Risk Factors for Progression of Cervical Congenital Scoliosis and Associated Compensatory Curve Behavior.

Background: This study investigated risk factors for progression of deformity in pediatric congenital cervical scoliosis (CCS) and evaluated the correlation between congenital cervical curves and compensatory thoracic and lumbar curves. Methods: Medical records were retrospectively reviewed for 38 pediatric patients with CCS with a minimum 2-year follow-up. Curve progression was defined as >10° increase in cervical coronal curve angle between presentation and last follow-up. Results: A total of 38 patients (16 girls, 22 boys) with a mean age at presentation of 5.6 ± 4.1 years met the inclusion criteria. Sixteen patients (42%) had curve progression with a mean follow-up of 3.1 ± 3.0 years. At presentation, T1 slope was significantly larger among children with progressive deformities (p = 0.041). A total of 18 of the 38 patients with strictly cervical spine deformity were then selected for subanalysis to evaluate the progression of compensatory curves. Cervical major coronal curves were found to significantly correlate with lumbar major coronal curves (r = 0.409), C2 central sacral vertical line (CSVL) (r = 0.407), and C7-CSVL (r = 0.403) (p < 0.05). Thoracic major coronal curves did not significantly correlate with cervical major coronal curves (r = 0.218) (p > 0.05). Conclusion: In conclusion, 42% of osseous CCS curves progressed over time in the overall cohort, and high initial T1 slope was found to be most highly correlated with progression of cervical deformity. Cervical major coronal curves significantly correlated with lumbar curve magnitude but not with thoracic curve size in isolated CCS, possibly due to the increased flexibility of the lumbar spine which may allow greater compensatory balance and thus have a greater correlation with cervical curve magnitude and possibly progression.

Congenital Cervical Scoliosis Treated with Concave Side Distraction with Three-Dimensional Printed Titanium Cage.

STUDY DESIGN: Single-center, retrospective study. OBJECTIVE: Hemivertebra resection is the only treatment option for congenital cervical scoliosis (CCS). However, this procedure is complex and technically demanding. It often requires a considerably long operation, and there is substantial intraoperative bleeding. Therefore, we have attempted to treat CCS with a concave side distraction comprising a three-dimensional (3D) printed titanium cage. The purpose of this study is to evaluate the safety and efficacy of this technique for the treatment of patients with CCS. METHODS: A series of 22 patients with CCS who underwent a concave side distraction technique between 2019 and 2021 were retrospectively reviewed and analyzed. Radiological measurements included the Cobb angle of the distraction segments, the kyphosis angle, the range of movement, and the distraction correction angle. Student's t-test and Spearman correlation analysis were used for statistical analysis. p < 0.05 was considered statistically significant. RESULTS: The study included 12 males and 10 females whose ages ranged from 6 to 14 years old (9.8 ± 2.1 years old). Follow-up times ranged from 15 to 30 months (25.8 ± 3.6 months). Among 22 patients, two patients developed a postoperative C5 nerve root palsy and recovered after being treated with conservative treatment for 6 months. The duration of surgery ranged from 229 to 756 min (389 ± 112 min), and the estimated volume of blood loss ranged from 100 to 600mL (235 ± 121 mL). The coronal Cobb angle (p < 0.001), kyphosis angle (p < 0.05), and range of movement (p < 0.001) between the last follow-up and preoperative period were significantly different. A total of 28 segments were distracted, and the Cobb angle of the distraction segment ranged from 2.4 to 14.1° (8.5 ± 3.0°). There were six upper cervical spines (8.9 ± 1.9°) and 22 lower cervical spines (8.4 ± 3.2°) with no significant difference between them (p = 0.130). In addition, there was no correlation between the angle of the concave side distraction and patients' age (r = 0.018, p = 0.315). The fusion was solid between the bone and the customized 3D-printed pore metal cage at the final follow-up. CONCLUSION: The concave side distraction comprising a customized 3D-printed titanium cage implantation can provide satisfactory correction results and is a safe and reliable procedure for treating CCS.

Evaluation and Comparation of a Novel Surgical Technique and Hemivertebra Resection to the Correction of Congenital Cervical Scoliosis in Lower Cervical and Cervicothoracic Spine.

OBJECTIVE: To report concave-side distraction technique to treat congenital cervical scoliosis in lower cervical and cervicothoracic spine. To evaluate and compare clinical and radiographic results of this procedure with classic hemivertebra resection procedure. METHODS: This study reviewed 29 patients in last 13 years. These patients were divided into convex-side resection group (group R) and concave-side distraction group (group D). Radiographic assessment was based on parameter changes preoperatively, postoperatively and at last follow-up. Demographic data, surgical data and complications were also evaluated and compared between the 2 groups. RESULTS: In group R, mean age was 8.9 ± 3.3 years and follow-up was 46 ± 18 months. Operation time and blood loss averaged 500 ± 100 minutes, 703 ± 367 mL. In group D, mean age was 9.9 ± 2.8 years and follow-up was 34 ± 14 months. Operation time and blood loss averaged 501 ± 112 minutes, 374 ± 181 mL. Structural Cobb angle was corrected from 29.4° ± 12.5° to 5.3° (2.1°-18.1°) (p = 0.001) and 33.7° ± 14.1° to 12.8° ± 11.4° (p < 0.001) in groups R and D. Compensatory Cobb angle had a spontaneous correction rate of 59.6% (40.0%-80.8%) and 59.7% ± 23.0% in groups R and D. Mandibular incline, clavicle angle and spine coronal balance were significantly improved at last follow-up in both groups. All correction rates were not statistically different between groups. However, group D had significant less blood loss (p < 0.001) and operation time (p = 0.004) per vertebra than group R. Seven patients developed C5 nerve root palsy and recovered by 6 months of follow-up. CONCLUSION: Both surgical procedures are safe and effective in correcting congenital cervical scoliosis. But concave-side distraction technique has less blood loss and time-consuming during surgery, which provides a better option for the treatment of congenital cervical scoliosis.

Cervical scoliosis and torticollis: a novel skeletal anomaly in broiler chickens.

BACKGROUND: Among the most prominent health problems marring the global poultry industry for several decades are skeletal abnormalities. The aim of this study was to investigate a recent emergence of a novel form of skeletal deformity affecting cervical spine in broiler chickens. This work presents the natural history of this newly emerging skeletal anomaly along with long term observations of epidemiological trends in commercial broiler flocks, and clinical and pathological features. RESULTS: In distinction from other forms of skeletal deformities commonly reported in broiler chickens, this new form of cervical spine anomaly have been observed in newly hatched chicks and in fully developed embryos that died in the shell. On clinical and post mortem examination this condition presents characteristic features consistent with congenital cervical scoliosis and torticollis (CCST). The pathogenesis of CCST appears to be linked to pathological remodeling of the cervical vertebrae bone associated with excessive activity of osteoclasts. Long term observations indicate that the incidence of CCST showed increasing epidemiological trends over time. More recently CCST has been observed in newly hatched chicks with incidence ranging from 0.1 to > 1%, and in fully developed embryos that failed to hatch about 4 to 5%. CONCLUSIONS: The increasing trends in incidence of CCST in commercial broiler flocks are of concern from an economic perspective, and also represent a very specific and important aspect of animal welfare.

Evaluation of a combined approach to the correction of congenital cervical or cervicothoracic scoliosis.

BACKGROUND CONTEXT: An anteroposterior combined approach has been used for the treatment of congenital cervical or cervicothoracic scoliosis. However, its outcomes and surgical risks have not been clarified. PURPOSE: We analyzed the characteristics of congenital cervical and cervicothoracic scoliosis and evaluated the outcomes of an anteroposterior combined approach for its treatment. STUDY DESIGN: We carried out a retrospective clinical study of prospectively collected data. PATIENT SAMPLE: Sixteen patients were treated between 2009 and 2013. Their average age was 9.2years. OUTCOME MEASURES: Radiographic and surgical outcomes were measured and recorded. We compared morphological parameters and preoperative and postoperative results. METHODS: All patients underwent surgery with a combined approach. The following radiographic parameters were measured: head tilt (HT), mandible incline (MI), shoulder balance (SB), structural and compensatory curves, cervical lordosis, C7 central sacral vertical line (C7-CSVL) ratio, C7 sagittal vertical axis (C7-SVA) ratio, C2-C7 SVA ratio, the angle between the upper endplate of the T2 vertebra and a horizontal line (T2 tilt), gravity line ratio. Demographic and surgical data were also collected. RESULTS: On average, the duration of follow-up was 68.0 months, surgical blood loss was 675mL, and the duration of surgery was 400.5 minutes. The average correction rate was 64.9% in the structural curve and 29.5% in the compensatory curve. Statistical analysis showed that MI significantly correlated with HT and SB (p<.05). The C7-CSVL ratio correlated with the HT, MI, and SB (p<.05). The C7-SVA ratio correlated with the structural curve and cervical lordosis (p<.05), and the gravity line ratio correlated with the structural and compensatory curve, cervical lordosis, and C7-SVA ratio (p<.05). Moreover, there were correlations between the structural and compensatory curves as well as between the structural curve and cervical lordosis (p<.05). There were significant differences before and after surgery in HT, MI, and structural and compensatory curves. Four patients developed nerve root palsy after surgical correction and totally recovered by 6 months of follow-up. CONCLUSION: The combined approach is an effective surgical option for congenital cervical or cervicothoracic scoliosis. The resection of the hemivertebra cannot only improve head-neck aesthetic appearance but can also maintain the growth potential of the neck.

Cervical hemivertebra resection and torticollis correction: report on two cases and literature review.

PURPOSE: Hemivertebra of the cervical spine is a rare but complex spinal malformation. To our knowledge, only one publication describes excision of an upper-middle cervical (between C2 and C4) hemivertebra. We present our experience with two cases of C3 hemivertebra resection and torticollis correction via a combined anterior-posterior-anterior surgical approach and short segment fixation. METHODS: Two 12-year-old patients with torticollis due to congenital C3 hemivertebra underwent surgery consisting of combined anterior vertebral body osteotomy, posterior element resection with segment instrumentation and deformity correction, and iliac bone graft reconstruction and fixation via an anterior approach. During the osteotomies, the transverse process accompanied with the vertebral artery was disconnected and freed away from the spinal column. Then the deformity was corrected without touching the vertebral artery, which made the procedure safe and comfortable. The details of this technique are presented. Pre- and postoperative radiographic features, as well as clinical outcomes were evaluated. RESULTS: The treatment process was uneventful. The patients had satisfactory clinical outcomes at a mean of 1.5 years follow-up. Head tilt and chin rotation were corrected completely. Radiographs showed favorable deformity correction, well-balanced coronal and sagittal alignment, and solid bony fusion. CONCLUSION: Combined anterior-posterior-anterior hemivertebra resection with short segment instrumentation is a reasonable option for the treatment of congenital cervical hemivertebra, which provided satisfactory deformity correction and good clinical outcomes. LEVEL OF EVIDENCE: 4.

Hemivertebra of the cervical spine: an uncommon background for neck pain, cervical scoliosis, and torticollis.

A 15-year-old female patient presented with neck pain accompanied by cervical scoliosis, on the existence of torticollis. Although rare, hemivertebra of the cervical spine is a congenital deformation associated with these three clinical features.

Multiple cervical hemivertebra resection and staged thoracic pedicle subtraction osteotomy in the treatment of complicated congenital scoliosis.

PURPOSE: To present our experience of staged correction with multiple cervical hemivertebra resection and thoracic pedicle subtraction osteotomy (PSO) treating a rare and complicated congenital scoliosis. METHODS: A 14-year-old male presented with progressive torticollis and spine deformity. The malformation developed since birth, and back pain after long-time sitting or exercise arose since 6 months before, which was unsuccessfully treated by physiotherapy. X-ray showed a right cervical curve of 60° and a left compensatory thoracic curve of 90°. Three-dimensional computed tomography (3-D CT) scan revealed three semi-segmented hemivertebrae (C4, C5 and C6) on the right side. Based on our staged strategy, the three consecutive cervical hemivertebrae, as the major pathology causing the deformity, were firstly resected by the combined posterior and anterior approach. Six months later, T6 PSO osteotomy was used to correct the structural compensatory thoracic curve. RESULTS: The cervical curve was reduced to 23° while the thoracic curve to 60° after the first-stage surgery, and the thoracic curve was further reduced to 30° after the second-stage surgery. The radiograph at 5-year follow-up showed that both the coronal and sagittal balance were well restored and stabilized, with the occipital tilt reduced from 12° to 0°. CONCLUSIONS: Our strategy may provide an option for similar cases with multiple consecutive cervical hemivertebrae and a large structural compensatory thoracic curve, which proved to achieve excellent correction in both the coronal and sagittal planes with acceptable neurologic risk.

Modificaciones del plano sagital cervical luego del tratamiento quirúrgico posterior en la escoliosis idiopática del adolescente Lenke 1 / Changes in the cervical alignment after posterior transpedicular instrumentation in Lenke type I adolescent idiopathic scoliosis

Introducción: Como la cifosis toracica y la lordosis cervical son directamente proporcionales, las modificaciones del plano sagital toracico impactarian sobre la columna cervical. Nuestro objetivo fue detectar cambios en el plano sagital cervical, a corto y mediano plazo, durante el tratamiento quirurgico segun una tecnica posterior. Materiales y Métodos: Estudio retrospectivo radiografico de tipo serie de casos, entre enero de 2005 y abril de 2009. Criterios de inclusion: escoliosis idiopatica del adolescente Lenke 1, tratamiento por via posterior con tornillos transpediculares. Seguimiento minimo 2 anos. Parametros analizados: nivel Cobb, nivel de instrumentacion proximal, densidad de implantes, lordosis cervical, cifosis toracica proximal, cifosis toracica principal, inclinacion sagital T1, balance sagital global, balance sagital cervical. Analisis estadistico mediante ANOVA de muestras repetitivas y Tukey, con el programa Graph-Pad-Prism. Resultados: 25 pacientes. Seguimiento promedio 4,3 anos. Cifosis toracica: media preoperatoria 26,8o, posoperatoria 20,6o. Efecto lordotizante despues del tratamiento quirurgico (p ≤0,001). La inclinacion sagital T1 y la cifosis proximal T2-T5 (p ≤0,038) mostraron un incremento hacia el ultimo control. El 72 % presentaba rectificacion o cifosis cervical antes de la cirugia. El 44 % experimento una mejoria hacia el ultimo control. Los niveles de artrodesis mas altos se correlacionaron con los casos que empeoraron su contorno sagital posoperatorio. Conclusiones: Nuestra tecnica de correccion genero un efecto lordotizante toracico. Esto se tradujo, a mediano plazo, en un incremento de la retropulsion del tronco y rectificacion o perdida de la lordosis a nivel cervical...

Background: As thoracic kyphosis and cervical lordosis are proportionally related, every change in the thoracic sagittal plane will impact on the cervical alignment. Our objective was to detect changes in the sagittal cervical plane at short- and medium term follow-up during surgical treatment, according to the posterior technique. Methods: Retrospective, radiographic case series study performed between January 2005 and April 2009. Inclusion criteria: Lenke type 1 adolescent idiopathic scoliosis, and posterior screw fixation surgery. Radiographic parameters: Cobb angle, uppermost instrumented vertebra, implant density, cervical lordosis, proximal thoracic kyphosis, main thoracic kyphosis, T1 sagittal tilt, global sagittal balance and cervical sagittal balance. Statistical analysis: ANOVA of repetitive samples and Tukey, using the Graph-Pad-Prism. Results: 25 patients. Mean follow-up 4.3 years. Thoracic kyphosis (T5-T12): average, preoperative 26.8º and 20.6º postoperative. Lordosing effect after surgical treatment (p ≤0.001). T1 sagittal tilt and T2-T5 proximal thoracic kyphosis (p ≤0.038) tended to increase at last control. Seventy two per cent of our sample showed rectification or even cervical kyphosis before surgery. Only 44 % had certain better alignment at the last follow-up. Higher UIV correlated with a worse cervical plane alignment after surgery. Conclusions: Our derotational concavity technique with poliaxial pedicle screws and titanium 5.5 rod demonstrated a lordosing effect in the thoracic sagittal plane. This was translated into a trunk retropulsion and rectification or lost of lordosis in the sagittal cervical plane in the medium-term follow-up...

Modificaciones del plano sagital cervical luego del tratamiento quirúrgico posterior en la escoliosis idiopática del adolescente Lenke 1 / Changes in the cervical alignment after posterior transpedicular instrumentation in Lenke type I adolescent idiopathic scoliosis

Introducción: Como la cifosis toracica y la lordosis cervical son directamente proporcionales, las modificaciones del plano sagital toracico impactarian sobre la columna cervical. Nuestro objetivo fue detectar cambios en el plano sagital cervical, a corto y mediano plazo, durante el tratamiento quirurgico segun una tecnica posterior. Materiales y Métodos: Estudio retrospectivo radiografico de tipo serie de casos, entre enero de 2005 y abril de 2009. Criterios de inclusion: escoliosis idiopatica del adolescente Lenke 1, tratamiento por via posterior con tornillos transpediculares. Seguimiento minimo 2 anos. Parametros analizados: nivel Cobb, nivel de instrumentacion proximal, densidad de implantes, lordosis cervical, cifosis toracica proximal, cifosis toracica principal, inclinacion sagital T1, balance sagital global, balance sagital cervical. Analisis estadistico mediante ANOVA de muestras repetitivas y Tukey, con el programa Graph-Pad-Prism. Resultados: 25 pacientes. Seguimiento promedio 4,3 anos. Cifosis toracica: media preoperatoria 26,8o, posoperatoria 20,6o. Efecto lordotizante despues del tratamiento quirurgico (p ≤0,001). La inclinacion sagital T1 y la cifosis proximal T2-T5 (p ≤0,038) mostraron un incremento hacia el ultimo control. El 72 % presentaba rectificacion o cifosis cervical antes de la cirugia. El 44 % experimento una mejoria hacia el ultimo control. Los niveles de artrodesis mas altos se correlacionaron con los casos que empeoraron su contorno sagital posoperatorio. Conclusiones: Nuestra tecnica de correccion genero un efecto lordotizante toracico. Esto se tradujo, a mediano plazo, en un incremento de la retropulsion del tronco y rectificacion o perdida de la lordosis a nivel cervical...(AU)

Background: As thoracic kyphosis and cervical lordosis are proportionally related, every change in the thoracic sagittal plane will impact on the cervical alignment. Our objective was to detect changes in the sagittal cervical plane at short- and medium term follow-up during surgical treatment, according to the posterior technique. Methods: Retrospective, radiographic case series study performed between January 2005 and April 2009. Inclusion criteria: Lenke type 1 adolescent idiopathic scoliosis, and posterior screw fixation surgery. Radiographic parameters: Cobb angle, uppermost instrumented vertebra, implant density, cervical lordosis, proximal thoracic kyphosis, main thoracic kyphosis, T1 sagittal tilt, global sagittal balance and cervical sagittal balance. Statistical analysis: ANOVA of repetitive samples and Tukey, using the Graph-Pad-Prism. Results: 25 patients. Mean follow-up 4.3 years. Thoracic kyphosis (T5-T12): average, preoperative 26.8º and 20.6º postoperative. Lordosing effect after surgical treatment (p ≤0.001). T1 sagittal tilt and T2-T5 proximal thoracic kyphosis (p ≤0.038) tended to increase at last control. Seventy two per cent of our sample showed rectification or even cervical kyphosis before surgery. Only 44 % had certain better alignment at the last follow-up. Higher UIV correlated with a worse cervical plane alignment after surgery. Conclusions: Our derotational concavity technique with poliaxial pedicle screws and titanium 5.5 rod demonstrated a lordosing effect in the thoracic sagittal plane. This was translated into a trunk retropulsion and rectification or lost of lordosis in the sagittal cervical plane in the medium-term follow-up...(AU)