The influence of elastic orthotic belt on sagittal profile in adolescent idiopathic thoracic scoliosis: a comparative radiographic study with Milwaukee brace

<p>Abstract</p> <p>Background</p> <p>The effectiveness of bracing on preventing curve progression in coronal plane for mild and moderate adolescent idiopathic scoliosis (AIS) patients has been confirmed by previous radiographic researches. However, a hypokyphotic effect on the sagittal plane has been reported by a few studies. A relatively increasing number of AIS patients were noticed to wear a new kind of elastic orthotic belt for the treatments of scoliosis without doctors' instructions. We postulate the correcting mechanism of this new appliance may cause flattening of the spine. To our knowledge, no study has investigated the effects of this new orthosis on the sagittal profile of AIS patients. The aim of this study was to evaluate and compare the effects of elastic orthotic belt and Milwaukee brace on the sagittal alignment in AIS patients.</p> <p>Methods</p> <p>Twenty-eight female AIS patients with mild or moderate thoracic curves were included in this study. Standing full-length lateral radiographs were obtained in three conditions: natural standing posture without any treatment, with elastic orthotic belt and with Milwaukee brace. Thoracic kyphosis (TK), lumber lordosis (LL) and pelvic incidence (PI) were measured and compared between the above three conditions.</p> <p>Results</p> <p>Both elastic orthotic belt and Milwaukee brace can lead to significant decrease of TK, however, the decrease of TK after wearing elastic orthotic belt is significantly larger than that after wearing Milwaukee brace. Compared with no treatment, LL was found to be significantly smaller after wearing Milwaukee brace, however, such significant decrease was not noted after wearing elastic orthotic belt. No significant changes were observed for the PI between 3 conditions.</p> <p>Conclusions</p> <p>The elastic orthotic belt could lead to more severe thoracic hypokyphosis when compared with Milwaukee brace. This belt may not be a suitable conservative method for the treatment of mild and moderate AIS patients.</p

Temporary use of shape memory spinal rod in the treatment of scoliosis

NiTinol shape memory alloy is characterized by its malleability at low temperatures and its ability to return to a preconfigured shape above its activation temperature. This process can be utilized to assist in scoliosis correction. The goal of this retrospective study was to evaluate the clinical and radiographic results of intraoperative use of shape memory alloy rod in the correction of scoliosis. From May 2002 to September 2006, 38 scoliosis patients (ranging from 50° to 120°; 22 cases over 70°) who underwent shape memory alloy-assisted correction in our institute were reviewed. During the operation, a shape memory alloy rod served as a temporary correction tool. Following correction, the rod was replaced by a rigid rod. The mean blood loss at surgery was 680 ± 584 ml; the mean operative time was 278 ± 62 min. The major Cobb angle improved from an average 78.4° preoperatively to 24.3° postoperatively (total percent correction 71.4%). In 16 patients with a major curve <70° and flexibility of 52.7%, the deformity improved from 58.4° preoperatively to 12.3° postoperatively (percent correction, 78.9%). In 22 patients with a major curve >70° and flexibility of 25.6%, the deformity improved from 94.1° preoperatively to 30.1° postoperatively (percent correction, 68.1%). Only one case had a deep infection. There were no neurologic, vascular or correction-related complications such as screw pullout or metal fracture. The study shows that the intraoperative use of a shape memory rod is a safe and effective method to correct scoliosis

Increased rod stiffness improves the degree of deformity correction by segmental pedicle screw fixation in adolescent idiopathic scoliosis

<p>Abstract</p> <p>Background</p> <p>There are limited reports in literature studying the impact of rod diameter and stiffness on the degree of deformity correction in patients with AIS.</p> <p>Aims</p> <p>The aims of this study were to evaluate the 3-dimentional deformity correction achieved by segmental pedicle screw fixation in patients with adolescent idiopathic scoliosis, and to find out if learning or the change to stiffer rods had any positive impact on deformity correction.</p> <p>Study design</p> <p>Retrospective study.</p> <p>Methods</p> <p>Plain radiographs and low-dose spine CTs of 116 consecutive patients (aged 15.9 ± 2.8 years) operated during the period 2005-2009 (group 1: patients operated autumn 2005-2006; group 2: 2007; group 3: 2008; group 4: 2009) were retrospectively evaluated.</p> <p>Results</p> <p>There was no statistically significant difference between the correction of the Cobb angle (P = 0.425) or lower end vertebra tilt (P = 0.298) in patients operated during the first versus the remaining periods of the study. No restoration of the sagittal kyphosis was reported in the first period compared with 5.9° in the last study period (P < 0.001). The correction of vertebral rotation was also improved from 4.2° to 7.8° (P < 0.001) for the same periods. For the whole study population, there was statistically significant correlation between the order of the operation (patient number) and the restoration of sagittal kyphosis (r = -0.344, P = 0.001), and the correction of vertebral rotation (r = 0.370, P < 0.001), but not for the Cobb angle or LEVT. However, there was no significant difference in restoration of sagittal kyphosis and the vertebral rotation in the first 17 patients compared with the last 17 patients operated with rods of 5.5 mm diameter (P = 0.621, and 0.941, respectively), indicating that rod stiffness had more impact on the deformity correction than did learning.</p> <p>Conclusions</p> <p>This study showed that rod stiffness had more impact on the deformity correction than did learning.</p

Comparison of effectiveness of Halo-femoral traction after anterior spinal release in severe idiopathic and congenital scoliosis: a retrospective study

<p>Abstract</p> <p>Background</p> <p>Halo-femoral traction could gradually improve the coronal and sagittal deformity and restore the trunk balance through the elongation of the spine. The purpose of this retrospective study was to assess the effectiveness of Halo-femoral traction after anterior spinal release in the management of severe idiopathic and congenital scoliosis.</p> <p>Methods</p> <p>Sixty patients with severe and rigid curve treated with anterior spinal release, Halo-femoral traction, and second stage posterior spinal fusion were recruited for this retrospective study. Idiopathic Scoliosis (IS) group was 30 patients (23 females and 7 males) with mean age of 15.5 years. The average coronal Cobb angle was 91.6° and the mean global thoracic kyphosis was 50.6°. The curve type of these patients were 2 with Lenke 1AN, 4 with Lenke 1A+, 1 with Lenke 1BN, 10 with Lenke 1CN, 3 with Lenke 1C+, 3 with Lenke 3CN, 3 with Lenke 3C+, and 4 with Lenke 5C+. Congenital Scoliosis (CS) group included 30 patients (20 females and 10 males) with average age of 15.2 years. The average coronal Cobb angle of the main curve before operation was 95.7° and the average thoracic kyphosis was 70.2°. All patients had a minimum 12-month follow-up radiograph (range 12–72 months, mean 38 months).</p> <p>Results</p> <p>The average traction time was 23 days and the average traction weight was 16 kg. Four patients experienced brachial plexus palsy and complete nerve functional restoration was achieved at two months follow-up. For the IS group, the post-operative mean Cobb angle of major curve averaged 40.1° with correction rate of 57.5%. For the CS group, the post-operative mean Cobb angle was 56.5° with average correction rate of 45.2%. The difference in curve magnitude between the IS and CS patients after posterior correction was statistically significant (t = 4.15, p < 0.001). The correction rate of kyphosis between IS and CS patients was also statistically significant (t = -2.59, p < 0.016).</p> <p>Conclusion</p> <p>Halo-femoral traction was a safe, well-tolerated and effective method for the treatment of severe and rigid scoliosis patients. The posterior correction rate obtained after anterior release and traction was significant superior than that recorded from side bending film in current study.</p

Clinical effectiveness of Enneking appropriate versus Enneking inappropriate procedure in patients with primary osteosarcoma of the spine: a systematic review with meta-analysis

Purpose Primary osteosarcoma of the spine is a rare osseous tumour. En bloc resection, in contrast to intralesional resection, is the only procedure able to provide Enneking appropriate (EA) margins, which has improved local control and survival of patients with primary osteosarcoma of the spine. The objective of this study is to compare the risk of local recurrence, metastases development and survival in patients with primary osteosarcoma of the spine submitted to Enneking appropriate (EA) and Enneking inappropriate (EI) procedures. Methods A systematic search was performed on EBSCO, PubMed and Web of Science, between 1966 and 2018, to identify studies evaluating patients submitted to resection of primary osteosarcoma of the spine. Two reviewers independently assessed all reports. The outcomes were local recurrence, metastases development and survival at 12, 24 and 60 months. Results Five studies (108 patients) were included for systematic review. These studies support the conclusion that EA procedure has a lower local recurrence rate (RR 0.33, 95% CI 0.17-0.66), a lower metastases development rate (RR 0.39, 95% CI 0.17-0.89) and a higher survival rate at 24 months (RR 1.78, 95% CI 1.24-2.55) and 60 months (RR 1.97, 95% CI 1.14-3.42) of follow-up; however, at 12 months, there is a non-significant difference. Conclusions EA procedure increases the ratio of remission and survival after 24 months of follow-up. Multidisciplinary oncologic groups should weigh the morbidity of an en bloc resection, knowing that in the first year the probability of survival is the same for EA and EI procedures. Graphic abstract These slides can be retrieved under Electronic Supplementary Material

Pyogenic spondylitis

Pyogenic spondylitis is a neurological and life threatening condition. It encompasses a broad range of clinical entities, including pyogenic spondylodiscitis, septic discitis, vertebral osteomyelitis, and epidural abscess. The incidence though low appears to be on the rise. The diagnosis is based on clinical, radiological, blood and tissue cultures and histopathological findings. Most of the cases can be treated non-operatively. Surgical treatment is required in 10–20% of patients. Anterior decompression, debridement and fusion are generally recommended and instrumentation is acceptable after good surgical debridement with postoperative antibiotic cover

A Dutch guideline for the treatment of scoliosis in neuromuscular disorders

<p>Abstract</p> <p>Background</p> <p>Children with neuromuscular disorders with a progressive muscle weakness such as Duchenne Muscular Dystrophy and Spinal Muscular Atrophy frequently develop a progressive scoliosis. A severe scoliosis compromises respiratory function and makes sitting more difficult. Spinal surgery is considered the primary treatment option for correcting severe scoliosis in neuromuscular disorders. Surgery in this population requires a multidisciplinary approach, careful planning, dedicated surgical procedures, and specialized after care.</p> <p>Methods</p> <p>The guideline is based on scientific evidence and expert opinions. A multidisciplinary working group representing experts from all relevant specialties performed the research. A literature search was conducted to collect scientific evidence in answer to specific questions posed by the working group. Literature was classified according to the level of evidence.</p> <p>Results</p> <p>For most aspects of the treatment scientific evidence is scarce and only low level cohort studies were found. Nevertheless, a high degree of consensus was reached about the management of patients with scoliosis in neuromuscular disorders. This was translated into a set of recommendations, which are now officially accepted as a general guideline in the Netherlands.</p> <p>Conclusion</p> <p>In order to optimize the treatment for scoliosis in neuromuscular disorders a Dutch guideline has been composed. This evidence-based, multidisciplinary guideline addresses conservative treatment, the preoperative, perioperative, and postoperative care of scoliosis in neuromuscular disorders.</p