Suxi Gu

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° ± 4.9° vs. 22.88° ± 5.14°) and lumbar/thoracolumbar (50.2° ± 7.52° vs. 52.2° ± 6.40°). 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.

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.

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 α 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 &agr;, applied to each of the 22 questions of the adapted SRS-22, revealed very satisfactory internal consistency (Cronbach’s &agr; = 0.80–0.89) for function/activity and pain, and good consistency (Cronbach’s &agr; = 0.50–0.79) for the remaining domains. The test/retest reproducibility was found to be good (ICC ≥0.40–0.75) in the function/activity domain, and excellent (ICC ≥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.

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.

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.

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

BackgroundHigh 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.MethodsA 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.ResultsThere 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° (range, 40° to 86°). 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° (range, 0° to 4°). There was no pseudarthrosis and no major complications.ConclusionsIn 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.

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.

Posterior pedicle screws combined with shortening and release techniques for lumbar and thoracolumbar adolescent idiopathic scoliosis

Objective:  To prospectively evaluate the clinical and radiographic effects of posterior surgery with wide posterior shortening release and segmental pedicle screws techniques in a consecutive group of patients with thoracolumbar /lumbar adolescent idiopathic scoliosis.