Objective To analyze the correlation between the polymorphism on interleukin 6 (IL-6) gene promoter region-174 locus and adolescent idiopathic scoliosis (AIS), including the susceptibility, the bracing effectiveness, and the possible mechanism. Methods The 182 AIS patients and 210 healthy controls who met the inclusion criteria between January 2013 and January 2016 were collected as research objects. The genotype of IL-6 gene promoter region-174 locus, the serum IL-6, the bone mineral density (BMD) of femoral neck and vertebrae (L1–4), and the bone metabolism parameters, including bone alkaline phosphatase (BALP), bone gla protein (BGP), tartrate resistant acid phosphatase 5b (TRACP-5b), urine Ca, and urine Ca/Cr, were detected. All research objects were divided into the AIS group and the control group according to whether they had AIS, the GG, CG, CC groups according to their genotype, and progression-free group and progression group according to the therapeutic effectiveness of 1-year bracing treatment. Statistical analysis for the indexes were conducted respectively. Results There were significant differences in AIS history, BMD of femoral neck and lumbar vertebrae between the AIS group and control group (P<0.05). According to the therapeutic effecitveness of 1-year bracing treatment, 182 AIS patients were divided into progression-free group in 110 cases and progression group in 72 cases. The results of single factor analysis showed that there were significant differences in the genotype and allele distribution of IL-6 gene promoter region-174 locus, BMD of femoral neck and lumbar vertebrae, IL-6, TRACP-5b, urine Ca, and urine Ca/Cr between the progression-free group and progression group (P<0.05). The results of multivariable analysis showed that the BMD of lumbar vertebrae, TRACP-5b, and urine Ca were the influencing factors of bracing efficacy (P<0.05). According to the results of genotype detection, all research objects were divided into GG group in 264 cases, CG group in 104 cases, and CC group in 24 cases. The IL-6, TRACP-5b, urine Ca, and urine Ca/Cr of GG type carriers were higher and BMD of femoral neck and lumbar vertebrae were lower when compared with the CG and CC type carriers (P<0.05). The BMD of lumbar vertebrae of CG type carriers was lower than that of CC type carriers (P<0.05). Conclusion The polymorphism of IL-6 genepromoter region-174 locus wasn’t correlated with the AIS susceptibility, but it was correlated (not independently correlated) with the scoliosis progression under bracing treatment, and the risk for G-carried patients was higher. The mechanism may be that the polymorphism affected the IL-6 expression level and eventually affected the BMD of AIS patients through the bone metabolism.
ObjectiveTo explore the effect of a new rehabilitation intervention model based on International Classification of Functioning, Disability and Healthy (ICF) concept in perioperative treatment on patients with adolescent idiopathic scoliosis (AIS).MethodsFrom June 2017 to January 2019, AIS patients with Cobb angle below 80° were randomly divided into experimental group and control group by the method of randomized block design. The patients in the control group received routine perioperative rehabilitation intervention, while the patients in the experimental group received rehabilitation mode intervention based on ICF concept. The therapeutic effect of the two groups including functional and activity dimensions was observed.ResultsA total of 40 patients were included, with 20 in each group. Two patients withdrew the control group. On the fourth day after surgery, the total score of Modified Barthel Index (50.55±8.87 vs. 18.99±5.63; t=13.264, P<0.001) and Scoliosis Research Society-22 (SRS-22) (3.68±0.13 vs. 3.27±0.11; t=10.355, P<0.001) in the experimental group were all better than those in the control group. In the SRS-22 scores, statistically significant differences in comparison of function (2.79±0.29 vs. 1.90±0.48; t=6.884, P<0.001), and self image (3.91±0.27 vs. 3.38±0.32; t=5.539, P<0.001) between the two groups were found. There was no statistically significant difference in pain indicators and muscle strength between the two groups in the two postoperative evaluations (P>0.05). ConclusionsThe treatment based on the concept of ICF can improve the daily living ability in the short term with the safe and acceptable premise. The concept of stimulating patient autonomy, improving patient independence, and promoting social treatment, may improve the overall state of the patients.
ObjectiveTo investigate the changes and relationship of cervical spine sagittal alignment and other spinal-pelvic sagittal parameters in adolescent idiopathic scoliosis. MethodsBetween July 2011 and July 2014, 35 patients with idiopathic scoliosis who met the inclusion criteria underwent posterior pedicle screw instrumentation and fusion. There were 12 males and 23 females with a mean age of 16.2 years (range, 13-20 years), including 16 cases of Lenke type 1, 7 cases of Lenke type 2, 4 cases of Lenke type 3, 3 cases of Lenke type 4, 4 cases of Lenke type 5, and 1 case of Lenke type 6. The average follow-up time was 10.9 months (range, 5-36 months). The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), T1 slope, C2 slope, C7 sagittal vertical axis (C7 SVA), C2-7 plumbline (cSVA) were measured on pre-and post-operative standing lateral X-ray film. Based on preoperative CL, the patients were divided into kyphosis group (CL>0°) and lordosis group (CL < 0°); after operation, the patients were divided into restored lordosis (group A), decreased kyphosis (group B), and increased lordosis (group C) after operation. All data about sagittal profile changes were analyzed. The relations between CL and other spinal-pelvic parameters in the kyphosis and lordosis groups before operation were determined via Spearman correlation coefficient. ResultsStatistically significant changes were observed in PT, PI, SS, and LL between at pre-and post-operation (P < 0.05), but no significant difference was found in the other parameters (P>0.05). There were 17 patients in lordosis group and 18 in kyphosis group before operation. Intra-group comparisons showed significant changes in PT, PI, SS, C2 slope, and C7 SVA in lordosis group, and in PT, PI, SS, LL, CL, TK, T1 slope, and C2 slope in kyphosis group (P < 0.05). Subgroup comparisons showed significant changes in CL, TK, C2 slope, C7 SVA, and T1 slope before operation (P < 0.05) and T1 slope at last follow-up between 2 groups (P < 0.05). In kyphosis group, 7 cases (group A) had restored lordosis, 7 cases (group B) had decreased kyphosis, and 4 cases had increased lordosis. In lordosis group, 9 cases (group C) had increased lordosis, 3 cases had decreased lordosis, and 5 cases had kyphotic cervical alignment after operation. Significant difference was found in LL, CL, T1 slope, C2 slope, and C7 SVA of group A, in TK and CL of group B, and in CL and cSVA of group C between pre-and post-operation (P < 0.05). There were significant differences in pre-and post-operative LL between groups A and B (P < 0.05). In lordosis group, there was a strong correlation between CL and C2 slope (P < 0.05) at pre-operation. CL had strong correlation with C2 slope and T1 slope (P < 0.05) at pre-operation in kyphosis group, and CL had moderate correlation with cSVA (P < 0.05). ConclusionCervical sagittal alignment plays an important role in the balance of the spine and pelvis. The change of cervical sagittal alignment has a certain correlation with the change of thoracic kyphosis. Attention to properly maintaining or restoring cervical sagittal lordosis alignment should be considered in preoperative evaluation of adolescent indiopathic scoliosis.
ObjectiveTo investigate the short-term effectiveness of proximal fixation of one vertebra above to the upper end vertebra and the upper end vertebra in the treatment of Lenke type 1 adolescent idiopathic scoliosis (AIS) patients with preoperative right higher shoulder.MethodsThe clinical data of 37 Lenke type 1 AIS patients treated with posterior correction between January 2010 and December 2015 were retrospectively analysed. According to proximal fixation vertebra, the patients were divided into 2 groups: group A (n=17), proximal fixation of one vertebra above to the upper end vertebra; group B (n=20), proximal fixation of the upper end vertebra. There was no significant difference in gender, age, Risser stage, radiographic shoulder height (RSH), flexibility of proximal thoracic curve, flexibility of main thoracic curve, flexibility of thoracolumbar/lumbar curve between 2 groups (P>0.05). The main thoracic curve Cobb angle, proximal thoracic curve Cobb angle, thoracolumbar/lumbar curve Cobb angle, apical vertebral translation (AVT), clavicle angle (CA), RSH, coronal trunk shift, sagittal trunk shift, thoracic kyphosis (TK), and lumbar lordosis (LL) were measured by X-ray film before operation, and at 1 month, 1 year, and 2 years after operation. The correction indexes of main thoracic curve were evaluated, including the correction degree and correction rate of main thoracic curve and AVT correction at 1 month after operation, the loss degree and the loss rate of the correction of main thoracic curve at 2 years after operation.ResultsThe operation time and intraoperation blood loss in group A were significantly greater than those in group B (P<0.05). All the patients were followed up, and the follow-up time was 2-4 years (mean, 2.8 years) in group A and 2-3.5 years (mean, 2.6 years) in group B. No serious complication such as nerve damage occurred during perioperative period and follow-up period. No complication such as failure of fusion, loosening and rupture of internal fixator, adjacent segment degeneration, and proximal junctional kyphosis occurred. There was no significant difference between 2 groups in the correction degree and correction rate of main thoracic curve and AVT correction at 1 month after operation, the loss degree and the loss rate of the correction of main thoracic curve at 2 years after operation (P>0.05). Comparison within the two groups: except for LL had no significant difference between pre- and post-operation (P>0.05), the other indicators were significantly improved after operation (P<0.05) in the two groups. There were significant differences in RSH, CA, proximal thoracic curve Cobb angle, and thoracolumbar/lumbar curve Cobb angle at each time point after operation (P<0.05), and there were spontaneous correction during follow-up; however, there was no significant difference in main thoracic curve Cobb angle, AVT, TK, LL, trunk shift at each time point after operation (P>0.05), and there was no significant loss during follow-up. Comparison between the two groups: there was no significant difference in all the radiographic indexes at pre- and post-operation (P>0.05).ConclusionFor Lenke type 1 AIS patients with preoperative right high shoulder, proximal fixation vertebra be fixed to the upper end vertebral can obtain satisfactory short-term orthopedic effectiveness and reduce blood loss and operation time.
ObjectiveTo identify the prevalence of distal adding-on phenomenon after posterior selective fusion in type Lenke 1A idiopathic scoliosis, to analyze its risk factors so as to find the reasonable choice for lowest instrumented vertebra (LIV). MethodsA retrospective study was made on the clinical data of 43 patients with type Lenke 1A idiopathic scoliosis undergoing posterior selection fusion with pedicle screw instrumentation between July 2011 and December 2015. There were 15 males and 28 females, aged 12-18 years (mean, 16 years). The preoperative Cobb angle was (50.1±11.3)°. The anteroposterior and lateral radiographs were taken at preoperation, immediate after operation, and last follow-up to measure the radiographic parameters. Forty-three patients were divided into adding-on group and control group according to whether or not the occurrence of distal adding-on phenomenon on anteroposterior radiographs of the spine at last follow-up. All the factors that maybe cause distsal adding-on were evaluated by statistical analysis. ResultsThe patients were followed up 12-50 months (mean, 26.5 months). At last follow-up, distal adding-on was observed in 10 of 43 patients (23.3%), including 2 males (13.3%) and 8 females (28.6%). Univariate analyses showed following several factors associated with adding-on:preoperative lumbar flexibility, preoperative pelvic tilt in coronal plane, preoperative LIV+1 deviation from center sacral vertical line, L4 subtype, the difference between LIV and last touching vertebra (LTV) (LIV-LTV), the difference between LIV and lower end vertebra (LEV) (LIV-LEV), and the difference between LIV and stable vertebra (SV) (LIV-SV). The risk factors above were brought into Logistic regression model, the results showed that preoperative LIV+1 deviation (deviation>10 mm, odds ratio=10.812, P=0.026), LIV-LTV (LIV-LTV<1, odds ratio=9.017, P=0.04), and L4 subtype (1A-R, odds ratio=9.744, P=0.047) were significantly associated with adding-on. ConclusionPreoperative LIV+1 deviation of >10 mm, L4 subtype (1A-R) and LIV-LTV of <1 are independent predictive factors of adding-on after surgery. As high risk of adding-on was closely related with the incorrect fusion level, it plays an important role for surgeons to decide the level of the fusion before surgery thoroughly. The LIV should be extended at least to LTV+1 to avoid adding-on phenomenon.
ObjectiveTo systematically review the effect of Schroth therapy on adolescent idiopathic scoliosis. MethodsThe PubMed, EBSCO, Embase, Cochrane Library, Web of Science, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to November 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 14 RCTs involving 589 patients were included. The results of meta-analysis showed that Schroth therapy significantly reduced patients' Cobb angle (MD=−3.21, 95%CI −3.87 to −2.55, P<0.01) and angle of trunk rotation (ATR) (MD=−2.39, 95%CI −3.07 to −1.71, P<0.01), and improved SRS-22 quality of life score (MD=0.16, 95%CI 0.01 to 0.30, P=0.04) compared with the control group. Subgroup analysis results showed that Schroth therapy had a better effect on improving the quality of life in moderate patients. Schroth therapy for 1.5-3 months, 5-7 times therapy a week, and a single 30 minute and 40-60 minutes therapy showed better improvement in patients' quality of life. Conclusion Current evidence shows that Schroth therapy can effectively improve Cobb angle, ATR, and quality of life in adolescents with idiopathic scoliosis. The improvement effect on quality of life is influenced by the intervention period, frequency, and duration of each intervention.
ObjectiveTo develop a smart orthosis personalized management system for the treatment of patients with adolescent idiopathic scoliosis (AIS) and to evaluate the feasibility and efficiency through clinical preliminary applications.MethodsThe smart orthosis personalized management system consists of a wireless force monitor, a WeChat Mini Program, a cloud-based storage system, and a website backstage management system. Twenty-two patients with AIS who underwent orthosis treatment and met the selection criteria between March 2020 and December 2020 were enrolled. The follow-up time was 4 months. The parameters used to evaluate patients’ compliance were as follows (back and lumbar): baseline force value, measured force value, force compliance (measured force value/baseline force value×100%), measured wearing time (wearing time of force value was more than 0 N), and time compliance (measured wearing time/prescribed wearing time×100%), in which the prescribed wearing time was 23 hours/day. The baseline force values were measured at initiation, while the measured force value, measured wearing time, force compliance, and time compliance were measured during follow-up. The differences of these parameters between back and lumbar, and the differences among these parameters at 1, 2, 3, and 4 months after orthosis wearing were analyzed.ResultsThe average measured force value of 22 patients (back and lumbar) was (0.83±0.34) N, the average force compliance was 68.5%±17.9%, the average measured wearing time was (15.4±1.7) hours, and the average time compliance was 66.9%±7.7%. The baseline force value and measured force value of back were significantly higher than those of lumbar (P<0.05); the measured wearing time, force compliance, and time compliance between back and lumbar showed no significant difference (P>0.05). The measured force value, measured wearing time, force compliance, and time compliance at 1 month after wearing were significantly lower than those at 2, 3, and 4 months after orthosis wearing (P<0.05), no significant difference was found among 2, 3, and 4 months after orthosis wearing (P>0.05). At different time points after wearing, the measured force value of back were significantly higher than that of lumbar (P<0.05), while there was no significant difference between back and lumbar on the other parameters (P>0.05).ConclusionThe smart orthosis personalized management system has high feasibility to treat AIS, and can improve the compliance of such patients with orthosis wearing.
Adolescent idiopathic scoliosis refers to a three-dimensional spinal deformity or structural change that occurs in adolescence. The rotation of the vertebral body is greater than or equal to 10°. In order to avoid affecting the physical and mental health of patients, appropriate intervention and treatment of adolescent idiopathic scoliosis should be carried out as soon as possible. Based on the summary of non-surgical treatment of adolescent idiopathic scoliosis at home and abroad, this paper systematically introduces the mainstream early non-surgical treatment of adolescent idiopathic scoliosis, including observation and follow-up, electrical stimulation therapy, Chinese traditional chiropractic techniques, massage and manual reduction, functional training and exercise therapy, traction therapy and brace therapy, in order to provide a reference for the possible treatment research direction of adolescent idiopathic scoliosis in the future.
ObjectiveTo review the recent progress in research on the role of estrogen and estrogen receptor on the onset and progression of adolescent idiopathic scoliosis (AIS). MethodsThe recently published clinical and experimental 1iterature at home and abroad on abnormality of estrogen and its receptor in AIS was reviewed and summarized. ResultsThere are many abnormal changes of estrogen and estrogen receptor in most AIS patients, including higher serum estrogen concentration, unusual cellular response to estrogen, late age at menarche, and gene polymorphisms of estrogen receptor, which are closely associated with AIS predisposition, curve severity, and scoliosis progression. ConclusionEstrogen and its receptor participate in the onset and progression of AIS by certain mechanisms, but exact mechanism remains indefinite, which needs further research to better define the role of estrogen and its receptor in AIS.
In order to investigate the mechanical response of lumbar vertebrae during gait cycle in adolescents with idiopathic scoliosis (AIS), the present study was based on computed tomography (CT) data of AIS patients to construct model of the left support phase (ML) and model of the right support phase (MR), respectively. Firstly, material properties, boundary conditions and load loading were set to simulate the lumbar vertebra-pelvis model. Then, the difference of stress and displacement in the lumbar spine between ML and MR was compared based on the stress and displacement cloud map. The results showed that in ML, the lumbar stress was mostly distributed on the convex side, while in MR, it was mostly distributed on the concave side. The stress of the two types of stress mainly gathered near the vertebral arch plate, and the stress of the vertebral arch plate was transmitted to the vertebral body through the pedicle with the progress of gait. The average stress of the intervertebral tissue in MR was greater than that in ML, and the difference of stress on the convex and convex side was greater. The displacement of lumbar vertebrae in ML decreased gradually from L1 to L5. The opposite is true in MR. In conclusion, this study can accurately quantify the stress on the lumbar spine during gait, and may provide guidance for brace design and clinical decision making.