Paediatric Spinal Deformity

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Chronic Care".

Deadline for manuscript submissions: 30 April 2024 | Viewed by 12870

Special Issue Editor


E-Mail Website
Guest Editor
Orthopaedic and Spine Surgeon, Scottish National Deformity Centre, Royal Hospital for Children and Young People, University of Edinburgh, Edinburgh EH8 9YL, UK
Interests: treatment of paediatric spinal deformity such as scoliosis, kyphosis or spondylolisthesis; spinal deformity

Special Issue Information

Dear Colleagues, 

Scoliosis is a spinal condition that usually affects fit and healthy teenage patients during a period of rapid skeletal development. The development of a spinal curve produces major cosmetic concerns impacting patients’ emotional and physical balance during a sensitive period of growth, causing severe anxiety to teenagers and their families. Scoliosis can also develop in patients with underlying neurological or syndromic conditions, and this can impact associated medical co-morbidities and affect their life expectancy or quality of life. The last type of scoliosis seen in growing children is congenital, and this is due to abnormalities in the formation or separation of vertebrae occurring in the embryonic life as an isolated skeletal defect or as part of a wider multisystemic condition.

Kyphosis and spondylolysis/spondylolisthesis can develop in children and adolescents, and even though they require treatment with lesser frequency compared to scoliosis, they can also have an impact on patients’ level of activities and day-to-day life due to persistent pain or cosmetic effect.     

Spinal deformity treatment has advanced considerably in the past few decades and can achieve optimum curve correction and good clinical results. It is with continuous research and close monitoring of our outcomes that we can ensure that we are offering to our patients the best possible care while reducing the risk of major complications. Patients’ perception of surgical results is critical in order to better assess outcomes and the impact that surgery has on patients’ spinal-related health. 

The aim of this Special Issue is to collect articles from distinguished authors around the world who can present their experience in the aetiology, natural history, and management of young patients with severe spinal deformity. I hope that we can produce a spinal volume that will advance our knowledge in the care of children and adolescents with spinal deformities and that will be of value to colleagues who are faced with these clinical problems in their everyday medical practice.

Dr. Athanasios Tsirikos
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • scoliosis
  • kyphosis
  • spondylolysis
  • spondylolisthesis
  • natural history
  • prognosis
  • treatment
  • spinal fusion
  • outcomes
  • quality of life assessment questionnaires

Published Papers (9 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review

9 pages, 1060 KiB  
Article
Growing Rod versus Posterior Spinal Fusion Treatment of Juvenile Idiopathic Scoliosis: Unique Characteristics and Surgical Outcomes
by Elizabeth M. Wacker, Lindsay Schultz, Nichole Leitsinger, Viral V. Jain and Peter F. Sturm
Healthcare 2024, 12(4), 489; https://doi.org/10.3390/healthcare12040489 - 18 Feb 2024
Viewed by 540
Abstract
Progressive spinal curvature in juvenile idiopathic scoliosis (JIS) is challenging to treat. When conservative management fails, treatments include growing rods (GRs) or posterior spinal fusion (PSF). The purpose of this study is to compare the patient characteristics and outcomes of GR and PSF [...] Read more.
Progressive spinal curvature in juvenile idiopathic scoliosis (JIS) is challenging to treat. When conservative management fails, treatments include growing rods (GRs) or posterior spinal fusion (PSF). The purpose of this study is to compare the patient characteristics and outcomes of GR and PSF treatment of JIS. We performed a retrospective review of demographic, radiographic, and surgical data for all JIS patients requiring surgical treatment between 2012 and 2020. Patients who underwent any GR treatment were compared to PSF patients. A total of 36 patients (13 GR, 23 PSF) were reviewed. PSF patients had a larger pre-operative spinal height (p = 0.002), but similar pre-operative major curve magnitudes (p = 0.558). PSF treatment resulted in similar change in the T1-S1 length (p = 0.002), but a greater correction of the curve magnitude (p < 0.055) compared to GR patients. Eight patients initially treated with GRs later underwent definitive PSF treatment. This subset of patients had a greater spinal height before PSF (p = 0.006), but similar immediate post-PSF T1-S1 lengths (p = 0.437) and smaller changes in spinal height from PSF (p = 0.020) than primary PSF patients. At final follow-up, patients who underwent primary PSF versus PSF after GR had similar spinal heights (p = 0.842). The surgical intervention chosen to manage progressive JIS often differs based on patient characteristics. While this choice may impact immediate outcomes, the outcomes at final follow up are similar. Full article
(This article belongs to the Special Issue Paediatric Spinal Deformity)
Show Figures

Figure 1

13 pages, 1000 KiB  
Article
Segmental Rib Index and Spinal Deformity: Scoliogenic Implications
by Theodoros B. Grivas, Nikola Jevtic, Danka Ljubojevic, Samra Pjanic, Filip Golic and Elias Vasiliadis
Healthcare 2023, 11(22), 3004; https://doi.org/10.3390/healthcare11223004 - 20 Nov 2023
Viewed by 741
Abstract
The aim of this report is to evaluate the segmental rib index (RI) from the T1 to T12 spinal levels in mild and moderate idiopathic scoliosis (IS) curves of thoracic, thoracolumbar and lumbar type by gender. The relationship of segmental RI to the [...] Read more.
The aim of this report is to evaluate the segmental rib index (RI) from the T1 to T12 spinal levels in mild and moderate idiopathic scoliosis (IS) curves of thoracic, thoracolumbar and lumbar type by gender. The relationship of segmental RI to the frontal plane radiological deformity presented as the Cobb angle and to the posterior truncal surface deformity presented as the scoliometric readings of Angle of Trunk Rotation (ATR) in these patients is also assessed. Any statistically significant relationship between these parameters would be very important for biomechanical relations in rib cage (RC) deformity presented as rib hump deformity (RHD) and deformity in the spine, and would thus provide valuable information about scoliogeny. The segmental rib index (RI) is presented in 83 boys and girls with mild and moderate IS. The measurements include the scoliometric readings for truncal asymmetry (TA), the Cobb angle assessment and the segmental RI from T1-T12. The statistical package SPSS 23 was used for statistical analysis. The TA was documented and the Cobb angle is presented by gender and curve type. The segmental RI of thoracic, thoracolumbar and lumbar curves are presented for the first time. The correlations of the segmental RI to surface deformity presented as rib hump deformity (RHD) in all IS patients, and particularly in thoracic curves, to Cobb angle by gender and age and the comparison of the segmental RI index of asymmetric but not scoliotic children to the scoliotic peers by curve (in thoracic, thoracolumbar, lumbar curves) in boys and girls are presented. The findings emphasize the significant protagonistic role of thoracic asymmetry in relation to the spinal deformity, mainly in girls for the thoracic and in boys for the thoracolumbar curves. The cut-off point of age of the examined scoliotics was 14 years, which is when the RI shows a stronger correlation with spinal deformity, namely when thoracic deformity is decisively effective in the development of thoracic spinal deformity, in terms of Cobb angle. In summary, the results of this study may provide scoliogenic implications for IS, as far as the role of the thorax is concerned. Full article
(This article belongs to the Special Issue Paediatric Spinal Deformity)
Show Figures

Figure 1

15 pages, 4002 KiB  
Article
Posterior Vertebral Pedicular Tethering for the Treatment of Idiopathic Adolescent Scoliosis
by Jorge Mineiro
Healthcare 2023, 11(13), 1878; https://doi.org/10.3390/healthcare11131878 - 28 Jun 2023
Cited by 1 | Viewed by 1009
Abstract
Over the last decade, there has been a new wave of interest in non-fusion techniques for the treatment of adolescent idiopathic scoliosis. These are not new techniques, as they were first published and presented in the late 1950s, using compression of the convexity [...] Read more.
Over the last decade, there has been a new wave of interest in non-fusion techniques for the treatment of adolescent idiopathic scoliosis. These are not new techniques, as they were first published and presented in the late 1950s, using compression of the convexity or distraction of the concavity of the main curvature. More recently, anterior vertebral body tethering has raised great interest, as although it is a major procedure through the child’s chest, it seems appropriate for the thoracic curves. The main objective of this article is to describe Posterior Vertebral Pedicular Tethering (PVPT) as a “new” technique performed as a less invasive spinal procedure for the treatment of certain thoracolumbar and lumbar scoliosis in growing adolescents. It is an alternative growth modulation technique appropriate for thoracolumbar and lumbar curvatures where we observe reduction of the three plane deformity of idiopathic scoliosis in adolescents. Full article
(This article belongs to the Special Issue Paediatric Spinal Deformity)
Show Figures

Figure 1

15 pages, 1525 KiB  
Article
Benefits of Best Practice Guidelines in Spine Fusion: Comparable Correction in AIS with Higher Density and Fewer Complications
by Pedro Fernandes, Isabel Flores and Joaquim Soares do Brito
Healthcare 2023, 11(11), 1566; https://doi.org/10.3390/healthcare11111566 - 26 May 2023
Cited by 1 | Viewed by 1137
Abstract
Background: There is significant variability in surgeons’ instrumentation patterns for adolescent idiopathic scoliosis surgery. Implant density and costs are difficult to correlate with deformity correction, safety, and quality of life measures. Materials and Methods: Two groups of postoperative adolescents were compared based on [...] Read more.
Background: There is significant variability in surgeons’ instrumentation patterns for adolescent idiopathic scoliosis surgery. Implant density and costs are difficult to correlate with deformity correction, safety, and quality of life measures. Materials and Methods: Two groups of postoperative adolescents were compared based on exposure to a best practice guidelines program (BPGP) introduced to decrease complications. Hybrid and stainless steel constructs were dropped, and posterior-based osteotomies, screws, and implant density were increased to 66.8 ± 12.03 vs. 57.5 ± 16.7% (p < 0.001). The evaluated outcomes were: initial and final correction, rate of correction loss, complications, OR returns, and SRS-22 scores (minimum two-year follow-up). Results: 34 patients were operated on before BPGP and 48 after. The samples were comparable, with the exceptions of a higher density and longer operative times after BPGP. Initial and final corrections before BPGP were 67.9° ± 22.9 and 64.6° ± 23.7; after BPGP, the corrections were 70.6° ± 17.4 and 66.5° ± 14.9 (sd). A regression analysis did not show a relation between the number of implants and postoperative correction (beta = −0.116, p = 0.307), final correction (beta = −0.065, p = 0.578), or loss of correction (beta= −0.137, p = 0.246). Considering screw constructs only (n = 63), a regression model controlled for flexibility continued to show a slight negative effect of density on initial correction (b = −0.274; p = 0.019). Only with major curve concavity was density relevant in initial correction (b = 0.293; p = 0.038), with significance at 95% not being achieved for final correction despite a similar beta (b = 0.263; p = 0.069). Complications and OR returns dropped from 25.6% to 4.2%. Despite this, no difference was found in SRS-22 (4.30 ± 0.432 vs. 4.42 ± 0.39; sd) or subdomain scores pre- and post-program. Findings: Although it appears counterintuitive that higher density, osteotomies, and operative time may lead to fewer complications, the study shows the value of best practice guidelines in spinal fusions. It also shows that a 66% implant density leads to better safety and efficacy, avoiding higher costs. Full article
(This article belongs to the Special Issue Paediatric Spinal Deformity)
Show Figures

Figure 1

15 pages, 1377 KiB  
Article
Effectiveness of the Boston Brace in the Treatment of Paediatric Scoliosis: A Longitudinal Study from 2010–2020 in a National Spinal Centre
by Athanasios I. Tsirikos, Rachel Adam, Kirsty Sutters, Maureen Fernandes and Silvia García-Martínez
Healthcare 2023, 11(10), 1491; https://doi.org/10.3390/healthcare11101491 - 20 May 2023
Cited by 1 | Viewed by 1412
Abstract
Bracing can reduce curve progression in order to prevent or delay scoliosis surgery in growing children. Brace treatment is effective in adolescent idiopathic scoliosis (AIS), but there is less evidence of its efficacy in early-onset or non-idiopathic scoliosis. We assessed the outcome of [...] Read more.
Bracing can reduce curve progression in order to prevent or delay scoliosis surgery in growing children. Brace treatment is effective in adolescent idiopathic scoliosis (AIS), but there is less evidence of its efficacy in early-onset or non-idiopathic scoliosis. We assessed the outcome of bracing at the end point of treatment, including the patients’ perception of clinical results. We reviewed 480 patients treated using Boston brace from 2010–2020 (70% female); 249 patients completed bracing (52%) and 118 patients (47.4%) did not require surgery, with 83% having idiopathic scoliosis. Brace success was considered scoliosis below 50° at the end of bracing, with the patient skeletally mature. A total of 131 patients required scoliosis surgery after bracing (64% had idiopathic scoliosis; adolescents 57% and juveniles 43%). All patients had a minimum two-year follow-up after bracing or after scoliosis correction, with the quality of life assessment questionnaires. A total of 98 out of 182 patients with idiopathic scoliosis did not require surgery (54%). Thoracic scoliosis improved with bracing by a mean of 3.4° and thoracolumbar/lumbar scoliosis by a mean of 6.8°. A total of 85 patients with AIS (64%) but only 9 patients with JIS (20%) did not need surgery. In the AIS group, 97 patients had scoliosis of 20–40°; 71 of these patients (73.2%) did not require scoliosis correction at the end of bracing. In total, 84 patients with idiopathic scoliosis had surgery at a mean of 14 years (surgery was delayed by a mean of 3.2 years). In total, 20 of 67 patients with non-idiopathic scoliosis did not need surgery (30%). Thoracic scoliosis improved with bracing by a mean of 8.4° and thoracolumbar/lumbar scoliosis by a mean of 0.8°. A total of 47 patients with non-idiopathic scoliosis required surgery at a mean of 13.1 years (surgery was delayed by a mean of 5.2 years). Multivariate regression analysis showed that idiopathic scoliosis, AIS, closed triradiate cartilage, post-menarche status, higher Risser grade and smaller scoliosis angle at initial presentation predicted brace success. Patients reported good function and self-image, reduced pain and high satisfaction after treatment in both the bracing-only and the bracing followed by surgery groups. Full article
(This article belongs to the Special Issue Paediatric Spinal Deformity)
Show Figures

Figure 1

16 pages, 6195 KiB  
Article
Correction of Thoracic Hypokyphosis in Adolescent Scoliosis Using Patient-Specific Rod Templating
by Shivan Marya, Mahmoud Elmalky, Alex Schroeder and Anant Tambe
Healthcare 2023, 11(7), 980; https://doi.org/10.3390/healthcare11070980 - 29 Mar 2023
Cited by 2 | Viewed by 1503
Abstract
The emphasis of surgical correction in adolescent idiopathic scoliosis (AIS) has been given to coronal plane correction of deformity without addressing the sagittal plane thoracic hypokyphosis. Thoracic hypokyphosis has been implicated in cervical malalignment, increased incidence of proximal and distal junctional kyphosis, spinopelvic [...] Read more.
The emphasis of surgical correction in adolescent idiopathic scoliosis (AIS) has been given to coronal plane correction of deformity without addressing the sagittal plane thoracic hypokyphosis. Thoracic hypokyphosis has been implicated in cervical malalignment, increased incidence of proximal and distal junctional kyphosis, spinopelvic incongruence, and increased incidence of low back pain. The surgeon, variability in surgical technique, and difference in rod contouring have been implicated as factors resulting in less-than-adequate restoration of thoracic kyphosis. We hypothesised that predictable correction of hypokyphosis could be achieved by using a reproducible surgical technique with patient-specific rod templating. We describe a technique of correction of AIS with dual differential rod contouring (DDC) using patient-specific rod templating to guide intraoperative rod contouring. The pre- and post-operative radiographs of 61 patients treated using this technique were reviewed to compare correction of hypokyphosis achieved with that predicted. Analysis revealed that we achieved a kyphosis within +/− 5.5 of the predicted value. The majority of patients had a post-operative kyphosis within the optimal range of 20–40 degrees. We concluded that patient-specific rod templating in DDC helps surgeons to consistently achieve sagittal correction in AIS close to a predicted value while achieving a very good coronal plane correction. Full article
(This article belongs to the Special Issue Paediatric Spinal Deformity)
Show Figures

Figure 1

10 pages, 835 KiB  
Article
An Examination of the Number of Adolescent Scoliotic Curves That Are Braceable at First Presentation to a Scoliosis Service
by Laura Hartley, Conor Jones, Darren Lui, Jason Bernard, Timothy Bishop, Jan Herzog, Daniel Chan, Oliver Stokes and Adrian Gardner
Healthcare 2023, 11(3), 445; https://doi.org/10.3390/healthcare11030445 - 03 Feb 2023
Viewed by 1210
Abstract
Adolescent idiopathic scoliosis (AIS) affects between 0.5% and 5.2% of adolescents and is progressive in two-thirds of cases. Bracing is an effective non-operative treatment for AIS and has been shown to prevent up to 72% of curves from requiring surgery. This paper explores [...] Read more.
Adolescent idiopathic scoliosis (AIS) affects between 0.5% and 5.2% of adolescents and is progressive in two-thirds of cases. Bracing is an effective non-operative treatment for AIS and has been shown to prevent up to 72% of curves from requiring surgery. This paper explores the presentation of AIS in the UK and identifies who would be suitable for bracing, as per guidelines published by the Scoliosis Research Society (SRS) and British Scoliosis Society (BSS), through curve severity and skeletal maturity at presentation. There were 526 patients with AIS eligible for inclusion across three tertiary referral centres in the UK. The study period was individualised to each centre, between January 2012 and December 2021. Only 10% were appropriate for bracing via either SRS or BSS criteria. The rest were either too old, skeletally mature or had a curve size too large to benefit. By the end of data collection, 38% had undergone surgery for their scoliosis. In the UK, bracing for AIS is only suitable for a small number at presentation. Future efforts to minimise delays in specialist review and intervention will increase the number of those with AIS suitable for bracing and reduce the number and burden of operative interventions for AIS in the UK. Full article
(This article belongs to the Special Issue Paediatric Spinal Deformity)
Show Figures

Figure 1

Review

Jump to: Research

13 pages, 1507 KiB  
Review
Imaging Methods to Quantify the Chest and Trunk Deformation in Adolescent Idiopathic Scoliosis: A Literature Review
by Ana San Román Gaitero, Andrej Shoykhet, Iraklis Spyrou, Martijn Stoorvogel, Lars Vermeer and Tom P. C. Schlösser
Healthcare 2023, 11(10), 1489; https://doi.org/10.3390/healthcare11101489 - 19 May 2023
Cited by 1 | Viewed by 2518
Abstract
Background context: Scoliosis is a three-dimensional deformity of the spine with the most prevalent type being adolescent idiopathic scoliosis (AIS). The rotational spinal deformation leads to displacement and deformation of the ribs, resulting in a deformity of the entire chest. Routine diagnostic [...] Read more.
Background context: Scoliosis is a three-dimensional deformity of the spine with the most prevalent type being adolescent idiopathic scoliosis (AIS). The rotational spinal deformation leads to displacement and deformation of the ribs, resulting in a deformity of the entire chest. Routine diagnostic imaging is performed in order to define its etiology, measure curve severity and progression during growth, and for treatment planning. To date, all treatment recommendations are based on spinal parameters, while the esthetic concerns and cardiopulmonary symptoms of patients are mostly related to the trunk deformation. For this reason, there is a need for diagnostic imaging of the patho-anatomical changes of the chest and trunk in AIS. Aim: The aim of this review is to provide an overview, as complete as possible, of imaging modalities, methods and image processing techniques for assessment of chest and trunk deformation in AIS. Methods: Here, we present a narrative literature review of (1) image acquisition techniques used in clinical practice, (2) a description of various relevant methods to measure the deformity of the thorax in patients with AIS, and (3) different image processing techniques useful for quantifying 3D chest wall deformity. Results: Various ionizing and non-ionizing imaging modalities are available, but radiography is most widely used for AIS follow-up. A disadvantage is that these images are only acquired in 2D and are not effective for acquiring detailed information on complex 3D chest deformities. While CT is the gold standard 3D imaging technique for assessment of in vivo morphology of osseous structures, it is rarely obtained for surgical planning because of concerns about radiation exposure and increased risk of cancer during later life. Therefore, different modalities with less or without radiation, such as biplanar radiography and MRI are usually preferred. Recently, there have been advances in the field of image processing for measurements of the chest: Anatomical segmentations have become fully automatic and deep learning has been shown to be able to automatically perform measurements and even outperform experts in terms of accuracy. Conclusions: Recent advancements in imaging modalities and image processing techniques make complex 3D evaluation of chest deformation possible. Before introduction into daily clinical practice, however, there is a need for studies correlating image-based chest deformation parameters to patient-reported outcomes, and for technological advancements to make the workflow cost-effective. Full article
(This article belongs to the Special Issue Paediatric Spinal Deformity)
Show Figures

Figure 1

17 pages, 323 KiB  
Review
Paediatric Spinal Deformity Surgery: Complications and Their Management
by Simon B. Roberts and Athanasios I. Tsirikos
Healthcare 2022, 10(12), 2519; https://doi.org/10.3390/healthcare10122519 - 13 Dec 2022
Cited by 2 | Viewed by 1923
Abstract
Surgical correction of paediatric spinal deformity is associated with risks, adverse events, and complications that must be preoperatively discussed with patients and their families to inform treatment decisions, expectations, and long-term outcomes. The incidence of complications varies in relation to the underlying aetiology [...] Read more.
Surgical correction of paediatric spinal deformity is associated with risks, adverse events, and complications that must be preoperatively discussed with patients and their families to inform treatment decisions, expectations, and long-term outcomes. The incidence of complications varies in relation to the underlying aetiology of spinal deformity and surgical procedure. Intraoperative complications include bleeding, neurological injury, and those related to positioning. Postoperative complications include persistent pain, surgical site infection, venous thromboembolism, pulmonary complications, superior mesenteric artery syndrome, and also pseudarthrosis and implant failure, proximal junctional kyphosis, crankshaft phenomenon, and adding-on deformity, which may necessitate revision surgery. Interventions included in enhanced recovery after surgery protocols may reduce the incidence of complications. Complications must be diagnosed, investigated and managed expeditiously to prevent further deterioration and to ensure optimal outcomes. This review summarises the complications associated with paediatric spinal deformity surgery and their management. Full article
(This article belongs to the Special Issue Paediatric Spinal Deformity)
Back to TopTop