A three-dimensional analysis of scoliosis progression in non-idiopathic scoliosis: is it similar to adolescent idiopathic scoliosis?
To evaluate the three-dimensional (3D) characteristics of spine deformity in patients with non-idiopathic scoliosis compared with those observed in patients with adolescent idiopathic scoliosis (AIS).
A retrospective chart review was conducted to identify patients with non-idiopathic scoliosis. Twenty-eight patients with neural axis (NA) abnormalities (Chiari 1, syrinx) and 20 patients with connective tissue disorder (CTD) (Marfan’s, Beal’s, Ehlers-Danlos syndrome, mixed) were identified. The 3D parameters of the coronal, sagittal, and axial plane were compared with 284 AIS patients with a similar range of coronal deformity.
The average coronal curve was similar between all three groups (AIS 48 ± 15°, CTD 43 ± 22°, and NA 49 ± 18°; p = 0.4). The NA patients had significantly greater 3D thoracic kyphosis (20 ± 18° vs 10 ± 15°, p = 0.001) and less thoracic apical vertebral rotation (− 5 ± 18° vs − 12 ± 10°, p = 0.003) when compared with AIS. The CTD group’s 3D thoracic kyphosis (p = 0.7) and apical vertebral rotation (p = 0.09) did not significantly differ from AIS. Significant negative correlations were found in all three groups between thoracic kyphosis and coronal curve magnitude (AIS r = − 0.49, CTD r = − 0.772, NA r = −0.677, all p < 0.001).
Scoliotic patients with NA abnormalities have a more kyphotic, less-rotated 3D profile than patients with AIS, while scoliosis patients with CTD have 3D features similar to AIS. Irrespective of the underlying diagnosis, however, greater scoliotic curves were associated with a greater loss of intersegmental kyphosis, suggesting a similar biomechanical pathophysiology for curve progression.
KeywordsScoliosis Syndromic scoliosis Adolescent idiopathic scoliosis, 3D, deformity
Harms Study Group Investigators:
Aaron Buckland, MD; New York University
Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia
Amit Jain, MD; Johns Hopkins Hospital
Baron Lonner, MD; Mount Sinai Hospital
Benjamin Roye, MD; Columbia University
Burt Yaszay, MD; Rady Children’s Hospital
Chris Reilly, MD; BC Children’s Hospital
Daniel Hedequist, MD; Boston Children’s Hospital
Daniel Sucato, MD; Texas Scottish Rite Hospital
David Clements, MD; Cooper Bone & Joint Institute New Jersey
Firoz Miyanji, MD; BC Children’s Hospital
Harry Shufflebarger, MD; Nicklaus Children’s Hospital
Jack Flynn, MD; Children’s Hospital of Philadelphia
Jahangir Asghar, MD; Cantor Spine Institute
Jean Marc Mac Thiong, MD; CHU Sainte-Justine
Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia
Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad
Keith Bachmann, MD; University of Virginia
Larry Lenke, MD; Columbia University
Mark Abel, MD; University of Virginia
Michael Glotzbecker, MD; Boston Children’s Hospital
Michael Kelly, MD; Washington University
Michael Vitale, MD; Columbia University
Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation
Munish Gupta, MD; Washington University
Nicholas Fletcher, MD; Emory University
Patrick Cahill, MD; Children’s Hospital of Philadelphia
Paul Sponseller, MD; Johns Hopkins Hospital
Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children
Peter Newton, MD; Rady Children’s Hospital
Peter Sturm, MD; Cincinnati Children’s Hospital
Randal Betz, MD; Institute for Spine & Scoliosis
Ron Lehman, MD; Columbia University
Stefan Parent, MD: CHU Sainte-Justine
Stephen George, MD; Nicklaus Children’s Hospital
Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia
Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children
Tom Errico, MD; Nicklaus Children’s Hospital
Vidyadhar Upasani, MD; Rady Children’s Hospital
Research support is gratefully acknowledged from the Rady Children’s Foundation Assaraf Family Research Fund and from funding to the Setting Scoliosis Straight Foundation from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive and Zimmer Biomet in support of Harms Study Group Research.
Compliance with ethical standards
Conflict of interest
Dr. Bachmann reports funding to his institution from Setting Scoliosis Straight, during the conduct of this study; personal fees from Nuvasive, outside the submitted work.
Dr. Yaszay reports grants to his institution from the Setting Scoliosis Straight Foundation, during the conduct of the study; grants and personal fees from K2M, grants and personal fees from DePuy Synthes Spine, grants and personal fees from Nuvasive, personal fees from Medtronic, grants and personal fees from Orthopediatrics, personal fees from Stryker, personal fees from Globus, grants from Setting Scoliosis Straight Foundation, personal fees from Biogen, outside the submitted work. In addition, Dr. Yaszay has a patent K2M with royalties paid.
Dr. Upasani reports grants to his institution from the Setting Scoliosis Straight Foundation, during the conduct of this study; personal fees from DePuy Synthes Spine, personal fees from OrthoPediatrics, outside the submitted work.
Dr. Newton reports grants to his institution from the Setting Scoliosis Straight Foundation (SSSF receives grants from from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive and Zimmer Biomet in support of Harms Study Group research), during the conduct of the study; grants and other from the Setting Scoliosis Straight Foundation, other from the Rady Children’s Specialists, grants, personal fees and non-financial support from the DePuy Synthes Spine, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, grants from NuVasive, other from Electrocore, personal fees from Cubist, other from International Pediatric Orthopedic Think Tank, grants, non-financial support and other from Orthopediatrics, grants, personal fees and non-financial support from K2M, grants and non-financial support from Alphatech, grants from Mazor Robotics, outside the submitted work; In addition, Dr. Newton has a patent Anchoring systems and methods for correcting spinal deformities (8540754) with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems (8123749) licensed to DePuy Spine, Inc., a patent Screw placement guide (7981117) licensed to DePuy Spine, Inc., a patent compressor for use in minimally invasive surgery (7189244) licensed to DePuy Spine, Inc., and a patent posterior spinal fixation pending to K2M.
All remaining authors report funding to their institutions from the Setting Scoliosis Straight Foundation, during the conduct of this study; no other conflicts of interest, outside the submitted work.
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