Background: Anterior spinal growth tethering (ASGT) has been shown to alter spinal growth with the potential to correct scoliosis while maintaining spine flexibility. The purpose of this study was to report the 2 to 4-year outcomes of ASGT in skeletally immature patients with thoracic scoliosis. Methods: We conducted a retrospective review of patients with thoracic scoliosis who underwent ASGT with a minimum of 2 years of follow-up. Patient demographics, perioperative data, and radiographic outcomes are reported. A “successful” clinical outcome was defined as a residual curve of <35° and no posterior spinal fusion indicated or performed at latest follow-up. Results: Seventeen patients met the inclusion criteria. The etiology was idiopathic for 14 and syndromic for 3. The mean follow-up was 2.5 years (range, 2 to 4 years). Preoperatively, all patients were at Risser stage 0, with a mean age at surgery of 11 ± 2 years (range, 9 to 14 years). There was an average of 6.8 ± 0.5 vertebrae tethered per patient. The average thoracic curve magnitude was 52° ± 10° (range, 40° to 67°) preoperatively, 31° ± 10° immediately postoperatively, 24° ± 17° at 18 months postoperatively, and 27° ± 20° at latest follow-up (51% correction; range, 5% to 118%). Revision surgery was performed in 7 patients: 4 tether removals due to complete correction or overcorrection, 1 lumbar tether added, 1 tether replaced due to breakage, and 1 revised to a posterior spinal fusion. In 3 additional patients, posterior spinal fusion was indicated due to progression. Eight (47%) of the patients had a suspected broken tether. Ten (59%) of the 17 were considered clinically successful. Conclusions: Despite most patients having some remaining skeletal growth at the time of review, the results of the current study demonstrate that at mid-term follow-up, ASGT showed a powerful, but variable, ability to modulate spinal growth and did so with little perioperative and early postoperative risk. Fusion was avoided for 13 of the 17 patients. The overall success rate was 59%, with a 41% revision rate. Understanding the parameters leading to success or failure will be critical in advancing a reliable definitive nonfusion treatment for progressive scoliosis in the future. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Background: Anterior vertebral body tethering (AVBT) has been introduced as a means of correcting scoliosis without fusion. The purpose of this study was to compare outcomes for patients with thoracic idiopathic scoliosis between a group of patients who underwent AVBT and a matched cohort of patients treated with posterior spinal fusion and instrumentation (PSF). Methods: A retrospective study of patients who underwent AVBT and PSF for idiopathic scoliosis was conducted. The inclusion criteria were determined on the basis of the AVBT cohort: primary thoracic idiopathic scoliosis with a curve magnitude between 40° and 67°, Risser stage of ≤1, age of 9 to 15 years, no prior spine surgery, index surgery between 2011 and 2016, and minimum follow-up of 2 years. Demographic, radiographic, clinical, and patient-reported outcomes and revisions were compared between groups. Results: There were 23 patients in the AVBT cohort and 26 patients in the PSF cohort. The mean follow-up (and standard deviation) was similar between groups: 3.4 ± 1.1 years for the AVBT group and 3.6 ± 1.6 years for the PSF group (p = 0.6). Preoperatively, the groups were similar in all measurements of radiographic and clinical deformity, with mean main thoracic curves of 53° ± 8° for the AVBT group and 54° ± 7° for the PSF group (p = 0.4). At the time of final follow-up, the AVBT cohort had significantly more residual deformity, with a mean thoracic curve of 33° ± 18° compared with 16° ± 6° for the PSF group (p < 0.001). There were 9 revision procedures in the AVBT cohort (with 3 conversions to PSF and 3 more pending) and none in the PSF cohort. Revisions occurred at a mean postoperative time of 2.3 years (range, 1.2 to 3.7 years). Twelve patients (52%) had evidence of broken tethers; of these patients, 4 underwent revision. The post-intervention patient-reported outcomes were similar. Conclusions: Both AVBT and PSF resulted in postoperative correction; however, 2-year correction was better maintained in the PSF group. There were no differences in post-intervention patient-reported outcomes. AVBT resulted in less deformity correction and more revision procedures than PSF, but resulted in the delay or prevention of PSF in the majority of patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The current study examined how specific coping strategies mediate the relationship between Conscientiousness (C) and positive affect (PA) in a large, multiethnic sample. Using an internetbased daily diary approach, 366 participants (37.6% Caucasian, 30.6% Asian American, 20.7% Hispanic, 9.1% African American) completed measures that assessed daily stressors, coping strategies used to deal with those stressors, and PA over the course of five days. In addition, participants completed a measure of the Five-Factor Model of Personality. Problem-Focused coping partially mediated the relationship between C and PA. Individuals higher in C used more problemfocused coping, which, in turn, was associated with higher PA. The findings of the current study suggest C serves as a protective factor from stress through its influence on coping strategy selection. Other possible mediators in the C-PA relationship are discussed.
Understanding the difference between Lenke 1A-L and 1A-R curve types may be helpful in preventing the adding-on phenomena postoperatively. To prevent adding-on in 1A-R curves, we recommend fusing distally to 1 level above the neutral vertebra or 1 to 2 levels above the stable vertebra. In 1A-L curves, adding-on may simply be a need to balance some lumbar curve progression in a young, skeletally immature patient.
The current study used multilevel modeling of daily diary data to model within-person (state) and between-person (trait) components of coping variables. This application included the introduction of multilevel factor analysis (MFA) and a comparison of the predictive ability of these trait/state factors. Daily diary data was collected on a large (n = 366) multiethnic sample over the course of five days. Intraclass correlation coefficient for the derived factors suggested approximately equal amounts of variability in coping usage at the state and trait levels. MFAs showed that Problem-Focused Coping and Social Support emerged as stable factors at both the within-person and between-person levels. Other factors (Minimization, Emotional Rumination, Avoidance, Distraction) were specific to the within-person or between-person levels, but not both. Multilevel structural equation modeling (MSEM) showed that the prediction of daily positive and negative affect differed as a function of outcome and level of coping factor. The Discussion section focuses primarily on a conceptual and methodological understanding of modeling state and trait coping using daily diary data with MFA and MSEM to examine covariation among coping variables and predicting outcomes of interest.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.