Journal of Clinical Medicine

Editorial

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Open AccessEditorial

Special Issue: “Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients”

by Laura Scaramuzzo

J. Clin. Med. 2023, 12(2), 525; https://doi.org/10.3390/jcm12020525 - 9 Jan 2023

Cited by 1 | Viewed by 1336

Abstract

Adolescent idiopathic scoliosis (AIS) is a structural deformity of the spine involving all three planes of the space and arises in otherwise healthy children at or around puberty [...] Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

Research

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16 pages, 4275 KiB

Open AccessArticle

Fully Automated Measurement of Cobb Angles in Coronal Plane Spine Radiographs

by Kenneth Chen, Christoph Stotter, Thomas Klestil, Jennyfer A. Mitterer, Christopher Lepenik and Stefan Nehrer

J. Clin. Med. 2024, 13(14), 4122; https://doi.org/10.3390/jcm13144122 - 15 Jul 2024

Viewed by 1772

Abstract

Background/Objectives: scoliosis is a three-dimensional structural deformity characterized by lateral and rotational curvature of the spine. The current gold-standard method to assess scoliosis is the measurement of lateral curvature of the spine using the Cobb angle in coronal plane radiographs. The interrater variability [...] Read more.

Background/Objectives: scoliosis is a three-dimensional structural deformity characterized by lateral and rotational curvature of the spine. The current gold-standard method to assess scoliosis is the measurement of lateral curvature of the spine using the Cobb angle in coronal plane radiographs. The interrater variability for Cobb angle measurements reaches up to 10°. The purpose of this study was to describe and assess the performance of a fully automated method for measuring Cobb angles using a commercially available artificial intelligence (AI) model trained on over 17,000 images, and investigate its interrater/intrarater agreement with a reference standard. Methods: in total, 196 AP/PA full-spine radiographs were included in this study. A reference standard was established by four radiologists, defined as the median of their Cobb angle measurements. Independently, an AI-based software, IB Lab SQUIRREL (version 1.0), also performed Cobb angle measurements on the same radiographs. Results: after comparing the readers’ Cobb angle end vertebrae selection to the AI’s outputs, 194 curvatures were considered valid for performance assessment, displaying an accuracy of 88.58% in end vertebrae selection. The AI’s performance showed very low absolute bias, with a mean difference and standard deviation of differences from the reference standard of 0.16° ± 0.35° in the Cobb angle measurements. The ICC comparing the reference standard and the AI’s measurements was 0.97. Conclusions: the AI model demonstrated good results in the determination of end vertebrae and excellent results in automated Cobb angle measurements compared to radiologists and could serve as a reliable tool in clinical practice and research. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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11 pages, 5299 KiB

Open AccessArticle

The Incidence of Screw Failure in Fenestrated Polyaxial Pedicle Screws vs. Conventional Pedicle Screws in the Treatment of Adolescent Idiopathic Scoliosis (AIS)

by Calogero Velluto, Michele Inverso, Maria Ilaria Borruto, Andrea Perna, Guido Bocchino, Davide Messina and Luca Proietti

J. Clin. Med. 2024, 13(6), 1760; https://doi.org/10.3390/jcm13061760 - 19 Mar 2024

Cited by 1 | Viewed by 1096

Abstract

Background: Adolescent idiopathic scoliosis (AIS) is a spinal pathology affecting 0.47–5.2% of the population, often requiring surgical intervention to control deformity progression. Posterior spinal instrumentation and fusion with pedicle screw fixation are standard procedures for AIS curve correction; however, implant failure remains [...] Read more.

Background: Adolescent idiopathic scoliosis (AIS) is a spinal pathology affecting 0.47–5.2% of the population, often requiring surgical intervention to control deformity progression. Posterior spinal instrumentation and fusion with pedicle screw fixation are standard procedures for AIS curve correction; however, implant failure remains a significant complication, especially in multi-level fusions. This retrospective cohort study aims to compare the failure rates between conventional pedicle screws (CPSs) and fenestrated pedicle screws (FPSs) in AIS treatment, with a focus on investigating potential causes of these failures. Methods: This study, conducted from January 2016 to December 2020, involves a two-center retrospective analysis of AIS patients undergoing posterior instrumented fusion. Results: Data from a total of 162 patients (122 females and 40 males) revealed a mean age of 14.95 years (range: 11–18). The CPS group consisted of 80 patients (56 females and 24 males), whereas the FPS group consisted of 82 patients (66 females and 16 males) stratified by Risser grade and Lenke Classification. Radiological assessments, clinical outcomes, and SRS-22 scores were evaluated pre-operatively, at 6 months, and post-operatively (minimum follow-up of 2 years). Conclusions: Fenestrated pedicle screws (FPSs) pose concerns due to their lower mechanical strength compared to solid screws. Understanding their limitations and optimizing their application in AIS treatment is essential. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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12 pages, 250 KiB

Open AccessArticle

The Effect of the Direction of Primary Lateral Spinal Curvature on Postural Stability in Children with Scoliosis

by Andrzej Siwiec, Małgorzata Domagalska-Szopa, Ilona Kwiecień-Czerwieniec and Andrzej Szopa

J. Clin. Med. 2024, 13(6), 1690; https://doi.org/10.3390/jcm13061690 - 15 Mar 2024

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Abstract

Background: The purpose of the present study was to determine the impact of the direction and magnitude of primary lateral spinal curvature in children with scoliosis. Methods: Ninety-six children diagnosed with scoliosis were included in the study group, and fifty healthy peers were [...] Read more.

Background: The purpose of the present study was to determine the impact of the direction and magnitude of primary lateral spinal curvature in children with scoliosis. Methods: Ninety-six children diagnosed with scoliosis were included in the study group, and fifty healthy peers were included in the control group. Posturographic measurements of body weight distribution and posturometric tests with eyes open and closed were performed. Results: Based on the symmetry index values, the study group was divided into children with symmetrical and asymmetrical body weight distributions on the basis of support. Then, taking into account the direction of the primary curvature, children with asymmetrical body weight distributions were divided into: (1) children with left-sided or right-sided scoliosis with overload on the same side of the body; and (2) children with left-sided or right-sided scoliosis with overload on the opposite side of the body. According to both posturometric tests, increased CoP spatial displacement was observed in the children with scoliosis compared to the healthy controls. The obtained results showed that increased asymmetry index and Cobb angle values significantly increase medial–lateral postural instability in children with scoliosis. Conclusions: These findings suggest that treatment to restore symmetric body weight distribution may prevent the progression of postural instability; however, this requires confirmation through further investigation. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

8 pages, 1356 KiB

Open AccessArticle

What Is the Role of Traction Test Radiographs in the Preoperative Planning of Adolescent Idiopathic Scoliosis?

by Giovanni Andrea La Maida, Enrico Gallazzi, Federica Ramella, Marcello Ferraro, Andrea Della Valle, Davide Cecconi and Bernardo Misaggi

J. Clin. Med. 2023, 12(22), 6986; https://doi.org/10.3390/jcm12226986 - 8 Nov 2023

Cited by 1 | Viewed by 1020

Abstract

Lower instrumented vertebra (LIV) selection is critical to avoid complications like adding-on. This study aims to determine the usefulness of the traction test (TR) in selecting the LIV during surgery for adolescent idiopathic scoliosis (AIS). We analyzed 42 AIS patients with Lenke 1 [...] Read more.

Lower instrumented vertebra (LIV) selection is critical to avoid complications like adding-on. This study aims to determine the usefulness of the traction test (TR) in selecting the LIV during surgery for adolescent idiopathic scoliosis (AIS). We analyzed 42 AIS patients with Lenke 1 curves who had preoperative, postoperative, and at least 12-month follow-up X-rays, as well as preoperative side bending (SB) and TR radiograms. Neutral vertebra (NV), stable vertebra (SV), lower instrumented vertebra (LIV), and Cobb angles were identified and compared on all radiographic images. In 23 cases, the TR resulted in SV proximalization compared to the preoperative X-rays, while in 8 cases, SV-TR was more distal. This distalization occurred in 50% of Lenke 1C curves, where a greater correction of the distal curve was found. NV-TR was proximal to NV-preop in 9 cases, while NV-SB was proximal in 22 cases. LIV was proximal to SV-TR in 8 cases, while it was proximal to SV-preop in 22. One patient with LIV proximal to SV-TR developed adding-on. In conclusion, the TR is crucial in AIS preoperative planning as it provides information distinct from that of standard X-rays and SB: (1) it better assesses gravitational stability than rotational stability; and (2) choosing LIV equal to or proximal to SV-TR may prevent adding-on, except in ‘flexible’ Lenke 1C curves where LIV should be equal or distal to SV-preop. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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12 pages, 2241 KiB

Open AccessArticle

Development of Notch-Free, Pre-Bent Rod Applicable for Posterior Corrective Surgery of Thoracolumbar/Lumbar Adolescent Idiopathic Scoliosis

by Yoko Ishikawa, Satoshi Kanai, Katsuro Ura, Terufumi Kokabu, Katsuhisa Yamada, Yuichiro Abe, Hiroyuki Tachi, Hisataka Suzuki, Takashi Ohnishi, Tsutomu Endo, Daisuke Ukeba, Masahiko Takahata, Norimasa Iwasaki and Hideki Sudo

J. Clin. Med. 2023, 12(17), 5750; https://doi.org/10.3390/jcm12175750 - 4 Sep 2023

Cited by 1 | Viewed by 1322

Abstract

Adolescent idiopathic scoliosis (AIS), the most common pediatric musculoskeletal disorder, causes a three-dimensional spine deformity. Lenke type 5 AIS is defined as a structural thoracolumbar/lumbar curve with nonstructural thoracic curves. Although a rod curvature will affect clinical outcomes, intraoperative contouring of the straight [...] Read more.

Adolescent idiopathic scoliosis (AIS), the most common pediatric musculoskeletal disorder, causes a three-dimensional spine deformity. Lenke type 5 AIS is defined as a structural thoracolumbar/lumbar curve with nonstructural thoracic curves. Although a rod curvature will affect clinical outcomes, intraoperative contouring of the straight rod depends on the surgeon’s knowledge and experience. This study aimed to determine the optimum rod geometries to provide a pre-bent rod system for posterior spinal surgery in patients with Lenke type 5 AIS. These pre-bent rods will be beneficial for achieving proper postoperative outcomes without rod contouring based on surgeon experience. We investigated 20 rod geometries traced in posterior spinal reconstruction in patients with Lenke type 5 AIS. The differences between the center point clouds in each cluster were evaluated using the iterative closest point (ICP) method with modification. Before the evaluation using the ICP method, the point clouds were divided into four clusters based on the rod length using a hierarchical cluster analysis. Because the differences in the values derived from the ICP method were <5 mm for each length-based cluster, four representative rod shapes were generated from the length-based clusters. We identified four optimized rod shapes that will reduce operation time, leading to a decreased patient and surgeon burden. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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12 pages, 2103 KiB

Open AccessArticle

Factors Affecting Transcranial Motor-Evoked Potential Measurements Using Single-Train Stimulation with an Increased Number of Pulses during Adolescent Scoliosis Surgery: A Prospective Observational Study

by Takayuki Toki, Noriaki Fujita, Tomohiro Ichikawa, Noriki Ochi, Isao Yokota, Hideki Sudo and Yuji Morimoto

J. Clin. Med. 2023, 12(13), 4433; https://doi.org/10.3390/jcm12134433 - 30 Jun 2023

Cited by 1 | Viewed by 1394

Abstract

Measurement of transcranial motor-evoked potentials (TcMEPs) during scoliosis surgery helps detect postoperative new neurological defects. However, TcMEP interpretation is difficult owing to the influence of intraoperative physiological, pharmacological, and time-related factors as well as stimulation conditions. In this study, we aimed to investigate [...] Read more.

Measurement of transcranial motor-evoked potentials (TcMEPs) during scoliosis surgery helps detect postoperative new neurological defects. However, TcMEP interpretation is difficult owing to the influence of intraoperative physiological, pharmacological, and time-related factors as well as stimulation conditions. In this study, we aimed to investigate the effect of the abovementioned factors on TcMEP amplitude using single-train stimulation with an increased number of pulses (STS-INP) during adolescent scoliosis surgery; moreover, we evaluated the complications of TcMEP measurement. We included 50 patients and 706 TcMEP measurements. A total of 1412 TcMEP waveforms were analyzed, each on the bilateral abductor pollicis brevis, tibialis anterior, and abductor hallucis muscles. We estimated the mean difference (95% confidence interval (CI)) and predicted mean difference (95% CI) evaluated using the interquartile range of each factor, based on a mixed-effect model with random intercepts for TcMEP amplitude. The predicted mean differences in TcMEP amplitude were clinically small compared with the actual TcMEP amplitude, suggesting that each factor had a limited effect on TcMEP amplitude. No intraoperative bite injuries or seizures were observed. Using STS-INP during adolescent scoliosis surgery may enable accurate measurement of TcMEP amplitude with neither complications nor the influence of various intraoperative factors. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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10 pages, 787 KiB

Open AccessArticle

More Prevalent and Severe Low Bone-Mineral Density in Boys with Severe Adolescent Idiopathic Scoliosis Than Girls: A Retrospective Study of 798 Surgical Patients

by Zhichong Wu, Xiufen Zhu, Leilei Xu, Zhen Liu, Zhenhua Feng, Vivian Wing Yin Hung, Jack Chun Yiu Cheng, Yong Qiu, Wayne Y. W. Lee, Tsz Ping Lam and Zezhang Zhu

J. Clin. Med. 2023, 12(8), 2991; https://doi.org/10.3390/jcm12082991 - 20 Apr 2023

Cited by 5 | Viewed by 2264

Abstract

Introduction: A total of 0.1–0.8% of AIS patients progress to severe stages without clear mechanisms, and AIS girls are more prone to curve progression than boys. Recent studies suggest that AIS girls have systemic and persistent low bone-mineral density (BMD), which has been [...] Read more.

Introduction: A total of 0.1–0.8% of AIS patients progress to severe stages without clear mechanisms, and AIS girls are more prone to curve progression than boys. Recent studies suggest that AIS girls have systemic and persistent low bone-mineral density (BMD), which has been shown to be a significant prognostic factor of curve progression in AIS. The present study aimed to (a) investigate the prevalence of low BMD in patients with severe AIS and (b) assess the sexual dimorphism and independent risk factors of low BMD in severe AIS patients. Materials and Methods: A total of 798 patients (140 boys vs. 658 girls) with AIS who reached surgical threshold (Cobb ≥ 40°) were recruited. BMD were assessed using BMD Z-scores from dual-energy X-ray absorptiometry (DXA). Demographic, clinical, and laboratory values of the subjects were collected from their medical records. Logistic regression analysis was performed to identify independent risk factors of low BMD. Results: The overall prevalence of BMD Z-score ≤ −2 and ≤ −1 were 8.1% and 37.5%, respectively. AIS boys had significantly lower BMD Z-scores (−1.2 ± 0.96 vs. −0.57 ± 0.92) and higher prevalence of low BMD (Z-score ≤ −2: 22.1% vs. 5.2%, p < 0.001; Z-score ≤ −1: 59.3% vs. 32.8%, p < 0.001) than girls. Sex, BMI, serum alkaline phosphatase, and potassium were independent factors of low BMD in the severe AIS patients. Conclusions: The present large cohort of surgical AIS patients revealed that low BMD is more prevalent and severe in boys than in girls with severe curves. Low BMD may serve as a more valuable predictive factor for curve progression to the surgical threshold in boys than girls with AIS. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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16 pages, 6479 KiB

Open AccessArticle

Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached

by Jesús Burgos, Gonzalo Mariscal, Luis Miguel Antón-Rodrigálvarez, Ignacio Sanpera, Eduardo Hevia, Vicente García and Carlos Barrios

J. Clin. Med. 2023, 12(6), 2408; https://doi.org/10.3390/jcm12062408 - 21 Mar 2023

Cited by 3 | Viewed by 2378

Abstract

The aim of this study was to report the restoration of normal vertebral morphology and the absence of curve progression after the removal of instrumentation in AIS patients that underwent posterior correction of the deformity by a common all-screws construct without fusion. A [...] Read more.

The aim of this study was to report the restoration of normal vertebral morphology and the absence of curve progression after the removal of instrumentation in AIS patients that underwent posterior correction of the deformity by a common all-screws construct without fusion. A series of 36 AIS immature patients (Risser 3 or less) were included in the study. Instrumentation was removed once the maturity stage was complete (Risser 5). The curve correction was assessed pre- and postoperatively, before instrumentation removal, directly post-removal, and more than two years after instrumentation was removed. Epiphyseal vertebral growth modulation was assessed by the coronal wedging ratio (WR) at the apical level of the main curve (MC). The mean preoperative coronal Cobb was corrected from 53.7° ± 7.5 to 5.5° ± 7.5° (89.7%) at the immediate postop. After implant removal (31.0 ± 5.8 months), the MC was 13.1°. T5–T12 kyphosis showed significant improvement from 19.0° before curve correction to 27.1° after implant removal (p < 0.05). Before surgery, the WR was 0.71 ± 0.06, and after removal, 0.98 ± 0.08 (p < 0.001). At the end of the follow-up, the mean sagittal range of motion (ROM) of the T12-S1 segment was 51.2 ± 21.0°. The SRS-22 scores improved from 3.31 ± 0.25 preoperatively to 3.68 ± 0.25 at the final assessment (p < 0.001). In conclusion, a fusionless posterior approach using common all-pedicle screws correctly constructed satisfactory scoliotic main curves and permitted the removal of instrumentation once bone maturity was reached. The final correction was highly satisfactory, and an acceptable ROM of the previously lower instrumented segments was observed. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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10 pages, 1155 KiB

Open AccessArticle

Mobile Apps to Improve Brace-Wearing Compliance in Patients with Idiopathic Scoliosis: A Quality Analysis, Functionality Review and Future Directions

by Han Eol Cho, Chan Woong Jang, Sung Rae Cho, Won Ah Choi and Jung Hyun Park

J. Clin. Med. 2023, 12(5), 1972; https://doi.org/10.3390/jcm12051972 - 2 Mar 2023

Cited by 1 | Viewed by 2224

Abstract

This study was performed to review which mHealth apps that improve brace-wearing compliance are currently available, and to carry out their quality assessments by listing their functionalities. We found ten mHealth apps in the literature review and commercial mHealth apps market (Google Play [...] Read more.

This study was performed to review which mHealth apps that improve brace-wearing compliance are currently available, and to carry out their quality assessments by listing their functionalities. We found ten mHealth apps in the literature review and commercial mHealth apps market (Google Play and App store). Then, the quality of these apps was evaluated by their transparency, health content, excellent technical content, security/privacy, issues of usability, and subjective ratings (THESIS) scale, and the functionalities of the included apps were reviewed. Regarding these functionalities, four categories (data acquisition, compliance enhancement, educational components, and additional functionalities) and twelve subcategories were identified. The mean overall quality of the apps was 3.00 out of 5. Although four of the apps achieved a score of 3.0 or more for their overall quality, indicating an acceptable quality, none of the apps scored higher than 4.0, which indicated a high or excellent quality. According to the sections, the transparency section had the highest rating (3.92) and the security/privacy section received the lowest rating (2.02). Given that the overall quality of current mHealth apps was not high, and their potential to motivate patients with idiopathic scoliosis to adhere to their bracing treatment, it is necessary to develop high-quality apps with appropriate functionalities for supporting brace treatment. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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13 pages, 5380 KiB

Open AccessArticle

Influence of Lateral Translation of Lowest Instrumented Vertebra on L4 Tilt and Coronal Balance for Thoracolumbar and Lumbar Curves in Adolescent Idiopathic Scoliosis

by Katsuhisa Yamada, Hideki Sudo, Yuichiro Abe, Terufumi Kokabu, Hiroyuki Tachi, Tsutomu Endo, Takashi Ohnishi, Daisuke Ukeba, Katsuro Ura, Masahiko Takahata and Norimasa Iwasaki

J. Clin. Med. 2023, 12(4), 1389; https://doi.org/10.3390/jcm12041389 - 9 Feb 2023

Cited by 2 | Viewed by 1889

Abstract

This study aimed to evaluate the lowest instrumented vertebra translation (LIV-T) in the surgical treatment of thoracolumbar/lumbar adolescent idiopathic scoliosis and to analyze the radiographic parameters in relation to LIV-T and L4 tilt and global coronal balance. A total of 62 patients underwent [...] Read more.

This study aimed to evaluate the lowest instrumented vertebra translation (LIV-T) in the surgical treatment of thoracolumbar/lumbar adolescent idiopathic scoliosis and to analyze the radiographic parameters in relation to LIV-T and L4 tilt and global coronal balance. A total of 62 patients underwent posterior spinal fusion (PSF, n = 32) or anterior spinal fusion (ASF, n = 30) and were followed up for a minimum of 2 years. The mean preoperative LIV-T was significantly larger in the ASF group than the PSF (p < 0.01), while the final LIV-T was equivalent. LIV-T at the final follow-up was significantly correlated with L4 tilt and the global coronal balance (r = 0.69, p < 0.01, r = 0.38, p < 0.01, respectively). Receiver-operating characteristic analysis for good outcomes, with L4 tilt <8° and coronal balance <15 mm at the final follow-up, calculated the cutoff value of the final LIV-T as 12 mm. The cutoff value of preoperative LIV-T that would result in the LIV-T of ≤12 mm at the final follow-up was 32 mm in PSF, although no significant cutoff value was calculated in ASF. ASF can centralize the LIV better than PSF with a shorter segment fusion, and could be useful in obtaining a good curve correction and global balance without fixation to L4 in cases with large preoperative LIV-T. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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9 pages, 4339 KiB

Open AccessArticle

Prediction of Cobb Angle Using Deep Learning Algorithm with Three-Dimensional Depth Sensor Considering the Influence of Garment in Idiopathic Scoliosis

by Yoko Ishikawa, Terufumi Kokabu, Katsuhisa Yamada, Yuichiro Abe, Hiroyuki Tachi, Hisataka Suzuki, Takashi Ohnishi, Tsutomu Endo, Daisuke Ukeba, Katsuro Ura, Masahiko Takahata, Norimasa Iwasaki and Hideki Sudo

J. Clin. Med. 2023, 12(2), 499; https://doi.org/10.3390/jcm12020499 - 7 Jan 2023

Cited by 9 | Viewed by 2612

Abstract

Adolescent idiopathic scoliosis (AIS) is the most common pediatric spinal deformity. Early detection of deformity and timely intervention, such as brace treatment, can help inhibit progressive changes. A three-dimensional (3D) depth-sensor imaging system with a convolutional neural network was previously developed to predict [...] Read more.

Adolescent idiopathic scoliosis (AIS) is the most common pediatric spinal deformity. Early detection of deformity and timely intervention, such as brace treatment, can help inhibit progressive changes. A three-dimensional (3D) depth-sensor imaging system with a convolutional neural network was previously developed to predict the Cobb angle. The purpose of the present study was to (1) evaluate the performance of the deep learning algorithm (DLA) in predicting the Cobb angle and (2) assess the predictive ability depending on the presence or absence of clothing in a prospective analysis. We included 100 subjects with suspected AIS. The correlation coefficient between the actual and predicted Cobb angles was 0.87, and the mean absolute error and root mean square error were 4.7° and 6.0°, respectively, for Adam’s forward bending without underwear. There were no significant differences in the correlation coefficients between the groups with and without underwear in the forward-bending posture. The performance of the DLA with a 3D depth sensor was validated using an independent external validation dataset. Because the psychological burden of children and adolescents on naked body imaging is an unignorable problem, scoliosis examination with underwear is a valuable alternative in clinics or schools. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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10 pages, 2999 KiB

Open AccessArticle

Effects of Posterior Spinal Correction and Fusion on Postural Stability in Patients with Adolescent Idiopathic Scoliosis

by Satoshi Osuka, Hideki Sudo, Katsuhisa Yamada, Hiroyuki Tachi, Kentaro Watanabe, Fuma Sentoku, Takeshi Chiba, Norimasa Iwasaki, Masahiko Mukaino and Harukazu Tohyama

J. Clin. Med. 2023, 12(1), 270; https://doi.org/10.3390/jcm12010270 - 29 Dec 2022

Cited by 6 | Viewed by 1942

Abstract

The present study aimed to assess the effects of posterior spinal correction and fusion on postural stability in patients with adolescent idiopathic scoliosis (AIS). The study included 41 female patients with AIS at our institution. All patients performed three 10 s single-leg standing [...] Read more.

The present study aimed to assess the effects of posterior spinal correction and fusion on postural stability in patients with adolescent idiopathic scoliosis (AIS). The study included 41 female patients with AIS at our institution. All patients performed three 10 s single-leg standing trials on a force plate. The center of pressure (COP) was measured preoperatively, and at 1 week and 6 months postoperatively. The postural stability parameters were absolute minimum time-to-boundary (TTB), mean of the minimum TTB, mean COP velocity, standard deviation, range, and 95% confidence ellipse area. One-way repeated analysis of variance or Friedman test was applied to the postural stability parameters. Multiple comparisons were performed using the Bonferroni correction. The absolute minimum TTB and the mean minimum TTB showed a significant increase 6 months post-operation as compared to preoperatively and 1 week postoperatively. The COP velocity significantly decreased at 6 months post-operation compared to preoperatively and 1 week postoperatively. These changes in postural stability indicate that spinal correction and fusion can be considered to improve postural stability during single-leg standing tests in the postoperative period. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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12 pages, 2503 KiB

Open AccessArticle

Effect of Body Mass Index Percentile on Clinical and Radiographic Outcome and Risk of Complications after Posterior Instrumented Fusion for Adolescent Idiopathic Scoliosis: A Retrospective Cohort Study

by Laura Scaramuzzo, Fabrizio Giudici, Giuseppe Barone, Pierluigi Pironti, Marco Viganò, Domenico Ravier, Leone Minoia, Marino Archetti and Antonino Zagra

J. Clin. Med. 2023, 12(1), 76; https://doi.org/10.3390/jcm12010076 - 22 Dec 2022

Cited by 2 | Viewed by 1630

Abstract

Background: The aim of this study is to evaluate the effect of body mass index percentile (BMI%) at postoperative and medium follow-up in AIS patients undergoing posterior instrumented fusion (PSF). Methods: We analyzed 87 clinical records of patients (19 male, 68 female) who [...] Read more.

Background: The aim of this study is to evaluate the effect of body mass index percentile (BMI%) at postoperative and medium follow-up in AIS patients undergoing posterior instrumented fusion (PSF). Methods: We analyzed 87 clinical records of patients (19 male, 68 female) who underwent PSF. The patients were divided into four groups considering BMI%: underweight (UW), normal weight (NW), overweight (OW), and obesity (OB). Demographic, clinical (SRS-22), and radiographic data were collected. The primary outcome was to assess both the surgical and clinical outcomes, whilst the secondary outcome was to compare the radiological findings among the studied groups. Follow-ups were set preoperatively, at 6 months and 5 years. Results: Our results did not show significant differences of clinical outcomes among the studied groups, except for a longer surgical time and a higher hemoglobin decrease in UW and OB patients (p = 0.007). All BMI categories showed similar radiographic outcomes, with no statistical significance at final follow-up. OB patients showed a worse percentage of major curve correction compared to baseline and to UW and OW patients. Conclusions: The present study does not underline substantial differences in clinical and radiographic results among any of the studied groups. However, UW and OB patients showed a worse postoperative progress. Counseling should be provided for patients and families and the achievement of a normal BMI% should be recommended. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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4 pages, 218 KiB

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Reply to Lemans et al. Comment on “Burgos et al. Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached. J. Clin. Med. 2023, 12, 2408”

by Jesús Burgos, Gonzalo Mariscal, Luis Miguel Antón-Rodrigálvarez, Ignacio Sanpera, Eduardo Hevia, Vicente García and Carlos Barrios

J. Clin. Med. 2023, 12(14), 4773; https://doi.org/10.3390/jcm12144773 - 19 Jul 2023

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We thank Dr. Lemans and coworkers for their interest and knowledgeable comments [...] Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

3 pages, 219 KiB

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Comment on Burgos et al. Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached. J. Clin. Med. 2023, 12, 2408

by Justin V. C. Lemans, Tom P. C. Schlösser, René M. Castelein and Moyo C. Kruyt

J. Clin. Med. 2023, 12(14), 4677; https://doi.org/10.3390/jcm12144677 - 14 Jul 2023

Cited by 1 | Viewed by 606

Abstract

With great interest, we read the recently published paper “Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity is Reached” by Burgos et al. [...] Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

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