BACKGROUND The treatments for early-onset scoliosis(EOS),defined as curvature of the spine with onset before 10 years of age,continue to pose a great challenge for pediatric orthopedics.The treatment goals for EOS inc...BACKGROUND The treatments for early-onset scoliosis(EOS),defined as curvature of the spine with onset before 10 years of age,continue to pose a great challenge for pediatric orthopedics.The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function.Different surgical techniques have different advantages and drawbacks;however,the two major concerns in the management of EOS are repeated surgeries and complications.AIM To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries.METHODS In January 2021 two independent reviewers systematically searched three electronic medical databases(PubMed,the Cochrane Library,and Embase)for relevant articles.Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Due to the heterogeneity of articles and topics after data analysis,a descriptive(synthetic)analysis was performed.RESULTS A total of 2136 articles were found.Forty articles were included in this systematic review,after applying our inclusion and exclusion criteria.EOS surgery has a varying but high rate of complications.The most frequent complications were categorized as implant(54%),general(17%),wound(15%)and alignment(12%).The rate of complications might have been even higher than reported,as some authors do not report all types of complications.About 54%of patients required unplanned surgeries due to complications,which comprised 15%of all surgeries.CONCLUSION The literature concerning the definitions,collection,and interpretation of data regarding EOS surgery complications is often difficult to interpret.This creates problems in the comparison,analysis,and improvement of spine surgery practice.Additionally,this observation indicates that data on the incidence of complications can be underestimated,and should be interpreted with caution.Awareness of the high rate of complications of EOS surgery is crucial,and an optimal strategy for prevention should become a priority.展开更多
BACKGROUND The management of idiopathic scoliosis(IS)in skeletally immature patients should aim at three-dimensional deformity correction,without compromising spinal and chest growth.In 2019,the US Food and Drug Admin...BACKGROUND The management of idiopathic scoliosis(IS)in skeletally immature patients should aim at three-dimensional deformity correction,without compromising spinal and chest growth.In 2019,the US Food and Drug Administration approved the first instrumentation system for anterior vertebral body tethering(AVBT),under a Humanitarian Device Exception,for skeletally immature patients with curves having a Cobb angle between 35°and 65°.AIM To summarize current evidence about the efficacy and safety of AVBT in the management of IS in skeletally immature patients.METHODS From January 2014 to January 2021,Ovid Medline,Embase,Cochrane Library,Scopus,Web of Science,Google Scholar and PubMed were searched to identify relevant studies.The methodological quality of the studies was evaluated and relevant data were extracted.RESULTS Seven clinical trials recruiting 163 patients were included in the present review.Five studies out of seven were classified as high quality,whereas the remaining two studies were classified as moderate quality.A total of 151 of 163 AVBT procedures were performed in the thoracic spine,and the remaining 12 tethering in the lumbar spine.Only 117 of 163(71.8%)patients had a nonprogressive curve at skeletal maturity.Twenty-three of 163(14.11%)patients required unplanned revision surgery within the follow-up period.Conversion to posterior spinal fusion(PSF)was performed in 18 of 163(11%)patients.CONCLUSION AVBT is a promising growth-friendly technique for treatment of IS in growing patients.However,it has moderate success and perioperative complications,revision and conversion to PSF.展开更多
The treatments for early-onset scoliosis(EOS)remain great challenges for spine surgeons.This study aimed to comprehensively review the treatments for EOS,especially the advancements made in the last decade.Current stu...The treatments for early-onset scoliosis(EOS)remain great challenges for spine surgeons.This study aimed to comprehensively review the treatments for EOS,especially the advancements made in the last decade.Current studies on EOS were retrieved through a search on PubMed,UpToDate,the Web of Science Core Collection and Scopus were reviewed.The most pertinent information related to the current treatments for EOS was collected.The foci of treatments for EOS have included creating a well-developed thoracic cavity,improving lung volume,and improving pulmonary function.Conservative treatments include bracing,casting,halo-gravity traction,and physiotherapy.Serial casting is the most effective conservative treatment for EOS.Surgical treatments mainly include growth-friendly techniques,which are generally classified into three types according to the amount of correction force applied:distraction-based,compression-based,and growth-guided.The distraction-based systems include traditional or conventional growing rods,magnetically controlled growing rods,and vertical expandable prosthesis titanium ribs.The compression-based systems include vertebral body stapling and tethering.The growth-guided systems include the Shilla system and modern Luque trolley.In addition,some newer techniques have emerged in recent years,such as posterior dynamic deformity correction(ApiFix).For EOS patients presenting with sharp deformities in a long,congenital spinal deformity,a hybrid technique,one-stage posterior osteotomy with short segmental fusion and dual growing rods,may be a good choice.Hemivertebra resection is the gold standard for congenital scoliosis caused by single hemivertebra.Although the patient’s growth potential is preserved in growth-friendly surgeries,a high complication rate should be expected,as well as a prolonged treatment duration and additional costs.Knowledge about EOS and its treatment options is rapidly expanding.Conservative treatments have specific limitations.For curves requiring a surgical intervention,surgical techniques may vary depending on the patients’characteristics,the surgeon’s experience,and the actual state of the country.展开更多
文摘BACKGROUND The treatments for early-onset scoliosis(EOS),defined as curvature of the spine with onset before 10 years of age,continue to pose a great challenge for pediatric orthopedics.The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function.Different surgical techniques have different advantages and drawbacks;however,the two major concerns in the management of EOS are repeated surgeries and complications.AIM To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries.METHODS In January 2021 two independent reviewers systematically searched three electronic medical databases(PubMed,the Cochrane Library,and Embase)for relevant articles.Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Due to the heterogeneity of articles and topics after data analysis,a descriptive(synthetic)analysis was performed.RESULTS A total of 2136 articles were found.Forty articles were included in this systematic review,after applying our inclusion and exclusion criteria.EOS surgery has a varying but high rate of complications.The most frequent complications were categorized as implant(54%),general(17%),wound(15%)and alignment(12%).The rate of complications might have been even higher than reported,as some authors do not report all types of complications.About 54%of patients required unplanned surgeries due to complications,which comprised 15%of all surgeries.CONCLUSION The literature concerning the definitions,collection,and interpretation of data regarding EOS surgery complications is often difficult to interpret.This creates problems in the comparison,analysis,and improvement of spine surgery practice.Additionally,this observation indicates that data on the incidence of complications can be underestimated,and should be interpreted with caution.Awareness of the high rate of complications of EOS surgery is crucial,and an optimal strategy for prevention should become a priority.
文摘BACKGROUND The management of idiopathic scoliosis(IS)in skeletally immature patients should aim at three-dimensional deformity correction,without compromising spinal and chest growth.In 2019,the US Food and Drug Administration approved the first instrumentation system for anterior vertebral body tethering(AVBT),under a Humanitarian Device Exception,for skeletally immature patients with curves having a Cobb angle between 35°and 65°.AIM To summarize current evidence about the efficacy and safety of AVBT in the management of IS in skeletally immature patients.METHODS From January 2014 to January 2021,Ovid Medline,Embase,Cochrane Library,Scopus,Web of Science,Google Scholar and PubMed were searched to identify relevant studies.The methodological quality of the studies was evaluated and relevant data were extracted.RESULTS Seven clinical trials recruiting 163 patients were included in the present review.Five studies out of seven were classified as high quality,whereas the remaining two studies were classified as moderate quality.A total of 151 of 163 AVBT procedures were performed in the thoracic spine,and the remaining 12 tethering in the lumbar spine.Only 117 of 163(71.8%)patients had a nonprogressive curve at skeletal maturity.Twenty-three of 163(14.11%)patients required unplanned revision surgery within the follow-up period.Conversion to posterior spinal fusion(PSF)was performed in 18 of 163(11%)patients.CONCLUSION AVBT is a promising growth-friendly technique for treatment of IS in growing patients.However,it has moderate success and perioperative complications,revision and conversion to PSF.
基金The study was granted by a grant from the National Natural Science Foundation of China(No.81972037).
文摘The treatments for early-onset scoliosis(EOS)remain great challenges for spine surgeons.This study aimed to comprehensively review the treatments for EOS,especially the advancements made in the last decade.Current studies on EOS were retrieved through a search on PubMed,UpToDate,the Web of Science Core Collection and Scopus were reviewed.The most pertinent information related to the current treatments for EOS was collected.The foci of treatments for EOS have included creating a well-developed thoracic cavity,improving lung volume,and improving pulmonary function.Conservative treatments include bracing,casting,halo-gravity traction,and physiotherapy.Serial casting is the most effective conservative treatment for EOS.Surgical treatments mainly include growth-friendly techniques,which are generally classified into three types according to the amount of correction force applied:distraction-based,compression-based,and growth-guided.The distraction-based systems include traditional or conventional growing rods,magnetically controlled growing rods,and vertical expandable prosthesis titanium ribs.The compression-based systems include vertebral body stapling and tethering.The growth-guided systems include the Shilla system and modern Luque trolley.In addition,some newer techniques have emerged in recent years,such as posterior dynamic deformity correction(ApiFix).For EOS patients presenting with sharp deformities in a long,congenital spinal deformity,a hybrid technique,one-stage posterior osteotomy with short segmental fusion and dual growing rods,may be a good choice.Hemivertebra resection is the gold standard for congenital scoliosis caused by single hemivertebra.Although the patient’s growth potential is preserved in growth-friendly surgeries,a high complication rate should be expected,as well as a prolonged treatment duration and additional costs.Knowledge about EOS and its treatment options is rapidly expanding.Conservative treatments have specific limitations.For curves requiring a surgical intervention,surgical techniques may vary depending on the patients’characteristics,the surgeon’s experience,and the actual state of the country.
