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Genetic etiology hypothesis is widely accepted in the development of congenital scoliosis (CS). The delta-like 3 (DLL3) gene, a member of the Notch signaling pathway, was implicated to contribute to human CS. In this study, a case-control association study was conducted to determine the association of single nucleotide polymorphism (SNP) in the DLL3 gene with CS in a Chinese Han Population. Five known tagging SNPs of the DLL3 gene were genotyped among 270 Chinese Han subjects (128 nonsyndromic CS patients and 142 matched controls). CS patients were divided into 3 types: type I-failure of formation (29 cases), type II-failure of segmentation (50 cases), and type III-mixed defects (49 cases). The 5 SNPs were analyzed by the allelic and genotypic association analysis, genotype-phenotype association analysis, and haplotype analysis. Allele frequencies of 5 tagging SNPs (SNP1: rs1110627, SNP2: rs3212276, SNP3: rs2304223, SNP4: rs2304222, and SNP5: rs2304214) in CS cases and controls were comparable and there were no available inheritance models. The SNPs were not associated with clinical phenotypes. Moreover, the 5 makers in the DLL3 gene were found to be in strong linkage disequilibrium (LD). Both global haplotype and individual haplotype analyses showed that the haplotypes of SNP1/SNP2/SNP3/SNP4/SNP5 did not correlate with the disease (P >0.05). Together, these data suggest that genetic variants of the DLL3 gene are not associated with CS in the Chinese Han population., Competing Interests: The authors have no conflicts of interest to disclose.

Background: Gaining and maintaining spinal balance after surgery is of great importance for early onset scoliosis (EOS). However, tendency of balance on the coronal plane after growing rod surgery has not been studied before. This study evaluated the effect of growing rod treatment on coronal balance (CB) during serial lengthening surgeries in EOS., Methods: All EOS patients treated with growing rod technique in our hospital from August 2002 to June 2014 were retrospectively reviewed. Radiographic data before the sixth lengthening surgery were measured on the posteroanterior X-ray images, including global CB (C7 plumbline-central sacral vertical line, C7PL-CSVL), regional CB (apical vertebrae-CSVL), Cobb angle of the main curve and pelvic inlet width (PIW). Global CB index and regional CB index were calculated as dividing global CB and regional CB by PIW, respectively. The changes of these parameters during repeated lengthening surgeries were analyzed., Results: Five hundred seventy Radiographs of 67 patients, including 134 images before and after growing rod insertion surgeries and 436 images pre- and post-lengthening surgeries were measured. Global CB and global CB index did not show significant differences between every two set points during lengthening procedures (P > 0.05). The percentage of patients with C7PL-CSVL distance more than 20 mm roughly ranged from 30 to 45 % during the lengthening process. With regards to regional CB and main curve Cobb angles, there were significant differences between every two adjacent set points during the first five lengthening surgeries (P < 0.05)., Conclusions: Global CB did not significantly change during serial lengthening surgeries and C7PL-CSVL distances of greater than 20 mm comprised of over one third of patients during growing rod treatment. However, worsening regional CB and Cobb angles of the main curve during lengthening intervals were corrected by lengthening manipulation and maintained at a stable level.

Purpose: To investigate changes in thoracic dimensions (TDs) following repeated lengthening surgeries after dual growing rod treatment of early onset scoliosis and thereby its effect on thoracic growth., Methods: All EOS patients treated with dual growing rod technique in Peking Union Medical College Hospital from June 2004 to June 2014 were retrospectively reviewed. Thoracic spine height (T1-T12), total spine height (T1-S1), maximal coronal chest width and pelvic inlet width (PIW) were measured on the posteroanterior X-ray images after initial growing rod insertion surgery and after each lengthening surgery. Absolute TDs measurements were normalized by PIW. Changes of absolute and normalized TDs measurements with age and number of lengthening surgeries were analyzed., Results: Radiographs of 229 surgeries of 53 EOS patients were measured, including 49 images after initial growing rod insertion surgery and 180 images of lengthening surgeries. Significant positive correlations between age and all three absolute TDs were found (P < 0.01) whereas significant negative correlations between age and all three normalized TDs (P < 0.01) were identified. Similarly, negative correlations were also identified between number of lengthening surgeries and the three normalized TDs (P < 0.01). Significant differences of normalized TDs were identified between initial surgery and the first lengthening through covariance analysis (P < 0.01). Yet, such differences were seldom seen between every two adjacent lengthening surgeries., Conclusions: Growing rod technique could maintain TDs growth through repeated lengthening procedures but the growth rate was compromised as the number of lengthening procedures increased.

Purpose: Adolescent idiopathic scoliosis (AIS), the most common pediatric spinal deformity, is considered a complex genetic disease. Causing genes and pathogenesis of AIS are still unclear. This study was designed to identify differentially expressed long noncoding RNAs (lncRNAs) involving the pathogenesis of AIS., Methods: We first performed comprehensive screening of lncRNA and mRNA in AIS patients and healthy children using Agilent human lncRNA + mRNA Array V3.0 microarray. LncRNAs expression in different AIS patients was further evaluated using quantitative PCR., Results: A total of 139 lncRNAs and 546 mRNAs were differentially expressed between AIS patients and healthy control. GO and Pathway analysis showed that these mRNAs might be involved in bone mineralization, neuromuscular junction, skeletal system morphogenesis, nucleotide and nucleic acid metabolism, and regulation of signal pathway. Four lncRNAs (ENST00000440778.1, ENST00000602322.1, ENST00000414894.1, and TCONS&#95;00028768) were differentially expressed between different patients when grouped according to age, height, classification, severity of scoliosis, and Risser grade., Conclusions: This study demonstrates the abnormal expression of lncRNAs and mRNAs in AIS, and the expression of some lncRNAs was related to clinical features. This study is helpful for further understanding of lncRNAs in pathogenesis, treatment, and prognosis of AIS.

Objective: To evaluate clinical outcomes of growing rod technique in treating young children with congenital scoliosis., Methods: From August 2002 to October 2009, 34 patients with congenital scoliosis underwent growing rod procedures including 12 male and 22 female patients. Four patients underwent posterior correction surgeries with single growing rod (single growing rod group), 30 patients underwent posterior correction surgeries with dual growing rod(dual growing rod group). The average age at initial surgery was 6.9(2-13) years. Five patients with severe rigid deformity or kyphosis had an osteotomy at apex vertebra with short segmental fusion followed by dual growing rod technique. The analysis included age at initial surgery and final fusion (if applicable), number and frequency of lengthenings, and complications. Radiographic evaluation including scoliosis, trunk translation, length of T1-S1, thoracic kyphosis and lumbar lordosis was conducted., Results: The follow-up was 40.5 (24-110) months. In single growing rod group, the mean scoliosis Cobb angle improved from 80.9°to 59.5°after initial surgery and was 65.3°at the latest follow-up. T1-S1 length increased from average 24.3 cm to 26.0 cm after initial surgery, and to 31.1 cm at latest follow-up with an increase of 1.05 cm per year. The space available for lung ratio(SAL) in patients with thoracic curves improved from 0.81 to 0.92 at the latest follow-up. Three patients reached final fusion. Four complications occurred in 3 of the 4 patients. In dual growing rod group, the mean scoliosis Cobb angle improved from 72° ± 22°to 35 ± 14° after initial surgery and was 35 ± 17°at the last follow-up or post-final fusion. T1-S1 length increased from (25 ± 5) cm to (29 ± 5)cm after initial surgery and to (33 ± 5)cm at latest follow-up with an average T1-S1 length increase of 1.49 cm per year. The SAL in patients with thoracic curves improved from 0.84 ± 0.08 to 0.96 ± 0.06 at the latest follow-up. Three patients reached final fusion. Complications occurred in 7 of the 30 patients, and they had a total of 13 complications., Conclusions: Growing rod technique is a safe and effective choice for young children of long, complex congenital scoliosis. It maintains correction achieved at initial surgery while allowing spinal growth to continue. Implants-related complications remain the biggest challenge.

Objective: To investigate the incidences and characteristics of the ribs and intraspinal abnormalities in surgical patients with congenital scoliosis., Methods: We conducted a retrospective study of the medical records and spine radiographs of 118 patients underwent surgical treatment between January 2010 and March 2011 with congenital scoliosis. The average age was 14 years (3-50 years).Fifty-two were male and 66 were female patients. The rib and intraspinal abnormalities were compared in different vertebral anomalies. Pearson's χ(2) test were used to analyze the incidence of anomalies of the ribs and vertebrae, as well as intraspinal anomalies., Results: A total of 57 (48.3%) patients were found to have intraspinal abnormalities.Split cord deformities were identified to be the most common intraspinal anomaly (32.2%), followed by syringomyelia (21.2%).Sixty-nine patients (58.5%) had rib anomalies, which occurring on the concavity of the scoliosis was most frequent. The patients with mixed deformity and failure of segment were found to have a higher incidence of rib anomaly than those with failure formation (χ(2) = 14.05, P < 0.01). The patients with multiple level malformations were found to have significantly higher incidence of rib anomaly than those with single level malformation (χ(2) = 27.50, P < 0.01).Intraspinal anomalies occurred in 42 of 69 patients (60.9%) with rib anomalies and 15 of 49 patients (30.6%) without rib anomalies in congenital scoliosis. The occurrence of intraspinal malformation has significant difference with or without rib anomalies in congenital scoliosis (χ(2) = 10.5, P < 0.01)., Conclusions: The intraspinal malformation is common in patients with mixed defects and failures of segmentation. The rib anomalies occurring on the concavity of the scoliosis is most frequent. The incidence of intraspinal anomaly is significant higher in the patients with rib anomalies than those without rib anomalies. Both the occurrence and type of rib anomaly, combined with vertebral deformity are helpful in forecasting the occurrence of intraspinal abnormalis.

Background: Initial results for the use of single and dual growing rod techniques in the treatment of early onset scoliosis (EOS) has been seldom documented. The aim of this research was to investigate the initial efficacy of single and dual growing rods in treatment of EOS., Methods: A retrospective study of 25 early onset scoliosis cases treated with growing rod technique between November 2002 and May 2010 was performed, including six cases in the single growing rod group and 19 cases in the dual growing rod group. Operation time, intra-operative bleeding, correction rate, changes in C7-S1 distance, and incidence of complications of the first operation were compared for the two techniques., Results: The average post-operative follow-up duration was 31.9 months. There was no statistical difference observed between operation time, intra-operative bleeding, and complication incidence between the single and dual growing rod groups. In addition, no statistical difference was observed in the pre-operative coronal Cobb's angle (P > 0.05), or in the pre-operative sagittal Cobb's angle between both groups (P > 0.05). The correction rate of the dual growing rod group was significantly superior to that of the single growing rod group in the coronal plane (P < 0.01), but not in the sagittal plane (P > 0.05). The C7-S1 distance in the dual growing rod group was significantly larger than that in the single growing rod group (P < 0.05)., Conclusions: The growing rod technique is an effective option for surgical treatment of EOS. The dual growing rod technique shows relative superiority in the correction outcome as compared to the single growing rod technique.

Objective: To investigate the safety and effectiveness of one-stage posterior correction of scoliosis associated with little symptomatic syringomyelia., Methods: A total of 19 cases diagnosed as scoliosis with little symptomatic syringomyelia between January 2003 and November 2010 were included in this study (study group), the patients underwent one-stage posterior correction and instrumentation without neurosurgery for the syringomyelia. At the same time, 9 cases with severe symptomatic syringomyelia were included as the control group, the patients underwent neurosurgery before scoliosis correction, including suboccipital decompression and syrinx shunting. All patients underwent posterior pedicle screw or screw-hook hybrid instrumentation. The preoperative, postoperative and the last follow-up of the Cobb angle of the coronal main curve and thoracic kyphosis were measured. Also, the preoperative and postoperative of the apical vertebra translation, apical vertebra rotation and trunk shift were measured by the same person. The perioperative and the last follow-up complications of neurological injury were recorded. The surgical outcome and postoperative complications between the 2 groups were compared with the t student and chi-square statistics methods., Results: There were no significant differences in gender, age, the location, length and diameter of the syringomyelia of the 2 groups (P > 0.05). The follow-up period ranged from 6 to 45 months, with a mean of 28.6 months. The average preoperative Cobb angles of coronal main curves of the 2 groups were 71° ± 23° and 68° ± 19°, the postoperative Cobb angles were 27° ± 20° and 25° ± 16°, and the last follow-up Cobb angles were 29° ± 17° and 32° ± 20°. The coronal correction rate was 66% ± 19% in the study group and 65% ± 21% in the control group (t = 0.136, P = 0.893). There was no significant difference at the last follow-up(t = 0.210, P = 0.837). The average preoperative Cobb angles of thoracic kyphosis of the 2 groups were 35° ± 18° and 32° ± 19°, the postoperative Cobb angles were 25° ± 10° and 23° ± 9°, and the last follow-up Cobb angles were 24° ± 4° and 28° ± 8°. The mean sagittal correction rate of the 2 groups were 50% ± 58% and 57% ± 53% (t = -0.303, P = 0.764). There was also no significant difference at the last follow-up time (t = 0.769, P = 0.490). There were no significant difference, in terms of the postoperative of the apical vertebra translation, apical vertebra rotation and trunk shift between the 2 groups (P > 0.05). One case in the study group complicated with a pedicle screw breaking the anterior cortex of the vertebra and one in the control group complicated with a hook loosening, postoperatively. At the last follow-up time, the neurological symptoms of the 2 groups got no aggravating., Conclusion: One-stage posterior correction of scoliosis associated with little symptomatic syringomyelia may be effective and safe.

Objective: To evaluate the safety and effectiveness of correction of scoliosis associated with tethered cord without releasing it., Methods: Twenty-two cases diagnosed as scoliosis with tethered cord between December 2005 and January 2011 were investigated retrospectively in the study. There were 8 males and 14 females. The age was from 6 to 51 years, averaged 17.7 years. There were 7 patients with clinical symptoms before surgery. All the patients underwent posterior deformity correction and instrumentation by pedicle screws directly without releasing the tethered cord. Spinal cord monitoring was conducted in all the cases. The preoperative and postoperative Cobb angle of the coronal main curve and thoracic kyphosis were measured. Also, the preoperative and postoperative values of the apical vertebra translation, apical vertebra rotation and trunk shift were measured by the same person. The incidence of perioperative complications were recorded., Results: A total of 20 patients were followed up. The follow-up time was from 6 to 52 months, mean 23.5 months. The average Cobb angle of the coronal main curve were 68° ± 20° before surgery and 38° ± 21° after surgery with a mean correction of 48.1%. The difference was significant (t = 13.9, P < 0.05). The mean kyphosis was 65° ± 18° preoperatively and 28° ± 11° postoperatively, with a correction of 56.7%. The difference was also significant (t = 8.81, P < 0.05). The preoperative values of the apical vertebra translation, apical vertebra rotation and trunk shift were (5.4 ± 2.5) cm, 2.3° ± 0.6° and (2.0 ± 1.8) cm, respectively, which were corrected to (3.2 ± 1.8) cm, 1.2° ± 0.5° and (1.5 ± 1.1) cm after the surgery. Compared to the preoperative values, the difference were significant in the apical vertebra translation (t = 5.69, P < 0.05) and apical vertebra rotation (t = 10.07, P < 0.05). However, there was no difference in trunk shift. Postoperative complications occurred in 3 patients, including transient numbness of the lower extremity in 1 patient and hydrothorax in 2 patients. No neurological and instrumentation complications occurred during the follow-ups. Patients with clinical symptoms before surgery got no serious during the surgery and follow-ups., Conclusions: If there are no symptoms of tethering in scoliosis patients with tethered cord, the corrective surgeries may be safe and effective when spinal cord monitoring conducted without spinal cord untethering. But more cases are needed to confirm it.

Objective: To explore the clinical manifestations and surgical strategies of scoliosis associated with syringomyelia., Methods: A total of 50 cases diagnosed as scoliosis with syringomyelia between January 2003 and November 2010 were recruited. They were divided into 2 groups: Group A, neurosurgery before scoliosis correction, including suboccipital decompression and syrinx shunting; Group B, one-staged posterior correction and instrumentation without previous neurosurgery. The preoperative, postoperative and last follow-ups of Cobb angle of coronal main curve and thoracic kyphosis were measured. Also the preoperative and postoperative apical vertebra translation, apical vertebra rotation and trunk shift were measured by the same person. The surgical efficacies and complications of correction were compared between 2 groups., Results: All patients underwent posterior pedicle screw instrumentation and had a mean follow-up period of 32.1 months. Among them, 42 patients had clinical symptoms or signs preoperatively and 3 patients improved postoperatively. The mean correction of coronal curve was 65.7% and a mean loss of correction 6.4% during the follow-up. The mean correction of apical vertebra translation and apical vertebra rotation were 63.0% and 60.0% respectively. However, the trunk shift increased 0.4 cm. There were no statistically significant differences for the correction efficacies and complications between 2 groups (P > 0.05)., Conclusion: Scoliosis associated with syringomyelia may be effectively managed if a surgeon manipulates carefully intraoperatively and perioperative spinal monitoring is practiced. Furthermore syrinx will not increase the incidence of postoperative complications without prophylactic neurosurgery.

Objective: To determine the efficacy of imaging patients in a state of traction ("traction imaging") for selection of upper and lower vertebrae to undergo instrumentation (UIV and LIV, respectively) to correct moderate to severe, rigid scoliosis., Methods: Twenty-seven patients aged 11-21 years (average, 15.5 years) who had been treated at our institution for scoliosis of the thoracic spine between 2004 and 2008 were retrospectively analyzed. All patients were treated with the third multiple hook-screw and rod instrumentation system. Standardized radiographic measurements (anteroposterior, sagittal, bending, fulcrum, traction) were taken and Cobb's angles, apical vertebra translation (AVT), and traction-stable vertebrae determined., Results: All patients were followed for 6-36 months (average, 14.7 months). The Cobb's angles under preoperative vertical traction correlated positively with those measured postoperatively in standing anteroposterior film (P < 0.01). Preoperative AVT under vertical traction was significantly different from that measured postoperatively in standing anteroposterior film (P < 0.01). The traction radiography-determined UIV slant angles were significantly different from those preoperatively without traction and the postoperative values, whereas traction radiography-determined LIV values were not significantly different from those found preoperatively without traction (P > 0.05)., Conclusions: Traction radiographic imaging is an effective, feasible preoperative assessment for determining which vertebrae are stable, designing the surgical strategy and choosing the UIV and LIV for correcting moderate to severe, rigid scoliosis., (© 2012 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.)

Background: Pulmonary problems often occur in patients with early-onset scoliosis (EOS). However, lung function in patients with EOS after growing rod surgery has not been documented. The aim of this study was to investigate lung function after the treatment for EOS with growing rod and its possible correlative factors., Methods: Eight patients with EOS were treated with growing rod surgery at Peking Union Medical College Hospital from September 2002 to September 2009. Four patients had finished the final fusion surgery (group 1), and the other 4 (group 2) were in the process of periodic lengthening. Preoperative forced vital capacity (FVC), ratio of FVC to predicted FVC, forced expiratory volume in 1 second (FEV1), ratio of FEV1 to predicted FEV1, and radiographic measurements of Cobb's angle and C7-S1 distance were recorded. Lung function changes and correlations between lung function changes and radiographic changes (Cobb's angle and C7-S1 distance) were analyzed., Results: In group 1, FVC and FEV1 both increased. FVC showed a significant difference (P = 0.01), but FEV1 did not (P = 0.05). In group 2, FVC and FEV1 also increased, and both showed a significant difference (P = 0.04 and P = 0.02, respectively). Ratio of FVC to predicted FVC and ratio of FEV1 to predicted FEV1 changed similarly and did not show statistical differences in the 2 groups. There were no significant correlations between lung function changes and radiographic changes (Cobb's angle and C7-S1 distance) (P = 0.10 and P = 0.41, respectively)., Conclusions: Lung function increases after growing rod surgery in patients with EOS. Lung function changes do not correlate with Cobb's angle changes or C7-S1 distance changes.

Objective: To evaluate the surgical results of selective thoracic fusion (STF) for scoliosis associated with syringomyelia., Methods: From January 2001 to January 2009, 93 cases of scoliosis associated with syringomyelia were retrospectively reviewed. There were 11 cases who underwent STF and were followed up more than 2 years, which included 8 female and 3 male, the mean age was 14.9 years (9 - 21 years). Curve type, coronal and sagittal Cobb angle, apical vertebral rotation apical vertebral translation, flexibility, trunk shift were recorded and analyzed., Results: There were 9 double curves and 2 triple curves, the Lenke type of thoracolumbar/lumbar curve included Lenke A in 2 cases, Lenke B in 7 cases and Lenke C in 2 cases. The average coronal Cobb angle of thoracic curve before and after surgery were 62.6° and 19.0° respectively, and the average correction rate was 69.6%. The average coronal Cobb angle of thoracolumbar/lumbar curve before and after surgery were 36.1° and 11.6° respectively, and the average spontaneous correction rate was 67.9%. The followed up time ranged from 24 to 48 months (mean 29.5 months), the average loss of correction rate was 6.8%. Only one trunk decompensation was noted at final follow-up. Pedicle screw nut loosening occurred in one patient and this patient underwent revision surgery, no neurological complication was noted at final follow-up., Conclusions: STF could be safely performed in scoliosis associated with syringomyelia. Thoracolumbar/lumbar curve in these patients has similar spontaneous correction ability compared with idiopathic scoliosis patients. The satisfactory result could be achieved according to the STF criteria for IS.

Previous literatures revealed abnormal cross-sectional morphology of spinal cord in AIS, suggesting the presence of disproportional growth between the neural and skeletal system. No accurate measurement of whole spine by MRI multiplanar reconstruction and their correlation with Cobb angle were studied. In this study, MRI three-dimensional reconstruction of the whole spine was performed in 90 adolescents (49 AIS with thoracic/thoracolumbar curve, and 41 age-matched healthy controls). Measurements of the ratio of anteroposterior (AP) and transverse (TS) diameter of the cord, the concave and convex lateral cord space (LCS) were obtained at the apical level in AIS patients. Cerebellar tonsillar level related to the basion-opsithion line, location of conus medullaris, cord length, vertebral column length, cord/vertebral column length ratio were obtained. All of the same parameters were also measured in healthy controls at matched vertebral levels and their correlations with Cobb angle were made. We notice that AP, TS, AP/TS and LCS ratio were increased in AIS subjects with low-lying position of cerebellar tonsillar level and elevating position of conus medullary when compared with healthy controls (P < 0.01). AP, AP/TS and LCS ratio were correlated significantly with Cobb angle (P < 0.05). Cord length and vertebral column length were not significantly different between AIS and control group. However, cord/vertebral column length ratio was significantly smaller in AIS group (P < 0.01). Cord length, vertebral column length and cord/vertebral column length ratio were not related with age or Cobb angle (P > 0.05). These data suggest the presence of uncoupled neuro-osseous growth along the longitudinal axis of spinal cord with associated morphologic changes of cross-sectional configuration and relative position of the cord. Some changes are significantly relevant with Cobb angle, which may indicate pathogenesis of AIS.

Objective: To investigate whether the polymorphisms of WNT3A gene are associated with congenital scoliosis (CS) and its various clinical phenotypes in a Chinese Han population., Methods: A total of 127 CS patients admitted into PUMC were enrolled into this case-control study between October 2005 and September 2007. There were 55 boys and 72 girls with a mean age of 12.90 years old. Another 127 scoliosis-free control subjects at the same hospital during the same study period were frequency-matched with regards to age (± 3 years) and gender. Genomic DNA was extracted by QIAamp DNA Blood Mini Kit from peripheral blood leukocytes of each subject who had signed informed consent. Based on the genotypic data from the International HapMap project, the main functional single nucleotide polymorphisms (SNPs) were initially selected. The patients in the case group were classified into different clinical phenotypes according to vertebral defect type, location of deformity, extent of developmental disruption, combined rib malformations and neural canal deformity. The genotying of all selected SNPs was performed by SNPstream technology (Beckman Coulter SNPstream). All data of SNPs with polymorphism were processed by the association analysis based on a single SNP and between phenotypes and SNPs. And the pairwise linkage disequilibrium was calculated in the control population by Haploview 4.1 software., Results: The SNP1 (rs964941) and SNP2 (rs752107) of WNT3A were genotyped. There was no linkage disequilibrium between two SNPs. No association was observed between SNP1 and SNP2 genotypes or allele polymorphisms and risk of CS and various clinical phenotypes (P > 0.05)., Conclusions: The genetic variants of WNT3A gene may not be associated with the susceptibility to CS and various clinical phenotypes of CS in Chinese Han population.

Objective: to evaluate the outcomes and complications of posterior vertebral column resection in the treatment of severe and fixed spinal deformities., Methods: from January 2008 to January 2010, 15 consecutive cases (4 males, 11 females) of severe and fixed spinal deformities managed by single posterior vertebral column resection with transpedicular instrumentation were investigated retrospectively. The diagnosis included congenital scoliosis in 10 cases, adolescent idiopathic scoliosis in 1 case, congenital kyphosis in 3 cases, tuberculous kyphosis 1 case. Radiographs were measured to determine the regional coronal and sagittal curve magnitude, and the coronal and sagittal balance preoperatively, postoperatively and at the final follow-up. Operative reports and patient charts were reviewed to record operation time, intraoperative blood loss and complications., Results: the mean resected vertebrae was 1.8 (range, 1 - 5). The mean operation time was 331 min (range, 240 - 450 min) with an average blood loss of 1453 ml (range, 800 - 3000 ml). The average follow-up time was 13 months (range, 3 - 24 months). The regional scoliosis was corrected from 111° to 51°with a correction rate of 54.0%, and regional kyphosis from 104° to 39° with a correction rate of 62.5%. No obvious loss of correction was noted at the final follow-up. The coronal trunk shift improved from 19.5 mm preoperatively to 18.1 mm postoperatively and 12.4 mm at final follow-up. The sagittal balance improved from 20.0 mm preoperatively to -2.0 mm postoperatively and -1.1 mm at the final follow-up. Complications included partial pleural rupture requiring repair in 3 cases, transient muscle weakness of one lower limb after surgery but recovered completely at 6 month follow-up in 2 cases, and tightness of thorax after surgery in one case., Conclusions: posterior vertebral column resection is effective in treatment of severe and rigid spinal deformities. But it is a technique-demanding procedure with higher risks of major neurologic complications.

Background: Selective anterior thoracolumbar/lumbar (TL/L) fusion and instrumentation in adolescent idiopathic scoliosis (AIS) patients with a structural major TL/L curve and a nonstructural minor thoracic curve is rarely reported. We investigate the correction results of these patients., Methods: By reviewing the medical records and roentgenograms of AIS patients undergone selective anterior TL/L fusion and instrumentation, Cobb angle, correction rate of the major and minor curves, coronal balance, lowest instrumented vertebra (LIV) tilt, coronal disc angle immediately below the LIV (LIVDA) and radiographic shoulder height (RSH) were measured and analyzed., Results: Forty patients were included. For the major TL/L curve, the mean coronal Cobb angle before and after operation were 43.9° and 8.7°, respectively, with an average correction rate of 80.2% (P = 0.000). While for the minor thoracic curve, the mean coronal Cobb angle before and after operation were 27.2° and 14.3°, respectively, with an average spontaneous correction rate of 47.4% (P = 0.000). At final follow-up, the coronal Cobb angles of the major and minor curves were 13.7° and 17.1°, respectively, with a mean correction loss of 5.0° and 2.9°, respectively. The coronal balance before and after operations was 13.2 mm and 11.5 mm, respectively. At the final follow-up, it turned to 5.6 mm, which was much better than that after operation (P = 0.001). The mean LIV tilt was 23.5° before operation, and was significantly improved after operation (8.3°, P = 0.000). At final follow-up, it was well maintained (10.6°). The LIVDA averaged 3.5° before operation, and aggravated to 5.5° after operation (P = 0.100) and 7.4° at final follow-up (P = 0.012), respectively. The RSH was 7.3 mm before operation, 5.6 mm after operation, and 2.2 mm at the final follow-up. The RSH at the final follow-up was significantly improved compared with that after operation (P = 0.002)., Conclusions: Selective anterior TL/L fusion and instrumentation can get good correction results of both curves, with good results of the coronal balance and RSH in AIS patients, while a larger LIVDA.

Objective: To evaluate the different influences of anterior and posterior correction and fusion approaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis., Methods: The retrospective study was conducted with the medical records and radiographs of adolescent idiopathic thoracolumbar/lumbar scoliosis patients that underwent anterior (group A) or posterior (group B) correction and fusion surgery from December 1998 to May 2008. The correction of the main curve and changes of the disc wedging were analyzed., Results: Fifty-three patients were included, 26 in group A and 27 in group B. The mean coronal Cobb angles of the main curve in group A and group B were significantly corrected after surgery (P < 0.05), with an average correction rate of 75.2% and 88.2%, respectively. Upon final follow-up, the coronal Cobb angles of the two groups were 18.90 +/- 11.1 degrees and 7.70 +/- 5.6 degrees, respectively, with an average correction loss of 6.8 degrees +/- 6.5 degrees and 2.7 degrees +/- 3.3 degrees, respectively. The coronal Cobb angle after operation and at final follow-up, and the correction rate were significantly better in group B than those in group A (P < 0.05), while the coronal Cobb angle loss in group A was greater than that in group B (P < 0.05). The disc wedging before operation, after operation, and at final follow-up were 3.2 degrees +/- 3.0 degrees, 5.7 degrees +/- 3.0 degrees, and 8.6 degrees +/- 4.4 degrees in group A, and 2.4 degrees +/- 3.2 degrees, 3.3 degrees +/- 3.4 degrees, and 3.7 degrees +/- 3.6 degrees in group B, respectively. Postoperative disc wedging was significantly larger compared with preoperative measurements in group A (P < 0.05), but not in group B (P > 0.05). The difference between disc wedging at final follow-up and that after surgery was significant in group A (P < 0.05), but not in group B (P > 0.05). Between the two groups, group A had larger disc angles after operation and at final follow-up (P < 0.05), and a greater loss of disc angle (P < 0.05)., Conclusion: For adolescent idiopathic thoracolumbar/lumbar scoliosis, posterior approach using all pedicle screws might produce a better result in terms of disc wedging compared with anterior approach.

Objective: To analyze the radiological change of intervertebral angles after the short-segment fusion of degenerative lumbar scoliosis., Methods: From January 2001 to May 2007, 28 patients (mean age 62 years old) with degenerative lumbar scoliosis, including 6 male and 22 female, were reviewed retrospectively. The average vertebra number in the lumbar curve were 4.8, ranging from 3 to 6. All the patients underwent posterior decompressive laminotomy, pedicle screw fixation, and posterolateral fusion. The fusion levels were within the curve in all the cases (mean 3.3 vertebrae), without exceeding the end vertebrae. All the patients took standing lumbar antero-posterior and sagittal radiological images pre and post-surgery and upon follow up. The coronal scoliosis Cobb angle, anterior and sagittal intervertebral angles of upper adjacent segment of proximal fused vertebra were measured. The following aspects were also evaluated such as bone graft fusion and complications., Results: Follow up period of 25-97 months, average 50 months; post-operative scoliosis Cobb angle average correction rate was 33.7%, final follow up average correction loss was 3.7 degrees , pre-operative and final follow up results compared with post-operative indicated significant difference (P < 0.05); final follow-up antero-posterior proximal upper fusion segment intervertebral angle compared with pre-operative and postoperative presenting significant difference (P < 0.05). Upon final follow up, all cases did not present pseudo-arthrosis or internal instrumentation related complications., Conclusion: For degenerative lumbar scoliosis, short-segment fusion can produce limited correction on antero-posterior proximal upper fusion segment intervertebral angle and cannot stop its aggravation.

Objective: To investigate the efficacy and safety of a new method which determines the exact distal fusion level in the treatment of adolescent idiopathic scoliosis (AIS) with posterior pedicle screw fixation and to assess its clinical outcome., Methods: This prospective clinical study analyzed 31 AIS patients who met the inclusion criteria enrolled from July 2005 to September 2008. Based on the principle of our new criteria for selection of distal fusion level of AIS, all patients had posterior spinal fusion and instrumentation with pedicle screws. Cobb angle of the curve, tilt angle of the LIV, intervertebral angle and trunk shift were measured and analyzed., Results: Preoperative (42 + or - 17) degrees of thoracic curve was corrected to (12 + or - 7) degrees , with a curve correction of 70.6%. Preoperative (44 + or - 7) degrees of lumbar curve was corrected to (9 + or - 4) degrees , with a curve correction of 80.2%. The trunk shift were significantly improved from (13 + or - 8) mm to (9 + or - 7) mm before and after surgery respectively (P < 0.05). The tilt angles of the LIV before and after surgery were (20.8 + or - 5.7) degrees and (1.5 + or - 3.1) degrees respectively. The thoracic Cobb angle was (14 + or - 8) degrees and the lumbar Cobb angle was (9 + or - 5) degrees at latest follow up. The changes were of significance in the tilt angle of the LIV after surgery compared with that before surgery (P = 0.000). This angle averaged (0.8 + or - 3.7) degrees at final follow up, but the change was not significant compared with that after surgery (P > 0.05)., Conclusion: This is an effective method with the advantage of shortening the fusion level, reserving the distal motion segments and easing segmental degeneration adjacent to the fusion area.

Background: Treatment of rapidly progressing scoliosis in young children is a challenge for spine surgeons. Some surgeons had begun to use dual growing rod technique for treatment of rapidly progressing scoliosis in young children and had achieved acceptable results. The aim of this study was to determine the primary results and complications of this new technique in China., Methods: Eleven children suffering from rapidly progressing scoliosis were treated with dual growing rod technique between November 2004 and March 2009 at Peking Union Medical College Hospital (PUMCH). There were 10 females and 1 male in the group with Risser sign of 0 grade. The mean age at initial surgery was 6.1 years (range, 2.1-10.9 years). Ten patients were diagnosed as congenital scoliosis and 1 patient neuromuscular scoliosis. All the patients had 1-4 lengthening procedures (mean, 1.8 procedures) after the initial surgeries. The radiographic results of all the patients were investigated., Results: The coronal Cobb angle of scoliosis improved from (67.64+/-11.43) degrees to (34.64+/-8.26) degrees after initial surgery with the correction rate observed at (47.15+/-16.48)%. The coronal trunk shift improved from (2.00+/-1.73) cm to (1.49+/-1.31) cm after initial surgery. The T1-S1 height increased from (25.47+/-6.16) cm to (28.84+/-5.69) cm after initial surgery. The coronal Cobb angle of scoliosis was (36.82+/-11.76) degrees and the coronal trunk shift was (1.11+/-1.29) cm after the most recent lengthening procedure with the most recent correction rate observed at (44.73+/-19.43)%. The T1-S1 height was (31.29+/-4.50) cm after the most recent lengthening procedure with an average T1-S1 length increase of 1.6 (range, 1.0-2.7) cm per year during the lengthening period. The sagittal balance was maintained. Five of the total patients (45.5%) had complications including: hook displacement, pedical screw loosening, and broken rod. We performed revision surgeries with simultaneous lengthening procedures in all 5 cases with satisfactory results., Conclusions: The dual growing rod technique was useful in the management of rapidly progressing scoliosis in young children. This technique could control severe scoliosis, allow for spinal growth, and maintain the coronal and sagittal balance. But the technique has high complications requiring strict and regular follow-up.

Objective: To investigate whether polymorphisms of SIM2 gene are associated with congenital scoliosis (CS) in a Chinese Han population. and explore the relationship of between polymorphisms of SIM2 and clinical phenotypes of CS., Methods: A case-control design was employed in this study. A total of 127 patients (55 boys, 72 girls, mean age 12.90 y/o) diagnosed with CS admitted at Peking Union Medical College (PUMC) Hospital were enrolled between October 2005 and September 2007. The scoliosis-free control subjects (127 cases) at the same hospital during the same study period were frequency-matched to the cases on age (+/- 3 years) and gender. Genomic DNA was extracted by QIAamp DNA Blood Mini Kit from peripheral blood leukocytes of each subject who had signed informed consent. Based on genotype data from the International HapMap project, the main functional single nucleotide polymorphisms (SNPs) initially were selected. Case group were classified into different clinical phenotypes according to vertebral defect type, location of deformity, extent of developmental disruption, combined rib malformations and neural canal deformity. Genotying of all selected SNPs was done by SNPstream technology (Beckman Coulter SNPstream). All the data of SNPs with polymorphism were analyzed by association analysis based on a single SNP, the association analysis between phenotypes and SNPs. And pairwise linkage disequilibrium was calculated in the control population using Haploview 4.1 software., Results: SNP1 (rs2073601), SNP2 (rs2073417) and SNP3 (rs2051397) of SIM2 are genotyped. SNP2 and SNP3 in linkage disequilibrium. No association (P > 0.05) is observed between SNP1, SNP2 and SNP3genotypes/allele polymorphisms and risk of CS and different clinical phenotypes., Conclusion: Genetic variants of SIM2 gene may not be associated with the susceptibility to CS and different clinical phenotypes of CS in Chinese Han population.

Objective: To observe wedge changes in the vertebral bodies and intervertebral discs in progressive adolescent idiopathic scoliosis before and after conservative treatment with braces, and to explore the correlation between wedge changes in the vertebral bodies or intervertebral discs and scoliosis curves., Methods: Thirty-seven consecutive patients with adolescent idiopathic scoliosis were included in this study from June 2001 to August 2003. There were 31 female and 6 male patients, with an average age of 14.9 years. According to the Peking Union Medical College (PUMC) grading system, eight cases were Ia, three Ib, five Ic, twelve IIb1, three IIb2, three IIc1, one IIc3, and two IId1. Wedge changes in the vertebral bodies and intervertebral discs, and the scoliosis angles were measured by radiographic evaluation before conservative treatment with braces and before surgery., Results: In the mature patients (Risser sign IV, V, menarche two years or more previously), wedge changes in the vertebral bodies and intervertebral discs worsened with curve progression, and were poorly correlated with the degree of curve (r= 0.17). But in the developmentally immature patients (Risser sign 0-III, pre-menarche), there was a significant correlation with the degree of curve (r= 0.69). Wedge changes in the vertebral bodies and intervertebral discs worsened with curve progression, and were significantly correlated with the degree of curve., Conclusion: Wedge changes in the vertebral bodies and intervertebral discs have a positive correlation with degree of curve, which indicates that asymmetric growth of the cartilaginous endplate might be the primary cause of wedge change in the vertebral bodies., (© 2009 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.)

Objective: To evaluate the different influences upon the correction outcomes after anterior or posterior correction and fusion with lowest end vertebra instrumentation in adolescent idiopathic thoracolumbar/lumbar scoliosis., Methods: By reviewing the medical records and roentgenograms of adolescent idiopathic thoracolumbar/lumbar scoliosis patients undergoing anterior (single rod-Group A) or posterior (all pedicle screws-Group B) correction and instrumentation, the parameters of Cobb angle of the curve, correction rate and disc angle were measured and analyzed., Results: There were 18 patients in Group A and 21 patients in Group B. The curve included 5.0 vertebrae and 5.5 vertebrae (P = 0.134) respectively, and the fusion levels were 4.7 vertebrae and 5.4 vertebrae (P = 0.008) respectively. The mean pre-operative and post-operative coronal Cobb angles of the main curve in Groups A and B were 49.2 degrees and 10.3 degrees , 42.2 degrees and 5.0 degrees with an average correction rate of 78.5% and 87.8% respectively. The Cobb angles were all significantly corrected (all P = 0.000), and group B had a better correction result (P = 0.020). At final follow-up, the coronal Cobb angles in the two groups were 21.7 degrees and 7.7 degrees with an average correction loss of 8.3 degrees and 2.7 degrees (P = 0.001) respectively. The disc angles at pre-operation, post-operation and final follow-up were 3.1 degrees , 5.6 degrees and 7.3 degrees in Group A and 2.3 degrees , 4.2 degrees and 4.4 degrees in Group B respectively. The disc angle at post-operation was larger than that at pre-operation and the difference was significant in Group A (P = 0.049) while not in Group B (P = 0.050). The difference of post-operative disc angle between two groups was not significant (P = 0.231). At final follow-up, the disc angle was a little larger than that of post-operation without a significant difference (P = 0.112, P = 0.855) while Group A had a larger disc angle (P = 0.026). At final follow-up, the occurrence of proximal junctional kyphosis between Groups A and B was not significant (P = 0.235)., Conclusion: For adolescent idiopathic thoracolumbar/lumbar scoliosis, in comparison with the anterior approach, the posterior approach using all pedicle screws can achieve a better correction outcome, a less correction loss of coronal Cobb angle and a better disc angle with a longer fusion range.

Objective: To evaluate the safety and efficacy of apical pedicle subtraction osteotomy (PSO) in the treatment of severe kyphoscoliosis., Methods: The radiographic films of the 12 severe kyphoscoliosis patients treated with apical pedicle subtraction osteotomy were retrospectively reviewed, and the Cobb angles of the scoliosis and kyphosis and coronal trunk balance were measured and analyzed. Medical records and operation charts were reviewed to record any peri-operative complications., Results: Twelve patients were included in this study, 4 males and 8 females, with an average age of 20.1 years old. Of the 12 patients, 2 were adult kyphoscoliosis and 10 were congenital kyphoscoliosis. The mean follow-up time was 9.2 months. The mean fusion levels were 12 segments and the mean operation time was 5.0 hours. The mean estimated blood loss during operation was 1517 ml and the mean autotransfusion and allotransfusion were 780 ml and 1109 ml, respectively. The mean preoperative and postoperative coronal Cobb angle of the main curve was 100.9 degrees and 48.8 degrees , with an average correction rate of 51.8% (P = 0.000). The mean preoperative and postoperative sagittal Cobb angle of the kyphosis was 81.7 degrees and 42.2 degrees , with an average correction rate of 49.8% (P = 0.000). At final follow-up, the mean Cobb angles of the scoliosis and kyphosis were 50.7 degrees and 46.0 degrees , respectively, and no obvious correction loss was found (P = 0.763, P = 0.698). The mean coronal trunk balance before, after surgery and at final follow-up was 16.3 mm, 14.7 mm, and 12.0 mm, respectively. Only 1 patient had trunk shift greater than 20 mm at final follow-up. After operation, two patients suffered from transient numbness and weakness of the unilateral lower extremity with complete recovery in one week. No spinal cord injury occurred., Conclusions: Apical pedicle subtraction osteotomy can be easily performed in the treatment of severe rigid kyphoscoliosis with satisfactory correction results and few neurologic complications.

Objective: To measurement the vertebra morphology using multi-planar reformations method of multi-slice spiral CT (MSCT) in AIS girls, and To compare with age and gender-matched controls in order to affirm the morphology results of abnormal development of the anterior and posterior elements in AIS., Methods: Thoracic and lumbar spine multi-slice spiral CT was undertaken on 52 girls with AIS between the age of 10 and 18 years from June 2004 to May 2008 in Peking Union Medical College Hospital and Beijing Shijitan Hospital, and 54 age and gender-matched non-IS controls. Multiple measurements (including the anterior column and posterior column) of each thoracic and lumbar vertebra were obtained using the 3D-MPR technique. The patients and control were divided into 10-14 years old group and 15-18 years old group. The corresponding vertebral anterior height, vertebral posterior height, transverse distance, vertebra central width, vertebra anterior-posterior distance, area of pedicle, pedicle height, pedicle width, and upper-lower facet distance were compared., Results: Compared with the controls, the 10-14 years old group girls' spine had longer anterior column height, relative shorter posterior column (there are difference from thoracic 2-11 and lumbar 1-3, P < 0.05), relative longer anterior-posterior vertebral distance, vertebral wedging changes in vertebral, distinct vertebral and pedicle asymmetry on the concave and convex side, and upper-lower facet distance asymmetry on the concave and convex side. The difference between the anterior and the posterior column ratio was significantly different from that in the controls (P < 0.01). But there hadn't the same difference in 15 - 18 years old group., Conclusions: There are differences in coronal plane vertebra wedging changes in AIS patient. There are high vertebra height, relative shorter posterior column, relative longer anterior-posterior vertebral distance, and relative slender vertebra in 10 - 14 years old AIS patients. This may lead to the initial and progression of scoliosis.

Objective: To investigate whether single nucleotide polymorphisms (SNP) of the calmodulin1 (CALM1) and estrogen receptor-α genes correlate with double curve in adolescent idiopathic scoliosis (AIS)., Methods: A total of 67 Chinese patients with AIS with double curve and 100 healthy controls were recruited. Curve pattern and Cobb angle of each patient were recorded. The Cobb angle is at least 30°. There were 60 patients with Cobb angle ≥ 40°. According to the apical location of the major curve, there were 40 thoracic curve patients. Four polymorphic loci, including rs12885713 (-16C > T) and rs5871 in the CALM1 gene and rs2234693 (Pvu II) and rs9340799 (Xba I) in the estrogen receptor 1 (ER1) gene were analyzed by the ABI3730 genetic analyzer., Results: The current study indicates that: (i) there are statistical differences between patients with double curve, with Cobb angle ≥ 40° and with thoracic curve and healthy controls in the polymorphic distribution of the rs2234693 site of the ER1 gene, (P= 0.014, 0.0128, 0.0184 respectively); (ii) there is a difference between patients with double curve and controls in the polymorphic distribution of the rs12885713 site in the CALM1 gene (P= 0.034); and (iii) there is a difference between thoracic curve patients and controls in the polymorphic distribution of the rs5871 site in the CALM1 gene (P= 0.0102)., Conclusions: Different subtypes of AIS might be related to different SNP. A combination of CALM1 and ER1 gene polymorphisms might be related to double curve in patients with AIS. Further study is necessary to confirm these hypotheses., (© 2009 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.)

Objective: To evaluate the outcomes of selective anterior thoracolumbar or lumbar (TL/L) fusion for adolescent idiopathic scoliosis (AIS) with PUMCIId1 curves (Lenke type 5)., Methods: Thirty-five consecutive AIS patients (PUMC type IId1, Lenke type 5) with selective anterior TL/L fusion with single solid rod instrumentation were reviewed. The average follow-up was 36 months (range, 18 - 42 months). Standing anteroposterior and lateral radiographs were measured and analyzed., Results: The average preoperative Cobb angle of the TL/L curves was 45.6 degrees and corrected to 9.7 degrees postoperatively, with 79.7% curve correction. The thoracic curves decreased from 29.7 degrees preoperatively to 17.6 degrees postoperatively, with a spontaneous correction of 41.5%. There was an average 4.7 degrees and 2.5 degrees correction loss of the TL/L and the thoracic curves at the final follow-up respectively. Trunk shift deteriorated slightly from 14.0 mm preoperatively to 14.8 mm postoperatively, and improved significantly to 5.1 mm at the final follow-up. The lowest instrumented vertebra (LIV) tilt was significantly improved after surgery (from -21.8 degrees preoperatively to -1.5 degrees postoperatively) and well maintained at the final follow-up (-2.1 degrees). The coronal disc angle immediately above the upper instrumented vertebra (UIVDA) and below the LIV (LIVDA) averaged 0.5 degrees and 0.6 degrees respectively, and aggravated after surgery (0.9 degrees and 4.9 degrees, respectively). Both the UIVDA and LIVDA were significantly aggravated at the final follow-up (3.0 degrees and 7.8 degrees, respectively). The sagittal contours of T(5-12) and T(10)-L(2) were well maintained after surgery and at the final follow-up. The lumbar lordosis of L(1)-S(1) and the sagittal Cobb angle of the instrumented segments were reduced postoperatively and at the final follow-up. No pseudarthrosis or other complications were observed., Conclusion: Selective anterior TL/L fusion with single solid rod instrumentation is effective and safe for AIS with PUMCIId1 (Lenke type 5) curves, above and below the fusion and larger residual thoracic curve in some cases need further evaluated.

Objective: To summarize the clinical features and evaluate the surgical results of adolescent idiopathic scoliosis (AIS) with thoracolumbar kyphosis., Methods: Four hundred and thirteen AIS patients were retrospectively reviewed between January 2001 and January 2007. Among them, 10 patients had thoracolumbar kyphosis, including 2 males and 8 females. The average age at surgery was 14.3 years old. There were 3 PUMC type IIb2, 4 PUMC IIc3, 1 PUMCIId2, 2 PUMC IIIb. Eight patients underwent posterior correction and spinal fusion with instrumentation, 2 patients underwent anterior release, posterior correction and spinal fusion with instrumentation. By reviewing the roentgenograms of patients, the curve type, Cobb angle, flexibility, apical rotation and translation, coronal and sagittal trunk shift and thoracolumbar kyphosis were measured and analyzed., Results: Eight patients had double curves and 2 patients had triple curves. Among them, the Cobb angles of thoracolumbar or lumbar curve were larger than 45 degrees in 7 patients, the flexibility index was less than 70% in 6 patients, the apical vertebral rotation was larger than II degrees in 9 patients and the apical vertebral translation was larger than 2 cm in all patients. All the surgical treatment strategy and fusion level followed the criteria of PUMC classification. The coronal Cobb angles of thoracic curve before and after surgery were 71.7 degrees and 37.4 degrees respectively, and the average correction rate was 47.8%. The coronal Cobb angles of thoracolumbar or lumbar curve before and after surgery were 65.0 degrees and 27.8 degrees respectively, and the average correction rate was 57.2%. The Cobb angles of thoracolumbar kyphosis before and after surgery were 35.5 degrees and 4.2 degrees respectively, and the average correction rate was 88.2%. No trunk decompensation was noted at final follow-up. All patients were followed-up from 12 to 72 months; the average follow up was 23.1 months., Conclusions: AIS patients with thoracolumbar kyphosis usually have double or triple curves. In these patients, thoracolumbar curves or lumbar curves are severe and have obvious rotatory deformity. Thoracolumbar curve or lumbar curve should be fused in idiopathic scoliosis patients with thoracolumbar kyphosis to avoid trunk decompensation or junctional kyphosis. By using criteria of PUMC classification, these patients can be well identified and corresponding fusion level can be followed as well.

Objective: To study the relationship between the fulcrum bending flexibility (FBF) and correction rate (CR) of adult idiopathic scoliosis, and to explore the ability of FBF to assess the correction effect in relation to fulcrum bending flexibility., Methods: 69 patients with adult idiopathic scoliosis with structural curves at thoracic or lumbarthoracic segments, 16 males and 53 females, aged 26.5 (19 - 53) were treated by pedicle screws instrumentation. Pre-operative standing and fulcrum bending films and postoperative standing X-ray film were taken. Cobb angle was measured. The data underwent regression analysis with the software SPSS 10.0., Results: A regression formula was established: CR = 0.213 + 0.768 x FBF with P < 0.01., Conclusion: A definite linear relation exists between the FBF and CR of adult idiopathic scoliosis. By using the formula in proper samples, the effects of new instrumentation or correction technique can be objectively assessed.

Objective: To investigate the role of curved planar reformation (CPR) using multi-slice spiral CT scanning to evaluate the coronal and sagittal plane in scoliosis so as to affirm the features of supine coronal and sagittal plane in idiopathic scoliosis., Methods: Thoracic and lumbar spine multi-slice spiral CT scanning was undertaken on 45 patients with adolescent idiopathic scoliosis (AIS), all female, age 10 - 18. CPR was used to reconstruct the spine coronal and sagittal planes respectively. The values of main curve and compensate curve Cobb angles were obtained and compared with those obtained by X-ray films., Results: The average CPR coronal main curve Cobb angle was smaller by 10.17 degrees than that obtained by standing position film. The average CPR coronal compensate curve Cobb angle was smaller by 6.97 degrees than that obtained by standing position film. For scoliosis coronal flexibility assessment, fulcrum-bending method offered better surgical correction result than other methods. Only the post-operational Cobb angle was different between the 10 - 14 year-old group and 15 - 18 year-old group. Bending film showed differences in correction rate and flexibility rate between the main thoracic group and main lumbar/thoracolumbar group. The correction rate and flexibility rate of main curve and compensate curve of the 10 - 14 year-old group were significantly higher than those of the 15 - 18 year-old group. In the sagittal plane, the CPR thoracic kyphotic angle (T5-T12) and upper thoracic curve kyphosis of the main thoracic group were both smaller than those of the main lumbar/thoracolumbar group. The CPR thoracic kyphotic angle (T5-T12) of the 10 - 14 year-old group was significantly smaller than that of the 15 - 18 year-old group. Correlation analysis showed that the CPR main curve flexibility and bending film flexibility were positively corrected with the surgical correction rate., Conclusion: CPR using multi-slice spiral CT scanning is able to obtain multiple three-dimensional assessment by one scanning and is helpful in scoliosis curve type diagnosis and scoliosis 3D analysis.

Background: Patients with congenital scoliosis often also have intraspinal abnormalities and other organ defects, and few studies of the effects of congenital scoliosis on cardiac function and structure have been published., Methods: A total of 215 adolescent patients with congenital scoliosis (average age, 13.58 years) underwent preoperative echocardiography and were then assigned to subgroups according to apex vertebral rotation, side of convexity, curvature severity in the coronal and sagittal planes, type of deformity, and sex. Differences between the subgroups were compared by independent-samples t test or a one-factor analysis of variance., Results: We observed statistically significant differences between patients with right-sided scoliosis curvature and those with left-sided scoliosis curvature, respectively, in left ventricular inner diameter at end-diastole ((39.39 +/- 4.66) mm vs (41.74 +/- 4.90) mm), left ventricular inner diameter at end-systole ((24.80 +/- 3.45) mm vs (25.92 +/- 3.07) mm), interventricular septum thickness at end-diastole ((5.66 +/- 0.98) mm vs (5.98 +/- 1.03) mm), and posterior wall of left ventricle at end-diastole ((5.61 +/- 0.98) mm vs (6.06 +/- 1.20) mm). When the patients were evaluated by coronal plane Cobb angle, significant differences were found between those with Cobb angle of 40 degrees - 80 degrees and of > 80 degrees in left ventricular inner diameter at end-diastole ((40.97 +/- 5.06) mm vs (38.98 +/- 4.45) mm) and left ventricular inner diameter at end-systole ((25.53 +/- 3.39) mm vs (24.36 +/- 3.14) mm), respectively. When the patients were evaluated by sagittal plane Cobb angle (< 20 degrees, group 1; 20 degrees - 40 degrees, group 2; > 40 degrees, group 3), significant differences were found in right ventricular diameter between those with Cobb angle of < 20 degrees and of 20 degrees - 40 degrees ((18.27 +/- 3.66) mm vs (16.54 +/- 3.57) mm) and in diameter of aortic root between those with Cobb angle of 20 degrees - 40 degrees and of > 40 degrees ((23.83 +/- 3.39) mm vs (24.90 +/- 3.30) mm), respectively. No significant differences were found in ejection fraction and fractional shortening between patients according to apex vertebral rotation, side of convexity, coronal plane and sagittal plane Cobb angles, type of deformity, or sex., Conclusions: Congenital scoliosis influences cardiac structure, but not function.

Objective: To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion,, Methods: By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions: Group A was hook-screw-rod (hybrid) internal fixation type, Group B was screw-rod (all pedicle screws) internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed,, Results: Totally, 48 patients (7 males, 41 females) were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8 degrees and 47.4 degrees, respectively. After surgery, they were corrected to 13.7 degrees and 6.8 degrees, respectively. At final follow-up, they were 17.0 degrees and 9.5 degrees, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A (P = 0.003). The mean preoperative coronal Cobb angles of the lumbar curve were 32.6 degrees and 35.2 degrees, respectively. After surgery, they were corrected to 8.6 degrees and 8.3 degrees, respectively. At final follow-up, they were 10.3 degrees and 11.1 degrees, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A (P = 0.003). The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1 degrees and 1.8 degrees, 2.4 degrees and 2.4 degrees, respectively. No significant difference was noted (both P > 0.05). The decompensation rate at final follow-up in these 2 groups were 4% (1/25) and 7.1% (1/14) respectively, with no significant difference (P > 0.05)., Conclusions: Both all pedicle screws and hybrid instrumentation can offer good correction results of the thoracic curve and lumbar curve in posterior selective thoracic fusion in patients with adolescent idiopathic scoliosis. While with all pedicle screws, the correction results of the thoracic curve and lumbar curve are both better than those with hybrid instrumentation without increased decompensation rate.

Objective: To investigate whether: (i) rs12885713 (-16C > T) and rs5871 polymorphisms in the Calmodulin1 (CALM1) gene are predisposing factors for adolescent idiopathic scoliosis (AIS); and (ii) different single nucleotide polymorphisms (SNP) correlate with different subtypes of AIS., Methods: A total of 100 AIS patients with Cobb angle above 30° were recruited for this study together with 100 healthy controls. Curve pattern, Cobb angle, and Risser sign were recorded. Two polymorphic loci, rs12885713 (-16C > T) and rs5871 loci, of the CALM1 gene were analyzed. All patients were grouped according to the Peking Union Medical College (PUMC) classification, the apical location of the major curve, and the Cobb angle., Results: There was a statistically significant difference in the distribution of rs12885713 site polymorphism (P = 0.034) between PUMC type II (double curve) patients and controls, in the distribution of rs12885713 site polymorphism (P = 0.009) between lumbar curve cases and controls and in the distribution of rs5871 site polymorphism (P = 0.035) between thoracic curve patients and controls., Conclusion: Different subtypes of AIS might be related to different SNP. The susceptibility of PUMC type II (double curve) AIS and lumbar curve might be related to CALM1 rs12885713 site polymorphism, while rs5871 site polymorphism might be a risk indicator for thoracic curve cases., (© 2009 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.)

Objective: To investigate the association of polymorphisms of PAX1 gene with congenital scoliosis (CS) in Chinese Han population and the relationship between the PAX1 gene polymorphisms and the clinical phenotypes of CS., Methods: Peripheral blood samples were collected from 127 CS patients, 55 male and 72 female, aged (12.9 +/- 4.3) (2 - 23), and 127 sex- and age-matched controls. Based on genotype data from the International HapMap project, the tagging single nucleotide polymorphisms (tSNPs) were selected using Haploview 4.0 software. Hardy-Weinberg equilibrium was analyzed both in the control and case groups. The case group was classified into different clinical phenotypes according to vertebral defect type, location of deformity, extent of developmental disruption, combined rib malformations, and neural canal deformity. Genotyping of all selected SNPs was done by SNPstream technology. The association between phenotypes and SNP was analyzed. Pairwise linkage disequilibrium was calculated in the control population using Haploview 4.0 software., Results: The sites: SNP1 (rs17861031) and SNP2 (rs6047590), of PAX1 gene were genotyped and both polymorphisms were distributed in line with the Hardy-Weinberg equilibrium in these 2 groups. There was no linkage disequilibrium between these 2 SNPs. The genotype frequencies of SNP1AA, SNP1AG, SNP1GG, SNP2AA, SNP2AT, and SNP2TT of the case group were 2%, 26%, 72%, 2%, 19%, and 80% respectively, all not significantly different from those of the control group (2%, 26%, 72%, 2%, 26%, and 82% respectively, all P > 0.05). The allele frequencies of SNP1A, SNP1G, SNP2A, and SNP2T of the case group were 15%, 85%, 11%, and 89% respectively, all not significantly different from those of the control group (15%, 85%, 10%, and 90% respectively, all P > 0.05). No positive sites were found in different clinical phenotypes., Conclusion: The genetic variants of PAX1 gene may not be associated with the susceptibility to CS and different clinical phenotypes of CS in Chinese Han population.

Objective: To investigate the association between calmodulin1 (CALM1) gene or estrogen receptor-alpha (ESR1) polymorphisms and double curve of adolescent idiopathic scoliosis (AIS)., Methods: 67 double curve patients (30 degrees < Cobb angle < 90 degrees ), 100 controls. There were 4 polymorphic loci, rs12885713 (-16C > T) and rs5871 locus in CALM1 gene, rs2234693 (PvuII) and rs9340799 (XbaI) in ESR1 gene analyzed sequence by ABI3730 genetic analyzer., Results: There were 60 patients with Cobb angle > or = 40 degrees . According to the apical location of major curve, there were 40 thoracic curve patients. Furthermore, 1) there are statistical differences on the polymorphic distribution of ESR1 gene rs2234693 site between the double curve, Cobb angle > or = 40 degrees or thoracic curve patients and the controls, respectively (chi(2) = 6.081, 5.554, 6.1935; P = 0.014, 0.0128, 0.0184); 2) between the double curve cases and the controls, there is difference on the polymorphic distribution of rs12885713 site in CALM1 gene (chi(2) = 4.478; P = 0.034); 3) Between the thoracic curve patients and the controls, there is difference on the distribution of rs5871 allele polymorphism in CALM1 gene (chi(2) = 6.6061; P = 0.0102)., Conclusion: Double curve patterns might be related to ESR1 gene rs2234693 (PvuII) site polymorphism. It is necessary to clarify the association between the polymorphisms of ESR1 gene and CALM1 gene and different subtypes of adolescent idiopathic scoliosis in the further study.

Objective: To analyze and compare the Imaging findings of adult idiopathic scoliosis and degenerative scoliosis which were the most common adult scoliosis, and evaluate imaging characteristics., Method: The radiological and clinical data of 98 case, among them, 41 cases of adult idiopathic scoliosis and 57 cases of degenerative scoliosis, were analyzed retrospectively., Result: There were differences at presence age, sex ratio, anatomic area of scoliosis and apex between two types of adult scoliosis. The analyses and comparison between the two groups revealed significant change in the Cobb angle, involved segment and convex side orientation (all P < 0.05)., Conclusion: Adult idiopathic scoliosis and degenerative scoliosis show distinctive imaging characteristics. These characteristics combining clinical data are decisive in diagnosis.

Objective: To compare the effects in assessing the curve flexibility of the adolescent idiopathic scoliosis (AIS) and predicting the outcomes of operation among different radiological techniques: supine lateral bending (SB), traction (Tr), and fulcrum bending radiographs., Methods: 68 consecutive AIS patients, all with the single-curve types Ia/Ib/Ic according to the PUMC classification, divided into 4 groups according to the magnitude of Cobb's angle: moderate thoracic curve (n = 19, 40 degrees < Cobb's angle < or = 60 degrees ), severe thoracic curve (n = 13, Cobb's angle > 60 degrees ), moderate lumbar curve (n = 28, 35 degrees < Cobb's angle < or = 60 degrees ), and severe lumbar curve(n = 8, Cobb's angle > 60 degrees ) who were treated surgically underwent preoperative radiological evaluation including standing anteroposterior and lateral Tr, SB, and fulcrum bending radiographs. COBB angle was measured and the flexibility ratio was determined on each radiograph. The amounts of correction obtained by all radiographic methods were compared with the amount of surgical correction., Results: The post-operative Cobb's angle of the moderate thoracic curve group was 9 degrees , not significantly different from that by fulcrum bending radiograph (P = 0.076), but significantly different from those by the other methods (both P < 0.01). The post-operative COBB angle of the severe thoracic curve group was 40 degrees , significantly different from all the radiographs before operation (all P < 0.01). The post-operative Cobb's angle of the moderate lumbar curve group was 4 degrees , significantly different from those by fulcrum bending and Tr radiographs (both P < 0.01) and that by SB (P = 0.013). The post-operative Cobb's angle of the severe lumbar curve group was 24 degrees , significantly different from those of anteroposterior and Tr radiograph (both P < 0.01) and those of fulcrum-bending and SB radiographs (P = 0.021 and P = 0.011). In the moderate thoracic curve group the operation correction rate was not significantly different from the flexibility rate by fulcrum-bending radiograph (P = 0.111), and was significantly different from the flexibility rates by SB and Tr radiographs (P = 0.011 and P = 0.000). In the severe thoracic curve group the operation correction rate was significantly different from the flexibility rates by different kinds of radiograph (all P = 0.111). In the moderate lumbar curve group the operation correction rate was significantly different from the flexibility rates by different kinds of radiograph (P < 0.111 or P = 0.019). In the severe lumbar curve group the operation correction rate was significantly different from the flexibility rates by different kinds of radiograph (P < 0.01 or P = 0.017)., Conclusion: Fulcrum-bending radiography can better assess the flexibility and correction rate of thoracic curves in AIS, however, it can only predict those in moderate thoracic curves. Fulcrum-bending radiograph and SB radiograph are similar in predicting the flexibility in lumbar curves.

Objective: To compare the effect of posterior correction and fusion between segmental pedicle screw instrumentation with hybrid constructs in adolescent idiopathic scoliosis (AIS)., Methods: Study the clinical data of 40 AIS patients retrospectively. They were underwent posterior fusion and be distributed into two group, group A was hybrid instrumentation (20 cases) and group B was pedicle screw instrumentation (20 cases). Compared therapy effect, operative time, intraoperative blood loss., Results: The average major curve correction was 82.4% in the screw group and 71.8% in the hybrid group (P = 0.004). After one to three years follow-up, major curve correction was 77.0% and 62.5% respectively (P = 0.001). Average apical vertebral derotation showed 63% correction in the screw group and 32% in the hybrid group (P = 0.001). There was no statistical significance between two group in thoracic sagittal correction, the lowest instrumented vertebra below the lower end vertebra, trunk shift, operative time, and average estimated blood loss. There were no neurologic complications related to hybrid or pedicle screw instrumentation., Conclusion: Pedicle screw instrumentation was significantly better than hybrid constructs.

Objective: To compare the intra-observer reproducibility and inter-observer reliability regarding the results of Lenke's and Peking Union Medical College (PUMC) classification systems for adolescent idiopathic scoliosis (AIS)., Methods: Five spine surgeons independently measured the X ray films of 62 AIS patients using both Lenke and PUMC classification systems. Three weeks later, the spine surgeons repeated the same classification process. No measurement trace was allowed to be left on the X ray films. SAS software was used to calculate the Kappa values and analyze the intra-observer reproducibility and inter-observer reliability, Results: The overall reliability and reproducibility rates of the Lenke classification system were 69.8% (Kappa value = 0.675) and 74.2% (Kappa value = 0.690) respectively, in which the curve characteristic parameter reliability and reproducibility rates were 86.5% (Kappa value = 0.808) and 87.4% (Kappa value 0.826) respectively, the lumbar correction reliability and reproducibility rates were 95.2% (Kappa value = 0.919) and 94.5% (Kappa value = 0.908) respectively, and the sagittal thoracic correction reliability and reproducibility rates were 85.2% (Kappa value = 0.734) and 89.0% (Kappa value = 0.805 respectively). The reliability and reproducibility rates of the PUMC classification system were 91.0% (Kappa value = 0.896) and 90.2% (Kappa value = 0.892) respectively., Conclusion: The reliability and reproducibility rates of the Lenke classification system were better than the previously reported results. However, the PUMC classification system expresses better reliability and reproducibility. The PUMC classification system is relatively easier with fewer curve types, hence leading to less divergence among the clinicians. Comparing to the classifications used in the past, both classification systems have the advantages of correctly categorizing AIS according to its individual traits, as well as accurately examining the X ray results, hence achieving significance in terms of surgical outcome and design.

Objective: To evaluate the operative technique and preliminary results of video-assisted thoracoscopic anterior correction and fusion of scoliosis., Methods: Eleven cases underwent thoracoscopic anterior correction and fusion of scoliosis from March 2003 to April 2005 in our hospital were reviewed. They were all females with an average age of 13.1 years old. Of which, 9 cases were idiopathic scoliosis, 1 case was congenital scoliosis, and 1 case was Marfan syndrome scoliosis. The coronal Cobb angle and apical vertebral translation before and after surgery as well as at final follow-up were measured. The operation time, blood loss during operation, and peri-operative complications were recorded. Results The mean operation time was 6.4 hours, mean instrumented vertebrae were 6.4 segments, and mean blood loss during operation was 364 mL. The coronal Cobb angles of the thoracic curve before and after surgery were 45.5 degrees and 15.4 degrees respectively, with an average correction rate of 65.4%. The lumbar curve was corrected from 28.4 degrees lation to 11.8 degrees, with an average simultaneous correction rate of 57.2%. All of the patients were followed up regularly with an average time of 21.4 months. At the final follow-up, the coronal Cobb angles of the thoracic and lumbar curves were 19.0 degrees and 20.1 degrees, with a 3.6 degrees and 8.3 degrees loss of correction, respectively. The apical vertebral translation was improved from 32.3 mm to 10.5 mm for the thoracic curve, and from 13.1 mm to 8.2 mm for the lumbar curve. There were 6 cases with peri-operative complications, including 1 case of thoracic effusion, 1 case of chylothorax, 1 case of locking plug loosing, 2 cases of aggravation of the unfused lumbar curve (1 case also with thoracolumbar kyphosis), and 1 case with a screw tip causing a contour deformity of the aorta. And 4 of them underwent revision surgery., Conclusions: Video-assisted thoracoscopic anterior correction and fusion of scoliosis has good correction capability, less intraoperative bleeding, and favorable cosmetic effect for mild and moderate thoracic scoliosis, but with higher rates of correction loss of the lumbar curve and peri-operative complications. A surgeon should be cautious to perform this technique. ders

Objective: To analyze the correction results of the adolescent idiopathic scoliosis patients with a proximal thoracic (PT) curve., Methods: There were 13 cases of double thoracic curve (PUMC IIa) and 13 cases of triple curve (PUMC IIIa 11 cases, IIIb 2 case). The upper instrumented vertebra were at T(3) or above (fusion level including PT curve, Group A) in 18 cases, and at T(4) or T(5) (PT curve not fused, Group B) in 8 cases. Reviewing the medical records and radiographs of 26 adolescent idiopathic scoliosis patients with a proximal thoracic curve that underwent corrective surgery, the changes of the curve and the shoulder balance were analyzed., Results: The coronal Cobb angles of the PT curve and the main thoracic (MT) curve before operation were 45.3 degrees and 61.2 degrees in group A, 35.6 degrees and 58.9 degrees in group B. After operation, they were corrected to 24.2 degrees and 20.1 degrees , 26.4 degrees and 20.3 degrees , respectively. The correction rates of the PT curve and MT curve were 48.2% and 68.7%, 24.5% and 66.3%, respectively. The correction rates of the PT curve of group A was significantly better than group B (P = 0.006), but for the MT curve, the difference was not significant (P = 0.694). The incidence of radiographic shoulder height (RSH) over than 10 mm (shoulder imbalance) after operation in group B was higher than group A significantly (P = 0.038). The incidence rate of shoulder imbalance after operation of the patients with a left higher shoulder or balance shoulder was significantly higher than that of the patients with a right higher shoulder (P = 0.015)., Conclusions: Fusing the PT in patients with a left shoulder not lower than right side will make better coronal correction results of the PT curve and reduce the incidence of postoperative shoulder imbalance.

Objective: To investigate the changes of intervertebral angle and relative factors after anterior correction and instrumentation in thoracolumbar/lumbar (PUMCIb, Ic) adolescent idiopathic scoliosis patients., Methods: The clinical data, including roentgenograms of 18 PUMCIb, Ic adolescent idiopathic scoliosis patients, including 13 patients of Ib type, 2 males and 11 females, and 5 patients of Ic type, all females, 1 who underwent anterior correction and instrumentation, were collected. The Cobb angle of the coronal curve, correction rate, trunk shift, apical vertebra translation, intervertebral angle, and so on, were measured and analyzed., Results: The average coronal Cobb angle were 44.72 +/- 10.20 degrees and 6.51 +/- 7.54 degrees before and after surgery respectively, with an average correction rate of 81.2%. The average preoperative intervertebral angle was 3.57 +/- 3.48 degrees , and 2.02 +/- 4.37 degrees and 5.26 +/- 5.92 degrees 1 week and 1 year postoperatively. The changes were of significance in the intervertebral angle between preoperative and 1-week postoperative values (P = 0.035), and between the 1-week and 1-year postoperative values (P = 0.029). All 18 patients were grouped to Group A (n = 12) and Group B (n = 6) according to the fusion levels. In Group A the preoperative intervertebral angle was 4.07 +/- 3.98 degrees ; the intervertebral angle 1-week and 1-year postoperatively were 1.23 +/- 3.46 degrees and 4.01 +/- 4.72 degrees respectively. In Group B, the preoperative intervertebral angle was 1.97 +/- 1.76 degrees ; and the intervertebral angle 1-week, and 1-year postoperatively were 4.21 +/- 4.47 degrees and 7.12 +/- 5.09 degrees respectively. There were significant changes between the two groups about the intervertebral angle in different stages (P < 0.05). The analysis and comparison of the other variables between these two groups revealed significant changes in the preoperative apical vertebra translocation, number of fused segments and T12 approximately LI lordosis (all P < 0.05)., Conclusion: The intervertebral angle is much improved after anterior correction and instrumentation surgery, but it increases gradually during the follow-up. The fusion levels, the preoperative apical vertebra translocation, T12 approximately LIV lordosis, and the preoperative intervertebral angle may be correlated with the changes of postoperative intervertebral angle. In the current opinion, it's unworthy of preventing postoperative intervertebral angle changes by decreasing the correction rate or sacrificing the motion segment.

Objective: To look into the character of the expression of collagen type II and transforming growth factor beta1 (TGF-beta1), basic fibroblast growth factor (bFGF) in the apical articular process cartilages of adolescent idiopathic scoliosis (AIS) and congenital scoliosis (CS) patients., Methods: The articular processes of 22 AIS and 18 CS were collected. The techniques of HE staining, immunohistochemistry and in situ hybridization were adopted in this research. By comparing the apical processes with the end processes, the convex processes with the concave processes, the AIS processes with CS processes, the pathological changes of the articular process cartilages of these patients and the distribution of collagen type II and TGF-beta1, bFGF in them were studied. The images of immunohistochemistry and in situ hybridization were input into the image analysis system and were analyzed semi-quantitatively. The SAS software (8.01) was adopted, and P < 0.05 was defined as the significant level., Results: The expression of collagen type II and TGF-beta1, bFGF in AIS was similar to CS: the concave sides of apexes were higher than the convex sides. The comparisons had statistical significance. There was no statistical significance between upper and lower end vertebrae in convex and concave sides, between convex and concave sides in upper and lower end vertebrae. The apical vertebrae were significantly higher than the ipsilateral sides of upper or lower end vertebrae for collagen type II. There was no statistical difference of the expression at the concave, convex, upper, lower end vertebrae between AIS and CS., Conclusions: The cartilages of the apical processes show some signs of regression and hypoplasia in scoliosis. The concave side is more severe than the convex side. Increase of collagen type II and TGF-beta1, bFGF in the concave sides of apical processes in scoliosis may be the results of reconstruction of extracellular matrix and the compensation reactions which are caused by abnormal biomechanical forces such as compressive stresses. Compressive stress on the concave sides has more influences on the expression of collagen type II than tensile stress on the convex sides.

Objective: To construct a subtractive cDNA library from the spinal facets of adolescent idiopathic scoliosis (AIS) patient with suppression subtractive hybridization (SSH) technique and clone differentially expressed genes related to AIS in spinal facet., Methods: mRNA was isolated separately from the convex side and concave side apical facets of an adolescent idiopathic scoliosis patient. Moreover, single-strand (ss) and double-strand (ds) cDNAs were synthesized in turn using SMART PCR cDNA synthesis technology. (ds) cDNAs then were digested with Rsa I and divided into two groups, and ligated to the specific adaptor 1 and adaptor 2R, respectively. After cDNAs were hybridized with each other twice and underwent two rounds of nested PCR, the PCR products were ligated with pDrive Cloning Vectors to set up the subtractive library. Sequence analysis was performed and the acquired data were aligned against the GeneBank nucleotide database. Furthermore, the spinal facets of 11 IS patients were collected. The techniques of immunohistochemistry and in situ hybridization were adopted in order to approve the gene expression difference. The images of immunohistochemistry and in situ hybridization were input to the image analysis system and were analyzed semi-quantitatively., Results: A cDNA subtractive library of AIS in spinal facet was set up successfully with high subtractive efficiency. Beta2 Microglobulin (beta 2M) and calgranulin A (S100A8) were identified as highly differentially expressed genes in this study., Conclusion: All results confirm the effectiveness and sensitivity of SSH in detecting differentially expressed genes from a small amount of clinical samples. Information about such alterations in gene expression can be useful for elucidating the genetic events in the development of AIS.

Objective: To investigate the characteristics of the expression of transforming growth factor-beta(1) (TGF-beta(1)) and basic fibroblast growth factor (bFGF) in the apical articular process cartilages of adolescent idiopathic scoliosis (AIS) patients., Methods: The specimens of articular processes of 22 AIS patients and 18 congenital scoliosis (CS) patients were collected during operation. The pathology of the processes was observed with H.E staining. Immunohistochemistry and in situ hybridization were adopted to detect the expression of TGF-beta(1) and bFGF. The differences in the pathological changes, and expression of TGF-beta(1) and bFGF between the apical processes and the end processes, the convex processes and the concave processes, and the AIS processes and CS processes. The images of immunohistochemistry and in situ hybridization were input into the image analysis system and were analyzed semi-quantitatively. The SAS (8.01) software was adopted and (128.1 +/- 50.6 vs 165.4 +/- 59.2, 126.5 +/- 47.0 vs 168.3 +/- 46.8; 76.6 +/- 29.9 vs 96.4 +/- 28.4, 73.7 +/- 31.6 vs 101.8 +/- 39.4; 77.1 +/- 52.2 vs 114.4 +/- 59.4, and 69.5 +/- 40.1 vs 109.8 +/- 51.0 (P < 0.05) was defined as the significant levels., Results: The expression of TGF-beta(1) and the expression of bFGF were not significantly different between the AIS patients and the CS patients. The TGF-beta(1) expression in the concave side of the apical vertebrae of the AIS group was 165.4 +/- 59.2, significantly higher than that in the convex sides (128.1 +/- 50.6, P = 0.03), and the TGF-beta(1) expression in the concave side of the apical vertebrae of the CS group was 168.3 +/- 46.8, significantly higher than that of the convex side (126.5 +/- 47.0, P = 0.02). However, there was no statistically significant differences in the TGF-beta(1) expression between the concave and convex sides of the upper and lower end vertebrae and between the upper and lower end vertebrae. The bFGF expression in the concave side of the apical vertebrae of the AIS group, and the bFGF expression in the concave side of the apical vertebrae of the CS group was 101.8 +/- 39.4, significantly higher than that of the convex side (73.7 +/- 31, P = 0.02). However, there were no statistically significant differences in the bFGF expression between the concave and convex sides of the upper and lower end vertebrae and between the upper and lower end vertebrae., Conclusion: The cartilages of the apical processes show some signs of regression and hypoplasia in AIS patients, especially at the concave side in comparison with the convex side. Increase of TGF-beta(1) and bFGF in the concave sides of apical processes in AIS may be the results of reconstruction of extracellular matrix and the compensation reactions which are caused by abnormal biomechanical forces, especially compressive stresses.

Objective: To investigate the corrective results of congenital scoliosis with type II split spinal cord malformation., Methods: By reviewing the medical records and roentgenograms of congenital scoliosis patients with type II split spinal cord malformation that underwent corrective surgery, septum location and length, curve type, coronal and sagittal Cobb's angles, apical vertebral rotation and translation, and trunk shift were measured and analyzed., Results: A total of 23 congenital scoliosis patients with type II split spinal cord malformation were studied, 6 cases were due to failure of segmentation, 8 cases due to failure of formation, and the remaining 9 cases due to mixed defects. The fibrous septums were located in the thoracic spine in 8 patients, lumbar spine in 4 patients, thoracic and lumbar spine in 10 patients, and from cervical to lumbar spine in 1 patient The septum extended an average of 4.9 segments. Corrective surgeries included anterior correction with instrumentation in 2 patients, posterior correction with instrumentation in 11 patients, anterior release and posterior correction with instrumentation in 6 patients, anterior and posterior resection of the hemivertebra and posterior correction with instrumentation in 4 patients. The pre- and postoperative coronal Cobb's angles, apical vertebral translations, apical vertebral rotations, trunk shifts were 61.9 degrees and 32.5 degrees (P < 0.001), 48.9 mm and 31.5 mm (P < 0.001), 1.2 and 1.1, 12.7 mm and 8.2 mm, respectively. The average correction rate of coronal Cobb's angle was 47.5%. The sagittal balance was also well improved. The fibrous septums were all left in situ. There was no neurological complication., Conclusion: For congenital scoliosis with type II split spinal cord malformation, positive correction results with no neurological complication may be obtained without resection of the fibrous septum.

Objective: To evaluate the efficacy of simultaneous anterior and posterior hemivertebra resection in the treatment of congenital kyphoscoliosis caused by fully-segmented hemivertebra., Methods: Twenty-one consecutive cases with congenital kyphoscoliosis, which were 8 males and 13 females, underwent one-stage operation of anterior hemivertebra resection and posterior instrumentation. All of the hemivertebra were fully-segmented. The average age at surgery was 11.4 (range, 1.5-16) years old., Results: The average follow-up was 23 (range, 6-50) months. The average Cobb's angle of the coronal curve was 51.4 degrees (30 degrees - 120 degrees) before surgery, 16.9 degrees (0 degree - 54 degrees) after surgery, and 19.5 degrees at latest follow-up. The angle of segmental kyphosis was 37.1 degrees (0 degree - 95 degrees) before surgery and 16.1 degrees (0 degree - 48 degrees) after surgery, and 18.2 degrees at latest follow-up. Apical translation was improved from 4.7 cm to 1.9 cm. The average fusion segments were 4.8 (range, 2-10) segments. Complication included pressure sore in one case, pedicle cutting by pedicle screw in one case and elongation of the curve in one case. There was no obvious pseudarthrosis, decompensation, and kyphosis deformity aggravation at latest follow-up., Conclusion: One-stage hemivertebra resection has a good result in the surgical treatment of congenital kyphoscoliosis caused by fully-segmented hemivertebra, and may shorten fusion levels if performed at an earlier age.

Objective: To discuss the diagnosis and surgical treatment of congenital scoliosis (CS) with split cord malformation (SCM)., Methods: From May 1999 to June 2004, 353 cases of CS were admitted, and 58 cases were diagnosed CS combined with SCM via myelography and (or) CTM. According to Pang's classification for SCM, patients were divided into type I SCM and type II SCM. Two cases gave up operation, and surgeries were performed in 56 patients. Except that one case with arachnoid cyst underwent intraspinal exploration, all other 55 cases underwent spinal correction without dealing with the intraspinal abnormalities. Clinical manifestation, radiological findings, operative methods and results were retrospectively analyzed in this paper., Results: There were 11 patients (19%) with type I SCM and 47 patients (81%) with type II SCM. In the 56 cases who had surgical treatment, the Cobb angle in the patients with type I SCM (11 cases) was (60 +/- 25) degrees, and in type II SCM (45 cases) was (67 +/- 21) degrees pre-operation. The Cobb angle in type I SCM was (29 +/- 13) degrees and in type II SCM was (39 +/- 19) degrees post-operation, with the correction rate (51 +/- 17)% and (41 +/- 24)% respectively. No statistic differences were found between both types. And there were no new neurological deficits in both groups after the spinal correction operation. After average 17.3 months (4-59 months) follow-up, the correction loss was (6 +/- 10) degrees, (5 +/- 8) degrees in 7 patients with type I SCM and (6 +/- 10) degrees in 19 patients with type II SCM. There was no statistic difference in correction loss between both types. In the follow-up, the neurological symptoms and signs of the patients were stable., Conclusion: Considering the incidence of intraspinal anomalies in patients with congenital scoliosis, intraspinal examination via myelography, CTM or MRI should be performed prior to spinal correction surgery. For congenital scoliosis with type I SCM, the bone spur need not be excised before spinal correction if there is no signs of spinal cord tethered and the bone spur locate in the middle of the split cord where there are much space to accommodate it. For congenital scoliosis with type II SCM, if there are no progressive neurological manifestations, the split cord in the single tubular can tolerate the manipulation of spinal correction as the normal spinal cord.