The global burden of traumatic amputation in 204 countries and territories.

Background: Traumatic amputation leads to disability and imposes a heavy health burden. This study aims to explore the current status and temporal trends of the global burden of traumatic amputation according to sex, age, amputation site, cause, and reginal level of social development. Methods: The data were extracted from the Global Burden of Diseases (GBD) Study 2019. Prevalence, incidence, years lived with disability (YLDs) and corresponding age-standardized rate were compared. Estimated annual percentage change (EAPC) was applied to reflect trends in age-standardized rates over a specific period. Spearman rank test and curve fitting methods were used to analyze the relationship between disease burden and Socio-Demographic Index (SDI). Results: Globally, the incidence and prevalence number of traumatic amputation increased from 11.37 million and 370.25 million in 1990, to 13.23 million and 552.45 million in 2019, with a raise of 16.4 and 49.2%, respectively. But the age-standardized incidence rate (ASIR) (EAPC = -0.56; 95%CI, -0.72 to -0.41) and age-standardize prevalence rate (ASPR) (EAPC = -0.63; 95%CI, -0.74 to -0.52) declined during this period. The YLDs count also increased by 39.2% globally (from 5.28 million to 7.35 million), while the age-standardize YLDs rate (ASYR) decreased by an average of 1.00% per year (95% CI, -1.10 to -0.90) from 1990 to 2019. The incidence, prevalence, and YLDs rate of traumatic amputation continue to increase with age. Traumatic amputations were most common in the fingers, while unilateral lower limb amputation caused the greatest burden of disability. ASIR and SDI were positively correlated (ρ = 0.442, p < 0.001), while ASYR and SDI were not significantly correlated (ρ = -0.030, p = 0.669), and EAPC in ASYR and SDI were negatively correlated (ρ = -0.275, p < 0.001). Exposure to mechanical forces and falls were the leading causes of traumatic amputation. Conclusion: Despite the declining trends in ASIR, ASPR, and ASYR, the incidence, prevalence, and YLDs counts of traumatic amputation have increased significantly worldwide, especially in the older adults population. With the population aging, targeted health policies are needed to address the increasing global burden of traumatic amputations in the future.

Analysis of medical malpractice litigation following vertebral augmentation therapy in China from 2008 to 2018.

The first case of vertebral augmentation therapy in mainland China was reported in 2000. Since then, it has been widely used in China as a minimally invasive procedure to treat vertebral compression fractures. However, the characteristics of malpractice litigation involving vertebral augmentation therapy remains unclear. This study aims to analyze the characteristics of medical malpractice litigation involving vertebral augmentation therapy in mainland China for the past 10 years. Two online legal databases were queried for court verdicts involving vertebral augmentation therapy from Jan 2009 to Dec 2018 in mainland China. Each case file was then thoroughly reviewed and data pertaining to defendants, plaintiffs, case outcomes, allegations, and verdicts were abstracted, and descriptive analyses were performed. Level of evidence: LEVEL III. A total of 96 cases were enrolled for final analysis. The number of claims increased by five times during the past 10 years. More than two thirds (67.7%, n = 65) of the cases underwent percutaneous vertebroplasty, and 22.9% (n = 22) underwent percutaneous kyphoplasty, the rest (9.4%, n = 9) remained undefined. Paralysis was alleged in 35.4% of cases (n = 34), followed by significant physical injury (34.4%, n = 33). Cement leakage to spinal canal (44.8%, n = 43) is the most commonly cited reason for litigation, followed by incomplete informed consent (42.7%, n = 41), accidental dural puncture (20.8%, n = 20), unsatisfactory clinical outcome (18.8%, n = 18), and misdiagnosis (12.5%, n = 12). Acute pulmonary cement embolism (4.2%, n = 4), wrong-level vertebrae procedure (3.1%, n = 3) and postoperative infection (2.1%, n = 2) were less common causes for concern. Doctors successfully defended themselves only in 8 (8.3%) cases, which resulted in no indemnity payment. The rest 88 (91.7%) cases were closed with a mean verdict payout of 361,580 Yuan (51,654 US dollars). There is a quickly rising trend in the number of medical malpractice litigation involving vertebral augmentation therapy in China. Identifying the most common reasons for litigation and summarizing their characteristics may help decrease litigation rate and improve the patient experience.

Nuclear Receptor Coactivator 2 Promotes Human Breast Cancer Cell Growth by Positively Regulating the MAPK/ERK Pathway.

As a member of the p160 steroid receptor coactivator (SRC) family, nuclear receptor coactivator 2 (NCOA2) is known to play essential roles in many physiological and pathological processes, including development, endocrine regulation, and tumorigenesis. However, the biological function of NCOA2 in breast cancer is not fully understood. We found that the copy number of the NCOA2 gene was frequently amplified in four breast cancers datasets, varying from 6 to 10%, and the mRNA levels of NCOA2 were also upregulated in 11% of the sequenced cases/patients (TCGA provisional dataset). Next, we confirmed that NCOA2 silencing significantly suppressed cell proliferation in different breast cancer cell lines, by inducing cell cycle arrest and apoptosis. Mechanistically, whole-transcriptome sequencing (RNA-Seq) analysis showed that NCOA2 depletion leads to downregulation of the MAPK/ERK signaling cascade, possibly via downregulating NCOA2's downstream target RASEF. In conclusion, our results suggest NCOA2 as a potential target of therapeutics against breast cancer.

Curcumin may serve an anticancer role in human osteosarcoma cell line U-2 OS by targeting ITPR1.

The present study aimed to determine the mechanisms of action of curcumin in osteosarcoma. Human osteosarcoma U-2 OS cells was purchased from the Cell Bank of the Chinese Academy of Sciences. RNA sequencing analysis was performed for 2 curcumin-treated samples and 2 control samples using Illumina deep sequencing technology. The differentially expressed genes were identified using Cufflink software. Enrichment and protein-protein interaction network analyses were performed separately using cluster Profiler package and Cytoscape software to identify key genes. Then, the mRNA levels of key genes were detected by quantitative reverse transcription polymerase chain reaction (RT-qPCR) in U-2 OS cells. Finally, cell apoptosis, proliferation, migration and invasion arrays were performed. In total, 201 DEGs were identified in the curcumin-treated group. EEF1A1 (degree=88), ATF7IP, HIF1A, SMAD7, CLTC, MCM10, ITPR1, ADAM15, WWP2 and ATP5C1, which were enriched in 'biological process', exhibited higher degrees than other genes in the PPI network. RT-qPCR demonstrated that treatment with curcumin was able to significantly increase the levels of CLTC and ITPR1 mRNA in curcumin-treated cells compared with control. In addition, targeting ITPR1 with curcumin significantly promoted apoptosis and suppressed proliferation, migration and invasion. Targeting ITPR1 via curcumin may serve an anticancer role by mediating apoptosis, proliferation, migration and invasion in U-2 OS cells.

Working Cannula-Based Endoscopic Foraminoplasty: A Technical Note.

PURPOSE: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an eight-mm skin incision. For the patients with lumbar foraminal stenosis, the migrated disc is difficult to remove with a simple transforaminal approach. In such cases, the foraminoplasty techniques can be used. However, obtaining efficient foramen enlargement while minimizing radiation exposure and protecting the nerves can be challenging. METHODS: In this study, we propose a new technique called the Kiss-Hug maneuver. Under endoscopic viewing, we used the bevel tip of a working cannula as a bone reamer to enlarge the foramen. This allowed us to efficiently enlarge the lumbar foramen endoscopically without the redundancy and complications associated with reamers or trephines. RESULTS: Details of the four steps of the Kiss-Hug maneuver are reported along with adverse events. The advantages of this new technique include minimizing radiation exposure to both the surgeon and the patient and decreasing the overall operation time. CONCLUSION: The endoscopic Kiss-Hug maneuver is a useful and reliable foraminoplasty technique that can enhance the efficiency of foraminoplasty while ensuring patient safety and reducing radiation exposure.

Decreased Expression of miR-548c-3p in Osteosarcoma Contributes to Cell Proliferation Via Targeting ITGAV.

The members of the integrin αv (ITGAV) family are widely expressed on many types of tumors and have been reported to be involved into angiogenesis, tumor metastases, and multicellular radioresistance. Osteosarcoma (OS) is the most common primary malignant bone tumor and the role of ITGAV in OS needs to be further elucidated. MicroRNAs are aberrantly expressed in a variety of cancers. Thus, the authors collected OS tissues (n = 15) and corresponding paracancerous tissues (n = 15) and found that the expression of miR-548c-3p was significantly downregulated in OS tissues and cell lines 143B, SaoS2, and HOS when compared to the corresponding paracancerous tissues and human osteoblast cell line hFOB (OB3), respectively. In addition, the authors identified that miR-548c-3p could directly target the 3'-untranslated region of ITGAV, and miR-548c-3p overexpression inhibits the mRNA and protein levels of ITGAV, which were confirmed by the luciferase reporter assays. Interestingly, they also uncovered that miR-548c-3p overexpression or knockdown of ITGAV remarkably suppressed cell vitality and promoted apoptosis and G2/M cell cycle arrest, leading to abrogating the ability of colony formation. The results indicated that the miR-548c-3p, similar to the target agents against integrin αv in clinical trials, could negatively regulate the ITGAV and be a promising tumor therapeutic target.

Standard-b-value vs low-b-value DWI for differentiation of benign and malignant vertebral fractures: a meta-analysis.

OBJECTIVE: To determine the comparative diagnostic performance of standard-b-value (≥500 mm(2)) vs low-b-value (<500s mm(-2)) diffusion-weighted imaging (DWI) for discriminating malignant from benign vertebral compression fractures. METHODS: 12 studies with a total of 350 malignant and 312 benign vertebral fractures were included. RESULTS: The apparent diffusion coefficient (ADC) value of benign vertebral compression fractures was lower than that of malignant vertebral compression fractures (SMD = 1.81, 95% CI 0.98 to 2.64 Z = 4.27, p < 0.05). ADC value difference was more pronounced in the group of low-b-value DWI (SMD = 2.31, 95% CI 1.02 to 3.60 Z = 3.51, p < 0.05) than in the group of standard-b-value DWI (SMD = 1.38, 95% CI 0.18 to 2.59 Z = 2.25, p < 0.05). Ethnicity stratified analysis demonstrated higher ADC values in benign vertebral compression fractures in comparison to malignant tissues in both the Asian and Caucasian subgroups (Asians: SMD = 2.400, 95%CI 1.45 to approximately 3.35, p<0.05; Caucasians: SMD = 0.592, 95 % CI -0.848 to approximately 2.032, p < 0.05). And the ADC value difference was more pronounced in the Asian subgroup. CONCLUSION: ADC value appears to be a reliable method to differentiate benign from malignant fractures. Low-b-value DWI was more a valuable parameter than standard-b-value DWI for discriminating malignant from benign vertebral compression fractures. And the diffusion characteristics of the benign vertebral fractures such as osteoporosis, trauma and infection have rarely been investigated separately. ADVANCES IN KNOWLEDGE: The use of low-b-value DWI for differentiation of benign and malignant vertebral fractures is recommended.

MicroRNA-146a reduces IL-1 dependent inflammatory responses in the intervertebral disc.

Because miR-146a expression in articular chondrocytes is associated with osteoarthritis (OA), we assessed whether miR-146a is linked to cartilage degeneration in the spine. Monolayer cultures of nucleus pulposus (NP) cells from the intervertebral discs (IVD) of bovine tails were transfected with a miR-146a mimic. To provoke inflammatory responses and catabolic extracellular matrix (ECM) degradation, cells were co-treated with interleukin-1 (IL-1). Transfection of miR-146a decreases IL-1 induced mRNA levels of inflammatory genes and catabolic proteases in NP cells based on quantitative real-time reverse transcriptase PCR (qRT-PCR) analysis. Similarly, miR146a suppresses IL-1 induced protein levels of matrix metalloproteinases and aggrecanases as revealed by immunoblotting. Disc segments from wild type (WT) and miR-146a knockout (KO) mice were cultured ex vivo in the presence or absence of IL-1 for 3days. Histological and immuno-histochemical (IHC) analyses of disc organ cultures revealed that IL-1 mediates changes in proteoglycan (PG) content and in-situ levels of catabolic proteins (MMP-13 and ADAMTS-5) in the nucleus pulposus of the disc. However, these IL-1 effects are more pronounced in miR-146a KO discs compared to WT discs. For example, absence of miR-146a increases the percentage of MMP-13 and ADAMTS-5 positive cells after treatment with IL-1. Thus, miR-146a appears to protect against IL-1 induced IVD degeneration and inflammation. Stimulation of endogenous miR-146a expression or exogenous delivery of miRNA-146a are viable therapeutic strategies that may decelerate disc degeneration and regain a normal homeostatic balance in extracellular matrix production and turn-over.

Clinical and radiographic outcomes of the treatment of adolescent idiopathic scoliosis with segmental pedicle screws and combined local autograft and allograft bone for spinal fusion: a retrospective case series.

BACKGROUND: High morbidity has been reported with iliac crest bone graft harvesting; however, donor bone is typically necessary for posterior spinal fusion. Autograft bone combined with allograft may reduce the morbidity associated with iliac crest bone harvesting and improve the fusion rate. Our aim in this study was to determine the presence of complications, pseudarthrosis, non-union, and infection using combined in situ local autograft bone and freeze-dried cancellous allograft bone in patients undergoing posterior spinal fusion for the treatment of adolescent idiopathic scoliosis. METHODS: A combination of in situ local autograft bone and freeze-dried cancellous allograft blocks were used in 50 consecutive patients with adolescent idiopathic scoliosis treated by posterior fusion and Moss Miami pedicle screw instrumentation. Results were assessed clinically and radiographically and quality of life and functional outcome was evaluated by administration of a Chinese version of the SRS-22 survey. RESULTS: There were 41 female and 9 male patients included for analysis with an average age of 14.7 years (range, 12-17). All patients had a minimum follow-up of 18 months (range, 18 to 40 months). The average preoperative Cobb angle was 49.8 degrees (range, 40 degrees to 86 degrees ). The average number of levels fused was 9.8 (range, 6-15). Patients had a minimum postoperative follow-up of 18 months. At final follow-up, the average Cobb angle correction was 77.8% (range, 43.4 to 92.5%). There was no obvious loss in the correction, and the average loss of correction was 1.1 degrees (range, 0 degrees to 4 degrees ). There was no pseudarthrosis and no major complications. CONCLUSIONS: In situ autograft bone combined with allograft bone may be a promising method enhances spinal fusion in AIS treated with pedicle screw placement. By eliminating the need for iliac crest bone harvesting, significant morbidity may be avoided.

Differences in postoperative quality of life between adolescent patients with idiopathic scoliosis residing in urban and rural environments.

STUDY DESIGN: A prospective cross-sectional study. OBJECTIVE: To study the effects of living environment, rural and urban, on the postoperative quality of life in adolescent patients with idiopathic scoliosis (AIS) and to explore its causes. SUMMARY OF BACKGROUND DATA: Many factors are capable of influencing the health-related quality of life of AIS patients including degree of the malformation, culture, treatment method, and the living environment of the patient. METHODS: Postoperative AIS patients (n = 117, 16 males and 101 females) were divided into 2 groups (the urban group and the rural group). All patients completed the simplified Chinese version of the SRS-22 scale and the scores on the individual domain, and items were compared between the 2 groups. RESULTS: The score on satisfaction of management domain in the urban group was higher than that in the rural group, but the score on the self-image/appearance in the urban group was significantly lower (P < 0.05). There were no significant differences in function/activity, pain or mental health domain between the 2 groups (P > 0.05). Scores for items 12, 15, and 18 in the function/activity domain, items 4, 6, and 10 in the self-image/appearance domain, and item 22 in the satisfaction of management domain were significantly different between the 2 groups (P < 0.05). CONCLUSION: Living environment may influence the assessment results of the postoperative quality of life in AIS patients. The effects of environment (i.e., rural vs. urban) should be considered when using the SRS-22 scale to evaluate the quality of life of the patients.

Effect of preoperative brace treatment on quality of life in adolescents with idiopathic scoliosis following corrective surgery.

Bracing is frequently used for the treatment of adolescent idiopathic scoliosis. Such treatment is not always effective, and corrective surgery may be warranted. Brace treatment has been suggested to negatively affect quality of life. This study assessed postoperative quality of life and surgical outcome in Chinese patients with adolescent idiopathic scoliosis and failed brace treatment. Ninety-four patients with adolescent idiopathic scoliosis who underwent simple posterior corrective surgery and pedicle screw fixation were studied. The patients were divided into 2 groups: brace and surgery treatment (BS group) and surgery with no brace treatment (S group). Radiological parameters were assessed preoperatively, immediately postoperatively, and >2 years postoperatively. Postoperative quality of life was determined using the Scoliosis Research Society-22 (SRS-22) questionnaire. The preoperative minor curve Cobb angle was significantly greater in the BS group (34.9 degrees vs 29.4 degrees ; P=.037). Postoperative radiological parameters in the coronal and sagittal planes were similar. There were a significantly higher number of fused vertebrae in BS compared to S group patients (10.3 vs 9.6; P=.044). There were no significant postoperative differences between groups in function/activity, pain, mental health, or satisfaction of management as determined by the SRS-22. Self-image/appearance scores were significantly higher in BS compared to S group patients (4.0 vs 3.8; P=.010). Preoperative brace treatment may be a risk factor for minor curve progression but does not appear to significantly influence surgical outcome. Postoperative self-perceived quality of life is not negatively affected by preoperative brace treatment.

Coronal and sagittal plane correction in patients with Lenke 1 adolescent idiopathic scoliosis: a comparison of consecutive versus interval pedicle screw placement.

STUDY DESIGN: Prospective clinical study. OBJECTIVE: The aim of this study was to compare postoperative outcome in patients with Lenke 1 adolescent idiopathic scoliosis (AIS) after posterior correction and fusion with consecutive or interval pedicle screw constructs on the correction side. SUMMARY OF BACKGROUND DATA: Despite reports of satisfactory correction and maintenance of scoliotic curves after consecutive pedicle screw instrumentation on the correction side, there has been no comparison of outcome after consecutive versus interval pedicle screw placement. METHODS: Thirty patients with Lenke 1 AIS were randomly divided into 2 groups. In 1 group, posterior fusion was performed using consecutive pedicle screw placement on the correction side, whereas in the other, an interval placement construct was employed. The following variables were assessed preoperatively and postoperatively (between 2 and 4.1 y) to ascertain curve correction: thoracic coronal and sagittal Cobb angle and global coronal and sagittal balance. RESULTS: There were no preoperative or surgical between group differences for any variable. Thoracic coronal Cobb angle significantly decreased from 60.7+/-11.7 to 15.5+/-7.88 and from 61.87+/-9.93 to 15.67+/-7.35 in the consecutive and interval placement groups. Thoracic sagittal Cobb angle significantly decreased from 27.3+/-10.6 to 21.5+/-11.7 and from 27.1+/-9.83 to 22.0+/-11.3 in the consecutive and interval placement groups. Global sagittal balance significantly decreased from -2.33+/-5.05 to 1.33+/-3.22 and from -3.40+/-4.76 to 0.80+/-2.93 in the consecutive and interval placement groups. There were no between group differences for any postoperative measure. No neurologic complications of surgery were apparent in either group. CONCLUSIONS: Interval pedicle screw placement constructs seem to be equally effective as consecutive constructs for facilitating curve correction in patients with Lenke 1 AIS.

Single-staged anterior and posterior spinal fusion: a safe and effective alternative for severe and rigid adolescent idiopathic scoliosis in China.

AIM: Delayed treatment of adolescent idiopathic scoliosis (AIS) is common in Mainland China because of the lack of public education about health care resulting in the reluctance to undergo surgery. This leads to a high incidence of complex cases where surgeons may not be trained in advanced procedures. We report the efficacy of single-staged anterior and posterior spinal fusion for correction of severe AIS in China. METHODS: A retrospective review was performed of 31 consecutive cases in which patients were treated at the Orthopaedic Department of Changhai Hospital in Shanghai between 2001 and 2004 with a combined anterior and posterior spinal fusion with screws, hooks, sublaminar wires or cables. RESULTS: Thirty-one patients with AIS with Lenke type 1, 2, 3 and 4 curves were included for analysis. At least one of the curves was >or=90 degrees in each patient. The mean coronal and sagittal Cobb angles of the main thoracic curve were 98 degrees and 22 degrees before surgery, 50.5 degrees and 21 degrees after surgery, and 53.7 degrees and 24 degrees at follow-up, respectively. No neurological deficits or deaths occurred. Solid arthrodesis with coronal and sagittal balance was achieved in all patients. CONCLUSIONS: A single-stage anterior release and fusion and posterior fusion for treatment of severe AIS is good alternative to pedicle screws/vertebrectomy on the basis of risk-benefit balance, and can be performed by surgeons not experienced in more complex procedures. The risk of pulmonary complications may be preferable to the risk of severe neurological complications when thoracic pedicle screws are applied, especially when surgeons are not adequately trained in their use.

Adapted simplified Chinese (mainland) version of Scoliosis Research Society-22 questionnaire.

STUDY DESIGN: Validation study to define validity and reliability of an adapted and translated questionnaire. OBJECTIVE: This study attempted to validate the traditional Chinese (Hong Kong) version of the modified Scoliosis Research Society (SRS) Outcomes Instrument, SRS-22, into simplified Chinese for use in mainland China. SUMMARY OF BACKGROUND DATA: Although a traditional Chinese (Hong Kong) adaptation of the SRS-22 has been previously validated, no culturally adapted, validated SRS-22 exists for use in mainland China. METHODS: Adhering to International Quality of Life Assessment Project guidelines, the adapted traditional Chinese SRS-22 was translated into simplified Chinese while referencing the original English questionnaire. To examine the psychometric properties and clinical application of the adapted simplified Chinese SRS-22, a survey was conducted in a group of randomly selected 87 patients previously surgically treated at an outpatient clinic. Reliability assessment of the simplified Chinese version of the SRS-22 was determined by calculating Cronbach's alpha and intraclass coefficient (ICC) values. Concurrent validity was evaluated by comparing SRS-22 domains with relevant domains of the simplified Short-Form-36 questionnaire; correlation was made using Pearson correlation coefficients. RESULTS: Cronbach's alpha, applied to each of the 22 questions of the adapted SRS-22, revealed very satisfactory internal consistency (Cronbach's alpha = 0.80-0.89) for function/activity and pain, and good consistency (Cronbach's alpha = 0.50-0.79) for the remaining domains. The test/retest reproducibility was found to be good (ICC > or =0.40-0.75) in the function/activity domain, and excellent (ICC > or =0.75) in the remaining domains. In terms of concurrent validity, 3 domains had excellent correlation, while 10 had good correlation, and 21 had moderate correlation. DISCUSSION: The authors report the validation of a simplified Chinese SRS-22 for use in mainland China, which is culturally relevant, reliable, repeatable, psychometrically sound, and suitable for immediate clinical use.

Comparison of selective anterior versus posterior screw instrumentation in Lenke5C adolescent idiopathic scoliosis.

STUDY DESIGN: Retrospective review of anterior and posterior fusions for treatment of Lenke5C adolescent idiopathic scoliosis (AIS). OBJECTIVE: To compare the clinical and radiographic results of anterior versus posterior pedicle screw instrumentation in Lenke5C AIS. SUMMARY OF BACKGROUND DATA: Anterior and posterior pedicle screw instrumentations are 2 established methods of correcting Lenke5C AIS. However, there are few reports that compare the 2 methods. METHODS: Forty-six consecutive patients with Lenke5C AIS curves underwent selective lumbar or thoracolumbar fusion (1999-2005). Twenty-two patients had anterior surgery, and 24 patients had posterior surgery. Patients were evaluated at a minimum 2-year follow-up. RESULTS: No complications occurred in either group. The number of levels involved in the major curve was similar for the anterior and posterior groups (5.5 vs. 5.7). Preoperative thoracic (24.13 degrees +/- 4.9 degrees vs. 22.88 degrees +/- 5.14 degrees) and lumbar/thoracolumbar (50.2 degrees +/- 7.52 degrees vs. 52.2 degrees +/- 6.40 degrees). Cobb values for the 2 groups were also similar. The percent correction of the lumbar curve was similar between the 2 groups at all stages of follow-up (56% vs. 57.7%), as was the percent of spontaneous correction of the unfused thoracic curve (25% vs. 27.2%). However, fusion levels were significantly shorter in the anterior group (mean, 5.09 vs. 6.13), and there were 8 patients (4 in the anterior group and 4 in the posterior group) whose thoracic curve became greater at the latest follow-up. The thoracolumbar/lumbar-thoracic Cobb ratio for these 8 patients was less than that for the other patients (1.34 vs. 2.43), and their curve flexibility was worse. CONCLUSION: Selective anterior and posterior screw instrumentation both achieved good surgical lumbar and subsequent spontaneous thoracic correction. There was no statistically significant difference between the 2 groups in lumbar correction or thoracic correction, but fusion levels were shorter in the anterior group. Patients with late thoracic curve decompensation had smaller thoracolumbar/lumbar-thoracic Cobb ratios and less preoperative flexibility than those who did not decompensate.

Shoulder balance after surgery in patients with Lenke Type 2 scoliosis corrected with the segmental pedicle screw technique.

OBJECT: The authors evaluated the effectiveness of Lenke Type 2 criteria in scoliosis correction with the segmental pedicle screw (PS) technique, with emphasis on shoulder balance. METHODS: Twenty-five consecutive patients with Lenke Type 2 scoliosis (structural double thoracic curves, sidebending Cobb angle > 25 degrees , or T2-5 kyphosis > 20 degrees ) who underwent segmental PS instrumentation were included in this study. At surgery, the patients were an average of 14.1 years of age, and the average duration of follow-up was 2.9 years. For radiological evaluation of the patients, preoperative, postoperative, and the latest available follow-up radiographs were used. The difference between right and left shoulder heights was determined to assess shoulder balance. All patients were treated with fusion of both the proximal and distal curves. RESULTS: The mean preoperative proximal thoracic curve of 43 degrees was corrected to 21 degrees postoperatively, a 51.2% correction. The preoperative lower thoracic curve of 61 degrees was corrected to 23 degrees , for a 62.3% correction. The preoperative shoulder height difference of -5.92 +/- 12.52 mm (range: -31 to +14 mm, negative designating a lower left shoulder) was improved to 1.52 +/- 8.12 mm. Postoperatively, no patient had significant or moderate shoulder imbalance, 4 patients had minimal shoulder imbalance, and 21 patients had balanced shoulders. CONCLUSIONS: Although Lenke Type 2 criteria were developed wth Cotrel-Dubousset instrumentation, they are successfully applied to determining thoracic fusion when segmental PS instrumentation is used.

Abnormal ossification as a cause the progression of adolescent idiopathic scoliosis.

Although, there is no generally accepted scientific theory for the etiology of adolescent idiopathic scoliosis (AIS), the relative anterior spinal column overgrowth has been postulated as a mechanism of AIS progression by many morphological studies. The normal spinal growth involves both kinds of ossification: endochondral and membranous ossification. Considering the uncoupled anterior-posterior column growth of AIS patients, the uncoupled endochondral-membranous ossification could possibly play an important role in the progression of AIS. Meanwhile, other observations found that the uncoupling of ossification was not limited to the spinal column, but rather a systemic phenomenon. This consideration leads us to carefully dissect the underlying abnormal molecular pathways, cytokines or receptors of ossification, such as BMP-Smads, Runx2, FGFR-3, and will raise the hope to detect the AIS progression potentiality and help to formulate the appropriately personalized treatment strategy for patients.