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Personalized Therapy and Clinical Outcomes for Adolescent Idiopathic Scoliosis
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Personalized Therapy and Clinical Outcomes for Adolescent 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 (15 April 2022) | Viewed by 16752

Special Issue Editor

Dr. Per Trobisch

E-Mail Website
Guest Editor
Eifelklinik St. Brigida, Simmerath, Gemrany
Interests: scoliosis

Special Issue Information

Dear Colleagues,

This Special Issue of J Clin Med is dedicated to the treatment of patients with idiopathic scoliosis.

Improvements of existing treatment options such as scoliosis-specific exercises, braces, and spinal fusion, as well as the introduction of innovative methods such as vertebral body tethering have resulted in an increased complexity of available options and a more individualized treatment strategy.

It is a pleasure to serve as guest editor for this special issue and I invite you to submit your research (studies, reviews) with a focus on Current concepts and innovative methods to this issue.

 

Dr. Per Trobisch
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

  • scoliosis
  • AIS
  • VBT
  • spinal fusion
  • motion preservation
  • brace
  • surgery

Published Papers (7 papers)

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Editorial

Jump to: Research, Review

3 pages, 162 KiB  
Editorial
The Risk and Benefits of Various Innovations in Fusion and Fusionless Surgery for AIS
by Tom P. C. Schlösser and Per D. Trobisch
J. Clin. Med. 2023, 12(13), 4552; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12134552 - 7 Jul 2023
Viewed by 698
Abstract
Adolescent idiopathic scoliosis is the most common variety of the condition, constituting a three-dimensional deformity of the spine and chest that primarily affects otherwise healthy adolescents [...] Full article
(This article belongs to the Special Issue Personalized Therapy and Clinical Outcomes for Adolescent Idiopathic Scoliosis)

Research

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8 pages, 436 KiB  
Article
At Mean 30-Year Follow-Up, Cervical Spine Disease Is Common and Associated with Thoracic Hypokyphosis after Pediatric Treatment of Adolescent Idiopathic Scoliosis
by Ernest Young, Christina Regan, Bradford L. Currier, Michael J. Yaszemski and A. Noelle Larson
J. Clin. Med. 2022, 11(20), 6064; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11206064 - 14 Oct 2022
Cited by 4 | Viewed by 1446
Abstract
Patients with adolescent idiopathic scoliosis (AIS) often have reduced sagittal thoracic kyphosis (hypokyphosis) and cervical lordosis causing an uneven distribution of physiologic load. However, the long-term consequences of hypokyphosis in AIS patients have not been previously documented. To evaluate whether uneven load distribution [...] Read more.
Patients with adolescent idiopathic scoliosis (AIS) often have reduced sagittal thoracic kyphosis (hypokyphosis) and cervical lordosis causing an uneven distribution of physiologic load. However, the long-term consequences of hypokyphosis in AIS patients have not been previously documented. To evaluate whether uneven load distribution leads to future complications in patients with AIS, we conducted a retrospective chart review and subsequently surveyed 180 patients treated for idiopathic scoliosis between 1975 and 1992. These patients all had a minimum follow-up time of 20 years since their treatment. We observed a ten-fold increase in the incidence of anterior cervical discectomy and fusion (ACDF) compared to reported rates in the non-pathologic population. Out of the 180 patients, 33 patients met the criteria and returned for follow-up radiographs. This population demonstrated a statistically significant increased rate of cervical osteoarthritis and disc degeneration. Overall, our study suggests that hypokyphosis in patients with AIS presents with increased rates of cervical spine degeneration and dysfunction, suggesting that these patients may require additional follow-up and treatment. Full article
(This article belongs to the Special Issue Personalized Therapy and Clinical Outcomes for Adolescent Idiopathic Scoliosis)
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11 pages, 3060 KiB  
Article
Pulmonary Complications after Vertebral Body Tethering: Incidence, Treatment, Outcomes and Risk Factor Analysis
by Per Trobisch, Filippo Migliorini, Thomas Vanspauwen and Alice Baroncini
J. Clin. Med. 2022, 11(13), 3778; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11133778 - 29 Jun 2022
Cited by 11 | Viewed by 2508
Abstract
Introduction: Vertebral body tethering (VBT) is gaining popularity for the management of selected AIS patients. The most frequent non-mechanical complications after VBT are pulmonary complications, with a reported incidence of up to 8% for recurrent pleural effusion. However, only trace data have been [...] Read more.
Introduction: Vertebral body tethering (VBT) is gaining popularity for the management of selected AIS patients. The most frequent non-mechanical complications after VBT are pulmonary complications, with a reported incidence of up to 8% for recurrent pleural effusion. However, only trace data have been published on this topic. We aimed to analyze the incidence, timing, treatment, outcomes and risk factors of pulmonary complications after VBT. Materials and Methods: All patients who underwent VBT between September 2018 and September 2022 were retrospectively reviewed. The rate of pulmonary complications was analyzed and the symptoms, timing of onset, treatment and outcomes were recorded. An analysis of demographic, radiographic, surgical and pulmonary function data was conducted to explore possible risk factors for pulmonary complications. Results: Data from 140 patients were available: 14 experienced a pulmonary complication 1 day to 6 weeks after VBT, with 9 presenting a recurrent pleural effusion. A total of 13 patients required invasive treatment. All recovered without sequelae. The risk factor analysis did not result in any significant observations. However, 11/14 patients had had a diaphragm split. Conclusion: Pulmonary complications were observed in 10% of patients. The timing, symptoms and required treatment were heterogeneous. Pleural effusion seems to be more common after diaphragm crossing, but evidence is not yet conclusive. Full article
(This article belongs to the Special Issue Personalized Therapy and Clinical Outcomes for Adolescent Idiopathic Scoliosis)
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10 pages, 3172 KiB  
Article
The Spring Distraction System for Growth-Friendly Surgical Treatment of Early Onset Scoliosis: A Preliminary Report on Clinical Results and Safety after Design Iterations in a Prospective Clinical Trial
by Casper S. Tabeling, Justin V. C. Lemans, Anouk Top, E. Pauline Scholten, Hilde W. Stempels, Tom P. C. Schlösser, Keita Ito, René M. Castelein and Moyo C. Kruyt
J. Clin. Med. 2022, 11(13), 3747; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11133747 - 28 Jun 2022
Cited by 6 | Viewed by 2053
Abstract
Background: The Spring Distraction System (SDS) is a dynamic growth-friendly implant to treat early onset scoliosis (EOS). Previous SDS studies showed promising results in terms of curve correction and complication profile. Nevertheless, complications did occur, which led to modifications in the implant [...] Read more.
Background: The Spring Distraction System (SDS) is a dynamic growth-friendly implant to treat early onset scoliosis (EOS). Previous SDS studies showed promising results in terms of curve correction and complication profile. Nevertheless, complications did occur, which led to modifications in the implant design. The main iterations were a larger rod diameter and a more sagittal stable sliding mechanism. The purpose of this study was to investigate the performance of these iterations. Methods: All patients treated with the modified SDS and >1 year follow-up were included. Radiographic outcomes, severe adverse events (SAEs), unplanned returns to the operating room (UPRORs) and health-related quality of life (HRQoL) were investigated. Results: Seventeen EOS patients (three congenital, four idiopathic, nine neuromuscular, one syndromic) were included. Mean age at surgery was 9.5 ± 2.5 years. Similar to the first generation SDS, about 50% initial correction was achieved and maintained, and spinal growth was near physiological. Most importantly, SAEs and UPRORs were diminished and favorable with 0.10/patient/year. In addition, HRQoL increased during the first year postoperatively, indicating the implant was well accepted. Conclusion: These preliminary results indicate that the iterations of the SDS are effective in terms of reducing SAEs and UPRORs and increasing HRQoL in patients with EOS. Full article
(This article belongs to the Special Issue Personalized Therapy and Clinical Outcomes for Adolescent Idiopathic Scoliosis)
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11 pages, 240 KiB  
Article
Vertebral Body Tethering in 49 Adolescent Patients after Peak Height Velocity for the Treatment of Idiopathic Scoliosis: 2–5 Year Follow-Up
by James Meyers, Lily Eaker, Jessica Zhang, Theodor di Pauli von Treuheim and Baron Lonner
J. Clin. Med. 2022, 11(11), 3161; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11113161 - 2 Jun 2022
Cited by 7 | Viewed by 3367
Abstract
Vertebral Body Tethering (VBT) is a non-fusion surgical treatment for Adolescent Idiopathic Scoliosis (AIS) that elicits correction via growth modulation in skeletally immature patients. VBT after peak height velocity is controversial and is the subject of this study. A retrospective review of Risser [...] Read more.
Vertebral Body Tethering (VBT) is a non-fusion surgical treatment for Adolescent Idiopathic Scoliosis (AIS) that elicits correction via growth modulation in skeletally immature patients. VBT after peak height velocity is controversial and is the subject of this study. A retrospective review of Risser 3–5 AIS patients treated with VBT, and min. 2-year FU was performed. Pre to post-op changes in clinical outcomes were compared using Student’s t-test or the Mann-Whitney test. A total of 49 patients met criteria, age 15.0 ± 1.9 years, FU 32.5 ± 9.1 months. For thoracic (T) major curvatures, T curvature improved from 51.1 ± 6.9° to 27.2° ± 8.1° (p < 0.01) and TL from 37.2° ± 10.7° to 19.2° ± 6.8° (p < 0.01). For thoracolumbar (TL) major curvatures, T improved from 37.2° ± 10.7° to 18.8° ± 9.4° (p < 0.01) and TL from 49.0° ± 6.4° to 20.1° ± 8.5° (p < 0.01). Major curve inclinometer measurements and SRS-22 domains, except activity, improved significantly (p ≤ 0.05). At the latest FU, one (2%) patient required fusion of the T curve and revision of the TL tether due to curve progression in the previously uninstrumented T curve and tether breakage (TB) in the TL. Twenty (41%) patients experienced TB. VBT in AIS patients with limited remaining skeletal growth resulted in satisfactory clinical outcomes at the latest FU. Full article
(This article belongs to the Special Issue Personalized Therapy and Clinical Outcomes for Adolescent Idiopathic Scoliosis)
7 pages, 1647 KiB  
Article
Thoracic Curve Correction Ratio: An Objective Measure to Guide against Overcorrection of a Main Thoracic Curve in the Setting of a Structural Proximal Thoracic Curve
by Matthew R. Landrum, Andrew H. Milby, Burt Yaszay, Stefan Parent, Susan E. Nelson, Joshua M. Pahys, Amer F. Samdani, Anthony C. Capraro, John M. Flynn, Patrick J. Cahill and on behalf of the Harms Study Group and Harms Non-Fusion Study Group
J. Clin. Med. 2022, 11(6), 1545; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11061545 - 11 Mar 2022
Cited by 1 | Viewed by 1903
Abstract
Purpose: The correction of double thoracic (Lenke 2) curves has been associated with higher rates of postoperative shoulder imbalance that may compromise long-term outcomes following spinal deformity correction. A number of methods have been proposed to mitigate this risk, though no accepted standard [...] Read more.
Purpose: The correction of double thoracic (Lenke 2) curves has been associated with higher rates of postoperative shoulder imbalance that may compromise long-term outcomes following spinal deformity correction. A number of methods have been proposed to mitigate this risk, though no accepted standard measurement exists. The purpose of this study is to validate a novel quantitative method of determining the relative curve correction magnitude in double thoracic curves. Methods: Retrospective data from a multi-center database of patients undergoing surgical correction of left-proximal thoracic, right-main thoracic Lenke 2 curves were analyzed. A novel measurement tool, the Thoracic Curve Correction Ratio (TCCR), was applied for the purposes of validation against historical data. Results: A total of 305 patients with complete two-year follow-up data were included. The TCCR, or the ratio of postoperative percent correction of the thoracic curves divided by the ratio of the preoperative curve magnitudes, displayed a significant negative correlation (Pearson R = −0.66; p < 0.001) with T1 tilt at two years postoperatively. Conclusions: The TCCR could be added as an important factor in the preoperative planning process and intraoperative assessment in order to reduce postoperative T1 tilt. While T1 tilt remains an imperfect surrogate measure for clinical shoulder balance, it serves as one of many potential measures that the surgeon may evaluate quantitatively and radiographically. Full article
(This article belongs to the Special Issue Personalized Therapy and Clinical Outcomes for Adolescent Idiopathic Scoliosis)
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Review

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13 pages, 1289 KiB  
Review
Vertebral Body Tethering: Indications, Surgical Technique, and a Systematic Review of Published Results
by Arimatias Raitio, Johanna Syvänen and Ilkka Helenius
J. Clin. Med. 2022, 11(9), 2576; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11092576 - 4 May 2022
Cited by 22 | Viewed by 4028
Abstract
Vertebral body tethering (VBT) represents a new surgical technique to correct idiopathic scoliosis using an anterior approach, spinal instrumentation with vertebral body screws, and a cable compressing the convexity of the curve. According to the Hueter-Volkmann principle, compression reduces and distraction increases growth [...] Read more.
Vertebral body tethering (VBT) represents a new surgical technique to correct idiopathic scoliosis using an anterior approach, spinal instrumentation with vertebral body screws, and a cable compressing the convexity of the curve. According to the Hueter-Volkmann principle, compression reduces and distraction increases growth on the growth plates. VBT was designed to modulate spinal growth of vertebral bodies and hence, the term ‘growth modulation’ has also been used. This review describes the indications and surgical technique of VBT. Further, a systematic review of published studies was conducted to critically evaluate the results and complications of this technique. In a total of 23 included studies on 843 patients, the preoperative main thoracic curve corrected from 49 to 23 degrees in a minimum 2 year follow-up. The complication rate of VBT was 18%. The results showed that 15% of VBT patients required reoperations for pulmonary or tether-related issues (10%) and less than 5% required conversion to spinal fusion. While the reported median-term results of VBT appear promising, long-term results of this technique are currently lacking. Full article
(This article belongs to the Special Issue Personalized Therapy and Clinical Outcomes for Adolescent Idiopathic Scoliosis)
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