BackgroundRisser’s sign is an established radiological marker for predicting growth potential in adolescent idiopathic scoliosis, but the accuracy of Risser’s staging has been debated. This research was designed to evaluate the accuracy of Risser’s staging and to identify causes of errors in Risser’s staging.Materials and methodsPlain radiographs of 89 adolescent idiopathic scoliosis patients were evaluated for Risser’s stage using both the Original and French methods. A three-dimensional computed tomography (3D-CT) was used to evaluate the accuracy of the plain radiographs. Inter- and intra-observer reliability of both methods was assessed on radiographs and 3D-CT images using weighted kappa statistics. The concordance rate for Risser’s staging between plain radiographs and 3D-CT images were calculated. The various sources of staging differences between the two imaging methods were noted, grouped, and analyzed to identify common error patterns.ResultsIntra- and inter-observer staging reliabilities on plain radiography were 0.91 and 0.94, respectively, using the Original method and 0.91 and 0.92, respectively, using the French method. Intra- and inter-observer reliabilities on 3D-CT were 0.98 and 0.99, respectively, using the Original method and 0.97 and 0.99, respectively, using the French method. Mean concordance rates between plain radiography and 3D-CT were 59.76% and 67.42% using the Original and French methods, respectively. Common sources of error leading to misinterpretation of Risser’s staging were miscalculation of apophysis excursion, skip ossification, isolated non-linear ossification, micro-fusion, and pseudo-fusion.ConclusionsRisser’s staging by plain radiography is reliable but not accurate. Variations in the iliac apophysis ossification and misinterpretation of apophysis fusion are the main sources of error.
SAART is effective in correcting the rib deformity without altering the pulmonary functions and SAART has less number of pulmonary complications as compared to CT.
Lumbar spinal steroid injections (LSSI) are universally used as preferred diagnostic or therapeutic treatment options before major spinal surgeries. Some recent studies have reported higher risks of surgical-site infection (SSI) for spinal surgeries performed after injections, while others have overlooked such associations. The purpose of this study is to systematically review the literature and perform a meta-analysis to evaluate the associations between preoperative LSSI and postoperative infection following subsequent lumbar decompression and fusion procedures. Three databases, namely PubMed, Scopus, and Cochrane Library, were searched for relevant studies that reported the association of spinal surgery SSI with spinal injections. After the comprehensive sequential screening of the titles, abstracts, and full articles, nine studies were included in a systematic review, and eight studies were included in the meta-analysis. Studies were critically appraised for bias using the validated MINOR (methodological index for non-randomized studies) score. The odds ratio (OR) and 95% confidence interval (CI) were calculated. Subgroup analysis was performed according to the time between LSSI and surgery and the type of lumbar spine surgery. Meta-analysis showed that preoperative LSSI within 30 days of lumbar spine surgery was associated with significantly higher postoperative infection compared with the control group (OR,1.79; 95% CI, 1.08-2.96). Based on subgroup analysis, lumbar spine fusion surgery within 30 days of preoperative LSSI was associated with significantly high-infection rates (OR, 2.67; 95% CI, 2.12-3.35), while no association was found between preoperative LSSI and postoperative infection for lumbar spine decompression surgeries. In summary, given the absence of high-level studies in the literature, careful clinical interpretation of the results should be performed. The overall risk of SSI was slightly higher if the spinal surgery was performed within 30 days after LSSIs. The risk was higher for lumbar fusion cases but not for decompression-only procedures.
The elite weight lifters had increased lumbar lordosis and decreased PT compared with the healthy volunteers. The ULL/TLL ratio may be used as a predictive marker for lumbar deformation.
Percutaneous thoracoplasty-only procedure gives significant rib humps correction and satisfactory clinical outcome. However, progression of the curve was observed after surgery. This suggests that the convex ribs function as a buttress for curve progression.
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