Biplanar stereoradiography predicts pulmonary function tests in adolescent idiopathic scoliosis: a cross-sectional study.

PURPOSE: Various spinal and rib cage parameters measured from complex examinations were found to be correlated with preoperative pulmonary function tests (PFT). The aim was to investigate the relationship between preoperative rib cage parameters and PFT using biplanar stereoradiography in patients with severe adolescent idiopathic scoliosis. METHODS: Fifty-four patients, 45 girls and nine boys, aged 13.8 ± 1.2 years, with Lenke 1 or 2 thoracic scoliosis (> 50°) requiring surgical correction were prospectively included. All patients underwent preoperative PFT and low-dose biplanar X-rays. The following data were collected: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, residual volume, slow vital capacity (SVC), total lung capacity (TLC), rib cage volume (RCV), maximum rib hump, maximum width, mean thoracic index, spinal penetration index, apical vertebral rotation, main curve Cobb angle (MCCA), T4-T12 kyphosis. The primary outcome was the relationship between rib cage parameters and PFT. The secondary outcome was the relationship between rib cage parameters and spine parameters. Data were analyzed using Spearman's rank test. A multivariable regression analysis was performed to compare PFTs and structural parameters. Significance was set at α = 0.05. RESULTS: The mean MCCA was 68.7° ± 16.7°. RCV was highly correlated with all pulmonary capacities: TLC (r = 0.76, p < 0.0001), SVC (r = 0.78, p < 0.0001) and FVC (r = 0.77, p < 0.0001). RCV had a low correlation with FEV1/FVC (r = - 0.34, p = 0.014). SPI was not correlated with any pulmonary parameters. CONCLUSION: Rib cage volume measured by biplanar stereoradiography may represent a prediction tool for PFTs. LEVEL OF EVIDENCE: Non-randomized cross-sectional study among consecutive patients, Level 2. These slides can be retrieved under Electronic Supplementary Material.

Kappa: Preliminary Results on a Novel Technique for Pelvic Fixation in Adult Spinal Deformity Correction.

Study Design: Retrospective cohort study. Objectives: Pelvic fixation in degenerative spinal deformation is as crucial as demanding. Several pelvic anchoring technics have been described, but loosening rates remain high for most solutions. Here is described the "Kappa" technic, combining ilio-sacral screws to S2A1 screws at 2 years of follow-up. Methods: Thirteen patients that underwent a spinal deformity correction with "Kappa" fixation to the pelvis and with more than 2 years of follow-up were prospectively included in this study. The surgical technic is described, and clinical and radiographic data have been collected for all patients. Results: The population exhibited an important pre-operative sagittal imbalance (mean SVA of 104,4 mm, mean PI-LL mismatch of 22,8°) that had improved significatively after surgery (mean SVA of 75,5 mm and mean PI-LL mismatch of 4,9°). No loosening of pull-out of the implants was to deplore at 2 years of follow-up. Conclusions: The association of ilio-sacral screw, resistant to pull-out because of the traction axis perpendicular to the construct, to S2A1 screws, known to be effective in sagittal balance restoration seems to be an effective and safe option to pelvic fixation for adult spinal deformity correction. Level of Evidence: IV.

3D quasi-automatic spine length assessment using low dose biplanar radiography after surgical correction in thoracic idiopathic scoliosis.

OBJECTIVE: Surgical correction of thoracic scoliosis leads to a height improvement. Our objectives were to assess how the linear and developed spinal column lengths relate to the frontal and sagittal parameters after a surgical correction of thoracic idiopathic scoliosis, and whether the measurement of these lengths is reliable using quasi-automatic 3D reconstruction methods with biplanar X-rays. METHODS: Consecutive children with thoracic idiopathic scoliosis who underwent spinal fusion surgery and biplanar pre and postoperative X-rays in free-standing position were included prospectively. Quasi-automatic computed 3D reconstructions of the spine were done using a previously validated technique and allowed the automatic computation of geometrical spinopelvic parameters including OD-pelvis, linear, and developed T1-T12 and T1-L5 lengths. RESULTS: Thirty patients with scoliosis were included, and 240 reconstructions were performed (2 operators x2 repetitions x30 patients pre and postoperative). The main thoracic Cobb angle, T1-T12, T1-L5 linear and developed distance, OD-pelvis were significantly improved (p < 0.001). The gain of the main thoracic Cobb angle (31.6°;SD = 9°) was correlated to the gain of the linear distance T1-T12 (15.3 mm;SD=7.3 mm)(rho = 0.76;p < 0.0001) and T1-L5 (24.7 mm;SD = 8 mm)(rho = 0.64;p < 0.0001). The postoperative change of developed length between T1-L5 represented 41% of the gain in linear distance between the same vertebrae. Similarly, the gain of T1-T12 developed length was 50% of linear T1-T12 height gain. Both differences were significant (p = 0.01). Absolute bias using Bland & Altman plots was lower than 1 mm for linear distance (0.1%) and lower than 2 mm (0.3%) for developed distance. CONCLUSION: The gain in spinal length is correlated to the thoracic Cobb angle correction in the surgical treatment of idiopathic thoracic scoliosis. The new significant finding is that the developed spinal height gain represented approximately a little less than 50% of the linear spinal height gain and these parameters were reliable from a 3D quasi-automatic reconstruction of biplanar X-ray.

Forearm reconstruction by induced-membrane technique after sarcoma resection in children: technique and functional outcome in three cases.

Forearm sarcoma is rare in children. Here, we report three cases. One child presented undifferentiated soft-tissue sarcoma involving the ulna, another had Ewing's sarcoma of the ulna, and the third had Ewing's sarcoma of the proximal radius. In the first case, there were episodes of iterative aseptic nonunion, treated surgically. At last follow-up (respectively 11, 9 and 8 years postoperatively), the mean Musculoskeletal Tumor Society (MSTS) score was 80%, 90% and 77% respectively, and all cases were in remission. The induced membrane technique to reconstruct bone defect after sarcoma resection in children is a possible limb-salvage strategy.

Is daily walking distance affected in adolescent idiopathic scoliosis? An original prospective study using the pedometer on smartphones.

BACKGROUND DATA: Little is known about daily walking distance levels, which accounts for approximately 80% of overall physical activity per day, in adolescents with idiopathic scoliosis (AIS). OBJECTIVE: The aim of this study was to assess the level of walking distance in AIS treated by bracing or not, comparing this activity with that of a control group. We used an original method based on smartphone pedometers for studying walking distance in everyday life. METHODS: Nineteen AIS patients, aged 14.1 (13-17) years, and 25 asymptomatic patients, aged 12.9 (12-14) years were included prospectively. The 19 AIS cases comprised 9 untreated individuals and 10 with ongoing night brace treatment. The mean walking distance per day as estimated by the pedometer application on smartphones for 2 months was assessed. Weekly sports activities (hours per week) were also reported. RESULTS: During the first month, the mean walking distance was 2.58±0.65 km/day for control patients, 2.31±1.38 km/day for untreated AIS, and 3.65±0.72 km/day for AIS patients treated with a night brace. During the second month, the mean walking distance was 2.60±0.73 km/day for control patients, 2.40±1.41 km/day for untreated AIS, and 3.70±0.72 km/day for AIS patients treated with a night brace. Statistical analysis between groups showed a statistically significant difference with a higher level of daily walking distance in adolescents treated with a night brace compared with other groups. CONCLUSION: The pedometer on smartphones is a cost-effective and friendly tool to assess adolescents' level of walking distance. Our results indicate no restriction in terms of daily walking distance between adolescents without scoliosis and those with idiopathic scoliosis. LEVEL OF EVIDENCE: Level II.