Radiological Outcomes of Re-tethering for Adolescent Idiopathic Scoliosis: A 2-to-5-year Follow-Up Case Series After Index Vertebral Body Tethering Failure.

PURPOSE: Vertebral Body Tethering (VBT) has been shown to have a less predictable outcome compared to spinal fusion in patients with adolescent idiopathic scoliosis (AIS). Tether breakage is a common mechanical event that sometimes leads to loss of correction. No data has been published that evaluates the outcome of re-tethering in patients who underwent revision surgery for failed VBT, which was the purpose of this study. METHODS: This is an analysis of a prospectively collected single center database of 290 patients who have had VBT. Patients for this study were included if they have had re-tethering after failed VBT and a minimum follow up of 24 months after index surgery as well as a minimum follow up of 12 months after revision surgery. Revision surgeries included tether exchange, tether reinforcement and/or mono- and bisegmental lateral fusion. Main outcome of interest was curve magnitude at latest follow up. RESULTS: 11 patients were identified who received VBT for 16 curves of which 13 curves have had failed index surgery. Mean follow up from index surgery was 40 months, time between index and revision surgery was 22 months and latest follow up after revision surgery 19 months. Re-tethering resulted in an additional correction of 42% for thoracic and 63% for thoracolumbar curves. These results remained clinically stable with only minor loss of correction at final follow up. No patient underwent or was indicated for spinal fusion. CONCLUSION: Re-tethering is feasible and able to achieve additional correction and a sustainable result.

The efficacy of anterior vertebral body tethering in lenke type 6 curves for adolescent idiopathic scoliosis.

PURPOSE: Spinal fusion is the standard treatment for severe forms of adolescent idiopathic scoliosis (AIS). However, with the lowest instrumented vertebra that is usually located at L3 or L4, patients are prone to develop adjacent segment degeneration in the long term. Vertebral body tethering (VBT) as motion preserving technique has become an alternative for select patients with AIS. Several studies have presented the outcome after thoracic VBT but no study has analyzed the outcome after VBT for Lenke type 6 curves. METHODS: This is a retrospective single center data analysis of patients who have had bilateral VBT for Lenke type 6 curves and a minimum follow up of 24 months. Radiographic analysis was performed on several time points. Suspected tether breakages were additionally analyzed with respect to location and time at occurrence. RESULTS: 25 patients were included. Immediate thoracic curve correction was 55.4% and 71.7% for TL/L curves. Loss of correction was higher for TL/L curves and resulted in a correction rate of 48.3% for thoracic curves and 48.9% for TL/L curves at 24 months post-operatively. 22 patients were suspected to have at least one segment with a tether breakage. Three patients required a re-VBT but no patient received posterior spinal fusion. CONCLUSION: Bilateral VBT for Lenke type 6 curves is feasible and shows a significant curve correction for thoracic and TL/L curves at a minimum of 24 months post-operatively. Tether breakage rate and loss of correction remain an unfavorable observation that needs to be improved in the future.

Early-term outcome of apical fusion with vertebral body tethering for thoracolumbar curves in adolescent idiopathic scoliosis: a preliminary study.

INTRODUCTION: Vertebral body tethering (VBT) has become an alternative option for select patients with idiopathic scoliosis. However, studies have shown a high number of tether breakages, specifically after thoracolumbar (TL) VBT, that can have a negative impact on the outcome, when the breakage occurs within the first year after surgery. In order to overcome this problem, we have started to apply an apical fusion (AF) in combination with TL VBT for select patients. This study aims to analyze the outcome after AF plus VBT. METHODS: This is a retrospective single surgeon's data analysis. All patients were included who have had TL VBT after January 2022 and a follow-up of 12 months. Patients were grouped based on whether they only had VBT or VBT + AF. RESULTS: Twenty-five patients were analyzed (15 VBT, 10 VBT + AF). Both groups showed a significant curve correction for thoracic and TL curves. Minor loss of correction was observed in both groups. A significant difference was seen regarding early tether breakages, which were found in 60% of VBT patients and 10% of VBT + AF patients. CONCLUSION: The preliminary data shows a significant reduction of early tether breakages when TL VBT is applied in combination with AF.

Assessing the Reproducibility of the Structured Abstracts Generated by ChatGPT and Bard Compared to Human-Written Abstracts in the Field of Spine Surgery: Comparative Analysis.

BACKGROUND: Due to recent advances in artificial intelligence (AI), language model applications can generate logical text output that is difficult to distinguish from human writing. ChatGPT (OpenAI) and Bard (subsequently rebranded as "Gemini"; Google AI) were developed using distinct approaches, but little has been studied about the difference in their capability to generate the abstract. The use of AI to write scientific abstracts in the field of spine surgery is the center of much debate and controversy. OBJECTIVE: The objective of this study is to assess the reproducibility of the structured abstracts generated by ChatGPT and Bard compared to human-written abstracts in the field of spine surgery. METHODS: In total, 60 abstracts dealing with spine sections were randomly selected from 7 reputable journals and used as ChatGPT and Bard input statements to generate abstracts based on supplied paper titles. A total of 174 abstracts, divided into human-written abstracts, ChatGPT-generated abstracts, and Bard-generated abstracts, were evaluated for compliance with the structured format of journal guidelines and consistency of content. The likelihood of plagiarism and AI output was assessed using the iThenticate and ZeroGPT programs, respectively. A total of 8 reviewers in the spinal field evaluated 30 randomly extracted abstracts to determine whether they were produced by AI or human authors. RESULTS: The proportion of abstracts that met journal formatting guidelines was greater among ChatGPT abstracts (34/60, 56.6%) compared with those generated by Bard (6/54, 11.1%; P<.001). However, a higher proportion of Bard abstracts (49/54, 90.7%) had word counts that met journal guidelines compared with ChatGPT abstracts (30/60, 50%; P<.001). The similarity index was significantly lower among ChatGPT-generated abstracts (20.7%) compared with Bard-generated abstracts (32.1%; P<.001). The AI-detection program predicted that 21.7% (13/60) of the human group, 63.3% (38/60) of the ChatGPT group, and 87% (47/54) of the Bard group were possibly generated by AI, with an area under the curve value of 0.863 (P<.001). The mean detection rate by human reviewers was 53.8% (SD 11.2%), achieving a sensitivity of 56.3% and a specificity of 48.4%. A total of 56.3% (63/112) of the actual human-written abstracts and 55.9% (62/128) of AI-generated abstracts were recognized as human-written and AI-generated by human reviewers, respectively. CONCLUSIONS: Both ChatGPT and Bard can be used to help write abstracts, but most AI-generated abstracts are currently considered unethical due to high plagiarism and AI-detection rates. ChatGPT-generated abstracts appear to be superior to Bard-generated abstracts in meeting journal formatting guidelines. Because humans are unable to accurately distinguish abstracts written by humans from those produced by AI programs, it is crucial to exercise special caution and examine the ethical boundaries of using AI programs, including ChatGPT and Bard.

Radiographic outcome after vertebral body tethering of the lumbar spine.

INTRODUCTION: Multiple studies have analyzed the outcome after thoracic Vertebral Body Tethering (VBT). The results seem reproducible with most studies reporting coronal correction rates around 50% and a tether breakage rate near 20% at two years follow-up. There is a paucity of data on lumbar VBT, and no study has yet analyzed the radiographic outcome after lumbar VBT in a double tether technique at two years follow-up, which was the aim of this study. METHODS: This is a retrospective, single surgeons' data analysis of all consecutive immature patients who have had VBT of the lumbar spine (to L3 or L4) between January 2019 and September 2020. Primary interest focused on coronal curve correction at two years post-operatively. Suspected tether breakages were analyzed separately and defined as an angular change of more than 5° between two adjacent screws. RESULTS: Forty-one patients were eligible for this study and 35 (85%) had complete two-year follow-up data. Average age at surgery was 14.3 years. All patients had a Sanders stage of 7 or below. Average curve correction for thoracolumbar/lumbar curves at two years follow-up was 50%. 90% of patients had at least one level with a suspected tether breakage. No patient required a revision surgery within two years from surgery but two patients were surgically revised after two years. CONCLUSION: VBT in the lumbar spine resulted in 50% coronal curve correction two years post-operatively despite a tether breakage in 90% of patients.

Motion preservation surgery for scoliosis with a vertebral body tethering system: a biomechanical study.

PURPOSE: There is a paucity of studies on new vertebral body tethering (VBT) surgical constructs especially regarding their potentially motion-preserving ability. This study analyses their effects on the ROM of the spine. METHODS: Human spines (T10-L3) were tested under pure moment in four different conditions: (1) native, (2) instrumented with one tether continuously connected in all vertebrae from T10 to L3, (3) additional instrumented with a second tether continuously connected in all vertebrae from T11 to L3, and (4) instrumented with one tether and one titanium rod (hybrid) attached to T12, L1 and L2. The instrumentation was inserted in the left lateral side. The intersegmental ROM was evaluated using a magnetic tracking system, and the medians were analysed. Please check and confirm the author names and initials are correct. Also, kindly confirm the details in the metadata are correct. The mentioned information is correct RESULTS: Compared to the native spine, the instrumented spine presented a reduction of less than 13% in global ROM considering flexion-extension and axial rotation. For left lateral bending, the median global ROM of the native spine (100%) significantly reduced to 74.6%, 66.4%, and 68.1% after testing one tether, two tethers and the hybrid construction, respectively. In these cases, the L1-L2 ROM was reduced to 68.3%, 58.5%, and 38.3%, respectively. In right lateral bending, the normalized global ROM of the spine with one tether, two tethers and the hybrid construction was 58.9%, 54.0%, and 56.6%, respectively. Considering the same order, the normalized L1-L2 ROM was 64.3%, 49.9%, and 35.3%, respectively. CONCLUSION: The investigated VBT techniques preserved global ROM of the spine in flexion-extension and axial rotation while reduced the ROM in lateral bending.

[Posttraumatic deformity of the thoracolumbar spine]. / Posttraumatische Fehlstellungen der Brust- und Lendenwirbelsäule.

Posttraumatic kyphotic deformities of the thoracolumbar spine may result in significant clinical complaints. If conservative treatment is not successful, surgical correction of the kyphosis becomes an option. In contrast to degenerative deformities, posttraumatic kyphotic deformities are usual limited to few segments and can be treated with shorter constructs. The surgical strategy depends on the rigidity and the localization of the posttraumatic kyphotic deformity. In this respect purely posterior approaches and combined posteroanterior surgical approaches are available each with different advantages and disadvantages.

PSO without neuromonitoring: analysis of peri-op complication rate after lumbar pedicle subtraction osteotomy in adults.

PURPOSE: A decompensated sagittal imbalance has been associated with worsening health-related quality of life outcomes and increasing pain. Significant improvement in sagittal balance can be achieved using a pedicle subtraction osteotomy (PSO); however, this procedure has a high complication profile. A lumbar PSO has the advantages of direct visualization of all neural structures and safer retraction of the thecal sac. Sacrificing neuromonitoring may reduce anaesthesia time and lead to improved cost effectiveness of the surgery. However, there are no studies analyzing the complication rate of lumbar PSO without the use of neuromonitoring. We hypothesize that the neurologic complication rate remains comparable to published studies even without the use of intraoperative neuromonitoring. METHODS: The medical records of all patients of a single institution who received a lumbar PSO for sagittal imbalance between July 2012 and June 2014 were retrospectively analyzed. All surgeries were performed by the first author and without the use of intraoperative neuromonitoring. We analyzed the 30-day complication rate. RESULTS: Twenty-two patients were included in this study. The average age at surgery was 67 years. 16 patients had at least one previous lumbar surgery. The average fusion length was seven segments. All patients were instrumented to the sacrum and 19 patients additionally received spinopelvic instrumentation. The average amount of focal correction was 28°. The average surgical time was 362 min and blood loss was 2302 mL. A total of eight patients with complications were identified. There was a new neurologic postoperative deficit in two patients presenting as a foot drop. Five patients had an unplanned revision surgery. CONCLUSION: Historically, PSOs are associated with a high surgical complication rate and our results show comparable outcomes and complications to those previously reported. In our series, the absence of neuromonitoring in lumbar PSOs does not appear to increase the risk of neurological injury.

The Mid-term Outcome of Intervertebral Disc Degeneration after Direct Vertebral Rotation in Adolescent Idiopathic Scoliosis: Magnetic Resonance Imaging-based Analysis for a Mean 11.6-year Follow-up.

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To evaluate the mid-term effect of intervertebral disc degeneration (DD) in adolescent idiopathic scoliosis (AIS) patients who underwent pedicle screw instrumentation (PSI) and rod derotation (RD) with direct vertebral rotation (DVR). SUMMARY OF BACKGROUND DATA: Posterior spinal fusion is a mainstay of surgical treatment in AIS, and DVR is considered a main corrective maneuver for vertebral rotation. However, the mid-term effect of intervertebral DD after DVR is still unknown in AIS. METHODS: A total of 336 vertebrae for 48 AIS patients who underwent PSI and RD with DVR were retrospectively assessed for intervertebral DD. They were divided into two groups based upon intervertebral DD, defined as Pfirmann grade more than IV. The Pfirrmann grade and modic change were evaluated at the disc above the uppermost instrumented vertebra (UIV), the disc below the lowest instrumented vertebra (LIV), and the lumbar disc levels. RESULTS: With the 11.6 years of mean follow-up, 41.7% (20/48) of patients exhibited DD, while modic changes were observed in 4.2% (2/48) of included patients. The disc below the LIV, L4-5, and L5-S1 were significantly shown to have an increasing trend of Pfirmann grade. The preoperative thoracic kyphosis was significantly lower in the DD group (22.0°) than in the non-DD group (31.4°) (P = 0.025) and negatively correlated with DD (r = -0.482, P = 0.018). The Pfirrmann grade of L5-S1 showed a high level of correlation with DD (r = 0.604, P < 0.001). CONCLUSIONS: The degenerative change at the disc below the LIV, L4-5, and L5-S1 levels was observed following PSI and RD with DVR. Thoracic hypokyphosis may negatively influence intervertebral discs in AIS patients required for deformity correction. Therefore, restoration of thoracic kyphosis is important to prevent long-term DD in AIS.

Adolescent Idiopathic Scoliosis: Is the Feasible Option of Minimally Invasive Surgery using Posterior Approach?

The purpose of this systematic review and meta-analysis is to perform a systematic review and meta-analysis of previous studies on minimally invasive scoliosis surgery (MISS) in adolescents with idiopathic scoliosis (AIS). Some data on MISS in AIS compared with conventional open scoliosis surgery (COSS) are conflicting. A systematic literature search was conducted in Medline, Embase, and Cochrane Library, including studies reporting outcomes for MISS in AIS. The meta-analysis compared the operative, radiological, and clinical outcomes and complications between MISS and COSS in patients with AIS. Of the 208 records identified, 15 nonrandomized studies with 1,369 patients (reviews and case reports are excluded) were included in this systematic review and meta-analysis. The mean scale was 6.1, and eight of the 15 included studies showed satisfactory quality using the Newcastle-Ottawa scale. For operative outcomes, MISS had significant benefits in terms of estimated blood loss (standard mean difference [SMD], -1.87; 95% confidence interval [CI], -2.94 to -0.91) and hospitalization days (SMD, -2.99; 95% CI, -4.45 to -1.53) compared with COSS. However, COSS showed significantly favorable outcomes for operative times (SMD, 1.71; 95% CI, 0.92-2.51). No significant differences were observed in radiological outcomes, including Cobb's angle of the main curve and thoracic kyphosis. For clinical outcomes, MISS showed significant benefits on the visual analog scale score (SMD, -0.91; 95% CI, -1.36 to -0.47). The overall complication rates of MISS were similar to those of COSS (SMD, 0.96; 95% CI, 0.61-1.52). MISS using the posterior approach provides equivalent radiological and clinical outcomes and complication rates compared with COSS. Considering the lower estimated blood loss, shorter hospitalization days, and longer operative times in MISS, COSS is still the mainstay of surgical treatment in AIS; however, MISS using the posterior approach is also one of the surgical options of choice in the case of moderate AIS.

Analysis of risk factors for loss of lumbar lordosis in patients who had surgical treatment with segmental instrumentation for adolescent idiopathic scoliosis.

PURPOSE: Iatrogenic flattening of lumbar lordosis in patients with adolescent idiopathic scoliosis (AIS) was a major downside of first generation instrumentation. Current instrumentation systems allow a three-dimensional scoliosis correction, but flattening of lumbar lordosis remains a significant problem which is associated with decreased health-related quality of life. This study sought to identify risk factors for loss of lumbar lordosis in patients who had surgical correction of AIS with the use of segmental instrumentation. METHODS: Patients were included if they had surgical correction for AIS with segmental pedicle screw instrumentation Lenke type 1 or 2 and if they had a minimum follow-up of 24 months. Two groups were created, based on the average loss of lumbar lordosis. The two groups were then compared and multivariate analysis was performed to identify parameters that correlated to loss of lumbar lordosis. RESULTS: Four hundred and seventeen patients were analyzed for this study. The average loss of lumbar lordosis at 24 months follow-up was an increase of 10° lordosis for group 1 and a decrease of 15° for group 2. Risk factors for loss of lumbar lordosis included a high preoperative lumbar lordosis, surgical decrease of thoracic kyphosis, and the particular operating surgeon. The lowest instrumented vertebra or spinopelvic parameters were two of many parameters that did not seem to influence loss of lumbar lordosis. CONCLUSION: This study identified important risk factors for decrease of lumbar lordosis in patients who had surgical treatment for AIS with segmental pedicle screw instrumentation, including a high preoperative lumbar lordosis, surgical decrease of thoracic kyphosis, and factors attributable to a particular operating surgeon that were not quantified in this study.

The Risk and Benefits of Various Innovations in Fusion and Fusionless Surgery for AIS.

Adolescent idiopathic scoliosis is the most common variety of the condition, constituting a three-dimensional deformity of the spine and chest that primarily affects otherwise healthy adolescents [...].

Rotational Changes Following Use of Direct Vertebral Rotation in Adolescent Idiopathic Scoliosis: A Long-term Radiographic and Computed Tomography Evaluation.

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To evaluate long-term rotational changes in the vertebrae of patients with adolescent idiopathic scoliosis (AIS) who underwent direct vertebral rotation (DVR). SUMMARY OF BACKGROUND DATA: DVR using thoracic pedicle screws, a rotational corrective maneuver used in the surgical treatment of AIS, was introduced in 2004. Although DVR is considered to be the main axial corrective maneuver, the long-term rotational changes of vertebrae following this treatment are not well understood. METHODS: A total of 135 vertebrae that underwent DVR using thoracic pedicle screws with a minimum 5-year follow-up were retrospectively assessed for the vertebral rotation angle. Vertebral rotation of the apical vertebra (AV), and distal end vertebra (EV) was evaluated using the Nash-Moe scale, the rotational angle to the sacrum (RAsac), and the Aaro and Dahlborn method. Student's t-test (paired means) was used for continuous variables, and the chi-square test was used for categorical variables, as appropriate. A comparison of two and three groups used a one-way repeated measures analysis of variance, and the post hoc analysis used the Bonferroni test. RESULTS: The mean Nash-Moe scale of distal EV showed statistically significant differences between preoperative and postoperative values (P=0.034) and no statistically significant difference between postoperative and last follow-up values (P=1.000). The last follow-up RAsac of AV did not differ significantly from the preoperative RAsac of AV (P=0.515). The last follow-up RAsac of distal EV was significantly lower than the preoperative RAsac of distal EV (P=0.001). Pearson's correlation analysis showed that the last follow-up RAsac of distal EV was correlated with Cobb angle of the main curve (r=0.459, P=0.004), loss of correction (r=0.541, P=0.001), and LIV tilt angle (r=0.504, P=0.001). CONCLUSIONS: The rotation regression phenomenon in AV and rotation maintenance in distal EV were observed after DVR over an average of 10-year follow-up. These findings suggest that the DVR in the surgical treatment of AIS has a positive long-term effect on the stabilization of distal EV from the point of view of axial rotation. LEVEL OF EVIDENCE: IV.

Postoperative trunk shift in Lenke 1 and 2 curves: how common is it? and analysis of risk factors.

The goal of surgical treatment for adolescent idiopathic scoliosis (AIS) is to achieve a solid fusion in a balanced spine. While many previous studies analyzed coronal balance, there is a paucity of studies that comment on postoperative trunk shift, which has shown to have impact on clinical outcome. The purpose of this retrospective, multicenter data analysis was to analyze the incidence of postoperative trunk shift in patients with surgical treatment for AIS. We conducted a retrospective, multicenter data analysis of 1,555 patients with AIS. Patients with a Lenke type 1 or 2 curve pattern and a minimum follow-up of 24 months after surgery were included. A >2 cm deviation of the trunk in relation to the pelvis was considered positive trunk shift. A subanalysis was performed to identify potential risk factors for trunk shift. 273 patients meeting the inclusion criteria were analyzed. While the preoperative prevalence of trunk shift was surgically reduced from 29.3 to 13.6%, 24 patients (8.8%) with postoperative trunk shift had not had preoperative trunk shift, and the trunk shift was considered iatrogenic. Undercorrection of the lumbar curve was identified as potential risk factor, whereas thoracic correction, coronal balance, angulation and translation of the lowest instrumented vertebra did not seem to influence postoperative trunk shift. Iatrogenic postoperative trunk shift has an incidence of 8.8% in the surgical treatment of AIS.

Feasibility of Single-Staged Bilateral Anterior Scoliosis Correction in Growing Patients.

STUDY DESIGN: Retrospective analysis. OBJECTIVES: The objective of this study was to analyze the feasibility of correcting double-curve scoliosis using dynamic scoliosis correction (DSC, also known as vertebral body tethering), which requires a bilateral anterior approach with deflation of both lungs. Typically, this approach falls under the exclusionary criteria for the eligibility for anterior scoliosis surgery. No data exists on the feasibility of single-staged bilateral DSC. METHODS: A retrospective analysis was performed utilizing the data from 25 patients who underwent a bilateral anterior thoracic approach and instrumentation. Thirty-day postoperative complication rates were analyzed. A learning curve subanalysis was also performed to compare the first 12 patients to the remainder of the 13 patients, with a T-test (P ≤ .05). RESULTS: Of the 25 patients treated, there was 1 intraoperative event: After performing lumbar DSC, the contralateral DSC was abandoned due to unexpected pleural scarring and staged selective thoracic fusion was performed. We observed 4 postoperative complications: 2 patients had recurrent pleural effusions, 1 patient was diagnosed with pneumonia, and 1 patient had a minor pulmonary embolism without cardiopulmonary consequences (after an international 24 hour flight). All patients recovered well. We observed a significant influence of learning curve on surgical time (328 vs 280 min, P = .03) and blood loss (480 vs 197 mL, P = .03). CONCLUSION: Data suggests that bilateral, single-stage surgery for DSC is feasible albeit with an elevated complication rate that may partially attributable to the learning curve. Future research should focus on the cause of pulmonary complications and include a matched comparative analysis with traditional posterior fusion.

The Prevalence of the Use of MIS Techniques in the Treatment of Adult Spinal Deformity (ASD) Amongst Members of the Scoliosis Research Society (SRS) in 2016.

STUDY DESIGN: Electronic survey administered to Scoliosis Research Society members. OBJECTIVE: To determine the prevalence of minimally invasive surgery (MIS) techniques for the treatment of adult spinal deformity. SUMMARY OF BACKGROUND DATA: There is a paucity of data available on the practice pattern, prevalence of minimally invasive spine surgery, and the preferred minimally invasive techniques in the treatment of adult spine deformity. METHODS: An electronic nine-question survey regarding individual usage pattern of minimally invasive spine surgery techniques was administered in 2016 to the members of the Scoliosis Research Society. Determinants included complexity in condition of patient population, prevalence of use of minimally invasive techniques in the surgeon's practice, prevalence of use of a particular MIS technique, strategy elected during surgery, adoption of staging of procedures and timing between staging of procedures. RESULTS: A total of 357 surgeons responded (61.3% response rate), and 154 (43.1%) of the respondents said that they use MIS as a part of their surgical treatment of adult spinal deformity. However, of these 154 respondents, 67 (43.5%) said that their MIS usage in deformity practice was between 1% and 20%. Only 11 (7.2%) said that they used MIS 81% to 100% of the time. The top MIS approaches that surgeons chose were MIS lateral lumbar interbody fusion 109 (70.59%) and MIS percutaneous screws 91 (58.8%). CONCLUSIONS: The low rate of adoption of these techniques among the SRS members may be due to the false perception that there is not enough data to support that MIS techniques are better. This and the fact that a practitioner needs to be facile at different MIS techniques may be the true impediment to the adoption of MIS techniques in the treatment of ASD. LEVEL OF EVIDENCE: Level IV.

Sagittal Spinopelvic Parameters in Scheuermann's Kyphosis: A Preliminary Study.

STUDY DESIGN: Retrospective, controlled, clinical study. OBJECTIVES: To define the average values for sagittal spinopelvic parameters including pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) in Scheuermann's kyphosis (SK); evaluate the differences in spinopelvic parameters among patients with SK and unaffected normal controls; and evaluate the correlation of various sagittal spinopelvic parameters to each other in SK and normal controls. METHODS: Prospectively collected radiographic data from a study on SK were compared with those from previously published series of unaffected patients. Measures were made according to standard, defined measurement methods. Parameters measured included PT, PI, SS, thoracic kyphosis, lumbar lordosis, and radiographic sagittal alignment. Values were compared using independent-samples t test. Pearson correlation coefficient was used to analyze relationships between variables. RESULTS: A total of 47 patients with SK and 50 control patients, mean age 16.1 and 13.5 years, respectively, were included. In SK, average PI was 42°, average PT was 7°, and average SS was 35°. These values were not different from those of normal controls (PI, 46° [p = .084]; PT, 8° [p = .476]; SS, 37° [p = .162]). Pelvic incidence directly correlated with lordosis in both groups (p < .005). T5-12 kyphosis correlated with lordosis in normal controls (p ≤ .05) but not in the SK group. Kyphosis in SK as quantified by greatest measurable Cobb angle did not correlate with PI or lordosis. CONCLUSIONS: Sagittal pelvic alignment in patients with SK is not different from that in normal subjects. Furthermore, in SK thoracic kyphosis did not correlate with any distal region of the spine (lumbar or pelvic). Further understanding of the relationship between sagittal spinopelvic alignment in various conditions causing spinal deformity will lead to better treatment of these conditions.

Disease severity and treatment in adolescent idiopathic scoliosis: the impact of race and economic status.

BACKGROUND CONTEXT: Ethnic disparities have been documented in the incidence and treatment of many diseases. Additionally, race and socioeconomic status (SES) have been shown to affect disease severity and access to care in the recent orthopedic literature. PURPOSE: To assess the role, if any, that race, SES, and health insurance type play in disease severity and treatment decisions in patients with adolescent idiopathic scoliosis. STUDY DESIGN: Retrospective chart review. PATIENT SAMPLE: Pediatric patients seen in a single surgeon's practice over 6 years (2004-2009). OUTCOME MEASURES: Treatment modality (observation, bracing, or surgery). METHODS: Data were obtained from 403 patients seen over 6 years (2004-2009). A patient-reported questionnaire was used to collect race, age, family income, and parent marital status data. Race was self-reported as "Asian," "black or African American," "Hispanic or Latino," "white or Caucasian," or "Other." Socioeconomic status was determined using family income and type of health insurance as indicators. Major curve magnitude and prescribed initial treatment (observation, brace, or surgery) were assessed from physician records. An independent sample t test was used to detect differences in curve magnitude of the different racial groups. A Pearson chi-square analysis was used to detect group differences for curves in surgical patients, defined as curves greater than 40°, and their initial treatment. RESULTS: Patients self-identified with one of the following racial groups: white (N=219), black (N=86), Hispanic (N=44), Asian (N=37), or Other (N=17). Mean curve magnitude was greater in black than in white patients (33° vs. 28°, p<.05). Black patients were more likely to present with curves in the surgical range (34% vs. 24%, p<.05) and were more likely to have surgery as their initial treatment than white patients (34% vs. 19%, p<.05). Black patients had more limited health care plans and lower incomes compared with whites (p<.001). Patients with higher access insurance plans presented at a younger age than patients with more limited access plans, irrespective of race (13.6 vs. 14.1, p<.05). There was no difference in Cobb angle at presentation by income or type of insurance. CONCLUSIONS: Curve magnitude and percentage of patients with curves in the surgical range were greater in black than in white patients. There was no difference in age on presentation or treatment offered across all racial groups. Black patients were more likely to have surgery as their initial treatment than white patients. While race did have an impact on disease severity in this single surgeon's practice, SES did not.