STUDY DESIGN/SETTING:This retrospective study analyzed bracing outcomes in patients with adolescent idiopathic scoliosis (AIS), focusing on curve pattern changes and brace efficacy. OBJECTIVE:To analyze the effectiveness of the Chêneau brace across different curve patterns and to evaluate the tendencies in curve evolution during treatment. BACKGROUND:AIS presents diverse curve patterns, each responding differently to bracing. Understanding these variations is crucial for optimizing treatment strategies. PATIENTS AND METHODS:The study included 177 patients with AIS treated with Chêneau orthoses, categorized based on curve patterns as per the main curve and modified Lenke (mLenke) classifications. We compared patients according to curve patterns and assessed changes in curve magnitude and pattern before and after treatment. RESULTS:Over an average follow-up of 28.1 ± 10.7 months, the primary curve magnitude decreased from 28.8 ± 6.6° to 25.9 ± 10.5°. Significant reductions were observed in mLenke V and VI patients ( P < 0.05). Patients with main lumbar curves showed better initial in-brace correction and curve control compared with those with main thoracic curves ( P < 0.05). In single-curve patterns, binary logistic regression indicated that mLenke V patients demonstrated higher rates of curve control compared with mLenke I patients ( P < 0.05). No significant differences were found in double-curve patterns between mLenke III and VI ( P > 0.05). At the final follow-up, thoracolumbar/lumbar curves improved significantly in mLenke III and VI patients ( P < 0.05), whereas thoracic curves did not ( P > 0.05). Furthermore, at the last follow-up, the proportions of mLenke I, II, and IV increased, whereas mLenke III, V, and VI decreased. CONCLUSIONS:Bracing outcomes were more favorable in patients with main lumbar curves than those with main thoracic curves. However, no significant differences were found in patients with double-curve patterns. Thoracic curves exhibited a higher progression risk compared with thoracolumbar/lumbar curves within the same curve pattern. During bracing, a tendency for primary curves to shift proximally was noted. LEVEL OF EVIDENCE:Level III.

Objective:To explore the situation and imaging features of scoliosis in patients with pectus excavatum (PE) and examine the risk factors for combined scoliosis.Methods:General profiles and imaging data were retrospectively reviewed for 575 PE children admitted from December 2017 to February 2022.The incidence and types of scoliosis were statistically examined.Two independent sample T and rank-sum tests were utilized for comparing general profiles and thoracic parameters of PE children with and without scoliosis.Binary logistic regression was utilized for examining the risk factors for combined scoliosis.Results:A total of 147 patients with scoliosis were detected with an incidence of 25.6%.The mean Cobb angle was (14.50±4.01°). There were 70 cases (47.6%) with a single thoracic curve and scoliosis was more likely to occur in individuals with advanced age and greater distribution of offset coefficient.The incidence of scoliosis in PE children is higher than that in normal population, especially in elder children( OR=1.894, P=0.003) and those with greater distribution of offset coefficient( OR=1.728, P=0.034; OR=2.035, P=0.015). Conclusion:The incidence of scoliosis in PE children is higher than that in normal children, especially in elder children and those with greater distribntion of offset coefficient.Clinicians should pay greater attention to spinal development and early interventions implemented if necessary.

Objectives:To analyze the clinical efficacy of Cheneau brace in adolescent idiopathic scoliosis(AIS)patients and to discuss the changes of curve type during the treatment.Methods:75 patients with AIS treated with Cheneau brace from October 2016 to November 2021 were included.There were 69 females and 6 males,averaged 11.9±1.0 years old when starting to wear the brace,with a mean initial main curve Cobb angle of 29.8°±8.5° and an initial Risser's sign ≤2.Clinical and imaging data were collected,including age,gender,menarche age,time of daily wear,and full-length radiographs of the spine before initial treatment and at the final follow-up.All the patients were followed up for 1 year after finishing brace treatment.The curve types of the patients were counted using the main curve type and the modified Lenke classification system(mLenke),and changes in curve types and the efficacy of bracing in patients with different curve types were analyzed.Results:After 25.7±10.8 months of brace treatment,the patients averaged 14.2±1.2 years old when finishing brace treatment,and the mean main Cobb angle was 27.6°±12.0°.Among the patients,scoliosis was controlled in 63 while progressed in 12,and 23 patients were treated surgically.The rates of success of brace and control of curve were higher in patients with main lumbar curve than those in patients with main thoracic curve(P=0.043,P=0.003).There was a difference in the rate of brace success and control of curve in patients with each mLenke classification(P＜0.001,P=0.005).The highest rates of brace success and control of curve were found in patients of mLenke type Ⅴ,while mLenke type Ⅳ patients had the lowest success rate of brace treatment success and mLenke type Ⅱ patients had the lowest rate of control of curve.Before and after brace treatment,there was a difference in the proportion of patients with each main curve type(P=0.019),and the proportion of patients with each mLenke classification had no statistical difference(P=0.071).There were differences in the rate of change of curve type in each main curve type and each mLenke classification both(P＜0.001,P=0.020).No significant differences were seen in the rates of success of brace treatment and control of curve between patients with and without change in curve type under the two curve type classifications.Conclusions:The efficacy of Cheneau brace varies among AIS patients with different curve types.Patients with a main thoracic curve tend to have a poor response to bracing compared with patients of main lumbar curve;During the treatment with Cheneau brace,the patient's curve types may change,and the overall trend of curve type change is upward shifting of the main curve.The rate and outcome of curve type changes vary among patients with different curve types,and curve type changes may also occur in curve controlled or corrected patients.

Objective:To explore the application of intervertebral autologous bone graft in situ in hemivertebral resection surgery in children.Methods:A retrospective study was conducted for 70 children undergoing single-level hemivertebral resection due to congenital scoliosis.According to different surgical approaches, they were divided into control group and observation group ( n=35 each). The control group underwent traditional posterior hemivertebral resection, bone grafting, fusion and internal fixation.The observation group underwent posterior hemivertebral resection, anterior structural reconstruction (massive autologous bone graft in situ for intervertebral fusion) and posterior bone grafting.Clinical data, surgical findings and postoperative follow-ups were recorded.Based upon radiographs of whole spine at the time of pre-operation, post-operation and follow-ups, the relevant sagittal and coronal imaging parameters were measured.Postoperative spinal computed tomography (CT) images were acquired during follow-ups for evaluating the outcomes of bone graft fusion. Results:No inter-group statistical difference existed in gender, height, age, weight, hemivertebral distribution, operative duration, intraoperative blood loss or length of hospitalization stay ( P>0.05). Preoperative coronal parameters (major curve Cobb's angle, proximal compensatory curve & distal compensatory curve) or sagittal plane parameters (segmental kyphosis angle, thoracic kyphosis angle, thoracolumbar kyphosis angle, sagittal plane balance & lumbar lordorsis angle) showed no significant difference ( P>0.05). At the last follow-up, loss of major curve Cobb's angle and segmental kyphosis angle were significantly smaller in observation group than those in control group, which had significant differences ( P<0.05); CT scan revealed that the rate of intervertebral fusion (level 1) was higher in observation group with a statistical difference ( P<0.05); no obvious operation-related complications occurred in neither groups. Conclusion:In situ intervertebral bone grafting of massive autogenous bone may achieve excellent correction and satisfactory intervertebral fusion through anterior support and reconstruction, which has significant advantages for the correction of lumbar lordosis.At the same time, due to anterior intervertebral support and fusion, it is more benefical to maintain postoperative kyphosis angle and avoid excessive angle loss.