Curve evolution during bracing in children with scoliosis secondary to early-onset neurofibromatosis type 1: indicators of rapid curve progression / 中华医学杂志(英文版)

BACKGROUND@#Scoliosis secondary to neurofibromatosis type 1 (NF1) in children aged 10°/year) were identified. The age at modulation and the AV before and after modulation were obtained. Patients with (n = 18) and without rapid curve progression (n = 10) were statistically compared.@*RESULTS@#Twenty-eight patients with a mean age of 6.5 ± 1.9 years at the initial visit were reviewed. The mean Cobb angle of the main curve was 41.7° ± 2.4° at the initial visit and increased to 67.1° ± 8.6° during a mean follow-up of 44.1 ± 8.5 months. The overall AV was 6.6° ± 2.4°/year for all patients. At the last follow-up, all patients presented curve progression of >5°, and 20 (71%) patients had progressed by >20°. Rapid curve progression was observed in 18 (64%) patients and was associated with younger age at the initial visit and a higher incidence of modulation change during follow-up (t = 2.868, P = 0.008 and 10°/year is associated with younger age at the initial visit, and modulation change indicated the occurrence of the rapid curve progression phase.

Ineffective treatment technique of convex epiphysiodesis for congenital scoliosis / 中国骨伤

OBJECTIVE@#To discuss the long-term outcome of convex epiphysiodesis in the treatment for congenital scoliosis (CS).@*METHODS@#The clinical data of 22 patients with hemivertebral deformity undergoing convex epiphysiodesis from the October 1998 to Febuary 2008 were respectively analyzed. There were 12 males and 10 females. The whole spine anteroposterior radiographs were taken preoperatively, at 3-month postoperatively and at the final follow-up to measure the main curve and the compensatory curve. The progression rate was calculated for each patient. Observing the correlation between the progression rate and annual progression of the scoliosis and age, gender, hemivertebral number, hemivertebral position, preoperative main curve Cobb angle and compensatory curve Cobb angle, comparing different ages, genders, hemivertebral number and position, and preoperative main curve Cobb angle on the progression of postoperative curve.@*RESULTS@#The mean Cobb angle of main curve changed from (40.5±9.8) ° before surgery to (39.5±11.1) ° at 3 months after surgery, which significantly increased to (46.8±13.9) ° in the final follow-up. Meanwhile the mean Cobb angle of compensatory curve was changed from (20.1±10.8) ° before surgery to (23.0±11.1) °, which significantly increased to (29.9±11.5) ° in the final follow-up. There were no significant differences in the Cobb angle of the main curve and the compensatory curve between postoperative 3 months and before operation (>0.05). The difference between the final follow-up and the preoperative, postoperative 3 months was statistically significant (<0.01). Twenty patients experienced progression of both main curve and compensatory curve, with a mean progression rate of (19.2±17.9)% for main curve and (39.6±37.0)% for compensatory curve. The annual progression volume was (1.5± 1.4) ° for main curve and (1.4±1.3) ° for compensatory curve. Three patients underwent lateral convex orthopedic internal fixation due to postoperative scoliosis progression. The curve progression was significantly correlated with age at the time of surgery and hemivertebral number. There was a significant correlation between the age of the operation, the main curve angle, the preoperative compensatory curve angle and the annual progression volume of the main curve (<0.05).@*CONCLUSION@#The convex epiphysiodesis technique cannot effectively prevent curve progression of CS patients in the long-term follow-up. It is not recommended to apply this technique to the treatment of patients with congenital hemivertebrae.

Comparison of sagittal plane morphology of spine and pelvis in adolescents with L₅S₁ developmental spondylolisthesis and isthmic spondylolisthesis / 中国骨伤

OBJECTIVE@#To compare the sagittal morphological features of the spine and pelvis between L₅S₁ dysplastic spondylolisthesis and isthmus spondylolisthesis in adolescent.@*METHODS@#Retrospective analysis of 24 cases of adolescent L₅S₁ spondylolisthesis with complete imaging data from May 2002 to December 2016. Those included 8 males and 16 females, aged from 10 to 18 years old with an average of (13.4±2.0) years. Among them, 9 cases were diagnosed as dysplastic spondylolisthesis (dysplasia group) and 15 cases isthmic spondylolisthesis (ischemic group). Radiographic parameters including slippage distance, slippage degree, slippage angle, sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), L₅ incidence(L₅I), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), sagittal pelvic thickness(SPT), lumbosacral angle (LSA), sacral table angle (STA) were measured on the spinal lateral X-ray of the standing position. Independent-samples t-test was used in the comparison of each variable between two groups. 0.05).@*CONCLUSIONS@#Significant different from isthmic spondylolisthesis, adolescents with dysplastic spondylolisthesis present a different spino-pelvic sagittal alignment, characterized with trunk forward leaning and pelvic retroversion. In case of sagittal imbalance, early surgical intervention is required to restore a balanced spino-pelvic alignment.

Case control studies on unilateral or bilateral pedicle fixation at the level of fracture versus posterior fixation alone in the treatment of thoracolumbar fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects of three fixation methods at the level of fracture in treating thoracolumbar fractures.</p><p><b>METHODS</b>From June 2012 to June 2015, 67 patients with thoracolumbar fractures were treated with posterior short-segment pedicle fixation. There were 45 males and 22 females, aged from 13 to 63 years old with an average of 42.5 years. According to the methods of fixation at the level of fracture, the patients were divided into three groups. Group A included 26 patients treated by traditional posterior fixation alone. Group B included 19 patients treated by posterior fixation with unilateral pedicle fixation at the level of fracture. In group C, 22 patients were treated by posterior fixation with bilateral fracture-level screws. Radiological parameters and clinical outcomes were compared among the three groups.</p><p><b>RESULTS</b>All the patients were followed up for 12 to 26 months with an average of 17.6 months. No complications such as incision infection, poor wound healing, internal fixation loosening and breakage were found. Preoperative, postoperative 1 week, and final follow-up, there were no significance differences among the three groups with respect to the relative height of the fractured vertebra (>0.05). The sagittal Cobb angles among the three groups were similar preoperatively, and a week after operation (>0.05). At latest follow-up, the sagittal Cobb angles and the correction loss of Cobb angle in group A were significantly larger than that of groups B and C (<0.05), while there was no statistical difference between group B and group C (>0.05). With respect to visual analogue scale (VAS) scores for back pain, the three groups were similar at preoperatively, a week after operation and the latest follow-up(>0.05).</p><p><b>CONCLUSIONS</b>Compared to traditional posterior fixation alone, unilateral or bilateral pedicle fixation at the level of fracture can significantly decrease the loss of correction in the middle-long term, and reduce the incidence of tardive kyphosis deformity and can obtain satisfactory radiological results and clinical outcomes with safe surgical procedures.</p>

The correlation between T1 tilt and cosmetic shoulder balance in Lenke type 2 adolescent idiopathic scoliosis patients / 中华外科杂志

<p><b>OBJECTIVE</b>To study the relationship between T1 tilt and cosmetic shoulder balance in adolescent idiopathic scoliosis (AIS) patients.</p><p><b>METHODS</b>Seventy-one Lenke type 2 AIS patients were recruited into the present study from January 2010 to December 2011. There were 61 female and 10 male patients, the average age was (15.1 ± 2.9) years (range 10-18 years); the average Risser sign was 2.8 (range 1-5). The patients were photographed from the back in neutral standing position on level ground wearing underpants. Also, all the patients had a standing posterior-anterior radiograph in a relaxed standing position. The cosmetic shoulder height (CSH), which included cosmetic inner shoulder height (CSHi) and cosmetic outer shoulder height (CSHo), were measured in the photographs. Positive value was defined as left shoulder was higher than the right shoulder, and negative value was defined as right shoulder was higher than the left shoulder. CSH > 5 mm was defined as positive CSH, CSH < -5 mm was defined as negative CSH, -5 mm ≤ CSH ≤ 5 mm was defined as leveled CSH. T1 tilts were measured in the posterior-anterior radiographs. Positive value was defined as the left proximal vertebral body up and right lower vertebral body down, and negative value was defined as the right proximal vertebral body up and left lower vertebral body down. T1 tilt > 5° was defined as positive T1 tilt, T1 tilt < -5° was defined as negative T1 tilt, -5° ≤ T1 tilt ≤ 5° was defined as leveled T1 tilt.</p><p><b>RESULTS</b>T1 tilt was found to be significantly correlated with CSHi and CSHo (r = 0.25 and 0.28, P < 0.05).For positive T1 tilt patients, there were 59.0% (36/61) patients with positive CSHo, 37.7% (23/61)with leveled CSHo, and 3.3% (2/61)with negative CSHo.For the patients with leveled T1 tilt, it was 3/10, 5/10 and 2/10.For positive T1 tilt patients, there were 83.6% (51/61) patients with positive CSHi, 11.5% (7/61) with leveled CSHi, and 4.9% (3/61) with negative CSHi; For the patients with leveled T1 tilt, it was 6/10, 2/10 and 2/10.</p><p><b>CONCLUSIONS</b>Although positive correlation is found between T1 tilt and cosmetic shoulder balance, positive T1 tilt is not an indicator of higher left shoulder.Elevated left shoulder, leveled shoulders and elevated right shoulder are all found in positive T1 tilt patients.</p>

The effect of sympathectomy on the development and progression of scoliosis in bipedal mice model / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of sympathectomy on the development and progression of scoliosis in bipedal C57BL/6J mice model.</p><p><b>METHODS</b>Sixty female 3-week-old C57BL/6J mice were selected to establish bipedal scoliotic mice model after amputations of forelimbs and tails. All mice were randomly divided into three groups, 20 mice for each group. Group 1 received daily intraperitoneal injection of 0.9% saline (5 mg/kg); while Group 2 and 3 received sympathectomy by daily intraperitoneal injection of propranolol (20 mg/kg) and guanethidine sulfate (40 mg/kg), respectively. Posteroanterior X-rays were obtained at 20th week. Curves were measured using Cobb method and scoliosis was defined as a Cobb angle of > 10°. Incidence of scoliosis and severity of curves were compared among groups using Chi-square test and One-way analysis of variance, respectively.</p><p><b>RESULTS</b>There were 17 (85.0%) mice presented scoliosis in Group 1; whereas 11 (55.0%) and 10 (50.0%) mice presented scoliosis in Group 2 and 3, respectively. The incidence of scoliosis was found to be higher in Group 1, and the difference was statistically significant (χ(2) = 6.172, P = 0.046). As for curve magnitudes, the mean Cobb angle was 20° ± 9° in Group 1, 10° ± 7° in Group 2, and 12° ± 8° in Group 3. The mean Cobb angle of Group 1 was significantly greater than those of Group 2 and 3 (F = 9.545, P < 0.001), but there was no significant difference in mean Cobb angle between Group 2 and 3.</p><p><b>CONCLUSIONS</b>Sympathetic nervous system may be involved in the development and progression of scoliosis in bipedal C57BL/6J mice model. Sympathectomy do not seem to dramatically decrease the incidence of scoliosis, probably due to that bipedalism itself may also be a cause of scoliosis in this animal model.</p>

Correlation between the shifting of medulla oblongata and cerebellum and syrinx resolution after posterior fossa decompression in Chiari malformation / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the changes of the position of medulla oblongata and cerebellum following posterior fossa decompression (PFD), and to investigate their influences on the prognosis of the syringomyelia in adolescents with Chiari malformation (CM).</p><p><b>METHODS</b>A retrospective review was performed on all CM patients between September 2006 and September 2011. A subset of 46 patients, including 25 male and 21 female patients, was finally enrolled according to the inclusion criteria. The initial age and duration of follow-up averaged 13.9 years (range, 10-17 years) and 13 months (range, 6-52 months), respectively. On mid-sagittal MRI, the following parameters were evaluated pre- and postoperatively (follow-up ≥ 6 months): the longitudinal and transverse position of bulbopontine sulcus, the fourth ventricle vertex, the lower extreme of cerebella tonsil, the cervico-medullary angle, the maximal syrinx/cord(S/C) ratio and the syrinx length. Changes in these parameters were analysed using the paired samples t test, and for these reaching statistical significances, an additional bivariate correlation analysis was performed to investigate their relation with syrinx resolution.</p><p><b>RESULTS</b>At the latest follow-up, upward shifting of the bulbopontine sulcus was observed in 31 patients(67.4%), with upward shifting of the lower extreme of cerebella tonsil presenting in 35 patients(76.0%). The maximal S/C ratio and the syrinx length were significantly improved postoperatively (t = 7.114 and 7.816, P = 0.000).Significant resolution of the syrinx was demonstrated in 40 patients(86.9%), and more specifically, the average improvement rates of the maximal S/C ratio and the syrinx length were 32% ± 30%and 43% ± 33%, respectively. In addition, the bivariate correlation analysis revealed that syrinx resolution was significantly correlated with the upward shifting of the bulbopontine sulcus (r = 0.332, P = 0.027) and lower extreme of cerebella (r = 0.298, P = 0.044) .</p><p><b>CONCLUSION</b>The upward shifting of the bulbopontine sulcus and the lower extreme of cerebella tonsil might be implicated in the mechanisms of postoperative syrinx resolution.</p>

Risk factors of thoracic curve decompensation after anterior selective fusion in adolescent idiopathic scoliosis with major thoracolumbar or lumbar curve / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the incidence of thoracic curve decompensation or proximal adding-on phenomenon after anterior selective fusion of thoracolumbar or lumbar curve in Lenke type 5 adolescent idiopathic scoliosis (AIS), and to identify its risk factors.</p><p><b>METHODS</b>From June 2001 to December 2008, 130 Lenke type 5 AIS patients with a Cobb angle of 40° - 73° treated with anterior selective thoracolumbar or lumbar fusion, and with a minimum 2-year postoperative regular follow-up were recruited in this study. The average age, Cobb angle and Risser sign of all patients was 14.8 ± 1.6 years, 46° ± 6° of major thoracolumbar or lumbar curve (TL or L), 25° ± 7° of proximal thoracic curve and 0-5, respectively. The patients were grouped according to the relationship between the upper instrumented vertebrae (UIV) and the upper end vertebrae (UEV), the patients' Risser sign and the relationship between UIV and C(7) plumb line (C(7)PL). The radiographic data of the patients were compared between patients with and without proximal adding-on by using t test, and the incidence of proximal adding-on was analyzed in terms of determination of UIV and Risser sign to identify the risk factors of this phenomenon by using Fisher's exact test.</p><p><b>RESULTS</b>Eleven patients were identified with proximal adding-on, thus the incidence of it was 8.5%. At last follow-up postoperatively, the average Cobb angle of TL or L and proximal thoracic curve was 9° ± 4° and 11° ± 5°, respectively. Moreover, the incidence of adding-on in Rissex sign grade 0 to 1 (3/8) was higher than that of grade 2 to 3 (12.1%) and grade 4 to 5 (4.5%). In addition, the incidence of adding-on in UIV lower than UEV group (20.6%) was obviously higher than that of UIV higher than or equal to UEV group (4.2%). The incidence of adding-on for patients with C(7)PL falls away from UIV (19.5%) were obviously higher than that of patients with C(7)PL falls between the pedicle and lateral margin of UIV (3.6%) and between bilateral pedicles of UIV (3.0%). Each group showed significant difference for the incidence of adding-on by Fisher's exact test (P < 0.05).</p><p><b>CONCLUSIONS</b>There exists the risk of proximal thoracic curve decompensation, with a not low rate, after anterior selective fusion for major TL or L curve AIS. The determination of UIV relative to UEV and the skeletal maturity of the patient are the two factors closely associated with the presence of such a phenomenon.</p>

Idiopathic thoracolumbar/lumbar scoliosis treated with anterior correction and interbody fusion with calcium phosphate cement / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical outcome and fusion rate in patients with idiopathic thoracolumbar/lumbar scoliosis treated with anterior correction and interbody fusion with calcium phosphate cement.</p><p><b>METHODS</b>From October 2006 to March 2008, 24 cases undergoing anterior correction and interbody fusion with calcium phosphate cement were enrolled. All of them were female, with an age ranged from 12 to 25 years. The mean Cobb angle of main curve was 46° ± 5° (range, 40° - 56°) before surgery. During operation, the most proximal and distal disc spaces were filled with rib autograft, while the remaining levels were filled with calcium phosphate cement. The interbody fusion rate, coronal correction and sagittal profile reconstruction were evaluated respectively by using χ² test and t test.</p><p><b>RESULTS</b>Interbody fusion was performed in 103 levels, including 48 levels with rib autograft and 55 levels with calcium phosphate cement. The mean follow-up period was 23.8 months (range, 12 - 33 months) in this series. At the follow-up of 6 months, fusion rate was found as 54.2% in the levels filled with rib autograft, while 50.9% in those filled with calcium phosphate cement. Solid fusion of the whole instrumented area was achieved in all cases with a minimum one-year follow-up. No instrumentation-related complications occurred. The correction rate of main curve was on an average of 76% ± 11% after surgery. A significant difference was found between preoperative and immediate postoperative value in terms of the main curve magnitude (46° ± 5° vs. 14° ± 5°, t = -26.95, P < 0.05). The correction loss of the main curve was -5.1° - 10.4° at the final follow-up. The coronal balance and lower instrumented vertebra tilting were significantly improved after operation. The thoracolumbar kyphosis was significantly reduced postoperatively (t = 3.11, P < 0.05).</p><p><b>CONCLUSION</b>Satisfactory bone fusion and correction maintenance can be achieved in idiopathic thoracolumbar/lumbar scoliosis treated by anterior instrumentation combined with interbody fusion using calcium phosphate cement.</p>

Early outcome of vertical expandable prosthetic titanium rib technique in treating early-onset scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the early outcome of vertical expandable prosthetic titanium rib (VEPTR) technique in treating early-onset scoliosis.</p><p><b>METHODS</b>This study recruited 11 early-onset scoliosis patients (8 boys and 3 girls) who received VEPTR treatment from December 2006 to July 2011 with a minimum follow-up of 12 months. The average age at initial surgery was (7 ± 3) years (range, 3.1 to 9.8 years). VEPTR device, either rib to rib or rib to lumbar, was implanted at initial surgery. During the regular post-operative follow-ups, expansion surgeries were scheduled at an interval of 6 to 12 months. Measurements of primary curve magnitude, apical vertebral translation, thoracic height and T(1)-S(1) height were performed on radiographs, and were compared between those of preoperatively, postoperatively, and at latest follow-up through paired-t tests.</p><p><b>RESULTS</b>All patients had a mean follow-up of (32 ± 11) months. Totally 41 surgeries were performed, averagely 3.7 surgeries per patient; and 30 expansion surgeries were carried out, averagely 2.7 surgeries per patient. The average interval for each expansion surgery was 8 months. From preoperatively to latest follow-up, the Cobb angle of primary curves was averagely corrected from 78° ± 18° to 55° ± 11° (t = 4.931, P < 0.05), and apical vertebral translation and thoracic kyphosis displayed slight improvement. Average thoracic height increased from (13.3 ± 2.0) cm to (17.2 ± 2.4) cm (t = 8.365, P < 0.001), and average T(1)-S(1) height from (24.4 ± 3.8) cm to (32.5 ± 5.3) cm (t = 9.080, P < 0.001). After initial surgery with VEPTR instrumented, gains in thoracic height and T(1)-S(1) height per expansion surgery averaged (0.8 ± 0.3) cm and (1.8 ± 0.4) cm, respectively. Eight complications occurred in 6 patients, including rib cradle dislodgements, displayed infection, intraoperative pleura rupture and loosening of lumbar pedicle screws.</p><p><b>CONCLUSIONS</b>VEPTR technique proves to be an effective way of preventing curve progression in early-onset scoliosis patients while allowing growth of spine and chest. Yet, indications for such a technique need to be strictly selected because of the relatively high complication rate.</p>

Association between tartrate-resistant acid phosphatase 5 gene polymorphism and adolescent idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate whether the titrate-resistant acid phosphatase 5 (ACP5) gene polymorphisms were associated with the occurrence or curve severity of adolescent idiopathic scoliosis (AIS).</p><p><b>METHODS</b>There were 372 AIS patients from January 2006 to December 2008 and 239 normal controls from March 2005 to August 2006 were recruited. The Cobb angles were ≥ 10° in all AIS patients. Using the haplotype data of Han population from the Hapmap Project, two tag SNPs (rs2229531, rs2071484) were defined for ACP5 gene. PCR-restriction fragment length polymorphism was used for the genotyping.</p><p><b>RESULTS</b>No polymorphism in rs2229531 was found in this study. The genotype and allele frequency distribution in rs2071484 were similar between AIS patients and normal controls (χ(2) = 3.336 and 1.438, P > 0.05). The mean maximum Cobb angles of different genotypes of rs2071484 in ACP5 gene were 38° ± 19° in AA, 34° ± 14° in AG and 38° ± 21° in GG, which were similar with each other among AIS patients who reached skeletal maturity or received surgery treatment (P = 0.157).</p><p><b>CONCLUSION</b>The ACP5 gene is neither associated with the occurrence nor the curve severity of AIS.</p>

Long term outcome of video-assisted thoracoscopic surgery for thoracic adolescent idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To study the long term outcomes and complications of video-assisted thoracoscopic surgery (VATS) in correcting thoracic adolescent idiopathic scoliosis (T-AIS) with more than five-year follow-up.</p><p><b>METHODS</b>The T-AIS patients underwent corrective surgery by VATS between June 2002 and December 2006 and experienced more than five-year follow-up were retrospectively reviewed. Nine female patients with T-AIS were recruited with a mean age of 14.3 years (range 11 - 16 years) at operation. Radiological parameters including thoracic and lumbar curves, thoracic kyphosis (T(5)-T(12)), sagittal alignment of the thoracolumbar junction (T(10)-L(2)) and lumbar lordosis (T(12)-S(1)) were measured on the X-rays taken preoperatively, 3 months, 2 year postoperatively and at latest follow-up. Complications occurred after operation and during follow-up were retrieved. The Chinese edition SRS-22 was finished by patients at the latest follow-up. Repeated-measures analysis of variance and paired t test were used for statistical analysis.</p><p><b>RESULTS</b>The patients were followed for a mean of 6.2 years (5 - 7.5 years) after VATS. The mean thoracic curve was corrected from 51° ± 8° preoperatively to 20° ± 8° at 3 months post-operation, and 21° ± 12° and 25° ± 13° at 2 year post-operation and latest follow-up, respectively. During the follow-up, no significant changes were observed regarding to coronal and sagittal radiological parameters (P > 0.05). Rod breakage occurred in 1 patient and Adding on was found in another one patient 2 year post-operation. Revision surgery was not needed for the solid fusion achieved and lack of correction loss. The mean score of SRS-22 at final follow-up was 4.3 ± 0.3, with high score in most of the domains.</p><p><b>CONCLUSIONS</b>Loss of curve correction and implant-related complication are found in VATS-treated T-AIS patients at the long-term follow-up. Although the patients show high scores in SRS-22, which indicated higher functional outcome and satisfaction to the operation, special care should be taken for applying VATS to T-AIS patients for the concern of long-term complication.</p>

A comparative study on the surgical outcomes of spinal fusion in adolescent idiopathic scoliosis patients with or without triradiate cartilages closed / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of potential spinal growth on the posterior-only spinal instrumentation of adolescent idiopathic scoliosis (AIS).</p><p><b>METHODS</b>From June 2003 to October 2007, 40 patients received posterior-only spinal instrumentation. Group of open triradiate cartilage (Group A) included 16 female AIS patients with mean age of 11.8, and group of closed triradiate cartilages (Group B) covered 24 female AIS patients with mean age of 13.7. The mean preoperative Cobb angles of Group A and B were 53.3° and 49.6° respectively, and the mean kyphosis in the sagittal plane was 27.7° and 27.8° respectively.</p><p><b>RESULTS</b>The post-operative Cobb angles were 22.2° (Group A) vs. 20.7° (Group B) (P = 0.34) with correction rate of 58.3% (Group A) vs. 57.7% (Group B) (P = 0.83). The mean Cobb angles at final follow-up were 24.8° (Group A) vs. 21.1° (Group B) (P = 0.05) with the correction loss of 5.3% (Group A) vs. 1.0% (Group B) (P = 0.01). In the sagittal plane, the average post-operative kyphosis was 22.5° (Group A) vs. 23.9° (Group B) (P = 0.49) with correction of 5.2° (Group A) vs. 3.9°(Group B) (P = 0.63). The mean kyphosis at final follow-up was 20.8°(Group A) vs. 24.7°(Group B) (P = 0.04) with the correction loss of -1.7° (Group A) vs. 0.8°(Group B) (P = 0.01). Group A showed obvious correction loss in the coronal plane and decrease of kyphosis in the sagittal plane. Adding on phenomenon was found in 2 cases with Lenke type I with selected fusion in Group A, but not in Group B.</p><p><b>CONCLUSIONS</b>Although similar post-operative correction is found in AIS patients with OTRC or CTRC, the loss of correction and "adding on phenomenon" are more likely to happen in patients with OTRC.</p>

Comparison of the sagittal profiles between thoracic idiopathic scoliosis patients with different curve progression / 中华外科杂志

<p><b>OBJECTIVES</b>To compare the sagittal profiles between thoracic idiopathic scoliosis (IS) patients with different curve progression and to determine the risk factors associated with curve progression.</p><p><b>METHODS</b>A total of 83 thoracic IS patients from September 2009 to May 2010 were included in this study and were divided into 3 groups according to different curve progression. All the patients did not receive any previous treatments. There were 26 skeletally mature patients whose Risser sign were 5 degree with Cobb angle < 40° in non-curve progression group (NCP group), 29 mature patients whose Risser sign were 5 degree with Cobb angle ≥ 40° in moderate curve progression group (MCP group) and 28 immature patients whose Risser sign ≤ 3 degree with Cobb angle ≥ 40° in severe curve progression group (SCP group). Five sagittal parameters, including thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI) and pelvic tilt (PT) were measured on the lateral X-ray films. Analysis of variance was used to compare these parameters among the 3 groups.</p><p><b>RESULTS</b>The average thoracic Cobb angle was significantly smaller in NCP group when compared with MCP group (P < 0.01) or SCP group (P < 0.01), but not significantly different between the 2 latter groups (P = 0.619). The average TK was 19° ± 7° in NCP group, 13° ± 6° in MCP group and 8° ± 5° in SCP group. The average TK was significantly smaller in SCP group when compared with MCP group (P = 0.011) or NCP group (P < 0.01), while the average TK was significantly smaller in MCP group when compared with NCP group (P < 0.01). None of the other 4 parameters showed any significant difference between the 3 groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Thoracic hypokyphosis is strongly associated with curve progression in thoracic IS patients. Pelvic sagittal profile may not be involved in the underlying mechanism of curve progression in thoracic IS patients.</p>

Anterior endoscopic release/posterior spinal instrumentation for severe and rigid thoracic adolescent idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVES</b>To compare the results of spinal correction for severe and rigid thoracic adolescent idiopathic scoliosis (T-AIS) by combined anterior endoscopic release/posterior hybrid constructs of proximal hooks and distal pedicle screws spinal fusion (APSF) and an all-pedicle screw construct posterior-only spinal fusion (PSSF).</p><p><b>METHODS</b>T-AIS patients with curves ≥ 70° and flexibility ≤ 50% who underwent APSF from November 2001 to December 2008 were retrospectively reviewed (APSF group). In addition, the patients treated by PSSF with comparable curve severity and flexibility were selected as control (PSSF group). All patients had a minimum 2-year follow-up. The thoracic curve and kyphosis were measured on standing long-cassette posteroanterior and lateral radiographs of entire spine taken at pre-operation, post-operation and last follow-up. The radiographic parameters, fusion levels, implant density and complications were compared between two groups.</p><p><b>RESULTS</b>There were 18 patients treated with APSF and 27 with PSSF, with mean age of (15.9 ± 2.1) years and (15.8 ± 2.9) years, respectively. In patients treated with APSF, the mean thoracic curve was 87° ± 12° with 58% ± 13% correction after operation; while in those treated with PSSF, the mean thoracic curve was 79° ± 8° with 59% ± 8% correction after operation. The number of levels fused was 12.7 ± 1.2 and 12.8 ± 1.4, while the implant density was 48% ± 5% and 61% ± 6% in APSF group and PSSF group, respectively. Patients treated with APSF and PSSF were followed by (4.5 ± 0.6) years and (2.8 ± 0.7) years, with a mean loss of correction of 4.4° and 1.9° at final follow-up. Despite the significant higher implant density found in PSSF (t = 6.123, P < 0.001), there were no statistically significant differences between the groups for gender, age, number of levels fused, preoperative coronal/sagittal Cobb measurements, coronal curve flexibility, or amount of postoperative coronal Cobb correction.</p><p><b>CONCLUSIONS</b>In patients with severe and rigid T-AIS, PSSF could achieve same curve correction as an APSF by increasing implant density. In treating scoliosis patients with high risk of having loss of curve correction, implant complications or pseudarthrosis, APSF is recommended to achieve solid spinal fusion.</p>

Pulmonary dysfunction patterns in patients with Marfan and Marfanoid syndrome associated with scoliosis and the influencing factors / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the impairment pattern and the influencing factors of pulmonary function in patients with Marfan and Marfanoid syndrome associated scoliosis (MS).</p><p><b>METHODS</b>In this retrospective study, totally 25 MS patients (aged 11 - 20 years, 11 boys and 14 girls) who received posterior instrumentation and fusion (Group A) and 38 adolescent idiopathic scoliosis (AIS) patients (Group B) (aged 10 - 19 years, 11 boys and 27 girls) were included from February 1998 to September 2007. The curve pattern was matched in both groups. The preoperative pulmonary function test (PFTs) were compared in two groups. And the parameters influencing the preoperative pulmonary function were analyzed in group A.</p><p><b>RESULTS</b>In Group A, the Cobb angle of thoracic curve was negatively correlated with the percentage of predicted pulmonary volumes (VC%, FVC% and FEV1%) (r = -0.514, -0.503, -0.464, P < 0.05). And the reduction of lung function parameters (VC%, FVC%, FEV1% and MMEF%) was more severe in Group A than in Group B with compared magnitude of thoracic curve (P < 0.05). In Group A, the extent of impairment of pulmonary function in patients with the number of vertebrae involved ≥ 8 were more severe than those involved < 8 vertebrae (P < 0.05). However, there was no significant difference of deterioration of lung function between the higher apex (T₄₋₈) subgroup and lower apex (T₉₋₁₂) subgroup. And no correlation was found between thoracic kyphosis and the degrees of impairment of respiration function.</p><p><b>CONCLUSIONS</b>Patients with MS have mixed ventilation dysfunction, which is more severe than AIS patients with matched age and Cobb angle. The pulmonary dysfunction in MS patients can be influenced by the severity of thoracic curve and the number of involved vertebrae.</p>

Efficacy of preoperative Halo-femoral traction in the treatment of rigid idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of preoperative Halo-femoral traction in the treatment of rigid idiopathic scoliosis.</p><p><b>METHODS</b>Sixteen patients with rigid idiopathic scoliosis treated with Halo-femoral traction before posterior spine fusion from July 2003 through May 2006 were studied retrospectively. There were 4 male and 12 female, with a mean age of 16 years (range, 12-20 years). The coronal Cobb angles of coronal major curve and the thoracic kyphosis (T(5)-T(12)) were 111 degrees and 64 degrees, respectively. All the patients underwent preoperative Halo-femoral traction. After the maximum weight traction for 2-3 weeks, a posterior instrumentation and fusion was performed. The correction rate of coronal major curve on preoperative side bending film, on supine film after Halo-femoral traction and after surgery was compared.</p><p><b>RESULTS</b>The maximum traction weight averaged 19 kg. All patients had an at least 12-month follow-up. One patient experienced transient brachial plexus palsy and complete recovery was achieved after reducing the traction weight. No neurologic complication, death and respiratory failure occurred after surgery. In comparison to the correction rate of 18.7% on preoperative side bending film, the correction rate of coronal major curve after Halo-femoral traction increased by 13.2% (P < 0.05). The postoperative correction rate of coronal major curve and thoracic kyphosis was 48.6% and 51.9%, respectively. At the final follow-up, the coronal and sagittal correction loss averaged 2.0% and 5.8%, respectively.</p><p><b>CONCLUSIONS</b>Preoperative Halo-femoral traction combined with intraoperative posterior spinal release can significantly enhance the correction rate for rigid idiopathic scoliosis. However, the traction complications should be worthy of vigilance.</p>

The pulmonary dysfunction patterns in scoliosis associated with neurofibromatosis type I / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the pulmonary dysfunction patterns in patients of scoliosis associated with neurofibromatosis type I (NF1) and to identify factors affecting the pulmonary function in patients with scoliosis associated with NF1.</p><p><b>METHODS</b>Preoperative pulmonary function tests (PFTs) were evaluated in 100 patients with scoliosis [NF1 group, 36 cases; idiopathic scoliosis (IS) group, 64 cases] from January 2003 to June 2009. According to location of apical vertebra and dystrophic change in patients with NF1, the parameters of pulmonary function [vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal mid-expiratory flow (MMEF), maximal voluntary ventilation (MVV)] were compared between NF1 group and IS group, and between the subgroups of NF1. The correlation between pulmonary function parameters and radiographic parameters of scoliosis was analyzed.</p><p><b>RESULTS</b>The VC, FVC, FEV1, MMEF, MVV in NF1 group and IS group were of no significant difference (P > 0.05). In NF1 patients, the pulmonary dysfunction was more severe in thoracic subgroup than non-thoracic subgroup (P < 0.05), while there was no difference between dystrophic scoliosis and non-dystrophic scoliosis (P > 0.05). The location of apical vertebra and the severity of scoliosis correlated significantly with the pulmonary dysfunction in NF1 group.</p><p><b>CONCLUSIONS</b>The pattern of pulmonary dysfunction in scoliosis associated with NF1 is similar with IS. Pulmonary dysfunction is more severe in thoracic scoliosis. The location of apical vertebra and the severity of scoliosis are the risk factors influencing the pulmonary dysfunction.</p>

Early outcome of one-stage posterior transpedicular hemi-vertebra resection in the treatment of children with congenital scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the early outcomes of children with congenital scoliosis treated by one-stage transpedicular hemi-vertebra resection.</p><p><b>METHODS</b>From July 2005 to June 2006, 27 consecutive cases of congenital scoliosis managed by one-stage transpedicular hemi-vertebra resection with instrumentation were investigated retrospectively. There were 11 girls and 16 boys, with a mean age of 5.5 years at surgery (range 1.3 - 10.0 years). Location of the hemi-vertebra was in the thoracic spine in 12 cases and in the lumbar spine in 15 cases. Radiographic evaluations were performed on the preoperative, postoperative, and latest follow-up standing posteroanterior and lateral radiographs.</p><p><b>RESULTS</b>The average operation time was 4 hours (range 3-6 hours), and the mean blood loss during operation was 750 ml (range 300 - 2200 ml). The mean fusion level was 2 to 7 segments, average 4.4 segments. The average follow-up period was 16 months (range 12 - 34 months). Mean Cobb angle of the total main curve was 40.0° before surgery, 12.6° after surgery, and 15.2° at latest follow-up. Mean Cobb angle of the segmental main curve was 35.6° before surgery, 11.6° after surgery, and 12.1° at latest follow-up. The trunk shift was improved from 16.5 mm before operation to that of 7.5 mm after the operation and 7.6 mm at the latest follow-up. Compensatory cranial curve improved from 19.4° before surgery to 8.9° after surgery, and compensatory caudal curve improved from 26.3° to 12.8°. The angle of segmental kyphosis was 26.4° before surgery and 14.6° after surgery in cases with thoracic hemivertebrae, and averaged 11.2° before surgery and 3.9° after surgery in cases with lumbar hemivertebrae. Peri-operative complications included two pedicle screws malpositioning and one case with pelvic tilt. There was no neurological complication.</p><p><b>CONCLUSION</b>One-stage transpedicular hemi-vertebra resection with instrumentation has a good capability of correcting deformity on the frontal and sagittal planes, which is available in children with middle or lower thoracic or lumbar hemivertebrae.</p>

Influence of preoperative thoracic kyphosis on the sagittal profile of the lumbar spine in idiopathic thoracic scoliosis following selective thoracic fusion / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the influence of thoracic kyphosis on the sagittal compensatory mode of the spine in idiopathic thoracic scoliosis after the selective thoracic fusion.</p><p><b>METHODS</b>Ninety AIS patients (mean age 14.5 years old) who received selective thoracic fusion from February 1999 to December 2005 in one institution with at least 24-month follow-up were evaluated. Forty-one patients underwent anterior spinal fusion and forty-nine patients underwent posterior spinal fusion. And then the patients were divided into two subgroups according to the magnitude of preoperative thoracic kyphosis (TK): Group A, TK less than 10 degrees ; and Group B, TK more than 10 degrees . The radiological parameters were measured including: thoracic and lumbar curve magnitude, TK, lumbar lordosis (LL), thoracolumbar junction kyphosis (T(10)-L(2), TJK), distal junctional kyphosis (DJK), sagittal vertical axis (SVA).</p><p><b>RESULTS</b>At final follow-up, TK, TJK and DJK increased significantly compared with preoperative Cobb angle in subgroup A patients who underwent anterior spinal fusion (P < 0.05). Generally, there was a lordosis loss of TJK and DJK during follow-up. While in subgroup B, TJK at final follow-up increased apparently compared with preoperative Cobb angle (P < 0.05). And there was a increased trend of DJK in spite of no significant difference, however, there was no obvious change of TK in subgroup B. At the final follow-up, TK and TJK increased significantly in subgroup A patients who underwent posterior spinal fusion (P < 0.05). And there was a increased tendency of DJK during follow-up, although there was no significant difference. And there was no obvious change of TK, TJK and DJK in subgroup B. There was a increased trend of LL in spite of no significant difference in group A patients who underwent anterior or posterior spinal fusion. The sagittal balance maintained well during follow-up in both groups.</p><p><b>CONCLUSIONS</b>For AIS patients with thoracic hypokyphosis, normal TK and LL could be achieved during follow-up with selective thoracic instrumentation. However, the increase of DJK and TJK may occur during the follow-up, and the risk factors may be the anterior short segmental fusion and the reconstruction of the sagittal profile in the hypokyphosis patients.</p>