The surgical treatment of severe scoliosis and kyphoscoliosis in the pediatric population is complicated and has high morbidity and mortality risks.Severe scoliosis has traditionally been defined by a coronal Cobb ang...The surgical treatment of severe scoliosis and kyphoscoliosis in the pediatric population is complicated and has high morbidity and mortality risks.Severe scoliosis has traditionally been defined by a coronal Cobb angle of greater than 90°or 100°.The usual corrective methods for these patients have been anterior or posterior release and osteotomies using a combined anterior-posterior or posterior-only approach.Many of these patients have pre-existing pulmonary compromise;therefore,an anterior approach is often not reasonable or possible.Acute correction of a deformity may also cause neurologic injury.Halo gravity traction(HGT)allows for progressive,gradual,and sustained correction of the spinal deformity in the coronal,sagittal,and axial planes,leading to a decrease in the amount of correction needed at definitive posterior fusion.This relates to decreased postoperative neurologic deficit and improved pulmonary function.Preoperative HGT has evolved to be the surgical adjunct in the treatment of severe spinal deformity.Indications for HGT,best protocols of application,and optimal duration of traction still lack uniformity;thus,a review of the literature remains relevant and necessary.This review summarizes the existing literature on HGT,including its indications,applications,duration of traction,and associated complications.展开更多
Congenital scoliosis(CS)is a prevalent spinal deformity with a multifaceted etiology that remains incompletely understood.Recent advances in genetic and epigenetic research have provided novel insights into CS pathoge...Congenital scoliosis(CS)is a prevalent spinal deformity with a multifaceted etiology that remains incompletely understood.Recent advances in genetic and epigenetic research have provided novel insights into CS pathogenesis.Herein,we review the current progress in genetics and epigenetics to examine genetic variants,susceptibility factors,and the epigenetic regulatory mechanisms implicated in CS.Through an analysis of diverse genetic markers,chromosomal abnormalities,and epigenetic modifications,the correlation between genetic predisposition and environmental influences in CS pathogenesis is elucidated.By integrating these genetic and epigenetic findings,this study aims to clarify the underlying etiology of CS to provide guidance on future clinical interventions and promote the development of personalized therapeutic strategies.展开更多
This letter compares the clinical efficacy and economic feasibility of the scoliocorrector fatma-UI(SCFUI)with direct vertebral rotation(DVR)in treating adolescent idiopathic scoliosis(AIS).SCFUI has shown promising r...This letter compares the clinical efficacy and economic feasibility of the scoliocorrector fatma-UI(SCFUI)with direct vertebral rotation(DVR)in treating adolescent idiopathic scoliosis(AIS).SCFUI has shown promising results in threedimensional spinal correction,providing superior rotational alignment compared to DVR and achieving significant improvements in coronal and sagittal planes.Additionally,SCFUI’s advanced design reduces risks associated with AIS surgeries and enhances overall patient outcomes.Economic analysis reveals SCFUI as a cost-effective option,potentially lowering long-term healthcare costs by minimizing complications and revisions.Our findings suggest that SCFUI is a viable,innovative approach in AIS treatment,meeting clinical and economic demands in orthopedic care.展开更多
Congenital atrial septal defect(ASD)with severe scoliosis is a rare compound malformation inchildren.Severe sco liosis should be corrected as soon as possible.The growth rod is suitable for patients withearly scoliosi...Congenital atrial septal defect(ASD)with severe scoliosis is a rare compound malformation inchildren.Severe sco liosis should be corrected as soon as possible.The growth rod is suitable for patients withearly scoliosis and obvious scoliosis under 10 years old.However,the fluoroscopic radiopaque of titaniumalloy plate will inevitably partly make the operative field of interventional occlusion blind.We presenta7-year-old Chinese girl with ASD and scoliosis who underwent spinal correction with a dual-growthrod.In this case,we performed transcatheter closure of ASD solely under the guidance of transthoracicechocardiography.Transthoracic echocardiography(TTE)has been reported as efficacious and safe forassessment and guidance of ASD occlusion.For patients with visual field occlusion under fluoroscopy,theapplication of TTE is efficacious and safe for assessmnent and guidance of ASD occlusion.展开更多
BACKGROUND Congenital scoliosis(CS)is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis.It occurs in 0.5%-1%in 1000 births and may rarely occur with congenital...BACKGROUND Congenital scoliosis(CS)is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis.It occurs in 0.5%-1%in 1000 births and may rarely occur with congenital defects affecting the heart or genitourinary system.Truncus arteriosus(TA)is a life-threatening cardiac defect in which a single arterial trunk supplies both systemic and pulmonary circulation,leading to complications such as pulmonary hypertension,heart failure,and severe hypoxia.Although rare individually,the co-occurrence of both conditions poses unique diagnostic and therapeutic challenges,with limited documentation in medical literature.CASE SUMMARY We present a 36-week preterm neonate with CS associated with TA type 1,pre-senting with respiratory distress,cyanosis,and altered spinal curvature.This case demonstrates the complexity of managing neonates with multiple congenital de-fects.Here,the patient was managed with oxygen supplementation,heart failure medication,nasogastric feeding,and multidisciplinary care to optimize her for surgical corrections.A coordinated,interdisciplinary approach was employed to optimize outcomes,particularly in a resource-limited setting.Immediate re-spiratory and cardiovascular stabilization and long-term orthopedic and cardiac interventions were central to improving the patient’s quality of life and survival.CONCLUSION Recognizing co-existing congenital anomalies and their embryological interre-lation is critical in holistic patient care,particularly during neonatal and infancy.展开更多
Due to the lack of human avoidance analysis,the orthosis cannot accurately apply orthopedic force during orthopedic,resulting in poor orthopedic effect.Therefore,the relationship between the human body’s active avoid...Due to the lack of human avoidance analysis,the orthosis cannot accurately apply orthopedic force during orthopedic,resulting in poor orthopedic effect.Therefore,the relationship between the human body’s active avoidance ability and force application is studied to achieve accurate loading of orthopedic force.First,a high-precision scoliosis model was established based on computed tomography data,and the relationship between orthopedic force and Cobb angle was analyzed.Then 9 subjects were selected for avoidance ability test grouped by body mass index calculation,and the avoidance function of different groups was fitted.The avoidance function corrected the application of orthopedic forces.The results show that the optimal correction force calculated by the finite element method was 60 N.The obese group had the largest avoidance ability,followed by the standard group and the lean group.When the orthopedic force was 60 N,the Cobb angle was reduced from 33.77°to 20°,the avoidance ability of the standard group at 50 N obtained from the avoidance function was 20.28%and 10.14 N was actively avoided.Therefore,when 50 N was applied,60.14 N was actually generated,which can achieve the orthopedic effect of 60 N numerical simulation analysis.The avoidance effect can take the active factors of the human body into consideration in the orthopedic process,so as to achieve a more accurate application of orthopedic force,and provide data reference for clinicians in the orthopedic process.展开更多
[Objectives]This meta-analysis evaluated the efficacy of Traditional Chinese Medicine(TCM)manual therapies(Tuina,Daoyin,acupotomology)for idiopathic scoliosis(IS),with dual focus on radiographic outcomes(Cobb angle,ve...[Objectives]This meta-analysis evaluated the efficacy of Traditional Chinese Medicine(TCM)manual therapies(Tuina,Daoyin,acupotomology)for idiopathic scoliosis(IS),with dual focus on radiographic outcomes(Cobb angle,vertebral rotation)and patient-centered metrics(pain,disability,quality of life).[Methods]This study systematically searched PubMed,Cochrane Library,EMBASE,Web of Science,CNKI,Wanfang,and VIP databases(from inception to July 2025)for randomized controlled trials(RCTs)comparing TCM manual therapies against controls(bracing,exercise,sham,or no intervention).Two reviewers independently extracted data and assessed methodological quality using the PEDro scale.Meta-analyses employed random-effects models(Stata 18)to calculate Hedges'g with 95%confidence intervals(CI).Heterogeneity was quantified via I 2 statistics,and subgroup analyses examined intervention types(standalone versus combined)and control groups.[Results]Radiographic outcomes:TCM therapies significantly reduced Cobb angle(Hedges'g=-0.93;95%CI:-1.37,-0.49;p<0.001)and vertebral torsion rotation(VTR;g=-0.71;95%CI:-0.91,-0.51;p<0.001)versus controls;patient-centered outcomes:substantial pain reduction(VAS:g=-1.47;95%CI:-2.64,-0.30;p=0.01)and disability improvement(ODI:g=-1.10;95%CI:-1.57,-0.64;p<0.001)were observed.Quality of life(SRS-22)showed non-significant gains(g=2.01;95%CI:-0.43,4.45;p=0.11).[Conclusions]TCM manual therapies significantly improve spinal alignment and reduce pain/disability in IS patients,particularly when integrated with exercise regimens.While results support their role as complementary interventions,standardization of protocols and long-term efficacy studies are needed for clinical implementation.展开更多
BACKGROUND Depression and anxiety are prevalent psychological challenges among patients with adolescent idiopathic scoliosis(AIS),affecting individuals across both sex and age groups.AIM To explore the network structu...BACKGROUND Depression and anxiety are prevalent psychological challenges among patients with adolescent idiopathic scoliosis(AIS),affecting individuals across both sex and age groups.AIM To explore the network structure of depression and anxiety symptoms,with a focus on identifying differences at the symptom level between sex and age subgroups.METHODS A total of 1955 participants diagnosed with AIS aged 10-18 years were assessed using the Patient Health Questionnaire Depression Scale(PHO-9)and the Generalized Anxiety Disorder Scale(GAD-7),and 765 patients exhibiting PHQ-9 or GAD-7 scores ≥ 5 were enrolled in our study. Network analysis and network comparison tests were utilized toconstruct and compare the depression-anxiety symptoms networks among sex and age subgroups.RESULTSThe results revealed GAD3 “Excessive worry” and PHQ2 “Sad mood” were the most significant central symptomsin all subgroups, while “Sad mood” had higher strength than “Excessive worry” in the lower age group. In thenetwork comparisons, the female network exhibited tighter connectivity, especially on GAD6 “Irritability” andGAD2 “Uncontrollable worry”, while only PHQ3 “Sleep” and PHQ9 “Suicidal ideation” had differences at thelocal level in the lower age group.CONCLUSIONSeveral interventions targeting excessive worry and sad mood could reduce the risk of depression and anxietysymptoms in the AIS population. Furthermore, specific anxiety symptoms in females, along with sleep disturbancesand suicidal ideation in the lower age group, should be addressed at an early stage to prevent significantdisruptions in mental health trajectories.展开更多
Background: Turner syndrome (TS) affects approximately one in 2500 live births in females. Scoliosis is one of the skeletal manifestations of TS, but most cases only require observation or conservative treatment. We e...Background: Turner syndrome (TS) affects approximately one in 2500 live births in females. Scoliosis is one of the skeletal manifestations of TS, but most cases only require observation or conservative treatment. We experienced two adolescent TS cases in which progression of scoliosis required surgical intervention, which is very rare in TS. Case Presentation: Case 1: An 11-year-old female with TS had a single thoracic curve that rapidly progressed to a triple major curve with a 76˚ main thoracic curve at age 13.5 years. Case 2: A 14-year-old female with TS had a 59˚ single thoracic curve. In both cases, growth hormone and estrogen replacement therapy were administered preoperatively and planned postoperatively. Posterior correction and instrumented fusion using simultaneous translation on two rods technique and direct vertebral rotation with the use of multiple rod introducers were successfully performed in both cases. No crankshaft phenomenon or distal adding on were observed during those postoperative courses. Conclusions: Although curve pattern of the deformity is similar to adolescent idiopathic scoliosis (AIS), bone quality in patient with TS is lower. In the context of surgical interventions for scoliosis associated with TS, it is imperative to employ surgical techniques that take into account the suboptimal bone quality. If continuation of hormone replacement therapy is planned after corrective surgery for scoliosis in TS patients, it is essential to follow the patient closely postoperatively until bone maturation is complete.展开更多
The dynamic response characteristics of scoliosis and kyphosis to vibration are currently unclear.The finite element method(FEM)was employed to study the vibration response of patients with idiopathic scoliosis and ky...The dynamic response characteristics of scoliosis and kyphosis to vibration are currently unclear.The finite element method(FEM)was employed to study the vibration response of patients with idiopathic scoliosis and kyphosis.The objective is to analyze the dynamic characteristics of idiopathic scoliosis and kyphosis using FEM.The finite element model of T1—S1 segments was established and verified using the CT scanning images.The established scoliosis and kyphosis models were verified statistically and dynamically.The finite element software Abaqus was utilized to analyze the mode,harmonic response,and transient dynamics of scoliosis and kyphosis.The first four natural frequencies extracted from modal analysis were 1.34,2.26,4.49 and 17.69 Hz respectively.Notably,the first three natural frequencies decreased with the increase of upper body mass.In harmonic response analysis,the frequency corresponding to the maximum amplitude in x direction was the first order natural frequency,and the frequency corresponding to the maximum amplitude in y and z directions was the second order natural frequency.At the same resonance frequency,the amplitude of the thoracic spine was larger relative to that of the lumbar spine.The time domain results of transient analysis showed that the displacement dynamic response of each segment presented cyclic response characteristics over time.Under 2.26 Hz excitation,the dynamic response of the research object appeared as resonance.The higher the degree of spinal deformity,the greater the fundamental frequency.The first three natural modes of scoliosis and kyphosis contain vibration components in the vertical direction.The second order natural frequency was the most harmful to patients with scoliosis and kyphosis.Under cyclic loading,the deformation of the thoracic cone exceeds that of the lumbar cone.展开更多
Objective:Strabismus is associated with a higher prevalence of idiopathic thoracic scoliosis(ITS)in children.This study aims to investigate whether superior oblique palsy(SOP)poses a higher risk for developing ITS amo...Objective:Strabismus is associated with a higher prevalence of idiopathic thoracic scoliosis(ITS)in children.This study aims to investigate whether superior oblique palsy(SOP)poses a higher risk for developing ITS among children and adolescents.Methods:A cross-sectional study.The study group comprised 347 consecutive candidates for SOP surgery aged 4 to 18 years;Patients within the same age range with ocular trauma were enrolled as the control group.Preoperative chest plain radiographs were used to measure the Cobb angle.Demographic information and clinical data,including diopter,best corrected visual acuity,deviation degree,and binocular function,were analyzed.Results:A significantly higher prevalence of ITS was found in study group compared with control group(12.68%vs 4.18%,P<0.001).Additionally,the mean Cobb angle was lagger in SOP group than that in control group(5.02°±3.87°vs 3.84°±3.09°,P<0.001).Males in SOP group showed a higher prevalence of ITS(12.9%vs 2.87%,P=0.007),but there was no significant difference in females between two groups(12.3%vs 7.69%,P=0.295).Good near stereopsis acuity was significantly associated with high prevalence of thoracic scoliosis(P<0.001).Multivariate logistic regression analysis revealed that a large distant magnitude of deviation(>20 PD)and near stereoacuity were significantly associated with ITS.Conclusions:Patients with SOP have a significantly higher risk of developing idiopathic thoracic scoliosis,especially those with good near stereoscopic and large distant magnitude of deviation.展开更多
Adolescent idiopathic scoliosis(AIS)is a dynamic progression during growth,which requires long-term collaborations and efforts from clinicians,patients and their families.It would be beneficial to have a precise inter...Adolescent idiopathic scoliosis(AIS)is a dynamic progression during growth,which requires long-term collaborations and efforts from clinicians,patients and their families.It would be beneficial to have a precise intervention based on cross-scale understandings of the etiology,real-time sensing and actuating to enable early detection,screening and personalized treatment.We argue that merging computational intelligence and wearable technologies can bridge the gap between the current trajectory of the techniques applied to AIS and this vision.Wearable technologies such as inertial measurement units(IMUs)and surface electromyography(sEMG)have shown great potential in monitoring spinal curvature and muscle activity in real-time.For instance,IMUs can track the kinematics of the spine during daily activities,while sEMG can detect asymmetric muscle activation patterns that may contribute to scoliosis progression.Computational intelligence,particularly deep learning algorithms,can process these multi-modal data streams to identify early signs of scoliosis and adapt treatment strategies dynamically.By using their combination,we can find potential solutions for a better understanding of the disease,a more effective and intelligent way for treatment and rehabilitation.展开更多
BACKGROUND Adolescent idiopathic scoliosis remains a major problem due to its high incidence,high risk,and high cost.One of the aims of the management in scoliosis is to correct the deformity.Many techniques are avail...BACKGROUND Adolescent idiopathic scoliosis remains a major problem due to its high incidence,high risk,and high cost.One of the aims of the management in scoliosis is to correct the deformity.Many techniques are available to correct scoliosis deformity;however,they are all far from ideal to achieve three-dimensional correction in scoliosis.AIM To develop a set of tools named Scoliocorrector Fatma-UI(SCFUI)to aid threedimensional correction and to evaluate the efficacy,safety,and functional outcome.METHODS This study consists of two stages.In the first stage,we developed the SCFUI and tested it in finite element and biomechanical tests.The second stage was a single-blinded randomized clinical trial to evaluate the SCFUI compared to direct vertebral rotation(DVR).Forty-four subjects with adolescent idiopathic scoliosis were randomly allocated into the DVR group(n=23)and SCFUI group(n=21).Radiological,neurological,and functional outcome was compared between the groups.RESULTS Finite element revealed the maximum stress of the SCFUI components to be between 31.2-252 MPa.Biomechanical analysis revealed the modulus elasticity of SCFUI was 9561324±633277 MPa.Both groups showed improvement in Cobb angle and sagittal profile,however the rotation angle was lower in the SCFUI group(11.59±7.46 vs 18.23±6.39,P=0.001).Neurological and functional outcome were comparable in both groups.CONCLUSION We concluded that SCFUI developed in this study resulted in similar coronal and sagittal but better rotational correction compared to DVR.The safety and functional outcomes were also similar to DVR.展开更多
OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative in...OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.展开更多
OBJECTIVE:To investigate the effect of spinal manipulation(SM)on degenerative scoliosis by evaluating patients’visual analog scale(VAS)scores,Cobb angles,sagittal vertical axis(SVA),and apical vertebral rotation(AVR)...OBJECTIVE:To investigate the effect of spinal manipulation(SM)on degenerative scoliosis by evaluating patients’visual analog scale(VAS)scores,Cobb angles,sagittal vertical axis(SVA),and apical vertebral rotation(AVR)and to explore factors that influence treatment effect.METHODS:A total of 55 patients with degenerative scoliosis received 4 weeks of SM.After treatment,patients were divided into two groups:the remission group(VAS score<40 mm)and the non-remission group(VAS score≥40 mm).Pre-versus post-treatment VAS scores,Cobb angles,SVA,and AVR were compared in each group and in the total population.Baseline data(sex,age,symptom characteristics,duration of symptoms,VAS score,Cobb angle,SVA,and AVR)were compared between groups.Factors influencing the post-treatment VAS score were explored with multiple linear regression analysis.RESULTS:No changes were found in the Cobb angle(P=0.722)or AVR(P=0.424)after intervention in the overall population.However,the SVA(P<0.001)and VAS score(P=0.000)changed significantly after treatment.Similar changes were observed in the remission group(n=29).Multiple linear regression revealed that the only factors influencing treatment effect were symptom characteristics,SVA,and VAS score.CONCLUSION:SM relieved pain and improved sagittal imbalance in patients with degenerative scoliosis.It did not lessen the severity of coronal curvature or vertebral rotation.Factors influencing the effect of SM included symptom characteristics,VAS score,and SVA.A larger randomized trial is needed to further confirm our results.展开更多
Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Metho...Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions： Group A was hook-screw-rod （hybrid） internal fixation type, Group B was screw-rod （all pedicle screws） internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients （7 males, 41 females） were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted （both P〉0.05）. The decompensation rate at final follow-up in these 2 groups were 4% （1/25） and 7.1% （1/14） respectively, with no significant difference （P〉0.05）.展开更多
AIM: To investigate the risk indicators, pattern of clinical presentation and treatment strategy of superior mesenteric artery syndrome (SMAS) after scoliosis surgery.METHODS: From July 1997 to October 2003, 640 patie...AIM: To investigate the risk indicators, pattern of clinical presentation and treatment strategy of superior mesenteric artery syndrome (SMAS) after scoliosis surgery.METHODS: From July 1997 to October 2003, 640 patients with adolescent scoliosis who had undergone surgical treatment were evaluated prospectively, and among them seven patients suffered from SMAS after operation. Each patient was assigned a percentile for weight and a percentile for height. Values of the 5th、 10th、 25th、 50th、 75th、 and 95thpercentiles were selected to divide the observations. The sagittal Cobb angle was used to quantify thoracic or thoracolumbar kyphosis. All the seven patients presented with nausea and intermittent vomiting about 5 d after operation.An upper gastrointestinal barium contrast study showed a straight-line cutoff at the third portion of the duodenum representing extrinsic compression by the superior mesenteric artery (SMA).RESULTS: The value of height in the seven patients with SMAS was above the mean of sex- and age-matchednormal population, and the height percentile ranged from 5% to 50%. On the contrary, the value of weight was below the mean of normal population with the weight percentile ranging from 5% to 25%. Among the seven patients, four had a thoracic hyperkyphosis ranging from 55° to 88°(average 72°), two had a thoracolumbar kyphosis of 25° and 32° respectively. The seven patients were treated with fasting, antiemetic medication, and intravenous fluids infusion. Reduction or suspense of traction was adopted in three patients with SMAS during halo-femoral traction after anterior release of scoliosis. All the patients recovered completely with no sequelae. No one required operative intervention with a laparotomy.CONCLUSION: Height percentile＜50% , weight percentile ＜25%, sagittal kyphosis, heavy and quick halo-femoral traction after spinal anterior release are the potential risk indicators for SMAS in patients undergoing correction surgery for adolescent scoliosis.展开更多
The human spinal column is a dynamic,segmented,bony,and cartilaginous structure that protects the neurologic system and simultaneously provides balance and flexibility.Children with developmental disorders that affect...The human spinal column is a dynamic,segmented,bony,and cartilaginous structure that protects the neurologic system and simultaneously provides balance and flexibility.Children with developmental disorders that affect the patterning or shape of the spine can be at risk of neurologic and other physiologic dysfunctions.The most common developmental disorder of the spine is scoliosis,a lateral deformity in the shape of the spinal column.Scoliosis may be part of the clinical spectrum that is observed in many developmental disorders,but typically presents as an isolated symptom in otherwise healthy adolescent children.Adolescent idiopathic scoliosis(AIS)has defied understanding in part due to its genetic complexity.Breakthroughs have come from recent genome-wide association studies(GWAS)and next generation sequencing(NGS)of human AIS cohorts,as well as investigations of animal models.These studies have identified genetic associations with determinants of cartilage biogenesis and development of the intervertebral disc(IVD).Current evidence suggests that a fraction of AIS cases may arise from variation in factors involved in the structural integrity and homeostasis of the cartilaginous extracellular matrix(ECM).Here,we review the development of the spine and spinal cartilages,the composition of the cartilage ECM,the so-called"matrisome"and its functions,and the players involved in the genetic architecture of AIS.We also propose a molecular model by which the cartilage matrisome of the IVD contributes to AIS susceptibility.展开更多
This opinion review considers the prevailing question of whether to screen or notto screen for adolescent idiopathic scoliosis. New and improved standards ofpeople-oriented care and person-centredness, as well as impr...This opinion review considers the prevailing question of whether to screen or notto screen for adolescent idiopathic scoliosis. New and improved standards ofpeople-oriented care and person-centredness, as well as improved principles ofpreventive screening and guideline development, have been postulated andimplemented in health care systems and cultures. Recommendations addressingscreening for scoliosis differ substantially, in terms of their content, standards ofdevelopment and screening principles. Some countries have discontinued issuingrecommendations. In the last decade, a number of updated and newrecommendations and statements have been released. Systematically developedguidelines and recommendations are confronted by consensus and opinion-basedstatements. The dilemmas and discrepancies prevail. The arguments concentrateon the issues of the need for early detection through screening in terms of theeffectiveness of early treatment, on costs and cost-effectiveness issues, scientificand epidemiologic value of screenings, and the credibility of the sources ofevidence. The problem matter is of global scale and applies to millions of people.It regards clinical and methodological dilemmas, but also the matter of vulnerableand fragile time of adolescence and, more generally, children’s rights. Thedecisions need to integrate people’s values and preferences – screening tests needto be acceptable to the population, and treatments need to be acceptable forpatients. Therefore we present one more crucial, but underrepresented in thediscussion, issue of understanding and implementation of the contemporaryprinciples of person-centred care, standards of preventive screening, andguideline development, in the context of screening for scoliosis.展开更多
AIM: To evaluate published data on the predictors of progressive adolescent idiopathic scoliosis(AIS) in order to evaluate their efficacy and level of evidence. METHODS: Selection criteria:(1) study design: randomized...AIM: To evaluate published data on the predictors of progressive adolescent idiopathic scoliosis(AIS) in order to evaluate their efficacy and level of evidence. METHODS: Selection criteria:(1) study design: randomized controlled clinical trials, prospective cohort studies and case series, retrospective comparative and none comparative studies;(2) participants: adolescents with AIS aged from 10 to 20 years; and(3) treatment: observation, bracing, and other. Search method: Ovid MEDLINE, Embase, the Cochrane Library, Pub Medand patent data bases. All years through August 2014 were included. Data were collected that showed an association between the studied characteristics and the progression of AIS or the severity of the spine deformity. Odds ratio(OR), sensitivity, specificity, positive and negative predictive values were also collected. A metaanalysis was performed to evaluate the pooled OR and predictive values, if more than 1 study presented a result. The GRADE approach was applied to evaluate the level of evidence.RESULTS: The review included 25 studies. All studies showed statistically significant or borderline association between severity or progression of AIS with the following characteristics:(1) An increase of the Cobb angle or axial rotation during brace treatment;(2) decrease of the rib-vertebral angle at the apical level of the convex side during brace treatment;(3) initial Cobb angle severity(> 25o);(4) osteopenia;(5) patient age < 13 years at diagnosis;(6) premenarche status;(7) skeletal immaturity;(8) thoracic deformity;(9) brain stem vestibular dysfunction; and(10) multiple indices combining radiographic, demographic, and physiologic characteristics. Single nucleotide polymorphisms of the following genes:(1) calmodulin 1;(2) estrogen receptor 1;(3) tryptophan hydroxylase 1;(3) insulin-like growth factor 1;(5) neurotrophin 3;(6) interleukin-17 receptor C;(7) melatonin receptor 1B, and(8) Scoli Score test. Other predictors included:(1) impairment of melatonin signaling in osteoblasts and peripheral blood mononuclear cells(PBMC);(2) G-protein signaling dysfunction in PBMC; and(3) the level of platelet calmodulin. However, predictive values of all these findings were limited, and the levels of evidence were low. The pooled result of brace treatment outcomes demonstrated that around 27% of patents with AIS experienced exacerbation of the spine deformity during or after brace treatment, and 15% required surgical correction. However, the level of evidence is also low due to the limitations of the included studies.CONCLUSION: This review did not reveal any methods for the prediction of progression in AIS that could be recommended for clinical use as diagnostic criteria.展开更多
文摘The surgical treatment of severe scoliosis and kyphoscoliosis in the pediatric population is complicated and has high morbidity and mortality risks.Severe scoliosis has traditionally been defined by a coronal Cobb angle of greater than 90°or 100°.The usual corrective methods for these patients have been anterior or posterior release and osteotomies using a combined anterior-posterior or posterior-only approach.Many of these patients have pre-existing pulmonary compromise;therefore,an anterior approach is often not reasonable or possible.Acute correction of a deformity may also cause neurologic injury.Halo gravity traction(HGT)allows for progressive,gradual,and sustained correction of the spinal deformity in the coronal,sagittal,and axial planes,leading to a decrease in the amount of correction needed at definitive posterior fusion.This relates to decreased postoperative neurologic deficit and improved pulmonary function.Preoperative HGT has evolved to be the surgical adjunct in the treatment of severe spinal deformity.Indications for HGT,best protocols of application,and optimal duration of traction still lack uniformity;thus,a review of the literature remains relevant and necessary.This review summarizes the existing literature on HGT,including its indications,applications,duration of traction,and associated complications.
基金Supported by the National Natural Science Foundation of China,No.82460940Major Project of Gansu Province Joint Fund,No.23JRRA1519+2 种基金Key Science and Technology Project of Gansu Province,No.21ZD4FA009Natural Science Foundation of Gansu Province,No.24JRRA1040Gansu Province Famous Traditional Chinese Medicine Inheritance Studio Project。
文摘Congenital scoliosis(CS)is a prevalent spinal deformity with a multifaceted etiology that remains incompletely understood.Recent advances in genetic and epigenetic research have provided novel insights into CS pathogenesis.Herein,we review the current progress in genetics and epigenetics to examine genetic variants,susceptibility factors,and the epigenetic regulatory mechanisms implicated in CS.Through an analysis of diverse genetic markers,chromosomal abnormalities,and epigenetic modifications,the correlation between genetic predisposition and environmental influences in CS pathogenesis is elucidated.By integrating these genetic and epigenetic findings,this study aims to clarify the underlying etiology of CS to provide guidance on future clinical interventions and promote the development of personalized therapeutic strategies.
文摘This letter compares the clinical efficacy and economic feasibility of the scoliocorrector fatma-UI(SCFUI)with direct vertebral rotation(DVR)in treating adolescent idiopathic scoliosis(AIS).SCFUI has shown promising results in threedimensional spinal correction,providing superior rotational alignment compared to DVR and achieving significant improvements in coronal and sagittal planes.Additionally,SCFUI’s advanced design reduces risks associated with AIS surgeries and enhances overall patient outcomes.Economic analysis reveals SCFUI as a cost-effective option,potentially lowering long-term healthcare costs by minimizing complications and revisions.Our findings suggest that SCFUI is a viable,innovative approach in AIS treatment,meeting clinical and economic demands in orthopedic care.
基金supported by the National Natural Science Foundation of China(82271725).
文摘Congenital atrial septal defect(ASD)with severe scoliosis is a rare compound malformation inchildren.Severe sco liosis should be corrected as soon as possible.The growth rod is suitable for patients withearly scoliosis and obvious scoliosis under 10 years old.However,the fluoroscopic radiopaque of titaniumalloy plate will inevitably partly make the operative field of interventional occlusion blind.We presenta7-year-old Chinese girl with ASD and scoliosis who underwent spinal correction with a dual-growthrod.In this case,we performed transcatheter closure of ASD solely under the guidance of transthoracicechocardiography.Transthoracic echocardiography(TTE)has been reported as efficacious and safe forassessment and guidance of ASD occlusion.For patients with visual field occlusion under fluoroscopy,theapplication of TTE is efficacious and safe for assessmnent and guidance of ASD occlusion.
文摘BACKGROUND Congenital scoliosis(CS)is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis.It occurs in 0.5%-1%in 1000 births and may rarely occur with congenital defects affecting the heart or genitourinary system.Truncus arteriosus(TA)is a life-threatening cardiac defect in which a single arterial trunk supplies both systemic and pulmonary circulation,leading to complications such as pulmonary hypertension,heart failure,and severe hypoxia.Although rare individually,the co-occurrence of both conditions poses unique diagnostic and therapeutic challenges,with limited documentation in medical literature.CASE SUMMARY We present a 36-week preterm neonate with CS associated with TA type 1,pre-senting with respiratory distress,cyanosis,and altered spinal curvature.This case demonstrates the complexity of managing neonates with multiple congenital de-fects.Here,the patient was managed with oxygen supplementation,heart failure medication,nasogastric feeding,and multidisciplinary care to optimize her for surgical corrections.A coordinated,interdisciplinary approach was employed to optimize outcomes,particularly in a resource-limited setting.Immediate re-spiratory and cardiovascular stabilization and long-term orthopedic and cardiac interventions were central to improving the patient’s quality of life and survival.CONCLUSION Recognizing co-existing congenital anomalies and their embryological interre-lation is critical in holistic patient care,particularly during neonatal and infancy.
基金the Applied Basic Research Program of Educational Department of Liaoning Province(No.LJKZZ20220058)。
文摘Due to the lack of human avoidance analysis,the orthosis cannot accurately apply orthopedic force during orthopedic,resulting in poor orthopedic effect.Therefore,the relationship between the human body’s active avoidance ability and force application is studied to achieve accurate loading of orthopedic force.First,a high-precision scoliosis model was established based on computed tomography data,and the relationship between orthopedic force and Cobb angle was analyzed.Then 9 subjects were selected for avoidance ability test grouped by body mass index calculation,and the avoidance function of different groups was fitted.The avoidance function corrected the application of orthopedic forces.The results show that the optimal correction force calculated by the finite element method was 60 N.The obese group had the largest avoidance ability,followed by the standard group and the lean group.When the orthopedic force was 60 N,the Cobb angle was reduced from 33.77°to 20°,the avoidance ability of the standard group at 50 N obtained from the avoidance function was 20.28%and 10.14 N was actively avoided.Therefore,when 50 N was applied,60.14 N was actually generated,which can achieve the orthopedic effect of 60 N numerical simulation analysis.The avoidance effect can take the active factors of the human body into consideration in the orthopedic process,so as to achieve a more accurate application of orthopedic force,and provide data reference for clinicians in the orthopedic process.
文摘[Objectives]This meta-analysis evaluated the efficacy of Traditional Chinese Medicine(TCM)manual therapies(Tuina,Daoyin,acupotomology)for idiopathic scoliosis(IS),with dual focus on radiographic outcomes(Cobb angle,vertebral rotation)and patient-centered metrics(pain,disability,quality of life).[Methods]This study systematically searched PubMed,Cochrane Library,EMBASE,Web of Science,CNKI,Wanfang,and VIP databases(from inception to July 2025)for randomized controlled trials(RCTs)comparing TCM manual therapies against controls(bracing,exercise,sham,or no intervention).Two reviewers independently extracted data and assessed methodological quality using the PEDro scale.Meta-analyses employed random-effects models(Stata 18)to calculate Hedges'g with 95%confidence intervals(CI).Heterogeneity was quantified via I 2 statistics,and subgroup analyses examined intervention types(standalone versus combined)and control groups.[Results]Radiographic outcomes:TCM therapies significantly reduced Cobb angle(Hedges'g=-0.93;95%CI:-1.37,-0.49;p<0.001)and vertebral torsion rotation(VTR;g=-0.71;95%CI:-0.91,-0.51;p<0.001)versus controls;patient-centered outcomes:substantial pain reduction(VAS:g=-1.47;95%CI:-2.64,-0.30;p=0.01)and disability improvement(ODI:g=-1.10;95%CI:-1.57,-0.64;p<0.001)were observed.Quality of life(SRS-22)showed non-significant gains(g=2.01;95%CI:-0.43,4.45;p=0.11).[Conclusions]TCM manual therapies significantly improve spinal alignment and reduce pain/disability in IS patients,particularly when integrated with exercise regimens.While results support their role as complementary interventions,standardization of protocols and long-term efficacy studies are needed for clinical implementation.
基金Supported by The Sanming Project of Medicine in Shenzhen,No.SZSM202211003Shenzhen-Hong Kong Jointly Funded Project,Shenzhen Science and Technology Program,No.SGDX20230116093645007+1 种基金Shenzhen Second People's Hospital Clinical Project,No.20243357003Shenzhen Medical Research Fund,No.B2303005.
文摘BACKGROUND Depression and anxiety are prevalent psychological challenges among patients with adolescent idiopathic scoliosis(AIS),affecting individuals across both sex and age groups.AIM To explore the network structure of depression and anxiety symptoms,with a focus on identifying differences at the symptom level between sex and age subgroups.METHODS A total of 1955 participants diagnosed with AIS aged 10-18 years were assessed using the Patient Health Questionnaire Depression Scale(PHO-9)and the Generalized Anxiety Disorder Scale(GAD-7),and 765 patients exhibiting PHQ-9 or GAD-7 scores ≥ 5 were enrolled in our study. Network analysis and network comparison tests were utilized toconstruct and compare the depression-anxiety symptoms networks among sex and age subgroups.RESULTSThe results revealed GAD3 “Excessive worry” and PHQ2 “Sad mood” were the most significant central symptomsin all subgroups, while “Sad mood” had higher strength than “Excessive worry” in the lower age group. In thenetwork comparisons, the female network exhibited tighter connectivity, especially on GAD6 “Irritability” andGAD2 “Uncontrollable worry”, while only PHQ3 “Sleep” and PHQ9 “Suicidal ideation” had differences at thelocal level in the lower age group.CONCLUSIONSeveral interventions targeting excessive worry and sad mood could reduce the risk of depression and anxietysymptoms in the AIS population. Furthermore, specific anxiety symptoms in females, along with sleep disturbancesand suicidal ideation in the lower age group, should be addressed at an early stage to prevent significantdisruptions in mental health trajectories.
文摘Background: Turner syndrome (TS) affects approximately one in 2500 live births in females. Scoliosis is one of the skeletal manifestations of TS, but most cases only require observation or conservative treatment. We experienced two adolescent TS cases in which progression of scoliosis required surgical intervention, which is very rare in TS. Case Presentation: Case 1: An 11-year-old female with TS had a single thoracic curve that rapidly progressed to a triple major curve with a 76˚ main thoracic curve at age 13.5 years. Case 2: A 14-year-old female with TS had a 59˚ single thoracic curve. In both cases, growth hormone and estrogen replacement therapy were administered preoperatively and planned postoperatively. Posterior correction and instrumented fusion using simultaneous translation on two rods technique and direct vertebral rotation with the use of multiple rod introducers were successfully performed in both cases. No crankshaft phenomenon or distal adding on were observed during those postoperative courses. Conclusions: Although curve pattern of the deformity is similar to adolescent idiopathic scoliosis (AIS), bone quality in patient with TS is lower. In the context of surgical interventions for scoliosis associated with TS, it is imperative to employ surgical techniques that take into account the suboptimal bone quality. If continuation of hormone replacement therapy is planned after corrective surgery for scoliosis in TS patients, it is essential to follow the patient closely postoperatively until bone maturation is complete.
基金the National Natural Science Foundation of China(No.32260235)。
文摘The dynamic response characteristics of scoliosis and kyphosis to vibration are currently unclear.The finite element method(FEM)was employed to study the vibration response of patients with idiopathic scoliosis and kyphosis.The objective is to analyze the dynamic characteristics of idiopathic scoliosis and kyphosis using FEM.The finite element model of T1—S1 segments was established and verified using the CT scanning images.The established scoliosis and kyphosis models were verified statistically and dynamically.The finite element software Abaqus was utilized to analyze the mode,harmonic response,and transient dynamics of scoliosis and kyphosis.The first four natural frequencies extracted from modal analysis were 1.34,2.26,4.49 and 17.69 Hz respectively.Notably,the first three natural frequencies decreased with the increase of upper body mass.In harmonic response analysis,the frequency corresponding to the maximum amplitude in x direction was the first order natural frequency,and the frequency corresponding to the maximum amplitude in y and z directions was the second order natural frequency.At the same resonance frequency,the amplitude of the thoracic spine was larger relative to that of the lumbar spine.The time domain results of transient analysis showed that the displacement dynamic response of each segment presented cyclic response characteristics over time.Under 2.26 Hz excitation,the dynamic response of the research object appeared as resonance.The higher the degree of spinal deformity,the greater the fundamental frequency.The first three natural modes of scoliosis and kyphosis contain vibration components in the vertical direction.The second order natural frequency was the most harmful to patients with scoliosis and kyphosis.Under cyclic loading,the deformation of the thoracic cone exceeds that of the lumbar cone.
基金the National Natural Science Foundation of China grant NSFC(82070995).
文摘Objective:Strabismus is associated with a higher prevalence of idiopathic thoracic scoliosis(ITS)in children.This study aims to investigate whether superior oblique palsy(SOP)poses a higher risk for developing ITS among children and adolescents.Methods:A cross-sectional study.The study group comprised 347 consecutive candidates for SOP surgery aged 4 to 18 years;Patients within the same age range with ocular trauma were enrolled as the control group.Preoperative chest plain radiographs were used to measure the Cobb angle.Demographic information and clinical data,including diopter,best corrected visual acuity,deviation degree,and binocular function,were analyzed.Results:A significantly higher prevalence of ITS was found in study group compared with control group(12.68%vs 4.18%,P<0.001).Additionally,the mean Cobb angle was lagger in SOP group than that in control group(5.02°±3.87°vs 3.84°±3.09°,P<0.001).Males in SOP group showed a higher prevalence of ITS(12.9%vs 2.87%,P=0.007),but there was no significant difference in females between two groups(12.3%vs 7.69%,P=0.295).Good near stereopsis acuity was significantly associated with high prevalence of thoracic scoliosis(P<0.001).Multivariate logistic regression analysis revealed that a large distant magnitude of deviation(>20 PD)and near stereoacuity were significantly associated with ITS.Conclusions:Patients with SOP have a significantly higher risk of developing idiopathic thoracic scoliosis,especially those with good near stereoscopic and large distant magnitude of deviation.
基金by National Natural Science Foundation of China(No.62306083)the Postdoctoral Science Foundation of Heilongjiang Province of China(LBH-Z22175)the Ministry of Industry and Information Technology。
文摘Adolescent idiopathic scoliosis(AIS)is a dynamic progression during growth,which requires long-term collaborations and efforts from clinicians,patients and their families.It would be beneficial to have a precise intervention based on cross-scale understandings of the etiology,real-time sensing and actuating to enable early detection,screening and personalized treatment.We argue that merging computational intelligence and wearable technologies can bridge the gap between the current trajectory of the techniques applied to AIS and this vision.Wearable technologies such as inertial measurement units(IMUs)and surface electromyography(sEMG)have shown great potential in monitoring spinal curvature and muscle activity in real-time.For instance,IMUs can track the kinematics of the spine during daily activities,while sEMG can detect asymmetric muscle activation patterns that may contribute to scoliosis progression.Computational intelligence,particularly deep learning algorithms,can process these multi-modal data streams to identify early signs of scoliosis and adapt treatment strategies dynamically.By using their combination,we can find potential solutions for a better understanding of the disease,a more effective and intelligent way for treatment and rehabilitation.
基金The study was reviewed and approved by the Ethical Committee Faculty of Medicine,University of Indonesia(Approval No.KET-615/UN2.F1/ETIK/PPM.00.02/2020)Ethical Committee of Fatmawati General Hospital(Approval No.DM 01.01/VIII.2/1294/2020).
文摘BACKGROUND Adolescent idiopathic scoliosis remains a major problem due to its high incidence,high risk,and high cost.One of the aims of the management in scoliosis is to correct the deformity.Many techniques are available to correct scoliosis deformity;however,they are all far from ideal to achieve three-dimensional correction in scoliosis.AIM To develop a set of tools named Scoliocorrector Fatma-UI(SCFUI)to aid threedimensional correction and to evaluate the efficacy,safety,and functional outcome.METHODS This study consists of two stages.In the first stage,we developed the SCFUI and tested it in finite element and biomechanical tests.The second stage was a single-blinded randomized clinical trial to evaluate the SCFUI compared to direct vertebral rotation(DVR).Forty-four subjects with adolescent idiopathic scoliosis were randomly allocated into the DVR group(n=23)and SCFUI group(n=21).Radiological,neurological,and functional outcome was compared between the groups.RESULTS Finite element revealed the maximum stress of the SCFUI components to be between 31.2-252 MPa.Biomechanical analysis revealed the modulus elasticity of SCFUI was 9561324±633277 MPa.Both groups showed improvement in Cobb angle and sagittal profile,however the rotation angle was lower in the SCFUI group(11.59±7.46 vs 18.23±6.39,P=0.001).Neurological and functional outcome were comparable in both groups.CONCLUSION We concluded that SCFUI developed in this study resulted in similar coronal and sagittal but better rotational correction compared to DVR.The safety and functional outcomes were also similar to DVR.
文摘OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.
基金Supported by the Special Subject for the Construction of the National Traditional Chinese Medicine Clinical Research Base Effect of Spinal Manipulation on Degenerative Scoliosis and Factors Influencing Treatment Effect(JDZX2015271)Basic Scientific Research Project of Chinese Academy of Traditional Chinese Medicine Clinical and Experimental Study on Delaying The Degeneration of Bone and Joint(ZZ10-022)。
文摘OBJECTIVE:To investigate the effect of spinal manipulation(SM)on degenerative scoliosis by evaluating patients’visual analog scale(VAS)scores,Cobb angles,sagittal vertical axis(SVA),and apical vertebral rotation(AVR)and to explore factors that influence treatment effect.METHODS:A total of 55 patients with degenerative scoliosis received 4 weeks of SM.After treatment,patients were divided into two groups:the remission group(VAS score<40 mm)and the non-remission group(VAS score≥40 mm).Pre-versus post-treatment VAS scores,Cobb angles,SVA,and AVR were compared in each group and in the total population.Baseline data(sex,age,symptom characteristics,duration of symptoms,VAS score,Cobb angle,SVA,and AVR)were compared between groups.Factors influencing the post-treatment VAS score were explored with multiple linear regression analysis.RESULTS:No changes were found in the Cobb angle(P=0.722)or AVR(P=0.424)after intervention in the overall population.However,the SVA(P<0.001)and VAS score(P=0.000)changed significantly after treatment.Similar changes were observed in the remission group(n=29).Multiple linear regression revealed that the only factors influencing treatment effect were symptom characteristics,SVA,and VAS score.CONCLUSION:SM relieved pain and improved sagittal imbalance in patients with degenerative scoliosis.It did not lessen the severity of coronal curvature or vertebral rotation.Factors influencing the effect of SM included symptom characteristics,VAS score,and SVA.A larger randomized trial is needed to further confirm our results.
文摘Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions： Group A was hook-screw-rod （hybrid） internal fixation type, Group B was screw-rod （all pedicle screws） internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients （7 males, 41 females） were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted （both P〉0.05）. The decompensation rate at final follow-up in these 2 groups were 4% （1/25） and 7.1% （1/14） respectively, with no significant difference （P〉0.05）.
文摘AIM: To investigate the risk indicators, pattern of clinical presentation and treatment strategy of superior mesenteric artery syndrome (SMAS) after scoliosis surgery.METHODS: From July 1997 to October 2003, 640 patients with adolescent scoliosis who had undergone surgical treatment were evaluated prospectively, and among them seven patients suffered from SMAS after operation. Each patient was assigned a percentile for weight and a percentile for height. Values of the 5th、 10th、 25th、 50th、 75th、 and 95thpercentiles were selected to divide the observations. The sagittal Cobb angle was used to quantify thoracic or thoracolumbar kyphosis. All the seven patients presented with nausea and intermittent vomiting about 5 d after operation.An upper gastrointestinal barium contrast study showed a straight-line cutoff at the third portion of the duodenum representing extrinsic compression by the superior mesenteric artery (SMA).RESULTS: The value of height in the seven patients with SMAS was above the mean of sex- and age-matchednormal population, and the height percentile ranged from 5% to 50%. On the contrary, the value of weight was below the mean of normal population with the weight percentile ranging from 5% to 25%. Among the seven patients, four had a thoracic hyperkyphosis ranging from 55° to 88°(average 72°), two had a thoracolumbar kyphosis of 25° and 32° respectively. The seven patients were treated with fasting, antiemetic medication, and intravenous fluids infusion. Reduction or suspense of traction was adopted in three patients with SMAS during halo-femoral traction after anterior release of scoliosis. All the patients recovered completely with no sequelae. No one required operative intervention with a laparotomy.CONCLUSION: Height percentile＜50% , weight percentile ＜25%, sagittal kyphosis, heavy and quick halo-femoral traction after spinal anterior release are the potential risk indicators for SMAS in patients undergoing correction surgery for adolescent scoliosis.
基金supported by the NIH (NICHD P01 HD084387 to C.A.W., N.A. and L.S.K. and NIAMS R01AR067715 to C.G.)the Texas Scottish Rite Hospital Research Fund (to C.A.W. and J.J.R.)
文摘The human spinal column is a dynamic,segmented,bony,and cartilaginous structure that protects the neurologic system and simultaneously provides balance and flexibility.Children with developmental disorders that affect the patterning or shape of the spine can be at risk of neurologic and other physiologic dysfunctions.The most common developmental disorder of the spine is scoliosis,a lateral deformity in the shape of the spinal column.Scoliosis may be part of the clinical spectrum that is observed in many developmental disorders,but typically presents as an isolated symptom in otherwise healthy adolescent children.Adolescent idiopathic scoliosis(AIS)has defied understanding in part due to its genetic complexity.Breakthroughs have come from recent genome-wide association studies(GWAS)and next generation sequencing(NGS)of human AIS cohorts,as well as investigations of animal models.These studies have identified genetic associations with determinants of cartilage biogenesis and development of the intervertebral disc(IVD).Current evidence suggests that a fraction of AIS cases may arise from variation in factors involved in the structural integrity and homeostasis of the cartilaginous extracellular matrix(ECM).Here,we review the development of the spine and spinal cartilages,the composition of the cartilage ECM,the so-called"matrisome"and its functions,and the players involved in the genetic architecture of AIS.We also propose a molecular model by which the cartilage matrisome of the IVD contributes to AIS susceptibility.
基金We wish to deeply thank and,at the same time,dedicate this work to our Dear colleague and co-author,Professor Ejgil Jespersen,who sadly fell seriously ill.He has always been an advocate for the humanistic and personal way of treating every person,even when he or she happens to be in a role of a patient.We are grateful for his expertise,inspiration,and friendship.
文摘This opinion review considers the prevailing question of whether to screen or notto screen for adolescent idiopathic scoliosis. New and improved standards ofpeople-oriented care and person-centredness, as well as improved principles ofpreventive screening and guideline development, have been postulated andimplemented in health care systems and cultures. Recommendations addressingscreening for scoliosis differ substantially, in terms of their content, standards ofdevelopment and screening principles. Some countries have discontinued issuingrecommendations. In the last decade, a number of updated and newrecommendations and statements have been released. Systematically developedguidelines and recommendations are confronted by consensus and opinion-basedstatements. The dilemmas and discrepancies prevail. The arguments concentrateon the issues of the need for early detection through screening in terms of theeffectiveness of early treatment, on costs and cost-effectiveness issues, scientificand epidemiologic value of screenings, and the credibility of the sources ofevidence. The problem matter is of global scale and applies to millions of people.It regards clinical and methodological dilemmas, but also the matter of vulnerableand fragile time of adolescence and, more generally, children’s rights. Thedecisions need to integrate people’s values and preferences – screening tests needto be acceptable to the population, and treatments need to be acceptable forpatients. Therefore we present one more crucial, but underrepresented in thediscussion, issue of understanding and implementation of the contemporaryprinciples of person-centred care, standards of preventive screening, andguideline development, in the context of screening for scoliosis.
文摘AIM: To evaluate published data on the predictors of progressive adolescent idiopathic scoliosis(AIS) in order to evaluate their efficacy and level of evidence. METHODS: Selection criteria:(1) study design: randomized controlled clinical trials, prospective cohort studies and case series, retrospective comparative and none comparative studies;(2) participants: adolescents with AIS aged from 10 to 20 years; and(3) treatment: observation, bracing, and other. Search method: Ovid MEDLINE, Embase, the Cochrane Library, Pub Medand patent data bases. All years through August 2014 were included. Data were collected that showed an association between the studied characteristics and the progression of AIS or the severity of the spine deformity. Odds ratio(OR), sensitivity, specificity, positive and negative predictive values were also collected. A metaanalysis was performed to evaluate the pooled OR and predictive values, if more than 1 study presented a result. The GRADE approach was applied to evaluate the level of evidence.RESULTS: The review included 25 studies. All studies showed statistically significant or borderline association between severity or progression of AIS with the following characteristics:(1) An increase of the Cobb angle or axial rotation during brace treatment;(2) decrease of the rib-vertebral angle at the apical level of the convex side during brace treatment;(3) initial Cobb angle severity(> 25o);(4) osteopenia;(5) patient age < 13 years at diagnosis;(6) premenarche status;(7) skeletal immaturity;(8) thoracic deformity;(9) brain stem vestibular dysfunction; and(10) multiple indices combining radiographic, demographic, and physiologic characteristics. Single nucleotide polymorphisms of the following genes:(1) calmodulin 1;(2) estrogen receptor 1;(3) tryptophan hydroxylase 1;(3) insulin-like growth factor 1;(5) neurotrophin 3;(6) interleukin-17 receptor C;(7) melatonin receptor 1B, and(8) Scoli Score test. Other predictors included:(1) impairment of melatonin signaling in osteoblasts and peripheral blood mononuclear cells(PBMC);(2) G-protein signaling dysfunction in PBMC; and(3) the level of platelet calmodulin. However, predictive values of all these findings were limited, and the levels of evidence were low. The pooled result of brace treatment outcomes demonstrated that around 27% of patents with AIS experienced exacerbation of the spine deformity during or after brace treatment, and 15% required surgical correction. However, the level of evidence is also low due to the limitations of the included studies.CONCLUSION: This review did not reveal any methods for the prediction of progression in AIS that could be recommended for clinical use as diagnostic criteria.
