The Course of Sagittal Plane Abnormality in the Patients With Congenital Scoliosis Managed With Convex Growth Arrest
Bibliographic record
Abstract
In Brief Summary of Background Data. Patient age; localization, length, and magnitude of the curve; and sagittal plane alignment are reported to be the major determinants in the selection of patients for convex growth arrest. Although the existence of sagittal plane abnormality (kyphosis or lordosis) is accepted as a contraindication for convex growth arrest, this issue has not been discussed in detail. Objectives. The purposes of this study are to investigate the effect of sagittal plane abnormality on the control of coronal plane deformity and to evaluate the course of sagittal plane abnormality of the patients with congenital scoliosis who were satisfactorily managed with convex growth arrest. Study Design. Retrospective analysis. Methods. Inclusion criteria are: 1) a diagnosis of congenital scoliosis in a patient younger than 6 years of age, 2) treatment with convex growth arrest, 3) follow up for more than 2 years, 4) stabilized or improved coronal plane deformity, and 5) abnormal sagittal plane alignment within the scoliotic segment before surgery. The patients were evaluated with anteroposterior and lateral radiographs, and segmental measurements were compared according to the normal of their corresponding age. Results. A total of 38 patients with congenital scoliosis treated with convex growth arrest were reviewed. Among 13 patients with segmental sagittal plane deformity, 2 were excluded because of insufficient control of the scoliosis. Eleven patients (8 girls, 3 boys) with a mean age of 35 months (range 6–72 months) and mean follow-up of 40 months (range 24–76 months) fulfilled these criteria. The coronal plane deformities were 58° (range 36°–105°) before surgery and 52° (13°–107°) at the final follow-up. While six of the curves improved, the remaining ones stabilized. Sagittal segmental alignments within the scoliotic segments were hyperkyphotic in 9 patients and hypokyphotic in 1 and lordotic in 1. At the end of the follow-up, sagittal Cobb angle of the abnormal segments remained stable in 7 patients and deteriorated in 4. None of the 4 patients required any reconstructive spine procedure for kyphosis during follow-up. Conclusion. Sagittal segmental abnormality does not have a negative effect on the control of scoliosis in themajority of the patients (11 of 13). If the coronal curvestabilizes or improves, then sagittal segmental abnormality could also be stabilized (in 7 of 11 patients). Among 38 patients with congenital scoliosis treated with convex growth arrest, 13 had segmental sagittal plane abnormality within the scoliotic segments before surgery. Eleven of these patients were managed satisfactorily with convex growth arrest and followed for a minimum of 2 years. Seven patients (64%) had stable sagittal plane deformity while 4 (36%) deteriorated. Presence of abnormal kyphosis or lordosis segmentally might not be considered an absolute contraindication for patients who are going to be treated with convex growth arrest. However, follow-up until skeletal maturity is needed to delineate definitive results.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".