Excessive posterior placement of upper instrumented vertebra relative to lower instrumented vertebra as a predictor of proximal junction kyphosis after selective spinal fusion for adolescent idiopathic scoliosis Lenke type 5C curves.

PURPOSE: We defined sagittal S-line tilt (SSLT) as the tilt of the line connecting the upper instrumented vertebra and the lower instrumented vertebra. This study aimed to: (1) examine the correlation between SSLT and proximal junctional angle (PJA) change values, and (2) determine the cut-off value of SSLT with respect to proximal junctional kyphosis (PJK) occurrence. METHODS: Eighty-six consecutive patients (81 female and 5 male; mean age: 15.8 years) with Lenke 5C AIS who underwent posterior selective spinal fusion. Pearson's correlation coefficients were used to examine the relationship between preoperative SSLT and changes in PJA from preoperative to 2 years postoperative. The impact of SSLT on PJK at 2 years after surgery was assessed using a receiver operating characteristic (ROC) curve. RESULTS: We observed a moderate positive correlation between preoperative SSLT and change in PJA (R = 0.541, P < 0.001). We identified 18 patients (21%) with PJK at 2 years postoperative. Mean preoperative SSLT in the PJK group and the non-PJK group differed significantly at 23.3 ± 4.1° and 16.1 ± 5.0°, respectively (P < 0.001). The cut-off value of preoperative SSLT for PJK at 2 years postoperative was 18° in ROC curve analysis, with a sensitivity of 94%, specificity of 68%, and area under the ROC curve of 0.868. CONCLUSION: In selective lumbar fusion for AIS Lenke type 5C curves, preoperative SSLT was significantly correlated with PJA change from preoperative to 2 years postoperative. SSLT was a predictor of PJK occurrence, with a cut-off value of 18°.

Applications of artificial intelligence for adolescent idiopathic scoliosis: mapping the evidence.

PURPOSE: Adolescent idiopathic scoliosis (AIS) is a common spinal deformity with varying progression, complicating treatment decisions. Artificial intelligence (AI) and machine learning (ML) are increasingly prominent in orthopedic care, aiding in diagnosis, risk-stratification, and treatment guidance. This scoping review outlines AI applications in AIS. METHODS: This study followed PRISMA-ScR guidelines and included articles that reported the development, use, or validation of AI models for treating, diagnosing, or predicting clinical outcomes in AIS. RESULTS: 40 full-text articles were included, with most studies published in the last 5 years (77.5%). Common ML techniques were convolutional neural networks (55%), decision trees and random forests (15%), and artificial neural networks (15%). Most AI applications in AIS were for imaging analysis (25/40; 62.5%), focusing on automatic measurement of Cobb angle, and axial vertebral rotation (13/25; 52%) and curve classification/severity (13/25; 52%). Prediction was the second most common application (15/40; 37.5%), with studies predicting curve progression (9/15; 60%), and Cobb angles (9/15; 60%). Only 15 studies (37.5%) reported clinical implementation guidelines for AI in AIS management. 52.5% of studies reported model accuracy, with an average of 85.4%. CONCLUSION: This review highlights the applications of AI in AIS care, notably including automatic radiographic analysis, curve type classification, prediction of curve progression, and AIS diagnosis. However, the current lack of clear clinical implementation guidelines, model transparency, and external validation of studied models limits clinician trust and the generalizability and applicability of AI in AIS management.

Three-Level Concavity Apical Pediculectomy During Intraoperative Neuromonitoring Loss: Following the Checklist Resulted in an Ambulatory Patient.

Adolescent idiopathic scoliosis is the most common form of scoliosis, with severe cases leading to a decline in patients with worsening angulation of deformity. Technical nuances of spinal flexibility and cord type based on the extent of the deformity may impact operating safety and outcome, with risks including neurological loss during and after surgical intervention. Here we present a case of posterior osteotomy and correction of a patient with adolescent idiopathic scoliosis with a T2 - L3 fusion in which transcranial motor evoked potentials (TcMEPs) and somatosensory evoked potentials (SSEPs) were lost intraoperatively, thus requiring application of operative consensus guidelines for the loss of neuromonitoring data. Particularly, the discussion focuses on the decision-making process that resulted in the complete recovery of TcMEPs and SSEPs post-operatively.

Effectiveness and Safety of High-Dose Tranexamic Acid in Adolescent Idiopathic Scoliosis Surgery: A Meta-analysis and Systematic Review.

OBJECTIVE: This systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective controlled studies (RCSs) aims to evaluate the efficacy and safety of high-dose tranexamic acid (TXA) in spinal correction surgery for adolescent idiopathic scoliosis (AIS) patients. METHODS: In March 2024, a comprehensive search was conducted in PubMed, Web of Science, Embase, and Cochrane databases to identify RCTs and RCSs comparing the effects of high-dose TXA on blood loss and transfusion requirements during spinal correction surgery. RESULTS: This meta-analysis included 10 clinical trials encompassing a total of 741 patients. The pooled results indicated that the use of high-dose TXA significantly reduced intraoperative blood loss [WMD = -519.83, 95% CI (-724.74, -314.92), P < 0.00001], transfusion rate [RR = 0.28, 95% CI (0.17, 0.45), P < 0.00001], total blood loss [WMD = -891.09, 95% CI (-1623.92, -158.26), P = 0.02], and postoperative blood loss [WMD = -105.91, 95% CI (-141.29, -70.52), P < 0.00001]. There was no significant difference in operative time [WMD = -18.96, 95% CI (-40.20, 2.28), P = 0.08] and blood loss per segment [WMD = -50.51, 95% CI (-102.19, 1.17), P = 0.06]. Both groups had a comparable incidence of thromboembolic events. CONCLUSION: Our meta-analysis suggests that the use of high-dose TXA reduces intraoperative blood loss, transfusion rate, total blood loss, and postoperative blood loss in spinal correction surgery for AIS patients. However, there were no significant differences in operative time and blood loss per segment.

Risk of coronal imbalance after posterior surgery for adolescent idiopathic scoliosis of type Lenke 5C.

PURPOSE: To investigate the incidence, risk factors, and clinical impact of persistent coronal imbalance (PCI) in Lenke5C adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF). METHODS: We analyzed the medical records of 112 Lenke5C AIS patients. They were grouped into PCI (+) group and PCI (-) group according to the occurrence of PCI at 2 years after surgery. Coronal and sagittal parameters were measured and compared between both groups preoperatively, immediately postoperatively, and 2 years postoperatively. Scoliosis Research Society⁃22 (SRS⁃22) score was used to evaluate clinical outcomes. RESULTS: Of the 112 patients, 12 had coronal imbalance persisting 2 years after surgery. Logistic regression analysis indicated risk factors including older age [odds ratio(OR)= 1.841, 95% confidence interval (CI) 1.147-2.132, P = 0.001], lower preoperative flexibility main thoracic (MT) curve (OR = 1.308,95% CI: 1.041-2.015, P = 0.016), greater preoperative apical vertebral translation (AVT) of the thoracolumbar/lumbar (TL/L) curve (AVT-TL/L) (OR= 2.291, 95%CI: 1.120-4.719, P = 0.001), larger preoperative lowest instrumented vertebra tilt (LIV lilt) (OR = 2.141, 95% CI: 1.491-3.651, P = 0.011), postoperative immediate coronal imbalance (OR = 5.512, 95% CI: 4.531-6.891, P = 0.001). The satisfaction and total score of SRS-22 scale in PCI (+) group were lower than those in PCI (-) group at 2 years after surgery (P < 0.05). CONCLUSIONS: We found a 10.7% incidence of PCI in patients with Lenke5C AIS undergoing PSF. PCI adversely affects clinical outcomes. Risk factors of PCI included older age, reduced preoperative MT curve flexibility, increased preoperative AVT in the TL/L curve, greater preoperative LIV tilt, and immediate postoperative coronal imbalance.

Axial rod slip at the end-of-construct screw in scoliosis surgery: relevance, occurrence and prevention.

PURPOSE: Despite standardized biomechanical tests for spinal implants, we recently recognized pedicle screw failure to maintain the rod fixated as a clinical concern in scoliosis surgery. This occurrence study investigates the risk and magnitude of axial rod slip (ARS), its relation with technique and preventive measures. METHODS: Retrospective multicenter review of all primary scoliosis cases (2018-2020) with > 1 year FU from three centers, instrumented with uniplanar screws and 5.5 mm CoCr rods (Mesa 2, Stryker Corporation, Kalamazoo, MI, USA). ARS was defined as > 1 mm change in residual distal rod length from the screw in the lowest instrumented vertebra (LIV) and assessed by two independent observers. Slip distance, direction, relation to distal screw density and time of observation were recorded, as well as the effect of ARS on caudal curve increase. To prevent slip, more recent patients were instrumented with a different end-of-construct screw (Reline, NuVasive Inc. San Diego, CA, USA) and analyzed for comparison. RESULTS: ARS risk was 27% (56/205) with a distance of 3.6 ± 2.2 mm, predominantly convex. 42% occurred before 4 months, the rest before 1 year. The caudal curve substantially increased three times more often in patients with ARS. Interobserver reliability was high and slip was in the expected direction. ARS was unrelated to distal screw density. Remarkable variation in ARS rates (53%, 31%, 13%) existed between the centers, while there was no difference in mean screw density (≈1.3 screws/level) or curve correction (≈60%). Revision surgery for ARS was required in 2.9% (6/207). Using the different end-of-construct screw, ARS risk was only 2% (1/56) and no revisions were required. CONCLUSION: This study demonstrates the prevalence of axial rod slip at the end of construct in scoliosis surgery and its clinical relevance. While minimal ARS can be subclinical, ARS should not be mistaken for adding on. The most severe ARS predominantly occurred convex at the high-loaded distal screw when L3 was the LIV. Longer constructs (LIV L3 or L4) have a higher risk of ARS. The minimal risk of ARS with another end-of-construct screw underscores the influence of screw type on ARS occurrence in our series. Further research is essential to refine techniques and enhance patient outcomes.

Appropriate pelvic obliquity measurement method in Lenke type 5C adolescent idiopathic scoliosis: a preliminary study.

Background: Although pelvic obliquity (PO) is a risk factor for postoperative coronal decompensation in corrective surgery in adolescent idiopathic scoliosis (AIS), especially Lenke 5C, methods of measuring PO are controversial. This study aimed to establish an appropriate measurement method using multiplanar reconstructed computed tomography (MPR-CT) images instead of standing posteroanterior (PA) whole-spine radiographs to evaluate PO in patients with Lenke 5C AIS. Methods: This study was a retrospective cross-sectional study. Twenty-five patients who underwent corrective surgery for AIS in Osaka University Hospital from August 2014 to February 2023 were included. Cobb angle, L5 tilt, C7 plumb line to center sacral vertebral line (C7PL-CSVL), and leg length discrepancy (LLD) were measured on standing PA whole-spine radiographs preoperatively. Sacral obliquity (SO), the slope of the upper endplate of S1, and iliac obliquity (IO), the tilt of the line connecting the iliac crests, were measured on standing PA whole-spine radiographs and MPR-CT (SO/IO-X-ray, SO/IO-CT, respectively). S1 angle and S2 angle were measured on CT. Results: The mean age of the patients was 18.7±3.9 years and all of them were females. SO-X-ray and SO-CT were larger than IO-X-ray and IO-CT, respectively. SO-X-ray was highly correlated with SO-CT (r=0.838, P<0.001). L5 tilt had higher correlation with SO-CT (r=0.884, P<0.001) than with SO-X-ray (r=0.726, P=0.001) and IO-CT (r=0.550, P=0.22). L5 tilt was correlated poorly with IO-X-ray (r=0.104, P=0.69). The S1 angle was 4.5±3.5° meanwhile the S2 angle was 1.2±2.1°, the sacral deformity was mainly due to the S1 vertebral wedging. Conclusions: Given the asymmetric sacral morphology, SO is more appropriate pelvic parameter than IO to represent the sacral tilt of Lenke 5C AIS, especially when measured using CT images to overcome the poor visibility on PA whole-spine radiographs.

Pre-contoured patient-specific rods result in superior immediate sagittal plane alignment than surgeon contoured rods in adolescent idiopathic scoliosis.

Background: Adolescent idiopathic scoliosis (AIS) surgery typically involves posterior spinal fusion (PSF) using rods contoured by the surgeon, which may be time-consuming and may not reliably restore optimal sagittal alignment. However, pre-contoured patient-specific rods may more optimally restore sagittal spinal alignment. This study evaluates the radiographic outcomes of AIS patients who underwent PSF utilizing surgeon contoured vs. pre-contoured rods. Methods: This is a retrospective cohort study of AIS patients who underwent PSF with either surgeon contoured or pre-contoured rods. Demographics, Lenke classification, fused levels, osteotomies, estimated blood loss (EBL), and surgical time were also obtained via chart review. Coronal curve magnitude, T5-T12 thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PI-LL mismatch, and T1 pelvic angle (TPA) were obtained pre-operatively, postoperatively and at last follow up. Outcome measures included rate of achievement of postoperative radiographic alignment goals (TK between 20 and 40 degrees, PI-LL mismatch within 10 degrees, and TPA <14 degrees). Predicted post-operative sagittal alignment was also compared with observed measurements. Student's and paired t-tests were performed to determine significant mean differences for continuous variables, and chi-square for categorical variables. Results: No differences were found in demographics, Lenke classification, preop radiographic measurements, fused levels, osteotomies, EBL, and surgical time in the surgeon contoured cohort (n=36; average follow up 11.3 months) and pre-contoured cohort (n=22; average follow up 9.7 months). At last follow up, 95.5% of patients with pre-contoured rods vs. 61.1% of patients with surgeon contoured rods (P=0.004) met TK goal. During assessment of first standing postoperative X-ray, 72.7% of patients with pre-contoured rods vs. 33.3% of patients with surgeon contoured rods met PI-LL mismatch goal (P=0.004). Other radiographic measurements were similar. Artificial intelligence (AI) predicted and observed differences for the pre-contoured group were 3.7 for TK (P=0.005), -7.6 for PI-LL mismatch (P=0.002), and -2.6 for TPA (P=0.11). Conclusions: AI and pre-contoured rods help achieve global sagittal balance with high accuracy and improved kyphosis restoration and PI-LL mismatch than surgeon contoured rods in AIS patients.

Consistent anatomical relationships of pedicle, lamina, and superior articulating process in severe idiopathic scoliosis allow for safe freehand pedicle screw placement: A proof-of-concept technical study.

Introduction: Transpedicular screw placement has superior pullout strength compared to alternative forms of spinal fusion and is often performed in deformity correction surgery with navigation for optimal accuracy and reliability. Freehand technique for pedicle screws minimizes operation time and radiation exposure without fluoroscopy but is not widely adopted given the challenge of difficult anatomical corridors and accurate placement, especially in idiopathic scoliosis and advanced deformity. We used a computer-generated model to assess a proof-of-concept and anatomical feasibility of a freehand screw technique in severe scoliosis. Methods: Three-dimensional (3D) reconstructions of vertebra from a sample of two male patients with severe idiopathic scoliosis deformity (1 thoracic and 1 lumbar) with Cobb angles of 100° were used for planned placement of 17 levels of thoracolumbar (6.5 mm × 45 mm) pedicle screws. 3D reconstruction of each vertebra was created and measurements of screw entries and trajectories were reproduced with a 3D slicer software image computing platform. Results: Accurate transpedicular screw placement is possible with anatomical landmarks based on the 3D reconstructed vertebral levels. A series of 5 figures were assembled to demonstrate sagittal, coronal, and axial planes and key anatomical landmarks and trajectories of thoracic and lumbar freehand pedicle screws in severe idiopathic scoliosis. Conclusions: Anatomical landmarks for freehand transpedicular screw placement (between pedicle, lamina, and superior articulating process) are constant and reliable in severe idiopathic scoliosis as evidenced by 3D computer modeling. Preoperative computed tomography modeling may assist appropriate screw entry and trajectory based on anatomical landmarks for spine surgeons, and guide freehand technique for screw placement in adolescent idiopathic scoliosis.

Representation and Race in Adolescent Idiopathic Scoliosis Research: Disparities in Curve Magnitude and Follow-Up.

STUDY DESIGN: Prospective Cohort Study. OBJECTIVE: The present study aims to determine if the racial representation of patients enrolled in a large prospective scoliosis registry is reflective of the general United States population. Further, we studied whether there was an association between race, pre-operative parameters, outcomes and loss to follow-up. METHODS: Prospectively collected data for patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS) was reviewed, including self-reported race/ethnicity. The U.S. pediatric population and U.S. patients enrolled in the prospective registry were compared. The data obtained was analyzed for variations between races, for pre-operative variables and follow-up. RESULTS: Of the 2210 included patients in the registry 66% of patients reported as White, while 52% of the 2018 U.S. pediatric population reported as White. 15% of the registry reported as Hispanic/Latino compared to 22% of the U.S. pediatric population, 13% Black compared to 14% of the U.S. pediatric population, and 4% Asian compared to 5% of the U.S. pediatric population. Asian and White patients had statistically significant higher 2-year follow-up in all but one of six enrollment sites (P < 0.001). Native American, Other, and Hispanic/Latino patients had the highest BMIs. Native American and Black patients had the highest pre-op thoracic Cobb angles. Pre-op ages of Black, Hispanic, and Native American patients were statistically lower (P < 0.01). CONCLUSION: This study demonstrates the association between race and patient follow-up and pre-operative factors in patients who underwent surgery for AIS. Black, Native American, and Hispanic populations were underrepresented both at pre-op and follow-up when compared to their relative proportion in the U.S. pediatric population.

The effect of bilateral ultrasound-guided erector spinae plane block on postoperative pain control in idiopathic scoliosis patients undergoing posterior spine fusion surgery: study protocol of a randomized controlled trial.

BACKGROUND: Posterior spinal fusion (PSF) for the correction of idiopathic scoliosis is associated with severe postoperative pain. Erector spinae plane block (ESPB) has been proposed to provide analgesia and reduce opioid consumption. We aimed to investigate the effect of bilateral ultrasound-guided single-shot ESPB on postoperative analgesia in pediatric patients undergoing PSF. METHODS: This double-blinded, randomized controlled trial will enroll 74 AIS patients undergoing elective PSF. Participants will be assigned to the ESPB group or control group at a 1:1 ratio. Patients in the ESPB group will receive ultrasound-guided bilateral ESPB preoperatively, and patients in the control group received sham ESPB using normal saline. The primary joint endpoints are the area under the curve (AUC) of numerical rating scale (NRS) score and opioid consumption in postoperative 24 h. The secondary endpoints are numerical rating scale (NRS) score and opioid consumption at postoperative 0.5, 3, 6, 9, 12, 24, 36, and 48 h, rescue analgesia, recovery outcomes, and adverse events. DISCUSSION: At present, studies investigating the effect of ESPB on pediatric patients are still needed. This study focuses on the effect of ESPB on pediatric patients undergoing PSF on postoperative pain control and intends to provide a new strategy of multimodal analgesia management for major spine surgery. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2300074505. Registered on August 8, 2023.

Incidence of Cervical Kyphosis and Factors Associated with Improvement in Postoperative Cervical Spinal Alignment in Idiopathic Scoliosis with Major Thoracolumbar/Lumbar and Thoracic Curves.

Background: This study aimed to compare the incidence and severity of cervical kyphosis before and after surgery between patients with adolescent idiopathic scoliosis (AIS) with major thoracolumbar/lumbar curves (Lenke type 5C group) and those with major thoracic curves (Lenke type 1A group). Further, factors associated with cervical spinal alignment changes after surgery in the two groups were examined. Methods: This study included consecutive patients with AIS who underwent posterior spinal fusion for Lenke type 1A and 5C curves and who were followed up for at least 1 year. To measure changes in sagittal alignment, all patients underwent radiography before, immediately after, and at 1 year after surgery. The correlation coefficients change the value of the C2-C7 angle before and after surgery (ΔC2-ΔC7) and other spinopelvic parameters were examined. Results: In total, 19 of 30 patients in the Lenke type 1A group and 21 of 36 in the Lenke type 5C group presented with cervical kyphosis preoperatively. Hence, the incidence of cervical kyphosis did not significantly differ between the two groups. Further, the two groups had significantly higher thoracic kyphosis (TK) and greater C2-C7 angles postoperatively. The TK of the Lenke type 5C group further increased at 1 year postoperatively. The Lenke 1A type group presented with a significant re-decrease in the C2-C7 angle at 1 year postoperatively. However, the C2-C7 angle of the Lenke type 5C group did not change. The ΔTK was closely associated with the ΔC2-ΔC7 in the Lenke type 1A group, but not in the Lenke type 5C group. Conclusions: In thoracic AIS, postoperative cervical alignment should achieve an adequate TK and promote correction of the coronal plane curve. Moreover, selective corrective surgery can improve postoperative cervical alignment in lumbar AIS.

The Optimal Lowest Instrumented Vertebra to Prevent the Distal Adding-On Phenomenon in Patients Undergoing Selective Thoracic Fusion for Adolescent Idiopathic Scoliosis with Lenke Type 1A and 1B Curves: Comparison of Nine Selection Criteria.

Background/Objectives: There is no solid consensus regarding which lowest instrumented vertebra (LIV) selection criterion is best to prevent distal adding-on (DA) after adolescent idiopathic scoliosis (AIS) surgery. This study aims to search out the LIV selection criteria in the literature and to compare the ability of each LIV selection criterion to prevent DA in patients with AIS. Methods: Patients who underwent thoracic fusion for AIS of Lenke type 1A or 1B were included in this study. Nine criteria for LIV selection were found in a literature review. For each patient, whether the postoperative actual location of LIV was met with the suggested locations of the LIV was assessed. The preventive ability of nine criteria against DA was evaluated using logistic regression analysis. The patients who met the LIV selection criteria but developed DA were investigated. Results: The study cohort consisted of 145 consecutive patients with a mean age of 14.8 years. The criteria of Suk (OR = 0.267), Parisini (OR = 0.230), Wang (OR = 0.289), and Qin (OR = 0.210) showed a significantly decreased risk of DA if the LIV selection criterion was chosen at each suggested landmark. As the additional levels were fused, there was no statistically significant benefit in further reducing the risk of DA. Among the patients who met each criterion, the incidence of DA was lower in criteria by Takahashi (5.9%), Qin (7.1%), and King (7.4%) than the others. Conclusions: Qin's criterion, using the substantially touching vertebra concept, has the highest preventive ability against DA development. Extending the instrumentation further distal to this suggested LIV criterion did not add further benefit.

The morphological discrepancy of neuromuscular junctions between bilateral paraspinal muscles in patients with adolescent idiopathic scoliosis: A quantitative immunofluorescence assay.

Introduction: Prior studies suggested that neuromuscular factors might be involved in the pathogenesis of adolescent idiopathic scoliosis (AIS). The neuromuscular junction (NMJ) is the important pivot where the nervous system interacts with muscle fibers, but it has not been well characterized in the paraspinal muscles of AIS. This study aims to perform the quantitative morphological analysis of NMJs from paraspinal muscles of AIS. Methods: AIS patients who received surgery in our center were prospectively enrolled. Meanwhile, age-matched congenital scoliosis (CS) and non-scoliosis patients were also included as controls. Fresh samples of paraspinal muscles were harvested intraoperatively. NMJs were immunolabeled using different antibodies to reveal pre-synaptic neuronal architecture and post-synaptic motor endplates. A confocal microscope was used to acquire z-stack projections of NMJs images. Then, NMJs images were analyzed on maximum intensity projections using ImageJ software. The morphology of NMJs was quantitatively measured by a standardized 'NMJ-morph' workflow. A total of 21 variables were measured and compared between different groups. Results: A total of 15 AIS patients, 10 CS patients and 5 normal controls were enrolled initially. For AIS group, NMJs in the convex side of paraspinal muscles demonstrated obviously decreased overlap when compared with the concave side (34.27% ± 8.09% vs. 48.11% ± 10.31%, p = 0.0036). However, no variables showed statistical difference between both sides of paraspinal muscles in CS patients. In contrast with non-scoliosis controls, both sides of paraspinal muscles in AIS patients demonstrated significantly smaller muscle bundle diameters. Conclusions: This study first elucidated the morphological features of NMJs from paraspinal muscles of AIS patients. The NMJs in the convex side showed smaller overlap for AIS patients, but no difference was found in CS. This proved further evidence that neuromuscular factors might contribute to the mechanisms of AIS and could be considered as a novel potential therapeutic target for the treatment of progressive AIS.

Real-time prediction of postoperative spinal shape with machine learning models trained on finite element biomechanical simulations.

PURPOSE: Adolescent idiopathic scoliosis is a chronic disease that may require correction surgery. The finite element method (FEM) is a popular option to plan the outcome of surgery on a patient-based model. However, it requires considerable computing power and time, which may discourage its use. Machine learning (ML) models can be a helpful surrogate to the FEM, providing accurate real-time responses. This work implements ML algorithms to estimate post-operative spinal shapes. METHODS: The algorithms are trained using features from 6400 simulations generated using the FEM from spine geometries of 64 patients. The features are selected using an autoencoder and principal component analysis. The accuracy of the results is evaluated by calculating the root-mean-squared error and the angle between the reference and predicted position of each vertebra. The processing times are also reported. RESULTS: A combination of principal component analysis for dimensionality reduction, followed by the linear regression model, generated accurate results in real-time, with an average position error of 3.75 mm and orientation angle error below 2.74 degrees in all main 3D axes, within 3 ms. The prediction time is considerably faster than simulations based on the FEM alone, which require seconds to minutes. CONCLUSION: It is possible to predict post-operative spinal shapes of patients with AIS in real-time by using ML algorithms as a surrogate to the FEM. Clinicians can compare the response of the initial spine shape of a patient with AIS to various target shapes, which can be modified interactively. These benefits can encourage clinicians to use software tools for surgical planning of scoliosis.

Association between Adverse Psychological Emotions and Postoperative Brace for Adolescent Idiopathic Scoliosis: A Prospective Cohort Study with Propensity Score Matching.

OBJECTIVE: Although the advantages of postoperative braces have been verified in many fields, it is not clear whether postoperative braces can help reduce patients' adverse psychological emotions such as kinesiophobia, anxiety, and depression. This study aims to analyze whether the use of a postoperative brace helps reduce adverse psychological emotions in adolescent idiopathic scoliosis (AIS) patients undergoing spinal deformity surgeries. METHODS: All consecutive patients who underwent spinal corrective surgeries at our institution between April 2023 and July 2023 formed the prospective cohort. Outcome measures were collected in the preoperative period, 3 months after surgery, and 6 months after surgery. All patients were assessed using the Tampa scale for kinesiophobia (TSK), the hospital anxiety and depression scale (HADS), and the numerical rating scale (NRS). A statistical model of propensity score matching was used to eliminate potential selection bias and maintain comparability. Multivariate linear regression models were used to determine the relationship between postoperative brace and adverse psychological emotions. RESULTS: After propensity score matching, this study ultimately enrolled 150 patients. There were no significant differences between the two groups in terms of demographic and perioperative variables. The fully adjusted model showed that the TSK scores of the non-brace group at the 3-month (ꞵ = 2.50, 95% CI 0.80-4.20, p = 0.005) and 6-month follow-up (ꞵ = 2.75, 95% CI 0.75-4.74, p = 0.007) were significantly higher than those of the brace group. The HADS score of the non-brace group at the 3-month follow-up was significantly higher than that of the brace group (ꞵ = 1.75, 95% CI 0.28-3.22, p = 0.019). The NRS score of the non-brace group at the 3-month follow-up was significantly higher than that of the brace group (ꞵ = 0.69, 95% CI 0.05-1.33, p = 0.034). At the 6-month follow-up, there were no significant difference for HADS score or NRS score between the two groups. CONCLUSION: In the early postoperative period, the postoperative brace could provide AIS patients with psychological supports and help them reduce the frequency of adverse psychological emotions. The postoperative brace could continuously improve the fear of movement within 6 months after surgery, and help reduce anxiety, depression, and pain within 3 months after surgery.

Optimising operating theatre (OT) efficiency while maintaining the standardised patient care in adolescent idiopathic scoliosis (AIS) surgery with the dedicated spine team approach: a specialised spine unit experience.

PURPOSE: To report the efficiency of OT utilisation and perioperative outcomes with a dedicated spine team approach in AIS patients who underwent posterior spinal fusion (PSF) surgeries in a consecutive case operation list. METHODS: Three AIS patients operated in a day (8:00 AM-8:00 PM) by a dedicated spine team were recruited between 2021 and 2022. The dedicated team comprised of three senior spine consultants who operated using a dual attending surgeon strategy, an anaesthetic consultant, dedicated surgical scrub nurses, anaesthesiology nurses, radiographers, and neuromonitoring technicians. Patients were categorised according to the sequence of operation list of the day (Case 1, Case 2, and Case 3). OT efficiency was represented by OT time in five stages (preoperative time, operative time, postoperative time, total OT time, and turnover time). OT time and perioperative outcomes were compared. RESULTS: 102 cases were analysed. On average, Case 1 began at 8:38 AM whereas Case 3 ended by 5:54 PM. OT efficiency was consistent throughout the day of operation with comparable OT time in all five stages between groups (p > 0.05). The mean turnover time was 15.1 ± 13.5 min and the mean operative time was 123.0 ± 28.1 min. Intraoperative arterial blood gas (ABG) parameters were maintained in an optimal range. The complication rate was 2.0% (N = 2/102). CONCLUSION: Consistent OT efficiency was demonstrated with a dedicated spine team approach. Despite performing three AIS cases in a consecutive case operation list, patients' safety was not compromised as perioperative outcomes between groups were comparable.

The Validation of the Japanese Version of the Scoliosis Research Society-30 Questionnaire for Adolescent Idiopathic Scoliosis Patients.

Introduction: The Scoliosis Research Society-30 (SRS-30) is a questionnaire originally developed from the SRS-22r questionnaire and is used to evaluate adolescent idiopathic scoliosis (AIS). It comprised questions on five domains: function, pain, self-image, mental health, and satisfaction, with seven additional questions related to postoperative aspects. In addition to the original English version, translations in multiple languages have been effectively applied. Herein, we evaluated the internal consistency and external validity of the Japanese version of the SRS-30 for AIS patients. Methods: Among the 30 questions in SRS-30, the eight additional questions from SRS-22r were translated and back-translated to create a Japanese version of the SRS-30. This translated questionnaire was then used to survey patients with AIS who underwent corrective fusion surgery one year postoperatively. The internal consistency of the responses was evaluated using the Cronbach α coefficient. Additionally, the Spearman correlation analyses were conducted to assess the correlation between the scores obtained from the SRS-30 Japanese version and SRS-22r and the Oswestry Disability Index (ODI) for the overall scale and the five domains. Results: A total of 81 cases (eight males and 73 females; mean age at surgery 14.4 years) were enrolled. The mean preoperative Cobb angle was 51.0°. The Cronbach α coefficient for the overall SRS-30 was 0.861, indicating high internal consistency, while the coefficients for each domain were as follows: function/activity, 0.697; pain, 0.405; self-image/appearance, 0.776; mental health, 0.845; and satisfaction, 0.559. The SRS-30 total score significantly correlated with the SRS-22r total (r=0.945, P<0.001) and the ODI (r=-0.511, P<0.001). The SRS-30 domains highly correlated with the corresponding SRS-22r domains, with correlations ranging from r=0.826 to 0.901 (all P<0.001). Conclusions: The Japanese version of the SRS-30 demonstrated good internal and external validity. The SRS-30 can be used as an assessment tool for health-related quality of life in AIS patients.

Exploring the Effectiveness of Hatha Yoga as a Complementary Treatment for Adolescent Idiopathic Scoliosis: Clinical Effect and Future Research Directions.

Adolescent idiopathic scoliosis (AIS) is a common spinal deformity that primarily affects adolescents during the key period of growth and development. While traditional treatment methods often involve bracing or surgery, Hatha yoga, a millennia-old practice rooted in Indian tradition, has emerged as a complementary option for AIS cases. This paper explores the potential benefits of Hatha yoga for adolescents with AIS. It also discusses the limitations of existing research, such as the lack of large-scale randomized controlled trials (RCTs), varying yoga protocols, and challenges in blinding participants and researchers. To address these limitations, I propose future research directions, including conducting large-scale RCTs, long-term follow-up studies, standardized yoga protocols, and assessing safety concerns. I also highlight the need for tailored interventions and comparative effectiveness studies to better understand the potential of Hatha yoga in the holistic treatment of AIS in adolescents.