Selection of distal fusion levels in the surgical management of thoracolumbar/lumbar adolescent idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of a new method which determines the exact distal fusion level in the treatment of adolescent idiopathic scoliosis (AIS) with posterior pedicle screw fixation and to assess its clinical outcome.</p><p><b>METHODS</b>This prospective clinical study analyzed 31 AIS patients who met the inclusion criteria enrolled from July 2005 to September 2008. Based on the principle of our new criteria for selection of distal fusion level of AIS, all patients had posterior spinal fusion and instrumentation with pedicle screws. Cobb angle of the curve, tilt angle of the LIV, intervertebral angle and trunk shift were measured and analyzed.</p><p><b>RESULTS</b>Preoperative (42 + or - 17) degrees of thoracic curve was corrected to (12 + or - 7) degrees , with a curve correction of 70.6%. Preoperative (44 + or - 7) degrees of lumbar curve was corrected to (9 + or - 4) degrees , with a curve correction of 80.2%. The trunk shift were significantly improved from (13 + or - 8) mm to (9 + or - 7) mm before and after surgery respectively (P < 0.05). The tilt angles of the LIV before and after surgery were (20.8 + or - 5.7) degrees and (1.5 + or - 3.1) degrees respectively. The thoracic Cobb angle was (14 + or - 8) degrees and the lumbar Cobb angle was (9 + or - 5) degrees at latest follow up. The changes were of significance in the tilt angle of the LIV after surgery compared with that before surgery (P = 0.000). This angle averaged (0.8 + or - 3.7) degrees at final follow up, but the change was not significant compared with that after surgery (P > 0.05).</p><p><b>CONCLUSION</b>This is an effective method with the advantage of shortening the fusion level, reserving the distal motion segments and easing segmental degeneration adjacent to the fusion area.</p>

A retrospective study of echocardiographic cardiac function and structure in adolescents with congenital scoliosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patients with congenital scoliosis often also have intraspinal abnormalities and other organ defects, and few studies of the effects of congenital scoliosis on cardiac function and structure have been published.</p><p><b>METHODS</b>A total of 215 adolescent patients with congenital scoliosis (average age, 13.58 years) underwent preoperative echocardiography and were then assigned to subgroups according to apex vertebral rotation, side of convexity, curvature severity in the coronal and sagittal planes, type of deformity, and sex. Differences between the subgroups were compared by independent-samples t test or a one-factor analysis of variance.</p><p><b>RESULTS</b>We observed statistically significant differences between patients with right-sided scoliosis curvature and those with left-sided scoliosis curvature, respectively, in left ventricular inner diameter at end-diastole ((39.39 +/- 4.66) mm vs (41.74 +/- 4.90) mm), left ventricular inner diameter at end-systole ((24.80 +/- 3.45) mm vs (25.92 +/- 3.07) mm), interventricular septum thickness at end-diastole ((5.66 +/- 0.98) mm vs (5.98 +/- 1.03) mm), and posterior wall of left ventricle at end-diastole ((5.61 +/- 0.98) mm vs (6.06 +/- 1.20) mm). When the patients were evaluated by coronal plane Cobb angle, significant differences were found between those with Cobb angle of 40 degrees - 80 degrees and of > 80 degrees in left ventricular inner diameter at end-diastole ((40.97 +/- 5.06) mm vs (38.98 +/- 4.45) mm) and left ventricular inner diameter at end-systole ((25.53 +/- 3.39) mm vs (24.36 +/- 3.14) mm), respectively. When the patients were evaluated by sagittal plane Cobb angle (< 20 degrees, group 1; 20 degrees - 40 degrees, group 2; > 40 degrees, group 3), significant differences were found in right ventricular diameter between those with Cobb angle of < 20 degrees and of 20 degrees - 40 degrees ((18.27 +/- 3.66) mm vs (16.54 +/- 3.57) mm) and in diameter of aortic root between those with Cobb angle of 20 degrees - 40 degrees and of > 40 degrees ((23.83 +/- 3.39) mm vs (24.90 +/- 3.30) mm), respectively. No significant differences were found in ejection fraction and fractional shortening between patients according to apex vertebral rotation, side of convexity, coronal plane and sagittal plane Cobb angles, type of deformity, or sex.</p><p><b>CONCLUSIONS</b>Congenital scoliosis influences cardiac structure, but not function.</p>