Fundamental principle of adult spinal deformity.

The management of adult spinal deformity (ASD) requires a personalized, multidisciplinary approach. Effective treatment hinges on thorough assessment using advanced imaging to understand the severity and impact of the spinal curvature. This paper underscores the importance of tailoring treatment plans to individual patient factors such as age, health, and psychological well-being, weighing both surgical and non-surgical options.Non-surgical treatments like pain management and physical therapy are preferred initially. If surgery is necessary, candidate selection and the choice of surgical technique are crucial. Minimally invasive procedures and advanced technologies like robotics enhance precision and reduce risks.Postoperative care and continuous monitoring are essential to assess the success of the intervention and manage any complications. This comprehensive strategy aims to improve overall functionality and quality of life, ensuring that treatment addresses both the physical deformity and its broader impacts. (Presented at the 2010th Meeting, May 20, 2024).

Spinal Deformity in Sotos Syndrome: First Results of Growth-friendly Spine Surgery.

BACKGROUND: Sotos syndrome (SS), or cerebral gigantism, describes children with macrocephaly, craniofacial abnormalities, general overgrowth, ligamentous laxity, developmental delay, and neurological disabilities. Fewer than 500 cases have been reported since Sotos and colleagues described the condition in 1964 and no literature exists on the management of spinal deformity in children under 10 years old.The aims of this study were: (1) to characterize the presentation of spinal deformities in patients with SS; and (2) to provide preliminary results of growth-friendly instrumentation (GFI) in these children. METHODS: Thirteen children (9 boys) with SS and minimum of 2-year follow-up were identified from 2 multicenter early-onset scoliosis (EOS) databases (1997-2017). Mean age at index surgery and follow-up duration were 5.0 years (range, 1.8 to 10 y) and 7.2 years (range, 2.1 to 14.9 y), respectively. Patients underwent GFI for a mean of 5.7 years (range, 2 to 10.2 y), with an average of 9 lengthenings (range, 2 to 18). Definitive spinal fusion was performed in 4 patients (31%). Major curve magnitude, T1-T12 and T1-S1 lengths, thoracic kyphosis, and lumbar lordosis were evaluated preindex, postindex, latest GFI, and postfusion, when possible. RESULTS: Five thoracolumbar (38%), 4 double major (31%), 2 main thoracic (15%), and 2 double thoracic curves (15%) were seen that spanned a mean of 6.8 levels (5 to 9). Major curves improved 36% (range, 5% to 71%), from a mean of 71 degrees (range, 48 to 90 degrees) to 46 degrees (range, 20 to 73 degrees) postindex surgery (P<0.001). Major curves remained stable at a mean of 52 degrees (range, 20 to 87 degrees) at latest GFI (P=0.36). True T1-T12 and T1-S1 growth velocities during GFI were 0.5 mm/mo (range, 0.4 to 0.8 mm/mo) and 0.8 mm/mo (range, 0.1 to 2.1 mm/mo), respectively. Twenty-six complications occurred in 9 patients (69%) averaging 2 complications per patient (range, 0 to 7). CONCLUSIONS: This is the first study to evaluate the outcomes of GFI in children with SS and EOS. Compared with published data for outcomes of GFI in EOS, children with SS may have less major curve correction. Growth-friendly surgery remains an effective treatment method for EOS in patients with SS. LEVELS OF EVIDENCE: Level IV-retrospective case-series.

The Study of Subthalamic Deep Brain Stimulation for Parkinson Disease-Associated Camptocormia.

BACKGROUND Camptocormia is an axis symptom of Parkinson disease. It remains uncertain whether treatment with medications and surgery are effective. In this study, we assessed the efficacy of subthalamic nucleus deep brain stimulation (STN DBS) in Parkinson disease-associated camptocormia and explored some of its mechanisms. MATERIAL AND METHODS Parkinson disease-associated camptocormia was diagnosed by the following procedures. All patients underwent bilateral STN DBS. The patents' camptocormia was rated by degree and MDS Unified Parkinson's Disease Rating Scale (UPDRS) item 3.13 before and after DBS surgery. Rehabilitation and psychological interventions were used after surgery, in addition to adjustments of medication and stimulus parameters. The treatment effects on camptocormia were assessed comparing medication-off (presurgery) versus stimulation-on (post-surgery). Ethical approval for this study was provided through the Center of Human Research Ethics Committee (No. 2019-35). This study trial was registered in Chinese Clinical Trial Registry (No. ChiCTR1900022655). All the participants provided written informed consent. RESULTS After DBS surgery, all of study patients' symptoms were improved, with different levels of improvement. The minimum and maximum improvement rates were 20% and 100% respectively. The score of item 3.13 of the MDS-UPDRS III and the degree of camptocormia were found to be obviously improved (P<0.05). CONCLUSIONS STN DBS can improve Parkinson disease-associated camptocormia; STN DBS assisted with rehabilitation and psychological intervention appears to be more effective.

Adult spinal deformity surgical decision-making score. Part 2: development and validation of a scoring system to guide the selection of treatment modalities for patients above 40 years with adult spinal deformity.

PURPOSE: We aimed to develop and internally validate a scoring system, the adult spinal deformity surgical decision-making (ASD-SDM) score, to guide the decision-making process for ASD patients aged above 40 years. METHODS: A multicentre prospective ASD database was retrospectively reviewed. The scoring system was developed using data from a derivation set and was internally validated in a validation set. The performance of the ASD-SDM score for predicting surgical management was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: A total of 702 patients were included for analysis in the present study. The scoring system developed based on 562 patients, ranging from 0 to 12 points, included five parameters: leg pain scored by the numerical rating scale; pain and self-image domains in the Scoliosis Research Society-22 score; coronal Cobb angle; and relative spinopelvic alignment. Surgical indication was graded as low (score 0 to 4), moderate (score 5 to 7), and high (score 8 to 12) groups. In the validation set of 140 patients, the AUC for predicting surgical management according to the ASD-SDM score was 0.797 (standard error = 0.037, P < 0.001, 95% confidence interval = 0.714 to 0.861), and in the low, moderate, and high surgical indication groups, 23.7%, 43.5%, and 80.4% of the patients, respectively, were treated surgically. CONCLUSIONS: The ASD-SDM score demonstrated reliability, with higher scores indicating a higher probability of surgery. This index could aid in the selection of surgery for ASD patients in clinical settings. These slides can be retrieved under Electronic Supplementary Material.

Coexistence of cervical vertebral scalloping, pedicle deficiencies and dural ectasia in type I neurofibromatosis.

Neurofibromatosis type 1 (NF-1; also known as Von Recklinghausen's disease) is a common autosomal dominant disease that occurs in the general population at the rate of 1 in 3000. Many NF-1 patients present with spinal malformations. A 54-year-old female patient was admitted to the Outpatient Clinic of Dermatology with gradually increasing swelling and spots on the body that had been present for a long period of time. Cervical vertebral scalloping, pedicle deficiencies and dural ectasia (DE) were also detected. She was diagnosed with NF-1. NF-1 is routinely seen in dermatology practice. Coexistence of NF-1 with vertebral scalloping, pedicle deficiencies and DE rarely occurs. Our case is the second reported instance in the literature of NF-1 with a spinal anomaly in the cervical region, and the first reported instance of the coexistence of NF-1 with cervical vertebral scalloping, pedicle deficiencies and DE.

Automated and objective measures of gait dynamics in camptocormia Parkinson's Disease subthalamic deep brain stimulation.

OBJECTIVE: Axial motor features are common in Parkinson's disease (PD). These include gait impairment and postural abnormalities, such as camptocormia. The response of these symptoms to deep brain stimulation (DBS) is variable and difficult to assess objectively. For the first time, this study analyzes the treatment outcomes of two PD patients with camptocormia that underwent bilateral subthalamic nucleus (STN)-DBS evaluated with disruptive technologies. PATIENTS AND METHODS: Two patients with PD and camptocormia who underwent STN-DBS were included. Gait parameters were quantitatively assessed before and after surgery by using the NeuroKinect system and the camptocormia angle was measured using the camptoapp. RESULTS: After surgery, patient 1 improved 29 points in the UPDRS-III. His camptocormia angle was 68° before and 38° after surgery. Arm and knee angular amplitudes (117.32 ±â€¯7.47 vs 134.77 ±â€¯2.70°; 144.51 ±â€¯7.47 vs 169.08 ±â€¯3.27°) and arm swing (3.59 ±â€¯2.66 vs 5.40 ±â€¯1.76 cm) improved when compared with his preoperative measurements. Patient 2 improved 22 points in the UPDRS-III after surgery. Her camptocormia mostly resolved (47° before to 9° after surgery). Gait analysis revealed improvement of stride length (0.29 ±â€¯0.03 vs 0.35 ±â€¯0.03 m), stride width (18.25 ±â€¯1.16 vs 17.9 ±â€¯0.84 cm), step velocity (0.91 ±â€¯0.57 vs 1.33 ±â€¯0.48 m/s), arm swing (4.51 ±â€¯1.01 vs 7.38 ±â€¯2.71 cm) and arm and hip angular amplitudes (131.57 ±â€¯2.45° vs 137.75 ±â€¯3.18; 100.51 ±â€¯1.56 vs 102.18 ±â€¯1.77°) compared with her preoperative results. CONCLUSION: The gait parameters and camptocormia of both patients objectively improved after surgery, as assessed by the two quantitative measurement systems. STN-DBS might have a beneficial effect on controlling axial posturing and gait, being a potential surgical treatment for camptocormia in patients with PD. However, further studies are needed to derive adequate selection criteria for this patient population.

Adult spinal deformity surgical decision-making score : Part 1: development and validation of a scoring system to guide the selection of treatment modalities for patients below 40 years with adult spinal deformity.

PURPOSE: We aimed to develop and internally validate a simple scoring system: the adult spinal deformity (ASD) surgical decision-making (ASD-SDM) score, which is specific to the decision-making process for ASD patients aged below 40 years. METHODS: A multicentre prospective ASD database was retrospectively reviewed. The scoring system was developed using data from a derivation cohort and was internally validated in a validation cohort. The accuracy of the ASD-SDM score was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: A total of 316 patients were randomly divided into derivation (253 patients, 80%) and validation (63 patients, 20%) cohorts. A 10-point scoring system was created from four variables: self-image score in the Scoliosis Research Society-22 score, coronal Cobb angle, pelvic incidence minus lumbar lordosis mismatch, and relative spinopelvic alignment, and the surgical indication was graded into low (score 0-4), moderate (score 5-7), and high (score 8-10) surgical indication groups. In the validation cohort, the AUC for selecting surgical management according to the ASD-SDM score was 0.789 (SE 0.057, P < 0.001, 95% CI 0.655-0.880). The percentage of patients treated surgically were 21.1%, 55.0%, and 80.0% in the low, moderate, and high surgical indication groups, respectively. CONCLUSIONS: The ASD-SDM score, to the best of our knowledge, is the first algorithm to guide the decision-making process for the ASD population and could be one of the indices for aiding the selection of treatment for ASD. These slides can be retrieved under Electronic Supplementary Material.

Growth-Friendly Spine Surgery in Escobar Syndrome.

BACKGROUND: The aims of this study were to characterize the spinal deformity of patients with Escobar syndrome, describe results of growth-friendly treatments, and compare these results with those of an idiopathic early-onset scoliosis (EOS) cohort to determine whether the axial stiffness in Escobar syndrome limited correction. METHODS: We used 2 multicenter databases to review the records of 8 patients with EOS associated with Escobar syndrome who had at least 2-year follow-up after initiation of growth-friendly treatment from 1990 to 2016. An idiopathic EOS cohort of 16 patients matched for age at surgery (±1 y), postoperative follow-up (±1 y), and initial curve magnitude (±10 degrees) was identified. A randomized 1:2 matching algorithm was applied (α=0.05). RESULTS: In the Escobar group, spinal deformity involved 7 to 13 vertebrae and ranged from no vertebral anomalies in 3 patients to multiple segmentation defects in 6 patients. Mean age at first surgery was 5 years (range, 1.4 to 7.8 y) with a mean follow-up of 7.5 years (range, 4.0 to 10 y). Mean major curve improved from 76 degrees at initial presentation, to 43 degrees at first instrumentation, to 37 degrees at final follow-up (both P<0.001). Mean pelvic obliquity improved from 16 degrees (range, 5 to 31 degrees) preoperatively to 4 degrees (range, 0 to 8 degrees) at final follow-up (P=0.005). There were no differences in the mean percentage of major curve correction between the idiopathic EOS and Escobar groups at the immediate postoperative visit (P=0.743) or final follow-up (P=0.511). There were no differences between the cohorts in T1-S1 height at initial presentation (P=0.129) or in growth per month (P=0.211). CONCLUSIONS: Multiple congenital fusions and spinal curve deformity are common in Escobar syndrome. Despite large areas of congenital fusion, growth-friendly constructs facilitate spinal growth and improve curve correction. These results are comparable to those in idiopathic EOS. LEVEL OF EVIDENCE: Level III-case-control study.

Continuous Activity Tracking Using a Wrist-Mounted Device in Adult Spinal Deformity: A Proof of Concept Study.

BACKGROUND: Sagittal imbalance in adult spinal deformity (ASD) likely influences balance and ambulatory capacity because of muscular demand, pain, and disability. Disability measures for ASD rely heavily on ambulatory function; however, current metrics may fail to fully capture its contribution. We sought 1) to determine the utility of continuous remote step count monitoring and activity tracking in ASD using a consumer-friendly accelerometer, and 2) to investigate trends and patterns both before and after surgical intervention. CASE DESCRIPTION: One patient with progressive ASD was enrolled. Daily step count (SC), distance traveled (DT), and levels of activity were measured using a wrist-mounted device for 17 months. Spinopelvic parameters were measured from standing radiographs. The patient underwent T4-ilium long-segment fusion for correction of progressive deformity (coronal cobb angle: 8°; sagittal vertical axis: 4 cm; coronal vertical axis: 2 cm); recovery was uneventful. The device was worn for 216 of 520 (41%) recorded days during waking hours, with an average SC of 5254 ± 2696 per day. SC (P < 0.001), DT (P < 0.001), and minutes of light activity (LA) (P < 0.001) declined over the 9-month preoperative course, whereas sedentary activity increased (P < 0.001). After surgery, SC, DT, and LA decreased in the early postoperative period, with a significant increase at 7-8 months compared with the preoperative period (P < 0.001). CONCLUSIONS: Wrist-mounted devices are a noninvasive and effective measure to track daily activity and ambulatory capacity of patients with spinal deformity. In a single case, progressive deformity correlated with worsening activity levels, whereas deformity correction improved SC and activity level. These results support remote activity monitoring as an exploratory outcome for future studies.

High Correlation Between Achieved and Expected Distraction Using Magnetically Controlled Growth Rods (MCGR) With Rib to Pelvis Fixation in Pediatric Spine Deformity.

PURPOSE: Magnetically controlled implant systems have been established to treat severe progressive spinal deformity in children. The purpose of this study was to evaluate (1) the ratio between achieved and expected distraction length, (2) the complication rate and its risk factors as well as (3) the correlation of the distraction length and the length of the spine. METHODS: A total of 40 patients with an average follow-up of 34 (14 to 57) months were prospectively included in the study. Children underwent lengthening procedures every three months. The ratio between the distraction lengths was determined by comparing the measured distraction length of the rod on radiographs with the distraction length displayed on the external remote controller for the magnetically controlled growing rod (MCGR). Age, weight, height, and complications were repeatedly recorded. RESULTS: The analysis of 746 procedures showed the actual distraction to be 94.4% of the expected one. No difference between implants on the concave and convex spinal side was observed. The overall complication rate was 4.6% mainly because of failure of the implant or lack of implant extension, which was directly related to an increased BMI. There was also a strong correlation between achieved implant distraction length and gain in spinal length. CONCLUSIONS: Our study demonstrates a high ratio (0.94) between achieved and expected distraction length of magnetically controlled spinal rods. The complication rate was low (4.6%) and correlated to a high BMI. The correlation between the achieved implant distraction length and spinal length indicates the efficiency of the MCGR therapy. LEVEL OF EVIDENCE: Therapeutic Level IV.

Analysis of factors affecting baseline SF-36 Mental Component Summary in Adult Spinal Deformity and its impact on surgical outcomes.

OBJECTIVES: To identify the factors that affect SF-36 mental component summary (MCS) in patients with adult spinal deformity (ASD) at the time of presentation, and to analyse the effect of SF-36 MCS on clinical outcomes in surgically treated patients. METHODS: Prospectively collected data from a multicentric ASD database was analysed for baseline parameters. Then, the same database for surgically treated patients with a minimum of 1-year follow-up was analysed to see the effect of baseline SF-36 MCS on treatment results. A clinically useful SF-36 MCS was determined by ROC Curve analysis. RESULTS: A total of 229 patients with the baseline parameters were analysed. A strong correlation between SF-36 MCS and SRS-22, ODI, gender, and diagnosis were found (p < 0.05). For the second part of the study, a total of 186 surgically treated patients were analysed. Only for SF-36 PCS, the un-improved cohort based on minimum clinically important differences had significantly lower mean baseline SF-36 MCS (p < 0.001). SF-36 MCS was found to have an odds ratio of 0.914 in improving SF-36 PCS score (unit by unit) (p < 0.001). A cut-off point of 43.97 for SF-36 MCS was found to be predictive of SF-36 PCS (AUC = 0.631; p < 0.001). CONCLUSIONS: The factors effective on the baseline SF-36 MCS in an ASD population are other HRQOL parameters such as SRS-22 and ODI as well as the baseline thoracic kyphosis and gender. This study has also demonstrated that baseline SF-36 MCS does not necessarily have any effect on the treatment results by surgery as assessed by SRS-22 or ODI. LEVEL OF EVIDENCE: Level III, prognostic study.

[Radiation-Induced Radiculopathy with Paresis of the Neck and Autochthonous Back Muscles with Additional Myopathy]. / Parese der Nacken- und autochthonen Rückenmuskulatur durch strahleninduzierte zervikale Radikulopathie mit Begleitmyopathie.

Radiation-induced tissue damage is caused by ionizing radiation mainly affecting the skin, vascular, neuronal or muscle tissue. Early damages occur within weeks and months while late damages may occur months or even decades after radiation.Radiation-induced paresis of the spine or the trunk muscles with camptocormia or dropped-head syndrome are rare but have already been described as long-term sequelae after treatment of Hodgkin's lymphoma. The differential diagnosis includes limb-girdle muscular dystrophy, fascioscapulohumeral muscular dystrophy (FSHD) or lysosomal storage diseases (e. g. Acid Maltase Deficiency). We present the case of a patient with long lasting diagnostics over many months due to different inconclusive results.

Pathophysiological Concepts and Treatment of Camptocormia.

Camptocormia is a disabling pathological, non-fixed, forward bending of the trunk. The clinical definition using only the bending angle is insufficient; it should include the subjectively perceived inability to stand upright, occurrence of back pain, typical individual complaints, and need for walking aids and compensatory signs (e.g. back-swept wing sign). Due to the heterogeneous etiologies of camptocormia a broad diagnostic approach is necessary. Camptocormia is most frequently encountered in movement disorders (PD and dystonia) and muscles diseases (myositis and myopathy, mainly facio-scapulo-humeral muscular dystrophy (FSHD)). The main diagnostic aim is to discover the etiology by looking for signs of the underlying disease in the neurological examination, EMG, muscle MRI and possibly biopsy. PD and probably myositic camptocormia can be divided into an acute and a chronic stage according to the duration of camptocormia and the findings in the short time inversion recovery (STIR) and T1 sequences of paravertebral muscle MRI. There is no established treatment of camptocormia resulting from any etiology. Case series suggest that deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) is effective in the acute but not the chronic stage of PD camptocormia. In chronic stages with degenerated muscles, treatment options are limited to orthoses, walking aids, physiotherapy and pain therapy. In acute myositic camptocormia an escalation strategy with different immunosuppressive drugs is recommended. In dystonic camptocormia, as in dystonia in general, case reports have shown botulinum toxin and DBS of the globus pallidus internus (GPi-DBS) to be effective. Camptocormia in connection with primary myopathies should be treated according to the underlying illness.

Update on pathology and surgical treatment for adult spinal deformity.

Update on pathologies of adult spinal deformity (ASD): With advancement of aging society, ASD has become one of the most notable topics of spinal disorders owing to its significant impact on health related quality of life. Treatment for ASD is challenging due to complex nature of deformity and high prevalence of comorbidities. Spino-pelvic harmony that is evaluated by pelvic incidence (PI) minus lumbar lordosis (LL) is the most important concept, which allows us to understand pathology of ASD more deeply. Proposed optimum "PI minus LL" is within ±10°. However, according to analysis of patients having good surgical outcomes, minimum requirement of postoperative "PI minus LL" is calculated by following equation: "PI minus LL" = 0.41PI - 11.12 (r = 0.45, p = 0.0059). "PI minus LL" is not fixed but flexible value reflecting the specific setting of the individual PI. To date, little is known about dynamic global sagittal alignment that is susceptible to compensatory mechanisms. Gait analysis revealed that compensated sagittal balance by pelvic retroversion in static standing was lost immediately after walking due to alignment change of the pelvis and worsened over time. Dynamic assessment of sagittal balance is recommended. Update on surgical strategies for ASD: We classified ASD into following 5 types in terms of curve patterns, global balance, and curve flexibility: Type 1, well-balanced scoliosis with flexible kyphosis is indicated for corrective posterior spinal fusion (PSF) without any release procedures; Type 2, poor-balanced scoliosis with flexible kyphosis is well corrected by aggressive intervertebral release with PSF; Type 3, fixed sagittal imbalance without coronal deformity is candidate for pedicle subtraction osteotomy; Type 4, fixed sagittal imbalance with coronal deformity is indicated for vertebral column resection; and Type 5, severe scoliosis without marked global sagittal malalignment can be treated by corrective anterior spinal fusion. Minimally invasive lateral access surgery can be solution for reduction of surgical morbidity.

Complications After Surgical Treatment of Adolescent Idiopathic Scoliosis.

Even with current techniques and instrumentation, complications can occur after operative treatment of adolescent idiopathic scoliosis. The most dreaded complications-neurologic deficits-are relatively infrequent, occurring in 1% or less of patients. Nonneurologic deficits, such as infection, pseudarthrosis, curve progression, and proximal junctional kyphosis, are more frequent, but are much less likely to require reoperation or to cause poor functional outcomes. Understanding the potential complications of surgical treatment of pediatric spinal deformity is essential for surgical decision-making.

Radiation-induced camptocormia and dropped head syndrome: Review and case report of radiation-induced movement disorders.

BACKGROUND: In recent years, camptocormia and dropped head syndrome (DHS) have gained attention as particular forms of movement disorders. Camptocormia presents with involuntary forward flexion of the thoracolumbar spine that typically increases during walking or standing and may severely impede walking ability. DHS is characterized by weakness of the neck extensors and a consecutive inability to extend the neck; in severe cases the head is fixed in a "chin to chest position." Many diseases may underlie these conditions, and there have been some reports about radiation-induced camptocormia and DHS. METHODS: A PubMed search with the keywords "camptocormia," "dropped head syndrome," "radiation-induced myopathy," "radiation-induced neuropathy," and "radiation-induced movement disorder" was carried out to better characterize radiation-induced movement disorders and the radiation techniques involved. In addition, the case of a patient developing camptocormia 23 years after radiation therapy of a non-Hodgkin's lymphoma of the abdomen is described. RESULTS: In total, nine case series of radiation-induced DHS (n = 45 patients) and-including our case-three case reports (n = 3 patients) about radiogenic camptocormia were retrieved. Most cases (40/45 patients) occurred less than 15 years after radiotherapy involving extended fields for Hodgkin's disease. CONCLUSION: The use of wide radiation fields including many spinal segments with paraspinal muscles may lead to radiation-induced movement disorders. If paraspinal muscles and the thoracolumbar spine are involved, the clinical presentation can be that of camptocormia. DHS may result if there is involvement of the cervical spine. To prevent these disorders, sparing of the spine and paraspinal muscles is desirable.

[Long-term effects of radiation on the spine - Results of a cohort of symptomatic survivors of childhood and review of the literature]. / Effets à long terme de la radiothérapie sur le rachis - Résultats d'une cohorte monocentrique de patients adultes guéris d'un cancer pédiatrique symptomatiques au plan rachidien et revue de la littérature.

OBJECTIVES: The objective of the present retrospective study was to describe the clinical, radiological and bone characteristics of long-term survivors who have received radiotherapy involving some part of the vertebral column for certain childhood tumors. PATIENTS AND METHODS: Monocentric descriptive study of a cohort of patients followed at Gustave-Roussy in the framework of long-term monitoring treated for a solid tumor in childhood with radiotherapy on part of the spine and having back pain and/or spinal deformity have been addressed in the Service of Musculoskeletal Rehabilitation at the Cochin Hospital. For each patient, were performed standardized radiographs of the entire spine and spinal MRI. RESULTS: Eighteen patients were evaluated (average age of 35.4 ± 6.9 years; mean age at radiation therapy: 3.6 ± 2.8 years). Original tumors were nephroblastoma (9 cases), neuroblastoma (4 cases) and medulloblastoma (3 cases). Of the 15 patients analyzed by X-rays of the entire spine, 67% (10/15) patients had scoliosis (2 with a Cobb angle > 20°), 73% (11/15) had an abnormal thoracic kyphosis, 67% (10/15) had abnormal lumbar lordosis. Of the 16 patients analyzed by MRI, 75% (12/16) had discopathies or anomalies of the discal plate, 63% (10/16) had mild abnormalities of bone marrow. Muscle abnormalities were common (81%, 13/16). CONCLUSION: The main risk factors of spinal deformities are intraductal tumor, spinal surgery, spinal radiotherapy and a young age at the time of the cancer. These cured children require dedicated monitoring. Currently, this risk is reduced with the actual techniques of radiotherapy.

The minimum clinically important difference in SRS-22R total score, appearance, activity and pain domains after surgical treatment of adult spinal deformity.

STUDY DESIGN: Longitudinal cohort. OBJECTIVE: To establish minimum clinically important difference (MCID) threshold values for Scoliosis Research Society-22R (SRS-22R) domains in patients with adult spinal deformity undergoing surgical correction. SUMMARY OF BACKGROUND DATA: The SRS-22R has been shown to be reliable, valid and responsive to change in patients with adult spinal deformity undergoing surgery. The MCID quantifies a threshold of improvement that is clinically relevant to the patient. METHODS: Patients in a prospective database who completed the SRS-22R preoperatively and the SRS-30 1 year postoperatively were identified. Answers to the last 8 questions of the SRS-30 were used as anchors to determine MCID for the pain, appearance and activity domains, subscore, and total score using receiver-operating-characteristic curve analysis. Calculations of MCID using distribution-based methods were also done. RESULTS: A total of 1321 patients were included in the analysis; 83% were females and 10% were smokers. Mean age was 53 years. Mean body mass index was 26.3 kg/m. Mean preoperative SRS-22R appearance score was 2.50 improving to 3.62 at 1 year postoperatively (P < 0.001). Mean preoperative SRS-22R activity score was 2.96 and it improved to 3.33 at 1 year postoperatively (P < 0.001). Mean preoperative SRS-22R pain score was 2.73 improving to 3.60 at 1 year postoperatively (P < 0.001). Mean preoperative total score was 2.93 and it improved to 3.65 at 1 year postoperatively (P < 0.001). There was a statistically significant difference in domain scores among the responses to the anchors (P < 0.001). The different calculation methods yielded MCID values of 0.19 to 1.23 for appearance, 0.23 to 0.60 for activity, 0.24 to 0.57 for pain, 0.16 to 0.43 for subscore, and 0.17 to 0.71 for total score. CONCLUSION: When combined with previous reports, the results of this study in a population with adult spinal deformity undergoing surgical treatment show MCID for SRS-22 scores can be estimated as 0.4. This corresponds to a change of 1 interval in 2 of the 5 questions for a single domain. LEVEL OF EVIDENCE: 2.