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Se Il Suk - One of the best experts on this subject based on the ideXlab platform.
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pediatric posterior vertebral column resection pvcr before and after ten years of age greater than 10 year follow up
Spine, 2016Co-Authors: Donggune Chang, Jae Hyuk Yang, Junghee Lee, Jin Hyok Kim, Seungwoo Suh, Young Hoon Kim, Se Il SukAbstract:Study design A retrospective study. Objective To compare the surgical outcomes of posterior vertebral column resection (PVCR) and its long-term effects on the deformity correction for Congenital Scoliosis in children less than 18 years of age. Summary of background data There have been no reports on surgical outcomes that pertain to the timing of surgery for Congenital Scoliosis in children under age 18 years with long term follow-up. Methods Forty-five Congenital Scoliosis patients (N = 45) under age 18 at the time of surgery were treated by PVCR. These cases were retrospectively studied and had a minimum 10-year follow-up. We assigned patients into two groups: Group 1 (N = 19) patients who had surgery before 10 years of age, Group 2 (N = 26) patients who had surgery after 10 years of age. Results In Group 1, the mean Cobb angle of the main curve was 44° before surgery, 10.2° after surgery, and 14.2° at last follow-up. In Group 2, the mean Cobb angle of the main curve was 48.7° before surgery, 17.2° after surgery, and 20.4° at the last follow-up. The mean operative time was 189 minutes in Group 1 and 245 minutes in Group 2. The mean estimated blood loss (EBL) per kilogram was 52.9 mL/kg in Group 1 and 48.1 mL/kg in Group 2. There were 22 complications for PVCR and the overall prevalence of complications was 48.9%. Conclusion PVCR is an effective procedure for the management of Congenital Scoliosis under age 18. PVCR for Congenital Scoliosis before the age of 10 years had significantly better deformity correction compared with the group after the age of 10 years and did not cause crankshaft phenomenon. Level of evidence 4.
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Congenital kyphoScoliosis in monozygotic twins ten year follow up treated by posterior vertebral column resection pvcr a case report
Medicine, 2016Co-Authors: Donggune Chang, Jae Hyuk Yang, Junghee Lee, Jin Hyok Kim, Seungwoo Suh, Young Hoon Kim, Se Il SukAbstract:The etiology of Congenital Scoliosis and its development remains unclear and has not yet been fully identified, even there are theories that Congenital Scoliosis could be derived from the failure of formation or failure of segmentation, which are etiologically heterogeneous with genetic, epigenetic, and environmental factors contributing to their occurrence. We reported a case of long-term follow-up after posterior vertebral column resection (PVCR) in both identical twins with similar Congenital kyphoScoliosis at thoracolumbar levels. Twin I had been noticed by his parents to have asymmetry of his back at age 5 years, but no treatment was given. Twin II was first noticed to have a spinal problem at 11 years of age by his parents. Overtime, spine of both twins became further deviated to the left with kyphosis and was referred to our hospital. Both monozygotic twins were treated by PVCR and satisfactory results were demonstrated at 10-year follow-up.This case is the first report on the surgical treatment with PVCR, almost simultaneously, in both identical twins who had similar Congenital vertebral anomalies causing kyphoScoliosis. Both identical twins with Congenital kyphoScoliosis had undergone surgical correction by PVCR, anterior support with a mesh cage and posterior fusion using pedicle screws at the age of 14 years and achieved a satisfactory correction and a stable spine without curve progression with 10-year follow-up.
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Congenital Scoliosis treated with posterior vertebral column resection in patients younger than 18 years longer than 10 year follow up
Journal of Neurosurgery, 2016Co-Authors: Donggune Chang, Jae Hyuk Yang, Junghee Lee, Jin Hyok Kim, Seungwoo Suh, Se Il SukAbstract:OBJECTIVE There have been no reports on the long-term radiographic outcomes of posterior vertebral column resection (PVCR) in patients with Congenital Scoliosis. The purpose of this study was to evaluate the surgical outcomes and complications after PVCR and its long-term effects on correcting this deformity in children with Congenital Scoliosis. METHODS The authors retrospectively analyzed the medical records of 45 patients with Congenital Scoliosis who were younger than 18 years at the time of surgery and who underwent PVCR and fusion with pedicle screw fixation (PSF). The mean age of the patients at the time of surgery was 11.3 years (range 2.4-18.0 years), and the mean length of follow-up was 12.8 years (range 10.1-18.2 years). RESULTS The mean Cobb angle of the main curve was 46.5° before PVCR, 13.7° immediately after PVCR, and 17.6° at the last follow-up. For the compensatory cranial curve, PVCR corrected the preoperative Cobb angle of 21.2° to 9.1° postoperatively and maintained it at 10.9° at the last follow-up. For the compensatory caudal curve, the preoperative Cobb angle of 23.8° improved to 7.7° postoperatively and was 9.8° at the last follow-up. The authors noted 22 complications, and the overall incidence of complications was 48.9%. CONCLUSIONS Posterior vertebral column resection is an effective procedure for managing Congenital Scoliosis in patients younger than 18 years. Use of PVCR and fusion with PSF for Congenital Scoliosis achieved rigid fixation and satisfactory deformity correction that was maintained over the long term. However, the authors note that PVCR is a technically demanding procedure and entails risks for major complications and excessive blood loss.
Jae Hyuk Yang - One of the best experts on this subject based on the ideXlab platform.
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pediatric posterior vertebral column resection pvcr before and after ten years of age greater than 10 year follow up
Spine, 2016Co-Authors: Donggune Chang, Jae Hyuk Yang, Junghee Lee, Jin Hyok Kim, Seungwoo Suh, Young Hoon Kim, Se Il SukAbstract:Study design A retrospective study. Objective To compare the surgical outcomes of posterior vertebral column resection (PVCR) and its long-term effects on the deformity correction for Congenital Scoliosis in children less than 18 years of age. Summary of background data There have been no reports on surgical outcomes that pertain to the timing of surgery for Congenital Scoliosis in children under age 18 years with long term follow-up. Methods Forty-five Congenital Scoliosis patients (N = 45) under age 18 at the time of surgery were treated by PVCR. These cases were retrospectively studied and had a minimum 10-year follow-up. We assigned patients into two groups: Group 1 (N = 19) patients who had surgery before 10 years of age, Group 2 (N = 26) patients who had surgery after 10 years of age. Results In Group 1, the mean Cobb angle of the main curve was 44° before surgery, 10.2° after surgery, and 14.2° at last follow-up. In Group 2, the mean Cobb angle of the main curve was 48.7° before surgery, 17.2° after surgery, and 20.4° at the last follow-up. The mean operative time was 189 minutes in Group 1 and 245 minutes in Group 2. The mean estimated blood loss (EBL) per kilogram was 52.9 mL/kg in Group 1 and 48.1 mL/kg in Group 2. There were 22 complications for PVCR and the overall prevalence of complications was 48.9%. Conclusion PVCR is an effective procedure for the management of Congenital Scoliosis under age 18. PVCR for Congenital Scoliosis before the age of 10 years had significantly better deformity correction compared with the group after the age of 10 years and did not cause crankshaft phenomenon. Level of evidence 4.
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Congenital kyphoScoliosis in monozygotic twins ten year follow up treated by posterior vertebral column resection pvcr a case report
Medicine, 2016Co-Authors: Donggune Chang, Jae Hyuk Yang, Junghee Lee, Jin Hyok Kim, Seungwoo Suh, Young Hoon Kim, Se Il SukAbstract:The etiology of Congenital Scoliosis and its development remains unclear and has not yet been fully identified, even there are theories that Congenital Scoliosis could be derived from the failure of formation or failure of segmentation, which are etiologically heterogeneous with genetic, epigenetic, and environmental factors contributing to their occurrence. We reported a case of long-term follow-up after posterior vertebral column resection (PVCR) in both identical twins with similar Congenital kyphoScoliosis at thoracolumbar levels. Twin I had been noticed by his parents to have asymmetry of his back at age 5 years, but no treatment was given. Twin II was first noticed to have a spinal problem at 11 years of age by his parents. Overtime, spine of both twins became further deviated to the left with kyphosis and was referred to our hospital. Both monozygotic twins were treated by PVCR and satisfactory results were demonstrated at 10-year follow-up.This case is the first report on the surgical treatment with PVCR, almost simultaneously, in both identical twins who had similar Congenital vertebral anomalies causing kyphoScoliosis. Both identical twins with Congenital kyphoScoliosis had undergone surgical correction by PVCR, anterior support with a mesh cage and posterior fusion using pedicle screws at the age of 14 years and achieved a satisfactory correction and a stable spine without curve progression with 10-year follow-up.
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Congenital Scoliosis treated with posterior vertebral column resection in patients younger than 18 years longer than 10 year follow up
Journal of Neurosurgery, 2016Co-Authors: Donggune Chang, Jae Hyuk Yang, Junghee Lee, Jin Hyok Kim, Seungwoo Suh, Se Il SukAbstract:OBJECTIVE There have been no reports on the long-term radiographic outcomes of posterior vertebral column resection (PVCR) in patients with Congenital Scoliosis. The purpose of this study was to evaluate the surgical outcomes and complications after PVCR and its long-term effects on correcting this deformity in children with Congenital Scoliosis. METHODS The authors retrospectively analyzed the medical records of 45 patients with Congenital Scoliosis who were younger than 18 years at the time of surgery and who underwent PVCR and fusion with pedicle screw fixation (PSF). The mean age of the patients at the time of surgery was 11.3 years (range 2.4-18.0 years), and the mean length of follow-up was 12.8 years (range 10.1-18.2 years). RESULTS The mean Cobb angle of the main curve was 46.5° before PVCR, 13.7° immediately after PVCR, and 17.6° at the last follow-up. For the compensatory cranial curve, PVCR corrected the preoperative Cobb angle of 21.2° to 9.1° postoperatively and maintained it at 10.9° at the last follow-up. For the compensatory caudal curve, the preoperative Cobb angle of 23.8° improved to 7.7° postoperatively and was 9.8° at the last follow-up. The authors noted 22 complications, and the overall incidence of complications was 48.9%. CONCLUSIONS Posterior vertebral column resection is an effective procedure for managing Congenital Scoliosis in patients younger than 18 years. Use of PVCR and fusion with PSF for Congenital Scoliosis achieved rigid fixation and satisfactory deformity correction that was maintained over the long term. However, the authors note that PVCR is a technically demanding procedure and entails risks for major complications and excessive blood loss.
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posterior multilevel vertebral osteotomy for severe and rigid idiopathic and nonidiopathic kyphoScoliosis a further experience with minimum two year follow up
Spine, 2011Co-Authors: Hitesh N Modi, Seungwoo Suh, Jae Young Hong, Jae Hyuk YangAbstract:Study design Prospective randomized study. Objective To evaluate the clinica! and radiologic outcome of posterior multilevel vertebral osteotomy (PMVO) in patients with severe kyphoScoliosis. Summary of background data Authors have developed and reported results of PMVO for correction of neuromuscular Scoliosis. PMVO has advantages such as, posterior-only procedure which avoids risk to pulmonary complications and gives satisfactory correction. However, its effect in correcting severe Scoliosis in presence of rigid kyphosis has not been reported. Methods Thirteen patients (7 idiopathic, 4 cerebral palsy, and 2 Congenital Scoliosis) with severe and rigid kyphoScoliosis were operated by posterior-only correction with pedicle screw fixation using PMVO. As per pathology, and associated severity of kyphosis little modification in the original technique was applied while correction and osteotomy. Neuromonitoring was applied in all patients during operation. The radiologic and clinical results were evaluated with an average follow-up of 42.9±11 months. All postoperative complications were also noted during the follow-up period. Results Average number of osteotomy was 4.2±0.8 (range, 3-5). Average preoperative Cobb angle, pelvic obliquity, thoracic kyphosis, and lumbar lordosis were 99.2°±29.6°, 8.6°±9°, 73.6°±56.9°, and -47.2°±63.2°, respectively, which improved after surgery to 44.7°±12.3°, 2.8°±2.9°, 45.3°±15.9°, and -47.7°±12.2°. All corrections were maintained at final follow-up. A 54.3% correction was achieved in coronal plane; and, full correction was achieved in sagital plane as thoracic kyphosis was restored within normal range. Average blood loss and operative time was 3015±1213 mL and 6.01±1.09 hours, respectively. Three patients had postoperative respiratory complications; 2 had hemothorax and 1 had atelectasis; none had follow-up consequences. All pulmonary complications were due to associated thoracoplasty during which pleura was ruptured intraoperatively. Two patients had complication related with the implants; 1 screw breakage and other screw prominence. There was no neurologic injury intraoperatively on motor-evoked po- tentials (MEP) or clinically after surgery. Conclusion PMVO exhibited satisfactory clinical and radiologic results in patients with severe and rigid Scoliosis associated with hyperkyphosis at minimum 2-year follow-up. It can be safely applied with modifications in original technique for complex Congenital Scoliosis with multilevel hemi or block vertebrae and idiopathic/nonidiopathic spinal deformities.
Donggune Chang - One of the best experts on this subject based on the ideXlab platform.
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pediatric posterior vertebral column resection pvcr before and after ten years of age greater than 10 year follow up
Spine, 2016Co-Authors: Donggune Chang, Jae Hyuk Yang, Junghee Lee, Jin Hyok Kim, Seungwoo Suh, Young Hoon Kim, Se Il SukAbstract:Study design A retrospective study. Objective To compare the surgical outcomes of posterior vertebral column resection (PVCR) and its long-term effects on the deformity correction for Congenital Scoliosis in children less than 18 years of age. Summary of background data There have been no reports on surgical outcomes that pertain to the timing of surgery for Congenital Scoliosis in children under age 18 years with long term follow-up. Methods Forty-five Congenital Scoliosis patients (N = 45) under age 18 at the time of surgery were treated by PVCR. These cases were retrospectively studied and had a minimum 10-year follow-up. We assigned patients into two groups: Group 1 (N = 19) patients who had surgery before 10 years of age, Group 2 (N = 26) patients who had surgery after 10 years of age. Results In Group 1, the mean Cobb angle of the main curve was 44° before surgery, 10.2° after surgery, and 14.2° at last follow-up. In Group 2, the mean Cobb angle of the main curve was 48.7° before surgery, 17.2° after surgery, and 20.4° at the last follow-up. The mean operative time was 189 minutes in Group 1 and 245 minutes in Group 2. The mean estimated blood loss (EBL) per kilogram was 52.9 mL/kg in Group 1 and 48.1 mL/kg in Group 2. There were 22 complications for PVCR and the overall prevalence of complications was 48.9%. Conclusion PVCR is an effective procedure for the management of Congenital Scoliosis under age 18. PVCR for Congenital Scoliosis before the age of 10 years had significantly better deformity correction compared with the group after the age of 10 years and did not cause crankshaft phenomenon. Level of evidence 4.
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Congenital kyphoScoliosis in monozygotic twins ten year follow up treated by posterior vertebral column resection pvcr a case report
Medicine, 2016Co-Authors: Donggune Chang, Jae Hyuk Yang, Junghee Lee, Jin Hyok Kim, Seungwoo Suh, Young Hoon Kim, Se Il SukAbstract:The etiology of Congenital Scoliosis and its development remains unclear and has not yet been fully identified, even there are theories that Congenital Scoliosis could be derived from the failure of formation or failure of segmentation, which are etiologically heterogeneous with genetic, epigenetic, and environmental factors contributing to their occurrence. We reported a case of long-term follow-up after posterior vertebral column resection (PVCR) in both identical twins with similar Congenital kyphoScoliosis at thoracolumbar levels. Twin I had been noticed by his parents to have asymmetry of his back at age 5 years, but no treatment was given. Twin II was first noticed to have a spinal problem at 11 years of age by his parents. Overtime, spine of both twins became further deviated to the left with kyphosis and was referred to our hospital. Both monozygotic twins were treated by PVCR and satisfactory results were demonstrated at 10-year follow-up.This case is the first report on the surgical treatment with PVCR, almost simultaneously, in both identical twins who had similar Congenital vertebral anomalies causing kyphoScoliosis. Both identical twins with Congenital kyphoScoliosis had undergone surgical correction by PVCR, anterior support with a mesh cage and posterior fusion using pedicle screws at the age of 14 years and achieved a satisfactory correction and a stable spine without curve progression with 10-year follow-up.
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Congenital Scoliosis treated with posterior vertebral column resection in patients younger than 18 years longer than 10 year follow up
Journal of Neurosurgery, 2016Co-Authors: Donggune Chang, Jae Hyuk Yang, Junghee Lee, Jin Hyok Kim, Seungwoo Suh, Se Il SukAbstract:OBJECTIVE There have been no reports on the long-term radiographic outcomes of posterior vertebral column resection (PVCR) in patients with Congenital Scoliosis. The purpose of this study was to evaluate the surgical outcomes and complications after PVCR and its long-term effects on correcting this deformity in children with Congenital Scoliosis. METHODS The authors retrospectively analyzed the medical records of 45 patients with Congenital Scoliosis who were younger than 18 years at the time of surgery and who underwent PVCR and fusion with pedicle screw fixation (PSF). The mean age of the patients at the time of surgery was 11.3 years (range 2.4-18.0 years), and the mean length of follow-up was 12.8 years (range 10.1-18.2 years). RESULTS The mean Cobb angle of the main curve was 46.5° before PVCR, 13.7° immediately after PVCR, and 17.6° at the last follow-up. For the compensatory cranial curve, PVCR corrected the preoperative Cobb angle of 21.2° to 9.1° postoperatively and maintained it at 10.9° at the last follow-up. For the compensatory caudal curve, the preoperative Cobb angle of 23.8° improved to 7.7° postoperatively and was 9.8° at the last follow-up. The authors noted 22 complications, and the overall incidence of complications was 48.9%. CONCLUSIONS Posterior vertebral column resection is an effective procedure for managing Congenital Scoliosis in patients younger than 18 years. Use of PVCR and fusion with PSF for Congenital Scoliosis achieved rigid fixation and satisfactory deformity correction that was maintained over the long term. However, the authors note that PVCR is a technically demanding procedure and entails risks for major complications and excessive blood loss.
Anna K Hellvocke - One of the best experts on this subject based on the ideXlab platform.
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expansion thoracoplasty the surgical technique of opening wedge thoracostomy
Journal of Bone and Joint Surgery American Volume, 2004Co-Authors: Robert M Campbell, Melvin D Smith, Anna K HellvockeAbstract:BACKGROUND: Children with Congenital thoracic Scoliosis associated with fused ribs with a unilateral unsegmented bar adjacent to convex hemivertebrae will invariably have curve progression without treatment. Surgery has been thought to have a negligible growth-inhibition effect on the thoracic spine in such patients because it has been assumed that the concave side of the curve and the unilateral unsegmented bar do not grow, but we are unaware of any conclusive studies regarding this assumption. METHODS: The changes in the length of the concave and convex sides, anterior and posterior vertebral edges, posterior arch, and unilateral unsegmented bars of the thoracic spine were measured in the twenty-one children with Congenital Scoliosis and fused ribs after expansion thoracoplasty had been carried out with use of a vertical, expandable titanium prosthetic rib. Three of these children hadundergone posterior spinal fusion previously. Measurements were made with use of a three-dimensional software program that analyzed baseline and follow-up computed tomography scans. The technique was validated through measurement of the thorax of a small female adult cadaver. RESULTS: The patients without spine fusion had an average age of 3.3 years at the time of the baseline computed tomography scan, and the average duration of follow-up was 4.2 years. On the average, these patients showed significant growth (p < 0.0001) of the concave side of the thoracic spine (an increase in length of 7.9 mm/yr, or 7.1%/yr) and the convex side (8.3 mm/yr, or 6.4%/yr) compared with the baseline lengths. There was no significant difference in the increases in length (p = 0.38) between the concave and convex sides. Eleven patients with an unsegmented bar had an average 7.3% increase in the length of the bar (p < 0.0001). In the three children with prior spinal fusion, the increase in length averaged only 4.6 mm/yr (3%/yr) on the concave side of the thoracic spine and 3.7 mm/yr (2.2%/yr) on the convex side; both increases were significant (p < 0.0001). CONCLUSIONS: Longitudinal growth of the thoracic spine in a normal child has been estimated to be 0.6 cm/yr between the ages of five and nine years. After expansion thoracoplasty, growth of the thoracic spine was approximately 8 mm/yr in our series of children with Congenital Scoliosis and fused ribs. After expansion thoracoplasty, both the concave and the convex side of the thoracic spine and unilateral unsegmented bars appeared to grow in these patients. When a thorax is already foreshortened by Congenital Scoliosis, control of spine deformity with expansion thoracoplasty allows growth of the thoracic spine, and it is likely that the longer thorax provides additional volume for growth of the underlying lungs with probable clinical benefit.
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expansion thoracoplasty the surgical technique of opening wedge thoracostomy surgical technique
Journal of Bone and Joint Surgery American Volume, 2004Co-Authors: Robert M Campbell, Melvin D Smith, Anna K HellvockeAbstract:BACKGROUND: Children with Congenital thoracic Scoliosis associated with fused ribs with a unilateral unsegmented bar adjacent to convex hemivertebrae will invariably have curve progression without treatment. Surgery has been thought to have a negligible growth-inhibition effect on the thoracic spine in such patients because it has been assumed that the concave side of the curve and the unilateral unsegmented bar do not grow, but we are unaware of any conclusive studies regarding this assumption. METHODS: The changes in the length of the concave and convex sides, anterior and posterior vertebral edges, posterior arch, and unilateral unsegmented bars of the thoracic spine were measured in the twenty-one children with Congenital Scoliosis and fused ribs after expansion thoracoplasty had been carried out with use of a vertical, expandable titanium prosthetic rib. Three of these children had undergone posterior spinal fusion previously. Measurements were made with use of a three-dimensional software program that analyzed baseline and follow-up computed tomography scans. The technique was validated through measurement of the thorax of a small female adult cadaver. RESULTS: The patients without spine fusion had an average age of 3.3 years at the time of the baseline computed tomography scan, and the average duration of follow-up was 4.2 years. On the average, these patients showed significant growth (p < 0.0001) of the concave side of the thoracic spine (an increase in length of 7.9 mm/yr, or 7.1%/yr) and the convex side (8.3 mm/yr, or 6.4%/yr) compared with the baseline lengths. There was no significant difference in the increases in length (p = 0.38) between the concave and convex sides. Eleven patients with an unsegmented bar had an average 7.3% increase in the length of the bar (p < 0.0001). In the three children with prior spinal fusion, the increase in length averaged only 4.6 mm/yr (3%/yr) on the concave side of the thoracic spine and 3.7 mm/yr (2.2%/yr) on the convex side; both increases were significant (p < 0.0001). CONCLUSIONS: Longitudinal growth of the thoracic spine in a normal child has been estimated to be 0.6 cm/yr between the ages of five and nine years. After expansion thoracoplasty, growth of the thoracic spine was approximately 8 mm/yr in our series of children with Congenital Scoliosis and fused ribs. After expansion thoracoplasty, both the concave and the convex side of the thoracic spine and unilateral unsegmented bars appeared to grow in these patients. When a thorax is already foreshortened by Congenital Scoliosis, control of spine deformity with expansion thoracoplasty allows growth of the thoracic spine, and it is likely that the longer thorax provides additional volume for growth of the underlying lungs with probable clinical benefit.
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growth of the thoracic spine in Congenital Scoliosis after expansion thoracoplasty
Journal of Bone and Joint Surgery American Volume, 2003Co-Authors: Robert M Campbell, Anna K HellvockeAbstract:Background: Children with Congenital thoracic Scoliosis associated with fused ribs with a unilateral unsegmented bar adjacent to convex hemivertebrae will invariably have curve progression without treatment. Surgery has been thought to have a negligible growth-inhibition effect on the thoracic spine in such patients because it has been assumed that the concave side of the curve and the unilateral unsegmented bar do not grow, but we are unaware of any conclusive studies regarding this assumption. Methods: The changes in the length of the concave and convex sides, anterior and posterior vertebral edges, posterior arch, and unilateral unsegmented bars of the thoracic spine were measured in the twenty-one children with Congenital Scoliosis and fused ribs after expansion thoracoplasty had been carried out with use of a vertical, expandable titanium prosthetic rib. Three of these children had undergone posterior spinal fusion previously. Measurements were made with use of a three-dimensional software program that analyzed baseline and follow-up computed tomography scans. The technique was validated through measurement of the thorax of a small female adult cadaver. Results: The patients without spine fusion had an average age of 3.3 years at the time of the baseline computed tomography scan, and the average duration of follow-up was 4.2 years. On the average, these patients showed significant growth (p < 0.0001) of the concave side of the thoracic spine (an increase in length of 7.9 mm/yr, or 7.1%/yr) and the convex side (8.3 mm/yr, or 6.4%/yr) compared with the baseline lengths. There was no significant difference in the increases in length (p = 0.38) between the concave and convex sides. Eleven patients with an unsegmented bar had an average 7.3% increase in the length of the bar (p < 0.0001). In the three children with prior spinal fusion, the increase in length averaged only 4.6 mm/yr (3%/yr) on the concave side of the thoracic spine and 3.7 mm/yr (2.2%/yr) on the convex side; both increases were significant (p < 0.0001). Conclusions: Longitudinal growth of the thoracic spine in a normal child has been estimated to be 0.6 cm/yr between the ages of five and nine years. After expansion thoracoplasty, growth of the thoracic spine was approximately 8 mm/yr in our series of children with Congenital Scoliosis and fused ribs. After expansion thoracoplasty, both the concave and the convex side of the thoracic spine and unilateral unsegmented bars appeared to grow in these patients. When a thorax is already foreshortened by Congenital Scoliosis, control of spine deformity with expansion thoracoplasty allows growth of the thoracic spine, and it is likely that the longer thorax provides additional volume for growth of the underlying lungs with probable clinical benefit. Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
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4 03 the growth of the thoracic spine in Congenital Scoliosis after expansion thoracoplasty
The Spine Journal, 2002Co-Authors: Robert M Campbell, Anna K HellvockeAbstract:Purpose of study: Children with Congenital thoracic Scoliosis associated with fused ribs with unilateral unsegmented bars adjacent to convex hemivertebra will invariably have curve progression without treatment. The growth inhibition effects on the thoracic spine by surgery is said to be neglectable, because it is assumed that the concave side of such curves and the unilateral unsegmented bars do not grow, but we are unaware of any conclusive studies regarding this assumption. Methods used: We measured the change in length of the thoracic spine on the concave, convex, anterior and posterior vertebral edges and the anterior surface of the posterior arch in 21 children (13 male, 8 female) with Congenital Scoliosis treated through expansion thoracoplasty by titanium rib prosthesis. Eleven unilateral unsegmented bars were also measured in 10 patients. Three of these children had undergone posterior spinal fusion before titanium rib implantation. Measurements were obtained using a three-dimensional software program (Vitrea 2, Vital Images, Inc, Minneapolis, MN), assessing baseline computed tomography (CT) scans and the latest follow-up scans. The technique was validated through measurement of a small female adult cadaver thorax. of findings: The average age at the baseline CT scan was 3.3 years, the average follow-up time 4.2 years (range, 1.8 to 6.2 years). An average of 7.6 prosthesis expansion surgeries (range, 1 to 16) were performed within the follow-up time. All patients on average showed significant growth (p<.0001) of the concave side of the thoracic spine (7.9 mm increase in length per year, 7.1% increase per year) and the convex side (8.3 mm increase in length per year, 6.4% increase per year) with no significant difference (p=.38) between sides. Unilateral unsegmented bars showed an average of 7.3% increase in length (p<.0001). Younger children showed more growth than older ones. In the three children with prior spinal fusion, the increase in length of the concave side of the thoracic spine was only 2.2 mm/year (2%/year) and the convex side 2.2 mm/year (3%/year), but both increases were significant (p<.0001). There was no correlation between the numbers of expansion surgeries and spinal growth. Relationship between findings and existing knowledge: Our findings suggest that thoracic unilateral unsegmented bars, thought incapable of growth in past literature, can grow when expansion thoracoplasty is performed. Continuing growth of the thoracic spine in such patients will likely result in a longer thorax, providing additional volume for growth of the underlying lungs with probable clinical benefit. Overall significance of findings: In children with Congenital Scoliosis treated through expansion thoracoplasty by titanium rib prosthesis, both concave and convex sides of the thoracic spine and unilateral unsegmented bars grow, allowing the thoracic spine to grow in length. Our results also suggest that younger children with prior spine fusion have less growth of the thoracic spine than children without spine fusions. Disclosures: Device or drug: Vertical Expandable Prosthetic Titanium Rib (VEPTR). Status: investigational. Conflict of interest: Robert Campbell, Jr., grant research from National Organization of Rare Disorders, FDA; Robert Campbell, Jr., Royalties, Synthes Spine Co.
Jianxiong Shen - One of the best experts on this subject based on the ideXlab platform.
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Older fusion-surgery age in Congenital Scoliosis patients is a risk factor for extended length of stay, more estimated blood loss, longer fused segments and higher medical costs: a retrospective study
'Springer Science and Business Media LLC', 2021Co-Authors: Xiran Chai, Jianxiong Shen, Shengru Wang, Yang Yang, Guanfeng Lin, Jianguo ZhangAbstract:Abstract Background Contradictory opinions about whether early correction and fusion surgeries should be performed for Congenital Scoliosis (CS) patients at a young age exist. The objectives of this study were to analyze the association between patient characteristics and fusion-surgery outcomes in CS patients treated with spinal correction and fusion surgeries and to report risk factors for extended length of stay (LOS), more estimated blood loss (EBL), longer fused segments and higher medical costs. Methods We analyzed data of 1,207 CS inpatients treated with fusion surgeries in our institute from January 2010 - December 2019. All patients underwent spinal X-ray, CT, MRI, echocardiogram and urogenital ultrasound. We analyzed demographic and clinical information and outcome measures, including LOS, EBL, fused segments and medical costs. Results Age at fusion (OR = 1.053; p
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lncrna sult1c2a regulates foxo4 in Congenital Scoliosis by targeting rno mir 466c 5p through pi3k atk signalling
Journal of Cellular and Molecular Medicine, 2019Co-Authors: Chong Chen, Haining Tan, Tianhua Rong, Youxi Lin, Liang Sun, Jinqian Liang, Peiyu Sun, Yang Jiao, Jianxiong ShenAbstract:Congenital Scoliosis (CS) is the result of anomalous vertebrae development, but the pathogenesis of CS remains unclear. Long non-coding RNAs (lncRNAs) have been implicated in embryo development, but their role in CS remains unknown. In this study, we investigated the role and mechanisms of a specific lncRNA, SULT1C2A, in somitogenesis in a rat model of vitamin A deficiency (VAD)-induced CS. Bioinformatics analysis and quantitative real-time PCR (qRT-PCR) indicated that SULT1C2A expression was down-regulated in VAD group, accompanied by increased expression of rno-miR-466c-5p but decreased expression of Foxo4 and somitogenesis-related genes such as Pax1, Nkx3-2 and Sox9 on gestational day (GD) 9. Luciferase reporter and small interfering RNA (siRNA) assays showed that SULT1C2A functioned as a competing endogenous RNA to inhibit rno-miR-466c-5p expression by direct binding, and rno-miR-466c-5p inhibited Foxo4 expression by binding to its 3' untranslated region (UTR). The spatiotemporal expression of SULT1C2A, rno-miR-466c-5p and Foxo4 axis was dynamically altered on GDs 3, 8, 11, 15 and 21 as detected by qRT-PCR and northern blot analyses, with parallel changes in Protein kinase B (AKT) phosphorylation and PI3K expression. Taken together, our findings indicate that SULT1C2A enhanced Foxo4 expression by negatively modulating rno-miR-466c-5p expression via the PI3K-ATK signalling pathway in the rat model of VAD-CS. Thus, SULT1C2A may be a potential target for treating CS.
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Identification of Competing Endogenous RNA Regulatory Networks in Vitamin A Deficiency-Induced Congenital Scoliosis by Transcriptome Sequencing Analysis
Karger Publishers, 2018Co-Authors: Chong Chen, Haining Tan, Tianhua Rong, Youxi Lin, Liang Sun, Jianxiong ShenAbstract:Background/Aims: Congenital Scoliosis (CS) is a result of anomalous development of vertebrae and is frequently associated with somitogenesis malformation. Although noncoding RNAs (ncRNAs) have been recently determined to be involved in the pathogenesis of CS, the competing endogenous RNA (ceRNA) regulatory networks in CS remain largely unknown. Methods: Sequencing was conducted to explore the ncRNA expression profiles in rat embryos (gestation day 9) following vitamin A deficiency (VAD) (n = 9 for the vitamin A deficiency-induced Congenital Scoliosis (VAD-CS) group and n = 4 for the control group). Real-time reverse transcriptase polymerase chain reaction (RT-PCR) was conducted to verify the expression levels of selected mRNAs, long noncoding RNAs (lncRNAs), circular RNAs (circRNAs), and microRNAs (miRNAs). Bioinformatics analysis was used to discover the possible relationships and functions of the ceRNAs. Results: A total of 749 mRNAs, 56 miRNAs, 685 lncRNAs, and 70 circRNAs were identified to have significantly different expression levels in the two groups. Wnt, PI3K-ATK, FoxO, EGFR, and mTOR were found to be the most significant pathways involved in VAD-CS pathogenesis. The circRNA/miRNA/mRNA and lncRNA/miRNA/mRNA networks of CS were built, and the gene expression mechanisms regulated by ncRNAs were unveiled via the ceRNA regulatory networks. Conclusion: We comprehensively identified ceRNA regulatory networks of embryonic somite development in VAD-CS as well as revealed the contribution of different ncRNA expression profiles. Our data demonstrate the association between mRNAs and ncRNAs in the pathogenic mechanism of CS
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Radiographic characteristics in Congenital Scoliosis associated with split cord malformation: a retrospective study of 266 surgical cases
BMC, 2017Co-Authors: Fan Feng, Jianguo Zhang, Chong Chen, Haining Tan, Jianxiong ShenAbstract:Abstract Background Vertebrae, ribs, and spinal cord are anatomically adjacent structures, and their close relationships are clinically important for planning better corrective surgical approach. The objective is to identify the radiographic characteristics in surgical patients with Congenital Scoliosis (CS) and coexisting split cord malformation (SCM). Methods A total of 266 patients with CS and SCM underwent surgical treatment at our hospital between May 2000 and December 2015 was retrospectively identified. The demographic distribution and radiographic data were collected to investigate the characteristics of spine curve, vertebral, rib, and intraspinal anomalies. According to Pang’s classification, all patients were divided into two groups: type I group is defined as two hemicords, each within a separate dural tube separated by a bony or cartilaginous medial spur, while type II group is defined as two hemicords within a single dural tube separated by a nonrigid fibrous septum. Results There were 104 patients (39.1%) in Type I group and 162 patients (60.9%) in Type II group. SCM was most commonly found in the lower thoracic and lumbar regions. The mean length of the septum in Type I SCM was significantly shorter than Type II SCM (2.7 vs. 5.2 segments). Patients in Type I group had a higher proportion of kyphotic deformity (22.1%). The vertebral deformities were simple in only 16.5% and multiple in 83.5% of 266 cases. Patients in Type I group presented higher prevalence of multiple (90.4%) and extensive (5.1 segments) malformation of vertebrae. In addition, hypertrophic lamina and bulbous spinous processes were more frequent in Type I group (29.7%), even developing into the “volcano-shape” deformities. Rib anomalies occurred in 62.8% of all patients and 46.1% of them were complex anomalies. The overall prevalence of other intraspinal anomalies was 42.9%. The most common coexisting intraspinal anomalies was syringomyelia (30.5%). Conclusion The current study, with the largest cohort to date, demonstrated that patients with CS and coexisting SCM presented high prevalence of multiple vertebral deformities, rib and intraspinal anomalies. The length of the split segment in Type I SCM was shorter than that in Type II SCM. Compared with Type II SCM, patients with Type I SCM presented with higher incidence of kyphotic deformity, more extensive and complicated vertebral anomalies, and more complex rib anomalies
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characteristics and clinical relevance of the osseous spur in patients with Congenital Scoliosis and split spinal cord malformation
Journal of Bone and Joint Surgery American Volume, 2016Co-Authors: Fan Feng, Jianxiong Shen, Jianguo Zhang, Shugang Li, Keyi YuAbstract:Background: The natural history of split spinal cord malformation (SCM) is still unclear. Knowledge of the characteristics of the osseous spur and its relationship with the spinal deformity may allow early identification of patients with a higher risk of a neurological deficit and enhance surgical decision-making. Methods: Eighty-five consecutive patients with Congenital Scoliosis and type-I SCM who had undergone surgical treatment at our hospital from May 2000 to December 2013 were identified retrospectively. There were 22 male and 63 female patients with an average age of 13.9 years at the time of surgery. Preoperative clinical and radiographic data were collected to investigate the characteristics of the Scoliosis and the osseous spur. Two groups were identified on the basis of whether the patients had intact neurological function (Group A) or a neurological deficit (Group B). Results: There were 52 patients (61%) in Group A (intact neurological function) and 33 patients (39%) in Group B (neurological deficit). There were no significant differences in the demographic distribution, curve magnitude, or length and thickness of the osseous spur between the 2 groups. In Group A, the location of the osseous spur relative to the apex of the major curve was proximal in 13 patients (25%), distal in 28 (54%), and central in 11 (21%). In Group B, the osseous spur was proximal in 7 (21%), distal in 8 (24%), and central in 18 (55%). The 2 groups differed significantly with respect to the location of the osseous spur (chi square = 10.898, p = 0.004). Group-B patients had a higher proportion of patients with kyphotic deformity (42%) than Group A (10%). The ratio of the diameters of the hemicords (concave side divided by convex side) differed significantly between the 2 groups (0.98 for Group A versus 0.89 for Group B, p = 0.030). Conclusions: The neurological status in patients with Congenital Scoliosis and type-I SCM appears to be closely related to the location of the osseous spur relative to the Congenital Scoliosis. An osseous spur at the apex of the Scoliosis may be related to a higher risk of developing a neurological deficit, especially in patients with kyphotic deformity. Asymmetric splitting of the spinal cord may contribute to neurological deficits. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.