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The global alignment and proportion (GAP) score was established based on American and European subjects, which might limit its applicability to the Chinese population due to ethnicity-related difference of sagittal alignment.To analyze the applicability of GAP score in the Chinese population and to investigate the age- and gender-associated differences of spinopelvic and GAP score parameters.A prospective cross-sectional radiographic study.Of 692 asymptomatic Chinese volunteers aged between 20 and 79 prospectively recruited between January 2017 and June 2019, 490 subjects were eventually included in this study.The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), L1-S1 lordosis, L4-S1 lordosis, sagittal vertical axis (SVA), T1 pelvic angle (TPA) and global tilt (GT) were measured on lateral X-rays. The GAP scores and its parameters including relative pelvic version (RPV), relative lumbar lordosis (RLL), lordosis distribution index (LDI) and relative spinopelvic alignment (RSA) were calculated for each subject.Subjects were divided into four groups: Group 1M: male subjects60 years old; Group 1F: female subjects60 years old; Group 2M: male subjects ≥60 years old and Group 2F: female subjects ≥60 years old. The GAP scores and categories were determined and compared between groups. The results of sagittal alignment were compared with the previous studies evaluating the normative sagittal alignment in other populations. Univariate linear regression analysis was carried out between pelvic incidence (PI) and sacral slope (SS), lumbar lordosis (LL) and global tilt (GT) in each group.The distributions of GAP categories and the updated Roussouly classification were statistically different from other populations. Significantly different distribution of GAP categories was observed between Group 1M and Group 2M, Group 1F and Group 2F, and Group 1M and Group 1F. Radiographic measurements and GAP parameters were significantly different between Group 1M and Group 2M, and Group 1F and Group 2F. Gender-related difference of parameters was more prominent between Group 1M and Group 1F. Linear relationship of PI with SS, LL and GT were different from the regression models of "ideal" sagittal alignment in GAP score.The GAP score might be inappropriate in Chinese population due to ethnicity-related alignment difference. Worse feasibility of GAP score was observed in female and old subjects.

A 3-column osteotomy is sometimes challenging in congenital kyphosis (CK) with many anterior unsegmented vertebrae (AUVs). This study compared surgical outcomes of single-level 3-column osteotomy and associated complications in CK with increasing number of AUVs.We retrospectively reviewed 25 consecutive patients with AUVs in CK who underwent surgery at a mean age of 16.2 ± 10.3 years. Patients were stratified into 2 groups according to the number of AUVs: 3 AUVs and ≥4 AUVs. Osteotomy types, surgical outcomes, and related complications were analyzed and compared between groups.The 3 AUVs group comprised 13 patients, and the ≥4 AUVs group comprised 12 patients. Pedicle subtraction osteotomy, grade 4 osteotomy, vertebral column resection, and vertebral column decancellation accounted for 15.4%, 38.5%, 46.1%, and 0% of procedures in the 3 AUVs group and 8.3%, 0%, 83.3%, and 8.3% of procedures in the ≥4 AUVs group. Preoperative focal kyphosis, which was significantly higher in the ≥4 AUVs group (82.9° ± 28° vs. 59.7° ± 9.4°, P = 0.010), was corrected in both groups postoperatively. The ≥4 AUVs group had significantly higher remaining kyphosis (33.6° ± 13.4° vs. 15.1° ± 9.1°, P0.001) with a significantly lower correction rate (61.2% ± 13.6% vs. 75.0% ± 15.6%, P = 0.001). The complication rate, mainly involving vertebral subluxation and proximal junctional kyphosis, was significantly higher in the ≥4 AUVs group than the 3 AUVs group (8/12 vs. 1/13, P = 0.004).Posterior single-level 3-column osteotomy can achieve satisfactory kyphosis correction in CK with 3 AUVs. Decreasing kyphosis correction and increasing surgery-related complications are prone to develop when treating CK with ≥4 AUVs.

Several osteotomy techniques including pedicle subtraction osteotomy and vertebral column resection have been employed in the correction of congenital kyphosis (CK) and satisfying outcomes have been demonstrated. However, the Scoliosis Research Society (SRS)-Schwab Grade 4 osteotomy, defined as resection of posterior elements, partial vertebral body, and superior adjacent disc, is rarely reported in the treatment of CK.The present study aimed to evaluate the efficiency and safety of SRS-Schwab Grade 4 osteotomy in patients with CK, and to propose its optimal indication.This is a retrospective analysis of clinical and radiographic outcomes of patients with CK undergoing SRS-Schwab Grade 4 osteotomy.Patients with thoracolumbar CK undergoing SRS-Schwab Grade 4 osteotomy from January 2010 to May 2015 followed up for at least 2 years were retrospectively reviewed.The thoracic kyphosis, lumbar lordosis, segmental kyphosis (SK), sagittal vertical axis (SVA), pelvic incidence, pelvic tilt, and sacral slope were measured on lateral spinal x-rays. Patients were required to fulfill the SRS-22 questionnaire at preoperation and the last follow-up.The sagittal spinal-pelvic parameters were assessed at preoperation, postoperation, and last follow-up. The comparison between preoperation and postoperation was performed by paired samples t test.A total of 38 patients with CK (17 male and 21 female) with an average age of 16.5±9.9 years were included. The mean operating time was 242.7±88.1 minutes and blood loss was 634.5±177.8 mL. The mean follow-up was 38.8±20.3 months. The SK was 49.5±11.7° at preoperation, 6.8±7.4° at postoperation (p.001), and 8.0±8.1° at the last follow-up. No significant correction loss during follow-up was found in SK (p=.125). The SVA was improved from -36.0±18.3 mm at preoperation to 3.7±17.8 mm at postoperation (p.001), and the correction was well maintained during follow-up (p=.113). Compared with preoperation, the mean postoperative scores of each domains of SRS-22 questionnaire improved at different levels. Intraoperative complications included one case with incidental dural tear and another with transient root injury. Proximal junctional kyphosis occurred in three patients at 6 months after operation and remained stable during the follow-up. At the last follow-up, all patients were identified to have achieved solid bony fusion.The SRS-Schwab Grade 4 osteotomy, if selected appropriately, could provide satisfying correction of congenital kyphosis. The correction could be well maintained during the longitudinal follow-up.

To evaluate the efficacy and safety of pre-operative Halo-gravity traction in the treatment of severe neurofibromatosis type 1 and congenital scoliosis patients with thoracic rotatory subluxation.Patients with neurofibromatosis type 1 and congenital scoliosis undergoing Halo-gravity traction were reviewed. Radiographic parameters were measured at pre-, post-traction and post-operation. The forced vital capacity and forced expiratory volume in 1 s were recorded at pre- and post-traction. The neurologic function were assessed according to the Frankel score. The complications during Halo-gravity traction, operation and post-operative follow-up were recorded.A total of 35 patients (21M and 14F) with rotatory subluxation including 18 neurofibromatosis type 1 and 17 congenital scoliosis patients were included, of whom the average age was 14.9 ± 4.8 years. The average duration of Halo-gravity traction was 72.3 ± 11.2 days, during which the average Cobb angle improved from 105.4 ± 34.2° to 81.7 ± 32.6° (P 0.001), and the global kyphosis decreased from 79.2 ± 22.5° to 59.7 ± 23.0° (P = 0.003). At pre-traction, the values of coronal and sagittal rotatory subluxation were 9.3 ± 5.2 mm and 7.5 ± 3.5 mm, which significantly improved to 6.7 ± 3.6 mm (P 0.001) and 4.9 ± 2.3 mm (P 0.001), respectively. The average improvement in forced vital capacity and forced expiratory volume in 1 s were from 43.6% to 54.2% predicted and from 40.4% to 48.8% predicted, respectively. After Halo-gravity traction, the Frankel scores improved from C to D in 3 patients, from D to E in 2 patients.Halo-gravity traction can improve the coronal and sagittal curvature, and the rotatory subluxation in neurofibromatosis type 1 and congenital scoliosis patients. The pre-operative Halo-gravity traction is a safe option for severe neurofibromatosis type 1 and congenital scoliosis patients with rotatory subluxation.

BACKGROUND CONTEXT The treatment of severe and rigid thoracic scoliosis was challenging. We employed Ponte osteotomy followed by sequential correction technique with satellite rods construction to treat severe rigid thoracic scoliosis aiming to achieve better correction with less complications. This technique could reduce the difficulty of rod installation by separated maneuvers and multi-rods system. Satisfactory correction rate and less correction loss during the longitudinal follow-up could be expected in this cohort. PURPOSE The objective of this study was to evaluate the safety and efficacy of this technique. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE A total of 32 patients (12 M, 20F) with severe rigid thoracic scoliosis (Cobb angle>100°) who underwent sequential correction technique with satellite rod construction between October 2012 and October 2016 and with more than 2 years follow-up were retrospectively reviewed. OUTCOME MEASURES Cobb angle of major curve, apex vertebral translation, trunk shift, thoracic kyphosis and lumbar lordosis were measured through standing X-ray imaging preoperatively, postoperatively and at final follow-up. The duration of operation, blood loss and complication were recorded. SRS-22 questionnaire was measured to evaluate the clinical outcomes. METHODS Cobb angle of major curve, apex vertebral translation, trunk shift, thoracic kyphosis and lumbar lordosis were measured through standing X-ray imaging preoperatively, postoperatively and at final follow-up. The duration of operation, blood loss and complication were recorded. SRS-22 questionnaire was measured to evaluate the clinical outcomes. RESULTS The average age was 21.3±10.8 years (range 17 to 46 years) and the average follow-up was 34.3±8.9 months. The mean preoperative Cobb angle of major curve was 117.8±9.8° (range 104° to 131°) with a mean flexibility of 13.9% and the mean thoracic kyphosis was 65.5±18.7° (range 48° to 87°) . The mean duration of operation was 267.4±42.3min and the mean blood loss was 895.4±103.1ml. The coronal main curve was corrected to 54.4±10.9° with a mean correction rate of 53.9%±9.3% and the mean thoracic kyphosis was corrected to 35.6±12.0°, which were both significantly improved (p CONCLUSIONS Sequential correction technique with satellite rods construction was a safe and effective strategy in the treatment of severe rigid thoracic scoliosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.