Advances on Scoliogeny, Diagnosis and Management of Scoliosis and Spinal Disorders

This book contains research articles on the advances in the aetiology of idiopathic scoliosis (IS), the spinal growth related to the implementation of growth modulation for the surgical treatment of early-onset IS, the non-surgical treatment of IS using Physiotheraputic Scoliosis Specific Exercises, and braces. Additionally, it focuses on issues related to surgical treatment, issues related to body posture and the quality of life of this sensitive group of people. The high quality of published papers in this Special Issue of the JCM serve these objectives

mHealth for the Monitoring of Brace Compliance and Wellbeing in Adolescents with Idiopathic Scoliosis: Study Protocol for a Feasibility Study

Attempts to optimize monitoring of brace adherence prescribed to adolescents with idiopathic scoliosis (IS) have generally relied on sensors. Sensors, however, are intrusive and do not allow the assessment of psychological and physical consequences of brace use that might underlie poor adherence. Mobile applications have emerged as alternatives to monitor brace compliance. However, the feasibility and utility of these app-based systems to assess key psychological and physical domains associated with non-adherence remain unexplored. This feasibility study aims to test the usability, acceptability, and clinical utility of an app-based system that monitors brace use and related psychological and physical factors. Forty adolescents with IS daily respond to the app for 90 days. The patient responses may generate clinical alarms (e.g., brace non-adherence, discomfort, or distress) that will be sent daily to the medical team. Primary outcomes will be app usability, acceptability, and response rates. Secondary outcomes will include brace adherence, the number of side effects reported, number and type of clinical alarms, stress, quality of life, perceived health status, and mood. If accepted by patients and clinicians, apps may allow rapid detection and response to undesired events in adolescents undergoing brace treatment

Psychosocial factors and their significance towards pain: a case study comparing monozygotic twins with AIS after spinal surgery

INTRODUCTION: Adolescent Idiopathic Scoliosis (AIS) is one of the most common spinal abnormalities in children, affecting 2% to 3% of adolescents in the United States. Its cause remains unclear. Many previous studies conclude that AIS may be caused by a combination of genetic and environmental factors, with very few consistencies. Severe scoliosis is usually treated with corrective surgery, and the etiology of post-surgical pain is even more unclear and has the opportunity to affect the patient well into adulthood. STUDY AIMS: By following a monozygotic twin pair with identical DNA, our retrospective case study can control for genetic disposition, and can look toward other possible causes for the pain the patients experienced. This study attempts to shed light on the complexities of AIS and pain with a focus on environmental and psychosocial factors. CASE PRESENTATION: We present a single pair of monozygotic twins treated for AIS with comparable spinal fusion surgeries performed at a large northeast urban children's hospital. Twin A and Twin B were initially treated with a brace for their scoliosis. Despite bracing, their curves progressed and warranted spinal fusion, with Twin A having a Cobb angle of 53°, and Twin B with 50°. The surgery was conducted simultaneously at the age of 13 by two different orthopedic surgeons. At age 7.5, Twin B was treated for Ebstein's anomaly of the tricuspid valve and significant dysrhythmias. METHODS: After the patients were discharged, a comprehensive retrospective chart review of the patients' pre-op, inpatient, and post-op pain and drug regiment was conducted. The patients were also asked to note their pain as they recovered after discharge. The patients and their mother completed self-report measures of multiple psychosocial variables both before and after surgery through REDCap. A Quantitative Sensory Test (QST) was also performed by the patients to assess their sensory sensitivity and pain thresholds. Mechanical, pressure, and thermal scores were obtained with the use of von Frey hairs, a pressure Algometer, and a Thermode. The QST was administered on the patients' palm/ thenar eminence (distant non-surgical site), and on their lower back (surgical site). The QST results were compared to a previous study's median cohort data, to discern if the patients presented hyper- or hyposensitivity for that particular test. RESULTS: Due to the limitations of case studies, the results presented here should be considered strictly preliminary. Twin B experienced more significant pain during both the acute and chronic recovery phases after surgery, and showed lower sensitivities during most pre-op QST trials. Twin B also scored markedly higher on a number of sub-variables in the psychosocial surveys. A notable correlation was the parent protective measure, indicating that the mother may have been more protective of Twin B. CONCLUSIONS: What is unique to this study is that age, gender, Cobb angle, fusion length, and genetic disposition are all controlled for, allowing us to analyze the patients based on other risk factors. Twin B shows consistently higher pain scores while in the hospital as well as while recovering at home. The parent self-report measures support these findings, showing a slight bias in favor of Twin B in regards to protectiveness, which also coincides with large-scale studies. Although preliminary, it is important not to underestimate the role environmental and psychosocial factors play in post-surgical pain

Factors affecting accuracy and fusion rate in lumbosacral fusion surgery - a preclinical and clinical study

Lumbosacral fusion surgery is indicated in symptomatic degenerative lumbosacral disorder, when the origin of pain is demonstrated to lie within the restricted number of functional spinal units and when the pain is refractory to the conservative treatment, to eliminate painful motion of the spinal units. Inaccurate placement of pedicle screws may cause neurological symptoms, and result in early hardware failure and return of spinal instability symptoms. All spinal instrumentation eventually fails without solid bony fusion, and the presence of symptomatic bony non-union at least a year after fusion surgery is defined as pseudoarthrosis. Bioactive glasses (BAGs) are synthetic, biocompatible, osteoconductive and osteostimulative materials with angiogenic and antibacterial properties, able to bond to bone. In a study of 147 patients and 837 pedicle screws placed due to degenerative lumbosacral spine disorder, 14.3 % breached the pedicle. New neurological symptoms corresponding to the breach were observed in 25.9 % of patients with pedicle breach, and 89.2 % of the symptomatic breaches were either medially or inferiorly. A preclinical controlled study of novel BAG S53P4 putty showed good biocompatibility, slightly higher intramedullary ossification of putty group compared to the control group, and that the binder agent did not disturb formation of new bone in vivo. The interbody fusion rate was 95.8 % with BAG S53P4 putty as bone graft expander with autograft in clinical lumbosacral interbody fusion, indicating at least as good interbody fusion results as the presently used materials. One early operative subsidence remaining unchanged over the study period was observed with putty.Lannerangan luudutusleikkausten tarkkuuteen ja luutumiseen vaikuttavat tekijät Lannerangan luudutusleikkaus voidaan tehdä oireisessa lannerangan rappeumasairaudessa, kun kivun syyn on osoitettu sijaitsevan rajallisessa määrässä selkärangan toiminnallisia yksikköjä ja kun kipu ei vähene leikkauksettomilla hoidoilla. Leikkauksella voidaan poistaa kipua tuottava selkärangan toiminnallisten yksikköjen liike. Epätarkka pedikkeliruuvien asettaminen voi aiheuttaa neurologisia oireita ja johtaa nopeaan kiinnitysosien irtoamiseen ja rangan epätukevuusoireiden palaamiseen. Suuri osa selkärangan kiinnityslaitteista irtoaa lopulta, jollei luutumista kiinnitettyjen kohtien välillä tapahdu. Vuoden kuluttua luudutusleikkauksesta oireista luutumatonta kiinnityskohtaa nimitetään pseudoartroosiksi. Bioaktiiviset lasit ovat synteettisiä, bioyhteensopivia, osteokonduktiivisia ja osteostimulatiivisia materiaaleja, joilla on angiogeenisiä ja antibakteerisia ominaisuuksia, ja ne voivat sitoutua suoraan luuhun. 147 potilaalle lannerangan rappeumasairauden vuoksi asetetut 837 pedikkeliruuvia käsittävän tutkimuksen mukaan 14.3 % ruuveista rikkoi luisen pedikkelin seinämän. 25.9 %:lla potilaista, joilla ruuvi läpäisi pedikkelin seinämän, ilmeni uusia neurologisia oireita, ja 89.2 %:lla oireisista potilaista pedikkeliruuvi läpäisi pedikkelin seinämän mediaalisesti tai inferiorisesti. Prekliinisessä kontrolloidussa tutkimuksessa uudenlainen bioaktiivisesta lasista valmistettu S53P4 luunkorviketahna todettiin bioyhteensopivaksi, ja sen avulla saavutettiin hieman vertailuryhmää parempi luutuminen luuydinontelossa. Tahnan sidosaineen ei eläinkokeessa todettu häiritsevän luun muodostumista. Kliinisessä tutkimuksessa saavutettiin 95.8 %:n luutuminen käytettäessä S53P4 biolasitahnaa yhdessä oman luun kanssa lannerangan nikamasolmujen välisessä luudutuksessa. Siten yhdessä oman luun kanssa käytettäessä S53P4 biolasitahnalla saadaan aikaan vähintään yhtä hyvä nikamasolmujen välinen luutuminen kuin nykyisin käytettävillä synteettisillä luunkorvikkeilla. Tutkimuksessa todettiin yksi leikkauksen yhteydessä tapahtunut nikamasolmujen välisen implantin päätelevyyn painuminen, jonka suuruus ei muuttunut seurantakuvantamisissa