Search Results (43)

Background and Objectives: Surgical site infections (SSIs) significantly impact pediatric spinal deformity surgery. Considering the increased risk of Gram-negative infections in neuromuscular scoliosis (NMS), broader antibiotic coverage could be advantageous. Some studies suggest extending this approach to all scoliosis etiologies to reduce SSI rates. This study evaluates whether a dual antibiotic prophylaxis with cephalosporin and aminoglycoside reduces SSI incidence within 90 days postsurgery in adolescent idiopathic scoliosis (AIS), NMS, and syndromic scoliosis (SS) patients. Materials and Methods: This study included pediatric patients with AIS, NMS, or SS curves, treated with posterior spinal fusion between January 2019 and December 2022, with a minimum two-year follow-up. The primary outcome was early SSI incidence and its correlation with dual antibiotic prophylaxis in pediatric scoliosis surgery. Secondary outcomes included operative data, blood loss, hemoglobin levels, hospital stay, complications, pelvic fixation, and radiographic correction and how these factors could be identified as potential risk factors for SSIs. Descriptive and inferential statistics were used to analyze antibiotic regimen, SSI risk, and perioperative variables using chi-square, Mann–Whitney U, ANOVA, and Cox regression. Significance was set at p < 0.05. Results: The study included 296 patients: 222 with AIS, 46 with NMS, and 28 with SS. Ninety days postsurgery, SSI rates were 1.2% in AIS (0.8% deep, 0.4% superficial), 6.5% in NMS (all superficial), and 3.5% in SS (all superficial). Deep SSIs in AIS were associated with methicillin-resistant Staphylococcus aureus (MRSA). None of the cases required implant removal. Univariate Cox regression did not reveal any statistically significant predictors for SSIs. However, older age at surgery showed a protective trend, while higher preoperative ASA scores seemed to be a negative prognostic factor (respectively p = 0.051 and p = 0.08). Conclusions: Dual antibiotic prophylaxis with cefazolin and amikacin was associated with a lower SSI rate after posterior spinal fusion for scoliosis, with no adverse events. Further studies are needed to refine dosage, timing, and duration. Full article

Background/Objectives: Early-onset scoliosis (EOS) frequently requires growth-friendly interventions, such as magnetically controlled growing rods (MCGRs), followed by definitive spinal fusion upon skeletal maturity. The optimal implant density (ID) for final posterior spinal fusion in these patients remains controversial. This study aimed to compare the radiographic, surgical, and economic outcomes associated with high-density (HD) versus low-density (LD) screw constructs in EOS patients previously treated with MCGRs undergoing definitive fusion. Methods: This retrospective study included 27 EOS patients who underwent definitive posterior spinal fusion between January 2017 and September 2022. Participants were categorized into two groups: HD (n = 13) and LD (n = 14). Primary outcomes included coronal and sagittal radiographic parameters assessed at early postoperative and final follow-up visits (minimum of 2 years). The secondary outcomes analyzed were major postoperative complications (grade ≥ IIIB according to Clavien–Dindo–Sink Classification [CDSC]), operative time, blood loss, hospital stay length, and total implant costs. Results: Baseline characteristics between the HD and LD groups were comparable. Early postoperative radiographic assessment demonstrated significantly greater thoracic kyphosis (16.3 ± 7.6° vs. 10.9 ± 14.4°, p = 0.021) and T1-S1 spinal height (43.3 ± 6.7 mm vs. 39.1 ± 4.3 mm, p = 0.039) in the HD group. At final follow-up, only T1-S1 spinal height remained significantly higher in the HD group (45.4 ± 7 mm vs. 39.7 ± 5.1 mm, p = 0.021). Implant costs were significantly higher in the HD group (EUR 6046.5 ± 1146.9 vs. EUR 4376.4 ± 999.4, p < 0.001), while operative time, blood loss, and hospital stay length showed no significant differences. HD constructs had three major complications requiring surgical revision, whereas LD constructs reported no perioperative complications but experienced three late-onset complications also necessitating revision surgery. Conclusions: LD constructs provided comparable long-term radiographic and clinical outcomes to HD constructs, with significantly lower implant-related costs. Despite initial superior kyphosis correction in HD constructs, this benefit diminished by the final follow-up. These findings support a selective, lower-density screw placement strategy to minimize costs and surgical complexity without compromising patient outcomes in EOS undergoing definitive spinal fusion. Full article

Background: Spinal asymmetries and postural deviations are common concerns in young athletes, particularly those engaged in sports requiring repetitive and asymmetrical movements. Soccer, as a dynamic sport, involves high levels of trunk rotation, rapid directional changes, and frequent loading asymmetry, which may predispose players to spinal deviations. This study aimed to investigate the regional prevalence of primary and secondary angle trunk rotation (ATR) in adolescent male soccer players across different age groups. Methods: A total of 502 male participants (291 soccer players and 211 nonathletes) aged 11 to 14 years were included in the study. Participants underwent scoliosis screening using a scoliometer following Adam’s forward bending test. ATR measurements were recorded at the thoracic and lumbar spinal regions, with primary ATR (ATR-A) and secondary ATR (ATR-B) assessed separately. A chi-square test (χ²) evaluated the association between training level and the regional prevalence of ATR across different age groups. Results: No significant differences were observed in the regional prevalence of ATR-A and ATR-B in the 11-year-old group. However, by age 12, significant differences emerged in ATR-A prevalence (χ²(3) = 16.469, p = 0.001), while ATR-B remained nonsignificant (χ²(2) = 4.040, p = 0.133). In the 13- and 14-year-old groups, significant associations were found for both ATR-A (χ²(3) = 57.219, p < 0.001; χ²(4) = 34.157, p < 0.001) and ATR-B (χ²(3) = 31.481, p < 0.001; χ²(2) = 17.805, p < 0.001), with moderate to strong effect sizes. Conclusions: While no significant differences were observed in younger players, 13- and 14-year-old soccer players exhibited a significantly higher prevalence of ATR than nonathletes. The findings suggest that soccer players exhibited a higher prevalence of spinal asymmetries, particularly in older age groups, with lumbar ATR being more pronounced. The study highlights an increasing trend of spinal asymmetries with training level among young soccer players, likely due to the cumulative effects of asymmetric movement patterns. These findings emphasize the need for early detection and corrective interventions to mitigate potential long-term musculoskeletal imbalances in adolescent soccer players. Full article

Background: All-day braces are predominantly used for the conservative treatment of adolescent idiopathic scoliosis (AIS). The Charleston Bending Brace is a pure nighttime brace. The aim of this study was to investigate the primary in-brace correction of the main curve of AIS when treated with the Charleston Bending Brace. Specifically, the factors influencing major curve correction were examined. Methods: The retrospective analysis included 97 patients with AIS who were treated between October 2010 and September 2020. Patients with secondary scoliosis or orthotic pretreatment were excluded. Standardized radiographs were used to determine the Cobb angle of the major and minor curves. Curve correction in relation to Lenke’s classification, the Risser stage, and rotation were assessed at four different time points (t0: before treatment, t1: 6–12 months, t2: 13–24 months, and t3: 25–36 months during treatment). Results: The average Cobb of the main curve at the beginning of the study was 25.7°. The night brace achieved excellent in-brace correction at t1, with nearly half of the patients (43%) showing a correction exceeding 80%. Curve localization, the Lenke type, and the Nash–Moe rotation significantly influenced initial in-brace curve correction at t1. At t2, there was also a significant in-brace correction of the initial Cobb by 93.0%. Similar improvements were observed at t3 for in-brace correction as well as without the brace (p < 0.031). Conclusions: The results of the study revealed good primary in-brace correction of the main curve of the AIS with the nighttime brace, which was at least equivalent when compared to values from the literature for the Chêneau brace. Also, while restricted to medium-term results due to our study limitations, the percentage of correction in out-of-brace data of our patients was similar to weaned 24 h brace patients. Full article

Background/Objectives: Scoliosis is a prevalent comorbidity in Rett syndrome (RTT), often necessitating surgical intervention. This study investigated the impact of a 10-month individualized home exercise program (HEP) on scoliosis progression and gross motor function in girls aged six to 16 years with RTT. Methods: A multiple-baseline single-case design (AABA) was employed with 20 participants. A remotely supervised HEP, based on established principles focused on posture and physical activity, was implemented daily for at least one hour. The primary outcome was the rate of scoliosis progression assessed through the Cobb angle change measured via spinal radiographs at baseline, pre-intervention, and post-intervention. The secondary outcome was the gross motor function. Results: The HEP did not significantly reduce the rate of scoliosis progression. However, individual responses varied, with three participants showing scoliosis reduction. Significant improvements were observed in gross motor function, particularly in standing, walking, and stair-climbing abilities. Conclusions: The HEP did not significantly impact overall scoliosis progression, but a significant improvement was found in gross motor function. Further research into larger sample sizes is needed to confirm the effectiveness of exercise interventions in people with RTT. Full article

Background: Given the prevalence of scoliosis, it is essential for residents in Physical and Rehabilitation Medicine to develop proficiency in evaluating spinal radiographs, particularly in measuring the Cobb angle. This education and training study aimed to define the minimum educational requirements for residents to achieve competency in Cobb angle measurement with acceptable inter- and intra-operator variability, as reported in the literature. Methods: In this ethics-approved study, Physical and Rehabilitation Medicine residents measured Cobb angles and the Risser index using specialized software on 30 different spinal X-rays, with oversight to ensure consistency and eliminate bias. Results: The data revealed that 44.4% of residents achieved the target accuracy for primary Cobb angles (<3.6°), but only 11.1% did so for secondary curves. For intra-operator error, 88.9% of residents met the target for primary curves, but only 11.1% achieved the target for secondary curves. The Risser index showed minimal deviation across all participants. Conclusions: These findings highlight that mastering Cobb angle measurement is challenging and generally requires more than 20 different measurements for inter-operator reliability and over 30 repetitions for intra-operator reliability, particularly when secondary curves are included. Full article

Limb Length Discrepancy (LLD) is a common condition that can result in gait abnormalities, pain, and an increased risk of early degenerative osteoarthritis in the lower extremities. Epidemiological studies indicate that mild LLD, defined as a discrepancy of 10 mm or less, affects approximately 60–90% of the population. While more severe cases are less frequent, they are associated with secondary conditions such as low back pain, scoliosis, and osteoarthritis of the hip or knee. LLD not only impacts daily activities, but may also lead to long-term complications, making early detection and precise measurement essential. Current LLD measurement methods include physical examination and imaging techniques, with physical exams being simple and non-invasive but prone to operator-dependent errors. To address these limitations and reduce measurement errors, we have developed an AI-based automated lower-limb length measurement system. This method employs semantic segmentation to accurately identify the positions of the femur and tibia and extracts key anatomical landmarks, achieving a margin of error within 4 mm. By automating the measurement process, this system reduces the time and effort required for manual measurements, enabling clinicians to focus more on treatment and improving the overall quality of care. Full article

Background/Objectives: A recent retrospective study conducted by our team identified a high percentage of postoperative pneumonia in children with neuromuscular scoliosis. Based on the findings in that study and our clinical experience, we aimed to assess the effectiveness of an optimized perioperative care protocol. Methods: As part of a prospective study, a multidisciplinary team developed a protocol that included preoperative nutritional and respiratory optimization, intra- and postoperative intravenous glucose infusion, early extubation, and postoperative nutritional optimization. Non-ambulant children between 6 and 18 years of age with neuromuscular scoliosis were eligible for inclusion in the study. The primary outcome was the rate of postoperative pneumonia within 30 days of surgery. The secondary outcome measures were the rate of postoperative complications, including readmissions. All the outcomes were compared to a retrospective control group that was receiving standard care during the same period. Results: Eleven children were included in the intervention group and 14 in the control group. In regard to the intervention group, the nutritional and respiratory assessment before surgery resulted in optimized treatment in 8/11 patients (73%) and 9/11 patients (82%), respectively. One patient (9%) in the intervention group and three patients (21%) in the control group developed postoperative pneumonia (relative risk 0.42, 95% confidence interval 0.05–3.50). The intervention and control groups did not differ significantly in terms of postoperative complications or readmission rates. Conclusions: The multidisciplinary care protocol is feasible, with a high compliance rate in regard to study procedures. A numerical reduction in the 30-day pneumonia rate did occur in the intervention group; however, this reduction did not reach statistical significance. Full article

Introduction: Intrawound application of vancomycin is becoming increasingly controversial for the prevention of surgical site infection (SSI). As children undergoing spinal fusion for secondary scoliosis are at high risk for SSIs, evidence regarding the impact of intraoperative vancomycin installation on SSI rates in these patients is of utmost importance. Methodology: A single surgeon cohort of patients under 18 years of age undergoing surgery for secondary scoliosis in 2017 was analyzed with regard to the development of SSIs requiring surgical revision and adverse events. Use of vancomycin was restricted to cases with higher risk of infection. Patients undergoing distraction surgery for growing devices were excluded. Results: After exclusions, 64 patients remained (vancomycin n = 39, control n = 25). The SSI rates were 12.8% in patients receiving vancomycin (n = 5/39) and 4% in the control group (n = 1/25, p = 0.785). None of the patients suffered from adverse events. Univariable logistic regression revealed younger age (p = 0.03) and meningomyelocele as predictors for SSI (p = 0.006), while the high-risk group receiving vancomycin was not at higher odds for SSI, also after adjustment for possible confounders such as age or MMC (p = 0.031; p = 0.009). Discussion: SSI rates were comparable between groups, suggesting a normalization of SSI risk in the vancomycin-treated patients with a preoperatively increased risk of SSI. Future, larger studies in these rare diseases are needed to confirm these results. Full article

Posterior spinal fusion for adolescent idiopathic scoliosis (AIS) causes severe postoperative pain. Thoracic paravertebral block (PVB) provides excellent analgesia during various surgeries. We examined the effects of PVB on postoperative analgesia in children undergoing AIS surgery. In this study, 32 children scheduled for AIS surgery were randomly assigned to receive either PVB (PVB group) or no block (control group). The PVB group underwent surgeon-performed PVB with 0.5 mL/kg of adrenalized 0.2% ropivacaine on each side. The primary outcome was the pain score at rest at 6 h postoperatively. Secondary outcomes included pain scores both at rest and during movement and analgesic use for 48 h postoperatively. The postoperative resting pain scores at 6 h were comparable between the control and PVB groups (5.2 ± 2.0 and 5.1 ± 1.8, respectively), with no significant differences. However, at 1 h postoperatively, the control group showed significantly higher resting and mean moving pain scores than the PVB group (p < 0.05). The pain scores at other time points and analgesic use were comparable between the groups. Initial benefits of surgeon-performed bilateral PVB were observed but diminished at 6 h postoperatively. Future research using various anesthetics is needed to extend the effects of PVB. Full article

Background/Objectives: To determine whether a sitting position with the femoral heads centered into the acetabulum is more effective than the usual sitting position in preventing migration percentage progression in non-ambulatory children with bilateral cerebral palsy. Methods: This was a multicenter, randomized controlled trial. Inclusion criteria: spastic or dyskinetic cerebral palsy, Gross Motor Function Classification System level IV-V, age 1–6 years, migration percentage <41%, and informed consent. Exclusion criteria: contractures affecting the hip, anterior luxation, previous hip surgery, and lumbar scoliosis. The treatment group sat with their hips significantly abducted to reduce the head into the acetabulum in a customized system for at least five hours/day for two years. Controls sat with the pelvis and lower limbs aligned but the hips less abducted in an adaptive seating system. The primary outcome was migration percentage (MP) progression. Health-related quality of life and family satisfaction were among the secondary outcomes. The study was approved by the local ethics board and conducted in accordance with CONSORT reporting guidelines. ClinicalTrials.gov ID: NCT04603625. Results: Overall median MP progression was 1.6 after the first year and 2.5 after the second year. No significant differences were observed between the groups. MP exceeded 40% and 50% in 1.8% and 0% of the experimental group and 5.4% and 3.6% of controls in years 1 and 2, respectively. Both groups expressed satisfaction with the postural system and stable health-related quality of life. Conclusions: MP remained stable over the two-year period in both groups. Considering outliers which progressed over 50%, a more protective trend of the hip-centering sitting approach emerged, but this needs to be confirmed in a final, larger dataset. Full article

Background: Neither radiological phenotypic characteristics nor reconstruction CT scan has been used to study the early anatomical disruption of the cranial bone in children with the so-called idiopathic type of West syndrome. Material and Methods: The basic diagnostic measures and the classical antiepileptic treatments were applied to these children in accordance with the conventional protocol of investigations and treatment for children with West syndrome. Boys from three unrelated families were given the diagnosis of the idiopathic type of West syndrome, aged 7, 10 and 12 years old. Parents underwent extensive clinical examinations. Three parents (age range of 28–41 year) were included in this study. All children showed a history of intellectual disabilities, cryptogenic epileptic spasms and fragmented hypsarrhythmia. These children and their parents were referred to our orthopedic departments because of variable skeletal deformities. Variable forms of skeletal deformities were the motive for the families to seek orthopedic advice. A constellation of flat foot, torticollis and early-onset osteoarthritis were observed by the family doctor. Apparently, and from the first clinical session in our practice, we felt that all these children are manifesting variable forms of abnormal craniofacial contour. Thereby, we immediately performed detailed cranial radiological phenotypic characterization of every affected child, as well as the siblings and parents, and all were enrolled in this study. All affected children underwent whole-exome sequence analysis. Results: The craniofacial phenotype of all children revealed apparent developmental anatomical disruption of the cranial bones. Palpation of the skull bones showed unusual palpable bony ridges along different sutural locations. A 7-year-old child showed abnormal bulging over the sagittal suture, associated with bilateral bony ridges over the squamosal sutures. AP skull radiograph of a 7-year-old boy with West syndrome showed facial asymmetry with early closure of the metopic suture, and other sutures seemed ill-defined. A 3D reconstruction CT scan of the skull showed early closure of the metopic suture. Another 3D reconstruction CT scan of the skull while the patient was in flexion showed early closure of the squamosal sutures, pressing the brain contents upward, causing the development of a prominent bulge at the top of the mid-sagittal suture. A reformatted 3D reconstruction CT scan confirmed the bilateral closure of the squamosal suture. Examination of the parents revealed a similar skull radiographic abnormality in his mother. A 3D reformatted frontal cranial CT of a 35-year-old mother showed early closure of the metopic and sagittal sutures, causing a mid-sagittal bony bulge. A 10-year-old boy showed an extremely narrow frontal area, facial asymmetry and a well palpable ridge over the lambdoid sutures. A 3D axial reconstruction CT scan of a 10-year-old boy with West syndrome illustrated the asymmetry of the posterior cranial bones along the lambdoid sutures. Interestingly, his 28-year-old mother has been a client at the department of spine surgery since she was 14 years old. A 3D reconstruction CT scan of the mother showed a noticeable bony ridge extending from the metopic suture upwards to involve the sagittal suture (red arrow heads). The black arrow shows a well demarcated bony ridge over the squamosal suture. A 3D reconstruction CT scan of the skull and spine showed the thick bony ridge of the metopic and the anterior sagittal as well as bilateral involvement of the squamosal, causing apparent anterior narrowing of the craniofacial contour. Note the lumbar scoliosis. A 12-year-old boy showed brachycephaly. A lateral skull radiograph of a 12-year-old boy with West syndrome showed premature sutural fusion, begetting an abnormal growth pattern, resulting in cranial deformity. The nature of the deformity depends on which sutures are involved, the time of onset and the sequence in which individual sutures fuse. In this child, brachycephalic secondary to craniosynostosis, which occurred because of bilateral early ossification of the coronal sutures, led to bi-coronal craniosynostosis. Thickened frontal bones and an ossified interclinoid ligament of the sella turcica were encountered. The lateral skull radiograph of a 38-year-old mother with a history of poor schooling achievements showed a very similar cranial contour of brachycephaly, thickening of the frontal bones and massive ossification of the clinoid ligament of the sella turcica. Maternal history revealed a history of multiple spontaneous miscarriages in the first trimester of more than five times. Investigating his parents revealed a brachycephalic mother with borderline intelligence. We affirm that the pattern of inheritance in the three boys was compatible with the X-linked recessive pattern of inheritance. Whole-exome sequencing showed non-definite phenotype/genotype correlation. Conclusions: The aim of this study was sixfold: firstly, to refute the common usage of the term idiopathic; secondly, we feel that it could be possible that West syndrome is a symptom complex rather than a separate diagnostic entity; thirdly, to further detect the genetic carrier, we explored the connection between the cranial bones in children with West syndrome with what has been clinically observed in their parents; fourthly, the early life anatomical disruptions of the cranial bones among these children seem to be heterogeneous; fifthly, it shows that the progressive deceleration in the development of this group of children is highly connected to the progressive closure of the cranial sutures; sixthly, we affirm that our findings are novel. Full article

Background: This study investigated risk factors for progression of deformity in pediatric congenital cervical scoliosis (CCS) and evaluated the correlation between congenital cervical curves and compensatory thoracic and lumbar curves. Methods: Medical records were retrospectively reviewed for 38 pediatric patients with CCS with a minimum 2-year follow-up. Curve progression was defined as >10° increase in cervical coronal curve angle between presentation and last follow-up. Results: A total of 38 patients (16 girls, 22 boys) with a mean age at presentation of 5.6 ± 4.1 years met the inclusion criteria. Sixteen patients (42%) had curve progression with a mean follow-up of 3.1 ± 3.0 years. At presentation, T1 slope was significantly larger among children with progressive deformities (p = 0.041). A total of 18 of the 38 patients with strictly cervical spine deformity were then selected for subanalysis to evaluate the progression of compensatory curves. Cervical major coronal curves were found to significantly correlate with lumbar major coronal curves (r = 0.409), C2 central sacral vertical line (CSVL) (r = 0.407), and C7-CSVL (r = 0.403) (p < 0.05). Thoracic major coronal curves did not significantly correlate with cervical major coronal curves (r = 0.218) (p > 0.05). Conclusion: In conclusion, 42% of osseous CCS curves progressed over time in the overall cohort, and high initial T1 slope was found to be most highly correlated with progression of cervical deformity. Cervical major coronal curves significantly correlated with lumbar curve magnitude but not with thoracic curve size in isolated CCS, possibly due to the increased flexibility of the lumbar spine which may allow greater compensatory balance and thus have a greater correlation with cervical curve magnitude and possibly progression. Full article

In this opinion article, there is an analysis and discussion regarding the effects of growth on the spinal and rib cage deformities, the role of the rib cage in scoliogeny, the lateral spinal profile in adolescent idiopathic scoliosis (AIS), the genetics and epigenetics of AIS, and the interesting and novel field investigating the sleep impact at nighttime on AIS in relation to the sequence of the scoliogenetic changes in scoliotics. The expressed opinions are mainly based on the published peer-reviewed research of the author and his team of co-authors. Based on the analysis noted above, it can be postulated that the vertebral growth changes in the spine during initial idiopathic scoliosis (IS) development are not primary-intrinsic but secondary changes. The primary cause starting the deformity is not located within the vertebral bodies. Instead, the deformations seen in the vertebral bodies are the secondary effects of asymmetrical loads exerted upon them, due to muscular loads, growth, and gravity. Full article

Background: The Sforzesco brace is a very rigid push-up brace effective in adolescent idiopathic scoliosis (AIS). We recently developed a new Sforzesco brace based on modularity (the Modular Italian brace—MI brace) that could allow standardization, facilitating global expertise diffusion, increased modifiability and adaptability, and cost savings due to longer brace life. We aimed to compare the short-term results of the two braces. Methods: The retrospective study included 231 consecutive AIS treated with a MI brace (N = 53) or Sforzesco brace (N = 178). The main outcome was the first 6-month follow-up out-of-brace radiograph Cobb angle change. Secondary outcomes included the in-brace Cobb degrees and aesthetics (TRACE), prominence (angle of trunk rotation and mm), kyphosis, and lordosis changes. Results: The two groups were similar at baseline, apart from more immature patients in MI brace. Both braces reduced the Cobb angle (−6° out-of-brace; −16° in-brace) without differences between groups. All secondary outcomes improved, apart from a statistically and clinically insignificant 3° kyphosis reduction. The MI brace participants were 4.9 times more likely to improve the Cobb angle than the Sforzesco brace (OR = 4.92; 95%CI 1.91–12.64; p = 0.001). Conclusions: These findings suggest that the MI-brace can be safely used instead of the classical Sforzesco brace. However, further studies of different designs and longer follow-ups are needed to confirm these findings. Full article