Preventing Fusion Mass Shift Avoids Postoperative Distal Curve Adding-on in Adolescent Idiopathic Scoliosis

Shigematsu, Hideki; Cheung, Jason Pui Yin; Bruzzone, Mauro; Matsumori, Hiroaki; Mak, Kwok Hang; Samartzis, D; Luk, Keith Dip Kei

doi:10.1007/s11999-016-5216-2

Cited by 25 publications

(16 citation statements)

References 55 publications

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“…Hence, the results of this study do not indicate the duration of brace wear required. In addition, curve flexibility has been shown to greatly influence the outcomes of bracing and surgery [ 32 33 34 35 ]. This aspect of bracing, as well as the varied responses of different curve patterns, is beyond the intent of this study and should be addressed in future studies.…”

Section: Discussionmentioning

confidence: 99%

APSS-ASJ Best Clinical Research Award: Predictability of Curve Progression in Adolescent Idiopathic Scoliosis Using the Distal Radius and Ulna Classification

Samartzis

Luk

2018

Asian Spine J

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Study DesignProspective study.PurposeTo determine the risk of clinically significant curve progression in adolescent idiopathic scoliosis (AIS) based on the initial Cobb angle and to test the utility of the distal radius and ulna (DRU) classification in predicting these outcomes.Overview of LiteratureDetermining the remaining growth potential in AIS patients is necessary for predicting prognosis and initiating treatment. Limiting the maturity Cobb angle to <40° and <50° reduces the risk of adulthood progression and need for surgery, respectively. The risk of curve progression is the greatest with skeletally immature patients and thus warrants close monitoring or early intervention. Many parameters exist for measuring the skeletal maturity status in AIS patients, but the DRU classification has been shown to be superior in predicting peak growth and growth cessation. However, its predictive capabilities for curve progression are unknown.MethodsTotally, 513 AIS patients who presented with Risser 0–3 were followed until either skeletal maturity or the need for surgery, with a minimum 2-year follow-up period. Outcomes of 40° and 50° were used for probability analysis based on the cut-offs of adulthood progression risk and surgical threshold, respectively.ResultsAt the R6/U5 grade, most curves (probability of ≥48.1%–55.5%) beyond a Cobb angle of 25° progressed to the 40° threshold. For curves of ≥35°, there was a high risk of unfavorable outcomes, regardless of skeletal maturity. Most patients with the R9 grade did not progress, regardless of the initial curve magnitude (probability of 0% to reach the 50° threshold for an initial Cobb angle of ≥35°).ConclusionsThis large-scale study illustrates the utility of the DRU classification for predicting curve progression and how it may effectively guide the timing of surgery. Bracing may be indicated for skeletally immature patients at an initial Cobb angle of 25°, and those with a scoliosis ≥35° are at an increased risk of an unfavorable outcome, despite being near skeletal maturity.

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Section: Discussionmentioning

confidence: 99%

APSS-ASJ Best Clinical Research Award: Predictability of Curve Progression in Adolescent Idiopathic Scoliosis Using the Distal Radius and Ulna Classification

Samartzis

Luk

2018

Asian Spine J

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“…Preoperative flexibility was assessed by fulcrum-bending radiographs of which the methods for obtaining fulcrum-bending radiographs have been previously reported. [17][18][19][20] All patients underwent standard implantation of the MCGR without any intraoperative rod distractions. Both single and dual MCGRs were included in this study.…”

Section: Methodsmentioning

confidence: 99%

Rod lengthening with the magnetically controlled growing rod: factors influencing rod slippage and reduced gains during distractions

Cheung¹,

Yiu²,

Samartzis³

et al. 2017

Spine Deformity

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Introduction: Ability to achieve successful MCGR distraction is crucial for gradual spine lengthening. Rod slippage has been described as a failure of internal magnet rotation leading to a slippage and an inability to distract the rod. However, its onset, significance and risk factors are currently unknown. In addition, how this phenomenon pertains to actual distracted lengths is unknown. Hence, the aims of this study are to identify the factors that are associated with rod slippage and to study the pattern of achieved length gain with a standard distraction methodology. Methods: A total of 22 patients with MCGR implantation with at least 6 distraction episodes were prospectively studied. Patients with rod slippage occurring ≤6 distraction episodes were considered early rod slippage while those >6 or have yet not slipped were grouped as late rod slippage. The association of parameters including body habitus, maturity status, age of implantation, total number of distractions, months of distraction from initial implantation, initial and postoperative Cobb angle, T1-T12, T1-S1, T5-T12 kyphosis, curve flexibility, fusion block length, and distance between magnets in dual rods and between the magnets and apex of the 2 curve with early or late onset of rod slippage was studied. Differences between expected and achieved distraction lengths were assessed with reference to rod slippage episodes and rod exchanges to determine any patterns of diminishing returns. Results: Patients had mean age of 7.1 years at diagnosis with mean follow-up of 49.8 months. A mean 32.4 distractions were performed per patient. Early rod slippage occurred in 14 patients and late rod slippage occurred in 8 patients. Increased height, weight, body mass index, older age, increased T1-12 and T1-S1 lengths, and less distance between magnets were significantly associated with early rod slippage. Expected distraction lengths did not translate to achieved distraction lengths. Reduced length gains were observed after achieving one-third of the allowable distracted length in the first MCGR implanted. However, this rate returned to its original baseline after rod exchange with another reduction observed after half of the total achievable length was obtained in the second MCGR. Conclusion: This is the first study to specifically analyze the impact of rod slippage on distraction lengths and the risk factors associated with its onset and frequency. Increased body habitus and reduced distance between internal magnets significantly influenced rod slippage events. In addition, mismatching between expected and achieved distraction lengths was illustrated. Diminishing returns in distracted length gains were only observed after a certain usage of the MCGR rather than the number of distractions and overall length gain. * indicated statistical significance Early slippage indicates a slippage ≤6 distractions. Late slippage indicates no slip or slippage >6 distractions BMI: body mass index; DRU: distal radius and ulna classification; FBCI: fulcrum bending corrective in...

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“…The assessment of spinal flexibility is crucial in management of adolescent idiopathic scoliosis (AIS) as it provides information regarding therapeutic strategies, optimal surgical correction and personalized preoperative planning. [1][2][3][4][5][6][7][8][9] Various methods for evaluating flexibility have been reported including active lateral bending radiographs in supine or standing posture, under traction or by fulcrum-bending radiographs. [1][2][3][4][5]7,[10][11][12][13][14][15][16][17][18] Spinal flexibility can also be used to predict the initial effect of orthotic treatment because more flexible spines are estimated to experience better correction by orthotic treatment.…”

Section: Introductionmentioning

confidence: 99%

Predictability of Supine Radiographs for Determining In-Brace Correction for Adolescent Idiopathic Scoliosis

Cheung

Yiu

Vidyadhara

et al. 2018

Spine

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Preventing Fusion Mass Shift Avoids Postoperative Distal Curve Adding-on in Adolescent Idiopathic Scoliosis

Abstract: Level II, prognostic study.

Cited by 25 publications

References 55 publications

APSS-ASJ Best Clinical Research Award: Predictability of Curve Progression in Adolescent Idiopathic Scoliosis Using the Distal Radius and Ulna Classification

APSS-ASJ Best Clinical Research Award: Predictability of Curve Progression in Adolescent Idiopathic Scoliosis Using the Distal Radius and Ulna Classification

Rod lengthening with the magnetically controlled growing rod: factors influencing rod slippage and reduced gains during distractions

Predictability of Supine Radiographs for Determining In-Brace Correction for Adolescent Idiopathic Scoliosis

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