Congenital scoliosis: a frontal plane evaluation of 251 operated patients 14 years old or older at follow-up

Posterior Hemivertebra Extended Resection Combined With Concave Anterior Column Reconstruction for Congenital Scoliosis

BACKGROUND

Posterior hemivertebra resection for hemivertebra deformities has been widely reported. However, achieving adequate correction of deformities through conventional hemivertebra resection remains technically challenging in older children. The authors developed a technique combining posterior hemivertebra extended resection with concave anterior column reconstruction. This study aimed to evaluate the outcomes of the modified posterior hemivertebra resection (MPHR) technique in older children with rigid congenital scoliosis.

METHODS

A retrospective analysis was conducted from June 2016 to February 2023 on 15 patients with congenital scoliosis, all of whom were over 10 years old and had less than 30% flexibility. They underwent posterior hemivertebra extended resection combined with concave anterior column reconstruction. The medical records and radiographs were reviewed to evaluate correction results and complications.

RESULTS

There were 7 males and 8 females with a mean age of 12.9±1.5 years. The mean follow-up time was 2.0±0.4 years. The segmental curve was 41±11 degrees preoperatively, 7±4 degrees postoperatively, and 8±4 degrees at the final follow-up, resulting in a correction rate of 80%. The segmental kyphosis improved from 41±26 to 7±7 degrees, resulting in a correction rate of 83%. The correction rate for the compensatory cranial and caudal curve were 59% and 66%, respectively. There was one superficial wound infection postoperatively.

CONCLUSIONS

The MPHR provides satisfactory correction of hemivertebra deformity in older children. The MPHR represents an alternative technique for older children with rigid curves.

LEVEL OF EVIDENCE

Level IV.

Hemivertebra Resection in Small Children. A Literature Review

STUDY DESIGN

Systematic review.

OBJECTIVE

To evaluate the lowest possible age to resect an HV in very young patients with a congenital deformity.

METHODS

We sought to retrieve all studies reporting age at HV excision in patients with congenital scoliosis. Studies written in English were included. No publication date restrictions were imposed. A search of the PubMed and LiLacs databases was conducted. Additionally, a hand search was performed to supplement the database search.

RESULTS

We found 140 articles. Twenty two studies were included into the final assessment. There was considerable heterogeneity in the included studies, both regarding age and the surgical techniques used. There was also a broad spectrum of recommendations regarding suggested age for treatment. The youngest patient undergoing resection and fusion was 3 months of life at the time of surgery.

CONCLUSION

How young a patient could and should be submitted to HV resection surgery is still a matter of debate in the literature. Prophylactic surgery might be a proper treatment for young children with congenital scoliosis before malformation becomes a deformity, adding no additional neurological, vascular, or anesthesia-related complications. The defect can be treated early while the deformity is treated late.

Long-term results of hemivertebra excision: How does the spine behave after the peak of puberty?

INTRODUCTION

Early hemivertebra (HV) excision and posterior spinal fusion (PSF) is advocated as the treatment of choice in congenital kyphoscoliosis. We assessed global spinal balance and spinal deformity status once the pubertal peak has taken place, in children with a history of HV excision and PSF at age younger than 5 years.

METHODS

Twenty-seven children with congenital kyphoscoliosis without co-existing proximal/distal congenital spinal abnormalities who underwent HV excision and PSF of ≤ 5 levels at age younger than 5 years and who had reached the peak of puberty at the last follow-up visit were evaluated.

RESULTS

Twenty-seven HV excision were performed. Mean age at surgery was 3 years and 2 months. A mean of 3.2 segments were fused. Imbalance of the trunk was observed in 80% of thoracic and 75% of thoracolumbar HV excision. No arthrodesis technique (4 cases) presented 100% of spine decompensation. All children younger than 2 years at the time of surgery developed spinal imbalance. Eighteen patients (67%) had global spine imbalance; 81% male population and 63% of the female population. Mean age at surgery was 3 years + 2 months. Mean age of the patients at the time of the study was 15 years + 5 months. Mean follow-up was 12 years + 3 months.

CONCLUSION

Many of these patients developed spinal imbalance and scoliosis worsened at the final follow-up. Early age at surgery, preoperative scoliosis severity, HV location, no arthrodesis technique, and the adding-on phenomenon may be involved.

Frequency and characteristics of congenital intraspinal abnormalities in a cohort of 128 patients with congenital scoliosis

OBJECTIVES

The aims of this study were to determine the incidence and main characteristics of associated intraspinal anomalies in patients with congenital scoliosis (CS) and to analyze the different factors that influence the curve progression.

DESIGN

This was a retrospective comparative study.

METHODS

This was a retrospective study of 128 patients with CS.

MAIN OUTCOME MEASUREMENTS

The incidence of the patients with intraspinal anomalies and their demographic, clinical, and radiological values was described.

RESULTS

Intraspinal anomalies were present in 13.3% of the patients. Among them, the most frequent anomaly was syringomyelia. The most frequent curve was the thoracic curve. The main deformity based on McMaster classification was formation failure. The curve progression during follow-up did not show significant differences between vertebral anomalies, syringomyelia, presence of thoracic anomalies, and gender (P > 0.05).

CONCLUSIONS

Our study showed a lower percentage of spinal anomalies compared to other series. As other studies, the progression of the scoliosis curve in patients with spinal anomalies seems primarily to be determined by the type of vertebral malformation.

LEVEL OF EVIDENCE

Level II.

Brace treatment can serve as a time-buying tactic for patients with congenital scoliosis

Background

Infantile patients with congenital scoliosis (CS) can be confronted with increasing risk of mortality and morbidity. To date, the effectiveness of conservative treatment in CS has not been sufficiently investigated. We aimed to evaluate the bracing outcome in patients with CS and to investigate whether wearing brace can effectively delay the surgical procedures.

Methods

A total of 39 braced CS patients including 25 boys and 14 girls were reviewed for the eligibility to be included in this study. Radiographic parameters including curve magnitude and T1 to T12 height were evaluated for each patient at the initiation of the treatment and at the final follow-up (FU), respectively. Duration of the follow-up and requirement of surgical interventions were also recorded. The student t test was used to compare the radiographic parameters between the initial visit and the last FU.

Results

The mean initial age at bracing was 4.1 ± 2.3 years, and 7.5 ± 1.8 brace modifications were performed during a mean FU period of 42.1 ± 26.5 months. The mean curve magnitude before bracing was 44.1 ± 12.2°, which was corrected to 41.3 ± 13.5° at the final visit (p = 0.33). T1-T12 height increased from 13.4 ± 2.5 to 17.1 ± 2.8 cm during the treatment (P < 0.001). Nine patients underwent surgical intervention due to the curve progression more than 5°, with the time of surgery delayed for 32.1 ± 18.2 months.

Conclusions

Brace treatment is an effective time-buying modality for CS patients, which may help maintain the body growth and delay the surgical intervention.

A comprehensive review of the diagnosis and management of congenital scoliosis

PURPOSE

To provide the reader with a comprehensive but concise understanding of congenital scoliosis METHODS: We have undertaken to summarize available literature on the pathophysiology, epidemiology, and management of congenital scoliosis.

RESULTS

Congenital scoliosis represents 10% of pediatric spine deformity and is a developmental error in segmentation, formation, or a combination of both leading to curvature of the spine. Treatment options are complicated by balancing growth potential with curve severity. Often associated abnormalities of cardiac, genitourinary, or intraspinal systems are concurrent and should be evaluated as part of the diagnostic work-up. Management balances the risk of progression, growth potential, lung development/function, and associated risks. Surgical treatment options involve growth-permitting systems or fusions.

CONCLUSION

Congenital scoliosis is a complex spinal problem associated with many other anomalous findings. Treatment options are diverse but enable optimization of management and care of these children.

CHANGES IN THE SAGITTAL BALANCE IN CONGENITAL SCOLIOSIS CORRECTION SURGERY

ABSTRACT Objective: This study aimed to determine whether surgery leads to changes in sagittal balance in patients with congenital scoliosis. Methods: We retrospectively reviewed all cases of scoliosis operated in a tertiary hospital between January 2009 and January 2013. In all cases the deformity in the coronal and sagittal planes, kyphosis, and lordosis were measured, using the Cobb method, and spinopelvic parameters: pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). Results A hundred and eleven medical records were analyzed, but the sample resulted in 10 patients, six of whom were females (60%). The average age was 13.4 years. In the comparative analysis between pre and postoperative, only the coronal deformity (12.37; CI 95% [7.88-16.86]; p<0.001), the sagittal deformity (12.71; CI 95% [4.21-21.22]; p=0.011), and the lumbar lordosis (9.9; CI 95% [0.38-19.42]; p=0.043) showed significant change. Conclusion: There was no change in the spinopelvic parameters of patients with congenital scoliosis undergoing surgery at IOF-FMUSP between 2009 and 2013; however, it was observed decrease in lumbar lordosis, and deformity angle in the sagittal and coronal planes.

Key role for the transcriptional factor, osterix, in spine development

BACKGROUND CONTEXT

Osterix (Osx) is an important transcriptional factor for bone formation; however, its role in spine development has not been determined.

PURPOSE

The goal of the present study is to observe the role of Osx in spine development.

STUDY DESIGN/SETTING

Deletion and overexpression of Osx were achieved in Osx knockout and transgenic mice, respectively, to determine the effect of Osx on spine development.

METHODS

With 2.3-kb type I collagen as a promoter, Osx were deleted in mice, and overexpression of Osx was obtained in Osx transgenic mice. Video, X-ray radiology, histology, tartrate-resistant acid phosphatase staining, Safranin O staining, and immunohistochemistry were used to assess the effect of Osx deletion and overexpression on spine development. This study was supported by National Science Foundation of China (81271935) and Foundation of State Key Laboratory of Trauma, Burns and combined injury (SKLZZ SKLZZ201124). No potential conflict of interest to disclose.

RESULTS

Overexpression of Osx did not have an obvious effect on spine development, whereas deletion of Osx led to severe spine deformities that included wedged vertebrae, spinal stenosis, and congenital scoliosis. Also, Osx deactivation resulted in shortened vertebrae and excessive bone volume in the vertebrae. TRAP staining showed that activity of osteoclasts decreased in Osx-null mice, and examination with TdT-mediated dUTP nick end labeling revealed that the apoptosis rate at the growth plate decreased significantly in Osx-null mice. Excessive formation of bone was positive for Safranin O staining.

CONCLUSIONS

Osx plays an important role in spine development, and its deactivation leads to severe spine deformities.