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Introduction: Available orthotic brace options for Congenital scoliosis are a few and are quite cumbersome to be tolerated by infants. Considering comfort, acceptance, and effectiveness, we have designed and developed a new spinal Orthosis, incorporating a flexible strap system. The purpose of this study was to investigate the effect of this novel flexible spinal Orthosis on scoliotic curve correction and progression. Methods: A 1-year-old female infant diagnosed with congenital Scoliosis was fitted with the novel flexible spinal orthotic brace to control the curve progression and to maintain an upright posture. The anterior-posterior radiographs were analyzed for measuring the Cobb angle. The plumb line test was used to assess the postural improvements. Before and After tests were conducted with and without the Novel spinal brace with an intervention period of 2 months. Discussion: The Cobb’s angle was found to be 7˚ less after the intervention period of 2 months. There was also a marked improvement in Body posture with a 6mm plumbline shift towards the midline. This indigenous flexible spinal brace can be considered as a new, effective method for the treatment of Congenital Scoliosis and it also can be used for maintaining an aligned posture. Key words: Congenital Scoliosis, Flexible spinal Brace, Cobb’s angle.

There has been a recent shift toward the analysis of the pathoanatomical variation of the adolescent idiopathic scoliosis (AIS) spine with the three dimensions, and research of level-wise vertebral body morphology in single anatomical planes is now replete within the field. In addition to providing a precise description of the osseous structures that are the focus of instrumented surgical interventions, understanding the anatomical variation between vertebral bodies will elucidate possible pathoaetiological mechanisms of the onset of scoliotic deformity. This review aimed to discuss the current landscape of AIS segmental vertebral morphology research and provide a comprehensive report of the typical patterns observed at the individual vertebral level. We have detailed how these vertebrae are typically characterised by lateral wedging to the convexity, have a marked degree of anterior overgrowth, are rotated towards the convexity, have inherent gyratory mechanical torsion created within them and are associated with pedicles on the concave side being narrower, longer and more laterally angled. For the most part, these findings are most pronounced at and around the apex of a scoliotic curve, with these deformations reducing towards junctional vertebrae. We have also summarised a nomenclature defined by the Scoliosis Research Society, highlighting the need for more consistent reporting of these level-wise dimensional anatomical changes. Finally, we emphasised how a marked degree of heterogeneity exists between the included investigations, namely in scoliotic curve-type inclusion, imaging modality and timepoint of analysis within scoliosis’ longitudinal development, and how improvement in these study design characteristics will enhance ongoing research.

To report two very similar cases of exotic congenital scoliosis associating diastematomyelia treated at different ages by different spinal approaches. The approach of these patients should be a multidisciplinary one due to the neurological and orthopedic problems. We present two cases of exotic congenital scoliosis with very similar spinal congenital defects located in the lower thoracic and lumbar area associating diastematomyelia. The age at surgery was 4 years in the first case and 12 years in the second case, respectively. Both cases were approached in a one-stage surgical procedure. The first step was the resection of the bony diastematomyelia, followed by spinal synthesis. Diastematomyelia was successfully resected in both cases, but scoliotic curve correction was poor due to improper spinal synthesis, in the first case, and old age at surgery moment, in the second case. Diastematomyelia resection is critical as the first surgical step. The presence of multiple spinal malformations, especially when present in a long spinal area, and older patients at surgery moment are predictors of poor results of scoliotic curve correction and spinal growth.

Background Decompressive laminectomy alone for degenerative lumbar scoliosis (DLS) is not recommended because it can lead to further instability. However, it is uncertain whether instability at the decompressed segments is directly affected by laminectomy or the natural progression of DLS. The purpose of this study was to evaluate the surgical outcome of decompressive laminectomy alone for DLS with spinal stenosis and to determine whether the procedure leads to post-laminectomy instability (PLI). Methods We retrospectively reviewed 60 patients with DLS. They were divided into 2 groups according to PLI criteria: stable group and PLI group. The PLI group was subdivided into 2 groups based on the level of PLI: the first group that showed PLI at the index laminectomy level (PLI-I) and the second group that showed PLI at another level other than the laminectomy level (PLI-NI). Radiological evaluation was performed to determine factors associated with the progression of DLS. Pain and disability outcomes were assessed. Results There were 34 patients (56.7%) in the stable group and 26 patients (43.3%) in the PLI group. Twelve patients (20.0%) underwent revision surgery. Eleven patients (18.3%) showed PLI at the index segments (PLI-I group), and 15 patients (25%) showed PLI at the adjacent or cephalad segments, not related to the laminectomy site (PLI-NI group). Four patients underwent revision surgery in the stable group and 8 in the PLI group. Survivorship analyses revealed that the predicted survivorship of DLS was 90.0% at 12 months and 86.4% at 24 months after laminectomy. Conclusions The development of PLI was not always related to laminectomy at the index level. However, PLI developed more rapidly at the index level, compared to the natural progression of the scoliotic curve at the adjacent segments.

Background. Brace treatment is frequently used in adolescent idiopathic scoliosis (AIS). However, due to different brace models, long-term results on spinal deformity development at the end of Chneau brace treatment are not often described and differ in results. Aim. The aim of this work was to analyze clinical and radiological data of AIS patients treated with Chneau braces from the beginning of treatment until the end of growth and brace therapy in order to define realistic treatment results and expectations in an everyday setting. Materials and methods. 52 AIS patients with Chneau brace treatment were followed from the beginning of treatment until the end of growth. Clinical data such as the initial Risser sign, age at treatment, gender, curve patterns and body mass index were analyzed. Results. At the beginning of brace therapy, the average age was 13.1 years and patients showed a mean scoliotic curve angle of 30.9. Four months of brace use reduced the scoliotic curve to 20.1. Nine months after the end of brace treatment and an average treatment duration of 17 months, scoliosis has increased up to 30.3 again. In children with a lower maturity status, the initial scoliotic curve was less than in more mature patients leading to less spinal deformity at the end of treatment. In addition, obese children had less scoliosis correction during brace therapy than normalweight children. Conclusion. In patients with AIS treated with a Chneau brace, the initial curvature correction was 35%. Nine months after the end of brace treatment, scoliotic curves identical to the deformities at the beginning of treatment could be observed.

Spine deformities could be considered a possible manifestation of the childhood hypotonia, typical feature of Kleefstra Syndrome (KS). There is a paucity of literature describing posterior spinal fusion in the Kleefstra syndrome patient. For patients who develop severe scoliotic curve, bracing is often ineffective and surgery is recommended. We report the first corrective surgery for scoliosis in one patient with KS. We describe a case of 13-year-old female with severe developmental scoliosis in KS. Preoperative examination showed a thoracolumbar scoliosis with left convex thoracic curve (T3-T9, 97°) and right convex thoracolumbar curve (T9-L3, 88°). Posterior correction, pedicle screw fixation and bone graft fusion T3-L5 was performed. Postoperatively, the thoracic curve was corrected to 33° while the thoracolumbar one to 26° and better standing posture was obtained. Six month follow-up images showed no loosening of the hardware. The patient is still in our follow-up program. Scoliosis seems to be a rare evenience of the severe hypotonia of patients with KS. We report the first case of scoliosis in KS treated successfully with surgery. Corrective surgery for spinal deformity, such as scoliosis, could help in posture and improve the quality of life especially in complicated patients such as syndromic ones.

Introduction/Background contextAdolescent idiopathic scoliosis (AIS) is the most common type of scoliosis, and affects up to 4% of adolescents in early stages1. The deformity can develop during any of the rapid periods of growth in children2, and the time of pubertal growth spurt also plays a role in spinal curve progression3. Hence it is crucial to detect the disease early, to provide timely intervention.Detection of scoliosis when it is mild or before the growth spurt can be conducted via various screening methods. Adam’s forward bend test (FBT) and scoliometer measurement of the angle of trunk rotation (ATR) are commonly used4, to observe lateral bending and rotation of the spine, causing a visible rib hump. Moiré topography can also be used, but is reserved for second tier due to some degree of ambiguity5. X-rays (XR) remain the best way to diagnose scoliosis, as it provides a clear image of the spine and allows measurement of Cobb angle; however it has risks associated including requirement of the use of ionising radiation6.Infrared (IR) thermography can be used to measure surface temperature and is performed with an IR camera. The temperature distribution and data matrix can be visualised into a thermal map, which has previously been studied and associated with the thermal asymmetry in paraspinal muscles7, as well as significant temperature differences between the convex and concave side of the spinal curvature for idiopathic scoliotic patients8. We hypothesize that such asymmetry and temperature differences may produce a detectable pattern on IR thermography, which would prompt further confirmatory investigations to reach a fast and non-radiation screening of AIS.Aims and ObjectivesFor the purposes of this study, the hypothesised thermal pattern detected by IR thermography will be compared to the spinal deformities observed on XR, the ground truth as labelled by specialists. This will allow us to establish a paired dataset comparing spine visualisation between the two imaging modalities. Thus, the compared dataset would enable the generation of a machine learning model capable of automated classification of the deformity severities. The predictive accuracy of the model will be evaluated by the specialists’ assessment results. The aim of the project is to use IR to predict the severity of the scoliotic curve, opening up the possibility of using IR thermography with no radiation exposure and fully automated analytical pipeline for the screening of AIS.

Objective: Assessment of scoliotic curve flexibility and stiffness is essential for planning surgical treatment in adolescent idiopathic scoliosis (AIS). Measurement of curve flexibility is currently insufficiently precise. The purpose of this study was to introduce and validate a novel method of superimposing radiographs for more reliable measurement of curve flexibility. Material and methods: Two independent radiologists measured Cobb angles separately on standard anterior-posterior (AP) (n = 48) and supine bending radiographs (n = 48), in patients with AIS, who were randomly included from a surgical database. The same readers repeated the measurements after the bending radiographs were semi-automatically superimposed on the AP radiographs by fusing the caudad end vertebra. Curve flexibility was calculated. Inter-reader agreement between the two independent readers was calculated using interclass correlation coefficient (ICC). Results: A moderate inter-reader agreement was achieved in the upper curve (ICC = 0.57) and a good agreement in the lower curve (ICC = 0.72) with the standard method of assessing curve flexibility. With the use of the semiautomatic superimposition, however, almost perfect agreement was achieved for both the upper and the lower curves flexibilities (ICC = 0.93 and 0.97, respectively). Conclusion: The introduced semi-automatic superimposition technique for measurement of scoliotic curve flexibility in AIS is more precise and reliable than the current standard method. Key Points : • A technique using semiautomatic superimposition of anterior-posterior and bending radiographs is introduced • Almost perfect agreement was achieved for scoliotic curves flexibilities measurements • This method is more precise and reliable than the current standard method

To evaluate fat infiltration in the multifidus muscle close to the scoliotic curve as seen in MRI compared with the histological evaluation in patients with adolescent idiopathic scoliosis (AIS). The evaluation of fatty infiltration in the multifidus muscle of patients with AIS by MRI was compared with biopsy. Fatty infiltration was greater in concave side than in the convex side in both MRI (P=0.005) and biopsy evaluation (P=0.026). There was no correlation between the fatty infiltration findings evaluated through MRI and biopsy. The MRI measurements do not express accurately the tissue changes observed in the biopsy.

Background Adolescent idiopathic scoliosis (AIS) is a condition resulting in spinal deformity and tissue adaptation of the paraspinal muscles. Although prior studies have demonstrated asymmetries in fiber type and other energetic features of muscle on the concave side of the curve, muscle morphology, architecture, and composition have not been evaluated. Therefore, the purpose of this study was to compare differences in paraspinal muscle microarchitecture and composition between concave and convex sides of a scoliotic curve in individuals with AIS. Methods Paraspinal muscle biopsies were obtained at the apex of the scoliotic curve in 29 individuals with AIS undergoing surgical deformity correction. Histological assays were performed to quantify fiber size, evidence of muscle degeneration and regeneration, and tissue composition (proportion of muscle, collagen, and fat). Differences between contralateral muscle samples were compared using two‐tailed paired Student's t tests, and relationships between clinical characteristics (age and curve severity) and muscle characteristics were investigated using Pearson correlations. Results Muscle fibers were significantly larger on the convex side of the curve apex (P = .001), but were lower than literature‐based norms for healthy paraspinal muscle. There were no differences in amount of degeneration/regeneration (P = .490) or the proportion of muscle and collagen (P > .350) between the concave and convex sides, but high levels of collagen were observed. There was a trend toward higher fat content on the concave side (P = .074). Larger fiber size asymmetries were associated with greater age (r = .43, P = .046), and trended toward an association with greater curve severity (r = .40, P = .069). Conclusions This study demonstrates that although muscle fibers are larger on the convex side of the scoliotic curve in AIS, muscles on both sides are atrophic compared to non‐scoliotic individuals, and demonstrate levels of collagen similar to severe degenerative spinal pathologies. These findings provide insight into biological maladaptations occurring in paraspinal muscle in the presence of AIS., Muscle adaptations in adolescent idiopathic scoliosis are not well described. Using intraoperative muscle biopsies from both the concave and convex side of the deformity, we found evidence of bilateral atrophy and degeneration as well as side‐specific size and compositional changes.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine, the aetiology and pathogenesis of which are poorly understood. Unfortunately, biomechanical data describing trunk muscle activation and intervertebral load, which can contribute to understanding the pathomechanics of the AIS spine, cannot be measured in vivo due to the invasiveness of the procedures. The present study provides the biomechanical characterization of the spinal loads in scoliotic subjects by exploiting musculoskeletal modelling approach, allowing for calculating biomechanical measures in an assigned posture. A spine model with articulated ribcage previously developed in AnyBody software was applied. The predicted outcomes were evaluated in the upright posture, depending on scoliosis severity and curve type, in a population of 132 scoliotic subjects with mild, moderate, and severe scoliosis. Radiographic-based three dimensional reconstruction of vertebral orientations and scaling of body segments and trunk muscle cross-section area guaranteed geometrical subject-specificity. Validation analysis supporting the application of the model was performed. Trunk muscles were found more activated in the convex side of the scoliotic curve, in agreement with reference in vivo measurements, with progressive increase with scoliosis severity. The intervertebral lateral shear was found positively correlated with the severity of the scoliosis, demonstrating that the transferred load is not a priori orthogonal to vertebral endplate in the frontal plane, and thus questioning the assumption of the 'follower load' approach in case of experimental or computational study on the scoliotic spine. The study opens the way for the subject-specific characterization of scoliosis in assigned loading and motion conditions.

The mechanism of the scoliotic curve development in healthy adolescents remains unknown in the field of orthopedic surgery. Variations in the sagittal curvature of the spine are believed to be a leading cause of scoliosis in this patient population. Here, we formulate the mechanics of S-shaped slender elastic rods as a model for pediatric spine under physiological loading. Second, applying inverse mechanics to clinical data of the subtypes of scoliotic spines, with characteristic 3D deformity, we determine the undeformed geometry of the spine before the induction of scoliosis. Our result successfully reproduces the clinical data of the deformed spine under varying loads, confirming that the prescoliotic sagittal curvature of the spine impacts the 3D loading that leads to scoliosis.

Purpose — to study alterations in the bony structures in cases of congenital deformity of the thoracic spine combined with malsegmentation of lateral surfaces of vertebrae due to pathological processes during growth period of childern and to find correlation with above alterations.Material and Methods. The study included 30 patients with congenital deformity of thoracic spine combined with malsegmentation of lateral surfaces of vertebrae. age of patients ranged from 3 to 10 years (mean of 7 years). gender distribution — 19 female and 11 male patients. all patients underwent imaging examination including spine roentgenography in two standard views in prone position as well as computer tomography.Results. Magnitude of deformity scoliotic curve was 67° (45–88°) and of pathological thoracic lordosis — 23° (18–27°). Mean number of block vertebral motion segments included into the main deformity curve was 6 (3–8). Mean distance between the outline of lateral vertebral surface and lateral outline of projection of curve root of apical vertebra on convex side of deformity (aB) was 6 mm (4–10 mm). correlation analysis demonstrated that aB distance mostly depended on the number of vertebral motion segments included into the block along non-segmental area: pearson coefficient 0.67. Based on cT scans the authors observed no rotation component of bodies’ deformity along the non-segmental area.Conclusion. Children with congenital thoracic spine deformity along with malsegmentation of lateral surfaces of vertebrae feature pathological lordosis in affected zone. alterations in the bony structures result from asymmetric growth of one half of the vertebral body at the level of non-segmentation. asymmetry severity has a strong correlation dependency from the number of vertebral bodies included in the block along the non-segmental area.

Objective. To analyze the incidence of adding-on phenomenon in the surgery of Lenke type 1 idiopathic scoliosis. Material and Methods. The study included prospective analysis of radiographs of 89 patients (82 females and 7 males) with idiopathic scoliosis who met the criteria for inclusion. The age of patients at the time of surgery ranged from 12 to 25 years (mean: 16.3 ± 4.4 years). The average follow-up period was 2.3 ± 0.4 years. Scoliotic deformity corresponded to grade III according to V.D. Chaklin’s classification in 24 patients, and to grade IV in 65. The magnitude of the primary thoracic curve varied from 30° to 103° of Cobb angle (mean: 61.1° ± 17.1°). In all cases, segmental third generation instrumentation (hybrid or laminar) was used in combination with intraoperative skeletal traction with an afford equal to 50 % of the patient’s body weight. Laminar fixation was used in 6 patients, and hybrid fixation with different extent of screw installation in 83. Results. The following parameters showed significant increase: the magnitude of thoracic curve according to Cobb – 16.0° ± 4.3°, the distance from the center of the vertebra located one level distal to the lowest instrumented vertebra, to the central sacral vertical line (LIV+1- CSVL) – 3.6 ± 2.5 mm, the tilt of the lower instrumented vertebra in the coronal plane (LIV tilt angle) – 3.6° ± 2.8°, the tilt of the ver- tebra located one level distal to the lowest instrumented vertebra (LIV+1 tilt angle) – 4.6° ± 2.5°, and the distance from the center of the apical vertebra of the primary curve to the central sacral vertical line (AV-CSVL) – 17.2 ± 12.0 mm. A significant correlation was found between postoperative magnitude of the scoliotic curve and AV-CSVL distance, postoperative LIV+1-CSVL distance and postoperative LIV+1 tilt angle. An increase in LIV+1 tilt angle in combination with an increase in LIV+1-CSVL distance by more than 4 mm (or degrees) could be a parameter for measuring the adding-on phenomenon. Conclusion. The indication for reoperation may probably be a significant tilt of the vertebra located below the lowest instrumented vertebra, accompanied by pain syndrome and coronal imbalance.

Objective. To assess the natural history of the lumbar spine deformity progression in children with isolated vertebral body malformation. Material and Methods . The natural course of spinal deformity associated with disrupted lumbar vertebra formation was analyzed in 40 patients aged 1 year 7 months to 17 years 11 months who received conservative treatment and dynamic follow-up during four years. Spondylography was performed in frontal and lateral projections in lying position every 6 months. Spondylograms were used to measure the magnitude of the angle of the local scoliotic and kyphotic components of deformity in the process of child’s growth and the magnitude of the angle of general lumbar lordosis. Results. The study showed that two components of deformity (scoliosis and kyphosis) were characterized by a progressive and stable course. Against the background of local curvature in the sagittal plane, the results of the study of general lordosis were distributed according to the age norm and to a flattening relative to the norm at the time of the last observation. Conclusion. At the primary examination of a patient, the initial magnitude of scoliotic curvature according to Cobb plays a predictive role in determining the further course of spinal deformity. When the magnitude of the primary curve is less than 30°, conservative therapy provides a stable course of congenital curvature, and in some children, a tendency to self-correction. Children with initial magnitude of the primary scoliotic curve of more than 30° have steady progression of congenital deformity in the lumbar spine of more than 6° during 4 years, which is an indication for surgical treatment at an early age.

Bilateral vertical expandable prosthetic titanium rib (VEPTR) treatment using rib-to-pelvis constructs without touching the spine is a safe surgical technique to correct scoliosis while still allowing further MRI or neurosurgical interventions. In this retrospective cohort study, 4 paraplegic children with spinal deformity after intraspinal tumors and 4 children with neuromuscular diseases were compared. VEPTR treatment was able to considerably reduce the main scoliotic curve in both patient groups (41 vs. 40%). However, the tumor group constantly showed more severe curve progression over time and less favorable pelvic obliquity control. In conclusion, bilateral VEPTR can be expected to be less satisfying in children with tumors.

The purpose of the study – to compare the effectiveness of surgical correction of spine lumbar congenital deformity by complete or partial resection of the abnormal vertebra in children.Material and methods. 68 children with isolated congenital malformation of the lumbar area of the spine were evaluated both clinically and instrumentally. Age of the patients was 6 months — 16 years 2 months (mean — 4 years 5 months). There were 41 female and 27 male patients. Patients were divided in two groups depending on the volume of the surgery. First group (n = 52) consisted of patients treated with complete hemivertebrae resection. Second group (n = 16) consisted of patients treated with partial resection of the malformed vertebrae.Results. After the surgery in the 1st group scoliotic curve was 0 to 21° and kyphotic curve was from -33 to 9°. 9 years post-op scoliotic and kyphotic curves were 0 to 22° and -31 to 10° respectively. In the 2nd group scoliotic curve was 3 to 27° and kyphotic curve was from -30 to 12°. 9 years post-op scoliotic and kyphotic curves were 7 to 41° and -26 to 8° respectively. Significant differences in the amount of scoliotic curve correction were revealed between the groups: in the 1st group mean Cobb angle for the scoliotic curve after surgery was 3,3° (correction — 94%), in the 2nd group — 13,6° (correction — 80%) (p0,05). Mean Cobb angle for the scoliotic curve in the long-term period was 5° (correction — 92%) for the 1st group wich was significantly lower (p0,05) comparing to the 2nd group (mean Cobb angle 18,3° correction — 62%).Conclusion. Our data showed higher efficacy of the complete resection of the hemivertebrae comparing to its partial resection in pediatric patients with isolated malformation in the lumbar spine. Complete removal of the vertebrae body, its growth plates and disks allowed to achieve radical correction of the deformity and to perform short fusion of the adjacent segments which was crucial for further normal growth and development of the child’s spine with saving the results in the long-term period. Thus complete resection of the malformed vertebrae with radical correction and short segment fusion is the most appropriate option in surgical treatment of pediatric patient of any age with isolated vertebrae malformation in the lumbar spine.

Objective. To analyze results of final surgical treatment for scoliosis in the first decade of life. Material and Methods . In 2008–2016, a total of 95 patients with infantile and juvenile scoliosis were operated on using VEPTR instrumentation. The final stage of surgical treatment was performed in 14 patients (9 girls, 5 boys). The average age at the start of treatment was 5.4 ± 2.1 years, average follow-up period – 2 years (6–36 months). Results . Average value of the primary scoliotic curve before surgery was 83.0° ± 14.8°, thoracic kyphosis 41.1° ± 11.9°, lumbar lordosis 49.5° ± 4.9°. At the last follow-up average value of the primary scoliotic curve was reduced to 56.8° ± 14.1°, thoracic kyphosis to 24.5° ± 8.5°, lumbar lordosis to 38.4° ± 5.1° (p < 0.05). Space available for lung before surgery was 84.5 ± 8.7 %, after surgery 94.8 ± 6.7 %, at the last follow-up it increased to 98.6 ± 5.4 %. Complications included 9 cases of instability of implant anchors and 1 case of suppuration. There were no neurological complications. Conclusion . Stage correction using different instrumentations is a method of choice for surgical treatment of infantile and juvenile scoliosis.

This study details a severe case of Scheuermann's disease (SD) in a well-preserved skeleton of a juvenile male (designated TOR302), dated to 3rd-4th century CE, from the late Roman necropolis of Torrenueva (Granada, Spain). Individual TOR302 shows an evident kyphotic curve in the thoraco-lumbar spine, which is characterised by: (i) vertebral bodies of thoracic vertebra T2, thoracic segment T4-T9, and thoraco-lumbar segment T12-L2 wedged at >5°; (ii) slight anterior extensions of the epiphyseal ring; (iii) Schmorl's nodes on the superior and/or inferior plates; and (iv) a Cobb angle of 75°, derived from thoracic segments T4-T9. In addition, TOR302 shows other skeletal malformations as the secondary results of abnormal growth, due to altered biomechanical forces imposed by the spinal deformity, including: (i) lateral distortion of the spine that causes a slight secondary scoliotic curve; (ii) pelvic obliquity; and (iii) discrepancy in the length of the limbs. We argue that the secondary skeletal abnormalities allowed the individual to adapt to his spinal deformity meaning he was able to walk without the aid of a stick. Despite SD being a common modern clinical finding, few cases have been reported in ancient skeletal remains. This case therefore represents an important contribution to the palaeopathological literature.

Objective. To analyze the effectiveness of intraoperative traction in the treatment of adolescent idiopathic scoliosis, including in relation to the initial magnitude of scoliotic curve. Material and Methods. Data on patients meeting the following criteria were selected from the electronic database and analyzed: idiopathic scoliosis (Lenke types I, III, V); age 10 to 20 years; surgery performed through posterior approach; hook or hybrid (using of pedicle screws only in the lumbar spine, at 2–4 levels) fixation; no previous history of spine surgery; and follow-up period at least two years. Results. Flattening of thoracic kyphosis and alignment of lumbar lordosis during surgical correction were significantly more pronounced in the traction group. Postoperative changes in the sagittal contour of the thoracic and lumbar spine did not differ significantly between the trac- tion and no-traction groups. Intraoperative traction was associated with significantly reduced blood loss, though operation time decreased statistically insignificantly. Normalization of the frontal imbalance in the immediate and long-term postoperative periods was different in the two groups, but these differences were insignificant. Intraoperative traction was most effective in the group with deformities of 50° to 75°, although it also increased the achieved correction in patients with scoliosis of a smaller and greater magnitude. Conclusion. The operation performed with intraoperative traction allows achieving greater correction during an intervention and smaller loss of correction during a long follow-up period than that without a distraction influence. This applies equally to both primary and sec- ondary curvatures.

We aimed to recognize radiographic and clinical prognostic factors of scoliotic curve behaviour after bracing.Our prognostic study was based on the 25 years outcomes of a Boston braced AIS cohort between 1978 and 1993 that were previously reported. All patients were followed-up during bracing, at short term and 25 years post-bracing. We evaluated the impact of socio-demographic, clinical and radiological parameters on the loss of curve correction after bracing.Seventy-seven patients were reevaluated at 25 years post-brace. The mean scoliotic curve was significantly increased after bracing until the 25 years follow-up (p 0.001). The mean loss of curve correction between the end of bracing and long-term follow-up was independent on the curve type, apical vertebra, premenarcheal status at bracing, time and duration of bracing, Cobb angle before or after bracing. The mean apical vertebral rotation after bracing was significantly related to the loss of curve correction (Spearman ρ = 0.2, p = 0.049). Apical vertebral rotation (Perdriolle method) greater than 20° post-bracing had a three times higher chance of progression 5° compared with lesser apical vertebral rotation (OR 3.071, CI 0.99-9.51). The rotation of the apical vertebra, type and magnitude of the scoliotic curve after bracing explained 27.4% of the variance in the loss of curve correction post-bracing (R square = 0.274, p 0.001).A scoliotic curve is expected to lose some correction after bracing. The apical vertebral rotation post-bracing mainly affected the long-term curve behaviour. Adolescents with apical vertebral rotation greater than 20° after bracing may need further attention.Prognostic study, Level II.

The aim of this study is to understand how many anchor sites are necessary to obtain maximum posterior correction of idiopathic scoliotic curve and if the alloy of instrumentation, stainless steel or titanium, may have a role in the percent of scoliosis correction. We reviewed 143 consecutive patients, affected by AIS (Lenke 1–2), who underwent a posterior spinal fusion with pedicle screw-only instrumentation between 2002 and 2005. According to the implant density and alloy used we divided the cohort in four groups. All 143 patients were reviewed at an average follow-up of 7, 2 years, the overall final main thoracic curve correction averaged 61.4%, whereas the implant density within the major curve averaged 71%. A significant correlation was observed between final% MT correction and preoperative MT flexibility and implant density. When stainless steel instrumentation is used non-segmental pedicle screw constructs seem to be equally effective as segmental instrumentations in obtaining satisfactory results in patients with main thoracic AIS. When the implant alloy used is titanium one, an implant density of ≥60% should be guaranteed to achieve similar results.

OBJECTIVES: The objective of this study was to evaluate whether the severity of deformities in patients with adolescent idiopathic scoliosis contributes to patients’ decision regarding whether to undergo an operation. METHODS: We evaluated body image factors in adolescent idiopathic scoliosis patients. We evaluated the magnitude of the main scoliotic curve, gibbosity (magnitude and location), shoulder height asymmetry and patient’s age. We analyzed the correlation of these data with the number of years the patient was willing to trade for surgery, as measured by the time-trade-off method. RESULTS: A total of 52 patients were studied. We did not find a correlation between any of the parameters that were studied and the number of years that the patient would trade for the surgery. CONCLUSIONS: The magnitude of body deformities in patients with adolescent idiopathic scoliosis does not interfere with the decision to undertake surgical treatment.

Context: Bracing is one of the most important treatment approaches that have been utilized in patients with scoliosis. Boston brace used to manage a scoliotic curve especially in lumbar and thoracolumbar areas. Objective: The aim of this review was to evaluate the efficiency of Boston brace to control the progression of the curve based on the available literature. Methods: A search was carried out using the following databases including Scopus, ISI Web of knowledge, PubMed, Ebsco, and Embasco. The key words used for the search were Boston brace, Boston orthosis which were used in combination with scoliosis. Articles identified were screened based on titles and abstracts. The quality of the studies was evaluated using Black and Down tool. Data were summarized based on PICO style. Results: Based on the aforementioned key words, 18 papers were selected, in which 7 studies focused on efficiency of Boston brace, 3 papers focused on quality of life, 5 papers on finite element analysis and 3 papers on comparison of efficiency of Boston with other available braces. The quality of the selected studies varied between 14 and 21. Conclusion: The results of most of the studies support the efficiency of this brace to control the progression of scoliotic curve, especially for the curve between T6 and L2. The efficiency of this brace may be due to its rigid structure and also location and direction of the straps.

Objective: To create a new instrumentation principle for the treatment of adolescent idiopathic scoliosis (AIS) and similar conditions. Methods: A new fixation format was created for the treatment of AIS using 3rd generation instrumentation in short, apical and single or multiple fixations. In patients presenting one scoliotic curve, one fixation is performed. In patients with two curves, two fixations are performed, and in those with three curves, three fixations are performed. To evaluate the new method, a retrospective study of 54 patients who had already undergone surgery for AIS and similar conditions using this innovation was conducted. Results: In this series, average corrections of 72% in the proximal curve, of 83% in the thoracic curve, and of 85% in the thoracolumbar curve were verified. Conclusions: It was concluded that the new fixation principle in the treatment of AIS and similar conditions using short, apical and multiple fixations presented excellent correction, better still in the curves that were more distal in relation to the spine. There was a significant statistical difference between the percentages of curvature correction. Level of Evidence III; Retrospective study. RESUMO Objetivo: Criar um novo princípio de instrumentação no tratamento da escoliose idiopática do adolescente (EIA) e similares. Métodos: Criou-se uma nova formatação de fixação no tratamento da EIA, usando-se instrumental de terceira geração, empregando-se fixações curtas, apicais, únicas ou múltiplas. Paciente apresentando uma curva escoliótica, realizou-se uma fixação, com duas curvas, duas fixações e três curvas, fez-se três fixações. Para avaliar o novo método, realizou-se um estudo retrospectivo de 54 pacientes já operados de EIA e Similares com a referida inovação. Resultado: Nessa casuística, constatou-se uma correção média de 72% na curva proximal, correção de 83% na curva torácica média e 85% na curva toracolombar. Conclusão: Concluiu-se que o novo princípio de fixação no tratamento da EIA e Similares, empregando fixações curtas, apicais e múltiplas, apresentou-se excelente correção, melhor ainda nas curvaturas mais distais em relação à coluna. Existe diferença estatística entre os percentuais de correção das curvaturas entre o pré e pós operatório. Nível de Evidência III; Retrospectivo. RESUMEN Objetivo: Crear un nuevo principio de instrumentación para el tratamiento de la escoliosis idiopática del adolescente (EIA) y afecciones similares. Métodos: Se creó un nuevo formato de fijación en el tratamiento de la EIA, utilizando instrumentos de 3ᵃ generación, en fijaciones cortas, apicales y únicas o múltiples. En pacientes que presentan una curva escoliótica, se realiza una fijación. En pacientes con dos curvas, se realizan dos fijaciones y en aquellos con tres curvas, se realizan tres fijaciones. Para evaluar el nuevo método, se realizó un estudio retrospectivo de 54 pacientes ya operados para corrección de EIA y afecciones similares utilizando esta innovación. Resultados: En esta casuística, se verificaron correcciones promedio del 72% en la curva proximal, corrección del 83% en la curva torácica media y del 85% en la curva toracolumbar. Conclusiones: Se concluyó que el nuevo principio de fijación en el tratamiento de la EIA y afecciones similares con fijaciones cortas, apicales y múltiples presentó una excelente corrección, mejor aún en las curvas más distales en relación con la columna vertebral. Hubo una diferencia estadística significativa entre los porcentajes de corrección de las curvaturas. Nivel de Evidencia III; Estudio retrospectivo.

The actual work is devoted to the construction of an individualized mathematical model of the spine, based on the X-ray images in the frontal and sagittal projections using deep learning convolutional neural networks. The semantic segmentation of X-ray images using the convolutional neural network U-Net is performed, also justifying the choice of network parameters and architecture. All stages of the individualized 30 model building are described, the results of each stage are presented. The model is constructed to subsequently determine the type and the extent of scoliosis with the aim of designing and implementing of the Cheneau corset.

Objective. To analyze anatomical and anthropometric parameters of vertebrae measured by a navigation system in children with thoracic idiopathic scoliosis. Material and Methods . A total of 20 patients aged 14-18 years with Grade 3 and 4 (according to V.D. Chaklin classification) right-sided thoracic idiopathic scoliosis were examined. Anatomical and anthropometric features of the thoracic and lumbar vertebrae were assessed using CT data in the navigation system. The total Cobb angle of scoliotic curve, rotation of apical and periapical vertebrae, external transverse and longitudinal diameters of the roots of vertebral arches at the T 2 -L 5 levels, and the coefficients of asymmetry of vertebral bone structures were determined. Results . The angle of scoliosis deformity ranged from 33.7° to 107.9° (mean: 61.4°), the angle of rotation of the apical vertebra - from 9.3° to 40.2° (mean: 21.09°). Positive correlation between the magnitude of scoliotic arch deformity and asymmetry coefficients of longitudinal diameter of the arch roots of the apical vertebrae was found. A pronounced asymmetry of right and left transverse diameters of arch roots of the T 3 -T 4 vertebrae, despite the absence of structural compensatory counter curve and torsional changes in these vertebrae. Conclusion . There are certain regularities and correlations between the type of idiopathic scoliosis and the absolute and relative values of vertebral parameters not only at the top of the curve, but also throughout the whole curvature arch.

Introduction. The analysis Results of surgical treatment of growing children with infantile and juvenile scoliosis (IS) can the optimal method of treatment select. In young children with significant growth potential spinal fusion may not be the best option as it limits further longitudinal growth of the spine and may to the thoracic insufficiency syndrome result. To address this problem recently several techniques focused, their have advantages and drawbacks.Material and methods. Since 2008 year 127 patients (64 girls, 63 boys) aged (4.5 ± 2.1) years were operated on. In group I 65 patients were operated on using VEPTR (Vertical Expandable Prosthetic Titanium Rib) instrumentation, in group II 42 patients using various spinal instrumentation. 20 patients with congenital kyphosis were excluded. The average follow-up time was (5.6 ± 1.1) years.Results. In group I average value of the primary scoliotic curve before surgery was (74.7 ± 22.9), secondary curve (42.8 ± 16.0), thoracic kyphosis (46.3 ± 27.4), lumbar lordosis (54.6 ± 14). Average value of the primary scoliotic curve after surgery was reduced to (51 ± 20) (correction 31.7%), at followup to (56.5 ± 18.5), secondary curve (31.8 ± 12.8) (25.7%), at follow-up to (32.4 ± 18.4), thoracic kyphosis (36.8 ± 20.8) (20,5%), at follow-up to (41.8 ± 21.0), lumbar lordosis (45.4 ± 12.7) (16,9%), at follow-up to (48.2 ± 11.7) (p < 0.05). Space available for lung before surgery was (84.5 ± 8.7) %, after surgery was (94.8 ± 6.7)%, at follow-up increased to (98.6 ± 5.4) % (p < 0.05). Complications included 11 implant dislocations and 1 infection. In group II average value of the primary scoliotic curve before surgery was (87.6 ± 6.6), secondary curve (47.8 ± 4.6), thoracic kyphosis (61.4 ± 10.4), lumbar lordosis (61.8 ± 4.9). Average value of the primary scoliotic curve after surgery was reduced to 50.6 ± 5.3 (correction 42.3%), at follow-up to (66.1 ± 6.3), secondary curve (24.1 ± 2.9) (49.6%), at follow-up to (37 ± 5.4), thoracic kyphosis (38.8 ± 7.7) (36.8%), at follow-up to (59.4 ± 11.2), lumbar lordosis (47.5 ± 4.1) (23.2%), at follow-up to (64.5 ± 4.5) (p < 0.05). Complications included 23 implant dislocations and 1 infection. No neurological complications.Conclusion. Stage correction fusions using various instrumentation is a method of choice for controlled correction of growing children with IS.

This is a report of three cases of patients with Adolescent Idiopathic Scoliosis who presented with multilevel noncontiguous fractures of the spine. Interestingly, the apical vertebrae of the scoliotic curve were involved in all these three cases. The first patient had a fracture at apical T7 of the main thoracic curve and a fracture dislocation at apical L1 at the compensatory lumbar curve. In the second patient, the fractures occurred at the apex of a lumbar major curve and the compensatory main thoracic curve at L2 and T8, respectively. In the third patient, one of the four fractures occurred over the apex of thoracic curve at T8. Therefore, when a patient with idiopathic scoliosis presents following a high-energy accident, a higher index of suspicion should be maintained to diagnose multilevel fractures, especially over the apical vertebrae. Minimally Invasive Stabilization technique is useful in the stabilization of multilevel noncontiguous spinal fractures in these patients.

The article deals with the analysis of the correlation between the anatomical shortening of the lower limb and the formation of a scoliotic curve. Despite the fact that the subject matter lacks sufficient research, an attempt is made to consider the data of domestic and foreign scientific studies that shed light on the issue. Within the framework of data analysis in an independent study of a group of 47 patients with shortening of the lower limb combined with vertebral scoliotic deformity, 4 different types of compensatory deformities of the spine were determined. Variants of possible correction were suggested depending on the type and complexity of the deformity. The conducted study stresses the importance of further theoretical and practical development of the subject matter and improvement of therapeutic and preventive measures for scoliosis.

Scoliosis is a lateral curvature in the normally straight vertical line of the spine, and the curvature can be moderate to severe. Different treatment can be used based on severity and age of subjects, but most common treatment for this disease is using orthosis. To design orthosis types of force arrangement can be varied, from transverse loads to vertical loads or combination of them. But it is not well introduced how orthoses control scoliotic curve and how to achieve the maximum correction based on force configurations and magnitude. Therefore, it was aimed to determine the effect of various loads configurations and magnitudes on curve correction of a degenerative scoliotic subject. A scoliotic subject participated in this study. The CT-Scan of the subject was used to produce 3D model of spine. The 3D model of spine was produced by Mimics software and the finite element analysis and deformation of scoliotic curve of the spine under seven different forces and in three different conditions was determined by ABAQUS software. The Cobb angle in scoliosis curve decreased significantly by applying forces. In each condition depends on different forces, different corrections have been achieved. It can be concluded that the configurations of the force application mentioned in this study is effective to decrease the scoliosis curve. Although it is a case study, it can be used for a vast number of subjects to predict the correction of scoliosis curve before orthotic treatment. Moreover, it is recommended that this method and the outputs can be compared with clinical findings.

Objective. To assess short-term results of a VEPTR instrumentation application for treatment of juvenile malignant progressing scoliotic deformity of the spine associated with neurofibromatosis type 1. Material and Methods. Three patients aged 5.5 to 7 years were operated on for severe deformity of the spine associated with neurofibromatosis type 1. The mean age at the time of deformity detection was 3.5 years. Average magnitude of the primary scoliotic curve was 89.3°. Device configuration was varied depending on nature of the deformity. Results. Primary scoliotic curvature was reduced after surgery down to 67°. Correction was 22.3° (25 %). Complications were not recorted. Conclusion. The VEPTR instrumentation is a method of choice for controlled correction of infantile and juvenile deformities of the spine and thorax of various etiology.

Objective. To analyze results of new method of treatment for progressive infantile and juvenile scoliosis of different etiology using VEPTR instrumentation. Material and Methods. Twenty-two patients aged 1.5–8.7 years were operated on, most of them for idiopathic and congenital scoliosis. The mean value of primary scoliotic curve was 66.3°. Besides routine investigations all patients underwent MRI and MSCT of the spine, as well as thorough examination by a neurologist, pediatrician, and specialized doctors. The arrangement of endocorrector depended on etiology and type of the spine deformity. Results. The first operation reduced the primary scoliotic curve angle to 47.9°. Correction was 18.4° (27.8 %). Before the first stage distraction in 12 patients, the mean deformity angle was 65.5°, and after expansion – 54.0°. Only two patients underwent more than two stage distractions. Complications were noted in two cases. Despite the large number of comorbidities, all patients showed tolerance to the performed intervention. Conclusion. The principal novelty of the method of treatment for progressive infantile and juvenile scoliosis requires accumulation of experience and revelation of advantages and drawbacks of the VEPTR instrumentation.

STUDY DESIGN Interobserver and intraobserver reliability study for the identification of the Lenke classification lumbar modifier by a panel of experts compared with a computer algorithm. OBJECTIVES To measure the variability of the Lenke classification lumbar modifier and determine if computer assistance using 3-dimensional spine models can improve the reliability of classification. SUMMARY OF BACKGROUND DATA The lumbar modifier has been proposed to subclassify Lenke scoliotic curve types into A, B, and C on the basis of the relationship between the central sacral vertical line (CSVL) and the apical lumbar vertebra. Landmarks for identification of the CSVL have not been clearly defined, and the reliability of the actual CSVL position and lumbar modifier selection have never been tested independently. Therefore, the value of the lumbar modifier for curve classification remains unknown. METHODS The preoperative radiographs of 68 patients with adolescent idiopathic scoliosis presenting a Lenke type 1 curve were measured manually twice by 6 members of the Scoliosis Research Society 3-dimensional classification committee at 6 months interval. Intraobserver and interobserver reliability was quantified using the percentage of agreement and kappa statistics. In addition, the lumbar curve of all subjects was reconstructed in 3-dimension using a stereoradiographic technique and was submitted to a computer algorithm to infer the lumbar modifier according to measurements from the pedicles. RESULTS Interobserver rates for the first trial showed a mean kappa value of 0.56. Second trial rates were higher with a mean kappa value of 0.64. Intraobserver rates were evaluated at a mean kappa value of 0.69. The computer algorithm was successful in identifying the lumbar curve type and was in agreement with the observers by a proportion up to 93%. CONCLUSIONS Agreement between and within observers for the Lenke lumbar modifier is only moderate to substantial with manual methods. Computer assistance with 3-dimensional models of the spine has the potential to decrease this variability.

An extremely unusual case of central core disease combined with a congenital spine deformity is described. The congenital myopathy was non-progressive, but the scoliotic curve worsened markedly. This case was characterised also by the type of squatting ambulation the child used until the age of 12, when the limb contractures were corrected surgically and with casting, permitting her to walk in an upright position. It was not feasible to perform spinal surgery.

OBJECTIVE: Spinal deformities are caused by a heterogeneous collection of disease processes. The progression of the scoliotic curve can vary depending on the individual patient, as well as the curve etiology. Noninvasive measurement techniques have been developed to obtain a baseline in addition to record curve progression. METHODS: We designed our study based on a comprehensive literature review and clinical experience. A systematic review of Medline for articles related to spinal deformities (scoliosis) and screening techniques was conducted up to and including those journal articles published in March 2007. RESULTS: There are numerous noninvasive modalities available to assess curve progression. CONCLUSION: The use of a detailed physical examination, serial examinations, and radiographic means serve well to document curve presence and monitor progression.

Objective. To analyze immediate and long-term results of surgical correction of spinal deformity in patients with neurofibromatosis type I. Material and Methods. A total of 24 patients (14 boys, 10 girls), mean age 14.2 years, were operated on during the period of 1996–2007. Out of them 16 patients had a rightsided curve, and 8 patients — left-sided one. Spinal deformity correction was performed with Cotrel — Dubousset instrumentation. In 14 cases main intervention was preceded by discectomy and interbody fusion with bone autograft at the apex of the primary scoliotic curve. In 10 cases both procedures were conducted under a single anesthetic event. Mean postoperative follow-up term was 1.4 years. Results. Mean initial value of the primary scoliotic curve was 102.6°, after surgery — 61.3°, and at final follow-up — 67.9°. Thoracic kyphosis before operation was 82.5°, after operation — 51.2°, and at final follow-up — 64.0°. The tilt of the lowest instrumented vertebra before operation was 16.7°, after operation — 9.5° and at final follow-up — 10.9°. Only mechanical complications were noted: rod fracture in 3 patients, and cranial hook dislocation in 1 patient. Histological analysis of surgical material showed that NF-I gene mutation led to the disturbance of organospecific differentiation of chondroblasts and to staging process of chondroblast — chondrocyte — osteoblast — osteocyte differentiation, which explains postoperative progression of the spinal deformity and formation of pseudoarthroses in the fusion mass. Conclusion. Spinal deformities associated with neurofibromatosis are rare but due to specificity of their pre- and postoperative course present significant challenge.

Purpose Cases of “non-idiopathic” scoliosis are deemed atypical. These require a comprehensive work-up in order to choose the best treatment (and to determine an extent of fusion if needed). Marfan syndrome (MFS) is a genetic disease often marked with the presence of scoliosis, which is poorly described in the literature. Knowing that the clinical diagnosis of MFS is not always obvious, we investigated how atypical the scoliosis associated with MFS was when compared with that of adolescent idiopathic scoliosis (AIS). Methods In our series, we included 30 patients diagnosed with MFS. Each patient was proposed to undergo a plain radiographic examination of the spine. Scoliotic patients were classified according to the Scoliosis Research Society (SRS) curve pattern classification. Curve patterns with a very low rate of occurrence in historic control were defined as “atypical”. Results A total of 19 patients were defined as scoliotic. In 9 cases, the curve pattern was atypical. In the other 10, the curve pattern was typical, but a fine analysis revealed some atypical features in the position of the apex and end vertebrae. Conclusions Scoliosis associated with MFS was found to be atypical in all cases. This supports the idea that an atypical curve pattern should be considered as an argument in favour of a non-idiopathic aetiology and, therefore, an appropriate work-up should be performed before deciding treatment.

At present, we survey the final results of 62 patients having been treated by a Milwaukee brace. The average curve amounted initially to 35 degrees. There succeeded a primary correction to 32 degrees. At start of weaning the initial angle of 35 degrees was reached again. During the weaning period an evident deterioration of 39 degrees occurred, and at the follow-up control 6 years after the end of weaning the curve was 42 degrees on the average. Thus, our own results are somewhat more unfavourable than those of Mellenkamp et al. In 1977, they reported the results of 47 patients who could be submitted to a follow-up control. The mean scoliotic curve of these 47 patients amounted to 44 degrees at start of treatment, at the last control, on the average 5 years after weaning from the Milwaukee brace, the mean angle was about 40 degrees. Essentially, we could prevent the progression of the curvature, too. If there occurred deteriorations in comparison with the initial angle, they were usually caused by a few patients who developed a drastic deterioration of their scoliosis.

Total disc mobility, segmental mobility, both depending upon location of the disc and upon its position within the scoliotic curve as well as the opening angle of the disc in the ap x-ray were measured in the so-called "bending-test" x-rays of the lumbar curve of 40 patients with idiopathic scoliosis. The measurements showed a maximum of mobility in the segments L2/3, L3/4 and L4/5. In no direct dependence an increased mobility of the most proximal motion segment against the next lower one of the lumbar curve was found. No direct relation between lateral flexion and degree of scoliosis was measurable. Mobility towards the convexity increases directly with the opening angle of the disc concerned while mobility towards the concavity decreases; lateral flexion remains constant altogether. The results achieved might become quite relevant in connection with the possible therapeutic progress in the treatment of lumbar scoliosis with enzymatic dissolution of nucleus pulposus.

64 patients in Milwaukee-Brace and 32 patients in Gschwend-Brace have been assessed for creating lordosis of the thoracic spine. In both types of braces induction of lordosis can be observed although there did not seem to exist a directly proportionate relationship towards the period of treatment. The degree of correction in the thoracic spine depends on the kyphosis at the onset of treatment. In marked kyphosis exceeding 60 degrees or corresponding kyphotic components in scoliosis the Milwaukee-Brace is preferred over against the Gschwend-Brace. In a pure kyphosis with minimal scoliotic curve the Gschwend-Brace remains the treatment of choice.

Objective: To determine the effectiveness and results of the plate-rod spinal system (PRSS) instrumentation in providing and maintaining scoliosis correction while allowing spinal growth in young children. Methods: From June 5, 2000, to July 10, 2006, a total of 23 patients with progressive early onset pediatric scoliosis underwent a one-stage PRSS procedure with no bony fusion. Analysis included age at surgery, measured changes in scoliosis angle, spinal growth, and complications. Results: The mean follow-up period was 2.8 ± 1.4 years, and more than 5 years in five cases. The mean correction varied from 80.7° to 30.5° after surgery, with a corrective rate of 62.2%. The average scoliotic curve in the latest follow-up was 34.7° (P > 0.05), indicting no significant loss of correction. The length of growth of the instrumented spine averaged 13.3 mm. No severe complications occurred in our series. Conclusion: The PRSS, which dispenses with bony fusion, is a safe and effective instrumentation for the management of juvenile scoliosis. It provides and maintains the desirable correction in a one-stage procedure, and allows continuous spinal growth.

A 9-year-old girl with congenital scoliosis, split cord malformation (SCM), and intramedullary teratoma was reported at the authors' institution. She had undergone three surgical corrections of the scoliosis without recognition of the existing teratoma, which was only revealed in a subsequent operative exploration of the spinal canal due to progressive neurological deficiency. The SCM was at the T9 level, and the teratoma at levels T10–T12. The teratoma was removed and the scoliotic curve was further corrected. These procedures resulted in restoring normal neurological function. This case shows that congenital scoliosis may coexist with other intraspinal deformities, and may be left unnoticed. Magnetic resonance imaging (MRI) is considered as a valuable means for the diagnosis of intraspinal teratoma.

Objective: To study the safety and efficacy of an innovative device using distraction-based magnetically controlled growing rods (MCGR) for the treatment of pediatric scoliosis. Methods: This is an evidence-based systematic review of literature for the surgical management of patients with pediatric scoliosis using MCGR technique. Six clinical studies regarding the use of MCGR were included in this review, with a total of 68 patients, and mean age of 8.38 years. The dual-rod (DR) technique of rod construct with MCGR was used in 33.85% and the single-rod (SR) in 66.15% of the patients. Results: The mean preoperative main coronal curve for the DR was 65.9°, and for the SR was 69.6° (p>0.05). At the latest follow-up, it was 36.8° for DR and 43.0° for SR (p0.05). Conclusion: Level IV of medical evidence supports the use of MCGR as a safe and effective alternative for the treatment of severe pediatric scoliosis. Recommendation Grade C supports the role of MCGR with DR construct as an option to achieve a better correction of the scoliotic curve and to maximize the postoperative T1-S1 spinal length.

Patients and Methods: A total of 68 girls and 17 boys with AIS were included in this cross-sectional study. The magnitude of curvature, thoracic kyphosis, flexibility and pattern of the deformity were measured on x-rays and compared between the two genders. Results: Although girls were significantly younger (15.3 ± 2.5 versus 16.7 ± 2.1 years; P = 0.036), however, the Risser sign was the same. Most of the males were hypokyphotic (70.6%), while most of the girls had normal thoracic kyphosis (69.1%) (P = 0.001). The main scoliotic curve (77.2 ± 18.2 versus 59.6 ± 18.6 degrees) and flexibility (25.5% ± 18.2% versus 41.9% ± 18.6%) were significantly greater and lower in males, respectively (P < 0.05). The typical AIS pattern was present in 64.7% of boys and 95.6% of girls (P < 0.001). Conclusions: The radiographic characteristics of AIS are substantially different between genders. In male patients, AIS is more severe and rigid compared to females. Also, hypokyphosis and atypical pattern of AIS are common findings in males compared to females.