Scoliocorrector Fatma-UI for correction of adolescent idiopathic scoliosis: Development, effectivity, safety and functional outcome

BACKGROUND Adolescent idiopathic scoliosis remains a major problem due to its high incidence,high risk,and high cost.One of the aims of the management in scoliosis is to correct the deformity.Many techniques are available to correct scoliosis deformity;however,they are all far from ideal to achieve three-dimensional correction in scoliosis.AIM To develop a set of tools named Scoliocorrector Fatma-UI(SCFUI)to aid threedimensional correction and to evaluate the efficacy,safety,and functional outcome.METHODS This study consists of two stages.In the first stage,we developed the SCFUI and tested it in finite element and biomechanical tests.The second stage was a single-blinded randomized clinical trial to evaluate the SCFUI compared to direct vertebral rotation(DVR).Forty-four subjects with adolescent idiopathic scoliosis were randomly allocated into the DVR group(n=23)and SCFUI group(n=21).Radiological,neurological,and functional outcome was compared between the groups.RESULTS Finite element revealed the maximum stress of the SCFUI components to be between 31.2-252 MPa.Biomechanical analysis revealed the modulus elasticity of SCFUI was 9561324±633277 MPa.Both groups showed improvement in Cobb angle and sagittal profile,however the rotation angle was lower in the SCFUI group(11.59±7.46 vs 18.23±6.39,P=0.001).Neurological and functional outcome were comparable in both groups.CONCLUSION We concluded that SCFUI developed in this study resulted in similar coronal and sagittal but better rotational correction compared to DVR.The safety and functional outcomes were also similar to DVR.

Percutaneous kyphoplasty in the treatment of Kümmell disease in lumbar scoliosis:A case report

BACKGROUND Due to mechanical imbalance in the spine,elderly scoliosis patients tend to develop vertebral fracture nonunion,i.e.,Kümmell disease,when osteoporotic vertebral compression fractures occur.However,accompanying vertebral rotational deformities make surgical procedures challenging risky.Such patients are usually compelled to undergo conservative treatment and there are very few reports on minimally invasive surgeries for them.We first-time report a patient with Kümmell disease and lumbar scoliosis treated with percutaneous kyphoplasty(PKP)under O-arm guidance.CASE SUMMARY An 89-year-old female was admitted to the hospital due to delayed low back pain after a fall.She was diagnosed with Kümmell disease based on physical and radiologic examinations.The patient experienced severe scoliosis and subsequently underwent O-arm-guided kyphoplasty,resulting in a significant alleviation of low back pain.CONCLUSION PKP has good efficacy in treating Kümmell disease.However,surgical risks are elevated in scoliosis patients with Kümmell disease due to the abnormal anatomical structure of the spine.O-arm assisted operations play a crucial role in decreasing surgical risks.

Implications of Pediatric Chest Wall Surgery on the Risk of Developing of Scoliosis

Scoliosis, a three-dimensional deformity of the spine, is commonly encountered in orthopedic and multidisciplinary settings, with idiopathic scoliosis being the most diagnosed form. Complications arising from thoracic chest wall surgeries, including thoracotomy and sternotomy, often include scoliosis among other complications. However, reported prevalence rates of scoliosis following chest wall surgery vary widely. This study aims to compare the prevalence of scoliosis in children who have undergone chest wall surgery to the prevalence of idiopathic scoliosis in the general population, as well as to observe gender ratios and curve direction in post-surgery scoliosis cases. A systematic review was conducted using PubMed and Scopus databases to identify relevant studies. Inclusion criteria comprised studies reporting scoliosis prevalence post chest wall surgery with follow-up times post-surgery. The search yielded 30 articles, all retrospective institutional cohort studies published between 1975 and 2024. Despite heterogeneity in study characteristics, the analysis revealed a 19% prevalence of acquired scoliosis among 5722 children who underwent chest wall surgery, higher than the reported 1% - 4% prevalence in the idiopathic population. Only three studies showed prevalence rates similar to the idiopathic population, possibly due to short follow-up periods. Further research with longer follow-up into skeletal maturity is warranted to better understand the implications of pediatric chest wall surgery on scoliosis development.

Early‐onset scoliosis in children aged 4–7 years in Nanjing,China:A cross‐sectional study

Background:This study aimed to investigate the potential variance in the prevalence of early‐onset scoliosis among children aged 4–7 years and analyze the influencing factors.The goal was to establish a crucial reference point for monitoring and evaluating spinal curvature development in preschoolers,ultimately to reduce the occurrence of adverse health outcomes.Methods:Children aged 4–7 years within the main urban area of Nanjing were selected using a stratified random sampling method.A team of four senior therapists conducted screenings for spinal curvature among children using visual inspection,the Adams forward bending test,and an electronic scoliometer to measure the angle of trunk rotation(ATR)and identify children displaying signs of scoliosis.Children with suspected scoliosis in the initial screening underwent X‐ray Cobb angle assessment for confirmation.The prevalence of early‐onset scoliosis was then determined from the screening results.R version 4.2.0 software was used to analyze the factors associated with scoliosis among children using partial least squares structural equation modeling.Results:A total of 2281 children were included in this study,consisting of 1211 boys and 1070 girls,with a mean age of 5.44±0.81 years(ranging from 4 to 7 years).Among them,7.58%exhibited positive signs of scoliosis,5.87%had early‐onset scoliosis,and the positive predictive value was 77.5%.Significant differences in ATR were observed among children in different age groups(Kruskal–Wallis=15,p=0.0104)and by sex(t=3.17,p=0.00153).Significant variations in ATR were noted in children with scoliosis(t=−22.7,p<0.001),with a cutoff at ATR=4.5°,and auxiliary values of 0.947 and 0.990.Children diagnosed with early‐onset scoliosis generally exhibited lower body mass index values,with a statistically significant difference(t=2.99,p=0.003).Conclusions:Using visual inspection,the Adams test,and an electronic scoliometer to measure the ATR,the present triad method is more sensitive for early scoliosis screening in children with abnormal posture aged 4–7 years.A full spine X‐ray is advised in children with an ATR over 4.5°and poor posture.

WOUND INFECTION AFTER SCOLIOSIS SURGERY:AN ANALYSIS OF 15 CASES

OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.

Posterior Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis Patients:a Comparison of All Pedicle Screws versus Hybrid Instrumentation

Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions： Group A was hook-screw-rod （hybrid） internal fixation type, Group B was screw-rod （all pedicle screws） internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients （7 males, 41 females） were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted （both P〉0.05）. The decompensation rate at final follow-up in these 2 groups were 4% （1/25） and 7.1% （1/14） respectively, with no significant difference （P〉0.05）.

Superior mesenteric artery syndrome following scoliosis surgery: Its risk indicators and treatment strategy

AIM: To investigate the risk indicators, pattern of clinical presentation and treatment strategy of superior mesenteric artery syndrome (SMAS) after scoliosis surgery.METHODS: From July 1997 to October 2003, 640 patients with adolescent scoliosis who had undergone surgical treatment were evaluated prospectively, and among them seven patients suffered from SMAS after operation. Each patient was assigned a percentile for weight and a percentile for height. Values of the 5th、 10th、 25th、 50th、 75th、 and 95thpercentiles were selected to divide the observations. The sagittal Cobb angle was used to quantify thoracic or thoracolumbar kyphosis. All the seven patients presented with nausea and intermittent vomiting about 5 d after operation.An upper gastrointestinal barium contrast study showed a straight-line cutoff at the third portion of the duodenum representing extrinsic compression by the superior mesenteric artery (SMA).RESULTS: The value of height in the seven patients with SMAS was above the mean of sex- and age-matchednormal population, and the height percentile ranged from 5% to 50%. On the contrary, the value of weight was below the mean of normal population with the weight percentile ranging from 5% to 25%. Among the seven patients, four had a thoracic hyperkyphosis ranging from 55° to 88°(average 72°), two had a thoracolumbar kyphosis of 25° and 32° respectively. The seven patients were treated with fasting, antiemetic medication, and intravenous fluids infusion. Reduction or suspense of traction was adopted in three patients with SMAS during halo-femoral traction after anterior release of scoliosis. All the patients recovered completely with no sequelae. No one required operative intervention with a laparotomy.CONCLUSION: Height percentile＜50% , weight percentile ＜25%, sagittal kyphosis, heavy and quick halo-femoral traction after spinal anterior release are the potential risk indicators for SMAS in patients undergoing correction surgery for adolescent scoliosis.

Screening for scoliosis-New recommendations,old dilemmas,no straight solutions

This opinion review considers the prevailing question of whether to screen or notto screen for adolescent idiopathic scoliosis. New and improved standards ofpeople-oriented care and person-centredness, as well as improved principles ofpreventive screening and guideline development, have been postulated andimplemented in health care systems and cultures. Recommendations addressingscreening for scoliosis differ substantially, in terms of their content, standards ofdevelopment and screening principles. Some countries have discontinued issuingrecommendations. In the last decade, a number of updated and newrecommendations and statements have been released. Systematically developedguidelines and recommendations are confronted by consensus and opinion-basedstatements. The dilemmas and discrepancies prevail. The arguments concentrateon the issues of the need for early detection through screening in terms of theeffectiveness of early treatment, on costs and cost-effectiveness issues, scientificand epidemiologic value of screenings, and the credibility of the sources ofevidence. The problem matter is of global scale and applies to millions of people.It regards clinical and methodological dilemmas, but also the matter of vulnerableand fragile time of adolescence and, more generally, children’s rights. Thedecisions need to integrate people’s values and preferences – screening tests needto be acceptable to the population, and treatments need to be acceptable forpatients. Therefore we present one more crucial, but underrepresented in thediscussion, issue of understanding and implementation of the contemporaryprinciples of person-centred care, standards of preventive screening, andguideline development, in the context of screening for scoliosis.

The cartilage matrisome in adolescent idiopathic scoliosis

The human spinal column is a dynamic,segmented,bony,and cartilaginous structure that protects the neurologic system and simultaneously provides balance and flexibility.Children with developmental disorders that affect the patterning or shape of the spine can be at risk of neurologic and other physiologic dysfunctions.The most common developmental disorder of the spine is scoliosis,a lateral deformity in the shape of the spinal column.Scoliosis may be part of the clinical spectrum that is observed in many developmental disorders,but typically presents as an isolated symptom in otherwise healthy adolescent children.Adolescent idiopathic scoliosis(AIS)has defied understanding in part due to its genetic complexity.Breakthroughs have come from recent genome-wide association studies(GWAS)and next generation sequencing(NGS)of human AIS cohorts,as well as investigations of animal models.These studies have identified genetic associations with determinants of cartilage biogenesis and development of the intervertebral disc(IVD).Current evidence suggests that a fraction of AIS cases may arise from variation in factors involved in the structural integrity and homeostasis of the cartilaginous extracellular matrix(ECM).Here,we review the development of the spine and spinal cartilages,the composition of the cartilage ECM,the so-called"matrisome"and its functions,and the players involved in the genetic architecture of AIS.We also propose a molecular model by which the cartilage matrisome of the IVD contributes to AIS susceptibility.

Predictors of spine deformity progression in adolescent idiopathic scoliosis: A systematic review with meta-analysis

AIM: To evaluate published data on the predictors of progressive adolescent idiopathic scoliosis(AIS) in order to evaluate their efficacy and level of evidence. METHODS: Selection criteria:(1) study design: randomized controlled clinical trials, prospective cohort studies and case series, retrospective comparative and none comparative studies;(2) participants: adolescents with AIS aged from 10 to 20 years; and(3) treatment: observation, bracing, and other. Search method: Ovid MEDLINE, Embase, the Cochrane Library, Pub Medand patent data bases. All years through August 2014 were included. Data were collected that showed an association between the studied characteristics and the progression of AIS or the severity of the spine deformity. Odds ratio(OR), sensitivity, specificity, positive and negative predictive values were also collected. A metaanalysis was performed to evaluate the pooled OR and predictive values, if more than 1 study presented a result. The GRADE approach was applied to evaluate the level of evidence.RESULTS: The review included 25 studies. All studies showed statistically significant or borderline association between severity or progression of AIS with the following characteristics:(1) An increase of the Cobb angle or axial rotation during brace treatment;(2) decrease of the rib-vertebral angle at the apical level of the convex side during brace treatment;(3) initial Cobb angle severity(> 25o);(4) osteopenia;(5) patient age < 13 years at diagnosis;(6) premenarche status;(7) skeletal immaturity;(8) thoracic deformity;(9) brain stem vestibular dysfunction; and(10) multiple indices combining radiographic, demographic, and physiologic characteristics. Single nucleotide polymorphisms of the following genes:(1) calmodulin 1;(2) estrogen receptor 1;(3) tryptophan hydroxylase 1;(3) insulin-like growth factor 1;(5) neurotrophin 3;(6) interleukin-17 receptor C;(7) melatonin receptor 1B, and(8) Scoli Score test. Other predictors included:(1) impairment of melatonin signaling in osteoblasts and peripheral blood mononuclear cells(PBMC);(2) G-protein signaling dysfunction in PBMC; and(3) the level of platelet calmodulin. However, predictive values of all these findings were limited, and the levels of evidence were low. The pooled result of brace treatment outcomes demonstrated that around 27% of patents with AIS experienced exacerbation of the spine deformity during or after brace treatment, and 15% required surgical correction. However, the level of evidence is also low due to the limitations of the included studies.CONCLUSION: This review did not reveal any methods for the prediction of progression in AIS that could be recommended for clinical use as diagnostic criteria.

Detecting Lumbar Implant and Diagnosing Scoliosis from Vietnamese X-Ray Imaging Using the Pre-Trained API Models and Transfer Learning

With the rapid growth of the autonomous system,deep learning has become integral parts to enumerate applications especially in the case of healthcare systems.Human body vertebrae are the longest and complex parts of the human body.There are numerous kinds of conditions such as scoliosis,vertebra degeneration,and vertebrate disc spacing that are related to the human body vertebrae or spine or backbone.Early detection of these problems is very important otherwise patients will suffer from a disease for a lifetime.In this proposed system,we developed an autonomous system that detects lumbar implants and diagnoses scoliosis from the modified Vietnamese x-ray imaging.We applied two different approaches including pre-trained APIs and transfer learning with their pre-trained models due to the unavailability of sufficient x-ray medical imaging.The results show that transfer learning is suitable for the modified Vietnamese x-ray imaging data as compared to the pre-trained API models.Moreover,we also explored and analyzed four transfer learning models and two pre-trained API models with our datasets in terms of accuracy,sensitivity,and specificity.

Increased Expression of Receptor Activator of Nuclear Factor-κB Ligand in Osteoblasts from Adolescent Idiopathic Scoliosis Patients with Low Bone Mineral Density

Persistent generalized low bone mineral density (BMD) has been reported in patients with adolescent idiopathic scoliosis (AIS).However,the exact mechanisms and causes of the low BMD in AIS patients are largely unknown.The purpose of this study was to examine the relationship between the receptor activator of NF-κB ligand (RANKL)/osteoprotegerin (OPG) levels in osteoblasts (OBs) from AIS patients with low BMD and with comparison made between the patients and controls.Twenty AIS patients and eight age-matched controls were included in the present study.The BMD of lumbar spine and proximal femur was measured in all subjects.OBs from the cancellous bone of each subject was harvested and primarily cultured.The mRNA and protein expression of RANKL and OPG in OBs was detected by RT-PCR and Western blotting.The results showed BMD was lower in AIS patients than in controls.A significantly higher mRNA and protein expression of RANKL was observed in OBs from AIS patients,while no significant difference was found in the expression of OPG between AIS patients and controls.As a result,RANKL/OPG ratio in patients with AIS was remarkably higher than controls.Our study preliminarily demonstrated expression of RANKL was higher in OBs from AIS patients with low BMD as compared with controls,suggesting the unbalanced RANKL/OPG ratio caused by an over-expression of RANKL in OBs may be responsible for the low BMD in AIS patients.

Benefits of the use of blood conservation in scoliosis surgery

AIM To investigate whether autologous blood transfusion(ABT) drains and intra-operative cell salvage reduced donor blood transfusion requirements during scoliosis surgery.METHODS Retrospective data collection on transfusion requirements of patients undergoing scoliosis surgery is between January 2006 and March 2010. There were three distinct phases of transfusion practice over this time: Group A received "traditional treatment" with allogeneic red cell transfusion(ARCT) in response to an intra- or postoperative anaemia(Hb < 8 g/d L or a symptomatic anaemia); Group B received intra-operative cell salvage in addition to "traditional treatment". In group C,ABT wound drains were used together with both intra-operative cell salvage and "traditional treatment".RESULTS Data from 97 procedures on 77 patients,there was no difference in mean preoperative haemoglobin levels between the groups(A: 13.1 g/d L; B: 13.49 g/d L; C: 13.66 g/d L). Allogeneic red cell transfusion was required for 22 of the 37 procedures(59%) in group A,17 of 30(57%) in group B and 16 of 30(53%) in group C. There was an overall 6% reduction in the proportion of patients requiring an ARCT between groups A and C but this was not statistically significant(χ2 = 0.398). Patientsin group C received fewer units(mean 2.19) than group B(mean 2.94)(P = 0.984) and significantly fewer than those in group A(mean 3.82)(P = 0.0322). Mean length of inpatient stay was lower in group C(8.65 d) than in groups B(12.83) or A(12.62).CONCLUSION When used alongside measures to minimise blood loss during surgery,ABT drains and intra-operative cell salvage leads to a reduced need for donor blood transfusion in patients undergoing scoliosis surgery.

Altered physiology of mesenchymal stem cells in the pathogenesis of adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis is the most common spinal deformity during puberty,especially in females.It is characterized by aberrant skeletal growth and generalized reduced bone density,which is associated with impaired bone mineral metabolism.Despite recent progress in multidisciplinary research to support various hypotheses,the pathogenesis of Adolescent idiopathic scoliosis is still not clearly understood.One of the hypothesis is to study the role of mesenchymal stem cells due to its involvement in the above-mentioned bone metabolic abnormalities.In this review,we will summarize reported literatures on the role of mesenchymal stem cells,particularly in the pathogenesis of Adolescent idiopathic scoliosis.In addition,we will describe the research on mesenchymal stem cells of Adolescent idiopathic scoliosis performed using bioinformatics tools.

Reliability of a Novel Cobb Protractor for Measuring the Cobb Angle of Radiograph in Scoliosis

Objective To introduce a novel Cobb protractor and assess its reliability and rapidity for measuring Cobb angle in scoliosis patients. Methods The novel Cobb protractor had two endplate markers. A measurement was performed just to align the two markers to each endplate of the curve. The Cobb angle on the posteroanterior radiographs of 24 patients clinically diagnosed with adolescent idiopathic scoliosis was measured by three orthopedic surgeons with both standard Cobb method and the new technique, and the time of measurement was recorded. Intraclass correlation coefficients(ICCs) were calculated to assess the reliability of the new method. Results The time for a measurement with the new tool was approximately 10 seconds less than the time that used to finish a measurement with the standard method(P<0.05). The overall mean Cobb angle for the major curve of the 24 patients was 47.8°. The mean overall intraobserver and interobserver ICC was 0.971 and 0.971 for the Cobb method group, while the overall intraobserver ICC and the interobserver was 0.985 and 0.979 for the new tool group. Conclusions The novel Cobb protractor could perform quick measurement and measure almost all forms of radiographs. The Cobb protractor might be an ideal instrument to measure the Cobb angle.

POSTERIOR SELECTIVE THORACIC FUSION IN ADOLESCENT IDIOPATHIC SCOLIOSIS

To define the criteria of posterior selective thoracic fusion in patients with adolescent idiopathic scoliosis. Methods By reviewing the medical records and roentgenograms of 17 patients with adolescent idiopathic scoliosis who un-derwent posterior selective thoracic fusion, the curve type, Cobb angle, apical vertebral rotation and translation, trunk shift, and thoracolumbar kyphosis were measured and analyzed. Results There were 17 King type Ⅱ patients (PUMC type: Ⅱb1 13, Ⅱc3 4). The coronal Cobb angle of thoracic curve be-fore and after operation were 56.9°and 21.6° respectively, the mean correction rate was 60.1%. The coronal Cobb angle of lumbar curve before and after operation were 34.8° and 12.1° respectively, and the mean spontaneous correction rate was 64.8%. At final follow-up, the coronal Cobb angle of thoracic and lumbar curve were 23.5° and 15.2° respectively, there were no significant changes in the coronal Cobb angle, apical vertebral translation and rotation compared with that after operation. One patient had 12° of thoracolumbar kyphosis after operation, no progression was noted at final follow-up. There was no trunk decompensation or deterioration of the lumbar curve. In this group, 3.9 levels were saved compared with fusing both the th-oracic and lumbar curves. Conclusion Posterior selective thoracic fusion can be safely and effectively performed in King type Ⅱ patients with a mo-derate and flexible lumbar curve, which can save more mobile segments and at the same time can maintain a good coronal and sagittal balance.

Serial elongation-derotation-flexion casting for children with early-onset scoliosis

Various early-onset spinal deformities, particularly infantile and juvenile scoliosis(JS), still pose challenges to pediatric orthopedic surgeons. The ideal treatment of these deformities has yet to emerge, as both clinicians and surgeons still face multiple challenges including preservation of thoracic motion, spine and cage, and protection of cardiac and lung growth and function. Elongation-derotation-flexion(EDF) casting is a technique that uses a custom-made thoracolumbar cast based on a three-dimensional correction concept. EDF can control progression of the deformity and- in some cases-coax the initially-curved spine to grow straighter by acting simultaneously in the frontal, sagittal and coronal planes. Here we provide a comprehensive review of how infantile and JS can affect normal spine and thorax and how serial EDF casting can be used to manage these spinal deformities. A fresh review of the literature helps fully understand the principles of the serial EDF casting technique and the effectiveness of conservative treatment in patients with early-onset spinal deformities, particularly infantile and juvenile scolisois.

Postoperative Disc Wedging in Adolescent Idiopathic Thoracolumbar/Lumbar Scoliosis:a Comparison of Anterior and Posterior Approaches

Objective To evaluate the different influences of anterior and posterior correction and fusion approaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis.Methods The retrospective study was conducted with the medical records and radiographs of adolescent idiopathic thoracolumbar/lumbar scoliosis patients that underwent anterior(group A) or posterior(group B) correction and fusion surgery from December 1998 to May 2008.The correction of the main curve and changes of the disc wedging were analyzed.Results Fifty-three patients were included,26 in group A and 27 in group B.The mean coronal Cobb angles of the main curve in group A and group B were significantly corrected after surgery(P<0.05),with an average correction rate of 75.2% and 88.2%,respectively.Upon final follow-up,the coronal Cobb angles of the two groups were 18.9°±11.1° and 7.7°±5.6°,respectively,with an average correction loss of 6.8°±6.5° and 2.7°±3.3°,respectively.The coronal Cobb angle after operation and at final follow-up,and the correction rate were significantly better in group B than those in group A(P<0.05),while the coronal Cobb angle loss in group A was greater than that in group B(P<0.05).The disc wedging before operation,after operation,and at final follow-up were 3.2°±3.0°,5.7°±3.0°,and 8.6°±4.4° in group A,and 2.4°±3.2°,3.3°±3.4°,and 3.7°±3.6° in group B,respectively.Postoperative disc wedging was significantly larger compared with preoperative measurements in group A(P<0.05),but not in group B(P>0.05).The difference between disc wedging at final follow-up and that after surgery was significant in group A(P<0.05),but not in group B(P>0.05).Between the two groups,group A had larger disc angles after operation and at final follow-up(P<0.05),and a greater loss of disc angle(P<0.05).Conclusion For adolescent idiopathic thoracolumbar/lumbar scoliosis,posterior approach using all pedicle screws might produce a better result in terms of disc wedging compared with anterior approach.

SIMULTANEOUS ANTERIOR AND POSTERIOR HEMIVERTEBRA RESECTION IN THE TREATMENT OF CONGENITAL KYPHOSCOLIOSIS

Objective To evaluate the efficacy of simultaneous anterior and posterior hemivertebra resection in the treatment of congenital kyphoscoliosis caused by fully-segmented hemivertebra. Methods Twenty-one consecutive cases with congenital kyphoscoliosis, which were 8 males and 13 females, underwent one-stage operation of anterior hemivertebra resection and posterior instrumentation. All of the hemivertebra were fully-segmented. The average age at surgery was 11.4 （range, 1.5-16） years old. Results The average follow-up was 23 （range, 6-50） months. The average Cobb＇s angle of the coronal curve was 51.4° （30°-120°） before surgery, 16.9° （0°-54°） after surgery, and 19.5° at latest follow-up. The angle of segmental kyphosis was 37.1° （0°-95°） before surgery and 16.1° （0°-48°） after surgery, and 18.2° at latest follow-up. Apical translation was improved from 4.7 cm to 1.9 cm. The average fusion segments were 4.8 （range, 2-10） segments. Complication included pressure sore in one case, pedicle cutting by pedicle screw in one case and elongation of the curve in one case. There was no obvious pseudarthrosis, decompensation, and kyohosis deformity aggravation at latest follow-up. Conclusion One-stage hemivortebra resection has a good result in the surgical treatment of congenital kyphoscoliosis caused by fully-segmented hemivertebra, and may shorten fusion levels if performed at an earlier age.

Neuromuscular scoliosis and pelvic fixation in 2015: Where do we stand?

Neuromuscular scoliosis is a challenging problem to treat in a heterogeneous patient population. When thedecision is made for surgery the surgeon must select a technique employed to correct the curve and achieve the goals of surgery, namely a straight spine over a level pelvis. Pre-operatively the surgeon must ask if pelvic fixation is worth the extra complications and infection risk it introduces to an already compromised host. Since the advent of posterior spinal fusion the technology used for instrumentation has changed drastically. However, many of the common problems seen with the unit rod decades ago we are still dealing with today with pedicle screw technology. Screw cut out, pseudoarthrosis, non-union, prominent hardware, wound complications, and infection are all possible complications when extending a spinal fusion construct to the pelvis in a neuromuscular scoliosis patient. Additionally, placing pelvic fixation in a neuromuscular patient results in extra blood loss, greater surgical time, more extensive dissection with creation of a deep dead space, and an incision that extends close to the rectum in patients who are commonly incontinent. Balancing the risk of placing pelvic fixation when the benefit, some may argue, is limited in non-ambulating patients is difficult when the literature is so mottled. Despite frequent advancements in technology issues with neuromuscular scoliosis remain the same and in the next 10 years we must do what we can to make safe neuromuscular spine surgery a reality.