European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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The choice of distal fusion level in adolescent idiopathic scoliosis (AIS) patients with major thoracolumbar or lumbar (TL/L) curves (Lenke type 3C, 5C, or 6C) remains debatable. One of the most controversial issues involves stopping the distal fusion at L3, which might result in an increased risk of decompensation but save more mobile spinal segments. The purpose of this study was to evaluate and compare the clinical and radiological outcomes of corrective surgery for AIS with major TL/L curves according to the distal fusion level. ⋯ There is no difference in the radiological and clinical outcomes in AIS according to the distal fusion level. Major TL/L curve correction in AIS may be sufficient distally at L3 in cases with an LEV ≥ L3 and LTV ≥ L4. However, stopping fusion at L3 requires caution in LEV ≤ L4 or LTV = L5 patients, as this correction rate might be suboptimal and causes a possible progression of the adjacent disc wedge angle.
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Personalized modeling of brace action has potential in improving brace efficacy in adolescent idiopathic scoliosis (AIS). Model validation and simulation uncertainty are rarely addressed, limiting the clinical implementation of personalized models. We hypothesized that a thorough validation of a personalized finite element model (FEM) of brace action would highlight potential means of improving the model. ⋯ In-depth analysis suggests that personalization of spinal functional units mechanical properties could improve the simulation's accuracy, but the model gave good results, thus justifying further research on its clinical application.
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To study the predictors of postoperative aggravation of shoulder imbalance in severe and rigid thoracic or thoracolumbar scoliosis. ⋯ Several radiographic parameters were found to affect postoperative aggravation of RSH and T1 tilt. In particular, preoperative RSH and T1 tilt were found to be independent predictive factors of postoperative aggravation of RSH and T1 tilt, respectively.
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Comparative Study
Accurate prediction of height loss in adolescent idiopathic scoliosis: Cobb angle alone is insufficient.
Spinal height loss due to scoliosis was mostly calculated by equations with Cobb angle as the unique independent variable in adolescent idiopathic scoliosis (AIS), with their accuracy being seriously doubted. The purpose of this study was to compare and correlate the measured loss in spinal height (ΔSHm) with the calculated loss in spinal height (ΔSHc), and to identify the key factors associated with height loss in AIS. ⋯ Previous height correction equations employing Cobb angle as the unique independent variable are inaccurate. Cobb angle, curve length, curve inclination, and number of vertebrae within the curve are all strong determinants responsible for the height loss in AIS.
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To evaluate clinical and radiological outcomes of growing rod (GR) in the management of Early Onset Scoliosis (EOS) with intraspinal anomalies. ⋯ Level 4 (case series).