bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Shoulder Imbalance Angular Parameters and the Usage of Midtrapezial Angle Clinically and Radiologically in Adolescent Idiopathic Scoliosis (AIS) Cases
Authors: Barishan Fatih , Akesen Burak 
Published: April 2016

Introduction Evaluating AIS patients with shoulder imbalance, radiologic angular parameters generally used are: radiographically costoclavicular intersection angle (CCA), angle of the line connecting the coracoids (Corac), the angle of line connecting the upper limit of the first costal angle (FRA), and the tilt angle of the first thoracic vertebra line (T1T). The angles shown on digital photographs are axillary folds line (ax), deltoids peak line (d) and midtrapezial line angle (tra) between the horizontal line. Material and Methods A total of 29 cases with AIS are separated into two groups, having distance of horizontal lines drawn from coraciods with 2cm shoulder height differences (SHD) and others. Statistics; paired-samples t-test or wilcoxon tests are used depending on normalization of variables. For each variable ROC analysis is performed. Pearsons correlation analyses used with the changes of shd valvues for each parameter. Results Sensitivity of ax is the highest value with 90% than to tra and cca of 80%. Tra and cca angles has highest spesifity valvues with 63.16% than to ax of 57,89%. All radiologic parameters changes found strongly correlated with the changes of shoulder height differences. Conclusion The mid trapezial and axillary fold angles over 2,8 and 2,9 degrees respectively is found in shoulder imbalance by cosmetic parameters. The costoclavicular intersection angle over 4 degree is found to be the radiologic shoulder imbalance parameter for ais. These cut off valvues can be usefull for determining the the shoulder imbalance for selection of upper enstrumantation levels in AIS. Midtrapezial angle can be used as a parameter of clinical cosmetic shoulder imbalance in adolescent idiopathic scoliosis. Axillary fold angles and costoclavicular intersection angle can also helpfull for defining shoulder imbalance in adolescent idiopathic scoliosis.
Pedicle Morphometric Analysis in Adolescent Idiopathic Scoliosis: Importance of Surgeon Familiarity with Patient Specific Variables
Authors: Sudarshan Pramod , Panda Aditya , Paramasivam Aghilavendan , Varma Vamsi Krishna , Hegde Sajan 
Published: April 2016

Introduction A morphometric analysis of convex and concave pedicles in scoliotic spines depends on the three-dimensional reconstructions of the spine. As the standard of care relies on two-dimensional X-rays, there have been few reports on this topic and an underestimation of the morphological irregularities. We present our data of AIS patients who underwent HRCT as part of the preoperative planning for robotic-guided corrective surgery. Material and Methods A retrospective study of adolescent idiopathic scoliosis patients indicated for corrective surgery at our center. All patients underwent a CT scan with 1-mm slice thickness as part of their preoperative planning. The morphometric parameters documented were: transverse pedicle width, pedicle angle and maximum chord length in both convex and concave sides of the curve and were analyzed in the software (Renaissance) used for robotic guidance. Results We reviewed charts of 23 patients with an average age of 14.9 years. Average Cobb angles of the major curve measured 48.4° (Range 27.7° to 82.8°). There were 7 type 5 Lenke curves, 6 type 3 and type 1, and 4 cases of type 6. On the concave side 247 pedicles were measured, of which 104 (42%) were hypoplastic (i.e., transverse pedicle width <4 mm). Of the 249 convex pedicles measured, 74 (30%) were hypoplastic ( p < 0.005). Mean concave pedicle angle was 15.6 ± 3.8° and maximum chord length was 40.9 ± 7.1 mm, while the convex pedicle angle was 16.1 ± 3.9° ( p = 0.22) and maximum chord length was 40.8 ± 6.4 mm ( p = 0.82). Conclusion Knowledge of patient-specific anatomical variances is critical when instrumenting scoliotic vertebrae. Based on our findings, despite the patient's added exposure to radiation, we advocate the use of CT-based preoperative planning to maximize safety of the instrumentation and emphasize the importance of Surgeon familiarity with patient specific anatomic variances in instrumentation of scoliotic vertebrae.
Shilla Procedure and Crankshaft Phenomenon
Authors: Kharrat Khalil , Sebaaly Amer , Kreichati Gaby , Rizkallah Maroun 
Published: April 2016

Introduction To evaluate in a retrospective study the capability of Shilla technique in preventing the crankshaft phenomenon in the treatment of the severe scoliosis in young children. Methods 11 scoliotic children (3M, 8F), Tanner 0, aged from 4 years 6 months to 11 years 6 months were operated by Shilla procedure and were reviewed with a followup from 3 years to 6 years 4 months.7 patients had their final fusion. The number of procedure, except for final arthrodesis was one in 5 patients and two in 6 patients. Results The mean preoperative Cobb angle was 57° (thoracic curve 67°, lumbar curve 55°). The growth continued in all children from 67 cm of the sitting height on initial examination to 72.5 cm at final follow-up. For the coronal angle, it was corrected form 57° to 34° at immediate post-op than an increase to 50° at final follow-up. In 7 children, the initial post-op correction was not maintained due to the crankshaft phenomenon observed in both fused instrumented apex curves (67° → 35° (immediate post op) → 51° on final follow-up) as well as in the non-fused non instrumented apex curves (54° → 40° (immediate post op) → 55° on final follow-up). Discussion and Conclusion: If the crankshaft was expected in bridged curves it also occurred in the apex fused-instrumented curves. Age of the children of 10 years 9 months, right in the growth spur appears to be its main cause. The children with controlled curves had a mean age of 7 years 8 months. In conclusion, the Shilla technique, even in apex fused instrumented curves was not able to control the crankshaft phenomenon during growth spurt. This should be taken in consideration for the timing of the final fusion.
Preoperative LIV Tilt Affects Post Operative Coronal Imbalance in Patients with Lenke 5C Scoliosis
Authors: Shetty Ajoy Prasad , Rajasekaran S. , Subramani Suresh , Kanna Rishi 
Published: April 2016

Introduction Lenke 5C curves are increasingly being treated through posterior pedicle screw based correction techniques. We evaluated different preoperative radiological parameters which could affect post operative coronal imbalance (POCI) in patients with Lenke 5C scoliosis treated with posterior instrumented correction. Methods We retrospectively evaluaed twenty-three cases with Lenke 5C scoliosis who underwent selective posterior pedicle screw based deformity correction. Fusion was performed from proximal neutral to distal stable vertebra. Preoperative, immediate post operative and final whole spine standing radiographs were analyzed. The pre-operavtive radiological parameters were assessed including lower instrumented vertebra(LIV) tilt and translation, Cobb angle,C7 offset from CSVL, lumbar lordosis and upper instrumented vertebra(UIV) tilt and translation. Post-operatively we assessed the correction in cobb angle and post-operative coronal imbalance. Results Twenty -three patients had a mean age: 11.8 ± 4.6 years, with 4 males and 19 females. There was a significant improvement in Cobb angle from mean of 55 ± 13.3° to mean of 14.7 ± 8.8°. Nineteen patients had lower instrumented vertebra at L4, 3 at L3 and one at L5. Correction was maintained with no significant loss in the late post op period (15.2 ±8.9 degrees). The mean pre op C7-CSVL distance was 24.7 mm While eight patients had immediate post operative coronal imbalance (POCI), six of them balanced at a mean 8.2 months. Four patients had POCI at the time of final follow-up including two, who developed late imbalance. POCI correlated with pre operative LIV tilt only > 25° ( p < 0.05) and not with LIV translation, UIV tilt or translation. Five of the eight patients with immediate POCI and all four patients with late POCI had preoperative LIV tilt > 25°. Conclusion In Lenke 5C scoliosis treated by posterior pedicle screw instrumentation, patients with a preoperative LIV tilt (>25°) have a risk of developing POCI.
Management of Children with Complicated Spinal Deformities in Countries with Minimal Resources
Authors: Ahmad Alaaeldin 
Published: April 2016

Introduction It is conceded that complicated spinal deformity in underdeveloped countries presents specific obstacles, but these are often made into “using cheaper screws” and being cost effective. In fact, this has become the main discourse for addressing scoliosis in the global South. It is not simply an extra problem on the margin but a fundamentally different institutional context which presents unique constraints and requires innovative solutions. We can innovate ways to make the surgery have less operative and postoperative demands, or to make those demands easier to deal with GIVEN the adverse institutional context. This is precisely where hybrid construct comes in as a surgical choice that is used for complicated spinal deformity in developing country with minimal resources for more than 5 years now. Material and Methods 13 cases presented with severe spinal deformity, all previously surgically treated for scoliosis, 7 congenital, 3 iatrogenic, 2 syndromic, 1 idiopathic. 8 of them with other associated problems, 6 with scoliosis, 6 with kyphoscoliosis and 1 with kyphosis. The surgical management before the hybrid construct were 28 procedures done, 4 posterior fusion with instrumentation, 3 posterior fusion in situ,2 anterior and posterior fusion in situ, 2 growing rods, 1 VEPTER, 1 posterior fusion and instrumentation with removal of the implants in same day. Results Mean age at surgery with hybrid construct 10.5 years, with mean followup time 34 months, all were done with rib hooks proximally and pedicular or iliac screws distally. mean preoperative thoracic scoliosis was 83 became 66, thoracic kyphosis 113 became 70, thoracolumbar scoliosis 60 became 40, thoracolumbar kyphosis 63 became 22. Complications, 8 complications were detected 2 infection, 1 proximal hook dislodgment, 1 implant exposure, 2 broken rod, 1spinal stenosis, 1 died from non-surgical related cause. Conclusion With this complex and demanding medical condition in developing countries, we think that hybrid construct may be a good and safe surgical option.
Comparison of the DIERS Formetric 4D Scanner and Plain Radiographs in Terms of Accuracy in Idiopathic Scoliosis Patients
Authors: Kumar Vishwajeet , Cole Ashley , Breakwell Lee , Michael Antony Louis Rex 
Published: April 2016

Introduction Comparison of the DIERS Formetric 4D Scanner and plain Radiographs in terms of accuracy in AdolIdiopathic Scoliosis (AIS) Patients. This project aims to determine the accuracy of the DIERS scanner and help decide whether it could be used instead of radiographs for some, or all, AIS patients. Material and Methods Two patient lists were combined; both patients who underwent an operation between 2011–2014 and patients on the Spinecor bracing program. Only preoperative radiographs were used of the operative group. Both DIERS Formetric scan and radiograph were be taken on the same day to prevent time related changes to scoliotic curve. Patients were excluded if they had had an operation to treat their scoliosis. Patients with braces were included so long as their X-ray was of them not wearing the brace. There was no restriction on BMI. Some patients had a double curve (thoracic and lumbar) and it was decided to only compare the greater curve. The radiographs were assessed to show the Cobb angle and the position of the greatest scoliotic curve. To confirm the accuracy of measurements, a senior consultant remeasured a total of 50 X-rays. The results he found averaged a 3.1 degree difference to that measured by the medical students. It was decided that this showed sufficient correlation that not all of the Cobb angles needed to be re checked. Following the radiograph assessment the DIERS Formetric scans were reviewed. Results A total of 85 patients (41 Spinecor, 44 preoperative) were measured providing a total of 236 X-rays. 71 X-rays were excluded: 3 due to the Cobb angle not indicating scoliosis (<10°) and 68 due to a DIERS scannot being performed on the same day. A total of 165 X-rays remained for comparison. The range of Cobb angles was between 10.3 and 82 degrees. The DIERS scanner averaged a Cobb angle of -3.49° below that measured on the X-ray. However, although this result seems very good, it is not pure correlation that needs to be taken into account. It would be expected that correlation would be found but, more importantly is the difference between the angles measured on X-ray when compared with DIERS. Interestingly the scanner seemed to overestimate curves of a small severity and underestimate larger curves. Conclusion Overall the Formetric scanner did average a small underestimate of the Scoliosis angle measured, and showed a good correlation when compared with X-ray. However, especially in severe curves (>65°) the level of accuracy deteriorated rapidly. It could be concluded that the Formetric scanner could replace X-rays for follow up patients within boundaries of magnitude of curve, but that it could not replace X-rays for early diagnosis or when the patient is having a pre-operative assessment.
Is Radiographic Control Necessary after Every Lengthening of Magnetically Controlled Growing Rod?
Authors: Yilgor Caglar , Alanay Ahmet 
Published: April 2016

Introduction A well-accepted imaging follow-up protocol to confirm the amount of lengthening, and check for the curve and the status of the implants for MCGR is not yet established. AP-lateral XR after each lengthening (usually every 2–3 months) is suggested. The aim of this study was to find out whether radiation exposure after every lengthening can be justified or not. Material and Methods A retrospective analysis of 14 consecutive patients (12F, 2M) with EOS of different etiologies treated by MCGR. Mean age was 7 (3–10). Examination of the back in terms of implant prominence was done carefully after each lengthening. Lengthening interval was 2–3 months. Patients had pre- and post-lengthening AP-lateral XR in every visit in the beginning of experience and this was subsequently changed to only AP post-lengthening XR. The XR were analyzed for the presence of failure to lengthen, collapse between 2 procedures and incidental mechanical failures such as rod breakages, hook/screw pullout. Results Mean preop coronal Cobb of 69.6° (38–101) was corrected to 39.1° (16–76) at the final follow-up. Average followup was 24 months (6–52). A total of 101 lengthenings were performed. 173 pre- and post-lengthening XR (110 AP, 63 lateral) were taken. There were a total of 5 mechanical failures in 2 pts. 4 were rod or substance breakages and 1 was hook dislodgement. All 5 were diagnosed in a non-planned control with the patient applying for either prominence of implants and/or history of trauma or unremitting pain. No other incidental mechanical failures were noted in any routine XR. Conclusion Routine XR taken before and after each lengthening procedure of a MCGR is not likely to reveal any significant findings. Post-lengthening AP XR with a decreased frequency (every 6 months) and AP-lateral XR only after a significant complaint or clinical findings should be considered.
All Pedicle Screw Instrumentation for Scheuermann's Kyphosis Correction
Authors: Koptan Wael , El-Sharkawi Mohammad , ElMiligui Yasser 
Published: April 2016

Introduction Scheuermann's kyphosis has long been treated by a two staged fusion and instrumentation with a hybrid construct using hooks, pedicle screws and sublaminar wires. Interest in all pedicle screws constructs led to its use in the treatment of Scheuermann's kyphosis. Materials and Methods The study included 18 patients who underwent a single stage correction by segmental all pedicle screw constructs (Group 1) and 17 who underwent a two staged fusion and instrumentation with a hybrid construct (Group 2). The average age was 16y+3m and 16y+8m respectively. The average preoperative dorsal kyphosis was 88 degrees (Group 1) and 80 degrees (Group 2). Results Both groups were followed for a minimum of 2 years. The deformity correction of Group 1 had an average of 57% postoperatively with 2.2% loss at final follow-up in comparison to Group 2 where the correction was 48% postoperatively with 3% loss at final follow-up. The operative time was considerably less in Group 1 with an average of 3.5 hour than Group 2 with an average of 5.15 hour. The average blood loss was 550 cc in Group 1 and 910 cc in Group 2. Conclusions The use of multiple levels all pedicle screws technique allowed a rigid anchor for posterior correction of the deformity with less operative time, blood loss, hospital stay without the need for anterior release.
Quality of Life of Children and Adolescents with Idiopathic Scoliosis Treated Conservatively with DoboMed Method
Authors: Kapustka Bartosz , Zimon Michalina , Matusik Edyta , Pawel Chodakowski , Durmala Jacek 
Published: April 2016

Introduction The purpose of this study was to determine the Quality of Life of children and adolescents with IS (idiopathic scoliosis) treated conservatively with DoboMed method. Material and Methods We examined group of 63 patients (54 girls) with mean age (14,7 years) – 32 were treated with a DoboMed method only and 31 were treated both with DoboMed method and with Cheneau brace. Mean patients' Cobb angle was 24,2° and mean apical vertebral rotation (AVR) was 11,4°. We also analyzed the patients' BMI (body mass index) z-score, the age of the diagnosis, the deformity location and the duration of brace application. Two questionnaires were used: BSSQ-Deformity and BSSQ-Brace, patients were examined twice at the beginning and at the end of hospitalization. Results At the beginning of hospitalization, the median value of BSSQ-Deformity was 18 and for BSSQ-Brace 9,5. Statistically significant correlations between BSSQ-Deformity results and patient's age, BMI z-score and numer of hospitalizations in the Department were observed. In the group of patients treated with a DoboMed method and a brace, we observed the higher level of stress associated with application of the brace (median=9,5) than the level of stress associated with a deformity (median=16) ( p = 0,0001). This group presented also a higher level of stress evaluated with BSSQ-Deformity than group treated only with DoboMed (median=19) ( p = 0,041). Conclusion Children and adolescents with a scoliosis treated with a DoboMed method presented a low or moderate level of stress associated with the deformity. Higher observed the level of stress was significantly correlated with an older age of patients, a higher BMI z-score value and more hospitalizations in the Department. There was no correlation between the patients' quality of life and the duration of a brace aplication. Group of patients treated with both: the physiotherapy and brace presented the higher level of stress associated with deformity. The level of stress associated with the brace usage (BSSQ-brace) is higher than a stress associated with deformity (BSSQ-deformity) in a group treated with the Chenau brace.
Posterior based 2 or 3 Column Spinal Osteotomies and Release followed by a Controlled Halo-Pelvic Distraction in the Management of Neglected and Complicated Spinal Deformities: A Safe and New Technique
Authors: Kanagaraju Vijayanth , Chhabra Harvinder 
Published: April 2016

Introduction Neglected severe and rigid spinal deformities pose a big challenge to spine surgeons. The neglect adds other risk factors like decompensated respiratory function, fused rigid curve and neurological deficit to an already complex problem. Single stage and anterior surgery are fraught with complications in an already compromised lung condition. The visco-elastic properties of spine utilized through awake halo-pelvic distraction aided by posterior release and a posterior based 2 or 3 column osteotomy allow safe correction of deformity before a definitive procedure is planned. We present our experience of treating 3 such cases. Materials and Methods Retrospective review of hospital records identified three patients. Two patients had neglected early onset congenital spinal deformity with intra-spinal anomaly. The third patient was an old operated case of neuromuscular scoliosis with fused spine with crankshaft phenomenon. All three patients presented with a poor pulmonary function on admission. The curves were severe( > 90°) and rigid with flexibility of only 10%. All three patients were managed by posterior release and periapical posterior based 2 or 3 column osteotomies with halo-pelvic distraction and finally posterior spinal instrumentation and fusion. Results Mean preoperative coronal cobb's angle 102° corrected to 72.33° after posterior based osteotomies and halo-pelvic distraction alone and was 56° after final posterior instrumentation with or without intraoperative manoeuvring. The results were encouraging at three years follow-up, with improved pulmonary function. Conclusion Staged surgeries with controlled and awake, axial distraction using halo-pelvic apparatus with posterior based spinal osteotomies and release offer a safe and effective option in the treatment of severe rigid three plane deformities of the spine with severe respiratory compromise.
Analysis of Curves of Allowances Submitted to Patients Arthrodesis Selective in Curves Lenke Type 1: Fellow up Two Years
Authors: Junior Charbel Jacob , Debom Tadeu Gervazoni , Maia Thiago Cardoso , Junior José Lucas Batista , Cardoso Igor Machado , Brazolino Marcus Alexandre Novo 
Published: April 2016

Introduction Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity, by definition is in the coronal plane deformity greater than 10 °, associated with the rotation of the vertebrae and costotransversais joints presents no definite etiology. The treatment of such deformity depends on the magnitude and location of the curve and be in accordance with the degree of growth potential of the patient. The goals of surgery are to correct the curve, restore balance in the coronal and sagittal plane, prevent progression and possible cardiopulmonary complications and consequently a cosmetic improvement. Objective To evaluate radiographically the behavior of the secondary curves in the coronal and sagittal plane in AIS patients classificad as Lenke I, who underwent surgical treatment of posterior arthrodesis selective in fellow up the two years. Methods A prospective study where of analyzed 40 patients with AIS, 33 female. The measurement of used radiographic parameters followed the recommended by Cobb with fellow up the 2 years. Results The mean Cobb index in the anteroposterior radiographs preoperatively examination was 29.97 ° for proximal thoracic curve, 59.08 ° for main thoracic curve and 35.26 ° for lumbar curve. The average postoperative was 19,56°, 14,73° and 12.5 ° respectively, with percentage of 34.73% correction, 75.06% and 64.64% for the respective curves Conclusion Surgical treatment by selective arthrodesis AIS Lenke type I provides correction of compensatory curves in the coronal and sagittal plane maintenance in fellow up the two years.