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Complex phenomena are prevalent during the formation of materials, and they affect the processing structure-function relationship. Here the authors elucidate the stochastic transformation processes happening during the spin coating of perovskite colloidal precursors by multimodal characterization.

Purpose: A hands-on-wall (HOW) position for low-dose stereoradiography of adolescent idiopathic scoliosis (AIS) patients would allow for skeletal maturity assessment of the hand and wrist. Our aims were twofold: confirm the reliability and validity of skeletal maturity assessment using the HOW radiographs and compare the spinal and pelvic 3D parameters to those of standard hands-on-cheeks (HOC) stereoradiographs., Methods: Seventy AIS patients underwent two successive stereoradiographs and a standard hand and wrist radiograph on the same day. Patients were randomly assigned to begin with HOW and follow with HOC, or vice versa. Raters assessed digital skeletal age (DSA), Sanders Simplified Skeletal Maturity (SSMS) and Thumb Ossification Composite Index (TOCI). 3D reconstructions of the spine and pelvis bones were performed for each stereoradiograph to measure nine clinically relevant spinal and pelvic 3D parameters., Results: Inter-rater and intra-rater reliabilities were excellent for DSA, SSMS and TOCI with both standard radiographs and HOW (ICC > 0.95). Strong correlation was found between ratings of both imaging types (ICC > 0.95). In the 3D reconstructions, kyphosis and sacral slope were slightly decreased in the HOW position, but within the clinical margin of error. All other parameters did not differ significantly between positions (p < 0.05)., Conclusion: The results suggest that HOW stereoradiographs allow clinicians to assess skeletal maturity of the hand and wrist with adequate reliability and validity. We recommend that scoliosis clinics adopt the HOW position to assess skeletal maturity because there is no significant clinical impact on the spinal and pelvic evaluation, and on radiation exposure, cost or time., (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)

Introduction: Since the outbreak of the COVID-19 pandemic, reduction of social activities and rapid adoption of telemedicine, decreasing face-to-face encounters seems to have negatively affected the timely Idiopathic Scoliosis (IS) referral with a spine specialist. We aim to document the progression of IS curves during COVID-19 pandemic reflected by the late presentation of patients at the initial visit with higher Cobb angles and to evaluate its influence on health-related quality of life scores., Materials and Methods: All IS patients scheduled for surgery between April 2019 and September 2021 were recruited in a prospective cohort study. The patients were divided into five cohorts of 6 month duration each according to their booking date: 2 periods before the 1st COVID-19 wave, one period during and two periods afterwards. In each cohort, patients were divided into 3: those who were scheduled for posterior spinal fusion (PSF) at 1st visit, those booked for vertebral body tethering (VBT) at 1st visit, and those scheduled for surgery but who have failed brace treatment. Variables included age, gender, Risser grade and preoperative SRS-22 scores. Chi 2 and ANOVA tests were used for comparison., Results: 173 patients were analyzed. 33 patients (13.1 ± 3 y.o.) were scheduled between Apr and Sept 2019; 38 (13.1 y.o. ± 2) between Oct 2019 and Mar 2020; 31 (13.4 ± 3 y.o.) between Apr and Sept 2020; 30 (14.3 ± 2 y.o.) between Sept 2020 and Mar 2021; and 41 patients (13.8 ± 2 y.o.) between Apr and Sept 2021. Non-statistically significant differences were found between periods before, during or after the COVID-19 first wave regarding patients' age, gender, Risser grade and SRS-22 scores. Average Cobb angles of patients at their 1st visit after the beginning of the COVID-19 pandemic were significantly higher than those before COVID-19 (52.2° ± 7° and 56.6° ± 13° vs 47.8° ± 12° and 45.2° ± 13°; p = 0.0001). More patients were booked for PSF (p < 0.0000) through the five evaluated periods, while the indication of VBT or surgery in patients previously braced progressively decreased., Conclusion: Patients presented at the scoliosis clinic for the 1st time after the 1st COVID-19 wave with significantly larger Cobb angles, and likely contributed to an increased proportion of PSF, as the potential window for bracing or VBT was missed due to a delayed consultation., (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)

Purpose: To identify the clinical phenotypes associated with the rate of progression while waiting for surgery and propose a classification scheme for identifying subgroups of patients to prioritize for surgery when long surgical delays are expected., Methods: We reviewed the clinical and radiographic data of a prospective cohort of patients scheduled for IS surgery from 2004 to 2020 with a minimum 1-year wait prior to surgery. Candidate predictors consisted of age, sex, Risser sign, menarchal status, angle of trunk rotation, scoliotic curve type, and main Cobb angle at baseline when scheduled for surgery. Univariate and Regression Tree analysis were performed to identify predictors associated with the annual curve progression rate in the main Cobb angle between baseline and surgery., Results: There were 214 patients (178 females) aged 15 ± 2 years, with a Risser sign 3.4 ± 1.6 and a main Cobb angle 55°±10° at baseline. The average wait prior to surgery was 1.3 ± 0.4 years. Only the Risser sign, menarchal status and sex were significantly associated with the annual progression rate. We have identified 3 clinically and significantly different groups of patients presenting slow (3 ± 4°/yr if Risser sign 3 to 5), moderate (8 ± 4°/yr if female with Risser sign 0 to 2 and post-menarchal), and fast (15 ± 10°/yr if Risser sign 0 to 2 and premenarchal or male) progression rates., Conclusion: We present an evidence-based surgical prioritization algorithm for pediatric idiopathic scoliosis that can easily be implemented in clinical practice when long surgical delays are expected., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: The objective of this study was to evaluate the safety and efficacy of a novel technique of formal reduction and circumferential fusion for pediatric high-grade spondylolisthesis (HGS)., Purpose: The safety and efficacy of formal reduction for high-grade spondylolisthesis (HGS) has never been thoroughly examined. This study reports the outcomes of 29 children with HGS who underwent a procedure of gradual reduction and circumferential fusion., Methods: 29 children (13 males, 16 females) were recruited between 2006 and 2010. Radiographic measurements (including % of slip, lumbosacral angle-LSA, pelvic incidence-PI, pelvic tilt-PT, sacral slope-SS, and proximal femoral angle-PFA) and quality of life assessment (SRS-22 questionnaire) were prospectively obtained at baseline and at the last post-operative follow-up (> 2 years post-op). Radiological measurements were used to classify patients according to the Spine Deformity Study Group (SDSG) classification., Results: Mean baseline slip % was 69.9 ± 16.5%. There were 13 patients with a balanced pelvic (SDSG Type 4) and 16 with an unbalanced pelvis (SDSG Type 5 and 6). On average, a reduction of 45.5 ± 15.3% (range 20-86%) was achieved safely with no major complication. In particular, of the 29 patients, only 3 had a L5 radiculopathy postoperatively that was self-resolved at follow-up. From a radiological standpoint, we observed a mean improvement of LSA from 80.3 ± 17.9° to 91.7 ± 13.6°. We also observed a statistically significant improvement in global HRQOL, and in the function and body image domains., Conclusion: This prospective study suggests that formal reduction of HGS followed by circumferential fusion is safe when using a standardized surgical technique based on gradual reduction. Performing this intervention could also help improve QOL in some patients., (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)

Study Design: Single-center, double-blinded, prospective crossover randomized controlled trial., Objective: To clinically validate the efficacy of nighttime braces designed automatically by a generative design algorithm to treat idiopathic scoliosis (IS). The tested hypothesis was the clinical equivalence of immediate in-brace correction for the new automatically generated brace design versus a standard Providence-type brace., Summary of Background Data: Documented efficacy of brace treatment varies between centers, and depends on the empirical expertise of the treating orthotist. Our group previously developed a fully automated generative brace design algorithm that leverages a patient-specific finite-element model (FEM) to optimize brace geometry and correction before its fabrication., Methods: Fifty-eight skeletally immature patients diagnosed with IS, aged between 10 and 16 years were recruited. All patients received both a nighttime brace automatically generated by the algorithm (test) and a Providence-type brace designed by an expert orthotist (control). Radiographs were taken for each patient with both braces in a randomized crossover approach to evaluate immediate in-brace correction., Results: The targeted 55 patients (48 females, 7 males) completed the study. The immediate Cobb angle correction was 57% 19 (test) versus 58% 21 (control) for the main thoracic (MT) curve, whereas it was 89% 25 (test) versus 87% 28 (control) for the thoracolumbar/lumbar (TLL) spine. The immediate correction with the test brace was noninferior to that of the Control brace ( P 0.001). The order in which the braces were tested did not have a residual effect on the immediate correction., Conclusion: The fully automated generative brace design algorithm proves to be clinically relevant, allowing for immediate in-brace correction equivalent to that of braces designed by expert orthotists. Patient 2 years follow-up will continue. This method's integration could help design and rationalize the design of braces for the treatment of IS., Level of Evidence: Level 2., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Observational Cohort study., Objectives: We aim to document the abandon and irregular compliance rate towards brace treatment during the COVID-19 pandemic and its impact on AIS progression., Methods: We reviewed a database of AIS patients recruited between March and September 2020. We included AIS patients under brace treatment according to SRS criteria. The patients were divided in 2 cohorts: those with self-reported Good-Compliance (GC) to treatment and those who had a Bad-Compliance (BC). Data analysis included biometric and radiographic data at first visit and last follow-up and percentage of progression. Unpaired student-t tests and Chi 2 were used for comparison., Results: 152 patients met inclusion criteria. 89 patients (age:12.1y.o.±1.4) reported good adherence to treatment, while 63 patients (age:12.7y.o.±1.8) were not compliant. Within the BC group, 18 patients reported irregular brace wear, while 45 had completely abandoned treatment (abandon rate of 29%). The GC cohort started treatment with a mean main thoracic (MT) curve of 26° and finished with 27°. The mean difference between measurements was +.65°±7.5; mean progression rate was - 4.6%. However, the BC cohort started with a mean MT curve of 27° and finished with 32°, with a mean increase of +5 ° ±8 and a mean progression rate of - 13%. The differences between the 2 cohorts were statistically significant ( P = .0002). Six patients from the BC group progressed and were offered surgery., Conclusion: The abandon rate of brace treatment in AIS significantly increased during the first wave of COVID-19 pandemic. Patients who voluntarily discontinued treatment had significant increases in curve progression and surgical indication rates., Level of Evidence: III., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Adolescent idiopathic scoliosis is a complex three-dimensional deformity of the spine, the moderate forms of which require treatment with an orthopedic brace. Existing brace design approaches rely mainly on empirical manual processes, vary considerably depending on the training and expertise of the orthotist, and do not always guarantee biomechanical effectiveness. To address these issues, we propose a new automated design method for creating bespoke nighttime braces requiring virtually no user input in the process. From standard biplanar radiographs and a surface topography torso scan, a personalized finite element model of the patient is created to simulate bracing and the resulting spine growth over the treatment period. Then, the topography of an automatically generated brace is modified and simulated over hundreds of iterations by a clinically driven optimization algorithm aiming to improve brace immediate and long-term effectiveness while respecting safety thresholds. This method was clinically tested on 17 patients prospectively recruited. The optimized braces showed a highly effective immediate correction of the thoracic and lumbar curves (70% and 90% respectively), with no modifications needed to fit the braces onto the patients. In addition, the simulated lumbar lordosis and thoracic apical rotation were improved by 5° ± 3° and 2° ± 3° respectively. Our approach distinguishes from traditional brace design as it relies solely on biomechanically validated models of the patient's digital twin and a design strategy that is entirely abstracted from empirical knowledge. It provides clinicians with an efficient way to create effective braces without relying on lengthy manual processes and variable orthotist expertise to ensure a proper correction of scoliosis., (© 2024. The Author(s).)

Introduction: Adolescent Idiopathic Scoliosis (AIS) is a 3D deformity of the spine that affects 3% of the adolescent population. Conservative treatments like bracing aim to halt the progression of the curve to the surgical threshold. Computer-aided design and manufacturing (CAD/CAM) methods for brace design and manufacturing are becoming increasingly used. Linked to CAD/CAM and 3D radiographic reconstruction techniques, we developed a finite element model (FEM) enabling to simulate the brace effectiveness before its fabrication, as well as a semi-automatic design processes. The objective of this randomized controlled trial is to compare and validate such FEM semi-automatic algorithm used to design nighttime Providence-type braces., Methods and Analysis: Fifty-eight patients with AIS aged between 10 to 16-years and skeletally immature will be recruited. At the delivery stage, all patients will receive both a Providence-type brace optimized by the semi-automatic algorithm leveraging a patient-specific FEM (Test) and a conventional Providence-type brace (Control), both designed using CAD/CAM methods. Biplanar radiographs will be taken for each patient with both braces in a randomized crossover approach to evaluate immediate correction. Patients will then be randomized to keep either the Test or Control brace as prescribed with a renewal if necessary, and will be followed over two years. The primary outcome will be the change in Cobb angle of the main curve after two years. Secondary outcomes will be brace failure rate, quality of life (QoL) and immediate in-brace correction. This is a single-centre study, double-blinded (participant and outcome assessor) randomized controlled trial (RCT)., Trial Registration Number: ClinicalTrials.gov: NCT05001568., Competing Interests: MC and AG are cofounders and shareholders of Modulate Technologies Inc. HL is a cofounder and shareholder of Spinologics Inc. CEA has a discovery grant from the Natural Sciences and Engineering Research Council of Canada (NSERC), and a NSERC industrial research grant with Medtronic of Canada paid to the university (outside the scope of the current study). SB declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The NSERC grant with Medtronic was not been used to fund this research project. A patent application on the optimization algorithm has been submitted. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Coulombe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: The aim of this study is to determine preoperative predictors of good radiographic outcomes in VBT patients at a minimum 2-year follow-up., Methods: From a single-center dataset, we reviewed patients who underwent VBT from January 2014 to November 2018. Data analysis included age, gender, Risser grade and biometric data. Radiographically, maximum Cobb angle, C-DAR and apical vertebral and disc wedging were measured preop and at a minimum 2-year follow-up. Patients were divided into two cohorts following two different outcome measures: (1) vertebral growth modulation, those patients that growth modulated or corrected ≥ 5° and those who did not; and (2) Maximum Cobb angle at 2 years, < and ≥ 40°. Student T and Chi 2 tests were used for comparison and a multiple linear correlation test was implemented between statistically significant variables., Results: 79 patients were recruited. 26 patients (33%) did growth modulate their spine at 2-year follow-up. These patients were significantly younger, and more skeletally immature with less height (147 cm vs 155 cm; p < 0.0001), weight (38 kg vs. 45 kg; p = 0.0009) and BMI (17 vs 18.8; p = 0.0229) as those who did not. Multiple linear regression model with these variables resulted in a moderate correlation (r 2  = 0.234). 67 patients (85%) finished at a 2-year follow-up with a maximum Cobb angle < 40°. These patients were also younger and skeletally immature. We found significant differences in outcome 2 regarding the average preoperative maximum Cobb angle (48.5° ± 9.5 vs. 59.1° ± 10), average C-DAR (7 ± 1.5 vs. 8.5 ± 2.1), average apical vertebral wedging (6.5° vs. 8.3°), average vertebral/disc wedging ratio (1.5 vs. 2.4) and the average immediate postoperative Cobb angle (25° vs. 38°). These variables predicted a 36% of the variation in final Cobb angle measurement at a 2-year follow-up (r2 = 0.362)., Conclusion: Curve severity determined by a preoperative C-DAR, preoperative Cobb angles and immediate postoperative Cobb angle are significantly related to curves < 40° at a minimum 2-year follow-up, while the potential to growth modulate the spine is more dependent on skeletal maturity, lower body weight and lower BMI. These patients' characteristics should be considered preoperatively., (© 2023. The Author(s), under exclusive licence to Scoliosis Research Society.)

Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional spinal deformity. The incidence of AIS in females is 8.4 times higher than in males. Several hypotheses on the role of estrogen have been postulated for the progression of AIS. Recently, Centriolar protein gene POC5 ( POC5 ) was identified as a causative gene of AIS. POC5 is a centriolar protein that is important for cell cycle progression and centriole elongation. However, the hormonal regulation of POC5 remains to be determined. Here, we identify POC5 as an estrogen-responsive gene under the regulation of estrogen receptor ERα in normal osteoblasts (NOBs) and other ERα-positive cells. Using promoter activity, gene, and protein expression assays, we found that the POC5 gene was upregulated by the treatment of osteoblasts with estradiol (E2) through direct genomic signaling. We observed different effects of E2 in NOBs and mutant POC5 A429V AIS osteoblasts. Using promoter assays, we identified an estrogen response element (ERE) in the proximal promoter of POC5 , which conferred estrogen responsiveness through ERα. The recruitment of ERα to the ERE of the POC5 promoter was also potentiated by estrogen. Collectively, these findings suggest that estrogen is an etiological factor in scoliosis through the deregulation of POC5.

Background Context: Idiopathic scoliosis (IS) can significantly alter the quality of life of adolescents. Some of the available questionnaires in French measuring the quality of life in this population show weak psychometric properties. The newly developed Italian Spine Youth Quality of Life (ISYQOL) questionnaire promises better properties., Purpose: To provide a French-Canadian version of the ISYQOL and to verify its psychometric characteristics., Study Design: Prospective validation of a cross-cultural adaptation of the ISYQOL questionnaire., Patient Sample: A total of 111 participants with idiopathic scoliosis (77.5% female, 10-18 years old, mean Cobb angle=28°) were included in the study., Outcome Measure: The French-Canadian version of the Italian Spine Youth Quality of Life (ISYQOL-F) questionnaire., Materials and Methods: The ISYQOL was translated into French using a forward-backward approach. We then verified the understanding of the translated items with two scoliosis experts and 10 adolescents. Afterward, 111 adolescents with IS were recruited by convenience at the scoliosis clinic and they completed the ISYQOL on three occasions (before seeing the specialist, 1 week, and 2 weeks after). Cronbach's alpha, intra-class (ICC), and Pearson correlation coefficients were used to respectively determine internal consistency, test-retest reliability, and concurrent validity with the SRS-22r and SF-12. The standard error of measurement (SEM) and 95% confidence minimal detectable change (MDC 95 ) were also calculated. The ceiling effect was quantified as the percentage of participants who scored the maximum on ISYQOL-F., Results: The ISYQOL-F showed good internal consistency with a Cronbach alpha of 0.81 and 0.85 respectively for items 1-13 (n=55; ISYQOL-F mean score ± SD = 63.9±13.5) and 1-20 (n=56; ISYQOL-F mean score ± SD=60.7±10.3). Test-retest reliability was excellent (ICC 3,1 =0.94). The SEM is 3.1 and the MDC 95 is 8.6. Correlations between ISYQOL-F and SRS-22r and between ISYQOL-F and SF-12 were moderate for total scores (r=0.56 and 0.50 respectively, p<.001), but low for each domain (between 0.20 and 0.48, p<.05). No significant ceiling effects were observed for ISYQOL-F (≤2.5%). In contrast, ceiling effects ranged from 3.6% to 30.6% for SRS-22r and 0%-68.5% for SF-12., Conclusions: The internal consistency and reliability of ISYQOL-F are good. The total score correlates moderately with the SRS-22r and SF-12. Unlike SRS-22r, the ISYQOL-F does not appear to have a ceiling effect. The ISYQOL-F may thus be suitable to assess quality of life in a population of French-Canadian adolescents with IS., Competing Interests: Declaration of competing interest The authors have no conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: The HRQoL after surgery for adolescent idiopathic scoliosis (AIS) is not affected by the presence of concomitant isthmic spondylolisthesis non-surgically treated. Improvement in QoL after surgery was similar for AIS patients with and without concomitant spondylolisthesis. The purpose is to compare preoperative and postoperative Health-Related Quality of Life (HRQoL) scores in operated AIS patients with and without concomitant isthmic spondylolisthesis., Methods: A retrospective study of a prospective cohort of 464 individuals undergoing AIS surgery between 2008 and 2018 was performed. All patients undergoing surgery for AIS with a minimum 2-year follow-up were included. We excluded patients with prior or concomitant surgery for spondylolisthesis. HRQoL scores were measured using the SRS-22 questionnaire. Comparisons were performed between AIS patients with versus without concomitant spondylolisthesis treated non-surgically., Results: AIS surgery was performed for 36 patients (15.2 ± 2.5 y.o) with concomitant isthmic spondylolisthesis, and 428 patients (15.5 ± 2.4 y.o) without concomitant spondylolisthesis. The two groups were similar in terms of age, sex, preoperative and postoperative Cobb angles. Preoperative and postoperative HRQoL scores were similar between the two groups. HRQoL improved significantly for all domains in both groups, except for pain in patients with spondylolisthesis. There was no need for surgical treatment of the spondylolisthesis and no slip progression during the follow-up duration after AIS surgery., Conclusion: Patients undergoing surgical treatment of AIS with non-surgical management of a concomitant isthmic grade I spondylolisthesis can expect improvement in HRQoL scores, similar to that observed in patients without concomitant spondylolisthesis., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Study Design: Observational cohort study., Objective: To test the hypothesis that anterior vertebral body growth modulation (AVBGM) achieves 3D deformity correction after 2-year follow-up while brace treatment limits curve progression for moderate idiopathic scoliosis (30-50°)., Summary of Background Data: For idiopathic scoliosis, bracing and AVBGM have overlapping indications in skeletally immature patients with moderate scoliosis curve angles, creating a grey zone in clinical practice between them. The relative 3D deformity control performance over a 2-year period between these fusionless treatments is still uncertain., Methods: A retrospective review of a prospective idiopathic scoliosis patients database, recruited between 2013 and 2018 was performed. Inclusion criteria were skeletally immature patients (Risser 0-2), with Cobb angles between 30° and 50° and a 2-year follow-up after bracing or AVBGM. 3D radiological parameters and health related quality of life (HRQoL) scores were evaluated. Unpaired t test was used., Results: Thirty nine patients (12.7 ± 1.3 y.o.) with Cobb angles more than or equal to 30° treated with brace and 41 patients (11.8 ± 1.2 y.o.) with presenting Cobb angles less than or equal to 50° who received AVBGM were reviewed. The statistical analysis of 3D deformity measurements showed that at 2-year follow-up, only the 3D spine length and both sides apical vertebral heights changed significantly with brace treatment. While AVBGM treatment achieved statistically significant correction differences in thoracic and lumbar Cobb angles, TrueKyphosis, 3D spine length, and selective left apical vertebral height ( P < 0.05). 35% of brace patients had a curve progression of more than 5° at final follow-up while it was 0% for AVBGM. HRQoL assessment showed no statistically significant differences between pre and post SRS-22 total scores for each group ( P > 0.05)., Conclusion: Even though these two cohorts are not fully comparable, bracing seems to control progression for a significant portion of patients with moderate scoliosis curves, while AVBGM significantly corrected and maintained 3D deformity parameters at 2-year follow-up., Competing Interests: Authors M.P.D., M.R.B., I.T., C.B., N.C., and S.B. declare that they have no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Multicenter numerical study., Objective: To biomechanically analyze and compare various passive correction features of braces, designed by several centers with diverse practices, for three-dimensional (3D) correction of adolescent idiopathic scoliosis., Summary of Background Data: A wide variety of brace designs exist, but their biomechanical effectiveness is not clearly understood. Many studies have reported brace treatment correction potential with various degrees of control, making the objective comparison of correction mechanisms difficult. A Finite Element Model simulating the immediate in-brace corrective effects has been developed and allows to comprehensively assess the biomechanics of different brace designs., Methods: Expert clinical teams (one orthotist and one orthopedist) from six centers in five countries participated in the study. For six scoliosis cases with different curve types respecting SRS criteria, the teams designed two braces according to their treatment protocol. Finite Element Model simulations were performed to compute immediate in-brace 3D correction and skin-to-brace pressures. All braces were randomized and labeled according to 21 design features derived from Society on Scoliosis Orthopaedic and Rehabilitation Treatment proposed descriptors, including positioning of pressure points, orientation of push vectors, and sagittal design. Simulated in brace 3D corrections were compared for each design feature class using ANOVAs and linear regressions (significance P ≤ 0.05)., Results: Seventy-two braces were tested, with significant variety in the design approaches. Pressure points at the apical vertebra level corrected the main thoracic curve better than more caudal locations. Braces with ventral support flattened the lumbar lordosis. Lateral and ventral skin-to-brace pressures were correlated with changes in thoracolumbar/lumbar Cobb and lumbar lordosis (r =- 0.53, r = - 0.54). Upper straps positioned above T10 corrected the main thoracic Cobb better than those placed lower., Conclusions: The corrective features of various scoliosis braces were objectively compared in a systematic approach with minimal biases and variability in test parameters, providing a better biomechanical understanding of individual passive mechanisms' contribution to 3D correction., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Adolescent Idiopathic Scoliosis (AIS) is a deformation of the spine and it is routinely diagnosed using posteroanterior and lateral radiographs. The Risser sign used in skeletal maturity assessment is commonly accepted in AIS patient's management. However, the Risser sign is subject to inter-observer variability and it relies mainly on the observation of ossification on the iliac crests. This study proposes a new machine-learning-based approach for Risser sign skeletal maturity assessment using EOS radiographs. Regions of interest including right and left humeral heads; left and right femoral heads; and pelvis are extracted from the radiographs. First, a total of 24 image features is extracted from EOS radiographs using a ResNet101-type convolutional neural network (CNN), pre-trained from the ImageNet database. Then, a support vector machine (SVM) algorithm is used for the final Risser sign classification. The experimental results demonstrate an overall accuracy of 84%, 78%, and 80% respectively for iliac crests, humeral heads, and femoral heads. Class activation maps using Grad-CAM were also investigated to understand the features of our model. In conclusion, our machine learning approach is promising to incorporate a large number of image features for different regions of interest to improve Risser grading for skeletal maturity. Automatic classification could contribute to the management of AIS patients., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Adolescent idiopathic scoliosis (AIS) is a complex common disorder of multifactorial etiology defined by a deviation of the spine in three dimensions that affects approximately 2% to 4% of adolescents. Risk factors include other affected family members, suggesting a genetic component to the disease. The POC5 gene was identified as one of the first ciliary candidate genes for AIS, as three variants were identified in large families with multiple members affected with idiopathic scoliosis. To assess the prevalence of p.(A429V), p.(A446T), and p.(A455P) POC5 variants in patients with AIS, we used next-generation sequencing in our cohort of French-Canadian and British families and sporadic cases. Our study highlighted a prevalence of 13% for POC5 variants, 7.5% for p.(A429V), and 6.4% for p.(A446T). These results suggest a higher prevalence of the aforementioned POC5 coding variants in patients with AIS compared to the general population.

For the brace treatment of adolescent idiopathic scoliosis (AIS), in-brace correction and brace-wear compliance are well-documented parameters associated with a greater chance of treatment success. However, the number of studies on the impact of sagittal and transverse correction on curve evolution in the context of bracing is limited. The objective of this work was to evaluate how immediate inbrace correction in the three anatomical planes is related to long-term curve evolution after two years of bracing. We performed a retrospective analysis on 94 AIS patients followed for a minimum of two years. We analyzed correlations between in-brace correction and two-year out-of-brace evolution for Cobb and apical axial rotations (ARs) in the medial thoracic and thoraco-lumbar/lumbar regions (MT & TL/L). We also studied the association between the braces' kyphosing and lordosing effect and the evolution of thoracic kyphosis (TK) and lumbar lordosis (LL) after two years. Finally, we separated the patients into three groups based on their curve progression results after two years (corrected, stable and progressed) and compared the 3D in-brace corrections and compliance for each group. Coefficients were statistically significant for all correlations. They were weak for Cobb angles (MT: -0.242; TL/L: -0.275), low for ARs (MT: -0.423; TL/L: -0.417) and moderate for sagittal curves (TK: 0.549; LL: 0.482). In-brace coronal correction was significantly higher in corrected vs stable patients (p=0.004) while compliance was significantly higher in stable vs progressed patients (p=0.026). This study highlights the importance of initial in-brace correction in all three planes for successful treatment outcomes.

Study Design: Single-center prospective randomized controlled trial., Objective: The aim of this study was to assess the computer-aided design/manufacturing (CAD/CAM) brace design approach, with and without added finite element modeling (FEM) simulations, after 2 years in terms of clinical outcomes, 3D correction, compliance, and quality of life (QoL)., Summary of Background Data: .: Previous studies demonstrated that braces designed using a combination of CAD/CAM and FEM induced promising in-brace corrections, were lighter, thinner, and covered less trunk surface. Yet, their long-term impact on treatment quality has not been evaluated., Methods: One-hundred twenty adolescent idiopathic scoliosis patients were recruited following Scoliosis Research Society standardized criteria for brace treatment; 61 patients in the first subgroup (CAD) were given braces designed using CAD/CAM; 59 in the second subgroup (CAD-FEM) received braces additionally simulated and refined using a patient-specific FEM built from 3D reconstructions of the spine, rib cage and pelvis. Main thoracic (MT) and thoraco-lumbar/lumbar (TL/L) Cobb angles, sagittal curves, and apical rotations were compared at the initial visit and after 2 years. Patient compliance and QoL were tracked respectively by using embedded temperature sensors and SRS-22r questionnaires., Results: Forty-four patients with CAD-FEM braces and 50 with CAD braces completed the study. Average in-brace correction was 9° MT (8° CAD-FEM, 10° CAD, P = 0.054) and 12° TL/L (same for both subgroups, P = 0.91). Out-of-brace 2-year progression from initial deformity was <4° for all 3D measurements. Sixty-six percent of all cases (30 CAD-FEM, 35 CAD) met the ≤5° curve progression criterion, 83% (38 CAD-FEM, 43 CAD) stayed <45°, and 6% (5 CAD-FEM, 1 CAD) underwent fusion surgery. 3D correction, compliance, and QoL were not significantly different between both subgroups (P > 0.05)., Conclusion: After 2 years, patients with braces designed using CAD/CAM with/without FEM had satisfying clinical outcomes (compared to the BrAIST study), 3D corrections, compliance and QoL. A more comprehensive optimization of brace treatment remains to be accomplished., Level of Evidence: 2.

Study Design: Retrospective analysis of consecutive cases., Objectives: To identify clinically relevant three-dimensional (3D) sub-groups for adolescent idiopathic scoliosis (AIS). Classifications for AIS are developed to assist surgeons in surgical planning and therapeutic management. However, current systems are based on two-dimensional (2D) parameters that do not completely describe the 3D deformity. Hence, variations in surgical results based on pre-operative 2D classifications may be attributed to the lack of 3D description., Methods: Subjects from a multicenter database of AIS patients were included in this study. All patients had bi-planar radiographs and 3D reconstruction of the entire spine. A clustering algorithm based on fuzzy c-means was utilized to identify sub-groups based on the following ten parameters measured on 3D reconstructions of the spine: Cobb angle, orientation of the plane of maximum curvature of the proximal thoracic, mid-thoracic (MT) and thoracolumbar (TLL) levels, axial rotation of the apical vertebra of the MT and TLL segments, T4-T12 thoracic kyphosis, and L1-S1 lumbar lordosis. Da Vinci views were also generated and analyzed for each patient in the study. A panel of four experienced spine surgeons from the SRS 3D Scoliosis Committee reviewed and evaluated each group to determine if cluster groups were clinically distinct from each other., Results: The clustering algorithm was able to detect 11 sub-groups. The population size for each cluster varied from 11 to 290. Statistically significant differences were seen between the parameters for each group. Four spine surgeons reviewed the three most representative cases of each group and unanimously agreed that each cluster group represents a sub-group that was not defined in current classifications., Conclusions: This study presents a new method of classifying AIS based on a fuzzy clustering algorithm using parameters describing the 3D characteristics of the deformity. Further clinical validation is needed to confirm the usefulness of this classification system., Level of Evidence: IV.

Background: Scoliosis has been reported after repair of esophageal atresia with or without tracheoesophageal fistula (EA-TEF). This study aims to investigate the prevalence and natural history of scoliosis and associated congenital vertebral anomalies in patients operated for EATEF., Methods: A retrospective review of patients operated for EA-TEF with radiological examination for the presence of scoliosis or associated spine congenital anomalies was done on 106 patients (ages 5-19 years)., Results: Scoliosis was found in 53 patients (49%) for which 46 of these were in the thoracic region and 33 were right-thoracic curves. After a follow-up ranging from 5 to 14 years, four patients (3.7%) out of 106 were operated for scoliosis. Right-sided thoracotomy (RST) was the identifiable risk factor for scoliosis development; all patients with scoliosis had their EA repaired through RST. Congenital vertebral anomalies were found in 8 of those patients (7.5%). After a median follow-up of 6.5 years, no patients progressed enough to require operation., Conclusion: Scoliosis affects one of every two patients operated for EA; it may progress to the indication of surgery. RST was the identifiable risk factor for scoliosis development., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to evaluate the factors associated with timing of lowest hemoglobin (Hb) level and the need for postoperative blood transfusion in posterior spinal fusion for adolescent idiopathic scoliosis., Methods: We conducted a retrospective review of all adolescent scoliosis patients undergoing posterior spinal fusion at our institution, 2002-2014. Surgery consisted of segmental pedicle screw fixation using multi-level pedicle screws. Blood-saving techniques were used in all patients. Data included Cobb angle, pre- and postoperative Hb levels, preoperative autologous blood donation (PABD), surgery duration, and allogeneic or autologous transfusion. We used linear and logistic regressions for statistical analysis., Results: There were 456 patients (402 female, 54 male), mean age 16 ± 5 years. Lowest Hb was observed on postoperative Days 2 (32.2%) and 3 (33.3%); 45.1% of postoperative transfusions occurred on Day 2. One hundred and eighty-eight (41%) patients who provided PABD had significantly lower preoperative Hb and received more transfusions intraoperatively (22.6% vs. 5.2%) and postoperatively (20% vs. 6.3%) than others. Probability of transfusion increased 49.6 (95% CI 17.40-141.37) times with preoperative Hb < 11 g/dL as compared to preoperative Hb > 14 g/dL. Probability of transfusion increased 4.3- and 9.8-fold when surgery duration exceeded 5 and 6 h, respectively. Probability of transfusion increased 3.3- and 5.3-fold with Cobb angle > 70° and 80°, respectively., Conclusions: We identified clear patient-specific perioperative parameters that affect risk of perioperative blood transfusion, including Cobb angle, PABD and preoperative Hb. Hb measurement beyond postoperative Day 3 is considered unnecessary unless clinically indicated. These slides can be retrieved under Electronic Supplementary Material.

Adolescent Idiopathic Scoliosis (AIS) is a spinal deformity that affects approximately 3 percent of human adolescents. Although the etiology and molecular basis of AIS is unclear, several genes such as POC5 have been identified as possible causes of the condition. In order to understand the role of POC5 in the pathogenesis of AIS, we investigated the subcellular localization of POC5 in cilia of cells over-expressing either the wild type (wt) or an AIS-related POC5 variant POC5A429V. Mutation of POC5 was found to alter its subcellular localization and to induce ciliary retraction. Furthermore, we observed an impaired cell-cycle progression with the accumulation of cells in the S-phase in cells expressing POC5A429V. Using immunoprecipitation coupled to mass spectrometry, we identified specific protein interaction partners of POC5, most of which were components of cilia and cytoskeleton. Several of these interactions were altered upon mutation of POC5. Altogether, our results demonstrate major cellular alterations, disturbances in centrosome protein interactions and cilia retraction in cells expressing an AIS-related POC5 mutation. Our study suggests that defects in centrosomes and cilia may underlie AIS pathogenesis., Competing Interests: The authors have declared that no competing interests exist.

Purpose: Previous studies did not specifically assess the influence of proximal femoral angle (PFA) on sagittal balance in high-grade spondylolisthesis (HGS). In addition, the relationship between PFA and quality of life (QOL) remains unknown. This study determines if increased PFA is associated with decreased QOL and sagittal balance in lumbosacral HGS., Methods: This retrospective case-control study was performed on a cohort of 56 normal subjects and 42 patients with HGS. Initially, PFA was measured twice by 3 raters in a random subset of 30 subjects (15 normal and 15 HGS) to determine the intrarater and interrater reliability of the measurement technique. PFA was then measured for all subjects. For the 42 patients with HGS, QOL was assessed from the SRS-22 questionnaire, in addition to the evaluation of the spino-pelvic balance., Results: The intrarater and interrater intraclass correlation coefficients for the measurement of PFA were, respectively, 0.951 and 0.958, suggesting excellent reliability. PFA was significantly higher in HGS patients (8.3° ± 6.7°; range - 5° to 24°) when compared to normal subjects (3.0° ± 3.1°; range - 6° to 10°). The PFA in HGS was 5.6° ± 5.6° (range - 5° to 18°), 8.9° ± 6.7° (range - 2° to 24°), and 14.0° ± 6.0° (range 7°-23°) in type 4 (balanced pelvis), type 5 (unbalanced pelvis/balanced spine), and type 6 (unbalanced pelvis and spine) subjects, respectively. There were, respectively, 23.5% (4/17), 26.3% (5/19), and 83.3% (5/6) of HGS patients with abnormal PFA ≥ 10° in type 4, type 5, and type 6 subgroups. Increased PFA in HGS patients was related with deteriorating self-image, pain, function and total SRS-22 score, as well as with increasing pelvic tilt and decreasing sacral slope., Conclusion: A PFA ≥ 10° is proposed as a criterion to define abnormal PFA. PFA was increased in HGS and increased along with deteriorating sagittal balance and QOL. PFA is a clinically relevant parameter of sagittal balance, and can be useful in the evaluation and management of patients with HGS.

Study Design: A randomized controlled trial., Objective: To investigate whether bracing after posterior spinal instrumented fusion (PSIF) can improve pain relief and quality of life (QoL) 6 weeks and 3 months postoperatively., Summary of Background Data: Braces are commonly prescribed after PSIF in patients with lumbar degenerative conditions with the aim of improving pain relief and QoL. However, there is a lack of evidence on the indication for postoperative bracing, as surgeons use braces mainly based on their experience and training., Methods: A randomized blinded and controlled trial of 43 patients with PSIF for lumbar degenerative conditions were recruited. The caregivers were blinded but not the orthotist in the present study. There were 25 patients in the brace group and 18 patients in the control group with similar baseline characteristics. All patients completed the Oswestry Disability Index (ODI), the short form (SF)-12v2 General Health Survey and Visual Analog Scale (VAS) for back pain preoperatively, at 6 weeks and 3 months follow-up. Wilcoxon-Mann-Whitney test and a level of significance of 0.05 were used for statistical analyses., Results: Both groups had comparable demographic characteristics, and preoperative SF-12v2, ODI, and VAS scores. The ODI, SF-12v2, and VAS for back pain were improved in comparison to preoperative scores. The improvement was significant at 3 months follow-up regarding ODI and VAS for both groups and significant only for the control group regarding SF-12v2 scores. The improvement in ODI, SF-12v2, and VAS was significantly greater for control group at 3 months postoperatively. Moreover, larger proportion of patients in the control group reached minimum clinically important difference as compared to brace group at 6 weeks and 3 months., Conclusion: Postoperative bracing did not result in better improvement in QoL or pain relief up to 3 months after PSIF in patients with lumbar degenerative conditions., Level of Evidence: 1.

Background: Recent studies showed that finite element model (FEM) combined to CAD/CAM improves the design of braces for the conservative treatment of adolescent idiopathic scoliosis (AIS), using 2D measurements from in-brace radiographs. We aim to assess the immediate effectiveness on curve correction in all three planes of braces designed using CAD/CAM and numerical simulation compared to braces designed with CAD/CAM only., Methods: SRS standardized criteria for bracing were followed to recruit 48 AIS patients who were randomized into two groups. For both groups, 3D reconstructions of the spine and patient's torso, respectively built from bi-planar radiographs and surface topography, were obtained and braces were designed using the CAD/CAM approach. For the test group, 3D reconstructions of the spine and patient's torso were additionally used to generate a personalized FEM to simulate and iteratively improve the brace design with the objective of curve correction maximization in three planes and brace material minimization., Results: For the control group (CtrlBraces), average Cobb angle prior to bracing was 29° (thoracic, T) and 25° (lumbar, L) with the planes of maximal curvature (PMC) respectively oriented at 63° and 57° on average with respect to the sagittal plane. Average apical axial rotation prior to bracing was 7° (T) and 9° (L). For the test group (FEMBraces), initial Cobb angles were 33° (T) and 28° (L) with the PMC at 68° (T) and 56° (L) and average apical axial rotation prior to bracing at 9° (T and L). On average, FEMBraces were 50% thinner and had 20% less covering surface than CtrlBraces while reducing T and L curves by 47 and 48%, respectively, compared to 25 and 26% for CtrlBraces. FEMBraces corrected apical axial rotation by 46% compared to 30% for CtrlBraces., Conclusion: The combination of numerical simulation and CAD/CAM approach allowed designing more efficient braces in all three planes, with the advantages of being lighter than standard CAD/CAM braces. Bracing in AIS may be improved in 3D by the use of this simulation platform. This study is ongoing to recruit more cases and to analyze the long-term effect of bracing., Trial Registration: ClinicalTrials.gov, NCT02285621.

Study Design: Retrospective study of a series of 286 patients with congenital scoliosis (CS)., Objective: To describe a large cohort of patients with CS and to propose an algorithm for genetic investigations SUMMARY OF BACKGROUND DATA.: CS is characterized by a spine curvature due to congenital malformations of the vertebrae and is frequently associated to other anomalies. The underlying causes remain unclear in most patients, although we know that genetics plays a role in the development of vertebral defects., Methods: Institutional review board approval was obtained. We performed a retrospective study by consulting the hospital charts of 286 patients with CS seen at the CHU Sainte-Justine, Montreal, from 2004 to 2015. We compile information on radiological findings, associated malformations, and genetic tests., Results: Results showed that 67.1% of patients had associated anomalies affecting different systems. Only a minority of patients had a syndromic diagnosis to explain their CS. Nevertheless, array comparative genomic hybridization performed in a minority of patients showed a high detection rate (31.3% had a chromosomal anomaly among 32 tested)., Conclusion: We suggest that every patient with CS should have thorough investigations to rule out associated anomalies and that different genetic tests should be offered according to the associated clinical findings., Level of Evidence: 4.

Study Design: Cohort study., Objectives: To assess breast asymmetry (BA) directly with 3D surface imaging and to validate it using MRI values from a cohort of 30 patients with significant adolescent idiopathic scoliosis (AIS). Also, to study the influence of posture (prone vs standing) on BA using the automated method on both modalities., Summary of Background Data: BA is a common concern in young female patients with AIS. In a previous study using MRI, we found that the majority of patients with significant AIS experienced BA of up to 21% in addition to their chest wall deformity. MRI is costly and not always readily available. 3D surface topography, which offers fast and reliable breast acquisitions without radiation or distortion of the body surface, is an alternative method in the clinical setting., Methods: Thirty patients with AIS were enrolled in the study on the basis of their thoracic curvature, skeletal and breast maturity, without regard to their perception of their BA. Each patient underwent two imaging studies of their torso: a 3D trunk surface topography and a breast MRI. An automated breast volume measuring method was proposed using a program developed with Matlab programming., Results: Strong correlations were obtained when comparing the proposed method to the MRI on the left breast volumes (LBV) (r = 0.747), the right breast volumes (RBV) (r = 0.805) and the BA (r = 0.614). Using the same method on both imaging modalities also yielded strong correlation coefficients on the LBV (r = 0.896), the RBV (r = 0.939) and the BA (r = 0.709)., Conclusions: The proposed 3D body surface automated measurement technique is feasible clinically and correlates very well with breast volumes measured using MRI. Additionally, breast volumes remain comparable despite being measured in different body positions (standing and prone) in a young cohort of AIS patients., Level of Evidence: Level IV., (Copyright © 2017 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To document values for parameters of global spinal balance in asymptomatic children and adolescents., Methods: Multicenter prospective study of normal sagittal global spinal balance in Caucasian children and adolescents. Spinosacral angle (SSA), spinal tilt (ST), and C7 translation ratio were evaluated in 646 asymptomatic children and adolescents (276 males and 370 females)., Results: Mean and standard deviation for SSA, ST, and C7 translation ratio were, respectively 132.1° ± 8.3°, 93.2° ± 4.6° and -0.7 ± 8.3. Mean ± 2 standard deviations were, respectively 116°-149° for SSA and 84°-102° for ST. C7 plumbline was behind the HA (hip axis) in 78 % of subjects. Correlations between global balance and age were small (-0.17 ≤ r ≤ 0.19)., Conclusion: Asymptomatic children and adolescents tend to stand with a stable global balance, and 95 % have an SSA and ST between 116° and 149° and 85°-102°, respectively. C7 plumbline in front of the HA is not necessarily associated with a spinal pathology.

Purpose: Clinical assessment of immediate in-brace effect of braces designed using CAD/CAM and FEM vs. only CAD/CAM for conservative treatment of AIS, using a randomized blinded and controlled study design., Methods: Forty AIS patients were prospectively recruited and randomized into two groups. For 19 patients (control group), the brace was designed using a scan of patient's torso and a conventional CAD/CAM approach (CtrlBrace). For the 21 other patients (test group), the brace was additionally designed using finite element modeling (FEM) and 3D reconstructions of spine, rib cage and pelvis (NewBrace). The NewBrace design was simulated and iteratively optimized to maximize the correction and minimize the contact surface and material., Results: Both groups had comparable age, sex, weight, height, curve type and severity. Scoliosis Research Society standardized criteria for bracing were followed. Average Cobb angle prior to bracing was 27° and 28° for main thoracic (MT) and lumbar (L) curves, respectively, for the control group, while it was 33° and 28° for the test group. CtrlBraces reduced MT and L curves by 8° (29 %) and 10° (40 %), respectively, compared to 14° (43 %) and 13° (46 %) for NewBraces, which were simulated with a difference inferior to 5°. NewBraces were 50 % thinner and had 20 % less covering surface than CtrlBraces., Conclusion: Braces designed with CAD/CAM and 3D FEM simulation were more efficient and lighter than standard CAD/CAM TLSO's at first immediate in-brace evaluation. These results suggest that long-term effect of bracing in AIS may be improved using this new platform for brace fabrication., Trial Registration: NCT02285621.

Background Context: The Boston brace (Bb) is the most widely used brace design to treat adolescent idiopathic scoliosis (AIS). The dynamic SpineCor (SC) brace is prescribed in several scoliosis clinics worldwide, but its effectiveness remains controversial., Purpose: The study aimed to compare the treatment effectiveness of SC in patients with AIS treated by the developers of the brace with that of the Bb at a single institution., Study Design/setting: This is a retrospective comparison between a cohort of AIS patients treated using the SC brace and a cohort treated using the Bb., Patient Sample: We assessed 243 patients treated with either Bb or SC brace to prevent the progression of AIS., Outcome Measures: The primary outcome was the progression in main Cobb angle when reaching one of the following end point criteria: (1) progression in Cobb angle of ≥6°, (2) main Cobb angle of ≥45°, (3) surgery undertaken, or (4) reaching skeletal maturity (Risser sign of 5 or growth of <1 cm in the previous 6 months)., Methods: Patients were identified at a single institution between 2000 and 2012 following the Scoliosis Research Society criteria for brace treatment: (1) diagnosis of AIS, (2) Risser sign of ≤2, (3) curve magnitude between 25° and 40°, and (4) age ≥10 years. A total of 97 patients treated with SC by the developers of the brace and 146 patients treated with Bb were identified. Data collection and radiograph measurements were performed by a single experienced nurse not involved in the decision-making for brace treatment or in the data analysis. Age and Risser sign at onset of treatment, initialmain Cobb angle, curve type, and duration of follow-up were similar in both cohorts. Statistical analysis was done using chi-square and logistic regression models, with a level of significance of .05., Results: The average progression was 14.7°±11.9° in the SC cohort compared with 9.6°±13.7° in the Bb cohort (p=.003). The average Cobb angle at the end point of the study reached 47°±13° in the SC cohort and 41.7°±14.2° in the Bb cohort (p=.005), whereas at the onset of bracing it was 32.2°±4.9° and 32.2°±4.4°, respectively, for the SC and Bb cohorts. The percentage of patients with a progression of ≥6° was 76% in the SC cohort and 55% in the Bb cohort (p=.001). The proportion of patients reaching 45° in the SC and Bb cohorts was, respectively, 51% and 37% (p=.03), whereas the proportion of patients referred to surgery was 39% and 30%, respectively, for the SC and Bb cohorts (p=.2). The odds of progressing ≥6° and of reaching ≥45° were 2.67 and 2.07 times greater, respectively, when using the SC brace., Conclusions: The SC brace did not prevent curve progression as effectively as the Bb. Although it has the potential benefit of increasing mobility during brace wear, the SC brace was associated with increased curve progression in comparison with the Bb. There is also a trend for increased risk of requiring surgery when the SC brace is worn., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Specialized centers of care for spinal cord injury (SCI) were first established in 1944 in England. The objective of these centers is to improve care and neurological recovery of patients suffering from a spinal cord injury. An interdisciplinary group of experts composed of medical and surgical specialists treating patients with SCI formulated the following questions: (1) Is there any evidence to suggest that specialized centers of care in SCI decrease the length of patient stay? and (2) Is there evidence that specialized centers of care for SCI reduce mortality and secondary complications? A systematic review of the current evidence was performed using multiple databases to answer these two specific questions. Two independent reviewers graded each paper using the Black and Downs method. Recommendations were then formulated based on the evidence available and were reviewed by a panel of experts using a modified Delphi approach. Two recommendations were formulated and both received complete agreement from a panel of experts. The first recommendation is "Early transfer of a patient with traumatic SCI to a specialized center of care should be done promptly to decrease overall length of stay." The second recommendation is "Early transfer of patients with traumatic SCI to an integrated multidisciplinary specialized center of care decreases overall mortality, and the number and severity of complications."

Cystic fibrosis transmembrane conductance regulator (CFTR) is a chloride channel highly expressed in epithelial cells of the gastrointestinal tract. Mutations in the CFTR gene cause cystic fibrosis (CF), a disease characterized by pancreatic insufficiency, fat malabsorption, and steatorrhea. Despite the administration of pancreatic enzymes to normalize malabsorption, CF patients still experienced lipid fecal loss, nutritional deficiencies, and abnormalities in serum lipid profile, suggesting the presence of intrinsic defects in the intestinal handling of nutrients. The objective of the present study was to assess the impact of CFTR gene knockdown on intracellular lipid metabolism of the intestinal Caco-2/15 cell line. Partial CFTR gene inactivation led to cellular lipid accretion of phospholipids, triglycerides, and cholesteryl esters. Likewise, secretion of these lipid fractions was significantly increased following CFTR gene manipulation. As expected from these findings, the output of triglyceride-rich lipoproteins showed the same increasing pattern. Investigation of the mechanisms underlying these changes revealed that CFTR knockdown resulted in raised levels of apolipoproteins in cells and media and microsomal transfer protein activity, two important factors for the efficient assembly and secretion of lipoproteins. Similarly, scrutiny of the enzymatic monoacylglycerol acyltransferase and diacylglycerol acyltransferase, which exhibit dynamic function in triacylglycerol resynthesis and chylomicron formation in enterocytes, revealed a significant augmentation in their activity. Conversely, cholesterol uptake mediated by Niemann-Pick C1 like 1, Scavenger Receptor Class B Type I, and ATP-binding cassette G8 remains unaffected by genetic modification of CFTR. Collectively, these results highlight the role played by CFTR in intestinal handling of lipids and may suggest that factors other than defective CFTR are responsible for the abnormal intracellular events leading to fat malabsorption in CF patients.