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Chan KHA, Chan KCA, Maliwat E, Cheung JPY, Cheung PWH. Factors contributing to bracing success in juvenile idiopathic scoliosis and current limitations : a systematic review and meta-analysis. Bone Jt Open 2025; 6:590-608. [PMID: 40437946 PMCID: PMC12120532 DOI: 10.1302/2633-1462.65.bjo-2024-0271.r1] [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] [Indexed: 06/01/2025] Open
Abstract
Aims There is a general lack of guidelines on nonoperative treatment in juvenile idiopathic scoliosis (JIS). This review aims to explore factors determining bracing success in JIS and to identify limitations in current literature. Methods A literature search was conducted according to the PRISMA 2020 guidelines. Data extraction focused on the factors affecting bracing success, including pre-brace curve magnitude in Cobb angle, curve type, pre-brace rib vertebral angle difference, in-brace correction, brace type, brace-wear compliance, the time of brace initiation, and bracing duration. Bracing success is defined as 1) avoidance of corrective surgical intervention (curve exceeding 45° at maturity) and/or 2) major curve Cobb angle of < 5° progression at maturity. Meta-analysis was performed for individual factors. Results After initial and full-text screening, 16 articles were included in the review. Pooled odds ratio (OR) from eight studies and 560 patients using the threshold of Cobb angle of 30° revealed that patients with pre-brace curve < 30° were associated with bracing success (odds ratio (OR) 3.58; 95% CI 2.26 to 5.65; p < 0.001; I2 = 0.08). Major thoracic curves were associated with reduced likelihood of bracing success compared to thoracolumbar/lumbar curves (OR 0.49; 95% CI 0.28 to 0.86; p = 0.010; I2 = 0.35). Full-time compliance was significantly associated with bracing success (OR 5.22; 95% CI 2.24 to 12.19; p < 0.001; I2 = 0.76). Conclusion This review identified that a pre-brace major Cobb angle < 30° and full-time compliance of at least 18 to 20 hours/day are prognostic factors favourable for bracing success, while presence of thoracic curves is prognostic for unfavourable brace outcome. Longer bracing duration does not translate to a higher success rate. Clinicians should devise more efforts to modify patient compliance in order to achieve optimal brace outcomes. The general lack of high-quality evidence and heterogeneity of results in existing studies indicates the need for further rigorous research on JIS.
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Affiliation(s)
- Kai Him Ambrose Chan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Kai Chun Augustine Chan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Elijah Maliwat
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Focsa LC, Simon AL, Finoco M, Krausse T, Ponchelet L, Ilharreborde B. Can Surgery Be Proposed to Adolescent Idiopathic Scoliosis Patients With Structural Lumbar Curves Associated With Nonreducible Iliolumbar Angle? J Pediatr Orthop 2025; 45:e449-e456. [PMID: 39877956 DOI: 10.1097/bpo.0000000000002905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2025]
Abstract
BACKGROUND Lower instrumented vertebra (LIV) selection for adolescent idiopathic scoliosis (AIS) with structural lumbar curves (Lenke 3, 5, and 6) remains debated. The iliolumbar angle (ILA) measurement is useful for assessing the lumbosacral junction flexibility. If it is nonreducible, surgeons need to make a difficult choice between a potential "imperfect" L4, associated with a residual lumbosacral curve, or a more distal fusion performed later in life due to poorer functional outcomes. The goal of this study was, therefore, to evaluate the postoperative radiographic and functional outcomes of AIS patients with nonreducible ILA. METHODS All consecutive AIS patients (2017 to 2022) with a structural lumbar curve and a posterior fusion ending on L4 were retrospectively included. Radiographic and functional outcomes (SRS-30 score) were reported with a minimum 2-year follow-up. Standing low dose stereoradiographs in both erect and maximum lateral bending positions were performed in all patients, and 2 groups of subjects were compared based on preoperative ILA flexibility [reducible group (R) or nonreducible group (NR)]. RESULTS A total of 122 patients were included (30% NR and 71% R). At a mean follow-up of 2.3±0.1 years, surgery was efficient in correcting the major curve (77% reduction rate in the R group and 76% in the NR group, P <10 -5 ), and significantly improved coronal balance (R, P <10 -5 and NR, P =0.03) as well as the ILA [mean ILA gain 14 degrees (R group), P <10 -5 and 16 degrees (NR group), P <10 -5 ]. The proportion of excellent results was higher in the R group, but 97% of outcomes were either excellent or acceptable in the NR group, and only 1 case of poor result (residual ILA >10 degrees) was reported in each group. No significant difference was found in SRS 30 scores between groups, but scores were significantly improved in the NR group for the excellent outcomes' subgroup [self-image ( P =0.04) and satisfaction ( P =0.02) domains]. CONCLUSIONS The current study confirms that posterior fusion ending on L4 can still be proposed to young AIS patients with structural lumbar curves, even if the lumbosacral flexibility is limited. LEVEL OF EVIDENCE Level III-comparative study.
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Affiliation(s)
- Laurentiu-Cosmin Focsa
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP)
| | - Anne-Laure Simon
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP)
- Paris Cité University, Paris, France
| | - Mikael Finoco
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP)
- Paris Cité University, Paris, France
| | - Thomas Krausse
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP)
| | - Louise Ponchelet
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP)
- Paris Cité University, Paris, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP)
- Paris Cité University, Paris, France
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Ta M, Khalifé M, Glorion C, Guigui P, Pannier S, Ferrero E. Spinal deformity transitional care from pediatric to adult population: a descriptive study. Spine Deform 2025; 13:745-751. [PMID: 39956845 DOI: 10.1007/s43390-024-01024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 12/08/2024] [Indexed: 02/18/2025]
Abstract
BACKGROUND Spinal deformity can develop in childhood and adulthood. There is often a loss of follow-up for these patients during the transition to adulthood. The aim of this study was to describe the management of those patients. Hypothesis transitional care enhances patient's adherence to long-term follow-up. METHODS A consultation was organized between two orthopedic surgery departments, one pediatric and the other adult, to ensure a transitional follow-up. All patients followed up in the pediatric department for spinal deformity between 2019 and 2021 were included (Ped group). Patients referred to the adult department were analyzed (Ped_Ad group). Data collected included type of deformity, age at first and last consultation, overall follow-up time, and number lost to follow-up (LTFU). RESULTS Overall, 383 patients were included: 11% were referred to an adult center (Ped_Ad), and 89% remained in pediatrics (Ped). Age at first and last consultation was significantly higher in the Ped_Ad group. Mean follow-up time was 4 years in both groups. In the Ped group, 18% of patients had undergone surgery, versus 61% in the Ped_Ad group. The rate of LTFU was twice higher in the Ped group (25%) than in the Ped_Ad group (12%), but the difference was not significant (p = 0.07). Among LTFU, patients aged between 14 and 16 years were the most represented (53%), and they were most often unoperated patients in the Ped group. CONCLUSION When adult follow-up was organized, adherence to follow-up was better. This would enable patients to be managed earlier, in the event of worsening of an unoperated deformity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Mélanie Ta
- Department of Orthopedic Surgery, Georges Pompidou European Hospital, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France.
| | - Marc Khalifé
- Department of Orthopedic Surgery, Georges Pompidou European Hospital, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France
- Department of Pediatric Orthopedic Surgery, Necker Hospital, Université Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
| | - Christophe Glorion
- Department of Pediatric Orthopedic Surgery, Necker Hospital, Université Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
| | - Pierre Guigui
- Department of Orthopedic Surgery, Georges Pompidou European Hospital, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France
| | - Stéphanie Pannier
- Department of Pediatric Orthopedic Surgery, Necker Hospital, Université Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
| | - Emmanuelle Ferrero
- Department of Orthopedic Surgery, Georges Pompidou European Hospital, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France
- Department of Pediatric Orthopedic Surgery, Necker Hospital, Université Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
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Xin H, Sui W, Mao W, Yang J, Shao X. Distinct clinical characteristics of adolescent idiopathic scoliosis with asymmetrical ESR1 expression in paraspinal muscle progenitor cells. JOR Spine 2024; 7:e70018. [PMID: 39600965 PMCID: PMC11597502 DOI: 10.1002/jsp2.70018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 10/14/2024] [Accepted: 11/10/2024] [Indexed: 11/29/2024] Open
Abstract
Background Previous studies found decreased ESR1 expression of concave paraspinal muscle progenitor cells could contribute to the initiation and progression of adolescent idiopathic scoliosis (AIS). The current study investigated the clinical characteristics of AIS with asymmetrical ESR1 expression in paraspinal muscle progenitor cells. Materials and Methods Bilateral deep paraspinal muscle progenitor cells were obtained from 25 consecutive eligible female patients with AIS. RT-qPCR was performed to evaluate the expression of ESR1. The demographic data (the age at surgery, height, weight, BMI, and age at initiation), posteroanterior and lateral radiographs data (Risser sign, Cobb angle, apical vertebral rotation, and location of apical vertebra), and MR imaging data (bilateral paraspinal muscle CSA ratio and bilateral fatty component ratio) were collected. The correlation between asymmetrical ESR1 expression of paraspinal muscle progenitor cells and the aforementioned clinical characteristics were analyzed. Results Twelve out of twenty-five patients (48%) showed bilateral ESR1 expression ratio (convex/concave) more than 1.5 folds, and they were divided into the ESR1 asymmetry group. When compared with the ESR1 symmetry group, patients in the ESR1 asymmetry group showed significantly more severe scoliosis (p = 0.041), more hypoplastic concave paraspinal muscle (p = 0.015), and more muscular fatty infiltration in the concave side (p = 0.034). The bilateral ESR1 expression ratio was significantly correlated with Cobb angle (r 2 = 0.282, p = 0.006), bilateral paraspinal muscle CSA ratio (r 2 = 0.253, p = 0.011), and bilateral fatty component ratio (r 2 = 0.248, p = 0.011). Conclusion There were 48% of AIS patients with significantly decreased ESR1 expression in concave paraspinal muscle progenitor cells (convex/concave>1.5 folds), while patients with more asymmetrical ESR1 expression showed more hypoplastic paraspinal muscle and fatty infiltration on the concave side, and more severe scoliotic deformity.
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Affiliation(s)
- Hanlong Xin
- Department of Orthopedic SurgeryTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityZhejiangChina
| | - Wenyuan Sui
- Spine CenterXin Hua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Wenhua Mao
- Department of Orthopedic SurgeryXianJu People's Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People's Hospital, Affiliated Xianju's Hospital, Hangzhou Medical CollegeZhejiangChina
| | - Junlin Yang
- Spine CenterXin Hua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xiexiang Shao
- Department of Orthopedic SurgeryTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityZhejiangChina
- Spine CenterXin Hua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
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Ng S, Changmeng Z, Cheung J, Shea GKH. A comparison of patients receiving vertebral body tethering for adolescent idiopathic scoliosis in the public and private hospital setting. J Orthop Surg Res 2024; 19:784. [PMID: 39578901 PMCID: PMC11583412 DOI: 10.1186/s13018-024-05254-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 11/08/2024] [Indexed: 11/24/2024] Open
Abstract
PURPOSE Vertebral body tethering (VBT) is a new growth-modulating surgery for adolescent idiopathic scoliosis (AIS) requiring a distinct skillset and intraoperative setup. We compared perioperative details and outcomes of VBTs performed in a public pediatric orthopedic hospital and a general private hospital setting. METHODS We identified all patients receiving VBT for AIS from 1/2020 to 12/2023 with ≥ 6 months post-operative follow-up, with surgeries performed by the same senior surgeons. Clinical, radiological, and surgical details were retrieved. RESULTS 24 VBTs were performed in the private setting and 16 in the public setting. Average age at operation was 11.9 ± 1.1 at a Sanders staging of 3.8 ± 1.2 when the major curve Cobb angle was 50.5 ± 8.0°. Tethered curves were most often thoracic in location (23/40) followed by thoracolumbar/lumbar curves (10/40) and double curve tethers (7/40). Overall correction ratio of 68.0 ± 19.0% was achieved. Time from booking to operation (82.2 ± 39.2 vs 63.1 ± 34.4 days, p = 0.112) and operation time (310 ± 86.4 min vs. 289 ± 87.4 min, p = 0.054) were longer in the public and private setting respectively but failed to reach statistical significance. Time to chest drain removal (1.5 ± 0.8 vs. 3.5 ± 1.7 days, p < 0.001) and length of stay (4.3 ± 0.9 vs. 6.6 ± 1.8 days, p < 0.001) were significantly shorter in the private setting, whilst complication rates remained similar (7/24 vs. 3/16, p = 0.456). CONCLUSION Expertise, resource availability, and costs differ in the public and private healthcare setting. With regards to VBT, the conditions for referral and surgical outcomes remained similar. Earlier drain removal and discharge for patients managed in the private setting was not associated with an increase in complication rate.
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Affiliation(s)
- Samuel Ng
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Zhang Changmeng
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jason Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Graham Ka Hon Shea
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
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Shea GKH, Ng SYL, Zhang C, Wang G. Prognosticating accelerated deterioration in skeletally mature adolescent idiopathic scoliosis curves of 40-50° using uniplanar radiographic measures of axial rotation. Spine Deform 2024; 12:1729-1734. [PMID: 39145791 PMCID: PMC11499377 DOI: 10.1007/s43390-024-00949-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 07/15/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE The management of adolescent idiopathic scoliosis (AIS) curves between 40 and 50° is controversial. Here, we investigated the prognostic significance of simple radiographic rotational parameters to identify curves of this magnitude with accelerated deterioration following skeletal maturity. METHODS Seventy-three patients were identified with AIS and Cobb angles of the major curve between 40 and 50° at skeletal maturity. We defined fast progressive curves as those increasing by ≥ 2° per year after skeletal maturity. From the apical vertebra of the major curve upon presentation and skeletal maturity, we determined the modified Nash-Moe index (×100), and from thoracic major curves, the Rib Index. T tests were performed to compare fast-progressive curves with those that deteriorated by < 2° per year. Receiver operator characteristic (ROC) curves were plotted to establish optimal cutoffs, sensitivity, and specificity measures for rotational parameters. RESULTS The average duration of follow-up post was 11.8 ± 7.3 years. Thirteen out of seventy-three patients were fast progressors. The modified Nash-Moe index was similar between groups at presentation (p = 0.477) but significantly higher in fast progressors than non-fast progressors at maturity for major thoracic curves (25.40 ± 6.60 vs. 19.20 ± 4.40, p < 0.001). Rib Index values were also higher among fast progressors at skeletal maturity (2.50 ± 0.90 vs. 1.80 ± 0.60, p = 0.026). An ROC curve for a modified Nash-Moe index of 0.235 for thoracic curves achieved an area under the curve (AUC) of 0.76 for discriminating fast progressors. A threshold of 1.915 for Rib Index at maturity achieved an AUC of 0.72 for discriminating fast progressors. In combining both rotational parameters, an AUC of 0.81 was achieved. CONCLUSION These simple rotational parameters may be useful to predict fast progression in 40-50° AIS curves following skeletal maturity indicated for early fusion, but further validation upon larger cohorts and non-thoracic major curves is required.
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Affiliation(s)
- Graham Ka-Hon Shea
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.
| | - Samuel Yan-Lik Ng
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Changmeng Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Guodong Wang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Singh M, Yan Z, Daher M, Hanna J, Diebo BG, Daniels AH. Curve Progression and Clinical Outcomes in Pregnant Females with Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 190:e525-e536. [PMID: 39074582 DOI: 10.1016/j.wneu.2024.07.165] [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: 06/19/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Prior reviews investigating the impact of pregnancy on adolescent idiopathic scoliosis (AIS) have reached different conclusions and a meta-analysis of curve progression among pregnant females with AIS and its effects on clinical outcomes has not previously been performed. METHODS A comprehensive search of major bibliographic databases (PubMed, Embase, and Scopus) was conducted for articles pertaining to spinal curve progression during pregnancy among patients with AIS. Patient demographics, scoliotic curve outcomes, and patient-reported quality of life measures were extracted. RESULTS Ten studies, including 857 patients with a mean age of 28.7 years, were included. Before pregnancy, 42.1% had undergone spinal fusion and 59.0% had a thoracic curve. Based on prepregnancy and postpregnancy radiographs, the curve increased from 33.9°-38.5°, and meta-analysis revealed a curve progression of 3.6° (range = -5.85 to 1.25, P = 0.003), primarily arising from loss of correction in the unfused group (Unfused = -5.0, P = 0.040; Fused = -3.0, P = 0.070). At the same time, 45.9% patients reported increased low back pain and many reported a negative body self-image and limitations in sexual function. However, 5 studies noted that pregnancy and number of pregnancies were not associated with curve progression, and multiple studies identified similar quality of life-related changes in non-pregnant patients with AIS. CONCLUSIONS Among unfused pregnant females with AIS, the spinal curvature increased significantly by 5.0° from before to after pregnancy. However, these changes may be independent of pregnancy status and occur with time. Such curve progression can contribute to a negative body self-image, low back pain, and functional limitations irrespective of pregnancy state.
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Affiliation(s)
- Manjot Singh
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA
| | - Zhao Yan
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA
| | - Mohammad Daher
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA
| | - John Hanna
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA
| | - Bassel G Diebo
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA.
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Khan MA, Quiceno E, Ravinsky RA, Hussein A, Abdulla E, Nosova K, Moniakis A, Bauer IL, Pico A, Dholaria N, Deaver C, Barbagli G, Prim M, Baaj AA. Is young adult idiopathic scoliosis a distinct clinical entity from adolescent idiopathic scoliosis? a Systematic Review and Meta-analysis comparing pre-operative characteristics and operative outcomes. Spine Deform 2024; 12:1241-1251. [PMID: 38722532 DOI: 10.1007/s43390-024-00892-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/01/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE This study aims to conduct a systematic review of the literature comparing pre-operative, intraoperative, and post-operative characteristics between adolescent idiopathic scoliosis (AIS) and young adult idiopathic scoliosis (YAdIS) patients. METHODS Following PRISMA guidelines, we conducted a search of the PubMed/Medline, EMBASE, and Cochrane Central databases to identify full-text articles in the English-language literature. Our inclusion criteria were studies that compared preoperative, intraoperative, and postoperative characteristics between AIS and YAdIS patients. We performed a meta-analysis reporting mean difference (MD) for continuous variables and Odds ratios (ORs) to assess differences in postoperative complications. RESULTS Seven studies consisting of 1562 patients were included in the meta-analysis. The AIS group exhibited less intraoperative bleeding and shorter surgical procedures, with a mean difference between groups of 122.3 ml (95% CI 46.2-198.4, p = 0.002) and 28.7 min (95% CI 6.5-50.8, p = 0.01), respectively. Although the preoperative Cobb angle did not differ between groups (p = 0.65), patients with AIS achieved superior postoperative deformity correction, with a mean difference of 7.3% between groups, MD - 7.3 (95% CI - 9.7, - 4.8, p < 0.00001), and lower postoperative Cobb angles of the major curve, MD 4.2 (95% CI 3.1, 5.3, p < 0.00001). YAdIS patients were fused, on average, 0.2 more vertebral levels than AIS patients, MD 0.2 (95% CI 0.01, 0.5, p = 0.04). AIS patients experienced a significantly shorter length of stay after the surgical procedure, with an MD of 0.8 days (95% CI 0.1, 1.6, p = 0.02). No significant difference was found between groups in terms of complications (p = 0.19). CONCLUSIONS YAdIS should be regarded as a distinct surgical entity, characterized by increased bleeding, longer surgical duration, greater deformity correction challenges, and the need for fusion of additional vertebral levels compared to AIS. Surgeons should be mindful of these differences and discuss them with patients and their families, especially in cases where the correction of the AIS deformity is delayed and there is a high risk of progression after skeletal maturity. Further research is needed to explore alternative surgical techniques and enhance outcomes for YAdIS patients.
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Affiliation(s)
- Monis A Khan
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Esteban Quiceno
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA.
| | - Robert A Ravinsky
- Department of Orthopedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Amna Hussein
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Ebtesam Abdulla
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Kristin Nosova
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Alexandros Moniakis
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Isabel L Bauer
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Annie Pico
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Nikhil Dholaria
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Courtney Deaver
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Giovanni Barbagli
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Michael Prim
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Ali A Baaj
- Department of Neurological Surgery, University of Arizona- College of Medicine-Phoenix, Phoenix, AZ, USA
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Lu D, Wang Z, Clar M, Shen J. Defining the gaps in transitional care to adulthood for patients in paediatric surgical specialties: a scoping review protocol. BMJ Open 2024; 14:e084287. [PMID: 39009454 PMCID: PMC11253754 DOI: 10.1136/bmjopen-2024-084287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/19/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION Transitioning patients from their paediatric centres to adulthood is an important subject for many of these patients living with different chronic pathologies. There are few studies that assess its effectiveness in paediatric surgical pathologies. The overall objective of this scoping review is to assess the extent of the literature describing transitional programmes dedicated to young patients living with surgical conditions. The primary question will look to assess what transitional programmes are available for young patients living with surgical conditions either operated or not. METHODS AND ANALYSIS The proposed scoping review will follow guidelines described by the Joanna Briggs Institute manual described by Peters et al in 2020. This protocol will employ the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols checklist. The concept that will be included in this review is the exposure of these patients to a transition of care pathway or care programmes. Patients between the ages of 16 and 30 with a surgical condition will be included. There will be no comparator. No specific outcomes will be assessed, however, the outcomes that will be found from the transition programmes will be reviewed. A knowledge synthesis librarian will search MEDLINE All (Ovid), Embase (Ovid), Web of Science Core Collection (Clarivate) and CINAHL Complete (EBSCOhost). The literature search will be limited to 2000 onwards publications. No language or age group limitation will be applied. The reference list of all included sources of evidence will be screened for additional studies. Screening of search results and data extraction from included studies will be completed in Covidence by two independent reviewers. We will also use the PAGER (Patterns, Advances, Gaps, Evidence for practice and Research recommendations) framework to report and summarise the results. ETHICS AND DISSEMINATION This review does not require ethics approval. Our dissemination strategy includes peer review publication, conference presentation, co-constructed guidelines with stakeholders and policymakers. TRIAL REGISTRATION This review is registered on OSF.
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Affiliation(s)
- Daisy Lu
- Université de Montréal, Montreal, Quebec, Canada
- Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Zhi Wang
- Université de Montréal, Montreal, Quebec, Canada
- Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Monique Clar
- Université de Montréal, Montreal, Quebec, Canada
| | - Jesse Shen
- Université de Montréal, Montreal, Quebec, Canada
- Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
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Hardesty CK. What's New in Pediatric Orthopaedics. J Bone Joint Surg Am 2024; 106:269-275. [PMID: 38113304 DOI: 10.2106/jbjs.23.01141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Christina K Hardesty
- Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
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