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Implications of Pediatric Chest Wall Surgery on the Risk of Developing of scoliosis

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Open Journal of Pediatrics 2024年第3期14卷 623-629页

作者： Rachel White Michael Ginzburg Sacramento USA

scoliosis, a three-dimensional deformity of the spine, is commonly encountered in orthopedic and multidisciplinary settings, with idiopathic scoliosis being the most diagnosed form. Complications arising from thoracic chest wall surgeries, including thoracotomy and sternotomy, often include scoliosis among other complications. However, reported prevalence rates of scoliosis following chest wall surgery vary widely. This study aims to compare the prevalence of scoliosis in children who have undergone chest wall surgery to the prevalence of idiopathic scoliosis in the general population, as well as to observe gender ratios and curve direction in post-surgery scoliosis cases. A systematic review was conducted using PubMed and Scopus databases to identify relevant studies. Inclusion criteria comprised studies reporting scoliosis prevalence post chest wall surgery with follow-up times post-surgery. The search yielded 30 articles, all retrospective institutional cohort studies published between 1975 and 2024. Despite heterogeneity in study characteristics, the analysis revealed a 19% prevalence of acquired scoliosis among 5722 children who underwent chest wall surgery, higher than the reported 1% - 4% prevalence in the idiopathic population. Only three studies showed prevalence rates similar to the idiopathic population, possibly due to short follow-up periods. Further research with longer follow-up into skeletal maturity is warranted to better understand the implications of pediatric chest wall surgery on scoliosis development.

关键词： Thoracotomy Sternotomy scoliosis

Promotion effect of FGF23 on osteopenia in congenital scoliosis through FGFr3/TNAP/OPN pathway

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Chinese Medical Journal 2023年第12期136卷 1468-1477页

作者： Hongqi Zhang Gang Xiang Jiong Li Sihan He Yunjia Wang Ang Deng Yuxiang Wang Chaofeng Guo Department of Spine Surgery and Orthopaedics Xiangya HospitalCentral South UniversityChangshaHunan 410000China National Clinical Research Center for Geriatric Disorder Xiangya HospitalCentral South UniversityChangshaHunan 410000China

Background:Congenital scoliosis(CS)is a complex spinal malformation of unknown etiology with abnormal bone metabolism.Fibroblast growth factor 23(FGF23),secreted by osteoblasts and osteocytes,can inhibit bone formation and mineralization.This research aims to investigate the relationship between CS and FGF23.Methods:We collected peripheral blood from two pairs of identical twins for methylation sequencing of the target region.FGF23 mRNA levels in the peripheral blood of CS patients and age-matched controls were measured.Receiver operator characteristic(ROC)curve analyses were conducted to evaluate the specificity and sensitivity of FGF23.The expression levels of FGF23 and its downstream factors fibroblast growth factor receptor 3(FGFr3)/tissue non-specific alkaline phosphatase(TNAP)/osteopontin(OPN)in primary osteoblasts from CS patients(CS-Ob)and controls(CT-Ob)were detected.In addition,the osteogenic abilities of FGF23-knockdown or FGF23-overexpressing Ob were examined.Results:DNA methylation of the FGF23 gene in CS patients was decreased compared to that of their identical twins,accompanied by increased mRNA levels.CS patients had increased peripheral blood FGF23 mRNA levels and decreased computed tomography(CT)values compared with controls.The FGF23 mRNA levels were negatively correlated with the CT value of the spine,and ROCs of FGF23 mRNA levels showed high sensitivity and specificity for CS.Additionally,significantly increased levels of FGF23,FGFr3,OPN,impaired osteogenic mineralization and lower TNAP levels were observed in CS-Ob.Moreover,FGF23 overexpression in CT-Ob increased FGFr3 and OPN levels and decreased TNAP levels,while FGF23 knockdown induced downregulation of FGFr3 and OPN but upregulation of TNAP in CS-Ob.Mineralization of CS-Ob was rescued after FGF23 knockdown.Conclusions:Our results suggested increased peripheral blood FGF23 levels,decreased bone mineral density in CS patients,and a good predictive ability of CS by peripheral blood FGF23 levels.FGF23 may contribute to osteopenia in CS pati

关键词： scoliosis Fibroblast growth factor 23 Fibroblast growth factor receptor 3 Osteopenia

Effectiveness of psychosocial interventions for pediatric patients with scoliosis:a systematic review

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World Journal of Pediatric Surgery 2023年第2期6卷 63-69页

作者： Maike van Niekerk Ann Richey John Vorhies Connie Wong Kali Tileston Pediatric Orthopaedic Surgery Stanford UniversityStanfordCaliforniaUSA Lane Medical Library Stanford UniversityStanfordCaliforniaUSA

Background Pediatric patients affected by scoliosis have complex psychological and social care needs,and may benefit from psychosocial interventions.We therefore aimed to summarize evidence of the efficacy of psychosocial interventions for this patient population.Methods Literature was identified by searching Medline,PsycINFO,Embase,EBSCO Cumulated Index to Nursing and Allied Health Literature(CINAHL),and Cochrane Central Register of Controlled Trials(CENTRAL)from database inception to 20 March 2022.Articles that evaluated the effectiveness of psychosocial interventions for pediatric patients diagnosed with scoliosis and reported at least one quantitative outcome were included.Article eligibility,data extraction,and quality assessment(using the Cochrane Collaboration's Risk of Bias Tool and Methodological Index for Non-Randomized Studies)were performed by two independent researchers.Findings are presented using narrative synthesis.Results We identified ten studies,all of which focused on adolescent idiopathic scoliosis.Studies included a total of 1007 participants,most of whom were female.Three studies focused on patients undergoing bracing,six on patients undergoing spinal surgery,and one on patients broadly.Brace compliance monitoring and counseling were found to significantly improve brace compliance quality and quantity.Proactive mental healthcare delivery by nurses after spinal surgery was similarly found to improve outcomes.Several studies examined the efficacy of brief educational interventions;most did not report clear evidence of their efficacy.The methodological quality of studies was often unclear due to limitations in articles'reporting quality.Conclusions Research on the efficacy of psychosocial interventions for pediatric patients with scoliosis is limited,with interventions involving frequent patient-provider interactions showing the most promise.Future clinical and research efforts should focus on developing and testing psychosocial interventions for this patient population,with emphasis on multid

关键词： patients scoliosis nurse

Acute spinal subdural haematoma complicating a posterior spinal instrumented fusion for congenital scoliosis:A case report

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World Journal of Clinical Cases 2023年第20期11卷 4890-4896页

作者： Godefroy Michon du Marais Anne Tabard-Fougère Romain Dayer Division of Paediatric Orthopaedics and Traumatology Unit Geneva University Hospitals and Geneva UniversityGeneva 1205Switzerland Division of Paediatric Orthopaedics Geneva University Hospitals and Geneva UniversityGeneva 1205Switzerland

BACKGROUND Acute spinal subdural haematoma(ASSH)is a rare and potentially devastating condition with a variable prognosis.Previously described subdural haematomas were thought to have occurred spontaneously or be related to major or minor iatrogenic or traumatic injuries caused by surgery,spinal puncture or epidural anaesthesia.Other contributing pathologies have been described,such as intradural tumours or spinal arteriovenous malformations.ASSH has also been associated with anticoagulation therapy,haemostatic abnormalities and risk factors such as pregnancy.To the best of our knowledge,this case study described the first reported occurrence of an ASSH during spinal surgery in a paediatric patient.The patient was not known to have any coagulopathies,and no obvious vascular lesions were documented.The surgical procedure did not directly involve the dura mater,and no evident intraoperative dural tears were found.CASE SUMMARY We reported and discussed a case of ASSH complicating a posterior spinal instrumented fusion during surgery for paediatric congenital scoliosis.This condition has not been previously described.We made recommendations for facing such an occurrence,explored its aetiology in the context of malformation and discussed the benefits of neuromonitoring during scoliosis correction and the management protocol.We conducted a PubMed literature review for cases of paediatric ASSH and other closely related disorders.We reviewed recommendations regarding neuromonitoring and treatment management in such cases.CONCLUSION ASSH is a rare complication of posterior spinal instrumented fusion.Published cases are more often associated with anticoagulation therapy or coagulopathy.Neuromonitoring is strongly recommended to detect and assess neurological status,thus enabling rapid diagnosis and treatment and facilitating early spinal decompression and a return to a normal neurological status.

关键词： Acute spinal subdural haematoma Congenital malformation Paediatric Posterior spinal instrumented fusion scoliosis Somatosensory evoked potential Case report

Surgical treatment of atlantoaxial dysplasia and scoliosis in spondyloepiphyseal dysplasia congenita:A case report

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World Journal of Orthopedics 2023年第11期14卷 827-835页

作者： Yang Jiao Jun-Duo Zhao Xu-An Huang Hao-Yu Cai Jian-Xiong Shen Department of Orthopaedic Surgery Peking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100730China

BACKGROUND Spondyloepiphyseal dysplasia congenita(SEDC)is a rare autosomal dominant hereditary disease caused by COL2A1 mutations.SEDC primarily involves the skeletal system,with typical clinical manifestations,including short stature,hip dysplasia,and spinal deformity.Due to the low incidence of SEDC,there are only a few case reports regarding the surgical treatment of SEDC complicated with spinal deformities.CASE SUMMARY We report a case of a 16-year-old male patient with SEDC.He presented with typical short stature,atlantoaxial dysplasia,scoliosis,and hip dysplasia.Cervical magnetic resonance imaging showed spinal canal stenosis at the atlas level and cervical spinal cord compression with myelopathy.The scoliosis was a right thoracic curve with a Cobb angle of 65°.He underwent atlantoaxial reduction,decompression,and internal fixation from C1–C2 to relieve cervical myelopathy.Three months after cervical surgery,posterior correction surgery for scoliosis was performed from T3 to L4.scoliosis was corrected from 66°to 8°and remained stable at 2-year follow-up.CONCLUSION This is the first case report of a patient with SEDC who successfully underwent surgery for atlantoaxial dysplasia and scoliosis.The study provides an important reference for the surgical treatment of SEDC complicated with spinal deformities.

关键词： Spondyloepiphyseal dysplasia congenita Surgical treatment Atlantoaxial dysplasia scoliosis Hip dysplasia Case report

Is it necessary to fuse to the pelvis when correcting scoliosis in cerebral palsy?

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World Journal of Orthopedics 2022年第4期13卷 365-372页

作者： Shane F Strom Matthew C Hess Achraf H Jardaly Michael J Conklin Shawn R Gilbert Department of Orthopaedics University of Alabama at BirminghamBirminghamAl 35294United States Department of Orthopaedics The Hughston Clinic/Hughston FoundationColumbusGA 31908United States

BACKGROUND Neuromuscular scoliosis is commonly associated with a large pelvic obliquity.scoliosis in children with cerebral palsy is most commonly managed with posterior spinal instrumentation and fusion.While consensus is reached regarding the proximal starting point of fusion,controversy exists as to whether the distal level of spinal fusion should include the pelvis to correct the pelvic obliquity.AIM To assess the role of pelvic fusion in posterior spinal instrumentation and fusion,particularly it impact on pelvic obliquity correction,and to assess if the rate of complications differed as a function of pelvic fusion.METHODS This was a retrospective,cohort study in which we reviewed the medical records of children with cerebral palsy scoliosis treated with posterior instrumentation and fusion at a single institution.Minimum follow-up was six months.Patients were stratified into two groups:Those who were fused to the pelvis and those fused to L4/L5.The major outcomes were complications and radiographic parameters.The former were stratified into major and minor complications,and the latter consisted of preoperative and final Cobb angles,L5-S1 tilt and pelvic obliquity.RESULTS The study included 47 patients.The correction of the L5 tilt was 60%in patients fused to the pelvis and 67%in patients fused to L4/L5(P=0.22).The pelvic obliquity was corrected by 43%and 36%in each group,respectively(P=0.12).Regarding complications,patients fused to the pelvis had more total complications as compared to the other group(63.0%vs 30%,respectively,P=0.025).After adjusting for differences in radiographic parameters(lumbar curve,L5 tilt,and pelvic obliquity),these patients had a 79%increased chance of developing complications(Relative risk=1.79;95%CI:1.011-3.41).CONCLUSION Including the pelvis in the distal level of fusion for cerebral palsy scoliosis places patients at an increased risk of postoperative complications.The added value that pelvic fusion offers in terms of correcting pelvic obliquity is not clear,as these patients

关键词： Cerebral palsy scoliosis Pelvic fusion Pelvic obliquity Spinal fusion Distal lumbar level

scoliosis in China： History and Present Status

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Chinese Medical Journal 2017年第21期130卷 2521-2523页

作者： Gui-Xing Qiu Department of Orthopaedics Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical Col ege Beijing 100730 China

scoliosis is a three-dimensional （3D） spinal deformity involving one or more spine curvatures with vertebral rotation. In the past 30 years, Chinese spine surgeons adopted international advanced technology and concepts, took advantage of abundant Chinese patient resources with severe deformity, and developed novel ideas and techniques, which promoted the development of the diagnosis and treatment for scoliosis.

关键词： China： Current Status History scoliosis

The identification of PAX7 variants and a potential role of muscle development dysfunction in congenital scoliosis

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Cell Regeneration 2022年第1期11卷 163-166页

作者： Muchuan Wang Ziquan Li Sen Zhao Zhifa Zheng Yipeng Wang Guixing Qiu Zhihong Wu Nan Wu Terry Jianguo Zhang Siyi Cai Department of Orthopedic Surgery State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijing 100730China Beijing Key Laboratory for Genetic Research of Skeletal Deformity Beijing 100730China Key laboratory of big data for spinal deformities Chinese Academy of Medical SciencesBeijing 100730China Medical Research Center Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesNo.1 ShuaifuyuanBeijing 100730China Department of Molecular and Human Genetics Baylor College of MedicineHoustonTX 77030USA

Dear Editor,Congenital scoliosis(CS)is a spinal malformation charac-terized by failure of vertebral formation or segmentation,or a mix of these deformities,resulting in longitudinal and rotational imbalance,and affects 0.05-0.1%of new-borns(Wu et al.2015).It is generally understood that the development of CS has an underlying genetic basis.Specifically,genes related to somite regulation or osteo-genesis during embryonic development are believed to be responsible for the vertebral malformations observed in CS patients(Pourquie 2011).

关键词： vertebral scoliosis

Treatment of early-onset scoliosis: techniques, indications, and complications

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Chinese Medical Journal 2020年第3期133卷 351-357页

作者： Yan-Bin Zhang Jian-Guo Zhang Department of Education Beijing Jishuitan Hospital4th Clinical Medical College of Peking UniversityBeijing 100035China Department of Orthopedics Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China.

The treatments for early-onset scoliosis(EOS)remain great challenges for spine surgeons.This study aimed to comprehensively review the treatments for EOS,especially the advancements made in the last decade.Current studies on EOS were retrieved through a search on PubMed,UpToDate,the Web of Science Core Collection and Scopus were reviewed.The most pertinent information related to the current treatments for EOS was collected.The foci of treatments for EOS have included creating a well-developed thoracic cavity,improving lung volume,and improving pulmonary function.Conservative treatments include bracing,casting,halo-gravity traction,and physiotherapy.Serial casting is the most effective conservative treatment for EOS.Surgical treatments mainly include growth-friendly techniques,which are generally classified into three types according to the amount of correction force applied:distraction-based,compression-based,and growth-guided.The distraction-based systems include traditional or conventional growing rods,magnetically controlled growing rods,and vertical expandable prosthesis titanium ribs.The compression-based systems include vertebral body stapling and tethering.The growth-guided systems include the Shilla system and modern Luque trolley.In addition,some newer techniques have emerged in recent years,such as posterior dynamic deformity correction(ApiFix).For EOS patients presenting with sharp deformities in a long,congenital spinal deformity,a hybrid technique,one-stage posterior osteotomy with short segmental fusion and dual growing rods,may be a good choice.Hemivertebra resection is the gold standard for congenital scoliosis caused by single hemivertebra.Although the patient’s growth potential is preserved in growth-friendly surgeries,a high complication rate should be expected,as well as a prolonged treatment duration and additional costs.Knowledge about EOS and its treatment options is rapidly expanding.Conservative treatments have specific limitations.For curves requiring a surgical intervention,surgical tec

关键词： Early-onset scoliosis Techniques Conservative treament Hemivertebra resection Fusionless Growth-friendly