Adolescent idiopathic scoliosis exceeding 70°: a single unit surgical experience

Solla, Federico; Clément, Jean-Luc; Doria, Carlo; Bertoncelli, Carlo M.; Rosello, Olivier; Rampal, Virginie

doi:10.23736/s0394-3410.18.03881-x

Cited by 5 publications

(6 citation statements)

References 33 publications

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“…Based on our literature review, the mean operative time and blood loss ranged from 130 to 597 minutes and 120 to 7034 mL, respectively with the average of 342.1 minutes and 1895.5 mL. 6,13,14,[27][28][29][30][31][32][33][34] Meanwhile, the mean operative time and blood loss in our study were 193.3 AE 47.9 minutes and 1612.2 AE 873.5 mL, in which were lower as compared to the literatures reviewed. If the cut off points used were the average operative time and blood loss from the literatures reviewed, the cases required to achieve the learning curve in this study would be much lesser.…”

Section: Discussioncontrasting

confidence: 52%

Learning Curve for a Dual Attending Surgeon Strategy in Posterior Spinal Fusion (PSF)

Chan

Lee

Ch’ng

et al. 2020

Spine

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Study Design. Retrospective study. Objective. To assess the learning curve of a dual attending surgeon strategy in severe adolescent idiopathic scoliosis patients. Summary of Background Data. The advantages of a dual attending surgeon strategy in improving the perioperative outcome in scoliosis surgery had been reported. However, the learning curve of this strategy in severe scoliosis had not been widely studied. Methods. A total of 105 patients with adolescent idiopathic scoliosis with Cobb angle of 90° or greater, who underwent posterior spinal fusion using a dual attending surgeon strategy were recruited. Primary outcomes were operative time, total blood loss, allogeneic blood transfusion requirement, length of hospital stay from time of operation and perioperative complications. Cases were sorted chronologically into group 1: cases 1 to 35, group 2: cases 36 to 70, and group 3: case 71 to 105. Mean operative time (≤193.3 min), total blood loss (≤1612.2 mL), combination of both and allogeneic blood transfusion were the selected criteria for receiver operating characteristic analysis of the learning curve. Results. The mean Cobb angle was 104.5° ± 12.3°. The operative time, total blood loss, and allogeneic blood transfusion requirement reduced significantly for group 1 (220.6 ± 54.8 min; 2011.3 ± 881.8 mL; 12 cases) versus group 2 (183.6 ± 36.7 min; 1481.6 ± 1035.5 mL; 3 cases) and group 1 versus group 3 (175.6 ± 38.4 min; 1343.7 ± 477.8 mL; 3 cases) (P < 0.05). There were six perioperative complications. Fifty-seven cases were required to achieve the preset criteria (mean operative time and mean total blood loss) (area under the curve 0.740; P < 0.001; sensitivity 0.675; specificity 0.662). Conclusion. There was significant improvement in operative time and total blood loss when comparing group 1 versus group 2 and group 1 versus group 3. The cut-off point for the learning curve was 57 cases when the preset criteria were fulfilled (≤193.3 min operative time and ≤1612.2 mL of total blood loss). Level of Evidence: 4

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Section: Discussioncontrasting

confidence: 52%

Learning Curve for a Dual Attending Surgeon Strategy in Posterior Spinal Fusion (PSF)

Chan

Lee

Ch’ng

et al. 2020

Spine

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“…The group of skeletally mature patients with a major curve angle moderately exceeding 50° needs a surgical scoliosis correction to avoid further curvature deterioration in adulthood, while in patients with a bigger curve angle, direct impairment can be found [ 2 , 46 , 47 ]. Studies concerning surgical scoliosis treatment classify severe curvature as a major curve angle exceeding 70° [ 48 , 49 , 50 ]. Thus, we used this value to categorize study subgroups.…”

Section: Discussionmentioning

confidence: 99%

Association of LBX1 Gene Methylation Level with Disease Severity in Patients with Idiopathic Scoliosis: Study on Deep Paravertebral Muscles

Janusz

Tokłowicz

Andrusiewicz

et al. 2022

Genes

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Idiopathic scoliosis (IS) is a multifactorial disease with a genetic background. The association of Ladybird Homeobox 1 (LBX1) polymorphisms with IS has been proven in multiple studies. However, the epigenetic mechanisms have not been evaluated. This study aimed to evaluate the LBX1 methylation level in deep paravertebral muscles in order to analyze its association with IS occurrence and/or IS severity. Fifty-seven IS patients and twenty non-IS patients were examined for the paravertebral muscles’ methylation level of the LBX1 promoter region. There was no significant difference in methylation level within paravertebral muscles between patients vs. controls, except for one CpG site. The comparison of the paravertebral muscles’ LBX1 promoter region methylation level between patients with a major curve angle of ≤70° vs. >70° revealed significantly higher methylation levels in 17 of 23 analyzed CpG sequences at the convex side of the curvature in patients with a major curve angle of >70° for the reverse strand promoter region. The association between LBX1 promoter methylation and IS severity was demonstrated. In patients with severe IS, the deep paravertebral muscles show an asymmetric LBX1 promoter region methylation level, higher at the convex scoliosis side, which reveals the role of locally acting factors in IS progression.

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“…There is no solid threshold for Cobb angle value when curvature significantly impacts the patients’ health. Studies concerning surgical treatment of IS classify scoliosis as a severe when a curvature exceeds 70° in Cobb angle [ 58 , 59 , 60 ]. Thus, we used this value to categorize study subgroups.…”

Section: Discussionmentioning

confidence: 99%

Methylation of Estrogen Receptor 1 Gene in the Paraspinal Muscles of Girls with Idiopathic Scoliosis and Its Association with Disease Severity

Janusz

Chmielewska

Andrusiewicz

et al. 2021

Genes

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Idiopathic scoliosis (IS) is a multifactorial disease with epigenetic modifications. Tissue dependent and differentially methylated regions (T-DMRs) may regulate tissue-specific expression of the estrogen receptor 1 gene (ESR1). This study aimed to analyze methylation levels within T-DMR1 and T-DMR2 and its concatenation with ESR1 expression of IS patients. The study involved 87 tissue samples (deep paravertebral muscles, both on the convex and the concave side of the curve, and from back superficial muscles) from 29 girls who underwent an operation due to IS. Patient subgroups were analyzed according to Cobb angle ≤70° vs. >70°. Methylation was significantly higher in the superficial muscles than in deep paravertebral muscles in half of the T-DMR1 CpGs and all T-DMR2 CpGs. The methylation level correlated with ESR1 expression level on the concave, but not convex, side of the curvature in a majority of the T-DMR2 CpGs. The T-DMR2 methylation level in the deep paravertebral muscles on the curvature’s concave side was significantly lower in patients with a Cobb angle ≤70° in four CpGs. DNA methylation of the T-DMRs is specific to muscle tissue location and may be related to ESR1 expression regulation. Additionally, the difference in T-DMR2 methylation may be associated with IS severity.

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Adolescent idiopathic scoliosis exceeding 70°: a single unit surgical experience

Cited by 5 publications

References 33 publications

Learning Curve for a Dual Attending Surgeon Strategy in Posterior Spinal Fusion (PSF)

Learning Curve for a Dual Attending Surgeon Strategy in Posterior Spinal Fusion (PSF)

Association of LBX1 Gene Methylation Level with Disease Severity in Patients with Idiopathic Scoliosis: Study on Deep Paravertebral Muscles

Methylation of Estrogen Receptor 1 Gene in the Paraspinal Muscles of Girls with Idiopathic Scoliosis and Its Association with Disease Severity

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