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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.

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.

Objective: Pedicle subtraction osteotomy (PSO) is a spinal realignment technique of correcting the sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal correction. However, the quantitative effect of PSO level and focal angular change on postoperative spino-pelvic parameters has not been fully elucidated. The purpose of this study was to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spino-pelvic parameters., Methods: Retrospective analysis was conducted for 34 patients undergoing PSO surgery for ankylosing spondylitis. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar lordosis, thoracic kyphosis), pelvic parameters of pelvic tilt (PT), pelvic incidence (PI) and sacral slope (SS) and global balance of sagittal vertical axis (SVA). And the correlations between PSO parameters (level and degree) and spino-pelvic parameters were analyzed., Results: There were significant changes in spino-pelvic parameters including decreased thoracic kyphosis, increased lumbar lordosis, decreased SVA, decreased PT and increased SS. The decreased SVA were 3.94 ± 3.38 and 3.97 ± 1.91 in lumbar/thoracic osteotomy respectively (P > 0.05). The decreased values of PT were 9.71 ± 6.46 and 5.20 ± 2.74 respectively (P < 0.05). Larger degree of osteotomy (≥ 22°) had greater SVA and PT decreases (P < 0.05)., Conclusion: PSO is a quite useful technique of restoring spinal alignment. Lumbar and larger degrees of osteotomy have greater effects on spino-pelvic parameters.

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 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.

Objective: To investigate the characteristic of the expression of collagen type I in the articular processes of apex from adolescent idiopathic scoliosis (AIS) patients., Methods: The apical processes of 11 AIS patients were collected. The techniques of HE staining and In-cell Western were adopted in this research. We studied the pathological changes of the apical processes and collected and cultured the osteoblast from the apical processes on both sides in vitro separately. After cell identification, we compared the secretion of collagen type I in the osteoblast from concave side to that of convex side., Results: The cartilages of the apical processes showed some signs of regression. The secretion of collagen type I of the osteoblast in vitro from the concave side of the apical articular process was significantly higher than that from the convex side (P < 0.05)., Conclusion: Significant difference of the gene expression of the osteoblasts from the apical process exists between the concave side and the convex side.