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State of the Art in Management of Idiopathic Scoliosis
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State of the Art in Management of Idiopathic Scoliosis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (10 March 2024) | Viewed by 2949

Special Issue Editor

Dr. Juan Bago

E-Mail Website
Guest Editor
Spine Research Unit, Vall d’Hebron Institute of Research, Barcelona, Spain
Interests: intervertebral disk degeneration; scoliosis; spine; spinal surgery; spine surgery

Special Issue Information

Dear Colleagues,

Despite advances in the diagnosis and treatment of idiopathic scoliosis, there are still notable gaps in knowledge. These gaps primarily concern etiology, conservative management, indications for surgery, and long-term outcomes.

The etiology of idiopathic scoliosis is still unclear, but advances in genetics and epigenetics have shed light on the condition. The risk factors for curve progression during growth have been fairly well established, which has enabled the development of prognostic formulas for late adolescence. However, little is known about the factors that influence progression during early and especially late adulthood. Conservative treatment is preferred for non-severe curves in adolescents. Information is now available on the efficacy of specific physiotherapy exercises and treatment with braces. Surgery is reserved for progressive curves in which conservative treatment has failed, and the curvature has reached a severe magnitude. Instrumented posterior fusion has been the standard of care for many years; however, new techniques have recently been introduced that require careful evaluation. Finally, there is a growing interest in the clinical situation of patients operated on as adolescents when they reach adulthood.

The purpose of this Special Issue is to provide a comprehensive overview of advances in the diagnosis, treatment, and management of idiopathic scoliosis. Therefore, researchers in the field of idiopathic scoliosis are encouraged to submit their findings as original articles or reviews.

Dr. Juan Bago
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • idiopathic scoliosis
  • conservative treatment
  • braces
  • specific exercises
  • surgical techniques
  • outcomes

Published Papers (5 papers)

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Research

10 pages, 254 KiB  
Article
Back Pain in Adolescents and Young Adults with Idiopathic Scoliosis—Identifying Factors Associated with Significant Pain—A Multivariate Logistic Regression Analysis
by Juan Bagó, Antonia Matamalas, Javier Pizones, Jesús Betegón, Judith Sánchez-Raya and Ferran Pellisé
J. Clin. Med. 2024, 13(8), 2366; https://doi.org/10.3390/jcm13082366 - 18 Apr 2024
Viewed by 312
Abstract
(1) Background: Previous data show that patients with idiopathic scoliosis (IS) can be classified into two groups according to pain intensity. This paper aims to determine which factors can independently predict the likelihood of belonging to a high-level pain group. (2) Methods [...] Read more.
(1) Background: Previous data show that patients with idiopathic scoliosis (IS) can be classified into two groups according to pain intensity. This paper aims to determine which factors can independently predict the likelihood of belonging to a high-level pain group. (2) Methods: The study used a prospective, multicenter, cross-sectional design. Two-hundred and seventy-two patients with IS (mean age 18.1 years) (females 83.5%) were included. The sample was divided into two groups. The PAIN group comprised 101 patients (37.1%) with an average NRS of 5.3. The NO-PAIN group consisted of 171 patients (62.9%) with an average NRS of 1.1. Data on various factors such as comorbidities, family history, curve magnitude, type of treatment, absenteeism, anxiety, depression, kinesiophobia, family environment, and social relationships were collected. Statistical analysis consisted of multivariate logistic regression analysis to identify independent predictors of high-level pain. (3) Results: In the final model, including modifiable and non-modifiable predictors, age (OR 1.07 (1.02–1.11)); Absenteeism (OR 3.87 (1.52–9.87)), HAD anxiety (OR 1.18 (1.09–1.29)) and an indication for surgery (OR 2.87 (1.28–6.43)) were associated with an increased risk of pain. The overall model is significant at p = 0.0001 level and correctly predicts 72.6% of the responses. (4) Conclusions: Age, an indication for surgery, anxiety, and work/school absenteeism are the variables that independently determine the risk of belonging to the high-level pain group (NRS > 3). Full article
(This article belongs to the Special Issue State of the Art in Management of Idiopathic Scoliosis)
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15 pages, 4795 KiB  
Article
The Influence of Increased Pedicle Screw Diameter and Thicker Rods on Surgical Results in Adolescents Undergoing Posterior Spinal Fusion for Idiopathic Scoliosis
by Pawel Grabala, Piotr Kowalski and Michal Grabala
J. Clin. Med. 2024, 13(8), 2174; https://doi.org/10.3390/jcm13082174 - 10 Apr 2024
Viewed by 409
Abstract
Background: Modern surgical techniques allow for the correction of spinal deformity, stopping its progression and improving pain relief and social and physical functioning. These instruments have different implant designs, screws, and rod diameters and can be composed of different metal alloys with different [...] Read more.
Background: Modern surgical techniques allow for the correction of spinal deformity, stopping its progression and improving pain relief and social and physical functioning. These instruments have different implant designs, screws, and rod diameters and can be composed of different metal alloys with different hardnesses, which can have a significant impact on the effect of correcting spinal deformities. We designed a retrospective cohort study based on the same surgical technique and spine system using different implant sizes, and compared the results across them. Methods: This is a retrospective review of adolescent idiopathic scoliosis (AIS) patients who underwent posterior spinal fusion (PSF) between 2016 and 2022 with a minimum two-year follow-up (FU) using two spinal implant systems: 5.5 and 6.0 mm diameter screws with double 5.5 mm titanium rods (Group 1 (G1)), and 6.0 and 6.5 mm diameter pedicle screws with double 6.0 mm cobalt–chromium rods (Group 2 (G2)). The evaluated data were as follows: preoperative personal data, radiographic outcomes, complications, and health-related quality of life questionnaire (HRQoL). The parameters were reviewed preoperatively, after the final fusion, and during the FU. Results: The mean age of all 260 patients at surgery was 14.8 years. The average BMI was also similar in both groups and was noted as 21. The mean levels of fusion and screw density were similar in both groups. The mean preoperative major curves (MCs) were 57.6° and 62.5° in G1 and G2, respectively. The mean flexibility of the curves was noted as 35% in G1 and 33% in G2. After definitive surgery, the mean percentage correction of the MC was better in G2 vs. G1, with 74.5% vs. 69.8%, respectively (p < 0.001). At the final FU, the average loss of correction was 5.9° for G1 and 3.2° for G2 (p < 0.001). The mean preoperative (TK) thoracic kyphosis (T2–T5) was 12.2° in G1 and 10.8° in G2. It was corrected to 15.2° in G1 and to 13° in G2. At the FFU, we noted a significant difference in the TK (T2–T5) between the groups, with 16.7° vs. 9.6° for G1 vs. G2, respectively (p < 0.001). Statistical significance was observed between the preoperative sagittal balance and the final follow-up for both groups (p < 0.001). Conclusions: AIS patients surgically treated with screws with a larger diameter and thicker and stiffer rods showed greater correction and postoperative thoracic kyphosis without implant failure. The complication rates, implant density, and clinical outcomes remained similar. The radiographic benefits reported in this cohort study suggest that large-sized screws and stiffer rods for the correction of pediatric spinal deformities are safe and very effective. Full article
(This article belongs to the Special Issue State of the Art in Management of Idiopathic Scoliosis)
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13 pages, 1462 KiB  
Article
Reliability of a New Digital Tool for Photographic Analysis in Quantifying Body Asymmetry in Scoliosis
by Javier Pizones, Lucía Moreno-Manzanaro, Anika Pupak, Susana Núñez-Pereira, Daniel Larrieu, Louis Boissiere, Sarah Richner-Wunderlin, Markus Loibl, Tais Zulemyan, Altug Yücekul, Sara Zgheib, Yann Philippe Charles, Dong-Gune Chang, Frank Kleinstueck, Ibrahim Obeid, Ahmet Alanay, Francisco Javier Sánchez Pérez-Grueso, Ferran Pellisé and on behalf of the ESSG
J. Clin. Med. 2024, 13(7), 2114; https://doi.org/10.3390/jcm13072114 - 05 Apr 2024
Viewed by 519
Abstract
Background: Advancements in non-ionizing methods for quantifying spinal deformities are crucial for assessing and monitoring scoliosis. In this study, we analyzed the observer variability of a newly developed digital tool for quantifying body asymmetry from clinical photographs. Methods: Prospective observational multicenter study. Initially, [...] Read more.
Background: Advancements in non-ionizing methods for quantifying spinal deformities are crucial for assessing and monitoring scoliosis. In this study, we analyzed the observer variability of a newly developed digital tool for quantifying body asymmetry from clinical photographs. Methods: Prospective observational multicenter study. Initially, a digital tool was developed using image analysis software, calculating quantitative measures of body asymmetry. This tool was integrated into an online platform that exports data to a database. The tool calculated 10 parameters, including angles (shoulder height, axilla height, waist height, right and left waistline angles, and their difference) and surfaces of the left and right hemitrunks (shoulders, waists, pelvises, and total). Subsequently, an online training course on the tool was conducted for twelve observers not involved in its development (six research coordinators and six spine surgeons). Finally, 15 standardized back photographs of adolescent idiopathic scoliosis patients were selected from a multicenter image bank, representing various clinical scenarios (different age, gender, curve type, BMI, and pre- and postoperative images). The 12 observers measured the photographs at two different times with a three-week interval. For the second round, the images were randomly mixed. Inter- and intra-observer variabilities of the measurements were analyzed using intraclass correlation coefficients (ICCs), and reliability was measured by the standard error of measurement (SEM). Group comparisons were made using Student’s t-test. Results: The mean inter-observer ICC for the ten measurements was 0.981, the mean intra-observer ICC was 0.937, and SEM was 0.3–1.3°. The parameter with the strongest inter- and intra-observer validity was the difference in waistline angles 0.994 and 0.974, respectively, while the highest variability was found with the waist height angle 0.963 and 0.845, respectively. No test–retest differences (p > 0.05) were observed between researchers (0.948 ± 0.04) and surgeons (0.925 ± 0.05). Conclusion: We developed a new digital tool integrated into an online platform demonstrating excellent reliability and inter- and intra-observer variabilities for quantifying body asymmetry in scoliosis patients from a simple clinical photograph. The method could be used for assessing and monitoring scoliosis and body asymmetry without radiation. Full article
(This article belongs to the Special Issue State of the Art in Management of Idiopathic Scoliosis)
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14 pages, 5201 KiB  
Article
Long-Term Health-Related Quality of Life (QOL) after Paediatric Spinal Deformity Surgery and Comparison with the General Population
by Athanasios I. Tsirikos and Silvia García-Martínez
J. Clin. Med. 2023, 12(22), 7142; https://doi.org/10.3390/jcm12227142 - 17 Nov 2023
Cited by 1 | Viewed by 622
Abstract
QOL questionnaires assess patients’ perception on surgical outcomes. We reviewed 1354 patients with spinal deformity. Four hundred and twenty-eight patients had >10 years of follow-up. The SRS-22r questionnaire was completed before surgery, at 6/12/24 months, 5–10 years and >10 years postoperatively. Patients with [...] Read more.
QOL questionnaires assess patients’ perception on surgical outcomes. We reviewed 1354 patients with spinal deformity. Four hundred and twenty-eight patients had >10 years of follow-up. The SRS-22r questionnaire was completed before surgery, at 6/12/24 months, 5–10 years and >10 years postoperatively. Patients with >10 years of follow-up completed the EQ-5D VAS/index and the VAS for back/leg pain. We used QOL data reporting in the general population of 20–29 and 30–39 years of age to compare against our patient cohort. Among the patients, 993 had AIS, 80 congenital scoliosis, 102 syndromic or secondary scoliosis, 105 Scheuermann kyphosis and 40 low-grade and 34 high-grade spondylolisthesis. SRS-22r total and domain scores improved from preoperative to follow-up in all diagnosis categories. At >10 years after surgery, patients with congenital scoliosis and Scheuermann kyphosis had better SRS-22r total/domain and EQ-5D (index/VAS) scores along with lower VAS back/leg pain scores compared to the other groups. Patients with congenital scoliosis and Scheuermann kyphosis had comparable SRS-22r total/domain, EQ-5D (index/VAS) and VAS back/leg pain scores to the general population in the 20–29 year category and better scores than the 30–39 year group. Patients with AIS, syndromic/secondary scoliosis and low/high-grade spondylolisthesis had reduced SRS-22r total/domain and EQ-5D (index/VAS) scores and higher VAS back/leg pain scores compared to the 20–29 year group but comparable scores to the 30–39 year group. Patients with spinal deformity reported improved QOL and high satisfaction after surgery which was maintained at >10 years of follow-up. Patients with congenital scoliosis and Scheuermann kyphosis had better QOL outcomes (comparable to the general population of similar age) as opposed to other types of scoliosis or lumbosacral spondylolisthesis. Full article
(This article belongs to the Special Issue State of the Art in Management of Idiopathic Scoliosis)
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13 pages, 2996 KiB  
Article
Rod Rotation with Outrigger Is Substantial for Correcting Apical Hypokyphosis in Patients with Adolescent Idiopathic Scoliosis: Novel Outrigger Device for Concave Rod Rotation
by Shoji Seki, Hiroto Makino, Yasuhito Yahara, Katsuhiko Kamei, Hayato Futakawa, Taketoshi Yasuda, Kayo Suzuki, Masato Nakano and Yoshiharu Kawaguchi
J. Clin. Med. 2023, 12(21), 6780; https://doi.org/10.3390/jcm12216780 - 26 Oct 2023
Viewed by 728
Abstract
The apical hypokyphosis of scoliotic patients is thought to lead to decreased lung capacity and cause shortness of breath. Additionally, concave rod curve reduction is a problem in the correction of apical hypokyphosis in posterior spinal fusion surgery in adolescent idiopathic scoliosis (AIS). [...] Read more.
The apical hypokyphosis of scoliotic patients is thought to lead to decreased lung capacity and cause shortness of breath. Additionally, concave rod curve reduction is a problem in the correction of apical hypokyphosis in posterior spinal fusion surgery in adolescent idiopathic scoliosis (AIS). We investigated the contributions of rod rotation (RR) with an outrigger device, followed by differential rod contouring (DRC) with the outrigger attached to the concave rod, designed to prevent concave rod curve-flattening. We analyzed and compared the results of segmental pedicle screw fixation without the outrigger in 41 AIS patients with thoracic curves (Lenke type I, 25; type II, 16) to those corrected using the outrigger in 36 patients (Lenke type I, 24; type II,12). The changes in the Cobb angle, apical kyphosis of five vertebrae, thoracic kyphosis (TK, T4–12), correction rate, correction angle of apical vertebral rotation, spinal penetration index (SPi), and rib hump index (RHi) before and after surgery were measured, and the contribution of the outrigger was analyzed. The mean scoliosis correction rates without and with the outrigger were 72.1° and 75.6°, respectively (p = 0.03). Kyphosis of the five apical vertebrae and TK were significantly greater in the surgery with the outrigger (p = 0.002). Significantly greater improvements in SPi and RHi were also noted in the surgery with the outrigger (p < 0.05). The use of concave RR and convex DRC with the outrigger appear to be advantageous for correcting apical hypokyphosis, followed by the subsequent formation of TK. As a result, breathing problems are less likely to occur during daily life because of improvements in SPi and RHi. Full article
(This article belongs to the Special Issue State of the Art in Management of Idiopathic Scoliosis)
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