Incidence and Risk Factors of Cardiac Abnormalities in Patients with Idiopathic Scoliosis

Prevalence of scoliosis and congenital heart disease based on school screening in Jinghong City, Yunnan Province

Objective

To investigate the prevalence of scoliosis and congenital heart disease (CHD) in the same area and to explore the relationship between them according to a joint school screening.

Methods

All students aged 6-15 years in 20 schools in Jinghong City, Yunnan Province, China was screened for scoliosis and CHD. Scoliosis screening completed through the Adam's forward bending test with scoliometer measurement, and CHD screening completed through auscultation combined with portable echocardiography (ECHO). The gender, age, distribution of ethnic groups, types of CHD, angle of trunk rotation (ATR) and location of scoliosis were recorded. The severity was divided into 3 grades by ATR. Then the relationship between scoliosis and CHD was analyzed.

Results

A total of 17,134 students was screened with a prevalence of suspected scoliosis of 1.7% (298 students), and the prevalence of suspected scoliosis in female was higher than that in male (2.4 vs. 1.2%, P < 0.001), which increased with age (P < 0.01). The prevalence of suspected scoliosis was no different among ethnic groups (P > 0.05). The severity of scoliosis was mainly grade 1 (68.5%), followed by grade 2 (27.2%) and grade 3 (4.4%). And scoliosis was mainly located in lumbar (37.6%). The prevalence of CHD was 3.15‰, and there was no difference in the prevalence of CHD between different gender, age and ethnic groups (P > 0.05). The most common type of CHD was atrial septal defect (27.78%), followed by ventricular septal defect (16.67%). There was only one CHD student in 298 suspected scoliosis students.

Conclusion

The prevalence of suspected scoliosis among primary school students was 1.74%, while the prevalence of congenital heart disease was 3.15‰ in Jinghong City, Yunnan Province. And the incidence of CHD in patients with mild suspected scoliosis was low and close to that in normal population.

Improvement of Cardiac and Pulmonary Function in Patients With Moderate-to-Severe Idiopathic Scoliosis After Posterior Corrective surgery-A Single-Center, Prospective Cohort Study

STUDY DESIGN

Prospective single-center cohort study.

OBJECTIVE

To evaluate cardiac morphology, cardiac function, and pulmonary hypertension impairment in patients with idiopathic scoliosis (IS) and their changes one year after scoliosis surgery.

METHODS

70 patients with IS with predominantly thoracic curvature Cobb angle >40° were enrolled and categorized into moderate (<70°) and severe (≥70°) groups. Preoperative radiography and transthoracic echocardiography were performed. Postoperatively, 51 patients completed a one-year follow-up and were compared with preoperative data.

RESULTS

(1) Left ventricular end-diastolic diameter (LVEDD), left ventricular global longitudinal strain (LVGLS), and e were lower and E/e was higher in the moderate vs severe group, and the aortic internal diameter and LVEF were lower in the severe group than in the control group (P < 0.05); (2) Right ventricular free wall strain (RVFWS), tricuspid annular plane systolic excursion (TAPSE), and TAPSE/systolic pulmonary artery pressure (SPAP) were lower, and SPAP was higher in the moderate vs severe group than in the control group (P < 0.05); (3) The thoracic curve Cobb angle was significantly negatively correlated with LVEDD, SV, LVGLS, RVFWS, TAPSE, TAPSE/SPAP and FVC and FEV1 measured/predicted (P < 0.05), and positively correlated with SPAP (P < 0.05); (4) After one-year postoperative follow-up, LVEDD, LVGLS, SV, e, RVFWS, TAPSE and TAPSE/SPAP were higher, and E/e and SPAP were lower (P < 0.05) compared to pre-operation.

CONCLUSION

Cardiac morphology, left and right heart function, and pulmonary function were impaired in patients with IS, and which showed significant improvement after posterior corrective surgery.

Digitalized 3D Spinal Decompression and Correction Device Improved Initial Brace Corrections and Patients' Comfort Among Adolescents with Idiopathic Scoliosis: A Single-Centre, Single-Blinded Randomized Controlled Trial

This study aimed to evaluate the efficacy of a novel three-dimensional (3D) spinal decompression and correction device in improving the in-brace correction and patient comfort level for adolescents with idiopathic scoliosis (AIS), and to assess the impact of the number of vertebrae involved in the scoliotic curve on the correction's effectiveness. A single-centre, single-blinded randomized controlled trial (RCT) was conducted in 110 AIS patients aged 10-18 years who were randomly allocated into four groups receiving 0-3 days of device intervention. Each session lasted for 30 min and was conducted twice daily. Significant improvements were observed in both the in-brace correction ratio and patient comfort level, particularly in the 2- and 3-day intervention groups (p < 0.001). The number of involved vertebrae for a scoliotic curve was positively correlated with the in-brace correction ratio in the no intervention (or 0-day) and 1-day intervention groups, while this correlation varied in the 2- and 3-day intervention groups. These findings suggested that the prolonged use of the 3D device could improve the correction ratios and patient comfort, while the role of vertebrae involvement in predicting the initial correction may require further exploration to optimize personalized treatment strategies in future clinical practice.

Surgical Treatment Strategies for Severe and Neglected Spinal Deformities in Children and Adolescents without the Use of Radical Three-Column Osteotomies

Background: Severe spinal deformity manifests as a pronounced deviation from the normal curvature of the spine in the frontal, sagittal, and horizontal planes, where the coronal plane curvature exceeds 90 degrees and may coincide with hyperkyphotic deformity. The most severe deformities exhibit rigidity, with flexibility below 30%. If left untreated or improperly treated, these deformities can result in serious complications associated with progression of the curvature. A combination of surgical techniques is frequently employed to attain optimal outcomes and minimize the risk of complications. The overall medical condition of the patient, their capacity to endure extensive procedures, the expertise of the surgeon, and the resources available all play significant roles in determining the course of management. A systematic and thorough review of the relevant literature was conducted utilizing a variety of electronic databases. The primary objective of this study was to scrutinize the surgical techniques commonly employed in complex spine surgeries for the management of severe scoliosis without resection vertebral body techniques, with higher potential risk of major complications, including permanent neurological deficit. Conclusions: Halo-gravity traction, halo femoral traction, and all techniques for releases of the spine (anterior, posterior, or combine), as well as thoracoplasty, have demonstrated significant effectiveness in managing severe and rigid idiopathic scoliosis. The combination of several of these methods can lead to optimal alignment correction without the need to perform high-risk techniques involving three-column osteotomies. Surgeons must customize the indications based on factors such as available resources, characteristics of the deformity, and the patient's individual profile. Surgical correction of severe scoliosis without vertebral body resection surgeries decreases the potential risks related to neurological and pulmonary complications while providing significant clinical improvement outcomes. The powerful Ponte osteotomy is indicated for severe scoliosis, curves with poor flexibility, for better restoration of hypokyphosis, and decrease of hyperkyphosis. These corrective techniques combined with HGT or temporary internal distraction rods are recommended as viable options for managing individuals with severe rigid spine deformity characteristics. Therefore, they also should be considered and performed by a proficient surgical team. The presence of neuromonitoring is crucial throughout these procedures.

Preoperative Echocardiogram Does Not Contribute to Surgical Risk Assessment in Patients With Large Curve Scoliosis and No Cardiac Risk Factors

OBJECTIVE

Severe scoliosis can affect thoracic organs, potentially leading to cardiovascular abnormalities. Thus, echocardiograms have been suggested for use in preoperative screening in patients with significant scoliosis. However, the utility of preoperative heart screenings in patients without known or suspected heart problems is not well understood. This study aims to find the incidence of cardiac findings in patients with severe scoliosis ≥90° without cardiac history.

METHODS

A single-institution retrospective chart review was performed. Inclusion criteria were scoliosis patients with curves ≥90 degrees and a screening echocardiogram performed within 6 months of spine surgery. Patients with a previous cardiac history, diagnosis associated with cardiac comorbidities (eg, connective tissue disease), or major coronal curves <90 degrees were excluded. Echocardiogram reports and perioperative clinical notes from involved services (including orthopaedics, cardiology, and anesthesia) were reviewed. Any postoperative use of vasopressors and reasons for their use were recorded.

RESULTS

Overall, 50 patients met the inclusion criteria. The mean age at surgery was 14.0 ± 4.9 years old (range: 2 to 33). The mean major curve was 108 ± 19 degrees (range: 90 to 160 degrees). A normal echocardiogram was seen in 38 (76%), whereas 6 patients (12%) had mild dilation of the aortic sinus or root, 4 (8%) had mild valvular regurgitation, 1 patient had a small atrial septal defect, and 1 had a trace pericardial effusion. No patient had any changes made to their perioperative plan and one patient was advised to see a cardiologist postoperatively. Postoperatively, 8 patients (16%) received vasopressors to raise blood pressure to meet preset goal MAP, but only one of these 8 had a positive echocardiogram (mild valvular insufficiency), which was not seen as a contributing factor to the use of pressors.

CONCLUSIONS

This study suggests that screening echocardiograms for patients without a cardiac history or related symptoms does not contribute to the evaluation of perioperative risk or anesthetic management. Creating clear, evidence-based guidelines for the utilization of perioperative testing, like echocardiograms, can reduce the social, time, and financial burdens on families. Such guidelines are vital for appropriate risk assessment and proper utilization of health care resources.

LEVEL OF EVIDENCE

Level III.

The relationship between mitral valve prolapse and thoracic skeletal abnormalities in clinical practice: a systematic review

BACKGROUND

Literature data suggest high inter-study variability in mitral valve prolapse (MVP) prevalence among individuals with thoracic skeletal abnormalities (TSA). This systematic review aimed at estimating the overall prevalence of MVP in individuals with the most common TSA, including not only the oldest studies (before the year 2000) but also the most recent ones (after the year 2000).

METHODS

PubMed and EMBASE databases were systematically reviewed in November 2023. Studies assessing the relationship between MVP and TSA and estimating the MVP prevalence in pectus excavatum (PE), pectus carinatum (PC), scoliosis, straight back syndrome (SBS) and Marfan syndrome (MS) were included. There was no limitation on time periods.

RESULTS

Twenty-five studies with a total of 2800 patients (27.9 ± 13.9 years, 48.2% females) were analyzed. The highest prevalence of MVP was observed among MS patients (47.3%), while the lowest was detected in PC individuals (23%). Prevalence of MVP was similar among PE (30.8%), scoliosis (26.3%) and SBS (25.5%) patients. When dividing the studies on the basis of temporal period, the average MVP prevalence was approximately two-fold higher in all studies conducted before the year 2000 in comparison with the most recent ones, regardless of TSA type. This discrepancy might be primarily ascribed to relevant differences in the echocardiographic criteria employed for MVP diagnosis before (less specific) and after (more specific) the year 2000, respectively.

CONCLUSIONS

The estimated MVP prevalence in TSA individuals is significantly higher than that observed in the general population. Individuals with TSA should be screened for MVP presence on transthoracic echocardiography.

The role of scoliosis on the comorbidity and demographics of neurofibromatosis type 1 patients: A retrospective analysis of the National Inpatient Sample database

Neurofibromatosis type 1 (NF1) is the most common neurocutaneous syndrome in the United States, affecting every 1 in 3000 individuals. NF1 occurs due to non-functional mutations in the NF1 gene, which expresses neurofibromin, a protein involved in tumour suppression. As a result, NF1 typically presents with non-cancerous neoplasm masses called neurofibromas across the body. Out of all NF1 abnormalities, the most common skeletal abnormality seen in around 10%-30% of NF1 patients is scoliosis, an improver curvature of the spine. However, there is a lack of research on the effects of scoliosis on demographics and morbidities of NF1 patients. We performed a national analysis to investigate the complex relationship between NF1 and scoliosis on patients' demographics and comorbidities. We conducted a retrospective cross-sectional analysis of the 2017 US National Inpatient Sample database using univariable Chi-square analysis and multivariable binary logistic regression analysis to determine the interplay of NF1 and scoliosis on patients' demographics and comorbidities. Our query resulted in 4635 total NF1 patients, of which 475 (10.25%) had scoliosis and 4160 (89.75%) did not. Demographic analysis showed that NF1 patients with scoliosis were typically younger, female and white compared to NF1 patients without scoliosis. Comorbidity analysis showed that NF1 patients with scoliosis were more likely to develop malignant brain neoplasms, epilepsy, hydrocephalus, pigmentation disorders, hypothyroidism, diabetes with chronic complications and coagulopathy disorders. NF1 patients with scoliosis were less likely to develop congestive heart failure, pulmonary circulation disease, peripheral vascular disease, paralysis, chronic pulmonary disease, lymphoma and psychosis. NF1 patients with scoliosis were predominantly younger, female, white patients. The presence of scoliosis in NF1 patients increases the risks for certain brain neoplasms and disorders but serves a protective effect against some pulmonary and cardiac complications.

Identification of an increased lifetime risk of major adverse cardiovascular events in UK Biobank participants with scoliosis

BACKGROUND

Structural changes caused by spinal curvature may impact the organs within the thoracic cage, including the heart. Cardiac abnormalities in patients with idiopathic scoliosis are often studied post-corrective surgery or secondary to diseases. To investigate cardiac structure, function and outcomes in participants with scoliosis, phenotype and imaging data of the UK Biobank (UKB) adult population cohort were analysed.

METHODS

Hospital episode statistics of 502 324 adults were analysed to identify participants with scoliosis. Summary 2D cardiac phenotypes from 39 559 cardiac MRI (CMR) scans were analysed alongside a 3D surface-to-surface (S2S) analysis.

RESULTS

A total of 4095 (0.8%, 1 in 120) UKB participants were identified to have all-cause scoliosis. These participants had an increased lifetime risk of major adverse cardiovascular events (MACEs) (HR=1.45, p<0.001), driven by heart failure (HR=1.58, p<0.001) and atrial fibrillation (HR=1.54, p<0.001). Increased radial and decreased longitudinal peak diastolic strain rates were identified in participants with scoliosis (+0.29, Padj <0.05; -0.25, Padj <0.05; respectively). Cardiac compression of the top and bottom of the heart and decompression of the sides was observed through S2S analysis. Additionally, associations between scoliosis and older age, female sex, heart failure, valve disease, hypercholesterolemia, hypertension and decreased enrolment for CMR were identified.

CONCLUSION

The spinal curvature observed in participants with scoliosis alters the movement of the heart. The association with increased MACE may have clinical implications for whether to undertake surgical correction. This work identifies, in an adult population, evidence for altered cardiac function and an increased lifetime risk of MACE in participants with scoliosis.

Scoliosis incidence and treatment methods

Scoliosis is defined as a three-dimensional deformity of the spine that is of particular interest to the lateral curvature of the spine. Various types of treatment approaches have been recommended for patients with scoliosis. The aim of this study was to provide an up-to-date review of scoliosis, focusing on issues such as its incidence and treatment methods. The ISI-Thomson Web Of Science International Virtual Library was accessed for this review. The search criteria selected were 'title', 'abstract' and 'keywords'. In the ISI Thomson Web of Science virtual library platforms, the keywords in the articles search were "scoliosis incidence" and "scoliosis treatment". Over the years, different therapeutic strategies have been addressed for patients with scoliosis, they differ depending on the type of scoliosis, the patient's age and the available therapeutic means. Keywords: Scoliosis, Incidence, Physical Treatment;

A Novel Classification of 3D Rib Cage Deformity in Subjects With Adolescent Idiopathic Scoliosis

STUDY DESIGN

This was a multicentric cross-sectional descriptive study.

OBJECTIVE

To analyze patterns of 3D rib cage deformity in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with the spinal deformity.

SUMMARY OF BACKGROUND DATA

Subjects with AIS present with rib cage deformity that can affect respiratory functions. The 3D rib cage deformities in AIS and their relationship to the spinal deformity are still unelucidated.

METHODS

A total of 200 AIS and 71 controls underwent low-dose biplanar x-rays and had their spine and rib cage reconstructed in 3-dimensional (D). Classic spinopelvic parameters were calculated in 3D and: rib cage gibbosity, thickness, width, volume and volumetric spinal penetration index (VSPI). Subjects with AIS were classified as: group I with mild rib cage deformity (n=88), group II with severe rib cage deformity (n=112) subgrouped into IIa (high gibbosity, n=48), IIb (high VSPI, n=48), and IIc (both high gibbosity and VSPI, n=16).

RESULTS

Groups IIa and IIb had a higher Cobb angle (33 vs. 54 degrees and 46 degrees, respectively) and torsion index (11 vs. 14 degrees and 13 degrees, respectively) than group I. Group IIb showed more severe hypokyphosis (IIb=21 degrees; IIa=33 degrees; I=36 degrees; control=42 degrees) with a reduced rib cage volume (IIb=4731 cm3; IIa=4985 cm3; I=5257 cm3; control=5254 cm3) and thickness (IIb=135 mm; IIa=148 mm; I=144 mm; control=144 mm). Group IIa showed an increasingly large local gibbosity descending from proximal to distal levels and did not follow the axial rotation of the spine. Group IIc showed characteristics of both groups IIa and IIb.

CONCLUSIONS

This new classification of 3D rib cage deformity in AIS shows that the management of cases with high VSPI (groups IIb and IIc) should focus on restoring as much kyphosis as possible to avoid respiratory repercussions. Treatment indications in groups I and IIa would follow the consensual basic principles reported in the literature regarding bracing and surgery.

Influence of Rib Cage on Static Characteristics of Scoliotic Spine

Background

Scoliosis is a three-dimensional (3D) deformity of the spine, which affects the patient's appearance and may lead to abnormal heart and lung function. The rib cage is a structure composed of ribs, sternum, and costal cartilage, which plays a vital role in stabilising the thoracolumbar spine. This study investigates the influence of the rib cage on the static characteristics of the scoliotic spine.

Methods

Two types of 3D finite element (FE) models with or without rib cage (from T1 to S) were established and analysed based on computed tomography (CT) images, to determine the effects of the rib cage on the static characteristics of the scoliotic spine. The FE software, ABAQUS, was used to analyse the static behaviours of scoliotic spine models under a range of loading conditions, including left side bending, right side bending, front tilt, rear supine, and vertical compression. The changes in the von Mises stress (VMS) within the intervertebral discs of spine models with or without rib cage were studied and compared.

Results

After including the rib cage, the maximum VMS at the stress concentrations of the normal and scoliotic spine effectively reduced. The VMS in normal intervertebral discs was gentler than that of scoliotic ones. However, the scoliotic spine was more likely to produce large stress concentration in the intervertebral discs of scoliotic segments.

Conclusions

Under the common postures, intervertebral discs of scoliotic segments are more susceptible to generate stress concentrations compared with the normal spine. The rib cage could effectively keep the intervertebral discs of scoliotic segments from further injuries. These results are of great significance for the prevention and treatment of the scoliotic spine.