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Peter O. Newton - One of the best experts on this subject based on the ideXlab platform.

  • Anterior Spinal Growth Modulation in Skeletally Immature Patients with Idiopathic Scoliosis: A Comparison with Posterior Spinal Fusion at 2 to 5 Years Postoperatively.
    The Journal of bone and joint surgery. American volume, 2020
    Co-Authors: Peter O. Newton, Tracey P Bastrom, Carrie E. Bartley, Dylan Kluck, Wataru Saito, Burt Yaszay
    Abstract:

    BACKGROUND Anterior vertebral body tethering (AVBT) has been introduced as a means of correcting scoliosis without fusion. The purpose of this study was to compare outcomes for patients with thoracic idiopathic scoliosis between a group of patients who underwent AVBT and a matched cohort of patients treated with posterior spinal fusion and instrumentation (PSF). METHODS A retrospective study of patients who underwent AVBT and PSF for idiopathic scoliosis was conducted. The inclusion criteria were determined on the basis of the AVBT cohort: primary thoracic idiopathic scoliosis with a curve magnitude between 40° and 67°, Risser stage of ≤1, age of 9 to 15 years, no prior spine surgery, index surgery between 2011 and 2016, and minimum follow-up of 2 years. Demographic, radiographic, Clinical, and patient-reported outcomes and revisions were compared between groups. RESULTS There were 23 patients in the AVBT cohort and 26 patients in the PSF cohort. The mean follow-up (and standard deviation) was similar between groups: 3.4 ± 1.1 years for the AVBT group and 3.6 ± 1.6 years for the PSF group (p = 0.6). Preoperatively, the groups were similar in all measurements of radiographic and Clinical Deformity, with mean main thoracic curves of 53° ± 8° for the AVBT group and 54° ± 7° for the PSF group (p = 0.4). At the time of final follow-up, the AVBT cohort had significantly more residual Deformity, with a mean thoracic curve of 33° ± 18° compared with 16° ± 6° for the PSF group (p < 0.001). There were 9 revision procedures in the AVBT cohort (with 3 conversions to PSF and 3 more pending) and none in the PSF cohort. Revisions occurred at a mean postoperative time of 2.3 years (range, 1.2 to 3.7 years). Twelve patients (52%) had evidence of broken tethers; of these patients, 4 underwent revision. The post-intervention patient-reported outcomes were similar. CONCLUSIONS Both AVBT and PSF resulted in postoperative correction; however, 2-year correction was better maintained in the PSF group. There were no differences in post-intervention patient-reported outcomes. AVBT resulted in less Deformity correction and more revision procedures than PSF, but resulted in the delay or prevention of PSF in the majority of patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  • Comparison of 3-dimensional spinal reconstruction accuracy: biplanar radiographs with EOS versus computed tomography.
    Spine, 2012
    Co-Authors: Diana A. Glaser, Josh Doan, Peter O. Newton
    Abstract:

    STUDY DESIGN Experimental study for systematic evaluation of 3-dimensional (3D) reconstructions from low-dose digital stereoradiography. OBJECTIVE To assess the accuracy of EOS (EOS Imaging, Paris, France) 3-dimensional (3D) reconstructions compared with 3D computed tomography (CT) and the effect spine positioning within the EOS unit has on reconstruction accuracy. SUMMARY OF BACKGROUND DATA Scoliosis is a 3D Deformity, but 3D morphological analyses are still rare. A new low-dose radiation digital stereoradiography system (EOS) was previously evaluated for intra/interobserver variability, but data are limited for 3D reconstruction accuracy. METHODS Three synthetic scoliotic phantoms (T1-pelvis) were scanned in upright position at 0°, ±5°, and ±10° of axial rotation within EOS and in supine position using CT. Three-dimensional EOS reconstructions were superimposed on corresponding 3D computed tomographic reconstructions. Shape, position, and orientation accuracy were assessed for each vertebra and the entire spine. Additional routine planer Clinical Deformity measurements were compared: Cobb angle, kyphosis, lordosis, and pelvic incidence. RESULTS Mean EOS vertebral body shape accuracy was 1.1 ± 0.2 mm (maximum 4.7 mm), with 95% confidence interval of 1.7 mm. Different anatomical vertebral regions were modeled well with root-mean-square (RMS) values from 1.2 to 1.6 mm. Position and orientation accuracy of each vertebra were high: RMS offset was 1.2 mm (maximum 3.7 mm) and RMS axial rotation was 1.9° (maximum 5.8°). There was no significant difference in each of the analyzed parameters (P > 0.05) associated with varying the rotational position of the phantoms in EOS machine. Planer measurements accuracy was less than 1° mean difference for pelvic incidence, Cobb angle (mean 1.6°/maximum 3.9°), and sagittal kyphosis (mean less than 1°, maximum 4.9°). CONCLUSION The EOS image acquisition and reconstruction software provides accurate 3D spinal representations of scoliotic spinal deformities. The results of this study provide spinal Deformity surgeons evidence pertaining to this new upright 3D imaging technology that may aid in the Clinical diagnosis and decision making for patients with scoliosis.

  • Surgical treatment of main thoracic scoliosis with thoracoscopic anterior instrumentation. Surgical technique.
    The Journal of bone and joint surgery. American volume, 2009
    Co-Authors: Peter O. Newton, Vidyadhar V. Upasani, Juliano Lhamby, Valerie L Ugrinow, Jeff B Pawelek, Tracey P Bastrom
    Abstract:

    The surgical outcomes in patients with scoliosis at two years following anterior thoracoscopic spinal instrumentation and fusion have been reported. The purpose of this study was to evaluate the results at five years. A consecutive series of forty-one patients with major thoracic scoliosis treated with anterior thoracoscopic spinal instrumentation was evaluated at regular intervals. Prospectively collected data included patient demographics, radiographic measurements, Clinical Deformity measures, pulmonary function, an assessment of intervertebral fusion, and the scores on the Scoliosis Research Society (SRS-24) outcomes instrument. Perioperative and postoperative complications were recorded. Patient data for the preoperative, two-year, and five-year postoperative time points were compared. In addition, a univariate analysis compared selected two-year radiographic, pulmonary function, and SRS-24 data of the study cohort and those of the patients lost to follow-up. Twenty-five (61%) of the original forty-one patients had five-year follow-up data and were included in the analysis. Between the two-year and five-year follow-up visits, no significant changes were observed with regard to the average percent correction of the major Cobb angle (56% +/- 11% and 52% +/- 14%, respectively), average total lung capacity as a percent of the predicted value (95% +/- 14% and 91% +/- 10%), and the average total SRS-24 score (4.2 +/- 0.4 and 4.1 +/- 0.7). Radio-graphic evaluation of intervertebral fusion at five years revealed convincing evidence of a fusion with remodeling and trabeculae present at 151 (97%) of the 155 instrumented motion segments. No postoperative infections or Clinically relevant neurovascular complications were observed. Rod failure occurred in three patients, and three patients required a surgical revision with posterior spinal instrumentation and fusion. Thoracoscopic anterior instrumentation for main thoracic idiopathic scoliosis results in five-year outcomes comparable with those reported previously for open anterior and posterior techniques. The radiographic findings, pulmonary function, and Clinical measures remain stable between the two and five-year follow-up time points. Thoracoscopic instrumentation provides a viable alternative to treat spinal Deformity; however, the risks of pseudarthrosis, hardware failure, and surgical revision should be considered along with the advantages of limited muscular dissection and improved scar appearance.

  • Surgical Treatment of Main Thoracic Scoliosis with Thoracoscopic Anterior Instrumentation
    The Journal of Bone and Joint Surgery-American Volume, 2009
    Co-Authors: Peter O. Newton, Jeff Pawelek, Vidyadhar V. Upasani, Juliano Lhamby, Valerie L Ugrinow, Tracey P Bastrom
    Abstract:

    ABSTRACT FROM THE ORIGINAL ARTICLE BACKGROUND: The surgical outcomes in patients with scoliosis at two years following anterior thoracoscopic spinal instrumentation and fusion have been reported. The purpose of this study was to evaluate the results at five years. METHODS: A consecutive series of forty-one patients with major thoracic scoliosis treated with anterior thoracoscopic spinal instrumentation was evaluated at regular intervals. Prospectively collected data included patient demographics, radiographic measurements, Clinical Deformity measures, pulmonary function, an assessment of intervertebral fusion, and the scores on the Scoliosis Research Society (SRS-24) outcomes instrument. Perioperative and postoperative complications were recorded. Patient data for the preoperative, two-year, and five-year postoperative time points were compared. In addition, a univariate analysis compared selected two-year radiographic, pulmonary function, and SRS-24 data of the study cohort and those of the patients lost to follow-up. RESULTS: Twenty-five (61%) of the original forty-one patients had five-year follow-up data and were included in the analysis. Between the two-year and five-year follow-up visits, no significant changes were observed with regard to the average percent correction of the major Cobb angle (56% ± 11% and 52% ± 14%, respectively), average total lung capacity as a percent of the predicted value (95% ± 14% and 91% ± 10%), and the average total SRS-24 score (4.2 ± 0.4 and 4.1 ± 0.7). Radio-graphic evaluation of intervertebral fusion at five years revealed convincing evidence of a fusion with remodeling and trabeculae present at 151 (97%) of the 155 instrumented motion segments. No postoperative infections or Clinically relevant neurovascular complications were observed. Rod failure occurred in three patients, and three patients required a surgical revision with posterior spinal instrumentation and fusion. CONCLUSIONS: Thoracoscopic anterior instrumentation for main thoracic idiopathic scoliosis results in five-year outcomes comparable with those reported previously for open anterior and posterior techniques. The radiographic findings, pulmonary function, and Clinical measures remain stable between the two and five-year follow-up time points. Thoracoscopic instrumentation provides a viable alternative to treat spinal Deformity; however, the risks of pseudarthrosis, hardware failure, and surgical revision should be considered along with the advantages of limited muscular dissection and improved scar appearance. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Surgical Treatment of Main Thoracic Scoliosis with Thoracoscopic Anterior Instrumentation. A Five-Year Follow-up Study” (2008;90:2077-89).

  • Is the Lumbar Modifier Useful in Surgical Decision Making? : Defining Two Distinct Lenke 1A Curve Patterns
    Spine, 2008
    Co-Authors: Firoz Miyanji, Jeff Pawelek, Scott Van Valin, Vidyadhar V. Upasani, Peter O. Newton
    Abstract:

    STUDY DESIGN Retrospective review of adolescent idiopathic scoliosis (AIS) patients. OBJECTIVE To investigate the Clinical Deformity and radiographic features of Lenke 1A and 1B curves to determine if the "A" and "B" lumbar modifiers actually describe 2 distinct curve patterns. SUMMARY OF BACKGROUND DATA The Lenke classification system attempts to address some of the shortcomings of the King-Moe classification system by providing a more comprehensive, reliable, and treatment-based categorization of all AIS deformities. Although this classification is useful in determining which regions of the spine should be fused, it does not necessarily divide AIS curves into distinct patterns. METHODS A critical analysis of the Clinical Deformity, radiographic features, and surgical treatment of AIS patients with Lenke 1A and 1B right thoracic curves was performed. Lenke 1A curves were differentiated according to the L4 coronal plane tilt. Analysis of variance and Pearson chi analysis were used to perform statistical comparisons between the individual curve patterns (P < or = 0.05). RESULTS Ninety-three patients with preoperative and 2-year postoperative data were included in this analysis (65 Lenke 1A, and 28 Lenke 1B). Thirty-three patients were subdivided as 1A-L (L4 tilted to the left) and 32 patients were subdivided as 1A-R (L4 tilted to the right). The interobserver reliability for determining the direction of L4 tilt was excellent (kappa = 0.94, P < or = 0.001). Patients with 1A-L curves were similar to patients with 1B curves with respect to the L4 tilt and the location of the stable vertebra (most often in the thoracolumbar junction). In contrast, patients with 1A-R curves had a more distal stable vertebra (most often L3 or L4). The surgical treatment also differed between these 2 groups with regards to the lowest instrumented vertebra (LIV). 1A-L and 1B curves were similar with a median LIV of T12, whereas the 1A-R curves had a more distal median LIV of L2 (P = 0.01). CONCLUSION Two Lenke 1A curve patterns can be described based on the direction of the L4 tilt. This distinction has ramifications regarding selection of fusion levels and assessing surgical outcomes. The A and B lumbar modifiers do not describe 2 distinct curve types within the Lenke 1 group; however, the tilt direction of L4 does allow subdivision of the Lenke 1A curves into 2 distinguishable patterns (1A-R and 1A-L). The 1A-L curves are similar to 1B curves and different in form and treatment from the 1A-R pattern.

Tracey P Bastrom - One of the best experts on this subject based on the ideXlab platform.

  • Anterior Spinal Growth Modulation in Skeletally Immature Patients with Idiopathic Scoliosis: A Comparison with Posterior Spinal Fusion at 2 to 5 Years Postoperatively.
    The Journal of bone and joint surgery. American volume, 2020
    Co-Authors: Peter O. Newton, Tracey P Bastrom, Carrie E. Bartley, Dylan Kluck, Wataru Saito, Burt Yaszay
    Abstract:

    BACKGROUND Anterior vertebral body tethering (AVBT) has been introduced as a means of correcting scoliosis without fusion. The purpose of this study was to compare outcomes for patients with thoracic idiopathic scoliosis between a group of patients who underwent AVBT and a matched cohort of patients treated with posterior spinal fusion and instrumentation (PSF). METHODS A retrospective study of patients who underwent AVBT and PSF for idiopathic scoliosis was conducted. The inclusion criteria were determined on the basis of the AVBT cohort: primary thoracic idiopathic scoliosis with a curve magnitude between 40° and 67°, Risser stage of ≤1, age of 9 to 15 years, no prior spine surgery, index surgery between 2011 and 2016, and minimum follow-up of 2 years. Demographic, radiographic, Clinical, and patient-reported outcomes and revisions were compared between groups. RESULTS There were 23 patients in the AVBT cohort and 26 patients in the PSF cohort. The mean follow-up (and standard deviation) was similar between groups: 3.4 ± 1.1 years for the AVBT group and 3.6 ± 1.6 years for the PSF group (p = 0.6). Preoperatively, the groups were similar in all measurements of radiographic and Clinical Deformity, with mean main thoracic curves of 53° ± 8° for the AVBT group and 54° ± 7° for the PSF group (p = 0.4). At the time of final follow-up, the AVBT cohort had significantly more residual Deformity, with a mean thoracic curve of 33° ± 18° compared with 16° ± 6° for the PSF group (p < 0.001). There were 9 revision procedures in the AVBT cohort (with 3 conversions to PSF and 3 more pending) and none in the PSF cohort. Revisions occurred at a mean postoperative time of 2.3 years (range, 1.2 to 3.7 years). Twelve patients (52%) had evidence of broken tethers; of these patients, 4 underwent revision. The post-intervention patient-reported outcomes were similar. CONCLUSIONS Both AVBT and PSF resulted in postoperative correction; however, 2-year correction was better maintained in the PSF group. There were no differences in post-intervention patient-reported outcomes. AVBT resulted in less Deformity correction and more revision procedures than PSF, but resulted in the delay or prevention of PSF in the majority of patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  • Surgical treatment of main thoracic scoliosis with thoracoscopic anterior instrumentation. Surgical technique.
    The Journal of bone and joint surgery. American volume, 2009
    Co-Authors: Peter O. Newton, Vidyadhar V. Upasani, Juliano Lhamby, Valerie L Ugrinow, Jeff B Pawelek, Tracey P Bastrom
    Abstract:

    The surgical outcomes in patients with scoliosis at two years following anterior thoracoscopic spinal instrumentation and fusion have been reported. The purpose of this study was to evaluate the results at five years. A consecutive series of forty-one patients with major thoracic scoliosis treated with anterior thoracoscopic spinal instrumentation was evaluated at regular intervals. Prospectively collected data included patient demographics, radiographic measurements, Clinical Deformity measures, pulmonary function, an assessment of intervertebral fusion, and the scores on the Scoliosis Research Society (SRS-24) outcomes instrument. Perioperative and postoperative complications were recorded. Patient data for the preoperative, two-year, and five-year postoperative time points were compared. In addition, a univariate analysis compared selected two-year radiographic, pulmonary function, and SRS-24 data of the study cohort and those of the patients lost to follow-up. Twenty-five (61%) of the original forty-one patients had five-year follow-up data and were included in the analysis. Between the two-year and five-year follow-up visits, no significant changes were observed with regard to the average percent correction of the major Cobb angle (56% +/- 11% and 52% +/- 14%, respectively), average total lung capacity as a percent of the predicted value (95% +/- 14% and 91% +/- 10%), and the average total SRS-24 score (4.2 +/- 0.4 and 4.1 +/- 0.7). Radio-graphic evaluation of intervertebral fusion at five years revealed convincing evidence of a fusion with remodeling and trabeculae present at 151 (97%) of the 155 instrumented motion segments. No postoperative infections or Clinically relevant neurovascular complications were observed. Rod failure occurred in three patients, and three patients required a surgical revision with posterior spinal instrumentation and fusion. Thoracoscopic anterior instrumentation for main thoracic idiopathic scoliosis results in five-year outcomes comparable with those reported previously for open anterior and posterior techniques. The radiographic findings, pulmonary function, and Clinical measures remain stable between the two and five-year follow-up time points. Thoracoscopic instrumentation provides a viable alternative to treat spinal Deformity; however, the risks of pseudarthrosis, hardware failure, and surgical revision should be considered along with the advantages of limited muscular dissection and improved scar appearance.

  • Surgical Treatment of Main Thoracic Scoliosis with Thoracoscopic Anterior Instrumentation
    The Journal of Bone and Joint Surgery-American Volume, 2009
    Co-Authors: Peter O. Newton, Jeff Pawelek, Vidyadhar V. Upasani, Juliano Lhamby, Valerie L Ugrinow, Tracey P Bastrom
    Abstract:

    ABSTRACT FROM THE ORIGINAL ARTICLE BACKGROUND: The surgical outcomes in patients with scoliosis at two years following anterior thoracoscopic spinal instrumentation and fusion have been reported. The purpose of this study was to evaluate the results at five years. METHODS: A consecutive series of forty-one patients with major thoracic scoliosis treated with anterior thoracoscopic spinal instrumentation was evaluated at regular intervals. Prospectively collected data included patient demographics, radiographic measurements, Clinical Deformity measures, pulmonary function, an assessment of intervertebral fusion, and the scores on the Scoliosis Research Society (SRS-24) outcomes instrument. Perioperative and postoperative complications were recorded. Patient data for the preoperative, two-year, and five-year postoperative time points were compared. In addition, a univariate analysis compared selected two-year radiographic, pulmonary function, and SRS-24 data of the study cohort and those of the patients lost to follow-up. RESULTS: Twenty-five (61%) of the original forty-one patients had five-year follow-up data and were included in the analysis. Between the two-year and five-year follow-up visits, no significant changes were observed with regard to the average percent correction of the major Cobb angle (56% ± 11% and 52% ± 14%, respectively), average total lung capacity as a percent of the predicted value (95% ± 14% and 91% ± 10%), and the average total SRS-24 score (4.2 ± 0.4 and 4.1 ± 0.7). Radio-graphic evaluation of intervertebral fusion at five years revealed convincing evidence of a fusion with remodeling and trabeculae present at 151 (97%) of the 155 instrumented motion segments. No postoperative infections or Clinically relevant neurovascular complications were observed. Rod failure occurred in three patients, and three patients required a surgical revision with posterior spinal instrumentation and fusion. CONCLUSIONS: Thoracoscopic anterior instrumentation for main thoracic idiopathic scoliosis results in five-year outcomes comparable with those reported previously for open anterior and posterior techniques. The radiographic findings, pulmonary function, and Clinical measures remain stable between the two and five-year follow-up time points. Thoracoscopic instrumentation provides a viable alternative to treat spinal Deformity; however, the risks of pseudarthrosis, hardware failure, and surgical revision should be considered along with the advantages of limited muscular dissection and improved scar appearance. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Surgical Treatment of Main Thoracic Scoliosis with Thoracoscopic Anterior Instrumentation. A Five-Year Follow-up Study” (2008;90:2077-89).

  • Surgical treatment of main thoracic scoliosis with thoracoscopic anterior instrumentation. a five-year follow-up study.
    The Journal of bone and joint surgery. American volume, 2008
    Co-Authors: Peter O. Newton, Jeff Pawelek, Vidyadhar V. Upasani, Juliano Lhamby, Valerie L Ugrinow, Tracey P Bastrom
    Abstract:

    Background: The surgical outcomes in patients with scoliosis at two years following anterior thoracoscopic spinal in-strumentation and fusion have been reported. The purpose of this study was to evaluate the results at five years. Methods: A consecutive series of forty-one patients with major thoracic scoliosis treated with anterior thoracoscopic spinal instrumentation was evaluated at regular intervals. Prospectively collected data included patient demographics, radiographic measurements, Clinical Deformity measures, pulmonary function, an assessment of intervertebral fusion, and the scores on the Scoliosis Research Society (SRS-24) outcomes instrument. Perioperative and postoperative complications were recorded. Patient data for the preoperative, two-year, and five-year postoperative time points were compared. In addition, a univariate analysis compared selected two-year radiographic, pulmonary function, and SRS-24 data of the study cohort and those of the patients lost to follow-up. Results: Twenty-five (61%) of the original forty-one patients had five-year follow-up data and were included in the analysis. Between the two-year and five-year follow-up visits, no significant changes were observed with regard to the average percent correction of the major Cobb angle (56% ± 11% and 52% ± 14%, respectively), average total lung capacity as a percent of the predicted value (95% ± 14% and 91% ± 10%), and the average total SRS-24 score (4.2 ± 0.4 and 4.1 ± 0.7). Radiographic evaluation of intervertebral fusion at five years revealed convincing evidence of a fusion with remodeling and trabeculae present at 151 (97%) of the 155 instrumented motion segments. No postoperative infections or Clinically relevant neurovascular complications were observed. Rod failure occurred in three patients, and three patients required a surgical revision with posterior spinal instrumentation and fusion. Conclusions: Thoracoscopic anterior instrumentation for main thoracic idiopathic scoliosis results in five-year outcomes comparable with those reported previously for open anterior and posterior techniques. The radiographic findings, pulmonary function, and Clinical measures remain stable between the two and five-year follow-up time points. Thoracoscopic instrumentation provides a viable alternative to treat spinal Deformity; however, the risks of pseudarthrosis, hardware failure, and surgical revision should be considered along with the advantages of limited muscular dissection and improved scar appearance. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Andrzej Szulc - One of the best experts on this subject based on the ideXlab platform.

  • Corrective bracing for severe idiopathic scoliosis in adolescence: influence of brace on trunk morphology.
    TheScientificWorldJournal, 2012
    Co-Authors: Edyta Kinel, T. Kotwicki, Wanda Stryła, Andrzej Szulc
    Abstract:

    Aim. The aim of the work was to study whether wearing a corrective brace by adolescent girls with severe idiopathic scoliosis can influence external shape of the trunk. Methods. Comparison of Clinical Deformity of two groups of girls matched for age and Cobb angle: group (1) of 23 girls, aged 14.9 ± 1.3 years, Cobb angle 55.0° ± 6.8°, who refused surgical treatment and have been wearing Cheneau brace for more than 6 months, compared with group (2) of 22 girls, aged 14.1 ± 1.8 years, Cobb angle 59.7° ± 14.6° never treated with corrective bracing. Clinical Deformity was assessed with the Bunnell scoliometer (angle of trunk rotation ATR) and surface topography (posterior trunk symmetry index POTSI and Hump Sum HS). Results. The ATR in the primary curvature was 11.9° ± 3.4° (5°–18°) in group 1 versus 15.1° ± 5.6° (6°–25°) in group 2 (P = 0.027). The HS was 16.8° ± 3.8 versus 19.2° ± 4.6, respectively, P = 0.07. The POTSI value did not differ between groups. Conclusion. Girls with Cobb angle above 45 degrees, who have been subjected to brace treatment, revealed smaller Clinical Deformity of their back comparing to nontreated girls having similar radiological curvatures.

  • Discrepancy in Clinical versus radiological parameters describing Deformity due to brace treatment for moderate idiopathic scoliosis
    Scoliosis, 2007
    Co-Authors: T. Kotwicki, Edyta Kinel, Wanda Stryla, Andrzej Szulc
    Abstract:

    Background The shape of the torso in patients with idiopathic scoliosis is considered to reflect the shape of the vertebral column, however the direct correlation between parameters describing Clinical Deformity and those characterizing radiological curvature was reported to be weak. It is not clear if the management proposed for scoliosis (physiotherapy, brace, surgery) affects equally the shape of the axial skeleton and the surface of the body. The aim of the study was to compare Clinical Deformity of (1) idiopathic scoliosis girls being under brace treatment for radiological curves of 25 to 40 degrees and (2) non treated scoliotic girls matched for age and Cobb angle. Methods Cross-sectional study of 24 girls wearing the brace versus 26 girls without brace treatment, matched for age and Cobb angle. Hypothesis: Patients wearing the brace for more than 6 months, when comparing to patients without brace, may present different external morphology of the trunk, in spite of having similar Cobb angle. Material. Inclusion criteria: girls, idiopathic scoliosis, growing age (10–16 years), Cobb angle minimum 25°, maximum 40°. The braced group consisted of girls wearing a TLSO brace (Cheneau) for more than 6 months with minimum of 16 hours per day. The non-braced group consisted of girls first seen for their spinal Deformity, previously not treated. The groups presented similar curve pattern. Methods. Scoliometer exam: angle of trunk rotation at three levels of the spine: upper thoracic, main thoracic, lumbar or thoracolumbar. The maximal angle was noted at each level and the sum of three levels was calculated. Posterior trunk symmetry index (POTSI) and Hump Sum were measured using surface topography. Results Cobb angle was 34.9° ± 4.8° in braced and 32.7° ± 4.9° in un-braced patients (difference not significant). The age was 14.1 ± 1.6 years in braced patients and 13.1 ± 1.9 years in un-braced group (p = 0.046). The value of angle of trunk rotation in the main curvature was 8.4° ± 2.7°in braced and 11.4° ± 2.7° in un-braced patients (difference extremely significant, p = 0.0003). The value of the sum of angles of trunk rotation at three levels of the trunk was 12.8° ± 4.6° in braced and 16.5° ± 3.8° in un-braced patients (difference very significant, p = 0.0038). The POTSI did not differ significantly between the groups (p = 0.78), the Hump Sum values were not quite different (p = 0.07). Conclusion (1) Adolescent girls wearing the brace for idiopathic scoliosis of 25 to 40 degrees of Cobb angle, reveal smaller Clinical rotational Deformity of their back than non-treated girls having similar radiological Deformity. (2) Evaluation of the results of treatment for idiopathic scoliosis should consider parameters describing both Clinical and radiological Deformity.

  • Discrepancy in Clinical versus radiological parameters describing Deformity due to brace treatment for moderate idiopathic scoliosis
    Scoliosis, 2007
    Co-Authors: T. Kotwicki, Edyta Kinel, Wanda Stryła, Andrzej Szulc
    Abstract:

    Background The shape of the torso in patients with idiopathic scoliosis is considered to reflect the shape of the vertebral column, however the direct correlation between parameters describing Clinical Deformity and those characterizing radiological curvature was reported to be weak. It is not clear if the management proposed for scoliosis (physiotherapy, brace, surgery) affects equally the shape of the axial skeleton and the surface of the body. The aim of the study was to compare Clinical Deformity of (1) idiopathic scoliosis girls being under brace treatment for radiological curves of 25 to 40 degrees and (2) non treated scoliotic girls matched for age and Cobb angle.

  • Estimation of the stress related to conservative scoliosis therapy: an analysis based on BSSQ questionnaires
    Scoliosis, 2007
    Co-Authors: T. Kotwicki, Edyta Kinel, Wanda Stryła, Andrzej Szulc
    Abstract:

    Background Adolescent girls treated with a brace for scoliosis are submitted to prolonged stress related to both the disease and the therapy. Currently proposed quality of life questionnaires are focused on the outcome of therapy. Bad Sobernheim Stress Questionnaire (BSSQ) enables monitoring of patients being under treatment with a brace or exercises. The aim of the study was to assess the stress level in conservatively managed scoliotic girls using BSSQ. Materials and methods 111 girls, aged 14,2 ± 2,2 years, mean Cobb angle of the primary curve 42,8° ± 17,0° and mean Bunnell angle of 11,4° ± 4,5° were examined with two versions of BSSQ (Deformity and Brace). The analysis considered the type of treatment, curve location, correlation of the total score with age, Cobb angle and Bunnell rotation angle. Results The BSSQ Deformity revealed the median of 17 points in patients managed with exercises (from 4 to 24 points), 18 in patients managed with a brace (from 8 to 24 points) and 12 in patients before surgery (from 3 to 21 points). Braced patients who completed both questionnaires (n = 50) revealed significantly higher score with BSSQ Deformity (median = 18) comparing to BSSQ Brace (median = 9). There was a correlation between the total score of BSSQ Deformity and the Cobb angle (r = -0,34), Bunnell primary curve rotation (r = -0,34) and Bunnell sum of rotation (r = -0,33) but not with the age of patients. Conclusion Scoliotic adolescents managed with exercises and brace suffered little stress from the Deformity. The brace increased the level of stress over the stress induced by the Deformity. The stress level correlated with Clinical Deformity (Bunnell angle), radiological Deformity (Cobb angle) and the type of treatment (exercises, bracing, surgery). Bad Sobernheim Stress Questionnaires are simple and helpful in the management of girls treated conservatively for idiopathic scoliosis.

Vidyadhar V. Upasani - One of the best experts on this subject based on the ideXlab platform.

  • Surgical treatment of main thoracic scoliosis with thoracoscopic anterior instrumentation. Surgical technique.
    The Journal of bone and joint surgery. American volume, 2009
    Co-Authors: Peter O. Newton, Vidyadhar V. Upasani, Juliano Lhamby, Valerie L Ugrinow, Jeff B Pawelek, Tracey P Bastrom
    Abstract:

    The surgical outcomes in patients with scoliosis at two years following anterior thoracoscopic spinal instrumentation and fusion have been reported. The purpose of this study was to evaluate the results at five years. A consecutive series of forty-one patients with major thoracic scoliosis treated with anterior thoracoscopic spinal instrumentation was evaluated at regular intervals. Prospectively collected data included patient demographics, radiographic measurements, Clinical Deformity measures, pulmonary function, an assessment of intervertebral fusion, and the scores on the Scoliosis Research Society (SRS-24) outcomes instrument. Perioperative and postoperative complications were recorded. Patient data for the preoperative, two-year, and five-year postoperative time points were compared. In addition, a univariate analysis compared selected two-year radiographic, pulmonary function, and SRS-24 data of the study cohort and those of the patients lost to follow-up. Twenty-five (61%) of the original forty-one patients had five-year follow-up data and were included in the analysis. Between the two-year and five-year follow-up visits, no significant changes were observed with regard to the average percent correction of the major Cobb angle (56% +/- 11% and 52% +/- 14%, respectively), average total lung capacity as a percent of the predicted value (95% +/- 14% and 91% +/- 10%), and the average total SRS-24 score (4.2 +/- 0.4 and 4.1 +/- 0.7). Radio-graphic evaluation of intervertebral fusion at five years revealed convincing evidence of a fusion with remodeling and trabeculae present at 151 (97%) of the 155 instrumented motion segments. No postoperative infections or Clinically relevant neurovascular complications were observed. Rod failure occurred in three patients, and three patients required a surgical revision with posterior spinal instrumentation and fusion. Thoracoscopic anterior instrumentation for main thoracic idiopathic scoliosis results in five-year outcomes comparable with those reported previously for open anterior and posterior techniques. The radiographic findings, pulmonary function, and Clinical measures remain stable between the two and five-year follow-up time points. Thoracoscopic instrumentation provides a viable alternative to treat spinal Deformity; however, the risks of pseudarthrosis, hardware failure, and surgical revision should be considered along with the advantages of limited muscular dissection and improved scar appearance.

  • Surgical Treatment of Main Thoracic Scoliosis with Thoracoscopic Anterior Instrumentation
    The Journal of Bone and Joint Surgery-American Volume, 2009
    Co-Authors: Peter O. Newton, Jeff Pawelek, Vidyadhar V. Upasani, Juliano Lhamby, Valerie L Ugrinow, Tracey P Bastrom
    Abstract:

    ABSTRACT FROM THE ORIGINAL ARTICLE BACKGROUND: The surgical outcomes in patients with scoliosis at two years following anterior thoracoscopic spinal instrumentation and fusion have been reported. The purpose of this study was to evaluate the results at five years. METHODS: A consecutive series of forty-one patients with major thoracic scoliosis treated with anterior thoracoscopic spinal instrumentation was evaluated at regular intervals. Prospectively collected data included patient demographics, radiographic measurements, Clinical Deformity measures, pulmonary function, an assessment of intervertebral fusion, and the scores on the Scoliosis Research Society (SRS-24) outcomes instrument. Perioperative and postoperative complications were recorded. Patient data for the preoperative, two-year, and five-year postoperative time points were compared. In addition, a univariate analysis compared selected two-year radiographic, pulmonary function, and SRS-24 data of the study cohort and those of the patients lost to follow-up. RESULTS: Twenty-five (61%) of the original forty-one patients had five-year follow-up data and were included in the analysis. Between the two-year and five-year follow-up visits, no significant changes were observed with regard to the average percent correction of the major Cobb angle (56% ± 11% and 52% ± 14%, respectively), average total lung capacity as a percent of the predicted value (95% ± 14% and 91% ± 10%), and the average total SRS-24 score (4.2 ± 0.4 and 4.1 ± 0.7). Radio-graphic evaluation of intervertebral fusion at five years revealed convincing evidence of a fusion with remodeling and trabeculae present at 151 (97%) of the 155 instrumented motion segments. No postoperative infections or Clinically relevant neurovascular complications were observed. Rod failure occurred in three patients, and three patients required a surgical revision with posterior spinal instrumentation and fusion. CONCLUSIONS: Thoracoscopic anterior instrumentation for main thoracic idiopathic scoliosis results in five-year outcomes comparable with those reported previously for open anterior and posterior techniques. The radiographic findings, pulmonary function, and Clinical measures remain stable between the two and five-year follow-up time points. Thoracoscopic instrumentation provides a viable alternative to treat spinal Deformity; however, the risks of pseudarthrosis, hardware failure, and surgical revision should be considered along with the advantages of limited muscular dissection and improved scar appearance. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Surgical Treatment of Main Thoracic Scoliosis with Thoracoscopic Anterior Instrumentation. A Five-Year Follow-up Study” (2008;90:2077-89).

  • Is the Lumbar Modifier Useful in Surgical Decision Making? : Defining Two Distinct Lenke 1A Curve Patterns
    Spine, 2008
    Co-Authors: Firoz Miyanji, Jeff Pawelek, Scott Van Valin, Vidyadhar V. Upasani, Peter O. Newton
    Abstract:

    STUDY DESIGN Retrospective review of adolescent idiopathic scoliosis (AIS) patients. OBJECTIVE To investigate the Clinical Deformity and radiographic features of Lenke 1A and 1B curves to determine if the "A" and "B" lumbar modifiers actually describe 2 distinct curve patterns. SUMMARY OF BACKGROUND DATA The Lenke classification system attempts to address some of the shortcomings of the King-Moe classification system by providing a more comprehensive, reliable, and treatment-based categorization of all AIS deformities. Although this classification is useful in determining which regions of the spine should be fused, it does not necessarily divide AIS curves into distinct patterns. METHODS A critical analysis of the Clinical Deformity, radiographic features, and surgical treatment of AIS patients with Lenke 1A and 1B right thoracic curves was performed. Lenke 1A curves were differentiated according to the L4 coronal plane tilt. Analysis of variance and Pearson chi analysis were used to perform statistical comparisons between the individual curve patterns (P < or = 0.05). RESULTS Ninety-three patients with preoperative and 2-year postoperative data were included in this analysis (65 Lenke 1A, and 28 Lenke 1B). Thirty-three patients were subdivided as 1A-L (L4 tilted to the left) and 32 patients were subdivided as 1A-R (L4 tilted to the right). The interobserver reliability for determining the direction of L4 tilt was excellent (kappa = 0.94, P < or = 0.001). Patients with 1A-L curves were similar to patients with 1B curves with respect to the L4 tilt and the location of the stable vertebra (most often in the thoracolumbar junction). In contrast, patients with 1A-R curves had a more distal stable vertebra (most often L3 or L4). The surgical treatment also differed between these 2 groups with regards to the lowest instrumented vertebra (LIV). 1A-L and 1B curves were similar with a median LIV of T12, whereas the 1A-R curves had a more distal median LIV of L2 (P = 0.01). CONCLUSION Two Lenke 1A curve patterns can be described based on the direction of the L4 tilt. This distinction has ramifications regarding selection of fusion levels and assessing surgical outcomes. The A and B lumbar modifiers do not describe 2 distinct curve types within the Lenke 1 group; however, the tilt direction of L4 does allow subdivision of the Lenke 1A curves into 2 distinguishable patterns (1A-R and 1A-L). The 1A-L curves are similar to 1B curves and different in form and treatment from the 1A-R pattern.

  • Surgical treatment of main thoracic scoliosis with thoracoscopic anterior instrumentation. a five-year follow-up study.
    The Journal of bone and joint surgery. American volume, 2008
    Co-Authors: Peter O. Newton, Jeff Pawelek, Vidyadhar V. Upasani, Juliano Lhamby, Valerie L Ugrinow, Tracey P Bastrom
    Abstract:

    Background: The surgical outcomes in patients with scoliosis at two years following anterior thoracoscopic spinal in-strumentation and fusion have been reported. The purpose of this study was to evaluate the results at five years. Methods: A consecutive series of forty-one patients with major thoracic scoliosis treated with anterior thoracoscopic spinal instrumentation was evaluated at regular intervals. Prospectively collected data included patient demographics, radiographic measurements, Clinical Deformity measures, pulmonary function, an assessment of intervertebral fusion, and the scores on the Scoliosis Research Society (SRS-24) outcomes instrument. Perioperative and postoperative complications were recorded. Patient data for the preoperative, two-year, and five-year postoperative time points were compared. In addition, a univariate analysis compared selected two-year radiographic, pulmonary function, and SRS-24 data of the study cohort and those of the patients lost to follow-up. Results: Twenty-five (61%) of the original forty-one patients had five-year follow-up data and were included in the analysis. Between the two-year and five-year follow-up visits, no significant changes were observed with regard to the average percent correction of the major Cobb angle (56% ± 11% and 52% ± 14%, respectively), average total lung capacity as a percent of the predicted value (95% ± 14% and 91% ± 10%), and the average total SRS-24 score (4.2 ± 0.4 and 4.1 ± 0.7). Radiographic evaluation of intervertebral fusion at five years revealed convincing evidence of a fusion with remodeling and trabeculae present at 151 (97%) of the 155 instrumented motion segments. No postoperative infections or Clinically relevant neurovascular complications were observed. Rod failure occurred in three patients, and three patients required a surgical revision with posterior spinal instrumentation and fusion. Conclusions: Thoracoscopic anterior instrumentation for main thoracic idiopathic scoliosis results in five-year outcomes comparable with those reported previously for open anterior and posterior techniques. The radiographic findings, pulmonary function, and Clinical measures remain stable between the two and five-year follow-up time points. Thoracoscopic instrumentation provides a viable alternative to treat spinal Deformity; however, the risks of pseudarthrosis, hardware failure, and surgical revision should be considered along with the advantages of limited muscular dissection and improved scar appearance. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Vincent Arlet - One of the best experts on this subject based on the ideXlab platform.

  • Technical Consideration for TLIF Cage Retrieval and Deformity Correction With Anterior Interbody Fusion in Lumbar Revision Surgeries.
    Spine deformity, 2019
    Co-Authors: M. Burhan Janjua, Nissim Ackshota, Vincent Arlet
    Abstract:

    Abstract Introduction Symptomatic pseudoarthrosis after transforaminal lumbar interbody fusion (TLIF) could result in sagittal malalignment. Revision posterior surgery with TLIF cage removal poses a challenge intraoperatively. The authors have proposed salvage anterior approach for cage removal and have discussed unique experience with the correction in their Deformity patients. Methods All patients with symptoms of Clinical Deformity or symptomatic pseudoarthrosis operated from January of 2012 to February of 2018 were included in the study. TLIF cage removal followed by anterior lumbar interbody fusion (ALIF) surgery was performed in all patients. Radiographic sagittal parameters including thoracic kyphosis (TK; T4–T12), sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), the mismatch between pelvic incidence (PI) and LL (PI-LL), sacral slope (SS), pelvic tilt (PT), and PI were analyzed. Results 6 patients (mean age of 57 years, 83% female) underwent TLIF retrieval through anterior approach and ALIF with hyperlordotic cages (HLCs), followed by posterior spinal fusion surgery. Described technique entails use of tailored instruments with sequential gentle distraction of end plates with TLIF spreader could facilitate in the cage removal. Mean number of interbody levels fused pre as well as post were 1.5. The radiographic sagittal parameters from preoperative versus postoperative standing were as follows: T4–T12 TK, 16° vs. 37.6°; LL, −25° vs. −47.6°; PT, 36° vs. 26°; PI-LL, 35° vs. 12.4°; SVA, 12° vs. 5.6°; and TPA, 44° vs. 25°, with p Conclusions Anterior approach is a suitable technique for TLIF cage removal while preserving the end plates for subsequent optimal interbody fusion at the index level in symptomatic pseudoarthrosis patients or those with Clinical Deformity. ALIF with HLCs with or without Ponte osteotomy can restore segmental and overall sagittal alignment.

  • Technical Consideration for TLIF Cage Retrieval and Deformity Correction With Anterior Interbody Fusion in Lumbar Revision Surgeries
    Spine Deformity, 2019
    Co-Authors: M. Burhan Janjua, Nissim Ackshota, Vincent Arlet
    Abstract:

    Introduction Symptomatic pseudoarthrosis after transforaminal lumbar interbody fusion (TLIF) could result in sagittal malalignment. Revision posterior surgery with TLIF cage removal poses a challenge intraoperatively. The authors have proposed salvage anterior approach for cage removal and have discussed unique experience with the correction in their Deformity patients. Methods All patients with symptoms of Clinical Deformity or symptomatic pseudoarthrosis operated from January of 2012 to February of 2018 were included in the study. TLIF cage removal followed by anterior lumbar interbody fusion (ALIF) surgery was performed in all patients. Radiographic sagittal parameters including thoracic kyphosis (TK; T4–T12), sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), the mismatch between pelvic incidence (PI) and LL (PI-LL), sacral slope (SS), pelvic tilt (PT), and PI were analyzed. Results 6 patients (mean age of 57 years, 83% female) underwent TLIF retrieval through anterior approach and ALIF with hyperlordotic cages (HLCs), followed by posterior spinal fusion surgery. Described technique entails use of tailored instruments with sequential gentle distraction of end plates with TLIF spreader could facilitate in the cage removal. Mean number of interbody levels fused pre as well as post were 1.5. The radiographic sagittal parameters from preoperative versus postoperative standing were as follows: T4–T12 TK, 16° vs. 37.6°; LL, −25° vs. −47.6°; PT, 36° vs. 26°; PI-LL, 35° vs. 12.4°; SVA, 12° vs. 5.6°; and TPA, 44° vs. 25°, with p