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Scoliosis and Spinal Deformity: Current Diagnosis, Treatment and Clinical Management
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Scoliosis and Spinal Deformity: Current Diagnosis, Treatment and Clinical Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 20 May 2024 | Viewed by 3438

Special Issue Editor

Prof. Dr. Rene Marten Castelein

E-Mail Website
Guest Editor
Department of Orthopaedic Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
Interests: etiology; pathogenesis; idiopathic scoliosis; imaging; treatment

Special Issue Information

Dear Colleagues,

Spinal deformities severely affect the lives of many people and frequently lead to morbidity. They have been the subject of many years of dedicated research into their etiology and pathogenesis. In the meantime, their management, both conservatively and surgically, although based to a large extent upon classic principles, has been revolutionized in recent decades. Modern imaging modalities aim to provide accurate three-dimensional images of the spine, as well as of essential soft tissue structures, such as the spinal cord, the nerve roots and the great vessels. The treatment of spinal deformities, although better than ever before and requiring fewer days in hospital, remains extensive, is associated with serious risks, and usually sacrifices the motion of certain spinal segments that are meant to move.

This Special Issue aims to collect the latest research on the etiology and pathogenesis, imaging, and treatment of scoliosis and spinal deformities.

It is my great pleasure to invite you to contribute a paper to this Special Issue.

Prof. Dr. Rene Marten Castelein
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. Journal of Clinical Medicine 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 2600 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

  • idiopathic scoliosis
  • neuromuscular scoliosis
  • spondylolisthesis
  • etiology
  • imaging
  • conservative treatment
  • surgery

Published Papers (7 papers)

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Research

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10 pages, 4921 KiB  
Article
Comparative Analysis of Monoaxial and Polyaxial Pedicle Screws in the Surgical Correction of Adolescent Idiopathic Scoliosis
by Jae Hyuk Yang, Hong Jin Kim, Tae Yeong Chang, Seung Woo Suh and Dong-Gune Chang
J. Clin. Med. 2024, 13(9), 2689; https://doi.org/10.3390/jcm13092689 - 03 May 2024
Viewed by 257
Abstract
Background: Although several biomechanical studies have been reported, few clinical studies have compared the efficacy of monoaxial and polyaxial pedicle screws in the surgical treatment of adolescent idiopathic scoliosis (AIS). This study aims to compare the radiological and clinical outcomes of mono- [...] Read more.
Background: Although several biomechanical studies have been reported, few clinical studies have compared the efficacy of monoaxial and polyaxial pedicle screws in the surgical treatment of adolescent idiopathic scoliosis (AIS). This study aims to compare the radiological and clinical outcomes of mono- and polyaxial pedicle screws in the surgical treatment of AIS. Methods: A total of 46 AIS patients who underwent surgery to treat scoliosis using pedicle screw instrumentation (PSI) and rod derotation (RD) were divided into two groups according to the use of pedicle screws: the monoaxial group (n = 23) and polyaxial group (n = 23). Results: The correction rate of the main Cobb’s angle was higher in the monoaxial group (70.2%) than in the polyaxial group (65.3%) (p = 0.040). No differences in the rotational correction of the apical vertebra were evident between the two groups. SRS-22 scores showed no significant differences according to the type of pedicle screws used. Conclusions: The use of polyaxial pedicle screws resulted in coronal, sagittal, and rotational correction outcomes comparable to those associated with the use of monoaxial pedicle screws for surgical treatment using PSI and RD to treat moderate cases of AIS. Full article
(This article belongs to the Special Issue Scoliosis and Spinal Deformity: Current Diagnosis, Treatment and Clinical Management)
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10 pages, 1797 KiB  
Article
The Prevalence of Cancer in Dutch Female Patients with Idiopathic Scoliosis Compared with the General Population
by Reinout R. O. Heijboer, Johan L. Heemskerk, Sigrid N. W. Vorrink and Diederik H. R. Kempen
J. Clin. Med. 2024, 13(9), 2616; https://doi.org/10.3390/jcm13092616 - 29 Apr 2024
Viewed by 344
Abstract
Background and Objectives: Epidemiological studies have demonstrated the potential oncogenic effects of cumulative radiation exposure, particularly during childhood. One group experiencing repeated exposure to radiation at an early age for multiple years is patients treated for idiopathic scoliosis (IS). This study aimed to [...] Read more.
Background and Objectives: Epidemiological studies have demonstrated the potential oncogenic effects of cumulative radiation exposure, particularly during childhood. One group experiencing repeated exposure to radiation at an early age for multiple years is patients treated for idiopathic scoliosis (IS). This study aimed to determine the relationship between childhood radiological exposure and adult cancer prevalence in children treated for IS. Materials and Methods: Data from 337 predominantly female patients treated at our hospital between January 1981 and January 1995 were gathered and compared to the Dutch national cancer rates. The standardized prevalence ratios for cancer in IS patients were compared with the cancer prevalence rates from the general Dutch population. Results: The overall cancer prevalence in women was 5.0%, with no significant difference compared to the general population (p = 0.425). The results of this study do not suggest that female patients treated for idiopathic scoliosis during childhood have an increased risk of cancer later in life. Conclusion: Despite being the largest recent study in its field, the modest participant number limits its ability to draw conclusions. However, the detailed data collected over a long observation period, alongside data from a period with comparable radiation rates, contributes to refining clinical practice and laying the groundwork for future systematic reviews. Full article
(This article belongs to the Special Issue Scoliosis and Spinal Deformity: Current Diagnosis, Treatment and Clinical Management)
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7 pages, 3543 KiB  
Communication
Revision of Surgery for Adolescent Idiopathic Scoliosis: Reasons, Treatments, and Clinical Management with Case Examples
by Lawrence G. Lenke, Veronica Lee and Fthimnir M. Hassan
J. Clin. Med. 2024, 13(8), 2233; https://doi.org/10.3390/jcm13082233 - 12 Apr 2024
Viewed by 382
Abstract
Adolescent idiopathic scoliosis (AIS) is a curvature of the spine that develops in children ages 10–18 and can be attributed to unknown causes. The Lenke AIS classification system provides a template to classify these deformities by curve type paired with recommended operative treatments. [...] Read more.
Adolescent idiopathic scoliosis (AIS) is a curvature of the spine that develops in children ages 10–18 and can be attributed to unknown causes. The Lenke AIS classification system provides a template to classify these deformities by curve type paired with recommended operative treatments. Treatment of this patient population has been associated with low complication rates and overall surgical success. Nonetheless, a fraction of patients remain susceptible to revision surgery. This manuscript will focus on the aspects of AIS surgery, highlighting case examples, the different treatment approaches, complication rates, and primary reasons for revision surgery and associated outcomes. Full article
(This article belongs to the Special Issue Scoliosis and Spinal Deformity: Current Diagnosis, Treatment and Clinical Management)
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8 pages, 1603 KiB  
Article
How Long Can You Delay? Curve Progression While Awaiting Vertebral Body Tethering Surgery
by Christina Regan, M. Bryant Transtrum, Bharadwaj Jilakara, Todd A. Milbrandt and A. Noelle Larson
J. Clin. Med. 2024, 13(8), 2209; https://doi.org/10.3390/jcm13082209 - 11 Apr 2024
Viewed by 316
Abstract
Background: The implications of delaying surgical intervention for patients with adolescent idiopathic scoliosis (AIS) wishing to undergo vertebral body tethering (VBT) have not yet been explored. It is important to understand how these delays can impact surgical planning and patient outcomes. Methods [...] Read more.
Background: The implications of delaying surgical intervention for patients with adolescent idiopathic scoliosis (AIS) wishing to undergo vertebral body tethering (VBT) have not yet been explored. It is important to understand how these delays can impact surgical planning and patient outcomes. Methods: This was a retrospective review that analyzed all AIS patients treated between 2015 and 2021 at a single tertiary center. Time to surgery from initial surgical consultation and ultimate surgical plan were assessed. Patient characteristics, potential risk factors associated with increased curve progression, and reasons for delay were also analyzed. Results: 174 patients were evaluated and 95 were scheduled for VBT. Four patients later required a change to posterior spinal fusion (PSF) due to excessive curve progression. Patients requiring PSF were shown to have significantly longer delays than those who received VBT. Additionally, longer delays, younger age, greater curve progression, and lower skeletal maturity were correlated with significant curve progression (≥5 degrees). Conclusions: Surgical delays for AIS patients awaiting VBT may lead to significant curve progression and necessitate more invasive procedures. Patients with longer delays experienced an increased risk of needing PSF instead of VBT. Of those requiring PSF, the majority were due to insurance denials. Optimizing surgical timing and shared decision-making among patients, families, and healthcare providers are essential for achieving the best outcomes. Full article
(This article belongs to the Special Issue Scoliosis and Spinal Deformity: Current Diagnosis, Treatment and Clinical Management)
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17 pages, 3284 KiB  
Article
Using Electric Stimulation of the Spinal Muscles and Electromyography during Motor Tasks for Evaluation of the Role in Development and Progression of Adolescent Idiopathic Scoliosis
by Christian Wong, Hamed Shayestehpour, Christos Koutras, Benny Dahl, Miguel A. Otaduy, John Rasmussen and Jesper Bencke
J. Clin. Med. 2024, 13(6), 1758; https://doi.org/10.3390/jcm13061758 - 19 Mar 2024
Viewed by 635
Abstract
Introduction: The role of the spinal muscles in scoliogenesis is not fully substantiated. Do they act scoliogenic (inducing scoliosis) or counteract scoliosis in adolescent idiopathic scoliosis (AIS)? In this study, we will examine this by using selectively placed Transcutaneous Electric Stimulation (TES) [...] Read more.
Introduction: The role of the spinal muscles in scoliogenesis is not fully substantiated. Do they act scoliogenic (inducing scoliosis) or counteract scoliosis in adolescent idiopathic scoliosis (AIS)? In this study, we will examine this by using selectively placed Transcutaneous Electric Stimulation (TES) combined with a cinematic radiographic technique and by performing electromyographic (EMG) evaluations during various motor tasks. Method: This is a cross-sectional study of subjects with small-curve AIS. Using cinematic radiography, they were evaluated dynamically either under electrical stimulation or when performing motor tasks of left and right lateral bending and rotation whilst measuring the muscle activity by EMG. Results: Forty-five patients with AIS were included as subjects. Five subjects volunteered for TES and six subjects performed the motor tasks with EMG. At the initial visual evaluation, and when stimulated with TES, the frontal plane spatial positions of the vertebral bodies showed discrete changes without an apparent pattern. However, analyzing the spatial positions when calibrated, we found that the spinal muscles exert a compressive ‘response’ with a minor change in the Cobb angle (CA) in small-curve AIS (CA = 10–20°). In larger curves (CA > 20°), TES induced a ‘larger deformity’ with a relative four-fold change in the CA compared to small-curve AIS with a ratio of 0.6. When evaluating local amplitude (peak) or cumulative (mean) EMG signals, we were unable to find consistent asymmetries. However, one subject had rapid progression and one regressed to a straight spine. When adding the absolute EMG ratios for all four motor tasks, the subject with progression had almost 10-fold less summed EMG ratios, and the subject with regression had more than 3-fold higher summed EMG ratios. Discussion: Based on these findings, we suggest that the spinal muscles in small-curve AIS have a stabilizing function maintaining a straight spine and keeping it in the midline. When deformities are larger (CA > 20°), the spine muscle curve exerts a scoliogenic ‘response’. This suggests that the role of the muscles converts from counteracting AIS and stabilizing the spine to being scoliogenic for a CA of more than 20°. Moreover, we interpret higher EMG ratios as heightened asymmetric spinal muscle activity when the spinal muscles try to balance the spine to maintain or correct the deformity. When progression occurs, this is preceded or accompanied by decreased EMG ratios. These findings must be substantiated by larger studies. Full article
(This article belongs to the Special Issue Scoliosis and Spinal Deformity: Current Diagnosis, Treatment and Clinical Management)
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11 pages, 1497 KiB  
Article
Hidden Blood Loss and Its Risk Factors for Oblique Lumbar Interbody Fusion
by Jae Hyuk Yang, Hong Jin Kim, Minsu An, Seung Woo Suh and Dong Gune Chang
J. Clin. Med. 2024, 13(5), 1454; https://doi.org/10.3390/jcm13051454 - 02 Mar 2024
Viewed by 483
Abstract
(1) Background: The amount of blood loss during oblique lumber interbody fusion (OLIF) surgery is often underestimated and may contribute to adverse postoperative outcomes. This study aims to evaluate hidden blood loss (HBL) in patients who underwent OLIF for degenerative lumbar spine disease [...] Read more.
(1) Background: The amount of blood loss during oblique lumber interbody fusion (OLIF) surgery is often underestimated and may contribute to adverse postoperative outcomes. This study aims to evaluate hidden blood loss (HBL) in patients who underwent OLIF for degenerative lumbar spine disease and to analyze its risk factors. (2) Methods: The medical records of 179 patients who underwent OLIF surgery from 2015 to 2022 were reviewed. The HBL and total blood loss (TBL) were estimated using the Gross formula. Pearson correlation, Spearman correlation, and multivariate linear regression analyses were used to investigate risk factors for HBL. (3) Results: The mean HBL was 675.2 mL, and the mean hemoglobin loss was 1.7 g/dL during OLIF surgery. In the multivariate linear regression analysis, TBL (p < 0.001), estimated blood loss (p < 0.001), and pedicle screw fixation type (p = 0.039) were identified as independent risk factors of HBL. (4) Conclusions: The OLIF is associated with substantial perioperative HBL, for which we identified risk factors of TBL, EBL, and pedicle screw fixation type. Notably, OLIF with percutaneous pedicle screw fixation resulted in greater HBL than stand-alone OLIF or OLIF with open pedicle screw fixation. Full article
(This article belongs to the Special Issue Scoliosis and Spinal Deformity: Current Diagnosis, Treatment and Clinical Management)
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19 pages, 697 KiB  
Systematic Review
Minimally Invasive Surgery for Adolescent Idiopathic Scoliosis: A Systematic Review
by Athanasios I. Tsirikos, Kaustubh Ahuja and Mohsin Khan
J. Clin. Med. 2024, 13(7), 2013; https://doi.org/10.3390/jcm13072013 - 29 Mar 2024
Viewed by 557
Abstract
Background: Minimally invasive surgical (MIS) techniques have gained popularity as a safe and effective alternative to open surgery for degenerative, traumatic, and metastatic spinal pathologies. In adolescent idiopathic scoliosis, MIS techniques comprise anterior thoracoscopic surgery (ATS), posterior minimally invasive surgery (PMIS), and vertebral [...] Read more.
Background: Minimally invasive surgical (MIS) techniques have gained popularity as a safe and effective alternative to open surgery for degenerative, traumatic, and metastatic spinal pathologies. In adolescent idiopathic scoliosis, MIS techniques comprise anterior thoracoscopic surgery (ATS), posterior minimally invasive surgery (PMIS), and vertebral body tethering (VBT). In the current systematic review, the authors collected and analyzed data from the available literature on MIS techniques in AIS. Methods: The articles were shortlisted after a thorough electronic and manual database search through PubMed, EMBASE, and Google Scholar. Results: The authors included 43 studies for the review; 14 described the outcomes with ATS, 13 with PMIS, and 16 with VBT. Conclusions: While the efficacy of the ATS approach is well-established in terms of comparable coronal and sagittal correction to posterior spinal fusion, the current use of ATS for instrumented fusion has become less popular due to a steep learning curve, high pulmonary and vascular complication rates, implant failures, and increased non-union rates. PMIS is an effective alternative to the standard open posterior spinal fusion, with a steep learning curve and longer surgical time being potential disadvantages. The current evidence, albeit limited, suggests that VBT is an attractive procedure that merits consideration in terms of radiological correction and clinical outcomes, but it has a high complication and re-operation rate, while the most appropriate indications and long-term outcomes of this technique remain unclear. Full article
(This article belongs to the Special Issue Scoliosis and Spinal Deformity: Current Diagnosis, Treatment and Clinical Management)
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