Can anterior vertebral body tethering provide superior range of motion outcomes compared to posterior spinal fusion in adolescent idiopathic scoliosis? A systematic review.

PURPOSE: Anterior vertebral body tethering (AVBT) was introduced as a fusionless alternative to treating adolescent idiopathic scoliosis (AIS) while preserving range of motion (ROM). This is the first systematic review to compare the ROM outcomes between AVBT and PSF in treating AIS. METHODS: We conducted a comprehensive search on PubMed, EMBASE, MEDLINE, and Cochrane Library. Inclusion criteria were patients with AIS treated with AVBT or PSF or both, and clearly defined ROM outcomes; exclusion criteria were scoliosis other than AIS, biomechanical or cadaveric studies, non-English publications, case reports, conference summaries, unpublished literature, commentaries, and reviews. Primary outcome was ROM. Secondary outcomes included Cobb angle correction, quality of life (QOL), complications, and muscle strength and endurance. RESULTS: Twelve studies were included in this review. We found moderate evidence to support that AVBT results in superior ROM outcomes than PSF while achieving comparable Cobb angle correction with low evidence. The comparison of QOL outcomes between AVBT and PSF remained inconclusive. In addition to the complications noted conventionally in PSF, AVBT could result in over-correction and distal adding-on. We also found very low evidence to support that AIS patients treated with AVBT have superior muscle strength and endurance when compared to those treated with PSF. CONCLUSIONS: AVBT provides better preservation of ROM and muscle strength postoperatively when compared with PSF, while achieving comparable curve correction. Future studies should explore the spinal growth trajectory to determine the window of opportunity for AVBT in AIS.

Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review.

BACKGROUND: Restoration of three-dimensional (3D) alignment is critical in correcting patients with adolescent idiopathic scoliosis using posterior spinal fusion (PSF). However, current studies mostly rely on 2D radiographs, resulting in inaccurate assessment of surgical correction and underlying predictive factors. While 3D reconstruction of biplanar radiographs is a reliable and accurate tool for quantifying spinal deformity, no study has reviewed the current literature on its use in evaluating surgical prognosis. PURPOSE: To summarize the current evidence on patient and surgical factors affecting sagittal alignment and curve correction after PSF based on 3D parameters derived from reconstruction of biplanar radiographs. METHODS: A comprehensive search was conducted by three independent investigators on Medline, PubMed, Web of Science, and Cochrane Library to obtain all published information on predictors of postoperative alignment and correction after PSF. Search items included "adolescent idiopathic scoliosis," "stereoradiography," "three-dimensional," "surgical," and "correction." The inclusion and exclusion criteria were carefully defined to include clinical studies. Risk of bias was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development, and Evaluations approach. 989 publications were identified, with 444 unique articles subjected to full-text screening. Ultimately, 41 articles were included. RESULTS: Strong predictors of better curve correction included preoperative normokyphosis (TK > 15°), a corresponding rod contour, intraoperative vertebral rotation and translation, and upper and lower instrumented vertebrae selected based on sagittal and axial inflection points. For example, for Lenke 1 patients with junctional vertebrae above L1, fusion to NV-1 (1 level above the neutral vertebra) achieved optimal curve correction while preserving motion segments. Pre-op coronal Cobb angle and axial rotation, distal junctional kyphosis, pelvic incidence, sacral slope, and type of instrument were identified as predictors with moderate evidence. For Lenke 1C patients, > 50% LIV rotation was found to increase spontaneous lumbar curve correction. Pre-op thoracolumbar apical translation and lumbar lordosis, Ponte osteotomies, and rod material were found to be predictors with low evidence. CONCLUSIONS: Rod contouring and UIV/LIV selection should be based on preoperative 3D TK in order to achieve normal postoperative alignment. Specifically, Lenke 1 patients with high-lying rotations should be fused distally at NV-1, while hypokyphotic patients with large lumbar curves and truncal shift should be fused at NV to improve lumbar alignment. Lenke 1C curves should be corrected using > 50% LIV rotation counterclockwise to the lumbar rotation. Further investigation should compare surgical correction between pedicle-screw and hybrid constructs using matched cohorts. DJK and overbending rods are potential predictors of postoperative alignment.

Knowledge difference of sexually transmitted infections between Hong Kong undergraduates from local and international secondary schools: A cross-sectional study.

Background: Since the delivery of sex education is not standardized across local and international secondary schools in Hong Kong, this study aims to assess and compare the knowledge level of sexually transmitted infections (STIs) between university students who attended local and international secondary schools in Hong Kong. Methods: From January to March 2019, we conducted a cross-sectional survey among undergraduates at the University of Hong Kong. The primary outcome was STI knowledge as measured by a 29-item quiz. A higher quiz score meant a better STI knowledge level. Students' attitude toward sexual health and their sex education history was collected. Bivariate and multivariate analyses were conducted to evaluate the association factor with a better STI knowledge level. Results: Three hundred and ninety six students were included in the analysis. Three hundred thirty three (85.35%) students attended local secondary schools and 58 (14.65%) students attended international secondary schools in Hong Kong; 200 (50.51%) students were male and 196 (49.49%) students were female. Compared with students from local secondary school, those from international secondary schools had a significantly higher STI quiz score (18.19 vs. 15.4, p = 0.003). The results of multiple linear regression revealed that students in a higher year of study (ß = 1.07, p < 0.001), from medical faculties (ß = 6.96, p < 0.001), and from international secondary schools (ß = 2.27, p = 0.003) achieved a higher STI quiz score. Conclusion: University students who attended international secondary schools in Hong Kong possess a significantly higher knowledge level of STIs compared with those who attended local secondary schools. Nonetheless, the overall STI awareness among university students is inadequate. The inadequacy of STI awareness calls for the need to plan and implement satisfactory, comprehensive, and standardized sex education across the overall education system in Hong Kong.