scholarly journals T1-weighted MR imaging of bone marrow pattern in children with adolescent idiopathic scoliosis: a preliminary study

2018 ◽  
Vol 12 (2) ◽  
pp. 181-186 ◽  
Author(s):  
S. I. Shiran ◽  
L. Shabtai ◽  
L. Ben-Sira ◽  
D. Ovadia ◽  
S. Wientroub
Keyword(s):  
Bone Marrow ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Lenke Classification ◽  
Adjacent Disc ◽  
Vertebral Bodies ◽  
Preliminary Study ◽  
Mri Study

Purpose Distinct normal physiological patterns of fat conversion in vertebrae were described both for children and adults. Our aim was to evaluate the T1-weighted bone marrow pattern of the vertebral bodies in various sites along the scoliotic spine of children with adolescent idiopathic scoliosis (AIS). Methods We retrospectively evaluated spine MRI studies of children with AIS. Scoliosis radiographs were assessed for type of curvature according to the Lenke classification. A paediatric neuroradiologist assessed the T1-weighted signal of vertebral bodies in comparison with the adjacent disc and distinct patterns of fatty conversion within the apical and stable vertebral bodies. Statistical assessment was performed. Results MRI study of the spines of 75 children with AIS were assessed, 59 (79%) of whom were female, with an age range of nine to 19 years. The relative overall T1-weighted signal intensity of the vertebral body bone marrow relative to the intervertebral disc was hyperintense in 76% and isointense in 24%. Fatty conversion grade of the stable vertebra was higher than the apex vertebra (p = 0.0001). A significant tendency to have more advanced fat conversion patterns in the apex vertebra up to age 13.5 years old compared with adolescents above that (p = 0.015) was seen. Conclusion This preliminary study suggests a different pattern of bone marrow conversion in AIS from the normal physiologic pattern described in the literature. Whether these changes are secondary to the biomechanics of the curved spine or may suggest that bone marrow maturation rate and content have a role in the pathogenesis of AIS remains to be further researched. Level of Evidence Level III (Diagnostic Study)

scholarly journals Does Thoracic Kyphosis Have Any Importance in Selective Versus Nonselective Fusion Preference in Patients With Lenke Type 5C Adolescent Idiopathic Scoliosis? A Contribution to the Guidance of the Lenke Classification

2021 ◽  
Author(s):  
Gökhan Karademir ◽  
Kerim Sarıyılmaz ◽  
Okan Özkunt ◽  
Mehmet Demirel ◽  
Fatih Dikici ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Thoracic Kyphosis ◽  
Sagittal Plane ◽  
Treatment Preference ◽  
Level Of Evidence ◽  
Lenke Classification ◽  
Selective Fusion ◽  
The Mean ◽  
Age Range

Abstract BackgroundAlthough Lenke classification analyses the sagittal plane as (+), N, and (-), it does not consider it in the choice of treatment, and it has limitations with overall thoracic kyphosis (TK). To investigate the importance of TK for treatment preference in patients with Lenke 5C adolescent idiopathic scoliosis (AIS) by comparing radiological outcomes of the patients who underwent selective fusion (SF) or nonselective fusion (NSF). MethodsThirty-two patients with Lenke type 5C AIS were included and then divided into two groups as per the fusion procedure used in the surgical treatment. SF group including 17 patients (15 females; mean age = 16 years, age range, 14–21) with normal TK and NSF group including 15 patients (11 females; mean age = 17 years, age range, 13–26) with thoracic hyper-kyphosis. Thorocolumbar/lumbar (TL/L) Cobb, thoracic (T) Cobb, TK and lumbar lordosis (LL) were measured on standing spine radiographs preoperatively and at the final follow-up. The correction rates (CR) of each radiographic parameter were calculated.ResultsNo significant differences were observed in the mean CR of all radiographic parameters, except TK and LL correction rates. The mean CR of TK was significantly higher in NSF group (-17% [range, -100–69]) than in SF group (67% [range, 9–100]) (p = 0.000). Likewise, the mean CR of LL was found significantly higher in NSF group (12.47% [range, -100–51]) than in SF group (-2.41% [range, -75–47]) (p = 0.036).ConclusionIn patients in whom Lenke's sagittal modifier is N, SF can be performed efficiently. NSF should be preferred in those with Lenke's sagittal modifiers (+) as TK can be better controlled with NSF.Level of Evidence: 3

scholarly journals ROLE OF DIFFERENT HORMONES IN THE PATHOGENESIS AND SEVERITY OF ADOLESCENT IDIOPATHIC SCOLIOSIS

2017 ◽  
Vol 25 (1) ◽  
pp. 15-17 ◽  
Author(s):  
RICARDO TEIXEIRA E SILVA ◽  
RENAN JOSE RODRIGUES FERNANDES ◽  
ALLAN HIROSHI DE ARAÚJO ONO ◽  
RAPHAEL MARTUS MARCON ◽  
ALEXANDRE FOGAÇA CRISTANTE ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Inverse Correlation ◽  
Serum Levels ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Hydroxyvitamin D

ABSTRACT Objective: To evaluate the hormonal profile of patients with adolescent idiopathic scoliosis (AIS) and its relationship to the severity of the curvature and quality of life . Method: Patients with scoliosis (Cobb angle above 10°), of both genders, diagnosed after 10 years of age were included, excluding those who presented other condition that could lead to scoliosis. Serum levels of 25-hydroxyvitamin D (25-OHD), cortisol and gastrin were correlated with Cobb angle and quality of life, measured by the SRS-30 questionnaire . Results: The levels of 25-OHD decreased in 97% of patients. There was an inverse relationship between gastrin levels and quality of life (p = 0.016). Moreover, there was an inverse correlation between the value of Cobb angle and quality of life (p = 0.036). There were no changes in cortisol levels. There was no correlation between Cobb angle and any of the hormones measured . Conclusion: The patients had levels of 25-OHD diminished, strengthening the hypothesis of its involvement in the development of AIS. This study also suggests that increased gastrin levels may be associated with a worse quality of life in patients with AIS. Level of Evidence II, Diagnostic Study.

scholarly journals ADOLESCENT IDIOPATHIC SCOLIOSIS AND SIMILAR CONDITIONS: THREE-DIMENSIONAL CLASSIFICATION

2018 ◽  
Vol 17 (4) ◽  
pp. 286-292
Author(s):  
Enguer Beraldo Garcia ◽  
Liliane Faria Garcia ◽  
Saulo Terror Giesbrecht ◽  
Luis Gustavo Vasconcelos ◽  
Enguer Beraldo Garcia Jr ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Sagittal Plane ◽  
Three Dimensional ◽  
Level Of Evidence ◽  
Quantitative Factor ◽  
Lenke Classification ◽  
Dimensional Classification ◽  
Significant Difference

ABSTRACT Objective: To create a new comprehensive, three-dimensional, applicable classification for Adolescent Idiopathic Scoliosis and similar conditions. Methods: The Three-Dimensional Classification was created with three components: the first, the quantitative factor, divides into three types according to the number of curves; the second, the locator factor defines the most structured point of the curve; and the third, the sagittal factor, evaluates the overall sagittal plane. To test the new classification, we studied the images of 99 patients comparing the intra- and interobserver agreement and reproducibility index of the Three-Dimensional Classification with that of Lenke. Results: It can be stated that, overall, the agreement between the three evaluators in relation to the Three-Dimensional Classification and that of Lenke in this series was considered very good. Conclusions: The case study showed a significant difference in the percentages between the two Classifications. In the evaluation of thoracic kyphosis, the Three-Dimensional Classification defined 26.6% of the cases as hyperkyphosis and 61.6% as normal, whereas the Lenke Classification defined 6.06% as hyperkyphosis and 84.18% as normal. However, in the global comparative analysis of the methods, the Three-Dimensional and Lenke systems presented statistically the same levels of agreement, since the values of the confidence intervals overlap. Level of Evidence II; Retrospective study.

scholarly journals Sagittal profile modifications in hybrid versus all screw technique in adolescent idiopathic scoliosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Laura Scaramuzzo ◽  
Antonino Zagra ◽  
Giuseppe Barone ◽  
Stefano Muzzi ◽  
Leone Minoia ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Thoracic Kyphosis ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Sagittal Profile ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Lenke Classification

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

A Decision Tree Can Increase Accuracy When Assessing Curve Types According to Lenke Classification of Adolescent Idiopathic Scoliosis

Spine ◽  
2010 ◽  
Vol 35 (10) ◽  
pp. 1054-1059 ◽  
Author(s):  
Philippe Phan ◽  
Neila Mezghani ◽  
Marie-Lyne Nault ◽  
Carl-Éric Aubin ◽  
Stefan Parent ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Decision Tree ◽  
Idiopathic Scoliosis ◽  
Lenke Classification

What happens to the unfused upper thoracic curve after posterior spinal fusion for adolescent idiopathic scoliosis?

2021 ◽  
pp. 1-7
Author(s):  
M. Omar Iqbal ◽  
Amer F. Samdani ◽  
Joshua M. Pahys ◽  
Peter O. Newton ◽  
Suken A. Shah ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Univariate Analysis ◽  
Posterior Spinal Fusion ◽  
Research Society ◽  
Curve Correction ◽  
Scoliosis Research Society ◽  
Lenke Classification ◽  
Upper Instrumented Vertebra ◽  
Upper Thoracic

OBJECTIVE Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS. METHODS The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1–4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)–22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model. RESULTS The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement. CONCLUSIONS Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1–4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.

scholarly journals Choosing the Distal Fusion Levels in Lenke Type 1 Adolescent Idiopathic Scoliosis: How Do the Existing Classifications and Recommendations Guide Us?

2020 ◽  
pp. 219256822091071
Author(s):  
Bhavuk Garg ◽  
Nishank Mehta ◽  
Rudra Narayan Mukherjee
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Treatment Outcomes ◽  
Outcome Measures ◽  
Deformity Correction ◽  
Sagittal Vertical Axis ◽  
Scoliosis Research Society ◽  
Lenke Classification ◽  
Selective Fusion ◽  
Significant Difference

Study Design: Retrospective cohort. Objective: ( a) To compare the recommendations of Lenke and Peking Union Medical College (PUMC) classifications in choosing distal fusion levels in Lenke 1 adolescent idiopathic scoliosis (AIS) curves and ( b) to analyze whether the variability in distal fusion levels influences treatment outcomes. Methods: Hospital records of Lenke 1 AIS patients operated for single stage, posterior-only deformity correction were analyzed. Distal fusion levels recommended by Lenke and PUMC classifications were calculated and were compared with the actual distal fusion levels. The study population was divided based on whether the actual distal fusion levels were in agreement, shorter or longer than those recommended by Lenke classification. Subgroup analysis of Lenke 1C curves was done. The groups were compared with regard to the following outcome measures: Cobb angle correction, postoperative sagittal vertical axis, postoperative C7 offset, and Scoliosis Research Society–22r (SRS-22r) score at 24 months. Results: The distal fusion levels recommended by the 2 classifications were in agreement in 92 of 104 cases. In all the cases with disparity, Lenke classification recommended shorter fusions than the PUMC classification. No statistically significant difference was observed in the outcome measures—whether the actual distal fusion levels were in agreement, shorter, or longer than those recommended by the Lenke classification or whether or not the recommendations for selective fusion of any of these classifications were adhered to. Conclusion: Lenke classification can save fusion levels without compromising on treatment outcomes when compared with PUMC classification. Variability in choice of distal fusion levels is not clinically significant at 24-month follow-up.

scholarly journals Concordance for curve type in idiopathic scoliosis among family members

2017 ◽  
Vol 25 (3) ◽  
pp. 90-94 ◽  
Author(s):  
Clarissa Miranda Carneiro de Albuquerque olbertz ◽  
Jérôme Sales de Gauzy ◽  
Paulo Cezar Vidal Carneiro de Albuquerque ◽  
Frank Accadbled ◽  
Paula Eduarda Miranda Carneiro de Albuquerque ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Prospective Study ◽  
Family Members ◽  
P Value ◽  
Curve Shape ◽  
Curve Pattern ◽  
Level Of Evidence ◽  
Lenke Classification ◽  
The Family ◽  
High Concordance

ABSTRACT OBJECTIVE: To evaluate the concordance for the curve pattern, side and levels of the superior apical vertebrae, apex and inferior apical vertebrae of curves in patients and their relatives with idiopathic scoliosis. METHODS: Concordance according to the Lenke classification for curve pattern, side and levels of the superior apical vertebrae, apex and inferior apical vertebrae were evaluated comparative and prospectively in 243 pairs of patients and respective relatives with idiopathic scoliosis. RESULTS: The family concordance for the curve pattern and side was 51.4% (125 pairs). Among these pairs, the concordance of the levels of the vertebrae was 91.2% (114 pairs). The concordance rate for the curve pattern and side between parents/children was 51.6% and between siblings was 50.0% (p-value= 0.411). The concordance rates of the levels of vertebrae were 86.8% and 95.1%, respectively (p-value = 0.219). CONCLUSION: Curve shape in idiopathic scoliosis is related to family and degree of kinship, since the data showed a high concordance for the curve pattern, side and levels of the apical vertebrae and apex between patients and relatives with this deformity. The concordance was higher in those with a closer degree of kinship. Level of Evidence II, Lesser Quality Prospective Study.

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