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.

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.

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.

Pain and Radiographic Changes in Adult Scoliosis Patients Using a Scoliosis Activity Suit: Case-Controlled 10-Year Follow-Up Results

Scoliosis in adult patients is known to increase across the lifespan and increases the chance of chronic pain in later adulthood. Non-surgical scoliosis treatment options for adults are not widely recommended, largely due to lack of research in this area. Pain management options for adults are focused primarily on treating scoliosis-related pain, and not necessarily the scoliosis itself, such as epidural injections, prescription pain medications, and general physical therapy. Recent studies reporting non-surgical, scoliosis-specific treatment methods in adults are encouraging, but their study designs limit extrapolation. The current study reports the self-reported pain and radiographic outcomes in adult patients wearing a scoliosis activity suit for at least 10 years. A total of 22 patient charts that fulfilled the inclusion criteria were selected for review. Cobb angle radiographic measurements and self-rated quadruple numerical pain rating scale (QVAS) at baseline and 10-year follow-up were used as the outcomes. Cobb angle measurements were compared at baseline and 10 years and subdivided according to scoliosis curve pattern. At 10 years, 68% of patients had improvements in their Cobb angle > 5˚, with an overall average of approximately 9˚. Significant differences were also observed in the 10-year Cobb angle measurements when compared to the predicted 10-year Cobb angles based on the established rate of linear progression in adults. A statistically significant change was also observed in the 10-year QVAS scores. These results suggest a potential role of the scoliosis activity suit for improving Cobb angles in adults and reducing scoliosis-related pain.

The Outcome of Posterior Spinal Fusion and Instrumentation of Adolescent Idiopathic Scoliosis without Wound Suction Drainage

Background: In spine surgery postoperative closed suction drainage is used to decrease the potential risks of wound hematoma formation, and reduces the risk of infection, cord compression and neurologic deficit. However, the efficacy of drains used for this purpose in adolescent idiopathic scoliosis is controversial. The purpose of this study is to evaluate outcomes of patients after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis without wound suction drainage. Methods: A total of 66 Patients who underwent posterior spinal fusion and instrumentation for the correction of Adolescent idiopathic scoliosis without the use of drain from January 2012 to January 2021 were included. Wound dehiscence, wound hematoma, infection, preoperative and postoperative hemoglobin levels and need for transfusion were described as frequency and mean values. Results: The average age was 15.06 years. Hospital stay was 2.2 days. Patients were followed-up over 50.21 months. There was no deep infection, wound hematoma. The difference between just postoperative and three days after operation hemoglobin levels was not significant and no need for transfusion. Only 3 (4.5%) cases with superficial skin infection and 4 (6%) cases with skin and Wound dehiscence were treated with dressing and antibiotics with full recovery. Conclusion: Without using drain for patients with idiopathic scoliosis who underwent posterior spinal fusion and instrumentation, no increase in blood loss, transfusion requirements, wound infection, skin dehiscence, and wound hematoma was observed.

Surgical treatment of atlantoaxial dysplasia and scoliosis in spondyloepiphyseal dysplasia congenita:A case report

BACKGROUND Spondyloepiphyseal dysplasia congenita(SEDC)is a rare autosomal dominant hereditary disease caused by COL2A1 mutations.SEDC primarily involves the skeletal system,with typical clinical manifestations,including short stature,hip dysplasia,and spinal deformity.Due to the low incidence of SEDC,there are only a few case reports regarding the surgical treatment of SEDC complicated with spinal deformities.CASE SUMMARY We report a case of a 16-year-old male patient with SEDC.He presented with typical short stature,atlantoaxial dysplasia,scoliosis,and hip dysplasia.Cervical magnetic resonance imaging showed spinal canal stenosis at the atlas level and cervical spinal cord compression with myelopathy.The scoliosis was a right thoracic curve with a Cobb angle of 65°.He underwent atlantoaxial reduction,decompression,and internal fixation from C1–C2 to relieve cervical myelopathy.Three months after cervical surgery,posterior correction surgery for scoliosis was performed from T3 to L4.Scoliosis was corrected from 66°to 8°and remained stable at 2-year follow-up.CONCLUSION This is the first case report of a patient with SEDC who successfully underwent surgery for atlantoaxial dysplasia and scoliosis.The study provides an important reference for the surgical treatment of SEDC complicated with spinal deformities.

Measuring the Level of Knowledge and Awareness about Scoliosis in Saudi Arabia

Background: Scoliosis is a serious condition occurring in 1% to 4% of the population. This study was conducted and designed to educate society about scoliosis and measure the knowledge and awareness about it. Methods: This was a cross-sectional study conducted on members of the Saudi Society who have consented to participate in this research between the 8th of January and 5th of February 2023. Results: A total of 427 people agreed to participate in the study. The highest percentage of the participants was female 69.1%. About 41% participants out of 427 were in the age group 18-25 years. Most of the participants were from the Middle Region. (71.9%) of participants were unfamiliar with scoliosis, while (72.1%) had no prior knowledge of the condition. Conclusion: This study indicates insufficient awareness and knowledge about scoliosis in Saudi Arabia. Therefore, further studies are needed to raise awareness about scoliosis and help people to learn more about this condition.

Research progress on the safety of nail placement in adolescent idiopathic scoliosis surgery

Adolescent idiopathic scoliosis is a spinal deformity with unknown etiology and high incidence,especially in adolescent females.If scoliosis patients do not get effective treatment in the early stage,the degree of scoliosis will continue to worsen with the growth of age or the rapid development of scoliosis in a short time,and the appearance deformities such as high and low shoulders and razor back will gradually appear,which can affect the cardiopulmonary function and even shorten life expectancy.It has a great impact on the physical and mental health of the patients.Mild scoliosis is often well controlled by bracing,and moderate to severe scoliosis deformity often requires scoliosis corrective surgery.In adolescent idiopathic scoliosis correction,pedicle screws offer better stability and firmness,stronger orthopedic force,and lower incidence of related complications caused by instruments than traditional hook and conical internal fixation instruments.At the same time,scoliosis patients have uneven development of the left and right sides of the vertebral body,narrow diameter of concave pedicle and varying degrees of rotation of parietal vertebra,resulting in changes in the position of important anatomical structures such as spinal cord and thoracic aorta in the spinal canal.It makes it difficult to place pedicle screws,resulting in a high misplacement rate.How to improve the safety of screw placement,reduce the misplacement rate and the risk of spinal cord,nerve root,blood vessels,viscera and so on,has always been the focus of spinal surgeons.This paper summarizes the related literature on the effects of new techniques such as pedicle anatomy,complications of nail placement and computer navigation,and 3D guided template on the accuracy of screw placement in adolescent idiopathic scoliosis patients,and the safety of nail placement.In order to provide reference for clinical practice.

Accuracy of screw placement in the apical region of Lenke 1 adolescent idiopathic scoliosis surgery using a calibration technique for the intraoperative navigation error

Objective:To study the position and the grade of screw perforation in the apical region of adolescent idiopathic scoliosis(AIS)surgery using a calibration technique for the intraoperative navigation error,and to analyze the related factors of navigation deviation and the clinical significance of the calibration technique.Methods:From 2017 to 2020,a total of 60 Lenke 1 AIS surgical cases were enrolled in this research.The 30 cases received surgery using the intraoperative navigation system(Navigation group)and another 30 cases were assisted with intraoperative navigation system with calibration technique(Calibration group)for the intraoperative navigation error.The basic information and radiological data of the both groups were all recorded.According to the Fu Chang-feng’s pedicle channel classification system,the pedicle on the apical region of the two groups was classified.And then the accuracy of screw placement of the two groups was evaluated according to the Rao’s classification.Results:A total of 600 screws were placed in the two groups.The 297 and 303 pedicle screws were implanted in the navigation group and the calibration group,respectively.In the apical region of the calibration group,the rates of the grade 0 screw placement in type A,B and C pedicle were 95.7%,86.7%and 68.9%respectively.It was a statistically significant difference from the 73.9%,66.9%and 30.0%in the navigation group respectively(P<0.05).In the calibration group,the rates of the medial cortical perforation in the type A,B,C and D pedicle were 0%,1.6%,1.6%and 0%,respectively.The corresponding rates were 16.3%,16.9%,30.0%and 47.6%in the navigation group,respectively.Moreover,in the concave side of the apical region of the calibration group,the rates of the medial cortical perforation in the type A,B,C and D pedicle were 0%,3.6%,2.6%and 0%,respectively.Compared with the calibration group,the corresponding rates were higher in the navigation group(34.4%,25.9%,37.2%and 60.0%,respectively).No serious complications such as spinal cord or neurovascular injury occurred for the two groups.Conclusion:Compared with the intraoperative navigation system,the calibration technique for the intraoperative navigation error could provide the higher accuracy of pedicle screw placement in the apical region of the major curve,the lower medial cortical perforation rate,the less screws misplacement rate on the concave side and the less complication rate of the severe Lenke 1 AIS patients.

Radiographic, Pain, and Functional Outcomes in an Adult Post-Fusion Patient Using a Scoliosis Activity Suit: Comparative Results after 8 Months

There are few conservative treatment options for adult patients with idiopathic scoliosis who are status post-fusion surgery. These typically include pharmacologic pain management, epidural injections, and generalized CAM treatments such as massage and chiropractic manipulation in the non-fused areas of the spine. The purpose of this study was to compare the post-treatment results in an adult post-fusion patient who wore a scoliosis activity suit for 8 months. Pain was evaluated using a quadruple visual analog scale (QVAS), while function was measured using an SRS-22r questionnaire. After 8 months of wearing the scoliosis activity suit, her pain scores improved, here SRS-22r improved, and a significant correction in radiographic Cobb angle was observed. This case report is the first to document a Cobb angle change in an adult patient wearing a scoliosis activity suit who is status post-fusion. Given that pain and dysfunction are primary reasons for scoliosis treatment in the adult population, more studies need to address the disparity between available treatments for adult scoliosis and the incidence of adult scoliosis, especially in the post-meno-pausal population. Future prospective studies should consider evaluating treatment effects of this suit using intent-to-treat methodology.

Acute spinal subdural haematoma complicating a posterior spinal instrumented fusion for congenital scoliosis:A case report

BACKGROUND Acute spinal subdural haematoma(ASSH)is a rare and potentially devastating condition with a variable prognosis.Previously described subdural haematomas were thought to have occurred spontaneously or be related to major or minor iatrogenic or traumatic injuries caused by surgery,spinal puncture or epidural anaesthesia.Other contributing pathologies have been described,such as intradural tumours or spinal arteriovenous malformations.ASSH has also been associated with anticoagulation therapy,haemostatic abnormalities and risk factors such as pregnancy.To the best of our knowledge,this case study described the first reported occurrence of an ASSH during spinal surgery in a paediatric patient.The patient was not known to have any coagulopathies,and no obvious vascular lesions were documented.The surgical procedure did not directly involve the dura mater,and no evident intraoperative dural tears were found.CASE SUMMARY We reported and discussed a case of ASSH complicating a posterior spinal instrumented fusion during surgery for paediatric congenital scoliosis.This condition has not been previously described.We made recommendations for facing such an occurrence,explored its aetiology in the context of malformation and discussed the benefits of neuromonitoring during scoliosis correction and the management protocol.We conducted a PubMed literature review for cases of paediatric ASSH and other closely related disorders.We reviewed recommendations regarding neuromonitoring and treatment management in such cases.CONCLUSION ASSH is a rare complication of posterior spinal instrumented fusion.Published cases are more often associated with anticoagulation therapy or coagulopathy.Neuromonitoring is strongly recommended to detect and assess neurological status,thus enabling rapid diagnosis and treatment and facilitating early spinal decompression and a return to a normal neurological status.

Multi-distortion suppression for neutron radiographic images based on generative adversarial network

Neutron radiography is a crucial nondestructive testing technology widely used in the aerospace,military,and nuclear industries.However,because of the physical limitations of neutron sources and collimators,the resulting neutron radiographic images inevitably exhibit multiple distortions,including noise,geometric unsharpness,and white spots.Furthermore,these distortions are particularly significant in compact neutron radiography systems with low neutron fluxes.Therefore,in this study,we devised a multi-distortion suppression network that employs a modified generative adversarial network to improve the quality of degraded neutron radiographic images.Real neutron radiographic image datasets with various types and levels of distortion were built for the first time as multi-distortion suppression datasets.Thereafter,the coordinate attention mechanism was incorporated into the backbone network to augment the capability of the proposed network to learn the abstract relationship between ideally clear and degraded images.Extensive experiments were performed;the results show that the proposed method can effectively suppress multiple distortions in real neutron radiographic images and achieve state-of-theart perceptual visual quality,thus demonstrating its application potential in neutron radiography.

Deep learning automation of radiographic patterns for hallux valgus diagnosis

Artificial intelligence(AI)and deep learning are becoming increasingly powerful tools in diagnostic and radiographic medicine.Deep learning has already been utilized for automated detection of pneumonia from chest radiographs,diabetic retinopathy,breast cancer,skin carcinoma classification,and metastatic lymphadenopathy detection,with diagnostic reliability akin to medical experts.In the World Journal of Orthopedics article,the authors apply an automated and AIassisted technique to determine the hallux valgus angle(HVA)for assessing HV foot deformity.With the U-net neural network,the authors constructed an algorithm for pattern recognition of HV foot deformity from anteroposterior highresolution radiographs.The performance of the deep learning algorithm was compared to expert clinician manual performance and assessed alongside clinician-clinician variability.The authors found that the AI tool was sufficient in assessing HVA and proposed the system as an instrument to augment clinical efficiency.Though further sophistication is needed to establish automated algorithms for more complicated foot pathologies,this work adds to the growing evidence supporting AI as a powerful diagnostic tool.

Pain and Radiographic Outcomes in Adult Idiopathic Scoliosis Patients Using a Scoliosis Activity Suit: An 18-Month Case Controlled Chart Review

There are few conservative treatment options for patients with adult idiopathic scoliosis. These typically include pharmacologic pain management, epidural injections, and generalized CAM treatments such as massage and chiropractic manipulation. The purpose of this study was to compare the post-treatment results in patients wearing the scoliosis activity suit versus baseline assessments as well as adult scoliosis patients who did not wear the activity suit. The pain and Cobb angle outcomes of 53 consecutive patients with adult idiopathic scoliosis following a trial of a scoliosis activity suit were reviewed. The average scores and measurements at 18 months were statistically significantly improved for both the quadruple numerical pain rating scale as well as Cobb angle. The scoliosis activity suit may be a viable supportive therapy for the treatment of chronic pain associated with adult idiopathic scoliosis. Further prospective studies should evaluate treatment effects of this suit using intent-to-treat methodology.

Radiography Image Classification Using Deep Convolutional Neural Networks

Research has shown that chest radiography images of patients with different diseases, such as pneumonia, COVID-19, SARS, pneumothorax, etc., all exhibit some form of abnormality. Several deep learning techniques can be used to identify each of these anomalies in the chest x-ray images. Convolutional neural networks (CNNs) have shown great success in the fields of image recognition and image classification since there are numerous large-scale annotated image datasets available. The classification of medical images, particularly radiographic images, remains one of the biggest hurdles in medical diagnosis because of the restricted availability of annotated medical images. However, such difficulty can be solved by utilizing several deep learning strategies, including data augmentation and transfer learning. The aim was to build a model that would detect abnormalities in chest x-ray images with the highest probability. To do that, different models were built with different features. While making a CNN model, one of the main tasks is to tune the model by changing the hyperparameters and layers so that the model gives out good training and testing results. In our case, three different models were built, and finally, the last one gave out the best-predicted results. From that last model, we got 98% training accuracy, 84% validation, and 81% testing accuracy. The reason behind the final model giving out the best evaluation scores is that it was a well-fitted model. There was no overfitting or underfitting issues. Our aim with this project was to make a tool using the CNN model in R language, which will help detect abnormalities in radiography images. The tool will be able to detect diseases such as Pneumonia, Covid-19, Effusions, Infiltration, Pneumothorax, and others. Because of its high accuracy, this research chose to use supervised multi-class classification techniques as well as Convolutional Neural Networks (CNNs) to classify different chest x-ray images. CNNs are extremely efficient and successful at reducing the number of parameters while maintaining the quality of the primary model. CNNs are also trained to recognize the edges of various objects in any batch of images. CNNs automatically discover the relevant aspects in labeled data and learn the distinguishing features for each class by themselves.

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.

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.

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.

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.

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.