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OBJECTIVE This study aimed to investigate reversal of vertebral wedging and to evaluate the contribution of vertebral remodeling to correction maintenance in patients with adolescent Scheuermann’s kyphosis (SK) after posterior-only instrumented correction. METHODS A retrospective cohort study of patients with SK was performed. In total, 45 SK patients aged 10–20 years at surgery were included. All patients received at least 24 months of follow-up and had Risser sign greater than grade 4 at latest follow-up. Patients with Risser grade 3 or less at surgery were assigned to the low-Risser group, whereas those with Risser grade 4 or 5 were assigned to the high-Risser group. Radiographic data and patient-reported outcomes were collected preoperatively, immediately postoperatively, and at latest follow-up and compared between the two groups. RESULTS Remarkable postoperative correction of global kyphosis was observed, with similar correction rates between the two groups (p = 0.380). However, correction loss was slightly but significantly less in the low-Risser group during follow-up (p < 0.001). The ratio between anterior vertebral body height (AVBH) and posterior vertebral body height (PVBH) of deformed vertebrae notably increased in SK patients from postoperation to latest follow-up (p < 0.05). Loss of correction of global kyphosis was significantly and negatively correlated with increased AVBH/PVBH ratio. Compared with the high-Risser group, the low-Risser group had significantly greater increase in AVBH/PVBH ratio during follow-up (p < 0.05). The two groups had similar preoperative and postoperative Scoliosis Research Society–22 questionnaire scores for all domains. CONCLUSIONS Obvious reversal in wedge deformation of vertebrae was observed in adolescent SK patients. Patients with substantial growth potential had greater vertebral remodeling and less correction loss. Structural remodeling of vertebral bodies has a positive effect and protects against correction loss. These results could be help guide treatment decision-making.

Study Design: A retrospective study. Objectives: To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery. Methods: This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal. Results: With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed. Conclusions: Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.

STUDY DESIGN A retrospective study. OBJECTIVE The aim of this study was to investigate the ability of Global Alignment and Proportion (GAP) score to predict the occurrence of adjacent segment degeneration (ASD) after fusion surgery for lumbar degenerative diseases. SUMMARY OF BACKGROUND DATA The recently developed GAP score was applied to predict postoperative complications for adult spinal deformity, as well as to facilitate future outcome-based research on optimal treatment for various spinal conditions. However, it remains unclear whether reconstruction of alignment according to GAP score can reduce the ASD rates. METHODS This study retrospectively reviewed 126 consecutive patients who had undergone lumbar fusion and had been followed over 2 years. Pre- and postoperative radiographs and MRI were analyzed for ASD. GAP scores were calculated based on the early postoperative spinopelvic parameters. Cochran-Armitage test of trend was performed to investigate the association between GAP score and the occurrence of ASD. Receiver-operating characteristic curves were used to analyze the predictive accuracy of the GAP score for ASD. RESULTS Radiographical ASD (R-ASD) and symptomatic ASD (S-ASD) were diagnosed in 44 (34.9%) patients and in 13 (10.3%) patients, respectively. The patients with a proportioned spinopelvic state according to the GAP score had significantly lower rates of ASD (R-ASD and S-ASD) or S-ASD than those with a moderately or severely disproportioned spinopelvic state. The area under curve for the GAP score predicting ASD and S-ASD was 0.691 (95% confidence interval [CI]: 0.596∼0.785, P

With the development of RGBD sensors, the high-quality color point cloud can be obtained expediently. In this paper, we propose a novel registration method for 3D color point clouds from different views, which is a critical issue in many applications. Different from traditional feature-based methods, we design a hybrid feature representation with color moments of the point, which could be applied naturally for any color point cloud. And these features are extracted from point clouds based on the supervoxel segmentation. By jointly conducting these features for similarity measure, a weight parameter is dynamically adapted between the color and the spatial information. The registration algorithm is under a classic iterative framework for building the correspondence and estimating transformation parameters. In addition, we provide a mutual correspondence matching condition with hybrid features to build some more robust relationships for estimating transformation parameters. Experimental results demonstrate that our method can effectively reduce the number of point data for registration and achieve good matching results even in a poor initial condition.

Study Design: A retrospective studyObjectives: To investigate the impact of radiological and surgical factors as well as proximal rod contouring angle (PRCA) on the development of proximal junctional kyphosis (PJK) in early-onset scoliosis(EOS) patients after growing rod (GR) treatment.Methods: We reviewed a consecutive series of EOS patients who had undergone growing rod (GR) treatment between 2009 and 2018 (minimum follow-up of 2 years) at a single institution. Patients were divided into PJK and non-PJK groups according to the occurrence of PJK or not during the follow-up periods. The demographic data, surgical strategies, and radiographic parameters were recorded and compared between the PJK and non-PJK groups. PJK was defined as a PJA＞10° at the last follow-up. PRCA was defined as the angle between the cephalad endplate of the UIV and the lower endplate of the second vertebra caudal to UIV and the PJA-PRCA was defined as the difference between the values of PJA and PRCA. Logistic regression was also performed to identify the risk factors for the occurrence of PJK.Results: This study finally included 95 patients. The mean age at the index surgery was 6.5±2.2 years. Mean follow-up lasted 4.4±1.9 years. Lengthening procedures averaged 4.0 ± 1.8 times. There were 20 patients who were observed with PJK (the incidence, 21.1%). In comparison with the non-PJK group, the PJK group showed a larger preoperative coronal cobb angle (81.8±20.6° vs 70.4±12.4°, P=0.041) and global kyphosis (GK) (56.0±15.3° vs. 45.9±12.9°, P=0.044), as well as a larger GK correction (40.4%±10.0% vs. 30.0%±14.2%, P=0.035). In addition, the PJK group had significantly larger postoperative PJA (10.8±3.1 vs. 5.3±3.1, P＜0.001) and greater postoperative PJA-PRCA (5.3±3.0 vs. 3.66±2.9, P=0.031). The proportion of patients with a value of PJA-PRCA greater than 5° in PJK group was significantly higher than that in the non-PJK group. Multiple logistic regression showed that preoperative GK＞50°, postoperative PJA＞10 and postoperative PJA-PRCA＞5° were the risk factors in predicting PJK after GR treatment.Conclusions: More than one-fifth EOS patients experienced PJK after GR treatment. Besides greater preoperative GK and larger postoperative PJA, PJA-PRCA mismatch may be an independent risk factor of PJK occurrence.

OBJECTIVE The objective of this study was to investigate the incidence and risk factors of coronal imbalance (CI) in patients with early-onset scoliosis (EOS) who underwent growing rod (GR) treatment. METHODS A consecutive series of 61 patients with EOS (25 boys and 36 girls, mean age 5.8 ± 1.7 years) who underwent GR treatment was retrospectively reviewed. Postoperative CI was defined as postoperative C7 translation on either side ≥ 20 mm. Patients were divided into an imbalanced and a balanced group. Coronal patterns were classified into three types: type A (C7 translation < 20 mm), type B (C7 translation ≥ 20 mm with C7 plumb line [C7PL] shifted to the concave side of the curve), and type C (C7 translation ≥ 20 mm and a C7PL shifted to the convex side of the curve). RESULTS Each patient had an average of 5.3 ± 1.0 lengthening procedures and was followed for an average of 6.2 ± 1.3 years. Eleven patients (18%) were diagnosed with CI at the latest distraction, 5 of whom graduated from GRs and underwent definitive fusion. However, these patients continued to present with CI at the last follow-up evaluation. The proportion of preoperative type C pattern (54.5% vs 16.0%, p = 0.018), immediate postoperative apical vertebral translation (30.4 ± 13.5 mm vs 21.2 ± 11.7 mm, p = 0.025), lowest instrumented vertebra tilt (11.4° ± 8.2° vs 7.3° ± 3.3°, p = 0.008), and spanned obliquity angle (SOA) (9.7° ± 10.5° vs 4.1° ± 4.5°, p = 0.006) values in the imbalanced group were significantly higher than in the balanced group. Multiple logistic regression demonstrated that a preoperative type C pattern and immediate postoperative SOA > 11° were independent risk factors for postoperative CI. CONCLUSIONS The incidence of CI in patients with EOS who underwent GR treatment was 18%. This complication could only be slightly improved after definitive spinal fusion because of the autofusion phenomenon. A preoperative type C pattern and immediate postoperative SOA > 11° were found to be the risk factors for CI occurrence at the latest follow-up.

Objectives To compare the differences in sagittal spinopelvic parameters between patients receiving monosegmental or multisegmental lumbar fusion and to assess the impact of fusion length on sitting balance. Methods The current study recruited 41 patients who had undergone lumbar fusion, consisting of 18 in the monosegmental group and 23 in the multisegmental group. And the control group included 50 lumbar degenerative patients who had no previous spinal fusion surgery. Spinopelvic parameters of patients were assessed: sagittal vertical axis, pelvic tilt, sacral slope, pelvic incidence, thoracic kyphosis, lumbar lordosis, and proximal femur angles. Results We observed significant differences in sitting TK (P = 0.031), LL (P = 0.012), PT (P = 0.009) and SVA (P = 0.009) among the three groups. When transitioning from standing to sitting, the multisegmental group had the least change in SVA (P = 0.016), PT (P = 0.043), and LL (P = 0.009), with a compensatory increase in TK (P = 0.021). Moderate to strong correlations were found between the change in the LL and those in the SVA (r = −0.548, P = 0.001), PT (r = −0.600, P = 0.001), and SS (r = 0.623, P = 0.001). Conclusion Multisegmental lumbar fusion significantly limits the lumbar mobility and affects the ability to compensate postural changes. Reducing the fusion segments as much as possible is of particular value in preserving lumbar mobility and maintaining the compensatory mechanism of spinopelvis.