The Efficacy of a Posterior Approach to Surgical Correction for Neglected Idiopathic Scoliosis: A Comparative Analysis According to Health-Related Quality of Life, Pulmonary Function, Back Pain and Sexual Function

Background: This study aimed to evaluate the treatment outcomes of severe idiopathic scoliosis (IS) and hypothesized that surgical treatment would have a superior impact on the health-related quality of life (HRQoL), pulmonary function (PF), back pain, and sexual function. Methods: We retrospectively reviewed 195 consecutive patients with IS classified into severe (SG) and moderate groups (MG) with a minimum follow-up of two years. Results: The mean preoperative curve was 131° and 60° in the SG and MG, respectively. The mean preoperative flexibility in the bending films averaged between 22% in the SG and 41% in the MG. After definitive surgery, the main curve was corrected to 61° and 18° in the SG and MG, respectively. The mean preoperative thoracic kyphosis was 83° in the SG and 25° in the MG, which was corrected to 35° in the SG and 25° in the MG. At baseline, the percentage of predicted lung volume (FVC) was significantly lower in the SG than that in the MG (51.2% vs. 83%). The baseline percentage of the predicted FEV1 values was also significantly lower in the SG than in the MG (60.8% vs. 77%). During the two-year follow-up, the percentage of predicted FVC showed significant improvement in the SG (69.9%) (p < 0.001), and the percentage of predicted FEV1 values during the follow-up improved significantly in the SG (76.9%) (p < 0.001) compared with the MG (81%), with no statistical difference observed during the two-year follow-up. The SRS-22r showed a clinically and statistically significant improvement in the preoperative results to those of the final follow-up (p < 0.001). Conclusions: Surgical treatment of severe scoliosis can be safe. It provided a mean correction of the deformity for 59% of patients and significantly improved respiratory function, with the percentage of predicted forced expiratory volume in 1 s improving by 60% and the forced vital capacity improving by 50%, resulting in clinically and statistically significant improvements in the SRS-22r, HRQoL outcome scores, and back pain (reduced from 36% to 8%), as well as improved sexual function. The planned surgical treatment can achieve a very significant deformity correction with a minimal risk of complications. The surgical treatment has a superior impact on the quality of life patients with severe spinal deformities and significantly improves function in every sphere of life

Impact of Pregnancy on Loss of Deformity Correction After Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis

OBJECTIVE: A retrospective multicenter comparative study was carried out to evaluate whether pregnancy leads to the loss of deformity correction (LOC) in female patients surgically treated for idiopathic scoliosis. METHODS: A total of 128 female patients who underwent segmental spinal instrumentation and fusion for adolescent idiopathic scoliosis (AIS) between 1999 and 2014 were reviewed. Of these patients, 62 became pregnant (surgery-pregnancy group [SPG]), whereas 66 did not (surgery-nonpregnancy [SNP] group). Radiographic parameters were analyzed before surgery, after surgery, before pregnancy, up to 1 year after delivery, and at final follow-up (FFU). Health-related quality of life was analyzed using the Scoliosis Research Society outcome questionnaire (SRS-22r). RESULTS: The mean age at the time of surgery was 16 years in both groups. The mean preoperative major curves were 65 degrees (standard deviation [SD], 12 degrees) versus 67 degrees (SD, 11 degrees), 18 degrees (SD, 9 degrees) versus 17 degrees (SD, 9 degrees) immediately after surgery, and 20 degrees (SD, 8 degrees) versus 20 degrees (SD, 8 degrees) at FFU in the SPG and SNP groups, respectively (P > 0.10 for all comparisons). The mean loss of correction was 3.5 degrees (SD, 3 degrees) in the SPG and 4.5 (SD, 3 degrees) for SNP groups, respectively (P = 0.379). The mean preoperative thoracic kyphosis (T5-T12) was 26.5 degrees (SD, 11.9 degrees) for SPG and 24.7 degrees (SD, 14.5 degrees) for SNP, after surgery 19.2 degrees (SD, 9.5 degrees) for SPG, 18.8 (SD, 8.9 degrees) for SNP and at FFU, 20.3 degrees (SD, 9 degrees) for SPG and 21.3 degrees (SD, 8.5 degrees) for SNP. CONCLUSIONS: Women who have undergone pedicle screw instrumentation and fusion who have had >= 1 pregnancies do not have curve progression or deterioration in the longer-term outcomes compared with patients who have not become pregnant.Peer reviewe

Prophylactic methylprednisolone to reduce inflammation and improve outcomes from one lung ventilation in children: a randomized clinical trial.

BACKGROUND: One lung ventilation (OLV) results in inflammatory and mechanical injury, leading to intraoperative and postoperative complications in children. No interventions have been studied in children to minimize such injury. OBJECTIVE: We hypothesized that a single 2-mg·kg(-1) dose of methylprednisolone given 45-60 min prior to lung collapse would minimize injury from OLV and improve physiological stability. METHODS: Twenty-eight children scheduled to undergo OLV were randomly assigned to receive 2 mg·kg(-1) methylprednisolone (MP) or normal saline (placebo group) prior to OLV. Anesthetic management was standardized, and data were collected for physiological stability (bronchospasm, respiratory resistance, and compliance). Plasma was assayed for inflammatory markers related to lung injury at timed intervals related to administration of methylprednisolone. RESULTS: Three children in the placebo group experienced clinically significant intraoperative and postoperative respiratory complications. Respiratory resistance was lower (P = 0.04) in the methylprednisolone group. Pro-inflammatory cytokine IL-6 was lower (P = 0.01), and anti-inflammatory cytokine IL-10 was higher (P = 0.001) in the methylprednisolone group. Tryptase, measured before and after OLV, was lower (P = 0.03) in the methylprednisolone group while increased levels of tryptase were seen in placebo group after OLV (did not achieve significance). There were no side effects observed that could be attributed to methylprednisolone in this study. CONCLUSIONS: Methylprednisolone at 2 mg·kg(-1) given as a single dose prior to OLV provides physiological stability to children undergoing OLV. In addition, methylprednisolone results in lower pro-inflammatory markers and higher anti-inflammatory markers in the children\u27s plasma

Influences of Increasing Pedicle Screw Diameter on Widening Vertebral Pedicle Size during Surgery in Spinal Deformities in Children and Adolescents without Higher Risk of Pedicle and Vertebral Breaches

Background: A very common technique for treating spinal deformities in children and adolescents is the use of segmental screws. In order to obtain proper stability and the best possible correction, the screws must first be precisely inserted. Additional factors influencing the quality and success of the operation are the size and quality of the bone, the skills of the surgeon, and biomechanical factors, i.e., the width and length of the screws used during surgery. Our study was focused on evaluating the effect of increasing the diameter of the instrumented pedicles by pedicle screws and assessing the safety of expanding these pedicles with screws of various sizes in children with spinal deformities during the growth period, using preoperative magnetic resonance imaging and postoperative computed tomography (CT) to assess and compare preoperative size measurements from MRI to postoperative CT measurements. Methods: We obtained data for evaluation from the available medical records and treatment histories of patients aged 2 to 18 who underwent surgical treatment of spinal deformities in the years 2016–2023. In 230 patients (28 male and 202 female), 7954 vertebral bodies were scanned by preoperative MRI, and 5080 pedicle screws were inserted during surgery, which were then assessed by postoperative CT scan. For the most accurate assessment, patients were classified into three age groups: 2–5 years (Group 1), 6–10 years (Group 2), and 11–18 years (Group 3). In addition, we studied implant subgroups: vertebral bodies with inserted pedicles of screw sizes 5.0 mm and 5.5 mm (Group S), and pedicles of screw sizes 6.0 mm, 6.5 mm, and 7.0 mm (Group L). Results: The morphology of pedicles (Lenke classification) analyzed before surgery using MRI was 55.2% type A, 33.8% type B, 4.7% type C, and 6.3% type D. The postoperative lateral and medial breaches were noted, and these did not cause any complications requiring revision surgery. The mean pedicle diameter before surgery for T1–L5 vertebral pedicles was between 3.79 (1.44) mm and 5.68 (1.64) mm. The mean expanding diameter of pedicles after surgery for T1–L5 vertebral pedicles ranged from 1.90 (0.39) mm to 2.92 (0.28) mm, which corresponds to the extension of the pedicle diameter in the mean range of 47% (4.1)–71% (3.0). We noted that the mean vertebral pedicle expansion was 49% in Group 1, 52% in Group 2, and 62% in Group 3 (N.S.), and the mean expansion for 7.0 mm screw pedicles was 78%. Conclusions: Our study confirms that there is a wide range of expansion of the vertebral pedicle during screw insertion (up to 78%) with a low risk of lateral or medial breaches and without an increased risk of complications. The larger the diameter of the screw inserted into the pedicle, the more the pedicle expands. Pedicle measurements by preoperative MRI may be helpful for sufficient reliability in preoperative planning

The Efficacy of a Posterior Approach to Surgical Correction for Neglected Idiopathic Scoliosis: A Comparative Analysis According to Health-Related Quality of Life, Pulmonary Function, Back Pain and Sexual Function

Background: This study aimed to evaluate the treatment outcomes of severe idiopathic scoliosis (IS) and hypothesized that surgical treatment would have a superior impact on the health-related quality of life (HRQoL), pulmonary function (PF), back pain, and sexual function. Methods: We retrospectively reviewed 195 consecutive patients with IS classified into severe (SG) and moderate groups (MG) with a minimum follow-up of two years. Results: The mean preoperative curve was 131° and 60° in the SG and MG, respectively. The mean preoperative flexibility in the bending films averaged between 22% in the SG and 41% in the MG. After definitive surgery, the main curve was corrected to 61° and 18° in the SG and MG, respectively. The mean preoperative thoracic kyphosis was 83° in the SG and 25° in the MG, which was corrected to 35° in the SG and 25° in the MG. At baseline, the percentage of predicted lung volume (FVC) was significantly lower in the SG than that in the MG (51.2% vs. 83%). The baseline percentage of the predicted FEV1 values was also significantly lower in the SG than in the MG (60.8% vs. 77%). During the two-year follow-up, the percentage of predicted FVC showed significant improvement in the SG (69.9%) (p p p < 0.001). Conclusions: Surgical treatment of severe scoliosis can be safe. It provided a mean correction of the deformity for 59% of patients and significantly improved respiratory function, with the percentage of predicted forced expiratory volume in 1 s improving by 60% and the forced vital capacity improving by 50%, resulting in clinically and statistically significant improvements in the SRS-22r, HRQoL outcome scores, and back pain (reduced from 36% to 8%), as well as improved sexual function. The planned surgical treatment can achieve a very significant deformity correction with a minimal risk of complications. The surgical treatment has a superior impact on the quality of life patients with severe spinal deformities and significantly improves function in every sphere of life

Basilar impression in osteogenesis imperfecta treated with staged halo traction and posterior decompression with short-segment fusion

Basilar impression is a cranial base abnormality associated with osteogenesis imperfecta (OI) with serious neurologic implications but controversial treatment options. Combined anterior and posterior decompression with long-segment posterior fusion is often recommended. We report a patient with OI (Sillence type III) with basilar impression treated with halo traction followed by posterior surgery. The patient was a 12-year-old female with a presentation of hiccups and change in upper extremity function. Diagnostic imaging revealed syringomyelia, compensated hydrocephalus, basilar impression, and Chiari type I malformation. The patient was treated with halo traction followed by posterior decompression fusion from the occipital bone to C2. Bone fusion and improved syrinx were evident on images during the 5 years of follow-up. Five years after surgery, syrinx recurred and the fourth ventricular catheter was revised. The treatment with halo traction followed by posterior-only surgery of basilar impression associated with OI resulted in a good postoperative outcome

Natural sagittal spino-pelvic alignment in boys and girls before, at and after the adolescent growth spurt

Adolescent idiopathic scoliosis occurs far more often in girls than in boys, and its initiation and progression normally takes place around the adolescent growth spurt. Despite extensive research into the topic, no solid explanation for both well-known phenomena has been offered. The sagittal profile of the growing spine has been demonstrated previously to play an important role in the spine's rotational stiffness. Changes in this sagittal alignment around the growth spurt can be inferred to play an important role in the spine's propensity to develop a rotatory deformity, i.e. scoliosis. The aim of this study was to quantify sagittal spino-pelvic alignment and orientation in space of each individual vertebra in normal boys and girls in the beginning, at the peak and at the end of pubertal growth. Standardized lateral radiographs of the spine of boys (n = 57) and girls (n = 99) between the age of seven and eighteen who underwent screening for scoliosis, but had a normal spine were enrolled in this study. Children with spino-pelvic pathology at initial screening or during follow-up were excluded. According to Dimeglio's data, subjects were classified into three groups: before, at and after the peak growth spurt. Seven regional sagittal spino-pelvic parameters, as well as the inclination angles of each individual vertebra between C7 and L5 compared to the gravity line, were measured semi-automatically using in-house developed software. In all subjects, the posteriorly tilted segment was longer, vertebrae T1-T8 were more posteriorly inclined and thoracic kyphosis, pelvic incidence and pelvic tilt were lower before as well as during the peak of the growth spurt, when compared to after the growth spurt (P a parts per thousand currency sign 0.023). Furthermore, in girls, thoracic kyphosis was smaller (P = 0.023), the posteriorly inclined segment was longer (P <0.001) and T1 as well as levels T3-T11 were more posteriorly inclined (P <0.05) compared to boys at all stages of development. At the peak of the growth spurt, girls had more posterior inclination of upper thoracic vertebrae and lower values for thoracic kyphosis than boys (P = 0.005). These results imply that the spines of girls during the growth spurt are more posteriorly inclined, and thus rotationally less stable, compared to boys at the same stage of development, as well as compared to girls after the growth spurt. This may explain why initiation and progression of adolescent idiopathic scoliosis are more prevalent in girls around puberty