Aims

The aims of our study were to provide long-term information on the behaviour of the thoracolumbar/lumbar (TL/L) curve after thoracic anterior correction and fusion (ASF) and to determine the impact of ASF on pulmonary function.

Aims. Only a few studies have investigated the long-term health-related quality of life (HRQoL) in patients with an idiopathic scoliosis. The aim of this study was to investigate the overall HRQoL and employment status of patients with an idiopathic scoliosis 40 years after diagnosis, to compare it with that of the normal population, and to identify possible predictors for a better long-term HRQoL. Methods. We reviewed the full medical records and radiological reports of patients referred to our hospital with a scoliosis of childhood between April 1972 and April 1982. Of 129 eligible patients with a juvenile or adolescent idiopathic scoliosis, 91 took part in the study (71%). They were evaluated with full-spine radiographs and HRQoL questionnaires and compared with normative data. We compared the HRQoL between observation (n = 27), bracing (n = 46), and surgical treatment (n = 18), and between thoracic and thoracolumbar/lumbar (TL/L) curves. Results. The mean time to follow-up was 40.8 years (SD 2.6) and the mean age of patients was 54.0 years (SD 2.7). Of the 91 patients, 86 were female (95%) and 51 had a main thoracic curve (53%). We found a significantly lower HRQoL measured on all the Scoliosis Research Society 22r instrument (SRS-22r) subdomains (p < 0.001) with the exception of mental health, than in an age-matched normal population. Incapacity to work was more prevalent in scoliosis patients (21%) than in the normal population (11%). The median SRS-22r subscore was 4.0 (interquartile range (IQR) 3.3 to 4.4) for TL/L curves and 4.1 (IQR 3.8 to 4.4) for thoracic curves (p = 0.300). We found a significantly lower self-image score for braced (median 3.6 (IQR 3.0 to 4.0)) and surgically treated patients (median 3.6 (IQR 3.2 to 4.3)) than for those treated by observation (median 4.0 (IQR 4.1 to 4.8); p = 0.010), but no statistically significant differences were found for the remaining subdomains. Conclusion. In this long-term follow-up study, we found a significantly decreased HRQoL and capacity to work in patients with an idiopathic scoliosis 40 years after diagnosis. Cite this article: Bone Joint J 2023;105-B(2):166–171

Introduction. We aimed to determine the midterm effect of pedicle screw instrumentation on sagittal plane alignment, compared with a hybrid alignment, in the treatment of thoracic adolescent idiopathic scoliosis (AIS). Methods. 88 consecutive patients with AIS with a Lenke type 1 curve treated between 1998 and 2003 were analysed. Thoracic hooks were used in 45 patients (group Hy) and thoracic screws alone in 43 patients (group TPS). Preoperative average age (Hy 15·3 years vs TPS 16 years), sex (38 female and seven male vs 37 female and six male), Risser sign (2·9 vs 2·9), main thoracic curve (64° vs 65·5°), and thoracic kyphosis (22·6° vs 21·4°) were similar in both groups. Pearson correlation coefficient and univariate ANOVA were used. Results. At a mean follow-up of 7·3 years (range 5–10), the TPS group had a greater final main thoracic curve correction (Hy 46·4% vs TPS 58·4%; p<0·001), with inferior loss of initial correction (–11·1° vs TPS –1·3°; p<0·0005). Absolute final thoracic kyphosis was similar in both groups (31·4° vs 25·4°; r=0·002; p>0·05), with both groups showing an equally statistically significant amelioration of the sagittal contour (Hy 49·2%; p<0·001 vs TPS 43·4%; p<0·001) (difference between groups p>0·05). We recorded a significant correlation between absolute kyphosis correction (final preoperative) and percentage main thoracic curve initial correction loss in the Hy group (r=0·35, p<0·001). The SRS–30 assessment showed an improvement in self-image and satisfaction, with no significant differences between groups. Conclusions. The previously reported loss of kyphosis after a pedicle screw instrumentation in AIS, when compared with hybrid or hook only implants, should be questioned. At a minimum 5 years of follow-up, sagittal contour in the thoracic spine was not less kyphotic when pedicle screws were compared with hybrid constructs. The higher the loss of initial correction of main thoracic curve, the greater the postoperative absolute kyphosis at T5–T12 level. The clinical relevance of such radiographic differences is still undetectable with present self-assessment methods

There is a need for non-radiographic, objective outcome measures for children with Adolescent Idiopathic Scoliosis (AIS). Standing balance and stability is altered in children with AIS. The Margin of Stability (MoS) has been used to compare gait stability in clinical populations. Our objective was to compare the MoS in anterior-posterior (MoS. AP. ) and mediolateral (MoS. ML. ) directions in girls with AIS to Controls. Girls with AIS and healthy girls walked at three speeds on an instrumented treadmill wearing retroreflective markers, surrounded by motion capture cameras. The MoS. AP/ML. was calculated at left and right heel strike. Data was processed in Visual 3D. A two-way ANOVA was used to compare MoS. AP/ML. between group, speed and the interaction between group and speed. Pearson's correlation coefficient was used to compare the MoS to Cobb angle. Statistical significance was accepted when p > 0.05. A priori power analysis suggested 12 participants per group. Three Cases and four Controls were recruited. Girls with AIS all had right-sided main thoracic curves (Lenke type 1a, 61.3° ± 10.0°). MoS. AP. was significantly bigger for Cases compared to Controls on the left (p=0.038) and right foot (p=0.041). There was no significant difference between Cases and Controls for MoS. ML. , but there was a visual trend for a smaller MoS. ML. in Cases. There was no significant difference for speed or the interaction between group and speed for MoS. AP. or MoS. ML. In Cases, MoS. AP. increased with increasing Cobb angle on the left (r. 2. =0.687, p=0.054) and right (r. 2. =0.634, p=0.067) and MoS. ML. decreased with increasing Cobb angle on the left (r. 2. =-0.912, p=0.002). Further subjects are being recruited. Girls with Lenke type 1a AIS are more stable in the AP direction and less stable in the ML direction than Controls during treadmill walking. AP stability increases and ML stability decreases with increasing Cobb angle. This research suggests that the MoS could be used as an outcome measure for children with AIS. Continued work is required to increase the power of this study. Further work could consider these changes during walking overground, measuring an MoS or MoS-like measure using a wearable device, and in different curve types

Aims. This study addressed two questions: first, does surgical correction of an idiopathic scoliosis increase the volume of the rib cage, and second, is it possible to evaluate the change in lung function after corrective surgery for adolescent idiopathic scoliosis (AIS) using biplanar radiographs of the ribcage with 3D reconstruction?. Methods. A total of 45 patients with a thoracic AIS which needed surgical correction and fusion were included in a prospective study. All patients underwent pulmonary function testing (PFT) and low-dose biplanar radiographs both preoperatively and one year after surgery. The following measurements were recorded: forced vital capacity (FVC), slow vital capacity (SVC), and total lung capacity (TLC). Rib cage volume (RCV), maximum rib hump, main thoracic curve Cobb angle (MCCA), medial-lateral and anteroposterior diameter, and T4-T12 kyphosis were calculated from 3D reconstructions of the biplanar radiographs. Results. All spinal and thoracic measurements improved significantly after surgery (p < 0.001). RCV increased from 4.9 l (SD 1) preoperatively to 5.3 l (SD 0.9) (p < 0.001) while TLC increased from 4.1 l (SD 0.9) preoperatively to 4.3 l (SD 0.8) (p < 0.001). RCV was correlated with all functional indexes before and after correction of the deformity. Improvement in RCV was weakly correlated with correction of the mean thoracic Cobb angle (p = 0.006). The difference in TLC was significantly correlated with changes in RCV (p = 0.041). It was possible to predict postoperative TLC from the postoperative RCV. Conclusion. 3D rib cage assessment from biplanar radiographs could be a minimally invasive method of estimating pulmonary function before and after spinal fusion in patients with an AIS. The 3D RCV reflects virtual chest capacity and hence pulmonary function in this group of patients. Cite this article: Bone Joint J 2022;104-B(1):112–119

Introduction. Thoracic pedicle screws have been proven to be safe and effective in the treatment of adolescent idiopathic scoliosis (AIS). However, the effect of the instrumentation alloy has not yet been investigated. We aimed to compare segmental versus non segmental thoracic pedicle screw instrumentation in patients with AIS. Methods. A consecutive series of 143 patients with AIS (Lenke classification 1–4) surgically treated from 1998 to 2005 by means of thoracic pedicle screws were retrospectively reviewed. Considering implant density (number of fixation anchors placed per available anchors sites; segmental =60% [S], non-segmental =60% [NS]) and implant alloy used (titanium [Ti] vs stainless steel [SS]) we divided the cohort into four groups: Ti-S (48 cases); Ti-NS (34 cases); SS-S (35 cases); and SS-NS (26 cases). Groups were similar for preoperative mean age, sex distribution, Risser sign, main thoracic curve, and thoracic kyphosis. Pearson correlation coefficient and univariate analysis of variance were used. Results. At a mean follow-up of 6·2 years (range 3–10) the overall final main thoracic curve correction was a mean of 61·4% (20–89), whereas the implant density within the major curve was 71% (15–100%). We recorded a significant correlation between implant density and percentage major curve correction (r=0·41, p<0·002); when the four groups were compared we noted that the SS-S group showed the greatest average correction (75%), followed by the Ti-S, SS-NS, and Ti-NS groups. We detected no significant differences between SS-S versus Ti-S versus SS-NS (r=0·002, p>0·05; r=0·13, p>0·05; r=0·07, p>0·01, respectively), whereas the Ti-NS group showed a statistically significant inferior percentage correction when compared with all other groups (average 52%; p<0·001). Nevertheless, no significant difference between groups was recorded on the SRS-30 assessment, showing a postoperative improvement in both self-image and satisfaction. Conclusions. When an SS instrumentation is used, non-segmental pedicle screw constructs seem to be equally effective as segmental instrumentations in obtaining satisfactory results in patients with main thoracic AIS. When the implant alloy used is titanium, an implant density of greater than 60% should be guaranteed so as to achieve similar results to those recorded in this study

To present the results of surgical correction in patients with double or triple thoracic/lumbar AIS (Lenke types 2,3,4) with the use of a novel convex/convex unilateral segmental screw correction technique in a single surgeon's prospective series. We reviewed the medical records and spinal radiographs of 92 consecutive patients (72 female-20 male). We measured scoliosis, thoracic kyphosis, lumbar lordosis, scoliosis flexibility and correction index, coronal and sagittal balance before and after surgery, as well as at minimum 2-year follow-up. SRS-22 data was available preoperatively, 6-month, 12-month and 2-year postoperatively for all patients. Surgical technique. All patients underwent posterior spinal fusion using pedicle screw constructs. Unilateral screws were placed across the convexity of each individual thoracic or lumbar curve to allow for segmental correction. ‘Corrective rod’ was the one attached to the convexity of each curve with the correction performed across the main thoracic scoliosis always before the lumbar. Maximum correction of main thoracic curves was always performed, whereas the lumbar scoliosis was corrected to the degree required to achieve a balanced effect across the thoracic and lumbar segments and adequate global coronal spinal balance. Concave screws were not placed across any deformity levels. Bilateral screws across 2 levels caudally and 1–2 levels cephalad provided proximal/distal stability of the construct. Mean age at surgery was 14.9 years with mean Risser grade 2.8. The distribution of scoliosis was: Lenke type 2–26 patients; type 3–43 patients; type 4–23 patients. Mean preoperative Cobb angle for upper thoracic curves was 45°. This was corrected by 62% to mean 17° (p<0.001). Mean preoperative Cobb angle for main thoracic curves was 70°. This was corrected by 69% to mean 22° (p<0.001). Mean preoperative Cobb angle for lumbar curves was 56°. This was corrected by 68% to mean 18° (p<0.001). No patient lost >2° correction at follow-up. Mean preoperative thoracic kyphosis was 34° and lumbar lordosis 46°. Mean postoperative thoracic kyphosis was 45° (p<0.001) and lumbar lordosis 46.5° (p=0.69). Mean preoperative coronal imbalance was 1.2 cm. This corrected to mean 0.02 cm at follow-up (p<0.001). Mean preoperative sagittal imbalance was −2 cm. This corrected to mean −0.1 cm at follow-up (p<0.001). Mean theatre time was 187 minutes, hospital stay 6.8 days and intraoperative blood loss 0.29 blood volumes (1100 ml). Intraoperative spinal cord monitoring was performed recording cortical and cervical SSEPs and transcranial upper/lower limb MEPs and there were no problems. None of the patients developed neurological complications, infection or detected non-union and none required revision surgery to address residual or recurrent deformity. Mean preoperative SRS-22 score was 3.6; this improved to 4.6 at follow-up (p<0.001). All individual parameters also demonstrated significant improvement (p<0.001) with mean satisfaction rate at 2-year follow-up 4.9. The convex-convex unilateral pedicle screw technique can reduce the risk of neurological injury during major deformity surgery as it does not require placement of screws across the deformed apical concave pedicles which are in close proximity to the spinal cord. Despite the use of a lesser number of pedicle fixation points compared to the bilateral segmental screw techniques, in our series it has achieved satisfactory scoliosis correction and restoration of global coronal and sagittal balance with improved thoracic kyphosis and preserved lumbar lordosis. These results have been associated with excellent patient satisfaction and functional outcomes as demonstrated through the SRS-22 scores

Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spine characterized by a Cobb angle of at least 10 degrees. The goal of surgery is to not only prevent progression but restore sagittal and coronal balance, protecting cardiopulmonary function and improving cosmesis. We reviewed the impact of deformity correction surgery in terms of radiology and patient reported outcome(PROMs). The senior authors prospectively maintained database from 2003 –2022 was retrospectively analysed in terms of pre- and post-operative patient reported outcome measures (SRS 22) as well as radiological parameters. 44 patients with AIS were identified with pre and post op PROMS. The average age at surgery was 15yrs with 84% female. 38% had a Lenke 1 curve and 3 patients had Lenke 6 curves. 73% had posterior surgery. There was a total improvement in SRS 22 scores by 7.8%. Patients reported significant satisfaction with treatment 4.8/5 and improvement in self-image with a change of 0.4 (p<0.001). However, no difference in function, pain and mental health were recorded. Overall, proximal thoracic (PT) curves improved from 24 degrees to 11 degrees (p<0.001), Main thoracic (MT) curve 55 degrees to 19 degrees and Thoracolumbar/Lumbar curves (TL/L) 45 degreesto 11 degrees. Pre-operative flexibility and post-operative correction were 0.40 and 0.41 respectively for PT curve. MT was 0.32 and 0.67. That for TL/L was 0.57 and 0.71 respectively. Surgery yields significant main curve correction correlating with high patient reported satisfaction rate. Although total SRS 22 score yielded 7.8% improvement, sub-analysis of self-image showed the most significant improvement

There is a significant positive association between hours of brace wear and rate of success in the treatment of Adolescent Idiopathic Scoliosis (AIS). The abandon rate reported in the literature averages 18%. In a recent randomized trial conducted at our center; the abandon rate was 4%. We aim to document the abandon rate towards brace treatment during the COVID-19 pandemic and its impact on AIS progression. We reviewed a database of AIS patients recruited between March and September 2020. Inclusion criteria were patients with AIS under brace treatment according to SRS criteria. The patients were divided in 2 cohorts: those with a self-reported good adherence to treatment and those who voluntarily abandoned treatment during follow-up. Patients with irregular adherence were excluded. Data analysis included age, gender, Risser stage, type of brace, Cobb angles at first visit and last follow-up (mean 11 months) and % of progression. Unpaired student tests were used for comparison. 154 patients met inclusion criteria. 20 patients were excluded due to irregular adherence. 89 patients (age: 12.1 y.o. ±1.4) reported good adherence to treatment, while 45 patients (age: 12.6 y.o. ±1.5) abandoned treatment, an abandon rate of 29%. The cohort of compliant patients started treatment with a mean main thoracic (MT) curve of 26° and finished with 27°. The mean difference between measurements was +0.65°±7.5; mean progression rate was −4.6%. However, patients who abandoned treatment started with a mean MT curve of 28° and finished with 33°, with a mean increase of +5°±8 and a mean progression rate of −11%. The differences between the 2 cohorts were statistically significant (p=0.002). Five (5) patients from the abandon group were offered for surgery because of curve progression. The abandon rate of brace treatment in AIS significantly increased during the first wave of COVID-19 pandemic. Patients who voluntarily discontinued treatment had significant increases in curve progression and surgical indication rates

Purpose of the study. To compare the effectiveness of unilateral and bilateral pedicle screw techniques in correcting adolescent idiopathic scoliosis. Summary of Background Data. Pedicle screw constructs have been extensively used in the treatment of adolescent patients with idiopathic scoliosis. It has been suggested that greater implant density may achieve better deformity correction. However, this can increase the neurological risk related to pedicle screw placement, prolong surgical time and blood loss and result in higher instrumentation cost. Methods. We reviewed the medical notes and radiographs of 139 consecutive adolescent patients with idiopathic scoliosis (128 female-11 male, prospectively collected single surgeon's series). We measured the scoliosis, thoracic kyphosis (T5-T12), and lumbar lordosis (L1-L5) before and after surgery, as well as at minimum 2-year follow-up. SRS 22 data was available for all patients. Results. All patients underwent posterior spinal arthrodesis using pedicle screw constructs. Mean age at surgery was 14.5 years. We had 2 separate groups: in Group 1 (43 patients) correction was performed over 2 rods using bilateral segmental pedicle screws; in Group 2 (96 patients) correction was performed over 1 rod using unilateral segmental pedicle screws with the 2. nd. rod providing stability of the construct through 2-level screw fixation both proximal and distal. Group 1. Mean Cobb angle before surgery for upper thoracic curves was 37°. This was corrected by 71% to mean 11° (p<0.001). Mean Cobb angle before surgery for main thoracic curves was 65°. This was corrected by 71% to mean 20° (p<0.001). Mean Cobb angle before surgery for thoracolumbar/lumbar curves was 60°. This was corrected by 74% to mean 16° (p<0.001). No patient lost >2° correction at follow-up. Mean preoperative thoracic kyphosis was 24° and lumbar lordosis 52°. Mean postoperative thoracic kyphosis was 21° and lumbar lordosis 50° (p>0.05). Mean theatre time was 5.5 hours, hospital stay 8.2 days and intraoperative blood loss 0.6 blood volumes. Complications: 1 transient IOM loss/no neurological deficit; 1 deep wound infection leading to non-union and requiring revision surgery; 1 rod trimming due to prominent upper end. Mean preoperative SRS 22 score was 3.9; this improved to 4.5 at follow-up (p<0.001). Pain and self-image demonstrated significant improvement (p=0.001, p<0.001 respectively) with mean satisfaction rate 4.9. Group 2. Mean Cobb angle before surgery for upper thoracic curves was 42°. This was corrected by 52% to mean 20° (p<0.001). Mean Cobb angle before surgery for main thoracic curves was 62°. This was corrected by 70% to mean 19° (p<0.001). Mean Cobb angle before surgery for thoracolumbar/lumbar curves was 57°. This was corrected by 72% to mean 16° (p<0.001). No patient lost >2° correction at follow-up. Preoperative scoliosis size for all types of curves correlated with increased surgical time (r=0.6, 0.4). Mean preoperative thoracic kyphosis was 28° and lumbar lordosis 46°. Mean postoperative thoracic kyphosis was 25° and lumbar lordosis 45° (p>0.05). Mean theatre time was 4.2 hours, hospital stay 8.4 days and intraoperative blood loss 0.4 blood volumes. Complications: 1 deep and 1 superficial wound infections treated with debridement; 1 transient brachial plexus neurapraxia; 1 SMA syndrome. Mean preoperative SRS 22 score was 3.7; this improved to 4.5 at follow-up (p<0.001). Pain, function, self-image and mental health demonstrated significant improvement (p<0.001 for all parameters) with mean satisfaction rate 4.8. Comparison between groups showed no significant difference in regard to age at surgery, preoperative and postoperative scoliosis angle for main thoracic and thoracolumbar/lumbar curves, as well as SRS scores and length of hospital stay. Better correction of upper thoracic curves was achieved in Group 1 (p<0.05), but upper thoracic curves in Group 2 were statistically more severe before surgery (p<0.05). Increased surgical time and blood loss was recorded in Group 1 (p<0.05, p=0.05 respectively). The implant cost was reduced by mean 35% in Group 2 due to lesser number of pedicle screws. Conclusion. Unilateral and bilateral pedicle screw instrumentation has achieved excellent deformity correction in adolescent patients with idiopathic scoliosis, which was maintained at follow-up. This has been associated with high patient satisfaction and low complication rates. The unilateral technique using segmental pedicle screw correction has reduced surgical time, intraoperative blood loss and implant cost without compromising surgical outcome for the most common thoracic and thoracolumbar/lumbar curves. The bilateral technique achieved better correction of upper thoracic scoliosis

Objectives: To evaluate the early coronal and sagittal correction of main thoracic adolescent idiopathic scoliosis using pedicle screw instrumentation and to determine whether implant density influences correction. Methods and results: 49 consecutive patients with Lenke I main thoracic adolescent idiopathic scoliosis underwent single stage posterior correction and instrumented spinal fusion with pedicle screw fixation between 2006 and 2008. All surgeries were performed in a single institution by a single surgeon using identical surgical technique and type of instrumentation. Pre- and postoperative radiographs were analyzed. The pre-operative main thoracic curve of 60.0 ± 13.4° was corrected to 17.4 ± 6.9° (69.9% correction) on the post-operative radiographs. The pre-operative thoracic kyphosis of 20.0 ± 10.2° decreased to 11.6 ± 4.9° post-operatively. There was a significant correlation between decrease in sagittal kyphosis and magnitude of coronal Cobb angle correction (P = 0.002). There was no correlation between implant density and magnitude of coronal or sagittal curve correction, with and without curve flexibility taken into consideration. Conclusions: Pedicle screw constructs provided excellent coronal correction of thoracic idiopathic scoliosis, however this was at the expense of sagittal contour. Decrease in sagittal kyphosis correlated with magnitude of coronal correction. Bilateral segmental pedicle screw fixation did not improve curve correction compared with unilateral or alternate segmental fixation. Ethics approval: None required. Caldicott and Data Protection Approval No. 661. Interest Statement: None

Introduction: In this study we focus on idiopathic scoliosis with a primary thoracic curve and a secondary lumbar curve. We were interested in how the lumbar curve corrects following selective thoracic fusion and whether one can predict the correction of the lumbar curve. In the literature it is said that the lumbar curve spontaneously corrects to balance the thoracic curve after selective thoracic fusion. Because of these findings we postulate there should be a correlation between the correction of the lumbar and thoracic curve of the scoliosis. Recently we showed in patients treated with Harrington instrumentation with sublaminar wiring (second generation technique) that the correction of the lumbar curve was not a reflection of the thoracic correction. So it is interesting to know whether with the use of third generation instrumentation techniques and more sophisticated classification systems the correlation of the unfused lumbar cure becomes more predictable. Objective: To establish whether in primary thoracic idiopathic scoliosis treated with selective thoracic fusion using CD instrumentation there is a significant correlation (p< 0.05) between the correction of the thoracic and lumbar curve. And to assess whether, in the in the individual patient, the lumbar modifier (A, B and C) according Lenke, can be used as a correct predictor of outcome results. The higher the correlation coefficient between the relative (%) corrections of the thoracic and lumbar curves, the higher the predictability of the correction of the unfused lumbar curve. Material and methods: We performed a retrospective study on 38 patients with adolescent idiopathic scoliosis treated by selective thoracic fusion (CD instrumentation). There were 29 female and nine male patients. For radiographic evaluation we used the standing antero-posterior and lateral projections of the thoracic and lumbar spine, preoperatively and at least one year postoperative. We assessed the frontal and sagittal Cobb angles. The angles were all measured by the same investigator (second author). Results: Using Pearson correlation analyses we found a significant correlation (p< 0.001) between the relative (%) corrections of thoracic and lumbar curves (table1). The correlation coefficient between the relative correction of the thoracic and lumbar curve decreased with the Lumbar modifier (A, B, C). Conclusion: A significant correlation is present between the relative corrections of the main thoracic curve and the lumbar curve after selective thoracic fusion in idiopathic scoliosis. The recently introduced new classification system seems to be of great predictable value for the spontaneous correction of the lumbar curve. Depending on the curve-type, a different technique for predicting the outcome should be used

The August 2024 Spine Roundup³⁶⁰ looks at: Laminectomy adjacent to instrumented fusion increases adjacent segment disease; Influence of the timing of surgery for cervical spinal cord injury without bone injury in the elderly: a retrospective multicentre study; Lumbar vertebral body tethering: single-centre outcomes and reoperations in a consecutive series of 106 patients; Machine-learning algorithms for predicting Cobb angle beyond 25° in female adolescent idiopathic scoliosis patients; Pain in adolescent idiopathic scoliosis; Teriparatide prevents surgery for osteoporotic vertebral compression fracture.

Aims. To clarify the asymmetrical ossification of the epiphyseal ring between the convex and concave sides in patients with adolescent idiopathic scoliosis (AIS). Patients and Methods. A total of 29 female patients (mean age, 14.4 years; 11 to 18) who underwent corrective surgery for AIS (Lenke type 1 or 2) were included in our study. In all, 349 vertebrae including 68 apical vertebrae and 87 end vertebrae in the main thoracic (MT) curve and thoracolumbar/lumbar (TL/L) curve were analysed. Coronal sections (anterior, middle and posterior) of the vertebral bodies were reconstructed from pre-operative CT scans (320-row detector; slice thickness, 0.5 mm) and the appearances of the ossification centre in the epiphyseal ring at four corners were evaluated in three groups; all vertebrae excluding end vertebrae, apical vertebrae and end vertebrae. The appearance rates of the ossification centre at the concave and convex sides were calculated and compared. Results. The appearance rates of the ossification centres in all vertebrae excluding end vertebrae and apical vertebrae were significantly lower on the concave side than on the convex side in both MT and TL/L curves irrespective of curve flexibility. There was no significant difference in the rate of appearance of the ossification centres on the concave or convex sides in end vertebrae. Conclusion. The asymmetric bony growth of vertebral body came into existence at both structural and non-structural curves, and was more apparent around the apical vertebrae. Evaluation of the ossification centre in the epiphyseal ring could be a measure of the effectiveness of brace treatment. Take home message: The ossification of the epiphyseal ring in patients with AIS was delayed or absent on the concave side particularly around the apical vertebrae. Cite this article: Bone Joint J 2016;98-B:666–71

Aims

The aim of this study was to review the current evidence surrounding curve type and morphology on curve progression risk in adolescent idiopathic scoliosis (AIS).

Introduction. Posterior spinal arthrodesis with thoracoplasty and an open anterior approach, with respect to a posterior only fusion, have a deleterious effect on pulmonary function for up to 5 years after surgical treatment of adolescent idiopathic scoliosis. We aimed to compare two groups of adolescents surgically treated for their spinal deformity either by posterior segmental fusion alone (PSF) or by posterior spinal fusion and thoracoplasty (PSF+T). We focused on the long-term effects of thoracoplasty on pulmonary function in the surgical treatment of adolescent idiopathic scoliosis. Methods. We compared 40 consecutive adolescent patients surgically treated between 1998 and 2001 by PSF+T with a similar cohort of 40 adolescents treated in the same period by PSF. Inclusion criteria were pedicle screw instrumentation alone and a minimum 5 years of follow-up. A radiographic analysis and a chart review were done, evaluating the pulmonary function tests (PFTs), the SRS-30 score questionnaire, and the Lenke classification system. A radiographic rib-hump (RH) assessment was also undertaken. Results. The entire series was reviewed at an average clinical follow-up of 8·3 years. The two groups did not differ significantly in terms of sex, age (PSF+T 16·3 years vs PSF 15·2 years), Lenke curve type classification, and preoperative Cobb main thoracic (MT) curve magnitude (66° vs 63°); however, final MT percentage correction (53·03% vs 51·35%; p<0·03), RH absolute correction (–2·1 cm vs –1·05; p<0·01), and RH overall percentage correction (55·4% vs 35·4%; p<0·0001) were greater in the PSF+T group than in the PSF group. We recorded no statistical differences between the two groups in PFTs both preoperatively and at last follow-up. Nevertheless, comparing preoperative with final PFTs within each group, only in the PSF group was both forced vital capacity and forced expiratory volume in 1 s significantly improved at final evaluation. At last follow-up visit, the SRS-30 scores did not differ significantly between the two groups (total score 4·1 vs 4·3). Conclusions. Our findings suggest that thoracoplasty did not adversely affect long-term PFTs in patients with adolescent idiopathic scoliosis treated by posterior spinal fusion alone with pedicle screws instrumentation, as already shown in previous reports. A trend towards better coronal plane correction and rib-hump improvement was recorded, although this improvement was not clearly reported in a self-assessment disease-specific questionnaire

Aims

The aim of this retrospective study was to compare the correction achieved using a convex pedicle screw technique and a low implant density achieved using periapical concave-sided screws and a high implant density. We hypothesized that there would be no difference in outcome between the two techniques.

Introduction. Our short segment anterior technique produces similar correction and better functional outcomes for patients with adolescent idiopathic scoliosis by instrumentation of fewer levels than does posterior segmental instrumentation. We present the results of the first consecutive 45 patients operated by the short segment bone-on-bone anterior scoliosis technique, with a mean follow-up of 6 years. Every patient was followed up over 2 years and none was lost to follow-up. Methods. The patients (28 with thoracic scoliosis; 17 with thoracolumbar scoliosis) were operated between 1996 and 2004 for single curve idiopathic scoliosis. The mean age was 19 years (range 9–51); 87% of the cohort was female and the mean follow-up was 72 months (range 28–121). We operated on curves less than 75° by the short segment anterior approach with total discectomy, bone-on-bone apposition, and dual-rod instrumentation. We assessed the sagittal and coronal corrections on erect anteroposterior and lateral radiographs done preoperatively, postoperatively, and at final follow-up. Results. A mean of five vertebrae (four discs) were instrumented. The mean operative time was 360 min, blood loss was 877mL, and hospital stay was 9·1 days. The preoperative thoracolumbar major curve was 50·5°, and 18·3° at final follow-up (image A, B). The preoperative lower tilt angle was 27·7°, and 8·3° at final follow-up. The main preoperative thoracic curve was 52·5°, and the final postoperative curve measured 27·9° (image C, D). The lower preoperative tilt angle was 20·9°, and 11° at final follow-up. Spontaneous improvement of 37·4% was noted in thoracic compensatory curves and 47·5% in thoracolumbar compensatory curves. The sagittal and coronal balance was restored in all patients. There was no loss of correction in the operated segment. There were no infections, non-unions, or neurological, vascular, pulmonary, or implant-related complications in the entire series. Union occurred in all the patients in 2–4 months. All the patients had an unrestricted lifestyle within 4 months. Conclusions. In treatment of single major curves of less than 75° in patients with adolescent idiopathic scoliosis, the short segment approach of straightening the apical five vertebrae while removing the apical four discs produces good clinical and radiological results with no loss of correction at 6 years. Our series was also free of mechanical complications, re-admissions, or “adding-on” as frequently seen in series of similar cases operated with posterior segmental implants. The short fusions, superb functional rehab, and lack of complications make the short segment bone-on-bone surgical reconstruction the optimal reconstructive option for well screened adolescents whose single curves fit the selection criteria well

Aims

Spinal fusion remains the gold standard in the treatment of idiopathic scoliosis. However, anterior vertebral body tethering (AVBT) is gaining widespread interest, despite the limited data on its efficacy. The aim of our study was to determine the clinical efficacy of AVBT in skeletally immature patients with idiopathic scoliosis.