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To measure the correlative parameters of vertebral pedicles from L₁ to S₁ by CT scan in the patients with thoracolumbar kyphosis secondary to ankylosing spondylitis(AS) and disc degenerative disease(DDD), and analyze their anatomical difference in order to provide the selection and placement of pedicle screw during operation.The clinical data of 30 male AS patients (AS group) with the mean age of(35.7±9.5) years (ranged, 23 to 51) and 30 male DDD patients (DDD group) with the mean age of(52.4±8.9) years(ranged, 39 to 64) underwent surgery in our institution from March 2012 to November 2014 were analyzed. The CT scans of lumbar and sacrum were performed before surgery. The parameters of vertebral pedicle from L₁ to S₁ were measured and compared, including pedicle width (PW), pedicle screw path length (PL), pedicle height (PH), pedicle transverse angle (EA), and pedicle inclined angle (FA). Paired sample t-test was used to detect the divergence in the above-mentioned data between left and right sides. In addition, results between two groups were compared using independent sample t-test.The study showed that a gradual increase in the average pedicle width both AS group and DDD group from L₁ to S₁. The average PW of AS group was bigger than DDD group in L₅ and S₁(Increasing the strength of internal fixation is feasible to insert the larger and bigger pedicle screws in low lumbar and S₁ among AS patients, while the EA should be decreased properly and the direction on the sagittal plane should be adjusted.

STUDY DESIGN A computed tomography study. OBJECTIVE To identify the best scoliotic deformity components that show impact upon the spontaneous postoperative modulation of the deformed anterior chest wall contour in right convex thoracic adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA Spontaneous postoperative aggravation of the anterior concave costal projection was a common occurrence in adolescent idiopathic scoliosis, yet the risk factors that effectively bridged the gap between what the surgeons did in the interior and how the rib cages reacted on the exterior were still open to debate. METHODS Pre- and postoperative computed tomographic scans of 77 patients with right convex thoracic adolescent idiopathic scoliosis were retrieved and analyzed. According to the postoperative variation of anterior chest wall angle (CWA), the patients were divided into 2 groups with either aggravated or improved CWA. Multiple scoliotic deformity parameters and their surgical correction rates were evaluated, correlated, and then compared between the 2 groups. Moreover, patients with apex located at T9 were isolated and evaluated independently. A logistic regression analysis was used to determine the independent predictors of the spontaneous postoperative modulation of the anterior chest wall contour. RESULTS The surgical correction rate of Cobb angle (supine), the rotational angle with respect to the sagittal plane (RAsag angle), the rotational angle with respect to the anterior midline of the body (RAml angle), the angle of lateral deviation of the apical vertebrae from the midline (MLdev angle), the posterior hemithorax ratio, the vertebral translation (VT), and the thoracic rotation averaged 64.6%, 19.5%, 30.8%, 39.2%, 15.0%, 41.2%, and 28.7%, respectively. Ratio of aggravated anterior chest wall contour was the highest at the T7 apex group (84.6%) as compared with T8 apex group (47.1%), T9 apex group (19.5%), and T10 apex group (0.0%). The preoperative CWA was significantly lower in the aggravated CWA group when compared with the improved group (2.1 ± 1.8°vs. 6.6 ± 2.4°, P < 0.001). Besides, in the aggravated CWA group, significantly greater surgical correction of VT and lesser correction of RAsag angle were demonstrated when compared with the improved CWA group (VT: 53.0% vs. 34.8%, P = 0.001; RAsag: 2.5% vs. 28.7%, P = 0.000). In the T9 subgroup, remarkably different correction rate of VT and RAsag were similarly observed (VT: 54.9% vs. 35.3%, P = 0.046; RAsag: 4.9% vs. 23.5%, P = 0.034). In terms of other deformity parameters, no significantly different correction rate was consistently detected. In the logistic regression analysis, apex location, CWA, and correction rate of RAsag were demonstrated to be independent factors predictive of the alteration of chest wall contour. CONCLUSION In addition to the smaller preoperative CWA and higher apex location, lesser correction of vertebral rotation, if accompanied by great surgical correction of apical VT, could also largely result in a poor postoperative anterior chest wall contour.

To investigate the clinical outcome and fusion rate in patients with idiopathic thoracolumbar/lumbar scoliosis treated with anterior correction and interbody fusion with calcium phosphate cement.From October 2006 to March 2008, 24 cases undergoing anterior correction and interbody fusion with calcium phosphate cement were enrolled. All of them were female, with an age ranged from 12 to 25 years. The mean Cobb angle of main curve was 46° ± 5° (range, 40° - 56°) before surgery. During operation, the most proximal and distal disc spaces were filled with rib autograft, while the remaining levels were filled with calcium phosphate cement. The interbody fusion rate, coronal correction and sagittal profile reconstruction were evaluated respectively by using χ² test and t test.Interbody fusion was performed in 103 levels, including 48 levels with rib autograft and 55 levels with calcium phosphate cement. The mean follow-up period was 23.8 months (range, 12 - 33 months) in this series. At the follow-up of 6 months, fusion rate was found as 54.2% in the levels filled with rib autograft, while 50.9% in those filled with calcium phosphate cement. Solid fusion of the whole instrumented area was achieved in all cases with a minimum one-year follow-up. No instrumentation-related complications occurred. The correction rate of main curve was on an average of 76% ± 11% after surgery. A significant difference was found between preoperative and immediate postoperative value in terms of the main curve magnitude (46° ± 5° vs. 14° ± 5°, t = -26.95, P0.05). The correction loss of the main curve was -5.1° - 10.4° at the final follow-up. The coronal balance and lower instrumented vertebra tilting were significantly improved after operation. The thoracolumbar kyphosis was significantly reduced postoperatively (t = 3.11, P0.05).Satisfactory bone fusion and correction maintenance can be achieved in idiopathic thoracolumbar/lumbar scoliosis treated by anterior instrumentation combined with interbody fusion using calcium phosphate cement.

To investigate whether the titrate-resistant acid phosphatase 5 (ACP5) gene polymorphisms were associated with the occurrence or curve severity of adolescent idiopathic scoliosis (AIS).There were 372 AIS patients from January 2006 to December 2008 and 239 normal controls from March 2005 to August 2006 were recruited. The Cobb angles were ≥ 10° in all AIS patients. Using the haplotype data of Han population from the Hapmap Project, two tag SNPs (rs2229531, rs2071484) were defined for ACP5 gene. PCR-restriction fragment length polymorphism was used for the genotyping.No polymorphism in rs2229531 was found in this study. The genotype and allele frequency distribution in rs2071484 were similar between AIS patients and normal controls (χ(2) = 3.336 and 1.438, P0.05). The mean maximum Cobb angles of different genotypes of rs2071484 in ACP5 gene were 38° ± 19° in AA, 34° ± 14° in AG and 38° ± 21° in GG, which were similar with each other among AIS patients who reached skeletal maturity or received surgery treatment (P = 0.157).The ACP5 gene is neither associated with the occurrence nor the curve severity of AIS.

To compare the sagittal profiles between thoracic idiopathic scoliosis (IS) patients with different curve progression and to determine the risk factors associated with curve progression.A total of 83 thoracic IS patients from September 2009 to May 2010 were included in this study and were divided into 3 groups according to different curve progression. All the patients did not receive any previous treatments. There were 26 skeletally mature patients whose Risser sign were 5 degree with Cobb angle40° in non-curve progression group (NCP group), 29 mature patients whose Risser sign were 5 degree with Cobb angle ≥ 40° in moderate curve progression group (MCP group) and 28 immature patients whose Risser sign ≤ 3 degree with Cobb angle ≥ 40° in severe curve progression group (SCP group). Five sagittal parameters, including thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI) and pelvic tilt (PT) were measured on the lateral X-ray films. Analysis of variance was used to compare these parameters among the 3 groups.The average thoracic Cobb angle was significantly smaller in NCP group when compared with MCP group (P0.01) or SCP group (P0.01), but not significantly different between the 2 latter groups (P = 0.619). The average TK was 19° ± 7° in NCP group, 13° ± 6° in MCP group and 8° ± 5° in SCP group. The average TK was significantly smaller in SCP group when compared with MCP group (P = 0.011) or NCP group (P0.01), while the average TK was significantly smaller in MCP group when compared with NCP group (P0.01). None of the other 4 parameters showed any significant difference between the 3 groups (P0.05).Thoracic hypokyphosis is strongly associated with curve progression in thoracic IS patients. Pelvic sagittal profile may not be involved in the underlying mechanism of curve progression in thoracic IS patients.

A retrospective radiographical study of pre- and postoperative anterior chest wall shape in thoracic adolescent idiopathic scoliosis.To assess the anterior chest wall deformity and define its relationship with other deformed components in adolescent idiopathic scoliosis. The surgical influence on the deformed chest wall contour was also evaluated to improve the clinical recognition of the risk factors associated with aggravated chest wall shape postoperatively.Anterior chest wall deformity is one of the major cosmetic concerns that may be attributable to rotational coupling in adolescent idiopathic scoliosis. Patients could be quite different in their anterior chest wall appearance with similar spinal angulation. The surgical improvement of this deformed chest wall shape is also quite elusive and the reverse could also happen despite excellent correction in Cobb angle. We investigated whether or not the anterior chest wall deformity was independent in the severity from the codevelopment of spinal curvature, translation, and vertebral rotation.In this retrospective study, 110 sets of computed tomographic scans, 70 of which had both pre- and postoperative images, were retrieved and analyzed. The ImageJ software (National Institutes of Health, Bethesda, MD) was used to manipulate formatted computed tomographic scans into 3-dimensional anterior chest wall reconstructions. Multiple anterior and posterior deformity parameters were evaluated, correlated, and compared.The preoperative Cobb angle of major thoracic curve, chest wall angle (CWA), rib hump (RH), angle of the sternum relative to the apical vertebral body (α), sternum-rib ratio (S-R ratio), apical vertebral rotation (AVR), and angle of trunk rotation (ATR) averaged 54.4° ± 15.2°, 5.4° ± 3.9°, 14.7° ± 5.4°, 80.5° ± 7.8°, 1.3° ± 0.2, 12.3° ± 6.5°, and 8.8° ± 4.6°, respectively. The thoracic Cobb angle demonstrated moderate correlation with CWA, RH, α, S-R ratio, AVR, and ATR (r = 0.377, 0.604, -0.401, 0.514, 0.530, and 0.517, respectively, P0.001). The RH demonstrated moderate correlation with AVR (r = 0.546, P0.001). No statistically significant relationships between CWA and RH, AVR, and ATR were detected (r = 0.129, 0.043, -0.039, P0.05). The AVR demonstrated significant correlation with α and S-R ratio (r = -0.757, P0.001; r = 0.213, P0.05). Averaged CWA with different curve apex showed a normal distribution shape, with the highest at T9 level. The postoperative thoracic Cobb angle, S-R ratio, AVR, and ATR improved significantly (P0.05), with the exception of the postoperative CWA and α (P0.05). Postoperative |CWA| aggravated in 52.8% of the patients, with 38.6% beyond 5°, which showed a significantly lower average preoperative CWA (3.0° ± 2.8°) compared with the rest of patients with decreased CWA (7.9° ± 3.1°) (P0.001).Idiopathic scoliosis is associated with distinctive anterior chest wall deformity, with its variations partially attributable to Cobb angle and apex location, but not directly correlated with AVR. Incidence of aggravated postoperative anterior chest wall shape is notable in our study, and patients should be informed of this risk beforehand. Small preoperative CWA and apical vertebra located above T9 were associated with relatively higher risk of postoperative chest wall shape aggravation.

To investigate the pulmonary dysfunction patterns in patients of scoliosis associated with neurofibromatosis type I (NF1) and to identify factors affecting the pulmonary function in patients with scoliosis associated with NF1.Preoperative pulmonary function tests (PFTs) were evaluated in 100 patients with scoliosis [NF1 group, 36 cases; idiopathic scoliosis (IS) group, 64 cases] from January 2003 to June 2009. According to location of apical vertebra and dystrophic change in patients with NF1, the parameters of pulmonary function [vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal mid-expiratory flow (MMEF), maximal voluntary ventilation (MVV)] were compared between NF1 group and IS group, and between the subgroups of NF1. The correlation between pulmonary function parameters and radiographic parameters of scoliosis was analyzed.The VC, FVC, FEV1, MMEF, MVV in NF1 group and IS group were of no significant difference (P0.05). In NF1 patients, the pulmonary dysfunction was more severe in thoracic subgroup than non-thoracic subgroup (P0.05), while there was no difference between dystrophic scoliosis and non-dystrophic scoliosis (P0.05). The location of apical vertebra and the severity of scoliosis correlated significantly with the pulmonary dysfunction in NF1 group.The pattern of pulmonary dysfunction in scoliosis associated with NF1 is similar with IS. Pulmonary dysfunction is more severe in thoracic scoliosis. The location of apical vertebra and the severity of scoliosis are the risk factors influencing the pulmonary dysfunction.

To investigate the association between the tissue inhibitor of metalloproteinase-2 (TIMP-2) gene polymorphisms with the predisposition and disease severity of thoracic adolescent idiopathic scoliosis (AIS).Three hundred and fifty-four female thoracic AIS patients treated from January 2007 to March 2009 and 210 healthy female who underwent health examination during March 2005 to June 2006 as normal controls were recruited in this study. One SNP-418G/C (rs8179090) in the promoter region were selected for TIMP-2 gene. PCR- RFLP was used for genotyping.No significant differences of genotype and allele frequency distribution were found between AIS patients and normal controls (P0.05). In AIS patients, the frequency of C allele of the patients with the body mass index (BMI)17 kg/m(2) was significantly higher than those with the BMIor = 17 kg/m(2) (P0.05), and the frequency of C allele of cases with the major Cobb angleor = 40 degrees was significantly higher than that with Cobb angle40 degrees (P0.05). Among the patients who reached skeletal maturity without any interference of natural history, significantly higher average maximum Cobb angle was found in patients with GC and CC genotype compare with those with GG genotype.The SNP-418G/C (rs8179090) in the promoter region of TIMP-2 gene may be associated with abnormal growth pattern and curve progression of thoracic AIS. TIMP-2 gene is a disease-modifier gene of thoracic AIS.