scholarly journals Survey to describe variability in early onset scoliosis cast practices

2018 ◽  
Vol 12 (4) ◽  
pp. 406-412 ◽  
Author(s):  
A. Grzywna ◽  
A. McClung ◽  
J. Sanders ◽  
P. Sturm ◽  
L. Karlin ◽  
...  
Keyword(s):  
Early Onset ◽  
Congenital Scoliosis ◽  
Patient Characteristics ◽  
Study Groups ◽  
Early Onset Scoliosis ◽  
Radiographic Evaluation ◽  
Level Of Evidence ◽  
Major Curve ◽  
Radiographic Measurements ◽  
Multicentre Research

Purpose To investigate paediatric orthopaedists’ cast practices for early onset scoliosis regarding patient selection, cast application, radiographic evaluation, treatment cessation and adjunctive bracing. Methods A casting survey was distributed to all paediatric orthopaedists in Children’s Spine and Growing Spine Study Groups (n = 92). Questions included physician and patient characteristics, technique, treatment, outcomes, radiographic measurements and comparison to other treatments. A total of 55 orthopaedists (60%) responded, and descriptive statistics were calculated on the subset who cast (n = 45). Results A majority of respondents use cast treatment for idiopathic and syndromic scoliosis patients, but not for neuromuscular or congenital scoliosis patients. Major curve angle ranked most important in orthopaedists’ decision to commence cast treatment, in comparison with rib-vertebra angle difference or clinical observations. The major curve angle threshold to initiate casting was a median of 30° (20° to 70°), and the minimum patient age was median ten months (3 to 24). First in-cast and out-of-cast radiographs are taken standing, supine, awake, under anesthesia and/or in traction. In all, 58% consistently cast over or under the arm, while 44% vary position by patient. Respondents were divided about the use of a brace after cast treatment: 22% do not prescribe a brace, 31% always do and 36% do in some patients. Conclusions Future multicentre research studies must standardize radiographic practices and consider age and major curve angle at cast initiation and termination, scoliosis aetiology, shoulder position and treatment duration. Practices need to be aligned or compared in these areas in order to distinguish what makes for the best cast treatment possible. Level of Evidence V, Expert opinion

scholarly journals EVALUATION OF THE VEPTR SYSTEM IN THE MANAGEMENT OF SPINAL DEFORMITIES BETWEEN 2008 AND 2014 AT THE ROOSEVELT INSTITUTE

2018 ◽  
Vol 17 (4) ◽  
pp. 266-269
Author(s):  
Carlos Segundo Montero ◽  
David Meneses ◽  
Fernando Alvarado ◽  
Wilmer Godoy ◽  
Maria Margarita Acosta ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Early Onset ◽  
Case Series ◽  
Deformity Correction ◽  
Congenital Scoliosis ◽  
Neuromuscular Scoliosis ◽  
Three Dimensions ◽  
Thoracic Wall ◽  
Level Of Evidence ◽  
Radiographic Images

ABSTRACT Objective: Traditional surgical treatments, such as on-site fusion and hemiepiphysiodesis, have not addressed chest deformity in its three dimensions, and are usually insufficient and unpredictable for the management of congenital and neuromuscular scoliosis. The application of the Vertical Expandable Prosthetic Titanium Rib (VEPTR) is a technique developed to treat early-onset progressive scoliosis that elongates the spine and thoracic wall, allowing adequate lung development. Methods: A case series retrospective study was conducted. We included 23 patients, including fifteen females and eight males diagnosed with congenital and neuromuscular scoliosis, who were treated with VEPTR type implants between January 2008 and May 2014. We obtained data about the implant and pre and postoperative radiographic images to assess the magnitude of the curve, and we measured the Cobb angle and length after lengthening, as well as evaluating the complications found. Results: There was an improvement in the postoperative Cobb angle. In patients with congenital scoliosis, deformity correction was 8.6% (p=0.014), and in neuromuscular scoliosis, we observed deformity correction of 19.5% (p=0.009). Likewise, we found gains in thoracic height through the device, which results in an average 10% lengthening of the spine in congenital scoliosis. In this study, we identified complications such as material migrations, rib synostosis, pressure zones, rib fracture, hemothorax, and deep wound infection. Conclusion: The natural history of progressive spinal deformity was improved in most of the minors, through the use of VEPTR. This allows us to continue managing patients in the future, in order to make a deeper assessment of its performance in treatment of early onset scoliosis. Level of Evidence III; Therapeutic studies - Investigating the results of a treatment.

scholarly journals Traditional growing rod for early-onset scoliosis in high-altitude regions: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Haijun Jiang ◽  
Junrui Jonathan Hai ◽  
Peng Yin ◽  
Qingjun Su ◽  
Shiqi Zhu ◽  
...  
Keyword(s):  
Cobb Angle ◽  
High Altitude ◽  
Early Onset ◽  
Repeated Measures ◽  
Early Onset Scoliosis ◽  
Sacral Slope ◽  
Growing Rods ◽  
Initial Surgery ◽  
Radiographic Measurements

Abstract Background Children with early-onset scoliosis living in high-altitude areas have severe deformities and poor nutritional status. However, no reports on early-onset scoliosis treatment using traditional growing rods in such children exist. Thus, we analyzed the outcomes of traditional growing rods treatment in such patients and the effect of altitude on therapy. Methods Between September 2007 and December 2017, 59 consecutive patients with EOS underwent systematic surgical correction using traditional growing rods. They were divided into the high-altitude and low-altitude groups, and differences in surgical efficacy and complications between the groups were analyzed pre- and postoperatively. Radiographic measurements, including the Cobb angle, thoracic kyphosis, lumbar lordosis, T1–S1 and T1–T12 heights, sagittal and coronal balance, distance between C7PL and sagittal vertical axis, pelvic incidence, sacral slope, and pelvic tilt were assessed preoperatively, postoperatively, and at the last follow-up. Continuous data were analyzed using paired or independent Student’s t tests, and they were compared preoperatively, postoperatively, and at the last follow-up using a repeated measures analysis of variance. Enumerated data were analyzed using the χ2 test. Results The mean patient age at the initial surgery and mean follow-up duration were 8.9 ± 2.4(5–14) years and 51.91 ± 25.23 months, respectively. Altogether, 234 operations were conducted for all patients with an average interval between operations of 11.4 ± 3.0 months. The average Cobb angle was similar in both groups preoperatively and at the last follow-up, it was significantly different postoperatively. TK was significantly different in all three periods. T1–S1 and T1–T12 heights were significantly different only during the preoperative period. The overall rates of complications and implant-related complications did not differ significantly between the groups. Conclusions Deformity in patients with EOS in high-altitude areas was more severe, and treatment using TGRs yielded a satisfactory therapeutic effect.

scholarly journals Posterior only instrumented fusion provides incomplete curve control for early-onset scoliosis in type 1 neurofibromatosis

2019 ◽  
Author(s):  
Jianguo zhang ◽  
Siyi Cai ◽  
zhenyao Li ◽  
Guixing Qiu ◽  
Jianxiong shen ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Early Onset ◽  
Neurofibromatosis Type ◽  
Posterior Spinal Fusion ◽  
Early Onset Scoliosis ◽  
Fusion Surgery ◽  
Major Curve

Abstract Background: The mid-long term outcomes of posterior spinal fusion in pediatric neurofibromatosis type 1 (NF-1) patients are rarely reported, so does the effectiveness of itsorthopeidc maintenance function. This study aims to evaluate the mid-long term surgical outcomes of posterior only instrumented spinal fusion for early-onset scoliosis (EOS) in NF-1 patients. Methods: A retrospective review was performed on a cohort of 10 NF-1 patients having EOS from 2008 to 2014 in our hospital, including four male and six female patients with an age averaged at 7.8 years old when they underwent posterior only instrumented spinal fusion for their EOS. Both general clinical data and surgical specific data of the patients were collected and reviewed, and the dystrophic progression of EOS was evaluated during the follow-up. Results: The average duration of follow-up was 54 months (24 to 88 months). All patients underwent posterior only instrumented spinal fusion at 1 stage. The primary curves of EOS were thoracic in 9 cases and 1 patient had lumbar scoliosis. Preoperative major curve was significantly corrected (from 66.1 to 31.1 degrees). However, the major curve deteriorated significantly to 40.1 degrees on average at the end of the follow-up. The T1-S1 distance increased 2.8 cm on average and kept increasing at a rate of 0.6cm/year during the follow-up. Conclusions: Posterior only fusion surgery was not a good option to treat the EOS in NF-1 patients despite the relatively short segments involvement in the disease. The maintenance of orthopedic effect after treatment was not satisfactory.

Comparison of two types of casting in early-onset scoliosis

2021 ◽  
Author(s):  
C Tassone ◽  
J Thometz ◽  
B Escott ◽  
C Spellman ◽  
XC Liu
Keyword(s):  
Early Onset ◽  
Early Onset Scoliosis ◽  
Chi Square ◽  
Radiographic Outcomes ◽  
Serial Casting ◽  
Radiographic Measurements ◽  
Wilcoxon Rank Sum Test ◽  
Chi Square Test ◽  
To Receive

Early-onset scoliosis (EOS) can be a progressive and debilitating condition if left untreated. Different casting techniques have fallen in and out of favor over the years for conservative management. Two types of casting, elongation-derotation-flexion (EDF) and body casting (BC) are employed at our institution. Here we compare the radiographic outcomes between these two types of casting in a cohort of patients diagnosed with EOS. Sixteen children with EOS were treated by EDF serial casting while seventeen children with the same diagnosis were treated by BC. Radiographic measurements included Cobb angle, rib-vertebral-angle difference (RVAD) and vertebral rotation (VR) by Nash-Moe method in casting (IC) or out of casting (OOC), thoracic height (TH) and width (TW). All of the patients had x-ray measurements at pre-casting OOC, 1st IC and final post-casting OOC. Casts were changed every 2–4 months. Independent two sample t-test, Wilcoxon rank-sum test, and Chi-square test were performed. There were no significant differences at the initial treatment for age, classification of EOS, OOC, RVAD, VR, kyphosis, TH, and TW between EDF and BC casting. There were no significant differences of changes for OOC, RVAD, VR, kyphosis, TH and TW from pre-casting to the final post-casting status between two casting techniques (P>0.05). However, children with EDF tended to receive 3 to 4 more castings than those with BC (7.5 vs.4 casts) (P=0.007) and achieved better outcomes in success (25% vs.20%) and improvement (50% vs.10%) (P=0.03). EDF has better outcomes with EOS improvement when there is treatment of longer duration.

Development of orthosis following EDF serial casting for infantile scoliosis

2021 ◽  
Author(s):  
C Tassone ◽  
A Syed ◽  
B Escott ◽  
XC Liu
Keyword(s):  
Cognitive Function ◽  
General Anesthesia ◽  
Cobb Angle ◽  
Early Onset ◽  
Cost Effective ◽  
Early Onset Scoliosis ◽  
Serial Casting ◽  
Radiographic Measurements ◽  
Cad Cam ◽  
Infantile Scoliosis

Elongation-de-rotation-flexion (EDF) casting is a popular treatment for early-onset-scoliosis (EOS). However, casting every 2 to 3 months using general anesthesia may affect cognitive function.[1,2] Aims of this study: 1) to develop a new orthosis for EOS treatment based on EDF technique (EDFO) and traction frame; 2) to evaluate emerging radiographic results from treatment. Mehta’s EDF serial casting method and AMIL traction frame were used to manually correct the spine for 3D trunk scan. Afterward, a digital spinal model was created and helped design the EDFO with CAD/CAM technology. Radiographic measurements included Cobb angle, RVAD, and thoracic height and width. Six patients (2 girls; 4 boys) diagnosed with idiopathic EOS were enrolled in the study. EDFO was applied at mean 36.5 months of age, after final EDF casting. The average major Cobb angle stabilized after treatment. Average RVAD increased. The average normalized thoracic width at last EDFO out-of-brace was less than prior to EDFO. The new asymmetric EDFO offers an alternative to serial casting and TLSO. EDFO is considered a cost-effective, safer, more breathable, removable, and less invasive modality.

scholarly journals Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

2017 ◽  
Vol 20 (6) ◽  
pp. 561-566 ◽  
Author(s):  
Zhonghui Chen ◽  
Song Li ◽  
Yong Qiu ◽  
Zezhang Zhu ◽  
Xi Chen ◽  
...  
Keyword(s):  
Early Onset ◽  
Thoracic Kyphosis ◽  
Sagittal Plane ◽  
Early Onset Scoliosis ◽  
Sagittal Profile ◽  
Neutral Position ◽  
Sagittal Vertical Axis ◽  
Spinal Growth ◽  
Radiographic Measurements

OBJECTIVEAlthough the vertical expandable prosthetic titanium rib (VEPTR) and growing rod instrumentation (GRI) encourage spinal growth via regular lengthening, they can create different results because of their different fixation patterns and mechanisms in correcting scoliosis. Previous studies have focused comparisons on coronal plane deformity with minimal attention to the sagittal profile. In this retrospective study, the authors aimed to compare the evolution of the sagittal spinal profile in early-onset scoliosis (EOS) treated with VEPTR versus GRI.METHODSThe data for 11 patients with VEPTR and 22 with GRI were reviewed. All patients had more than 2 years’ follow-up with more than 2 lengthening procedures. Radiographic measurements were performed before and after the index surgery and at the latest follow-up. The complications in both groups were recorded.RESULTSPatients in both groups had similar diagnoses, age at the index surgery, and number of lengthening procedures. The changes in the major coronal Cobb angle and T1–S1 spinal height were not significantly different between the 2 groups. Compared with the GRI group, the VEPTR group had less correction in thoracic kyphosis (23% ± 12% vs 44% ± 16%, p < 0.001) after the index surgery and experienced a greater correction loss in thoracic kyphosis (46% ± 18% vs 11% ± 8%, p < 0.001) at the latest follow-up. Although the increase in the proximal junctional angle was not significantly different (VEPTR: 7° ± 4° vs GRI: 8° ± 5°, p = 0.569), the incidence of proximal junctional kyphosis was relatively lower in the VEPTR group (VEPTR: 18.2% vs GRI: 22.7%). No significant changes in the spinopelvic parameters were observed, while the sagittal vertical axis showed a tendency toward a neutral position in both groups. The overall complication rate was higher in the VEPTR group than in the GRI group (72.7% vs 54.5%).CONCLUSIONSThe VEPTR had coronal correction and spinal growth results similar to those with GRI. In the sagittal plane, however, the VEPTR was not comparable to the GRI in controlling thoracic kyphosis. Thus, for hyperkyphotic EOS patients, GRI is recommended over VEPTR.

scholarly journals Study of the radiographic parameters of normal ankles

2020 ◽  
Vol 14 (1) ◽  
pp. 84-88
Author(s):  
Pedro Costa Benevides ◽  
Caio Augusto de Souza Nery ◽  
Alexandre Leme Godoy-Santos ◽  
José Felipe Marion Alloza ◽  
Marcelo Pires Prado
Keyword(s):  
Ankle Instability ◽  
Radiographic Measurement ◽  
Radiographic Evaluation ◽  
Diagnostic Study ◽  
Ankle Arthritis ◽  
Level Of Evidence ◽  
X Ray ◽  
Radiographic Parameters ◽  
Radiographic Measurements ◽  
Bibliographic Search

Objective: The authors carried out a bibliographic search for the radiographic parameters used to determine tibiotalar joint alignment, and suggest a set of parameters that constitute the minimum radiographic evaluation sufficient for the proper assessment of tibiotalar alignment. Methods: The search was conducted between May 2019 and January 2020 on the online platforms PudMed and Google Scholar with the following terms, used separately or jointly: “ankle arthritis, radiographic measurement, ankle alignment, alignment, anterior ankle instability, X-ray, and ankle injury”. Results: We selected twelve studies evaluating radiographic patterns of normal ankles, and identified a total of 15 radiographic measurements. Conclusion: The authors believe that a minimum radiographic assessment of tibiotalar alignment should include the following parameters on the anteroposterior radiograph: the distal tibial articular angle, the talar tilt and talus center migration. On the lateral radiograph, it should include: lateral distal tibial angle and lateral talar station. Level of Evidence V; Diagnostic Study; Expert Opinion.

scholarly journals Posterior only instrumented fusion provides incomplete curve control for early-onset scoliosis in type 1 neurofibromatosis

2020 ◽  
Author(s):  
Siyi Cai ◽  
Zhenyao Li ◽  
Guixing Qiu ◽  
Jianxiong shen ◽  
Hong Zhao ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Early Onset ◽  
Neurofibromatosis Type ◽  
Posterior Spinal Fusion ◽  
Early Onset Scoliosis ◽  
Fusion Surgery ◽  
Major Curve

Abstract Background: The mid-long term outcomes of posterior spinal fusion in pediatric neurofibromatosis type 1 (NF-1) patients are rarely reported, so does the effectiveness of itsorthopeidc maintenance function. This study aims to evaluate the mid-long term surgical outcomes of posterior only instrumented spinal fusion for early-onset scoliosis (EOS) in NF-1 patients. Methods: A retrospective review was performed on a cohort of 10 NF-1 patients having EOS from 2008 to 2014 in our hospital, including four male and six female patients with an age averaged at 7.8 years old when they underwent posterior only instrumented spinal fusion for their EOS. Both general clinical data and surgical specific data of the patients were collected and reviewed, and the dystrophic progression of EOS was evaluated during the follow-up. Results: The average duration of follow-up was 54 months (24 to 88 months). All patients underwent posterior only instrumented spinal fusion at 1 stage. The primary curves of EOS were thoracic in 9 cases and 1 patient had lumbar scoliosis. Preoperative major curve was significantly corrected (from 66.1 to 31.1 degrees). However, the major curve deteriorated significantly to 40.1 degrees on average at the end of the follow-up. The T1-S1 distance increased 2.8 cm on average and kept increasing at a rate of 0.6cm/year during the follow-up. Conclusions: Posterior only fusion surgery was not a good option to treat the EOS in NF-1 patients despite the relatively short segments involvement in the disease. The maintenance of orthopedic effect after treatment was not satisfactory.

Impact of presenting patient characteristics on surgical complications and morbidity in early onset scoliosis

2019 ◽  
Vol 62 ◽  
pp. 105-111
Author(s):  
Frank A. Segreto ◽  
Dennis Vasquez-Montes ◽  
Cole A. Bortz ◽  
Samantha R. Horn ◽  
Bassel G. Diebo ◽  
...  
Keyword(s):  
Surgical Complications ◽  
Early Onset ◽  
Patient Characteristics ◽  
Early Onset Scoliosis

scholarly journals Traditional Growing Rod for Early Onset Scoliosis in High Altitude Regions: a Retrospective Study

2021 ◽  
Author(s):  
Haijun Jiang ◽  
Junrui Jonathan Hai ◽  
Peng Yin ◽  
Qingjun Su ◽  
Shiqi Zhu ◽  
...  
Keyword(s):  
Cobb Angle ◽  
High Altitude ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
Continuous Data ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Initial Surgery ◽  
Radiographic Measurements

Abstract Background: Children with early-onset scoliosis (EOS) living in high-altitude areas have serious deformities and poor nutritional status. There are no reports on the treatment of EOS with traditional growing rods (TGRs)in children in high-altitude areas. This study aimed to analyze the outcomes of patients in high-altitude areas treated with TGRs and compare their results according to whether altitude had an effect on therapy.Methods: Between September 2007 and December 2017, 59 consecutive patients with EOS underwent systematic surgical correction using TGRs. Patients were divided into the high-altitude group(H-A group) and low-altitude group(L-A group), and differences in surgical efficacy and complications between the groups were analyzed pre- and postoperatively. Radiographic measurements included the Cobb angle, thoracic kyphosis (TK), lumbar lordosis, T1–S1range,T1–T12 range, sagittal balance, coronal balance, distance between the C7PL and sagittal vertical axis, pelvic incidence, sacral slope, and pelvic tilt, assessed preoperatively, postoperatively, and at the last follow-up. Paired or independent Student’s t-tests were used to analyze continuous data. The χ2 test was used to analyze enumeration data. Repeated measurement analysis of variance was used to compare continuous data preoperatively, postoperatively, and at the last follow-up.Results: Mean age of all patients at the initial surgery was 8.9±2.4(5–14) years; mean duration of follow-up was 51.91±25.23months.The number of surgical procedures for all patients was 234.The average interval between operations was 11.4±3.0months.The average Cobb angle was similar in both groups preoperatively and at the last follow-up(P>0.05),although it was significantly different postoperatively (P<0.05). TK was significantly different preoperatively, postoperatively, and at the last follow-up(P<0.05).T1-S1and T1-T12lengths were significantly different preoperatively (P<0.05) but not postoperatively and at the last follow-up(P>0.05). The overall rates of complications and implant-related complications did not differ significantly between the groups(P>0.05).Conclusion: Deformity in patients with EOS in high-altitude areas was more serious, and treatment using TGRs yielded a satisfactory therapeutic effect.

Sign in / Sign up

Export Citation Format

Share Document