Spine deformity最新文献

{"title":"Learning curve and long-term outcomes of minimally invasive correction and fusion for adolescent idiopathic scoliosis.","authors":"Matthew J Geck, Devender Singh, Ebubechi K Adindu, Ashley Duncan, John K Stokes, Eeric Truumees","doi":"10.1007/s43390-024-00998-6","DOIUrl":"https://doi.org/10.1007/s43390-024-00998-6","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Objective: </strong>This study sought to report the long-term outcomes of patients that underwent minimally invasive surgery (MIS) correction for Adolescent Idiopathic Scoliosis (AIS) in terms of radiographic, clinical, and patient-reported outcomes. Furthermore, we examined the learning curve of MIS technique over the course of 13 years. Both MIS and open techniques are used to surgically address AIS. MIS techniques are purported to preserve the midline spinal musculature and to decrease estimated blood loss (EBL) and hospital length of stay (LOS).</p><p><strong>Methods: </strong>Data were collected at a single tertiary care center of all consecutive AIS patients undergoing deformity surgery from January 2008 to October 2021. Demographic, clinical, and radiographic data were collected at various intervals. Descriptive and inferential analyses were conducted.</p><p><strong>Results: </strong>70 AIS patients were included in the study. Mean patient age was 16.2 years of which 95.7% were female, with a mean BMI of 21.7. The majority of the patients were Lenke type 1A (60%) followed by Lenke 1B (18.6%) with mean preop Cobb angle as 52.2°. The mean follow-up was approximately 6 years with 35.7% of our cohort meeting the long-term follow-up landmark (> 5 years, 2-11). The mean number of spinal levels treated was 9.3 with mean ASA score of 1.7. Overall, mean EBL was 151 cc with mean OR of 308 min. The mean LOS was 3.94 days with postop Day 1 as the initiation of ambulation. Overall, the percent correction at the last visit was significantly greater than preop (Cobb: 77.6%, p < 0.05). Mean loss of correction on follow-ups was less than 5º. The overall revision rate was 2.9%. At 2 years postop, 98.6% (69/70) of the patients achieved fusion with 100% (24/24) at 5 years, and 96% (24/25) beyond the 5-year mark. Surgeon's technical proficiency in performing MIS for the treatment of AIS corrections was achieved after 23 cases.</p><p><strong>Conclusions: </strong>Based on our cohort's 2-11 year follow-up data, we conclude that MIS provides an effective treatment option for AIS reconstruction. Our study indicates that MIS can achieve adequate deformity correction and positive long-term clinical outcomes as indicated by Cobb angle, VAS, ODI, and SRS-22r scores during follow-ups. If the individual goals of AIS surgery can be achieved, consideration should be given to less-invasive techniques.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should the C7-T1 Junction Be Feared? The Effect of a T1 Upper Instrumented Vertebra on Development of Proximal Junctional Kyphosis.","authors":"Carlos Monroig-Rivera, Ingrid Okonta, Jennifer M Bauer, Amit Jain, Firoz Miyanji, Stefan Parent, Peter Newton, V Salil Upasani, Patrick Cahill, Daniel Sucato, Paul D Sponseller, Amer Samdani, D'Marfeivel McLean, Jaysson T Brooks","doi":"10.1007/s43390-024-01002-x","DOIUrl":"https://doi.org/10.1007/s43390-024-01002-x","url":null,"abstract":"<p><strong>Purpose: </strong>Proximal junctional kyphosis is an infrequent complication in AIS; however, equipoise remains on the effects of ending a fusion proximally at the C7-T1 junction on the future development of PJK. The purpose of this study was to determine the rate of PJK in patients with AIS who had a UIV of T1 vs those with a UIV of T2 at 5 years of follow-up.</p><p><strong>Methods: </strong>A query was performed of a prospective, multi-center AIS database of patients who received a PSF with at least 5 years of follow-up. Patients with a T1 UIV (n = 29) were compared to those with a T2 UIV (n = 58). PJK was defined as a proximal junctional angle (PJA) > 10 degrees.</p><p><strong>Results: </strong>There was no difference between the T1 and T2 UIV cohorts in preoperative T2-T12 kyphosis or pelvic incidence; however preoperatively, T1 UIV patients had a significantly decreased PJA at - 3° ± 4.5° as compared to T2 UIV patients 1.6° ± 6.5° (p = 0.0014). No patients with a T1 UIV experienced PJK at 5-years of follow-up, while 16% of patients with a T2 UIV experienced PJK (p = 0.025). No patients in the T2 UIV cohort required revision surgeries for their PJK. There was no difference found in total SRS22 scores, however at 5 years of follow-up, T2 UIV patients had better Pain domain scores (4.4 ± 0.6) vs T1 UIV patients (4.0 ± 0.6; p = 0.004).</p><p><strong>Conclusion: </strong>While T1 is an uncommon UIV in AIS, at 5 years of follow-up, a T1 UIV did not result in PJK, nor did it result in a clinically significant change in patient-reported outcome scores.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surface vs. skeleton: the relationship between surface topographic and radiographic measurements of shoulder symmetry in patients with scoliosis.","authors":"Kiranpreet K Nagra, Jenna L Wisch, Ankush Thakur, Colson P Zucker, Na Cao, Mitchell Johnson Md, Don Li, Howard J Hillstrom, Benjamin N Groisser, Matthew E Cunningham, M Timothy Hresko, Ram Haddas, John S Blanco, Roger F Widmann, Jessica H Heyer","doi":"10.1007/s43390-024-00999-5","DOIUrl":"https://doi.org/10.1007/s43390-024-00999-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates the relationship between existing radiographic measurements of shoulder asymmetry with novel surface topographic (ST) measurements, hypothesizing that these relationships will be weak.</p><p><strong>Methods: </strong>Data were gathered from a prospectively collected registry of patients who underwent ST scanning at a single tertiary care institution. Inclusion criteria were diagnosis of juvenile or adolescent idiopathic scoliosis, age 11-21, same-day ST and EOS radiographic evaluation. Twelve radiographic variables that evaluate shoulder height were measured, as well as curve magnitudes and vertebral axial rotation. ST data were collected using the 3dMDbody scanning system. Three ST measurements of shoulder symmetry were evaluated: ST-based AC angle (the angle between a line made between the surface of the AC joints and a line parallel to the ground), Shoulder Normal Asymmetry angle (the angle between the mirrored normals to the planes defined by the jugular notch, vertebral prominence, and AC joint), and Shoulder Volume Asymmetry Index (difference in volumes between the right and left shoulder). Univariate, followed by a stepwise multivariate linear regression was performed to evaluate the correlations of the radiographic measurements to the ST-based measurements. Correlation categories: weak (x < 0.4), moderate (0.4 ≤ x < 0.6), strong (0.6 ≤ x < 0.8), and very strong (x ≥ 0.8).</p><p><strong>Results: </strong>141 patients with idiopathic scoliosis were evaluated (65.2% female, mean age 15.1 years, mean BMI 20.5 kg/m², with mean maximum curve 44.7 degrees). ST-based AC angle had moderate-to-strong correlations with several radiographic measurements, while ST-based Shoulder Normal Asymmetry angle and Shoulder Volume Asymmetry Index had weak or no correlation with individual radiographic measures. Multivariate models created using a combination of radiographic variables demonstrated a strongly positive correlation between radiographic variables and ST-based AC angle (R = 0.678) and moderately positive correlations with ST-based Shoulder Normal Asymmetry Angle (R = 0.488), and ST-based Shoulder Volume Asymmetry Index (R = 0.514).</p><p><strong>Conclusion: </strong>Radiographic measurements may be acceptable stand-ins for two-dimensional ST measurements such as AC angle, but not for more complex shoulder measurements based on three dimensions. This study demonstrates the inadequacy with which radiographic assessments evaluate shoulder height asymmetry and highlights the use of ST measurements.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compensatory thoracic curve correction in lumbar anterior vertebral body tether (VBT) versus lumbar posterior spinal fusion (PSF).","authors":"Jennifer M Bauer, Suken A Shah, Jaysson Brooks, Baron Lonner, Amer Samdani, Firoz Miyanji, Peter Newton, Burt Yaszay","doi":"10.1007/s43390-024-00994-w","DOIUrl":"https://doi.org/10.1007/s43390-024-00994-w","url":null,"abstract":"<p><strong>Purpose: </strong>Anterior vertebral body tethering (VBT) is a non-fusion surgical option for skeletally immature patients with idiopathic scoliosis. Prior studies demonstrated compensatory correction of the thoracic curve after lumbar posterior spinal fusion (PSF); however, no studies have examined thoracic curve correction after lumbar VBT.</p><p><strong>Methods: </strong>Patients with Lenke 5 + 6 lumbar scoliosis who underwent VBT and at least 2 years' follow-up were compared to matched lumbar PSF patients. Groups were compared for major lumbar (L) and compensatory thoracic (T) curve correction, coronal/sagittal balance, and complications.</p><p><strong>Results: </strong>24 AVBT and 24 PSF patients were matched 1:1 for skeletal maturity and curve flexibility. There were no significant differences between VBT and PSF for average pre-operative or 2 year post-operative major L or compensatory T curves. Average final L curve correction was 50% VBT and 60% PSF (p = 0.08); average T curve correction was 17% VBT and 20% PSF (p = 0.18). Compared to pre-operative flexibility radiographs, the final post-op thoracic curves were 6° (VBT) and 5° (PSF) larger. PSF had better coronal balance by average of 17 mm (p < 0.0001). There were seven (24%) reoperations in the VBT group: two overcorrections relaxed, two T adding-on (extended to T by PSF-1, VBT-1), one broken tether converted to PSF. There was one (4%) reoperation in the PSF group (10-year post-op extension).</p><p><strong>Conclusion: </strong>Compensatory thoracic correction was achieved to a similar degree for lumbar VBT and PSF patients. There was little change in thoracic curve magnitude over time, and, on average, the correction did not reach the pre-operative flexibility curve measurement. There was better coronal balance by PSF, and a higher rate of re-operation in VBT patients.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative anemia is associated with increased length of stay in adult spinal deformity surgery: evaluation of a large single-center patient cohort and future suggestions for patient optimization.","authors":"Mert Marcel Dagli, Connor A Wathen, Joshua L Golubovsky, Yohannes Ghenbot, John D Arena, Gabrielle Santangelo, Jonathan Heintz, Zarina S Ali, William C Welch, Jang W Yoon, Vincent Arlet, Ali K Ozturk","doi":"10.1007/s43390-024-01003-w","DOIUrl":"https://doi.org/10.1007/s43390-024-01003-w","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the relationship of preoperative hemoglobin levels as an independent prognostic factor for hospital and intensive care unit (ICU) length of stay (LOS) in patients undergoing surgery for adult spinal deformity (ASD), with the intent of determining whether there exists a correlation and enhancing patient preoperative optimization protocols.</p><p><strong>Methods: </strong>The authors reviewed consecutive patients who underwent elective thoracolumbosacral posterior spinal fusion (PSF) involving six or more vertebrae for ASD from January 1, 2013, to December 13, 2021, with a minimum follow-up period of two years. This study primarily investigated the association of preoperative hemoglobin levels with hospital and ICU LOS. To analyze the data, both unadjusted and adjusted generalized linear models (GLM), incorporating cubic splines for non-linear variables, were applied.</p><p><strong>Results: </strong>A total of 598 patients were included. GLMs for hospital and ICU LOS demonstrated nonlinear relationships with preoperative hemoglobin levels. Specifically, hospital LOS decreased with increasing preoperative hemoglobin until a significance threshold of 13.5 g/dl. Similarly, ICU LOS significantly decreased with increasing preoperative hemoglobin until 13.0 g/dl. Lower preoperative hemoglobin was associated with more perioperative transfusions, less likely discharge to home, and greater risk of reoperation.</p><p><strong>Conclusions: </strong>Preoperative anemia is an independent non-linear risk factor that significantly affects LOS, disposition, and outcomes after surgery for ASD. These findings advocate for a systemic preoperative approach and highlight the need for future research to improve postoperative outcomes and reduce hospital resource utilization.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A team approach to improve outcomes in pediatric scoliosis surgery: a review of the current literature.","authors":"Anshu Jonnalagadda, Jay Moran, Albert Rancu, Michael J Gouzoulis, Sahir S Jabbouri, Seongho Jeong, Dominick A Tuason","doi":"10.1007/s43390-024-01004-9","DOIUrl":"https://doi.org/10.1007/s43390-024-01004-9","url":null,"abstract":"<p><strong>Study design: </strong>Review article.</p><p><strong>Objective: </strong>To review the literature on the effect of specialized pediatric spine teams on clinical outcomes.</p><p><strong>Results: </strong>Thirty-eight studies were identified in the review. There were 11 studies discussing the efficacy of the dual-surgeon strategy, 5 studies discussing the benefits of adult dedicated spine teams, 3 studies discussing the benefits of dedicated pediatric spine teams, 8 studies discussing the healthcare professional composition of multidisciplinary spine teams, and 20 studies discussing various clinical markers evaluating the efficacy of new team- or protocol-based interventions.</p><p><strong>Conclusion: </strong>Pediatric spinal deformity surgery is a highly invasive procedure with room for intervention to minimize surgical complications and enhance patient outcomes. The use of standardized spine teams, comprising surgeons and various healthcare professionals from diverse disciplines, has proven to be an effective strategy for improving both quality and efficiency of care. Furthermore, implementing uniform protocols among these teams has led to reductions in surgical duration, hospitalization periods, and risks such as infections at the surgical site and excessive bleeding. Further studies are necessary to evaluate additional benefits that specialized pediatric spine teams can offer in terms of clinical outcomes.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research trends of biomechanics in scoliosis from 1999 to 2023: a bibliometric analysis.","authors":"Peng Dou, Xuan Li, Haobo Jin, Boning Ma, Ming Jin, Yi Xu","doi":"10.1007/s43390-024-01000-z","DOIUrl":"https://doi.org/10.1007/s43390-024-01000-z","url":null,"abstract":"<p><strong>Objective: </strong>Despite the abundance of research on the biomechanics of scoliosis, there is a lack of a comprehensive bibliometric analysis. This study utilizes bibliometric methods to elucidate the research trends and hotspots within this domain.</p><p><strong>Methods: </strong>The data for this study were obtained from the Web of Science Core Collection and then analyzed using the open-source Bibliometrix R package and Citespace.</p><p><strong>Results: </strong>The analysis encompassed 410 publications published from 1999 to 2023. There is a sustained increase in the number of publications within the field. Utilizing citation analysis and keyword analysis, the study identified key research focuses. Burst keyword analysis identified 19 keywords.</p><p><strong>Conclusions: </strong>The period from 1999 to 2023 has witnessed significant research attention on the biomechanics of scoliosis. The demographic shift towards an aging population has recently increased interest in ASD. Proximal biomechanical changes and transitional zones in PJK and PJF are hotspots in research, offering emerging scholars in this discipline valuable opportunities for exploration.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D external shape analysis and barycentremetry can provide early signs of progression in adolescent idiopathic scoliosis.","authors":"Tristan Langlais, Claudio Vergari, Nicolas Mainard, Xavier du Cluzel, Matthieu Baudoux, Laurent Gajny, Kariman Abelin-Genevois, Jean Claude Bernard, Zongshan Hu, Jack Chun Yiu Cheng, Winnie Chiu Wing Chu, Ayman Assi, Mohamad Karam, Ismat Ghanem, Tito Bassani, Fabio Galbusera, Luca Maria Sconfienza, Marco Brayda-Bruno, Isabelle Courtois, Eric Ebermeyer, Raphael Vialle, Jean Dubousset, Wafa Skalli","doi":"10.1007/s43390-024-01001-y","DOIUrl":"https://doi.org/10.1007/s43390-024-01001-y","url":null,"abstract":"<p><strong>Purpose: </strong>Our objective was to analysis the barycentremetry, obtained from the external envelope reconstruction of biplanar radiographs, in adolescent idiopathic scoliosis (AIS) and to determine whether assessing would help predict the distinction between progressive and stable AIS at the early stage.</p><p><strong>Methods: </strong>A retrospective study with a multicentre cohort of 205 AIS was conducted. All AIS underwent a biplanar X-ray between 2013 and 2020. Inclusion criteria were Cobb angle between 10° and 25°; Risser sign lower than 3; age higher than 10 years; and no previous treatment. A 3D spine reconstruction was performed, and the barycentremetry parameters were computed, i.e., the center of mass position at the apex and the axial torque at the apex, the upper and lower junction. A severity index, helping to distinguish stable and progressive AIS, was computed on the first radiograph, and weighted according to these parameters. A clinical and radiographic monitoring determined if AIS were classified such a stable or progressive scoliosis.</p><p><strong>Results: </strong>One hundred and sixty-two AIS were included (i.e., 87 were classified as stable and 75 as progressive). The apex center of mass position was different between the stable and progressive AIS groups (6 mm, SD = 4 mm for the whole cohort; 5 mm, SD = 4 mm for stable AIS versus 7 mm, SD = 4 mm for progressive AIS; p = 0.02). In AIS thoracic, the specificity and positive predictive value of the severity index increased by 19% and 16%, respectively, by adding the apex vertebral axial torque.</p><p><strong>Conclusion: </strong>Early assessment of the external envelope from biplanar X-ray reconstruction of idiopathic scoliosis showed that the apex centre of mass position was significantly different between progressive and stable scoliosis. The inclusion of the axial torque of the apex vertebra in the severity index is promising to help the clinician distinguish between stable and progressive thoracic AIS at an early stage.</p><p><strong>Level of evidence: </strong>II - Prognostic studies.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What imaging does my AIS patient need? A multi-group survey of provider preferences.","authors":"Jenny L Zheng, Ying Li, Grant Hogue, Megan Johnson, Jason B Anari, Maia D Regan, Keith D Baldwin","doi":"10.1007/s43390-024-00995-9","DOIUrl":"https://doi.org/10.1007/s43390-024-00995-9","url":null,"abstract":"<p><strong>Introduction: </strong>Adolescent idiopathic scoliosis (AIS) is a common diagnosis managed by pediatric orthopedic surgeons with nonoperative radiographic monitoring representing a cornerstone of treatment. Differences in practices and techniques for obtaining radiographic studies contribute to variation, cost of care, and hamper data aggregation. We surveyed several large organizations dedicated to children's orthopedics or scoliosis care to obtain a consensus for radiographic evaluation of AIS.</p><p><strong>Methods: </strong>A REDCap-based survey was developed across four institutions and beta-tested by staff and fellows from a single institution. The finalized survey was distributed to members of POSNA, PSSG, and SOSORT, and shared on social media. Participants were asked to rank the importance of various datapoints in radiographic assessment of the spinal deformity, skeletal maturity, and study indications during initial, subsequent, preoperative, and final office visits for AIS. Response rate for the overall group was 26%.</p><p><strong>Results: </strong>Cobb angle was considered the most important (> 94%) radiographic index across all time points. For positioning, 46% of respondents favored arms bent touching clavicles as the ideal positioning for X-rays, and another 24% favored arms down with palms forward (Table 2). The majority of respondents obtain lateral X-rays at the first visit (99%) and at the preoperative visit (70%). At the preoperative visit, sagittal contour (86%), apex location (85%), and Lenke classification (73%) were considered important factors to record. Flexibility studies are primarily obtained at the preoperative visit (89%) and 81% of respondents prefer bending films as the flexibility technique of choice. Regarding measures of skeletal maturity, Sanders bone age was considered to be the most important by over 70% of respondents across initial, subsequent, preoperative and brace wean visits (Fig. 2). MRIs were obtained routinely by 34% of respondents and only when the patient had a concerning symptom or finding for 67% of respondents.</p><p><strong>Conclusions: </strong>Despite large variations in radiographic examination of AIS, large areas of agreement were found. It is important to establish standards for positioning patients, evaluating skeletal maturity, and obtaining assessments including lateral views, flexibility studies, and advanced imaging. Establishing common practices for radiographic evaluation of AIS will allow for less variation in care and for critical questions to be answered through registry formation and large multicenter data collection.</p><p><strong>Significance: </strong>This study establishes current practitioner opinion on the radiographic evaluation of the AIS patient. Minimum data sets are useful for data aggregation and answering research questions in the face of data variability.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the information provided by large language models valid in educating patients about adolescent idiopathic scoliosis? An evaluation of content, clarity, and empathy : The perspective of the European Spine Study Group.","authors":"Siegmund Lang, Jacopo Vitale, Fabio Galbusera, Tamás Fekete, Louis Boissiere, Yann Philippe Charles, Altug Yucekul, Caglar Yilgor, Susana Núñez-Pereira, Sleiman Haddad, Alejandro Gomez-Rice, Jwalant Mehta, Javier Pizones, Ferran Pellisé, Ibrahim Obeid, Ahmet Alanay, Frank Kleinstück, Markus Loibl","doi":"10.1007/s43390-024-00955-3","DOIUrl":"https://doi.org/10.1007/s43390-024-00955-3","url":null,"abstract":"<p><strong>Purpose: </strong>Large language models (LLM) have the potential to bridge knowledge gaps in patient education and enrich patient-surgeon interactions. This study evaluated three chatbots for delivering empathetic and precise adolescent idiopathic scoliosis (AIS) related information and management advice. Specifically, we assessed the accuracy, clarity, and relevance of the information provided, aiming to determine the effectiveness of LLMs in addressing common patient queries and enhancing their understanding of AIS.</p><p><strong>Methods: </strong>We sourced 20 webpages for the top frequently asked questions (FAQs) about AIS and formulated 10 critical questions based on them. Three advanced LLMs-ChatGPT 3.5, ChatGPT 4.0, and Google Bard-were selected to answer these questions, with responses limited to 200 words. The LLMs' responses were evaluated by a blinded group of experienced deformity surgeons (members of the European Spine Study Group) from seven European spine centers. A pre-established 4-level rating system from excellent to unsatisfactory was used with a further rating for clarity, comprehensiveness, and empathy on the 5-point Likert scale. If not rated 'excellent', the raters were asked to report the reasons for their decision for each question. Lastly, raters were asked for their opinion towards AI in healthcare in general in six questions.</p><p><strong>Results: </strong>The responses among all LLMs were 'excellent' in 26% of responses, with ChatGPT-4.0 leading (39%), followed by Bard (17%). ChatGPT-4.0 was rated superior to Bard and ChatGPT 3.5 (p = 0.003). Discrepancies among raters were significant (p < 0.0001), questioning inter-rater reliability. No substantial differences were noted in answer distribution by question (p = 0.43). The answers on diagnosis (Q2) and causes (Q4) of AIS were top-rated. The most dissatisfaction was seen in the answers regarding definitions (Q1) and long-term results (Q7). Exhaustiveness, clarity, empathy, and length of the answers were positively rated (> 3.0 on 5.0) and did not demonstrate any differences among LLMs. However, GPT-3.5 struggled with language suitability and empathy, while Bard's responses were overly detailed and less empathetic. Overall, raters found that 9% of answers were off-topic and 22% contained clear mistakes.</p><p><strong>Conclusion: </strong>Our study offers crucial insights into the strengths and weaknesses of current LLMs in AIS patient and parent education, highlighting the promise of advancements like ChatGPT-4.o and Gemini alongside the need for continuous improvement in empathy, contextual understanding, and language appropriateness.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}