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21 pages, 9977 KiB

Open AccessArticle

Radiological Outcomes of Magnetically Controlled Growing Rods for the Treatment of Children with Various Etiologies of Early-Onset Scoliosis—A Multicenter Study

by Pawel Grabala, Munish C. Gupta, Daniel E. Pereira, Michal Latalski, Anna Danielewicz, Pawel Glowka and Michal Grabala

J. Clin. Med. 2024, 13(6), 1529; https://doi.org/10.3390/jcm13061529 - 07 Mar 2024

Cited by 1 | Viewed by 620

Abstract

Background: The management of spinal deformities diagnosed before the age of 10 is critical due to the child’s development, skeletal system, and growth mechanism. Magnetically controlled growing rods (MCGRs) are a surgical treatment option for the growing spine. The aim of this study [...] Read more.

Background: The management of spinal deformities diagnosed before the age of 10 is critical due to the child’s development, skeletal system, and growth mechanism. Magnetically controlled growing rods (MCGRs) are a surgical treatment option for the growing spine. The aim of this study was to analyze the radiological findings of patients treated with MCGRs for early-onset scoliosis (EOS) of various etiologies. We hypothesized that the MCGRs could provide acceptable long-term radiographic results, such as an increase in the T1–T12 and T1–S1 height and significant overall deformity correction. Methods: We retrospectively reviewed 161 EOS patients with a combined total of 302 MCGRs inserted at five institutions between 2016 and 2022 with a mean follow-up of at least two years. The Cobb angle of the major curve (MC), thoracic kyphosis (TK), lumbar lordosis (LL), and T1–T12 and T1–S1 height measurements were assessed before, after, and during the follow-up. Results: Among the 90 female and 71 male patients, there were 51 neurological, 42 syndromic, 58 idiopathic, and ten congenital scoliosis etiologies. Of the patients, 73 were aged under six years old. The mean follow-up time was 32.8 months. The mean age at placement of the MCGRs was 7 years and that at the last follow-up after fusion surgery was 14.5 years. The mean MC before the initial surgery was 86.2°; following rod implantation, it was 46.9°, and at the last follow-up visit, it was 45.8°. The mean correction rate among the etiology subgroups was from 43% to 50% at follow-up. The mean TK was noted as 47.2° before MCGR implantation, 47.1° after MCGR placement, and 44.5° at the last follow-up visit. The mean T1–T12 height increased by 5.95 mm per year, with a mean T1–S1 height of 10.1 mm per year. Conclusions: MCGR treatment allowed for an average correction of the curvature by 50% during the period of lengthening, while controlling any deformity and growth of the spine, with a significant increase in the T1–T12 and T1–S1 values during the observation period. MCGR treatment in EOS carries a risk of complications. While congenital and syndromic EOS often have short and less flexible curves in those groups of patients, single rods can be as effective and safe. Definitive fusion results in the mean final coronal correction between the start of MCGR treatment and after undergoing PSF of approximately 70%. The mean T1–T12 spinal height increased by 75 mm, while the T1–S1 spinal height gained a mean of 97 mm. Full article

(This article belongs to the Special Issue Spinal Disorders: Current Treatment and Future Opportunities: Part II)

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11 pages, 1350 KiB

Open AccessArticle

Osteophyte Bridge Formation Correlates with Vascular Calcification and Cardiovascular Disease in Diffuse Idiopathic Skeletal Hyperostosis

by Ryosuke Hirota, Atsushi Teramoto, Mitsunori Yoshimoto, Hiroyuki Takashima, Naomi Yasuda, Arihiko Tsukamoto, Noriyuki Iesato, Makoto Emori, Kousuke Iba, Nobuyoshi Kawaharada and Toshihiko Yamashita

J. Clin. Med. 2023, 12(16), 5412; https://doi.org/10.3390/jcm12165412 - 20 Aug 2023

Viewed by 890

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory spondyloarthropathy characterized by ectopic calcification of spinal cord tissue. Its etiology is possibly polygenic. However, its pathogenesis and systemic effects remain unclear. Recent studies have reported a high prevalence of DISH in heart failure patients. [...] Read more.

Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory spondyloarthropathy characterized by ectopic calcification of spinal cord tissue. Its etiology is possibly polygenic. However, its pathogenesis and systemic effects remain unclear. Recent studies have reported a high prevalence of DISH in heart failure patients. The authors investigated how the incidence and severity of DISH are associated with vascular calcification and the occurrence of cardiovascular events. In this retrospective chart review study, 500 patients with cardiovascular disease who underwent surgery (cardiovascular events group) and 500 patients with non-cardiovascular disease who underwent computed tomography scans (non-cardiovascular events group) were randomly selected to investigate the degree of ossification of the anterior longitudinal ligament and the incidence of DISH. We found that the incidence of DISH was higher in patients with cardiovascular events and that patients with DISH had more calcification of the coronary arteries and aorta. Next, we examined the relationship between the degree of coronary and aortic calcification, the incidence of DISH, and the degree of ossification of the anterior longitudinal ligament in the non-cardiovascular event group. The prevalence of DISH in the cardiovascular and non-cardiovascular groups was 31.4% and 16.5%, respectively (p = 0.007). Aortic calcification and a predominant degree of vascular calcification with a certain level of ossification of the anterior longitudinal ligament suggest some correlation between DISH and cardiovascular events. This study is important in understanding the pathophysiology and pathogenesis of DISH. Full article

(This article belongs to the Special Issue Spinal Disorders: Current Treatment and Future Opportunities: Part II)

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11 pages, 3449 KiB

Open AccessArticle

Independent Risk Factors of Postoperative Coronal Imbalance after Adult Spinal Deformity Surgery

by Alberto Ruffilli, Francesca Barile, Azzurra Paolucci, Marco Manzetti, Giovanni Viroli, Marco Ialuna, Fabio Vita, Tosca Cerasoli and Cesare Faldini

J. Clin. Med. 2023, 12(10), 3559; https://doi.org/10.3390/jcm12103559 - 19 May 2023

Viewed by 2214

Abstract

The aim of the present study is to elucidate preoperative risk factors for inadequate correction of coronal imbalance and/or creation of new postoperative coronal imbalance (iatrogenic CIB) in patients who undergo surgery for Adult Spinal Deformity (ASD). A retrospective review of adults who [...] Read more.

The aim of the present study is to elucidate preoperative risk factors for inadequate correction of coronal imbalance and/or creation of new postoperative coronal imbalance (iatrogenic CIB) in patients who undergo surgery for Adult Spinal Deformity (ASD). A retrospective review of adults who underwent posterior spinal fusion (>5 levels) for ASD was performed. Patients were divided into groups according to the Nanjing classification: type A (CSVL < 3 cm), type B (CSVL > 3 cm and C7 plumb line shifted to major curve concavity), and type C (CSVL > 3 cm and C7 plumb line shifted to major curve convexity). They were also divided according to postoperative coronal balance in balanced (CB) vs. imbalanced (CIB) and according to iatrogenic coronal imbalance (iCIB). Preoperative, postoperative, and last follow-up radiographical parameters and intraoperative data were recorded. A multivariate analysis was performed to identify independent risk factors for CIB. A total of 127 patients were included (85 type A, 30 type B, 12 type C). They all underwent long (average levels fused 13.3 ± 2.7) all-posterior fusion. Type C patients were more at risk of developing postoperative CIB (p = 0.04). Multivariate regression analysis indicated L5 tilt angle as a preoperative risk factor for CIB (p = 0.007) and indicated L5 tilt angle and age as a preoperative independent risk factors for iatrogenic CIB (p = 0.01 and p = 0.008). Patients with a preoperative trunk shift towards the convexity of the main curve (type C) are more prone to postoperative CIB and leveling the L4 and L5 vertebrae is the key to achieve coronal alignment preventing the “takeoff phenomenon”. Full article

(This article belongs to the Special Issue Spinal Disorders: Current Treatment and Future Opportunities: Part II)

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9 pages, 252 KiB

Open AccessArticle

Can We Predict Imbalance in Patients? Analysis of the CDC National Health and Nutrition Examination Survey

by Bassel G. Diebo, Sarah G. Stroud, Neil V. Shah, James Messina, James M. Hong, Daniel Alsoof, Kashif Ansari, Renaud Lafage, Peter G. Passias, Virginie Lafage, Frank J. Schwab, Carl B. Paulino, Roy Aaron and Alan H. Daniels

J. Clin. Med. 2023, 12(5), 1943; https://doi.org/10.3390/jcm12051943 - 01 Mar 2023

Viewed by 1292

Abstract

Understanding global body balance can optimize the postoperative course for patients undergoing spinal or lower limb surgical realignment. This observational cohort study aimed to characterize patients with reported imbalance and identify predictors. The CDC establishes a representative sample annually via the NHANES. All [...] Read more.

Understanding global body balance can optimize the postoperative course for patients undergoing spinal or lower limb surgical realignment. This observational cohort study aimed to characterize patients with reported imbalance and identify predictors. The CDC establishes a representative sample annually via the NHANES. All participants who said “yes” (Imbalanced) or “no” (Balanced) to the following question were identified from 1999–2004: “During the past 12 months, have you had dizziness, difficulty with balance or difficulty with falling?” Univariate analyses compared Imbalanced versus Balanced subjects and binary logistic regression modeling predicted for Imbalance. Of 9964 patients, imbalanced (26.5%) were older (65.4 vs. 60.6 years), with more females (60% vs. 48%). Imbalanced subjects reported higher rates of comorbidities, including osteoporosis (14.4% vs. 6.6%), arthritis (51.6% vs. 31.9%), and low back pain (54.4% vs 32.7%). Imbalanced patients had more difficulty with activities, including climbing 10 steps (43.8% vs. 21%) and stooping/crouching/kneeling (74.3% vs. 44.7%), and they needed greater time to walk 20 feet (9.5 vs. 7.1 s). Imbalanced subjects had significantly lower caloric and dietary intake. Regression revealed that difficulties using fingers to grasp small objects (OR: 1.73), female gender (OR: 1.43), difficulties with prolonged standing (OR: 1.29), difficulties stooping/crouching/kneeling (OR: 1.28), and increased time to walk 20 feet (OR: 1.06) were independent predictors of Imbalance (all p < 0.05). Imbalanced patients were found to have identifiable comorbidities and were detectable using simple functional assessments. Structured tests that assess dynamic functional status may be useful for preoperative optimization and risk-stratification for patients undergoing spinal or lower limb surgical realignment. Full article

(This article belongs to the Special Issue Spinal Disorders: Current Treatment and Future Opportunities: Part II)

12 pages, 5551 KiB

Open AccessArticle

Return to Sport after Adolescent Idiopathic Scoliosis (AIS) Correction Surgery: A Retrospective Data Analysis

by Wojciech Pepke, Abhilash Madathinakam, Tom Bruckner, Tobias Renkawitz, Stefan Hemmer and Michael Akbar

J. Clin. Med. 2023, 12(4), 1551; https://doi.org/10.3390/jcm12041551 - 16 Feb 2023

Cited by 2 | Viewed by 2037

Abstract

Sports are relevant to younger populations in society. Adolescent idiopathic scoliosis (AIS) patients who undergo surgical correction of the spine are often intensively involved in sports. For that, returning to the sport is often an important concern for the patients and their families. [...] Read more.

Sports are relevant to younger populations in society. Adolescent idiopathic scoliosis (AIS) patients who undergo surgical correction of the spine are often intensively involved in sports. For that, returning to the sport is often an important concern for the patients and their families. To the best of our knowledge, there is still a lack of scientific data indicating established recommendations about the time of returning to sport activities after surgical spinal correction. The aim of this study was to investigate (1) when AIS patients return to athletic activities after a posterior fusion, and (2) if they change their activities postoperatively. Furthermore, another question was (3) if the length of the performed posterior fusion or (4) fusion to the lower lumbar spine could have an influence on the rates or time of returning to sport activities postoperatively. Data collection was performed using questionnaires assessing patients’ contentment and athletic activity. Athletic activities were categorized into three categories: (1) contact, (2) contact/non-contact and (3) non-contact sports. The intensity of exercised sports, the time of returning to the sport and changes in sport habits were documented. Radiographs were evaluated pre- and postoperatively to determine the Cobb angle and the length of the posterior fusion via the identification of the upper (UIV) and lower instrumented vertebra (LIV). Stratification analysis due to the fusion length was performed to answer a hypothetical question. This retrospective survery of 113 AIS patients treated with a posterior fusion revealed that, on average, returning to sport activities required 8 months of postoperative rest. The preoperative to postoperative rate of patients participating in sport activities increased from 88 (78%) to 94 (89%). Furthermore, postoperatively, a relevant shift of exercised activities from contact to non-contact sports was noted. Further subanalysis revealed that only 33 subjects were able to return to exactly the same athletic activities as before surgery (10 months postoperatively). The assessment of radiographs revealed that in this study group, the length of the performed posterior fusion and fusions to the lower lumbar spine had no influence on the time of return to athletic activities. The results of this study might shed some light on postoperative recommendations for sport activities after AIS treatment with a posterior fusion and may be beneficial for surgeons treating patients. Full article

(This article belongs to the Special Issue Spinal Disorders: Current Treatment and Future Opportunities: Part II)

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10 pages, 252 KiB

Open AccessArticle

The Impact of Asymptomatic Human Immunodeficiency Virus-Positive Disease Status on Inpatient Complications Following Spine Surgery: A Propensity Score-Matched Analysis

by Neil V. Shah, Matthew J. Lettieri, Samuel Gedailovich, David Kim, Madhu Oad, Ryne J. Veenema, Adam J. Wolfert, George A. Beyer, Hanbin Wang, Ravi S. Nunna, Douglas A. Hollern, Renaud Lafage, Vincent Challier, Andrew A. Merola, Peter G. Passias, Frank J. Schwab, Virginie Lafage, Carl B. Paulino and Bassel G. Diebo

J. Clin. Med. 2023, 12(4), 1458; https://doi.org/10.3390/jcm12041458 - 12 Feb 2023

Cited by 1 | Viewed by 1438

Abstract

In the United States, nearly 1.2 million people > 12 years old have human immunodeficiency virus (HIV), which is associated with postoperative complications following orthopedic procedures. Little is known about how asymptomatic HIV (AHIV) patients fare postoperatively. This study compares complications after common [...] Read more.

In the United States, nearly 1.2 million people > 12 years old have human immunodeficiency virus (HIV), which is associated with postoperative complications following orthopedic procedures. Little is known about how asymptomatic HIV (AHIV) patients fare postoperatively. This study compares complications after common spine surgeries between patients with and without AHIV. The Nationwide Inpatient Sample (NIS) was retrospectively reviewed from 2005–2013, identifying patients aged > 18 years who underwent 2–3-level anterior cervical discectomy and fusion (ACDF), ≥4-level thoracolumbar fusion (TLF), or 2–3-level lumbar fusion (LF). Patients with AHIV and without HIV were 1:1 propensity score-matched. Univariate analysis and multivariable binary logistic regression were performed to assess associations between HIV status and outcomes by cohort. 2–3-level ACDF (n = 594 total patients) and ≥4-level TLF (n = 86 total patients) cohorts demonstrated comparable length of stay (LOS), rates of wound-related, implant-related, medical, surgical, and overall complications between AHIV and controls. 2–3-level LF (n = 570 total patients) cohorts had comparable LOS, implant-related, medical, surgical, and overall complications. AHIV patients experienced higher postoperative respiratory complications (4.3% vs. 0.4%,). AHIV was not associated with higher risks of medical, surgical, or overall inpatient postoperative complications following most spine surgical procedures. The results suggest the postoperative course may be improved in patients with baseline control of HIV infection. Full article

(This article belongs to the Special Issue Spinal Disorders: Current Treatment and Future Opportunities: Part II)

11 pages, 262 KiB

Open AccessArticle

The Impact of Prematurity at Birth on Short-Term Postoperative Outcomes Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

by Neil V. Shah, Marine Coste, Adam J. Wolfert, Samuel Gedailovich, Brian Ford, David J. Kim, Nathan S. Kim, Chibuokem P. Ikwuazom, Neil Patel, Amanda M. Dave, Peter G. Passias, Frank J. Schwab, Virginie Lafage, Carl B. Paulino and Bassel G. Diebo

J. Clin. Med. 2023, 12(3), 1210; https://doi.org/10.3390/jcm12031210 - 03 Feb 2023

Viewed by 1293

Abstract

Prematurity is associated with surgical complications. This study sought to determine the risk of prematurity on 30-day complications, reoperations, and readmissions following ≥7-level PSF for AIS which has not been established. Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS [...] Read more.

Prematurity is associated with surgical complications. This study sought to determine the risk of prematurity on 30-day complications, reoperations, and readmissions following ≥7-level PSF for AIS which has not been established. Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)-Pediatric dataset, all AIS patients undergoing ≥7-level PSF from 2012–2016 were identified. Cases were 1:1 propensity score-matched to controls by age, sex, and number of spinal levels fused. Prematurity sub-classifications were also evaluated: extremely (<28 weeks), very (28–31 weeks), and moderate-to-late (32–36 weeks) premature. Univariate analysis with post hoc Bonferroni compared demographics, hospital parameters, and 30-day outcomes. Multivariate logistic regression identified independent predictors of adverse 30-day outcomes. 5531 patients (term = 5099; moderate-to-late premature = 250; very premature = 101; extremely premature = 81) were included. Premature patients had higher baseline rates of multiple individual comorbidities, longer mean length of stay, and higher 30-day readmissions and infections than the term cohort. Thirty-day readmissions increased with increasing prematurity. Very premature birth predicted UTIs, superficial SSI/wound dehiscence, and any infection, and moderate-to-late premature birth predicted renal insufficiency, deep space infections, and any infection. Prematurity of AIS patients differentially impacted rates of 30-day adverse outcomes following ≥7-level PSF. These results can guide preoperative optimization and postoperative expectations. Full article

(This article belongs to the Special Issue Spinal Disorders: Current Treatment and Future Opportunities: Part II)

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2 pages, 153 KiB

Open AccessComment

Comment on Grabala et al. Radiological Outcomes of Magnetically Controlled Growing Rods for the Treatment of Children with Various Etiologies of Early-Onset Scoliosis—A Multicenter Study. J. Clin. Med. 2024, 13, 1529

by Casper S. Tabeling, Justin V. C. Lemans and Moyo C. Kruyt

J. Clin. Med. 2024, 13(8), 2434; https://doi.org/10.3390/jcm13082434 - 22 Apr 2024

Viewed by 188

Abstract

We read with great interest the study titled “Radiological Outcomes of Magnetically Controlled Growing Rods for the Treatment of Children with Various Etiologies of Early-Onset Scoliosis—A Multicenter Study” by Grabala and colleagues [...] Full article

(This article belongs to the Special Issue Spinal Disorders: Current Treatment and Future Opportunities: Part II)

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