A Practical Study of Diagnostic Accuracy: Scoliosis Screenings of Middle School Students by a Trained Nurse With a Smartphone Versus a Spine Surgeon With a Scoliometer
This study aimed to assess the accuracy of smartphone-aided diagnosis of scoliosis by a trained nurse compared with scoliometer-based diagnosis by a spine surgeon. Summary of Background Data. Many assessments have been developed to estimate the reliability of smartphone-aided measurements in diagnosing scoliosis. However, clinical studies assessing the accuracy of smartphone-aided diagnosis with radiographs or scoliometers are scarce. Methods. A total of 2702 grade 7 students (mean age 13.56 yrs, range 13–15) at 10 middle schools were first screened with a smartphone by a trained nurse from the orthopedics department. Approximately half a year later, most of the students underwent a chest x-ray examination as part of a compulsory medical examination. Students with suspicious findings in either the first screen or the chest x-ray were recommended to a scoliosis clinic for single-blind tests, such as a forward bending test (FBT) and an analysis of the angle of trunk rotation (ATR) with a scoliometer, performed by an experienced spine surgeon. Finally, the Cobb method was conducted with full-spine radiographs to serve as the gold standard. Results. The agreement between the first screening by the nurse and the second test by the spine surgeon was low in cases with a Cobb angle 10° (κ = 0.349 [0.19–0.50], P
Conclusions: Five years following “graduation” from growing surgery for early onset scoliosis, there is progression of curve magnitude in both the coronal and sagittal planes up to 2 years, with no further progression at 5 years. A total of 21% of patients undergo at least 1 revision surgery, and average time to revision surgery is over 2 years from last planned surgery. Risk of revision surgery was higher in patients who underwent a spinal fusion as their definitive treatment strategy. Level Evidence: Level III—retrospective comparative. Type of Evidence: Therapeutic.
Conclusions: This study demonstrates that there is minimal error due to image acquisition and measurement when using a biplanar slot scanner. Biplanar slot scanning technology tended to underestimate the size of the marker; however, the least accurate measurements only erred by 1.5% from the true length. This indicates that unlike traditional radiographs the sources of error in biplanar slot scanning images are not due to parallax and are likely due to patient-specific factors and rather than the technology itself.
Conclusions. Pelvic retroversion and increased translation of L3 from the central sacral line on the early postoperative radiograph were associated with late L3-4 disc wedging in AIS fusions to L3. Careful surgical planning and correction of sagittal alignment are imperative to ensure the long-term outcomes. Level of Evidence: 4
Seizure disorder in cerebral palsy (CP) has been described as a risk factor for postoperative complications after posterior spinal fusion. However, the effect of seizures on the maintenance of curve correction has not been reported. The aim of this study is to investigate associations between seizure history and maintenance of curve correction after posterior spinal fusion in children with CP. We analyzed records of 201 children with CP who underwent posterior spinal fusion with two-year follow-up. Patients were classified as having no seizures (31%); controlled seizures (54%); or poorly controlled seizures (PCS, 15%). Per...
The purpose of this study was to assess the surgical outcomes of posterior vertebral column resection (PVCR) with short-segment fusion for pediatric patients with congenital kyphoscoliosis (CKS). The medical records of 12 consecutive pediatric patients with CKS due to hemivertebrae located in thoracolumbar and lumbar area that had undergone PVCR and presented for follow-up at a minimum of 2 years were retrospectively reviewed. The mean follow-up period was 56.2 months, and the mean age at the surgery was 9.2 years. We evaluated radiographic parameters using plain radiographs, and evaluated segmental co...
The purpose of this retrospective study was to determine the most appropriate distal fusion level in terms of clinical results and radiological changes in Lenke 3C adolescent idiopathic scoliosis (AIS). Between June 2010 and May 2014, a total of 90 consecutive patients who underwent surgery for Lenke 3C AIS were divided into three groups as L2, L3, and L4 according to the fusion levels and compared in terms of functional and radiological outcomes. Patients were evaluated with Scoliosis Research Society 22 (SRS 22) and the Oswestry disability index (ODI) at the final follow-up. Preoperative standard posteroanterior and late...
Conclusions: The curve around the apex and upper thoracic segments in thoracic AIS is relatively rigid. Understanding differences in FI between each disk level is important for optimal corrective surgery.
ConclusionsFor lumbar IS, ARF and PRF have negative effects on IBC, coronal and sagittal rotation of the pelvis is related to IBC.
Conclusions: This large, longitudinal postoperative study of coronal balance documents a strong trend toward postoperative rebalancing, with the largest gains between first erect image and 6 months. The 31% of patients out of balance at first erect declined to only 12.1% at 2 years.
Conclusions: The results of this study support our current model of care utilizing a nonsurgical health care practitioner for spinal cast application. Level of Evidence: Level III—retrospective comparative.