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Bowen M, Desai V, Anari JB, Cahill PJ. Evaluation and Treatment of Thoracic Insufficiency Syndrome and Early-Onset Scoliosis. J Clin Med 2025; 14:753. [PMID: 39941426 PMCID: PMC11818242 DOI: 10.3390/jcm14030753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 01/16/2025] [Accepted: 01/17/2025] [Indexed: 02/16/2025] Open
Abstract
Thoracic insufficiency syndrome (TIS) and early-onset scoliosis (EOS) are complex pediatric conditions involving deformities of the spine and chest wall, which can significantly impact respiratory function and overall development. Managing these conditions requires a comprehensive approach that combines precise diagnosis and innovative treatment strategies. This opinion article provides a critical discussion of the diagnosis and treatment of TIS and EOS and reflects upon the advancement of methods that are crucial for assessing these conditions and guiding treatment decisions.
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Affiliation(s)
- Margaret Bowen
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Vineet Desai
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Jason B. Anari
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Patrick J. Cahill
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Mastrokostas PG, Mastrokostas LE, Emara AK, Wellington IJ, Ginalis E, Houten JK, Khalsa AS, Saleh A, Razi AE, Ng MK. Modern Internet Search Analytics: Is There a Difference in What Patients are Searching Regarding the Operative and Nonoperative Management of Scoliosis? Global Spine J 2025; 15:103-111. [PMID: 38613478 PMCID: PMC11571444 DOI: 10.1177/21925682241248110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
STUDY DESIGN Observational Study. OBJECTIVES This study aimed to investigate the most searched types of questions and online resources implicated in the operative and nonoperative management of scoliosis. METHODS Six terms related to operative and nonoperative scoliosis treatment were searched on Google's People Also Ask section on October 12, 2023. The Rothwell classification was used to sort questions into fact, policy, or value categories, and associated websites were classified by type. Fischer's exact tests compared question type and websites encountered between operative and nonoperative questions. Statistical significance was set at the .05 level. RESULTS The most common questions concerning operative and nonoperative management were fact (53.4%) and value (35.5%) questions, respectively. The most common subcategory pertaining to operative and nonoperative questions were specific activities/restrictions (21.7%) and evaluation of treatment (33.3%), respectively. Questions on indications/management (13.2% vs 31.2%, P < .001) and evaluation of treatment (10.1% vs 33.3%, P < .001) were associated with nonoperative scoliosis management. Medical practice websites were the most common website to which questions concerning operative (31.9%) and nonoperative (51.4%) management were directed to. Operative questions were more likely to be directed to academic websites (21.7% vs 10.0%, P = .037) and less likely to be directed to medical practice websites (31.9% vs 51.4%, P = .007) than nonoperative questions. CONCLUSIONS During scoliosis consultations, spine surgeons should emphasize the postoperative recovery process and efficacy of conservative treatment modalities for the operative and nonoperative management of scoliosis, respectively. Future research should assess the impact of website encounters on patients' decision-making.
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Affiliation(s)
- Paul G. Mastrokostas
- College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, NY, USA
| | | | - Ahmed K. Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Ian J. Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Hartford, CT, USA
| | | | - John K. Houten
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Amrit S. Khalsa
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ahmed Saleh
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Afshin E. Razi
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Mitchell K. Ng
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
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Qi H, Zhao Z, Zu F, Wang C, Wang C, Zhang Z, Tian X, Su D, Wang Z, Xue R, Hou Z, Chen W, Zhang D. Association of Body Mass Index and Central Obesity with Spinopelvic Alignment Parameters in a Chinese Population: A Prospective Study. World Neurosurg 2024; 189:e153-e161. [PMID: 38857870 DOI: 10.1016/j.wneu.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE The purpose of this study was to explore the impact of central obesity on spinal sagittal balance in adults aged 18 and older by examining correlations between waist circumference (WC) and abdominal circumference (AC) and spinopelvic alignment parameters. METHODS This prospective cohort study included 350 adults aged 18 and older. Participants underwent whole-body biplanar radiography using the EOS imaging system. Spinal and pelvic parameters were measured and correlated with body mass index, WC, and AC. Statistical analyses included one-way analysis of variance, Wilcoxon rank-sum tests for data with nonhomogeneous variances, and chi-squared tests for categorical data. Intra-rater and inter-rater reliability were assessed using intraclass correlation coefficients, with subsequent analyses to explore correlations between body measurements and spinal parameters. RESULTS The study found significant correlations between increased WC and AC and changes in spinopelvic parameters. However, obesity did not uniformly influence all sagittal alignment parameters. Significant variations in spinal measurements indicate that central obesity plays a role in altering spinal stability and alignment. CONCLUSIONS The findings highlight the impact of central obesity on spinal alignment and emphasize the importance of considering central obesity in clinical assessments of spinal pathologies. Further research is essential to better understand the relationship between obesity, spinal sagittal balance, and related health conditions.
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Affiliation(s)
- Hao Qi
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zenghui Zhao
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Feiyu Zu
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chenxi Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chenchen Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zuzhuo Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaonan Tian
- CT/MRI Department of the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dan Su
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhaoxuan Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rui Xue
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Hou
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China; Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Chen
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China; Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Di Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Lau KKL, Kwan KYH, Cheung JPY, Wong JSH, Shea GKH, Law KKP, Cheung KMC. Patient-perceived factors on treatment satisfaction in early onset scoliosis treated surgically with a minimum of ten years. J Orthop Surg Res 2024; 19:524. [PMID: 39210371 PMCID: PMC11363580 DOI: 10.1186/s13018-024-04993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 08/11/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The prognosis of surgically treated subjects with early onset scoliosis (EOS) into adulthood has been lacking. We aimed to investigate the patients' perspectives on satisfaction with surgical treatment. METHODOLOGY We included all surgical candidates with EOS who had undergone index spinal surgery for scoliosis correction between 2009 and 2013. The minimum duration of postoperative follow-up was 10 years at the time of survey completion. Three questionnaires were used in this study, comprising the revised Scoliosis Research Society questionnaire (SRS-22r), the Patient-Reported Outcomes Measurement Information System (PROMIS-29), and the World Health Organization Quality of Life (WHOQOL-BREF). Measures of treatment satisfaction were retrieved from SRS-22r. RESULTS There were 29 participants who completed the survey, and thereby included in the study (i.e., a response rate of 43% and a dropout rate of 6%). Amongst them, 14, 11, and 4 individuals received posterior spinal fusion (PSF), magnetically controlled growing rods (MCGR), and traditional growing rods, respectively. The average duration after the index spinal surgery was 12.6 ± 2.2 years. Our findings revealed that self-image (across all treatment groups), sleep disruption (only in PSF), and social aspects (in both PSF and MCGR) were significantly worse when compared to the normative values. According to the multivariable linear regression model (R-square = 0.690, p < .001), an increase in SRS-22r mental health (p = .008) and PROMIS-29 social participation scores (p = .004) corresponded to 0.511 and 0.055 points increases in satisfaction. Every unit increase in PROMIS-29 fatigue (p = .043) and WHOQOL-BREF physical domain scores (p = .007) was in conjunction with 0.019 and 0.040 points decreases in satisfaction. SRS-22r self-image (p = .056) and WHOQOL-BREF environmental domain scores (p = .076) were included in the model but did not reach statistical significance. CONCLUSIONS To improve the long term quality of life in surgical candidates with EOS, we demonstrated that mental health, social participation, fatigue, and physical health were significant factors associated with treatment satisfaction. Interestingly, demographic and radiographic parameters did not have a significant effect in our cohort.
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Affiliation(s)
- Kenney Ki Lee Lau
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kenny Yat Hong Kwan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Janus Siu Him Wong
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Graham Ka Hon Shea
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Karlen Ka Pui Law
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
- Department of Orthopaedics and Traumatology, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.
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Akhtar Y, Udupa JK, Tong Y, Liu T, Wu C, Kogan R, Al-Noury M, Hosseini M, Tong L, Mannikeri S, Odhner D, Mcdonough JM, Lott C, Clark A, Cahill PJ, Anari JB, Torigian DA. Auto-segmentation of thoraco-abdominal organs in pediatric dynamic MRI. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.04.24306582. [PMID: 38766023 PMCID: PMC11100850 DOI: 10.1101/2024.05.04.24306582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Purpose Analysis of the abnormal motion of thoraco-abdominal organs in respiratory disorders such as the Thoracic Insufficiency Syndrome (TIS) and scoliosis such as adolescent idiopathic scoliosis (AIS) or early onset scoliosis (EOS) can lead to better surgical plans. We can use healthy subjects to find out the normal architecture and motion of a rib cage and associated organs and attempt to modify the patient's deformed anatomy to match to it. Dynamic magnetic resonance imaging (dMRI) is a practical and preferred imaging modality for capturing dynamic images of healthy pediatric subjects. In this paper, we propose an auto-segmentation set-up for the lungs, kidneys, liver, spleen, and thoraco-abdominal skin in these dMRI images which have their own challenges such as poor contrast, image non-standardness, and similarity in texture amongst gas, bone, and connective tissue at several inter-object interfaces. Methods The segmentation set-up has been implemented in two steps: recognition and delineation using two deep neural network (DL) architectures (say DL-R and DL-D) for the recognition step and delineation step, respectively. The encoder-decoder framework in DL-D utilizes features at four different resolution levels to counter the challenges involved in the segmentation. We have evaluated on dMRI sagittal acquisitions of 189 (near-)normal subjects. The spatial resolution in all dMRI acquisitions is 1.46 mm in a sagittal slice and 6.00 mm between sagittal slices. We utilized images of 89 (10) subjects at end inspiration for training (validation). For testing we experimented with three scenarios: utilizing (1) the images of 90 (=189-89-10) different (remaining) subjects at end inspiration for testing, (2) the images of the aforementioned 90 subjects at end expiration for testing, and (3) the images of the aforesaid 99 (=89+10) subjects but at end expiration for testing. In some situations, we can take advantage of already available ground truth (GT) of a subject at a particular respiratory phase to automatically segment the object in the image of the same subject at a different respiratory phase and then refining the segmentation to create the final GT. We anticipate that this process of creating GT would require minimal post hoc correction. In this spirit, we conducted separate experiments where we assume to have the ground truth of the test subjects at end expiration for scenario (1), end inspiration for (2), and end inspiration for (3). Results Amongst these three scenarios of testing, for the DL-R, we achieve a best average location error (LE) of about 1 voxel for the lungs, kidneys, and spleen and 1.5 voxels for the liver and the thoraco- abdominal skin. The standard deviation (SD) of LE is about 1 or 2 voxels. For the delineation approach, we achieve an average Dice coefficient (DC) of about 0.92 to 0.94 for the lungs, 0.82 for the kidneys, 0.90 for the liver, 0.81 for the spleen, and 0.93 for the thoraco-abdominal skin. The SD of DC is lower for the lungs, liver, and the thoraco-abdominal skin, and slightly higher for the spleen and kidneys. Conclusions Motivated by applications in surgical planning for disorders such as TIS, AIS, and EOS, we have shown an auto-segmentation system for thoraco-abdominal organs in dMRI acquisitions. This proposed setup copes with the challenges posed by low resolution, motion blur, inadequate contrast, and image intensity non-standardness quite well. We are in the process of testing its effectiveness on TIS patient dMRI data.
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Studer D, Hasler CC. Diagnostic and therapeutic strategies in early onset scoliosis: A current concept review. J Child Orthop 2024; 18:113-123. [PMID: 38567043 PMCID: PMC10984154 DOI: 10.1177/18632521241228141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 04/04/2024] Open
Abstract
Substantial advances in the treatment of early onset scoliosis (EOS) over the past two to three decades have resulted in significant improvements in health-related quality of life of affected children. In addition to classifications that address the marked heterogeneity of this patient population, increasing understanding of the natural history of the disease, and new implants and treatment techniques have resulted in innovations unlike any other area of pediatric orthopedics. The growing understanding of the interaction between spinal and thoracic growth, as well as dependent lung maturation, has had a lasting impact on the treatment strategy of this potentially life-threatening disease. The previous treatment approach with early corrective fusion gave way to a growth-friendly concept. Despite the steady development of new growth-friendly surgical treatment options, whose efficacy still needs to be validated, as well as a revival of conservative growth control with serial casts and/or braces, the psychosocial burden of the long lasting and complication-prone treatments remains high. As a consequence, EOS still represents one of the greatest pediatric orthopedic challenges.
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Affiliation(s)
- Daniel Studer
- Orthopaedic Department, University Children’s Hospital Basel UKBB, Basel, Switzerland
| | - Carol Claudius Hasler
- Orthopaedic Department, University Children’s Hospital Basel UKBB, Basel, Switzerland
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