact of a perioperative pathway for spinal fusion in adolescent idiopathic scoliosis: a quality improvement project

OBJECTIVE

Prior studies show that recovery pathway implementation after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) reduces length of stay (LOS) without increasing complications, but little is known about the sustainability and longitudinal outcomes of these initiatives. This study aimed to establish and continually improve a perioperative pathway for AIS patients undergoing PSF while tracking long-term LOS performance with iterative improvements.

METHODS

Implementation of the AIS care pathway at a single freestanding tertiary children's hospital was initiated in January 2016 (Phase 1) with iterative annual changes and a comprehensive update in September 2021 (Phase 2). The pathway involves preoperative optimization, standardized protocols, multi-modal pain regimen, early transition to oral pain medications, and early and frequent mobilization. Outcomes were tracked longitudinally using quality-improvement methodology, and comparisons between each group were performed.

RESULTS

Four hundred thirty six AIS patients (86 pre-implementation, 257 Phase 1, 93 Phase 2) who underwent PSF were included. Baseline patient demographics and Cobb angles were similar. Hospital LOS decreased from 5.1 days pre-implementation to 2.3 days in a stepwise fashion corresponding with pathway modifications. Intensive care unit (ICU) admissions decreased from 100% pre-implementation to 0% during Phase 2. Perioperative order set compliance increased from 0% pre-implementation to 100%. There were no significant increases in readmissions or reoperations. Direct hospitalization costs decreased by $5854.95 per case.

CONCLUSIONS

A multidisciplinary perioperative pathway for AIS patients undergoing PSF significantly reduced hospital LOS by 55% and direct costs by 11.3%. Continuous improvement and data monitoring led to sustained positive outcomes over eight years.

LEVEL OF EVIDENCE

III.

Statistical Shape Modeling and Prediction of Lumbar Spine Morphology in Patients With Adolescent Idiopathic Scoliosis

A lumbar spine statistical shape model (SSM) was developed to explain morphological differences in a population with adolescent idiopathic scoliosis (AIS). Computed tomography (CT) was used to collect data on the lumbar spine vertebrae and curvature of 49 subjects. The CT data were processed by segmentation, landmark identification, and template mesh mapping, and then SSMs of the individual vertebrae and entire lumbar spine were established using generalized Procrustes analysis and principal component analysis (PCA). Scaling was the most prevalent variation pattern. The weight coefficient was optimized using the Levenberg-Marquardt (LM) algorithm, and multiple regression analysis was used to establish a prediction model for age, sex, height, and body mass index (BMI). The effectiveness of the SSM and prediction model was quantified based on the root-mean-square error (RMSE). An automatic measurement method was developed to measure the anatomical parameters of the geometric model. The lumbar vertebrae size was significantly affected by height, sex, BMI, and age, with men having lower vertebral height than women. The trends in anatomical parameters were consistent with previous studies. The vertebral SSMs characterized the shape changes in the processes, while the lumbar spine SSM described alignment changes associated with translatory shifts, kyphosis, and scoliosis. Quantifying anatomical variation with SSMs can inform implant design and assist clinicians in diagnosing pathology and screening patients. Lumbar spine SSMs can also support biomechanical simulations of populations with AIS.

Prevalence of metal hypersensitivity in pediatric spine surgery

PURPOSE

Delayed metal hypersensitivity reactions can cause complications in spine surgery. Currently, there is no information on the prevalence of metal hypersensitivity in pediatric patients undergoing spine surgery. The objective of this study is to determine the prevalence of metal hypersensitivity in pediatric patients undergoing spinal instrumentation.

METHODS

Retrospective chart review of patients who underwent spinal instrumentation with or without fusion at a single institution, from January 1, 2014, to December 31, 2020, was performed. Patients were pre-screened for history of allergic diseases, including previous reaction to metals, prior to surgery. Patch metal allergy testing (PMAT) for metal hypersensitivity was also performed.

RESULTS

Of the 796 pediatric patients who underwent spinal instrumentation procedures from 2014 to 2020, 118 (15%) screened positive for metal hypersensitivity. However, the number of patients with documented evidence of metal hypersensitivity diminished to 26 (3%) after PMAT verification. Nickel hypersensitivity was most prevalent, with 20 patients (16.9% of positive screening; 2.5% of all instrumented patients) demonstrating positive skin patch tests. The other most prevalent metal hypersensitivities included cobalt in 9 patients (7.6%; 1.1%), manganese in 3 patients (2.5%; 0.4%), and copper in 1 patient (0.8%; 0.1%). with a number needed to treat (NNT) of 5.

CONCLUSIONS

This study suggests that routine pre-operative PMAT is not necessary in all pediatric spine patients yet should be considered if patients report a history of prior metal hypersensitivity reactions.

Rare missense variants in FNDC1 are associated with severe adolescent idiopathic scoliosis

BACKGROUND

Scoliosis is the most common paediatric spinal deformity. More than 80% of scoliosis is idiopathic and appears during the adolescent growth spurt. Spinal fusion surgery is often required for patients with progressive adolescent idiopathic scoliosis (AIS), and the genetic risk factors for severe disease (defined here as curve >35 degrees) are largely unknown.

METHODS

To explore the role of rare variants in severe AIS, exome sequence data from 1221 individuals with AIS were compared with both 1397 in-house European ancestry controls and 56885 gnomAD non-Finish European controls. Segregation analysis of variants in prioritised genes was performed in additional family members. A replication study was performed using the Geisinger MyCode cohort. FNDC1 function was investigated in fndc1 null mutant zebrafish.

RESULTS

Rare variants were enriched in 84 genes, including RAF1 (Noonan syndrome), FBN1 (Marfan syndrome) and FNDC1, in individuals with severe AIS. FNDC1, which had previously been associated with joint hypermobility, harboured missense variants in 4.0% of individuals with AIS compared with 2.3% of controls (p=0.00764, OR=1.78). FNDC1 variants segregated with AIS in five multiplex families with incomplete penetrance. In addition, FNDC1 rare variants were also associated with scoliosis in the Geisinger MyCode cohort (p=0.0002, OR=3.6). Disruption of the fndc1 locus in zebrafish resulted in increased bone mineral density.

CONCLUSION

We broadened the phenotype associated with RAF1 and FBN1 variants and identified FNDC1 as a novel gene associated with severe AIS. Mechanistic alterations of bone mineral density or joint hypermobility may explain the association of FNDC1 missense variants with AIS.

Compliance of Physiotherapeutic Scoliosis-Specific Exercise in Adolescent Idiopathic Scoliosis: A Scoping Review

Background: Non-surgical management of adolescent idiopathic scoliosis (AIS) includes physiotherapeutic scoliosis-specific exercise (PSSE). Determining the efficacy of PSSE in AIS has been challenging as the clinical effect is closely linked to exercise compliance (a dose-response relationship), with home exercise programs (HEPs) showing a general trend for decreased participation over time. The existing literature reports contradictory definitions and parameters of appropriate PSSE compliance in AIS. As such, this scoping review is necessary for therapists to identify PSSE prescription consistency, enabling clear guidelines for improved PSSE compliance. Methods: A scoping review of the literature was conducted to synthesize original research from inception to November 2024 and reference lists were examined for studies reporting compliance, adherence, or motivational strategies for PSSE in AIS. Results: Fifteen articles with a focus on PSSE in AIS were included in this review. The results demonstrate that compliance (C) and adherence (A) are terms commonly used interchangeably, only half of the studies clearly define compliance and/or adherence, and some utilize motivational strategies; however, outcomes of compliance/adherence were often not reported in the Results section or reflected in the discussion of results. Conclusions: Compliance and/or adherence are inconsistently reported within studies and numerous variations exist in (1) the section of the paper it is mentioned, (2) whether the inclusion criteria hinged on patient compliance/adherence, and (3) whether motivational strategies were employed and outcomes reported. Notably, there was a lack of compliance or adherence reporting in Results and Discussion sections of papers. The definition of appropriate compliance and any effective motivational strategies to improve compliance to achieve the desired results for treatment of AIS remain undetermined.

ICPPNet: A semantic segmentation network model based on inter-class positional prior for scoliosis reconstruction in ultrasound images

OBJECTIVE

Considering the radiation hazard of X-ray, safer, more convenient and cost-effective ultrasound methods are gradually becoming new diagnostic approaches for scoliosis. For ultrasound images of spine regions, it is challenging to accurately identify spine regions in images due to relatively small target areas and the presence of a lot of interfering information. Therefore, we developed a novel neural network that incorporates prior knowledge to precisely segment spine regions in ultrasound images.

MATERIALS AND METHODS

We constructed a dataset of ultrasound images of spine regions for semantic segmentation. The dataset contains 3136 images of 30 patients with scoliosis. And we propose a network model (ICPPNet), which fully utilizes inter-class positional prior knowledge by combining an inter-class positional probability heatmap, to achieve accurate segmentation of target areas.

RESULTS

ICPPNet achieved an average Dice similarity coefficient of 70.83% and an average 95% Hausdorff distance of 11.28 mm on the dataset, demonstrating its excellent performance. The average error between the Cobb angle measured by our method and the Cobb angle measured by X-ray images is 1.41 degrees, and the coefficient of determination is 0.9879 with a strong correlation.

DISCUSSION AND CONCLUSION

ICPPNet provides a new solution for the medical image segmentation task with positional prior knowledge between target classes. And ICPPNet strongly supports the subsequent reconstruction of spine models using ultrasound images.

Are we being forthright with the patients about vertebral body tethering? Quality, contemporaneity, and readability analysis of the online content about vertebral body tethering

PURPOSE

The majority of patients refer to online patient education content before elective surgeries, including Vertebral Body Tethering (VBT). The purpose of this study was to evaluate the quality, contemporaneity, and readability of patient information web pages across different sources (teaching hospital, private HCF, commercial/news, and non-profit organization) on VBT.

METHODS

The search results from Google and Bing were analyzed using a systematic approach, excluding peer-reviewed articles, insurance policy documents, and videos. Forty-seven web pages were reviewed for quality based on preoperative, operative, and postoperative information, alongside compliance with Journal of American Medical Association (JAMA) benchmark criteria. The web page content was assessed using a contemporaneity score, which evaluated the inclusion of the latest research. Readability was assessed using the Flesch-Kincaid Grade level and Gunning-Fog Index.

RESULTS

The overall mean quality score, JAMA score, and contemporaneity scores were 7.63 (95% CI 6.63-8.64) out of 16, one (95% CI 0.68-1.32) out of four, and 0.61 (95% CI 0.33-0.9) out of five, respectively. The mean Flesch-Kincaid grade level and Gunning-Fog index were 11.7 (95% CI 10.88-12.55) and 14.94 (95% CI 14.12-15.75), respectively. Higher Quality scores also correlated with better Flesch-Kincaid and Gunning-Fox readability scores (Quality score-Flesch-Kincaid grade level: ρ = - 0.38, p = 0.0074; Quality score-Gunning-Fog index: ρ = - 0.354, p = 0.0161).

CONCLUSION

Existing patient education material contains limited and fragmentary information, lacks essential details, does not reflect the current limitations of VBT, and is written at a much advanced reading level than recommended. The material requires thorough revision, given that VBT is a relatively new surgical procedure with evolving indications and outcomes.

Clinical Outcomes and Inflammatory Response to the Enhanced Recovery After Surgery (ERAS) Protocol in Adolescent Idiopathic Scoliosis Surgery: An Observational Study

Limited data exist on the clinical outcomes and inflammatory response of Enhanced Recovery After Surgery (ERAS) protocols in adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF). This study evaluates ERAS's impact by analyzing blood parameters and serum protein, surgical, and radiological parameters to assess safety, feasibility, and clinical outcomes. Between July 2021 and July 2022, 30 AIS patients underwent PSF with standardized pain management, high-dose tranexamic acid, early mobilization, and reduced opioid use. Blood tests and serum markers (IL-6, IL-1β, IL-1α, IL-10, TNF-α, IL-8, PGE2) were measured preoperatively and on postoperative day 2. Pain levels (VAS) were recorded preoperatively, on postoperative days 1 and 2, and at discharge. Results showed increased postoperative white blood cell counts, reduced hemoglobin and hematocrit, and elevated C-reactive protein levels. IL-6 was the only inflammatory marker significantly elevated, indicating a controlled inflammatory response. Pain peaked on day 1 but significantly decreased by discharge, confirming the effectiveness of multimodal analgesia. The average hospital stay was 6.97 ± 2.03 days, with low rehospitalization (6.66%) and manageable complications (20%). In conclusion, ERAS effectively optimizes AIS patient recovery, stabilizing pain, reducing complications, and improving perioperative care.

Assessing the Diagnostic Validity of Torsobarography in Scoliosis

Adolescent idiopathic scoliosis (AIS) is treated with various forms of conservative care or surgery, depending on the degree of severity. When AIS is detected early, it can be monitored and initially treated with reduced invasiveness to prevent further progression. AIS manifests itself through deformations of the trunk, which are mostly identified as asymmetries in manual clinical examination. Torsobarography is a new pressure-based surface topographic system for posture analysis and evaluates such associated morphologic asymmetries. The aim of this study is to investigate the diagnostic validity of torsobarography by examining correlation of extracted torsobarographic indices with the Cobb angle and its ability to differentiate between different severities of scoliosis: no scoliosis, mild scoliosis, and moderate scoliosis. A total of 87 subjects (51 females and 36 males) were examined with torsobarography. Six torsobarographic indices were calculated for all subjects: torsobarography angle (TBA), sagittal imbalance index (SII), torso asymmetry index (TAI), shoulder asymmetry angle (SAA), waist asymmetry angle (WAA), and pelvis asymmetry Angle (PAA). These indices were correlated with the Cobb angle, and the differences between severities were statistically analyzed. Three out of six indices (TBA, TAI, and WAA) were able to significantly distinguish between mild and moderate scoliosis. Additionally, those indices showed moderate correlation (ρ = 0.37-0.50) with the Cobb angle measurements. The WAA was the only statistically significant index capable of differentiating between no scoliosis and moderate scoliosis. This study is the first to demonstrate that torsobarography can distinguish between different severities of scoliosis and thus identify a scoliotic deformity that requires bracing over monitoring.

Radiographic and clinical findings associated with Klippel-Feil Syndrome: a case series

OBJECTIVES

To characterize the patient demographics, medical comorbidities, spinal anatomic characteristics, and surgical management of patients with Klippel-Feil Syndrome (KFS).

METHODS

An institutional billing database was used to identify patients with KFS, which was confirmed by the authors' review of imaging. The patient data were categorized by patient demographics, medical comorbidities, spinal anatomic characteristics, and surgical management.

RESULTS

In our cohort of 93 patients with KFS, more females than males (53% vs 47%) were affected. The mean age was 46 years old. The most common levels of fusion were C2-C3 (15%) and C5-C6 (13%). Following the Samartzis classification, 67% were type I, 14% were type II, and 22% were type III. There was a 29% occurence of scoliosis. Among those with scoliosis, 27% were diagnosed in adolescence, 40% had scoliosis in the cervical region, 20% thoracic, and 20% lumbar. A total of 26% of patients underwent spine surgery primarily for stenosis (6/24) and myelopathy (5/24). Of the spine surgeries, 58.3% were posterior-based procedures, 16.7% anterior and posterior-based procedures, 12.5% anterior-based procedures, 8.3% of patients had a spinal discectomy, and 1 patient underwent a torticollis release. A total of 18 out of 24 of the surgical procedures (75%) were at or adjacent to the level of congenital fusion.

CONCLUSION

KFS is commonly associated with degenerative changes, neural compression, and traumatic instability in intervertebral discs adjacent to fused vertebrae. Surgical intervention in patient with KFS largely involved posterior spinal fusions involving or adjacent to levels of congenital vertebral fusions.

Patient education strategies in pediatric orthopaedics: using ChatGPT to answer frequently asked questions on scoliosis

PURPOSE

Patients increasingly rely on online resources to better understand their health conditions. ChatGPT could satisfy the demand for reliable and accessible online health education resources, yet few studies have applied this to pediatric orthopaedic counseling. This study quantifies the accuracy and comprehensibility of ChatGPT responses to frequently asked questions (FAQs) regarding scoliosis.

METHODS

Twelve FAQs regarding scoliosis were compiled following a literature review, and ChatGPT Version 3.5 was utilized to answer them. The responses were analyzed for accuracy and clarity using the Mika et al. scoring system and modified DISCERN score in collaboration with two fellowship-trained pediatric orthopaedic surgeons. Readability was assessed using several published educational-level indices.

RESULTS

The ChatGPT responses received a Mika et al. average of 2.4 (satisfactory requiring minimal to moderate clarification) and an averaged mean DISCERN score of 45.9. The estimated reading level necessary for comprehension ranged from 11th grade to college graduate.

CONCLUSIONS

When prompted with 12 scoliosis FAQs, ChatGPT produces responses of satisfactory accuracy but require further clarification and are written at an inappropriately high reading level for the scoliosis patient population. Future research should explore strategies to verify the reliability of AI services for counseling on other pediatric orthopaedic conditions.

Smartphone-based surface topography app accurately detects clinically significant scoliosis

PURPOSE

The purpose of this study was twofold: (1) to validate the predictive capabilities of the Scoliosis Assessment App using ST technology against X-ray "ground truth" in patients being evaluated for clinically significant scoliosis; and (2) to compare the diagnostic accuracy of the App versus the commonly used scoliometer tool.

METHODS

A multicenter, prospective validation study was conducted among patients with known or suspected scoliosis. The App determined an Asymmetry Index to predict the likelihood of clinically significant disease (MCM ≥ 20°) as determined by X-ray. Outcomes included the sensitivity, specificity, and area under the receiver operating characteristic curve (ROC AUC) associated with the Apps prediction of clinically significant disease.

RESULTS

Fifty-five patients were evaluated with a mean age of 13.6 ± 2.1 years. The App correctly classified 91% (50/55) of the patients compared to 69% (38/55) for the scoliometer. The sensitivity of the App was 96.4% (89.6-100% CI) versus 50% (28.1-71.9% CI) for the scoliometer (P < 0.05), while the specificity values were 85.2% (71.8-98.9% CI) and 88.9% (74.4-100% CI), respectively. ROC analysis indicated a statistically significant difference in accuracy (AUC) in favor of the App (95% versus 71%; P = 0.015).

CONCLUSION

The Scoliosis Assessment App using ST technology offers an accurate, accessible, and non-ionizing method of detecting clinically significant scoliosis, suggesting that the App can be used for detection and monitoring as an alternative to radiography and as a replacement for scoliometer without diminishing the standard of care. Further studies are required to assess variations of sensitivity in a large cohort of patients and clinical utility as an alternative to radiographs.

The Impact of Adolescent Idiopathic Scoliosis on Pregnancy

➢ Physiologic changes during pregnancy alter the biomechanics of the spine, including increased ligamentous laxity, lumbar lordosis, and pelvic tilt.➢ Patients with adolescent idiopathic scoliosis treated with a fusion construct with the lowest instrumented vertebra of L3 and below have an increased risk of developing low back pain during pregnancy.➢ There is a low risk of curve progression during pregnancy for patients with adolescent idiopathic scoliosis treated with spinal fusion.➢ Although neuraxial anesthesia is possible in patients who had previously undergone spinal fusion for adolescent idiopathic scoliosis, successful placement may require a more experienced provider and more attempts to place the epidural.

Patient-reported outcomes following surgery for adolescent idiopathic scoliosis performed in adolescence versus adulthood

INTRODUCTION

The Scoliosis Research Society 22r (SRS-22r) questionnaire is a proven tool in assessing healthcare-related quality of life (HRQoL) in idiopathic scoliosis and is the adopted patient-reported outcome measure for the deformity pathway recorded into the British Spinal Registry (BSR). Surgery for adolescent idiopathic scoliosis (AIS) is performed frequently in teenagers; however, patients also present with curves in the surgical range into adulthood. This work aimed to assess HRQoL differences between patients following surgery for AIS performed in adolescence and adulthood using SRS-22r data collected from the BSR.

METHODS

An anonymised BSR search of pre- and postoperative SRS-22r scores for patients with diagnoses of AIS and adult idiopathic scoliosis was conducted. Data from all subdomains were compared preoperatively and at the two-year postoperative timepoint.

RESULTS

Preoperative SRS-22r scores were analysed for 1,912 patients with AIS and 65 with adult idiopathic scoliosis. Patients with adult idiopathic scoliosis had significantly lower preoperative SRS-22r scores in all subdomains (p<0.05). By two years postoperatively, both groups of patients had improved SRS-22r scores significantly compared with baseline in all subdomains (p<0.001). A cross-group analysis revealed patients with AIS had significantly better function scores years postoperatively than their adult counterparts (p=0.005).

CONCLUSIONS

This work confirms there are benefits following surgery for AIS in improving HRQoL, but has also provided HRQoL data in adult patients, who again show similar improvements following surgery from baseline. This is of value when counselling patients regarding anticipated benefits of surgery performed in childhood and adulthood.

Adjacent point aided vertebral landmark detection and Cobb angle measurement for automated AIS diagnosis

Adolescent Idiopathic Scoliosis (AIS) is a prevalent structural deformity disease of human spine, and accurate assessment of spinal anatomical parameters is essential for clinical diagnosis and treatment planning. In recent years, significant progress has been made in automatic AIS diagnosis based on deep learning methods. However, effectively utilizing spinal structure information to improve the parameter measurement and diagnosis accuracy from spinal X-ray images remains challenging. This paper proposes a novel spine keypoint detection framework to complete the intelligent diagnosis of AIS, with the assistance of spine rigid structure information. Specifically, a deep learning architecture called Landmark and Adjacent offset Detection (LAD-Net) is designed to predict spine centre and corner points as well as their related offset vectors, based on which error-detected landmarks can be effectively corrected via the proposed Adjacent Centre Iterative Correction (ACIC) and Corner Feature Optimization and Fusion (CFOF) modules. Based on the detected spine landmarks, spine key parameters (i.e. Cobb angles) can be computed to finish the AIS Lenke diagnosis. Experimental results demonstrate the superiority of the proposed framework on spine landmark detection and Lenke classification, providing strong support for AIS diagnosis and treatment.

Correction of L5 Tilt in 2-Row Vertebral Body Tethering Versus Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

STUDY DESIGN

Single-center retrospective cohort study.

OBJECTIVE

To compare the correction of fractional curve and L5 tilt in 2RVBT versus PSF with LIV in the lumbar spine.

SUMMARY OF BACKGROUND DATA

Vertebral body tethering, an AIS fusion-alternative, avoids rigid constructs, allowing for lower instrumented vertebra (LIV) selection. Single-tether constructs break, but mini-open thoracoscopic assistant double-row vertebral body tethering (2RVBT) reduces this. Limited comparative studies exist with posterior spinal fusion (PSF).

METHODS

Retrospective analysis of AIS correction surgeries with lumbar LIV using preoperative and minimum 2-year postoperative imaging. Patients were divided into 2RVBT or PSF groups. Data included age, Riser, UIV, LIV, instrumented levels, and revision rates. Radiographic analyses included preoperative and postoperative main curve Cobb (MCC), secondary curve Cobb (SCC), fractional curve Cobb (FCC), and L5 tilt.

RESULTS

Ninety-nine patients participated (49 in 2RVBT, 50 in PSF). Preoperatively, secondary CC differed significantly (2RVBT: 44.6±10.4 degrees vs. PSF: 39.5±11.8 degrees, P =0.026), but not L5 tilt, MCC, or FCC. Postoperatively, MCC (2RVBT: 25.7±12.3 degrees vs. PSF: 19.5±7.4 degrees, P =0.003) and SCC (2RVBT: 18.0±8.4 degrees vs. PSF: 14.5±6.6 degrees, P =0.012) varied. Preoperative to postoperative changes in MCC (2RVBT: -32.0±11.3 degrees vs. PSF: -37.2±13.3 degrees, P =0.044) and L5 tilt (-13.8±9.0 degrees vs. PSF: -8.1±6.8 degrees, P =0.001) differed. Revision rates were similar (2RVBT: 2.0%, PSF: 4.0%, P =0.57). In 2RVBT, 3 tethers broke, 1 revision occurred for a broken tether, and 1 pleural effusion needed thoracocentesis. In PSF, 1 superficial infection needed surgery, and 1 revision was for add-on phenomenon. After PSM for Lenke classification, 54 patients remained (27 in each group). At 2 years, 2RVBT showed less MCC correction (-30.8±11.8 degrees vs. -38.9±11.9 degrees, P =0.017), but greater L5 tilt correction (-14.6±10.0 degrees vs. -7.5±6.0 degrees, P =0.003).

CONCLUSIONS

This study with a minimum 2-year radiographic follow-up demonstrates that 2RVBT results in greater L5 tilt correction when compared with posterior spinal fusion after PSM for Lenke classification and similar rates of revision surgery.

LEVEL OF EVIDENCE

Level III.

Severe (>100 Degrees) Thoracic Adolescent Idiopathic Scoliosis - A Comparison of Surgical Approaches

Study DesignRetrospective.ObjectiveSevere curves >100° in adolescent idiopathic scoliosis (AIS) are rare and require careful operative planning. The aim of this study was to assess baseline, perioperative, and 2-year differences between anterior release with posterior instrumentation (AP), posterior instrumentation with posterior column osteotomies (P), and posterior instrumentation with 3-column vertebral osteotomies (VCR).MethodsTwo scoliosis datasets were queried for primary cases of severe thoracic AIS (≥100°) with 2-year follow-up. Pre- and 2-year postoperative radiographic measures (2D and estimated 3D kyphosis), clinical measurements, and SRS-22 outcomes were compared between three approaches.ResultsSixty-one patients were included: 16 AP (26%), 38 P (62%), 7 VCR (11%). Average age was 14.4 ± 2.0 years; 75.4% were female. Preoperative thoracic curve magnitude (AP: 112°, P: 115°, VCR: 126°, P = 0.09) and T5-T12 kyphosis (AP: 38°, P: 59°, VCR: 70°, P = 0.057) were similar between groups. Estimated 3D kyphosis was less in AP vs P (-12° vs 4°, P = 0.016). Main thoracic curves corrected to 36° in AP vs 49° and 48° for P and VCR, respectively (P = 0.02). Change in estimated 3D kyphosis was greater in AP vs P and VCR (34° vs 13°, P = 0.009; 34° vs 7°, P = 0.046). One incomplete spinal cord injury had residual deficits (P; 1/61, 1.6%). All SRS-22 domains improved postoperatively.ConclusionAll approaches obtained satisfactory coronal and sagittal correction, but AP had smaller residual coronal deformity and greater kyphosis restoration than the other approaches. This information may help inform the decision of whether to include an anterior release for large thoracic AIS curves.

The Impact of the Lowest Instrumented Vertebra on the Correction of the Minor Curve During Selective Fusion in Patients With Adolescent Idiopathic Scoliosis

STUDY DESIGN

Retrospective single-center data analysis.

OBJECTIVE

The aim of this investigation was to give advises for choosing the LIV in selective fusion to reach the best correction of the minor curve and sagittal profile.

SUMMARY OF BACKGROUND DATA

Scoliotic curves can be classified as structural or nonstructural. If selective fusion is performed, the nonstructural curves are not instrumented. The choice of the lowest instrumented vertebra (LIV) and the impact of different levels of the LIV on the correction of the minor curve in the frontal profile and on the sagittal balance is under debate.

METHODS

Forty-seven consecutive patients treated by posterior instrumented fusion were included in this retrospective investigation. Impact of the level of the LIV with regard to distance to end vertebra (EV), to the stable vertebra (StV), to the sagittal infliction point (IP), and to the apex of the lumbar lordosis on the correction of the minor curve was analyzed.

RESULTS

Distance of LIV to EV was significant with regard to correction of the minor curve if it was more than 5 levels ( P <0.001). Distance of LIV to StV was significant with regard to correction of the minor curve if it was more than 4 levels ( P <0.01). Distance of LIV to IP was significant with regard to correction of the minor curve if it was more than 2 levels ( P <0.01).

CONCLUSIONS

Choosing a LIV that was more than 2 levels higher or lower than the sagittal infliction point showed a significantly higher correction of the minor curve. We therefore recommend to keep that distance when LIV is chosen.

Effectiveness of bracing combined with exercise-based treatment of adolescent idiopathic scoliosis: Assessing the synergistic benefits: A systematic review

The purpose of this study was to evaluate evidence on the effectiveness of combined bracing and exercise on adolescent idiopathic scoliosis (AIS). From inception to April 28, 2022, PubMed and Web of Science searched for randomized clinical and nonrandomized prospective studies reporting Cobb angle (CA), angle of trunk rotation (ATR), quality of life (QoL), and pulmonary function (PF) in AIS patients treated with exercise and braces (10 years-skeletal maturity). Two authors analyzed and extracted data for this review. The PEDro scale was used to assess the risk of bias (RoB). Therapy protocols and basic data have been collected. Each CA, ATR, QoL, and PF study's evidence and strength were also included. A total of 12 studies with 714 patients with AIS were included. Five studies used a control group with exercises and 7 with braces. The results showed that exercise-brace can decrease CA and ATR and increase QoL and PF with AIS; however, the strength of conclusion for all outcomes was moderate. In this review, 4 studies were categorized as low RoB, 3 as moderate RoB, and 5 as high RoB. Level of evidence analysis revealed that 12 studies were classified as level of evidence B. The current studies do not sufficiently support the effects of exercise and brace therapy on CA, ATR, QoL, and PF in patients with AIS.

Techniques of Deformity Correction in Adolescent Idiopathic Scoliosis-A Narrative Review of the Existing Literature

Surgical management of adolescent idiopathic scoliosis [AIS] is a complex undertaking with the primary goals to correct the deformity, maintain sagittal balance, preserve pulmonary function, maximize postoperative function, and improve or at least not harm the function of the lumbar spine. The evolution of surgical techniques for AIS has been remarkable, transitioning from rudimentary methods of spinal correction to highly refined, biomechanically sound procedures. Modern techniques incorporate advanced three-dimensional correction strategies, often leveraging pedicle screw constructs, which provide superior rotational control of the vertebral column. A number of surgical techniques have been described in the literature, each having its own pros and cons. This narrative review provides a detailed analysis of the contemporary surgical techniques used in the treatment of patients with AIS.

Ultrasound vs. x-ray: a new way for clinicians to track scoliosis progression?

This retrospective study, utilising prospectively collected data, investigates the use of spine ultrasound as an alternative method for assessing scoliosis, with the aim of reducing radiation exposure. We included 92 patients aged 10 to 16 years with suspected idiopathic scoliosis. Exclusion criteria were weight over 150 kg, metal implants, pre-existing conditions, secondary deformities, and cognitive impairments. Each patient underwent clinical assessment and full spine radiographs, followed by spine ultrasound using the Scolioscan® system. Unprocessed B-mode ultrasound images were analysed using automatic measurements. The correlation between Ultrasound Coronal Angle (UCA) and Radiographic Cobb Angle (RCA) was evaluated at initial and follow-up visits. Strong correlations were found between UCA and RCA, with correlation coefficients ranging from 0.786 to 0.903 (p<0.001). The regression formula showed good predictive accuracy for curve progression on follow-up radiographs. The best results were observed in females and in primary thoracic curves (r = 0.936, p<0.001). Although only four patients exhibited true progression (≥5° increase in Cobb angle), changes in scoliotic angles were effectively detected using ultrasound. This study confirms the feasibility of unprocessed spine ultrasound for scoliosis monitoring in clinical settings. Automatic measurements without 3D reconstruction make ultrasound a practical tool for tracking progression. The regression model shows potential for predicting curve progression, although further validation is needed. These findings suggest spine ultrasound could reduce the need for radiographs, benefiting patients by minimising radiation exposure while providing reliable monitoring of scoliosis progression and treatment outcomes.

New horizons for adolescent idiopathic scoliosis treatment through PosturalSpine® D'Amanti Method

The aim of the study is to compare improvement outcomes in patients (aged between 8 and 18 years old) with idiopathic scoliosis treated with a traditional technique with those treated with an innovative method. The study included 17 participants allocated into two groups: experimental (n=8) and control (n=9) groups. The first group was treated with a new method with PosturalSpine® D'Amanti method, twice a week for 30 min per session while the second group was treated with kinesitherapy and traditional tools three times week for 45 min per session. The two groups are similar in the anthropometric characteristics, in baseline Risser index and in the Cobb angles average and no statistically significant differences were found between the two groups. After one year of motor intervention, both treatment groups showed improvements in the progression of scoliotic curves and the PosturalSpine® group showed a significantly higher improvement than the control group. Our results therefore suggest that this new specific method with PosturalSpine® D'Amanti method could play a significant role in improving adolescent idiopathic scoliosis compared to traditional exercises.

Impact of growth on spinal biomechanics and tether force in VBT: a simulation study

PURPOSE

Vertebral Body Tethering (VBT) allows correction of scoliosis while preserving the spinal mobility. Despite an increasing availability of data on clinical experience and surgical techniques, there is still a lack of knowledge on the underlying biomechanics, specifically when considered in combination with growth. Therefore, the purpose of this study is to develop a growing flexible spine model to investigate spinal biomechanics after VBT surgery.

METHODS

A multi-body simulation approach was chosen. A growing, flexible thoracolumbar VBT spine model was developed to analyze the spinal biomechanics during various physiological movements and growth. The model includes a flexible spine with a VBT device and a musculoskeletal system. Therefore, the resulting tether tension and intervertebral compression force can be calculated with respect to the human anatomy and material properties of the VBT device.

RESULTS

During growth, the tether and compression forces increase continuously with the highest forces between L1 and L2. The highest tether force is measured at 50° lateral bend at 200 N pre-tension. The compression forces in a tethered spine are during adolescence up to twice higher than in a healthy spine.

CONCLUSION

The simulated biomechanical data provides insight into the forces exerted on the spine during various physiological movements and the remaining growth. They are consistent with previously published clinical data and underlie the finding that age at surgery or residual growth doesn't greatly affect tether forces. During growth, however, intervertebral compression forces increase.

Sex and age differences in depression and anxiety networks among adolescents with idiopathic scoliosis: A network analysis

BACKGROUND

Depression and anxiety are prevalent psychological challenges among patients with adolescent idiopathic scoliosis (AIS), affecting individuals across both sex and age groups.

AIM

To explore the network structure of depression and anxiety symptoms, with a focus on identifying differences at the symptom level between sex and age subgroups.

METHODS

A total of 1955 participants diagnosed with AIS aged 10-18 years were assessed using the Patient Health Questionnaire Depression Scale (PHO-9) and the Generalized Anxiety Disorder Scale (GAD-7), and 765 patients exhibiting PHQ-9 or GAD-7 scores ≥ 5 were enrolled in our study. Network analysis and network comparison tests were utilized to construct and compare the depression-anxiety symptoms networks among sex and age subgroups.

RESULTS

The results revealed GAD3 "Excessive worry" and PHQ2 "Sad mood" were the most significant central symptoms in all subgroups, while "Sad mood" had higher strength than "Excessive worry" in the lower age group. In the network comparisons, the female network exhibited tighter connectivity, especially on GAD6 "Irritability" and GAD2 "Uncontrollable worry", while only PHQ3 "Sleep" and PHQ9 "Suicidal ideation" had differences at the local level in the lower age group.

CONCLUSION

Several interventions targeting excessive worry and sad mood could reduce the risk of depression and anxiety symptoms in the AIS population. Furthermore, specific anxiety symptoms in females, along with sleep disturbances and suicidal ideation in the lower age group, should be addressed at an early stage to prevent significant disruptions in mental health trajectories.

How is familial idiopathic scoliosis transmitted? Analysis of 26 pedigrees

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine, affecting 1-3 % of the population, predominantly female patients, especially for severe curves. Its etiology is still debated, but a genetic involvement is certain, alongside with epigenetic and environmental factors. Isolated or sporadic cases are frequent, but AIS also affect families, with a reported heritability up to 38%.

HYPOTHESIS

The main hypothesis of this study was that a particular form of AIS, familial AIS, displays specific forms of transmission, linked to gender.

PATIENTS AND METHODS

Pedigree of 26 families with at least 2 confirmed cases of AIS were studied in affected individuals, as well as the absence of scoliosis signs in healthy relatives. The prevalence of AIS was calculated after correction for bias. The transmission was first analyzed globally, then according to the gender of the affected parents and children.

RESULTS

26 families were included, consisting of 94 patients affected with AIS, adjusted to 66 patients and 160 healthy relatives in the analysis corrected by the proband method, for a prevalence of 29.2%. The transmission of AIS was higher to daughters (49%) than to sons (17%) of affected parent, suggesting a Carter effect (differential transmission according to the gender). Moreover, out of 66 AIS patients in the proband-adjusted analysis, 49 (74.2%) were female and 17 (25.8%) male (ratio = 3), demonstrating the higher penetrance in female for familial AIS.

DISCUSSION

This study underlines an autosomic dominant mode of inheritance in familial idiopathic scoliosis, with an incomplete penetrance (transmission rate <50%). Clinicians should be aware of a specific form of familial AIS, to counsel families.

LEVEL OF EVIDENCE

IV; Prognostic study.

Evaluation of Primary Correction and Its Influencing Factors in Adolescent Idiopathic Scoliosis After Treatment with the Charleston Bending Brace as the Sole Intervention

BACKGROUND

All-day braces are predominantly used for the conservative treatment of adolescent idiopathic scoliosis (AIS). The Charleston Bending Brace is a pure nighttime brace. The aim of this study was to investigate the primary in-brace correction of the main curve of AIS when treated with the Charleston Bending Brace. Specifically, the factors influencing major curve correction were examined.

METHODS

The retrospective analysis included 97 patients with AIS who were treated between October 2010 and September 2020. Patients with secondary scoliosis or orthotic pretreatment were excluded. Standardized radiographs were used to determine the Cobb angle of the major and minor curves. Curve correction in relation to Lenke's classification, the Risser stage, and rotation were assessed at four different time points (t0: before treatment, t1: 6-12 months, t2: 13-24 months, and t3: 25-36 months during treatment).

RESULTS

The average Cobb of the main curve at the beginning of the study was 25.7°. The night brace achieved excellent in-brace correction at t1, with nearly half of the patients (43%) showing a correction exceeding 80%. Curve localization, the Lenke type, and the Nash-Moe rotation significantly influenced initial in-brace curve correction at t1. At t2, there was also a significant in-brace correction of the initial Cobb by 93.0%. Similar improvements were observed at t3 for in-brace correction as well as without the brace (p < 0.031).

CONCLUSIONS

The results of the study revealed good primary in-brace correction of the main curve of the AIS with the nighttime brace, which was at least equivalent when compared to values from the literature for the Chêneau brace. Also, while restricted to medium-term results due to our study limitations, the percentage of correction in out-of-brace data of our patients was similar to weaned 24 h brace patients.

To Screen or Not to Screen: "False Positive" Cases-Can They Be Treated as Definitely False? Properly Selecting the Screening Age-Range Groups in Scoliosis Screening Programs

Background/Objectives: This opinion paper provides a brief overview of the history of school scoliosis screening programs following the introduction. Methods: It outlines the international administrative policies of these programs, their impact on the frequency of surgical procedures, and the effects of discontinuing school-based scoliosis screenings. Results: The primary focus is on analyzing the role of "false positive" cases detected during the Adam's bending test, which has contributed to the discontinuation of these programs in certain countries. This focused discussion is based on the impact of growth on the relationship between spinal and rib cage deformities. Furthermore, we propose the selection of the optimal age range for screening, considering the correlation between idiopathic scoliosis prevalence and geographical latitude. Conclusions: Lastly, we emphasize the importance of continuing scoliosis screening programs in schools.

The Efficacy of a Novel Hybrid Brace in the Treatment of Adolescent Idiopathic Scoliosis: A Prospective Case-Series Study

Background/Objectives: Bracing is an effective treatment for preventing curve progression in skeletally immature adolescent idiopathic scoliosis (AIS) patients. A novel hybrid brace has been developed to overcome the limitations of conventional rigid and soft braces. This study aimed to evaluate the clinical efficacy of the novel hybrid brace. Methods: We enrolled AIS patients who were candidates for brace treatment: aged 10-18 years, with a coronal Cobb angle of 20-45° and a Risser stage of 0-2. The primary outcome was the rate of successful brace treatment, defined as meeting all three criteria: (1) less than 5° of progression in the Cobb angle during follow-up, (2) less than 45° of Cobb angle at the final follow-up, and (3) avoidance of surgical treatment. Results: A total of 24 patients (1 male, 23 female) with a mean age of 12.2 ± 1.2 years were included in this study. At the initiation of bracing, the major curve had a mean Cobb angle of 34.5 ± 6.3° and an in-brace correction (IBC) rate of 41.5 ± 16.0%. The hybrid brace demonstrated a success rate of 91.7% (22/24) during a mean follow-up period of 22.1 ± 6.4 months. After brace treatment, seven (29.2%) patients showed an improvement of more than 5° in their Cobb angle. When compared to a matched control from a retrospective cohort, the hybrid brace demonstrated a greater success rate (91.7% vs. 83.3%) and a higher proportion of patients with an improved curve (29.2% vs. 12.5%), although statistically insignificant. Conclusions: A novel hybrid brace was effective in preventing curve progression in skeletally immature patients with AIS.

A team approach to improve outcomes in pediatric scoliosis surgery: a review of the current literature

STUDY DESIGN

Review article.

OBJECTIVE

To review the literature on the effect of specialized pediatric spine teams on clinical outcomes.

RESULTS

Thirty-eight studies were identified in the review. There were 11 studies discussing the efficacy of the dual-surgeon strategy, 5 studies discussing the benefits of adult dedicated spine teams, 3 studies discussing the benefits of dedicated pediatric spine teams, 8 studies discussing the healthcare professional composition of multidisciplinary spine teams, and 20 studies discussing various clinical markers evaluating the efficacy of new team- or protocol-based interventions.

CONCLUSION

Pediatric spinal deformity surgery is a highly invasive procedure with room for intervention to minimize surgical complications and enhance patient outcomes. The use of standardized spine teams, comprising surgeons and various healthcare professionals from diverse disciplines, has proven to be an effective strategy for improving both quality and efficiency of care. Furthermore, implementing uniform protocols among these teams has led to reductions in surgical duration, hospitalization periods, and risks such as infections at the surgical site and excessive bleeding. Further studies are necessary to evaluate additional benefits that specialized pediatric spine teams can offer in terms of clinical outcomes.

Role of spinal MRI for pre-operative work up in patients with adolescent idiopathic scoliosis: a retrospective case study and narrative review

INTRODUCTION

There remains variability in the acquisition of whole-spine MRI prior to surgical correction in patients with adolescent idiopathic scoliosis (AIS). In this study, we take a retrospective look at the clinical impact of uniformly obtaining spinal MRI on all patients with a diagnosis of AIS.

METHODS

Three hundred thirty four patients with presumed AIS who underwent surgery between 2017 and 2022 were identified; 283 of these patients who were asymptomatic and had a preoperative MRI in the database were included. We investigated radiographic, demographic, and clinical risk factors for the presence of neural axis anomalies. Radiologists' reports were reviewed to determine the level of the conus medullaris and the presence of any intra-spinal dysraphisms. The utility of known risk factors for neural axis anomalies and the utility of MRI identifying anomalies on clinical decision-making, intra-operative neuromonitoring (IONM) alerts, and postoperative neurologic insult in asymptomatic AIS patients were investigated.

RESULTS

There were 283 patients with a mean age of 14.1 years, 67 males (22.6%) and 26 (9.2%) left-sided thoracic curves. MRI identified nine patients with central cord dilations, four patients with low cerebellar tonsils, four patients with Chiari Malformations, five patients with low-lying conus, one patient with a tethered cord, and five patients with arachnoid cysts. Six (2.1%) of the 283 patients underwent a neurosurgical intervention and 3 (50%) of the 6 went on to have IONM alerts. Eighteen (6.4%) of the 283 patients had IONM alerts and 5 (28%) of the 18 had neural axis anomalies. None of the patients with IONM alerts had a permanent neurologic deficit post-operatively.

CONCLUSION

In asymptomatic patients presumed to have AIS, 9.9% had a neuro-axis anomaly, 2.1% needed a neurosurgical intervention, and 6.4% of the patients had an IONM alert. We did not find known risk factors for identifying neural axis anomalies to have statistically significant application in asymptomatic AIS patients. Presence of neuroaxis anomalies increased the chance of having IONM alerts, however, we were unable to demonstrate if neurosurgical interventions in these patients with anomalies were preventative for IONM alerts or have statistically significant protection against clinical complications.

Multi-scale topology optimisation design and mechanical property analysis of porous interbody fusion cage

BackgroundTitanium (Ti) and polyether ether ketone (PEEK) interbody fusion cages cause postoperative stress shielding problems. The porous cage design is one of the solutions advanced to mitigate this problem.ObjectiveExploring the mitigation of stress shielding with a porous interbody fusion cage after surgery for idiopathic scoliosis.MethodsThe porous interbody fusion cage was constructed based on the multiscale topology optimisation method, and the postoperative lumbar spine models implanted with it. The porous Ti and PEEK fusion cages were evaluated under physiological conditions to investigate their mechanical properties.ResultsThe volume of the porous fusion cage was reduced by 52.57%, and the stress was increased by 242.76% and 252.46% compared with the Ti and PEEK fusion cage; the modulus of elasticity of the porous fusion cage was reduced by 76.85%, and the strain was increased by 131.40%∼686.51% compared with the Ti cage; the porous fusion cage increased L3 cortical bone stress by 13.36% and 13.52% and cancellous bone by 82.93% and 76.72%, respectively, compared with the original interbody fusion cages.ConclusionThe porous interbody fusion cage has a much more lightweight design which facilitates growth of bone tissue. However, a frame structure should be constructed to minimize issues with stress peaks and localised stress concentrations. It also has a significantly lower stiffness which helps alleviate vertebral stress shielding, further fostering bone growth. The porous fusion cage thus meets the clinical requirements for better fusion outcomes.

The Relationship Between Orthodontic Abnormalities and Spinal Deformities: A Review of Literature

Spinal deformities comprise abnormal curvatures of the spine which impact posture, musculoskeletal balance, as well as biomechanical function. Malocclusion, the improper contact between occlusal surfaces of opposing teeth, affects the occlusal relationship and functionality of the temporomandibular joint (TMJ). While both conditions have been extensively studied independently, their interconnection remains a subject of debate. The aim of this work is to comprehensively review the current literature concerning spinal curvature abnormalities and stomatognathic alterations, concomitantly investigating the relationship between these disorders. Research findings highlighted how changes in the TMJ biomechanics may modify occlusion patterns affecting head posture and, consequentially, spinal alignment. Proprioceptive feedback from the periodontal ligament and trigeminal nerve plays a crucial role in controlling muscle tension and, therefore, normal TMJ function. Disruptions in this feedback contribute to occlusal alterations which, in turn, may induce postural adaptations influencing the spinal curvature. Studies also demonstrated a statistical correlation between adolescent idiopathic scoliosis (AIS) and orthodontic anomalies such as overbite, overjet, and mandibular retrusion. Additionally, reverse chewing cycles (RCCs), a characteristic of crossbite, have been found to be more prevalent in individuals with scoliosis, suggesting a possible link between dysfunctional mastication and spinal deformities. Considering the complex interplay between occlusion and posture, a multidisciplinary approach to diagnosis and treatment is regarded as essential. While orthodontic treatment effectively corrects malocclusion, evidence suggests that dental bracing may influence TMJ function and spinal alignment, especially in pediatric patients still subject to growth spurts. Despite emerging data indicating a relationship between malocclusion and spinal deformities, further research is required in order to clarify such causality and promote the creation of therapeutic schemes for patients concurrently affected by these pathologies.

What imaging does my AIS patient need? A multi-group survey of provider preferences

INTRODUCTION

Adolescent idiopathic scoliosis (AIS) is a common diagnosis managed by pediatric orthopedic surgeons with nonoperative radiographic monitoring representing a cornerstone of treatment. Differences in practices and techniques for obtaining radiographic studies contribute to variation, cost of care, and hamper data aggregation. We surveyed several large organizations dedicated to children's orthopedics or scoliosis care to obtain a consensus for radiographic evaluation of AIS.

METHODS

A REDCap-based survey was developed across four institutions and beta-tested by staff and fellows from a single institution. The finalized survey was distributed to members of POSNA, PSSG, and SOSORT, and shared on social media. Participants were asked to rank the importance of various datapoints in radiographic assessment of the spinal deformity, skeletal maturity, and study indications during initial, subsequent, preoperative, and final office visits for AIS. Response rate for the overall group was 26%.

RESULTS

Cobb angle was considered the most important (> 94%) radiographic index across all time points. For positioning, 46% of respondents favored arms bent touching clavicles as the ideal positioning for X-rays, and another 24% favored arms down with palms forward (Table 2). The majority of respondents obtain lateral X-rays at the first visit (99%) and at the preoperative visit (70%). At the preoperative visit, sagittal contour (86%), apex location (85%), and Lenke classification (73%) were considered important factors to record. Flexibility studies are primarily obtained at the preoperative visit (89%) and 81% of respondents prefer bending films as the flexibility technique of choice. Regarding measures of skeletal maturity, Sanders bone age was considered to be the most important by over 70% of respondents across initial, subsequent, preoperative and brace wean visits (Fig. 2). MRIs were obtained routinely by 34% of respondents and only when the patient had a concerning symptom or finding for 67% of respondents.

CONCLUSIONS

Despite large variations in radiographic examination of AIS, large areas of agreement were found. It is important to establish standards for positioning patients, evaluating skeletal maturity, and obtaining assessments including lateral views, flexibility studies, and advanced imaging. Establishing common practices for radiographic evaluation of AIS will allow for less variation in care and for critical questions to be answered through registry formation and large multicenter data collection.

SIGNIFICANCE

This study establishes current practitioner opinion on the radiographic evaluation of the AIS patient. Minimum data sets are useful for data aggregation and answering research questions in the face of data variability.

LEVEL OF EVIDENCE

Level V.

Investigating the long-term outcomes and efficacy of surgical intervention in patients with adolescent idiopathic scoliosis and Cobb angles ranging between 40 and 50 degrees

PURPOSE

Patients with adolescent idiopathic scoliosis (AIS) are either managed with non-operative strategies or surgery depending on the severity of lateral curvature and impact on quality of life. However, supportive evidence for the appropriate treatment approach is lacking in AIS patients with Cobb angles between 40 and 50 degrees. Therefore, we investigated differences in long-term patient-centered outcomes in AIS patients with Cobb angles between 40 and 50 degrees who received either operative or non-operative management.

METHODS

A total of 919 patients aged 10-21 years old with adolescent idiopathic scoliosis and 40-50 degree Cobb angles were identified from the HARMS Study Group (HSG) registry and dichotomized based on operative or non-operative management. Baseline and 2 year follow-up SRS-22 scores from these patients were analyzed for significant differences between the total score values, domain values, and the magnitude of score change over time using multiple comparisons analyses. Multivariable regressions adjusting for age, body mass index, location of spinal deformity, and management strategy were also performed.

RESULTS

Operative versus non-operative strategy was significantly, independently associated with differences in SRS-22 total and domain scores over time (effect likelihood ratio test, p < 0.03 for all regressions). Operatively managed patients had significantly greater improvement in SRS-22 total and domain scores over the follow-up duration compared to non-operatively managed patients (p < 0.02 for all comparisons).

CONCLUSIONS

This preliminary analysis suggests that operatively managed patients may have had better long-term outcomes than non-operatively managed patients within this AIS subpopulation. These findings support the need for further prospective investigation to determine the optimal management strategy to improve evidence-based, patient-reported outcomes for AIS patients with Cobb angles between 40 and 50 degrees.

LEVEL OF EVIDENCE

Level III.

Behavioral effects of academic pressure on the risk of adolescent idiopathic scoliosis: a case-control study

Adolescent idiopathic scoliosis (AIS) is a prevalent spinal deformity with significant health implications. While genetic and demographic factors are well-established, the influence of academic pressure and posture, especially in competitive educational environments, remains less understood. This case-control study analyzed data from a population-based AIS screening program, including 547 cases and 2735 matched controls. AIS cases were identified using the Adam's forward-bending test and scoliometer measurements, with controls matched by age, sex, and school. Conditional logistic regression assessed the associations between academic pressure, sedentary behaviors, and AIS risk. Our study shows that early engagement in extracurricular activities before age five-common in competitive academic settings-raised the AIS risk with an OR of 2.18 (95% CI 1.03-4.61, P = 0.041). Students who spent time outdoors during school breaks had a 57% lower AIS risk (OR 0.43, 95% CI 0.20-0.92, P = 0.031) compared to those who stayed indoors, emphasizing the importance of physical activity during academic hours. Over two hours of daily outdoor physical activity reduced AIS risk by 48% (OR 0.52, 95% CI 0.28-0.97, P = 0.04), with a 65% reduction for more than three hours (OR 0.35, 95% CI 0.17-0.72, P = 0.005). Additionally, higher BMI was associated with an 8% lower AIS risk (OR 0.92, 95% CI 0.87-0.98, P = 0.006). Sedentary behaviors, such as watching television for over three hours daily, doubled AIS risk (OR 2.08, 95% CI 1.06-4.09, P = 0.033). These findings underscore the need for balanced educational policies that incorporate physical activity to reduce AIS risk among adolescents.

Persistence of Primitive Reflexes as Possible Predictive Factors for Progression, Prevention, and Early Rehabilitation Intervention in Idiopathic Scoliosis

Background and objectives: Idiopathic scoliosis is a three-dimensional spinal deformity characterized by a lateral curvature exceeding 10 degrees in the frontal plane accompanied by vertebral rotation in the transverse plane. Despite extensive research on genetic and neurological factors, its etiology is uncertain. This prospective observational study aims to investigate the relation between the primitive reflexes, specifically, the asymmetric tonic neck reflex (ATNR), symmetric tonic neck reflex (STNR), and spinal Galant reflex (SGR), which play key roles in early motor development and postural control and the severity of idiopathic scoliosis (measured via the Cobb angle and the Nash-Moe rotational quota. Additionally, the study evaluated whether the retention of primitive reflexes correlates with increased progression risk over 12 months of conservative treatment. Materials and Methods: Our study cohort included 162 patients, aged 7-19 years, diagnosed with idiopathic scoliosis, who underwent clinical examination and assessment of retained primitive reflexes using standardized grading systems. Results: A total of 162 patients (95 girls, 67 boys; mean age: 12.73 ± 2.74 years) met the inclusion criteria. In 73.5% of the cases, scoliosis was detected, with the majority occurring in the dorsal region (40.1%). The mean initial Cobb angle was 13.49° ± 7.14°, with no significant change after 12 months of conservative treatment (p = 0.584). Nash-Moe rotation scores were 1 in 52.5% and 2 in 22% of the cases. Retention of the following primitive reflexes were identified at baseline: Moro (19.1%), ATNR (38.3%), STNR (44.4%), and GSR (27.8%). GSR retention significantly correlated with the Cobb angle (p = 0.011; R = 0.233). All the reflex scores decreased significantly after 12 months, but no correlation existed between the retained reflexes and scoliosis progression. Patients with a history of quadrupedal locomotion had significantly lower ATNR (p = 0.002), STNR (p < 0.001), and GSR (p = 0.017) retention. Conclusions: These findings suggest that primitive reflex testing could serve as an early screening tool in scoliosis risk stratification, being a cost-effective, non-invasive instrument for identifying at-risk children before clinically significant deformity develops.

A novel portable and radiation-free method for assessing scoliosis: an accurate and reproducible study

BACKGROUND

This study aimed to evaluate the accuracy and reproducibility of a newly developed portable and radiation-free three-dimensional spine sensing system (3D-SSS) for scoliosis assessment.

METHODS

A total of 145 patients underwent full-spine imaging using the EOS imaging system, and 3D-SSS data were collected between February 2023 and April 2023. A radiologist used sterEOS software to reconstruct the spine in 3D and obtain the Cobb angle. One radiologist and one orthopedist independently measured the patients using 3D-SSS, with the orthopedist performing two measurements per patient. The 3D-SSS post-processing system automatically generated the Cobb angle.

RESULTS

The mean Cobb angles obtained from EOS and 3D-SSS were 13.7 ± 9.9° (0.5∽45.7°) and 12.5 ± 8.6° (0.4∽40°), respectively. The intraclass correlation coefficient (ICC) for reliability between EOS and 3D-SSS was 0.921, indicating excellent agreement. Bland-Altman analysis revealed a bias of -1.171° between EOS and 3D-SSS, with only 10 patients outside the limits of agreement (-8.3∽6.0°). The root mean square error between EOS and 3D-SSS was 3.2°. A strong correlation was observed between the Cobb angles measured by EOS and 3D-SSS (r = 0.931, P < 0.001). The receiver operating characteristics curve showed that the diagnostic performance of 3D-SSS for scoliosis was 0.953 (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of 3D-SSS for diagnosing scoliosis were 87.8%, 92.1%, 93.5%, and 85.3%, respectively. The intraobserver and interobserver ICCs for Cobb angles derived from 3D-SSS were 0.969 and 0.934, respectively, demonstrating excellent reproducibility.

CONCLUSIONS

The portable and radiation-free 3D-SSS accurately measured scoliosis and provided highly reproducible data. This system offers a novel method for clinicians to screen and monitor scoliosis in young patients.

Impact of surgical treatment for adolescent idiopathic scoliosis on maternal and obstetric outcomes: a meta-analysis

PURPOSE

To compare the maternal and obstetric health outcomes between pregnant AIS patients treated surgically (AIS surgery), pregnant AIS patients treated conservatively (AIS conservative), and pregnant healthy controls.

METHODS

A systematic review and meta-analysis were conducted according to the PRISMA guidelines (PROSPERO: CRD42023439219). PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched for relevant studies. The risk ratios (RR) and mean differences (MD) were calculated for dichotomous and continuous variables. Heterogeneity was assessed using the chi2 and I2 tests. A fixed-effects or random-effects model was used based on heterogeneity results.

RESULTS

Nine studies involving 4718 women were included. The frequency of caesarean section was higher in the AIS surgery group than in the healthy controls (RR 1.54, 95% CI 1.19 to 1.99), but not compared to the AIS conservative group (RR 1.28, 95% CI 0.96 to 1.69). Patients in the AIS surgery group were more likely to receive general anesthesia during caesarean section than were healthy controls (RR 11.69, 95% CI 3.03 45.13). Patients in the AIS surgery group reported more back pain during pregnancy than healthy controls (RR 4.02, 95% CI 1.20 to 13.49), but not compared to the AIS conservative group (RR 0.81, 95% CI 0.58 1.15). The AIS surgery group had worse scores on the SRS-22 pain and function domains than the healthy controls. There were no differences in marital status or the number of children between the groups.

CONCLUSION

Pregnant AIS patients treated surgically may have a higher risk of caesarean section and more back pain during pregnancy compared to healthy controls. The AIS surgery group also had worse scores on the SRS-22 pain and function domains than the healthy controls. However, there were no differences in marital status or number of children between the groups.

Prevalence of incorrect posture among school adolescents after the COVID-19 pandemic: a large population-based scoliosis screening in China

BACKGROUND

The spinal health of teenagers is adversely affected by the effects of COVID-19, and large-scale scoliosis screening for teenagers after the pandemic has not been reported. This study aimed to explore the prevalence of incorrect posture among Chinese adolescents after the COVID-19 pandemic.

METHODS

This was a large-scale cross-sectional study based on school scoliosis screening. Each student underwent visual inspection, Adam's forward bending test, and trunk rotation angle measurement. A scoliometer was used for posture assessment. The participants were subgrouped based on sex, age, and ethnicity to compare the prevalence of suspected scoliosis. Univariate and multivariate logistic regression (LR) models were used to evaluate factors associated with suspected scoliosis.

RESULTS

During the post-COVID-19 pandemic period, 1,793,787 students participated. The overall prevalence of incorrect postures among Chinese adolescents was 79.92%, and the most common incorrect postures were high and low shoulders (74.18%) and scapular tilt (70.46%). A total of 97,529 students (5.44%) were suspected to have scoliosis. More females (7.5%) than males (3.7%) and more students aged > 15 years (15.12%) than those aged 10-15 years (7.58%) and < 10 years (0.88%) were suspected to have scoliosis. Univariate LR analysis showed that sex, age, grade, and various incorrect postures were significantly associated with suspected scoliosis. Multivariate LR analysis showed that being female (OR = 2.54, 95% CI: 1.68-3.85), age of 10-15 years (OR = 30.34, 95% CI: 4.99-12.64), and ages of > 15 years (OR = 22.30, 95% CI: 10.84-45.87), and incorrect posture, especially the lumbar eminence and right rib hump were high risk factors for suspected scoliosis.

CONCLUSIONS

The prevalence of incorrect posture and suspected scoliosis among Chinese adolescents increased significantly after the COVID-19 pandemic. Early screening of high-risk populations for suspected scoliosis and effective interventions should be implemented to prevent adolescent idiopathic scoliosis during the post-COVID-19 period.

Effects of spinal deformities on lower limb kinematics during walking: a systematic review and meta-analysis

Spinal deformities characterized by malalignment of the spinal column, including scoliosis, hyper kyphosis, and lordosis, can significantly impact lower limb kinematics, potentially leading to altered gait patterns. We aimed to synthesize existing literature investigating the effect of spinal deformities on lower limb kinematics during walking. We searched Four databases including PubMed, Web of Science, Scopus and Embase from their inception through 29th December 2024. The Newcastle-Ottawa Scale was applied to assess quality of included studies and the Grading of Recommendations Assessment, Development and Evaluation (GRADE system) was employed to assess the overall quality of the evidence in the meta-analysis. Mean differences and 95% confidence intervals (CI) were calculated with random effects model in RevMan version 5.4. The review included 35 studies with 1941 participants. Regarding scoliosis, strong evidence suggested a significant increase in right leg stance% and non-significant changes in left leg cadence, right and left leg speed and ankle transverse ROM in individuals with scoliosis compared to controls. Sensitivity analysis showed strong evidence of decrease in right leg stride length and ankle sagittal ROM, decrease in left leg single support and non-significant change in left leg step length. Individuals with sagittal malalignment showed strong evidence of significant reduction in velocity; moderate evidence suggested a significant increase in double support and a decrease in stride length, knee and hip sagittal ROM. Sensitivity analysis revealed strong evidence of a significant decrease in cadence during walking in individuals with sagittal trunk malalignment compared to controls. Participants with adult spinal deformity exhibited strong evidence of increased double support and decreased cadence during walking compared to controls. Spinal deformities significantly alter lower limb kinematics during gait. Our findings highlight the essential need for clinicians to take gait alterations into account when developing targeted interventions for individuals with spinal deformity.

Patient and parent perspectives on being invited to join a trial of night-time only versus full-time bracing for adolescent idiopathic scoliosis : a qualitative study

Aims

The Bracing Adolescent Idiopathic Scoliosis (BASIS) study is a randomized controlled non-inferiority pragmatic trial of 'full-time bracing' (FTB) compared to 'night-time bracing' (NTB) for the treatment of adolescent idiopathic scoliosis (AIS). We anticipated that recruiting patients to BASIS would be challenging, as it is a paediatric trial comparing two markedly different bracing pathways. No previous studies have compared the experiences of AIS patients treated with FTB to those treated with NTB. This qualitative study was embedded in BASIS to explore families' perspectives of BASIS, to inform trial communication, and to identify strategies to support patients treated in a brace.

Methods

Semi-structured interviews were conducted with parents (n = 26) and young people (n = 21) who had been invited to participate in BASIS at ten of the 22 UK paediatric spine services in hospitals recruiting to BASIS. Audio-recorded interviews were transcribed and analyzed thematically.

Results

Families viewed their interactions with BASIS recruiters positively, but were often confused about core aspects of BASIS, such as the aims, expectations of bracing, and the process of randomization. Participants typically expressed a preference for NTB, but recruiters may have framed NTB more favourably. Patients and parents reported challenges wearing a brace, such as physical discomfort, feelings of self-consciousness, difficulty participating in physical activities, and strain on financial resources to support brace use. Patients in FTB reported more pronounced challenges. While families valued health professional support, they felt there was a lack of social, emotional, and school support, and relied on online resources, as well private counselling services to address this need.

Conclusion

The findings informed the development of resources and strategies, including guidance for schools and the recommendations in this paper, to support patients to wear NTB and FTB as prescribed. The results indicated opportunities for recruiters to enhance trial communication in ways that could improve informed consent and recruitment to BASIS, and inform future trials of bracing.

Surface topography demonstrates gradual improvement in spinal range of motion in all three planes following posterior spinal fusion in adolescent idiopathic scoliosis

INTRODUCTION

After posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS), there is alteration in trunk range of motion (ROM) in the coronal, sagittal and axial planes. Previous studies have shown that ROM decreases with increased number of levels fused, which may affect the ROM between patients who undergo non-selective thoracic fusion (NSF) and selective thoracic fusion (STF) patient groups. This study sought to longitudinally evaluate the ROM of the trunk in patients with AIS who underwent posterior spinal fusion, using surface topography, comparing STF and NSF patient motion at multiple time points postoperatively.

METHODS

A retrospective review of data from a single-center prospective registry was conducted. Inclusion criteria required subjects to span 11-21 years of age at surgery, a diagnosis of AIS, and valid ROM measurements obtained via ST scanning. Axial, sagittal and coronal ROM was performed at six timepoints: preoperative, 6 weeks, 3, 6, 12, and 24 months postoperative. All patients had an upper instrumented vertebra (UIV) of T2, T3 or T4, and a lower instrumented vertebra (LIV) of T12, L1, L2 or L3. STF was defined as an LIV of T12 or L1, and NSF as LIV as L2 or L3. SRS22r was collected at all time points. Generalized estimation equation modeling across timepoints were conducted.

RESULTS

54 patients were evaluated: 40 patients in the NSF group (average preoperative Cobb angle of 56.4 ± 12.3°) and 14 in the STF group (average preoperative Cobb angle of 57.4° ± 6.7°). In the NSF group, ROM in the coronal and axial planes decreased significantly postoperatively and remained significantly decreased at 24 months postoperatively (25% decrease in the axial plane, 20% in the coronal plane). Sagittal ROM had significant decrease in ROM at all time points, but at 2 years postoperatively was no longer significant, although still 17% decreased. In the STF group, all three planes had significantly decreased initially but axial and coronal planes returned to baseline (no significant difference from preoperative values) at 24 months, while sagittal plane motion remained significantly diminished, although only by 4%. STF demonstrated no difference in SRS22r total, pain or self-image scores between preoperative and 2 years, while NSF had worse SRS22r total, pain, and self image scores at 2 years vs. preoperative values. When comparing NSF to STF, there was diminished axial, sagittal and coronal plane range of motion at 24 months postoperatively, but no differences in SRS22r total.

CONCLUSION

The coronal, sagittal, and axial ROM as measured by ST demonstrated significant decreases from preoperative to postoperative following PSF; however, this deficit trends towards improvement over time. Our data demonstrates that at two years, NSF has poorer motion than STF patients in all three planes.

Adolescent vs. Young Adult Idiopathic Scoliosis patients: how different are their two year postoperative radiographic and clinical outcomes?

PURPOSE

To compare the long-term outcomes among AIS (10-18 years) and young AdIS (YAdIS) (19-40 years) patients with minimum 2 year follow up.

METHODS

A retrospective review of AIS and YAdIS patients who underwent primary corrective surgery at a single center was conducted. Demographic, radiographic, operative data, patient reported outcome measures (PROMs), including the ODI and SRS-22r, and long-term complications were collected. A 1:1 propensity score matched (PSM) analysis was implemented to limit selection bias by controlling for gender, curve type, total instrumented levels (TIL), and main coronal cobb angle.

RESULTS

95 patients (60 AIS, 35 YAdIS) were identified. Following PSM, 27 matched pairs were identified. AIS patients had greater LL (-55.6 ± 14.0 vs. -61.8 ± 11.7, p = 0.0486) at preop, less OR time (4.7 ± 1.2 h vs. 5.2 ± 1.5 h, p = 0.0468), intraoperative transfusion rates (70.4% vs. 96.3%, p = 0.0082), and postop Hb (9.0 ± 1.9 vs. 10.1 ± 1.4, p = 0.0280) and Hct (26.4 ± 5.4 vs. 29.7 ± 3.7, p = 0.0453). YAdIS patients had greater T2-T12 TK (42.7 ± 13.6 vs. 36.3 ± 11.0, p = 0.0412), T2-T5 TK (19.4 ± 9.4 vs. 13.3 ± 8.7, p = 0.0187), and TPA (12.4 ± 7.9 vs. 7.4 ± 8.9, p = 0.0200). There were no significant differences in baseline and 2 year follow up PROMs and in the rates of 2 year complications, including proximal/distal junctional kyphosis (PJK/DJK), pseudarthrosis, rod fracture, curve progression, and revision (p > 0.05).

CONCLUSION

Despite differences in operative characteristics, idiopathic scoliosis (IS) patients who underwent corrective surgery at a younger age had comparable PROMs and 2 year outcomes to older patients. Corrective fusion surgery is safe and effective in both adolescents and young adults and may avoid the higher complication rates seen in older adults.

Organization of a Pediatric Scoliosis Surgery Task Force and Analysis of Clinical and Radiographic Outcomes

Objective  To demonstrate how a surgical task force can help provide access to surgical procedures for many patients waiting for surgery in the Brazilian Unified Health System (Sistema Único de Saúde - SUS, in Portuguese) waiting list. Methods  This is a retrospective cohort study involving 28 patients on the SUS waiting list included in a pediatric scoliosis surgery task force. We analyzed medical records, epidemiological data, and clinical and radiographic outcomes. Results  The data showed that the postoperative outcomes of curve correction and complications, such as infections, surgical wounds, pain, or other events, were consistent with the literature on the subject. Conclusion  Therefore, we believe a task force is critical for facilitating access to surgical procedures and restoring the quality of life of hundreds of patients.

Evaluating dimensionality reduction of comorbidities for predictive modeling in individuals with neurofibromatosis type 1

Objective

Dimensionality reduction techniques aim to enhance the performance of machine learning (ML) models by reducing noise and mitigating overfitting. We sought to compare the effect of different dimensionality reduction methods for comorbidity features extracted from electronic health records (EHRs) on the performance of ML models for predicting the development of various sub-phenotypes in children with Neurofibromatosis type 1 (NF1).

Materials and Methods

EHR-derived data from pediatric subjects with a confirmed clinical diagnosis of NF1 were used to create 10 unique comorbidities code-derived feature sets by incorporating dimensionality reduction techniques using raw International Classification of Diseases codes, Clinical Classifications Software Refined, and Phecode mapping schemes. We compared the performance of logistic regression, XGBoost, and random forest models utilizing each feature set.

Results

XGBoost-based predictive models were most successful at predicting NF1 sub-phenotypes. Overall, features based on domain knowledge-informed mapping schema performed better than unsupervised feature reduction methods. High-level features exhibited the worst performance across models and outcomes, suggesting excessive information loss with over-aggregation of features.

Discussion

Model performance is significantly impacted by dimensionality reduction techniques and varies by specific ML algorithm and outcome being predicted. Automated methods using existing knowledge and ontology databases can effectively aggregate features extracted from EHRs.

Conclusion

Dimensionality reduction through feature aggregation can enhance the performance of ML models, particularly in high-dimensional datasets with small sample sizes, commonly found in EHRs health applications. However, if not carefully optimized, it can lead to information loss and data oversimplification, potentially adversely affecting model performance.