Study Design.: A prospective controlled cohort study. Objective.: The aim of this study was to explore the interventional effect of exercise therapy on idiopathic scoliosis (IS) and identify an optimal intervention window. Summary of Background Data.: Early conservative treatment is helpful for IS. In addition to bracing, current evidence suggests that exercise can play an important role. Methods.: We included 99 patients with IS who were treated at the Guangdong Xinmiao Scoliosis Center from August 2013 to September 2017. The inclusion criteria were: new IS diagnosis, Cobb angle 10° to 25°, Risser 0 to 3 grade, only treated with the Xinmiao treatment system (XTS; >3 days/week, >1 h/day), and follow-up >1 year. Patients were divided into three age groups: A, <10 years (n = 29); B, 10 to 12 years (n = 24); and C, 13 to 15 years (n = 46). The percentages of curve improvement (Cobb angle decrease ≥5°), stability (Cobb angle change × ±5°), and progression (Cobb angle increase ≥5°) were compared. Results.: The groups showed significant differences for major curve correction, Risser sign, first referral, and final follow-up of the main curve (all P < 0.05). The major curve in group A decreased significantly by 6.8° (44% correction), compared to 3.1° (18% correction) and 1.5° (9% correction) in groups B and C, respectively. In group A, 69.0% (20/29) had curve improvement, 27.6% (8/29) stabilized and 3.4% (1/29) progressed. In group B, 45.8% (11/24) improved, 50% (12/24) stabilized, and 4.2% (1/24) progressed. In group C, 26.1% (12/46) improved, 63.0% (29/46) stabilized, and 10.9% (5/46) progressed. There was also a significant difference in final Risser grade among the groups (P < 0.05). Conclusion.: For IS patients with Cobb angles between 10° and 25°, our exercise protocol can effectively control or improve curve progression. Younger patients with a lower Risser grade are most likely to respond. Level of Evidence: 2

Background: Difficult procedures of severe rigid spinal deformity increase the risk of intraoperative neurological injury. Here, we aimed to investigate the preoperative and intraoperative risk factors for postoperative neurological complications when treating severe rigid spinal deformity. Methods: One hundred seventy-seven consecutive patients who underwent severe rigid spinal deformity correction were assigned into 2 groups: the neurological complication (NC, 22 cases) group or non-NC group (155 cases). The baseline demographics, preoperative spinal cord functional classification, radiographic parameters (curve type, curve magnitude, and coronal/sagittal/total deformity angular ratio [C/S/T-DAR]), and surgical variables (correction rate, osteotomy type, location, shortening distance of the osteotomy gap, and anterior column support) were analyzed to determine the risk factors for postoperative neurological complications. Results: Fifty-eight patients (32.8%) had intraoperative evoked potentials (EP) events. Twenty-two cases (12.4%) developed postoperative neurological complications. Age and etiology were closely related to postoperative neurological complications. The spinal cord functional classification analysis showed a lower proportion of type A, and a higher proportion of type C in the NC group. The NC group had a larger preoperative scoliosis angle, kyphosis angle, S-DAR, T-DAR, and kyphosis correction rate than the non-NC group. The results showed that the NC group tended to undergo high-grade osteotomy. No significant differences were observed in shortening distance or anterior column support of the osteotomy area between the two groups. Conclusions: Postoperative neurological complications were closely related to preoperative age, etiology, severity of deformity, angulation rate, spinal cord function classification, intraoperative osteotomy site, osteotomy type, and kyphosis correction rate. Identification of these risk factors and relative development of surgical techniques will help to minimize neural injuries and manage postoperative neurological complications.

Background: Although it is speculated that scoliosis may induce cardiac dysfunction, there is no report about evaluation of cardiac function, especially right cardiac function in patients with scoliosis. Therefore, we evaluated right ventricular function in idiopathic scoliotic patients with mild to severe curves and compared them with healthy children and adolescents matched in age, then explored relationship between scoliosis and right ventricular function. Methods: Thirty-seven patients diagnosed with idiopathic scoliosis with a mean age of 16y/o (range, 8-25y/o) and an average spine curve of 77.5°Cobb (range, 30-157°) were studied by echocardiography. TAD was obtained using M-mode echocardiography. Similar examination was performed in a control group of 17 healthy individuals in matched-age. According to the different curve degree, all patients were divided into 3 groups (mild, moderate and severe). Comparison was done among the groups and the relationship between TAD and spine curve of Cobb was analyzed. Results: Patients with severe scoliosis showed depressed TAD. There was good correlation between TAD and spine curve of Cobb. Conclusions: Patients with severe scoliosis showed a significant lower right ventricular systolic function.

Proximal junctional kyphosis (PJK) is a common sagittal complication of adolescent idiopathic scoliosis (AIS) following corrective surgery, leading to new deformities, pain, and even revision surgery. This study aimed to investigate the risk and predictive factors for PJK in Lenke type 5 AIS patients after correction, and identify parameters relevant to intraoperative guidance. Thirty-five patients with Lenke type 5 AIS who underwent corrective surgery at our hospital between January 2008 and February 2016 were divided into the PJK (n = 15) and non-PJK (n = 20) groups. Correlation and receiver operating characteristic (ROC) curve analyses were performed to screen significant parameters and calculate their thresholds. Survival analysis was performed to examine differences between the groups. Independent t tests revealed significant differences between groups in the preoperative pelvic incidence, preoperative pelvic tilt, postoperative proximal junctional angle (PJA), and postoperative thoracic kyphosis (TK). The postoperative PJA, postoperative TK, and other parameters correlated significantly with changes in the PJA at final follow-up. ROC curves revealed that the postoperative PJA and postoperative TK effectively predicted the occurrence of PJK, with thresholds of 9.45° and 25.25°, respectively. The estimated survival times were 14.7 months for PJA > 9.45° and TK > 25.25°, 19.2 months for PJA > 9.45°, and 33.9 months for TK > 25.25°. This study showed that the postoperative PJA and postoperative TK can be used to effectively predict the occurrence of PJK in Lenke type 5 AIS patients following corrective surgery, with thresholds of 9.45° and 25.25°, respectively.

Background: Spinal fractures have become a significant cause of health loss and an increasing disease burden due to their high incidence and disability risk. However, the current understanding of the disease burden and its trend remains limited, which hinders the effectiveness of public health interventions. Methods: Data for this study were sourced from the standardized Global Burden of Disease (GBD) 2021 database. Various analytical methods, including trend analysis, correlation analysis, age-period-cohort analysis, frontier analysis, health inequality analysis, and predictive analysis, were used to explore the current status and trends of the disease burden associated with spinal fractures. Results: From 1990 to 2021, the age-standardized rate (ASR) of spinal fractures globally showed a downward trend, and this trend is expected to continue in the future. However, the absolute number of spinal fracture cases has steadily increased. Since 2018, the rate of decline in the age-standardized prevalence rate and years lived with disability has slowed. In 2021, there were 7.4975 million new cases of spinal fractures globally, with 5.3714 million existing patients, resulting in 546 000 years lived with disability. Significant disease burden inequalities were observed across different regions, with a notable increase in the burden as the Socio-Demographic Index (SDI) rises. High-SDI regions and countries faced the most severe disease burden. The ASR remained low for individuals under 60 years of age, with both the ASR and actual cases higher in males than females. For individuals aged 60 years and above, the ASR significantly increased, with females surpassing males. The ASR shows an overall decreasing trend across different genders and age groups, but the absolute inequality is greater in men than in women. Additionally, falls, other exposures to mechanical forces, and motor vehicle road injuries were the leading causes of spinal fractures. Conclusion: Although the ASR of spinal fractures has significantly decreased, the absolute number of patients continues to rise, and heterogeneity exists across countries, regions, age groups, genders, and over time. These findings highlight the need for more targeted and personalized public health interventions in the future.