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Grabala P, Gregorczyk J, Fani N, Galgano MA, Grabala M. Surgical Treatment Strategies for Severe and Neglected Spinal Deformities in Children and Adolescents without the Use of Radical Three-Column Osteotomies. J Clin Med 2024; 13:4824. [PMID: 39200966 PMCID: PMC11355333 DOI: 10.3390/jcm13164824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Severe spinal deformity manifests as a pronounced deviation from the normal curvature of the spine in the frontal, sagittal, and horizontal planes, where the coronal plane curvature exceeds 90 degrees and may coincide with hyperkyphotic deformity. The most severe deformities exhibit rigidity, with flexibility below 30%. If left untreated or improperly treated, these deformities can result in serious complications associated with progression of the curvature. A combination of surgical techniques is frequently employed to attain optimal outcomes and minimize the risk of complications. The overall medical condition of the patient, their capacity to endure extensive procedures, the expertise of the surgeon, and the resources available all play significant roles in determining the course of management. A systematic and thorough review of the relevant literature was conducted utilizing a variety of electronic databases. The primary objective of this study was to scrutinize the surgical techniques commonly employed in complex spine surgeries for the management of severe scoliosis without resection vertebral body techniques, with higher potential risk of major complications, including permanent neurological deficit. Conclusions: Halo-gravity traction, halo femoral traction, and all techniques for releases of the spine (anterior, posterior, or combine), as well as thoracoplasty, have demonstrated significant effectiveness in managing severe and rigid idiopathic scoliosis. The combination of several of these methods can lead to optimal alignment correction without the need to perform high-risk techniques involving three-column osteotomies. Surgeons must customize the indications based on factors such as available resources, characteristics of the deformity, and the patient's individual profile. Surgical correction of severe scoliosis without vertebral body resection surgeries decreases the potential risks related to neurological and pulmonary complications while providing significant clinical improvement outcomes. The powerful Ponte osteotomy is indicated for severe scoliosis, curves with poor flexibility, for better restoration of hypokyphosis, and decrease of hyperkyphosis. These corrective techniques combined with HGT or temporary internal distraction rods are recommended as viable options for managing individuals with severe rigid spine deformity characteristics. Therefore, they also should be considered and performed by a proficient surgical team. The presence of neuromonitoring is crucial throughout these procedures.
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Affiliation(s)
- Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, Medical University of Bialystok Children’s Clinical Hospital, Waszyngtona 17, 15-274 Bialystok, Poland
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
| | - Jerzy Gregorczyk
- Medical Faculty, Medical University of Warsaw, 02-091 Warsaw, Poland; (J.G.); (N.F.)
| | - Negin Fani
- Medical Faculty, Medical University of Warsaw, 02-091 Warsaw, Poland; (J.G.); (N.F.)
| | - Michael A. Galgano
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27516, USA;
| | - Michał Grabala
- 2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok Clinical Hospital, ul. M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland;
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Dong Y, Wang S, Tang N, Zhao H, Yu B, Zhang J. Revision Surgery After Spinal Fusion in Adolescent Idiopathic Scoliosis. Global Spine J 2024; 14:603-609. [PMID: 35862230 PMCID: PMC10802548 DOI: 10.1177/21925682221117130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective Aanalysis of a Large Cohort of Cases. OBJECTIVES To explore the rate and cause of revision surgery after spinal fusion in adolescent idiopathic scoliosis(AIS). METHODS The patients diagnosed with AIS who underwent spinal fusion surgery in a single center from 2002 to 2018 were retrospectively analyzed. All the patients were followed up at least 2 years. The causes of revision surgery were analyzed and the incidence of revision surgery was counted. RESULTS A total of 1816 AIS patients were included in the study. After an average of 8.5 years (range 3-18 years) follow-up, a total of 51 patients underwent 54 revision operations. The overall revision rate is 2.8%. The revision rate of combined approach (anterior and posterior) and anterior approach was 6.6% (8/122), and the revision rate of posterior approach was 2.5% (43/1694). The most common causes of revision were malposition of implants/implants failure (37%), followed by poor wound healing/ infection (23%). Spinal decompensation, adding on and proximal junctional kyphosis (PJK) accounted for 20%. The compensatory curve continued to worsen after selective fusion accounted for 14% and finally the discomfort with the implants accounted for 6%. CONCLUSIONS The overall revision rate of spinal fusion for AIS is 2.8%. The implants and incision problems were the most common causes of revision surgeries.
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Affiliation(s)
- Yulei Dong
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Ning Tang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Hong Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Bin Yu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
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Ishikawa Y, Kanai S, Ura K, Kokabu T, Yamada K, Abe Y, Tachi H, Suzuki H, Ohnishi T, Endo T, Ukeba D, Takahata M, Iwasaki N, Sudo H. Development of Notch-Free, Pre-Bent Rod Applicable for Posterior Corrective Surgery of Thoracolumbar/Lumbar Adolescent Idiopathic Scoliosis. J Clin Med 2023; 12:5750. [PMID: 37685817 PMCID: PMC10488454 DOI: 10.3390/jcm12175750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS), the most common pediatric musculoskeletal disorder, causes a three-dimensional spine deformity. Lenke type 5 AIS is defined as a structural thoracolumbar/lumbar curve with nonstructural thoracic curves. Although a rod curvature will affect clinical outcomes, intraoperative contouring of the straight rod depends on the surgeon's knowledge and experience. This study aimed to determine the optimum rod geometries to provide a pre-bent rod system for posterior spinal surgery in patients with Lenke type 5 AIS. These pre-bent rods will be beneficial for achieving proper postoperative outcomes without rod contouring based on surgeon experience. We investigated 20 rod geometries traced in posterior spinal reconstruction in patients with Lenke type 5 AIS. The differences between the center point clouds in each cluster were evaluated using the iterative closest point (ICP) method with modification. Before the evaluation using the ICP method, the point clouds were divided into four clusters based on the rod length using a hierarchical cluster analysis. Because the differences in the values derived from the ICP method were <5 mm for each length-based cluster, four representative rod shapes were generated from the length-based clusters. We identified four optimized rod shapes that will reduce operation time, leading to a decreased patient and surgeon burden.
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Affiliation(s)
- Yoko Ishikawa
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
- Department of Orthopaedic Surgery, Eniwa Hospital, 2-1-1 Kogane-Chuo, Eniwa 061-1449, Hokkaido, Japan;
| | - Satoshi Kanai
- Division of Systems Science and Informatics, Hokkaido University Graduate School of Information Science and Technology, N14W9, Sapporo 060-0814, Hokkaido, Japan
| | - Katsuro Ura
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Terufumi Kokabu
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
- Department of Orthopaedic Surgery, Eniwa Hospital, 2-1-1 Kogane-Chuo, Eniwa 061-1449, Hokkaido, Japan;
| | - Katsuhisa Yamada
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Yuichiro Abe
- Department of Orthopaedic Surgery, Eniwa Hospital, 2-1-1 Kogane-Chuo, Eniwa 061-1449, Hokkaido, Japan;
| | - Hiroyuki Tachi
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
- Department of Orthopaedic Surgery, Eniwa Hospital, 2-1-1 Kogane-Chuo, Eniwa 061-1449, Hokkaido, Japan;
| | - Hisataka Suzuki
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
- Department of Orthopaedic Surgery, Eniwa Hospital, 2-1-1 Kogane-Chuo, Eniwa 061-1449, Hokkaido, Japan;
| | - Takashi Ohnishi
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Tsutomu Endo
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Daisuke Ukeba
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
| | - Hideki Sudo
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N15W7, Sapporo 060-8638, Hokkaido, Japan; (Y.I.); (K.U.); (T.K.); (K.Y.); (H.T.); (H.S.); (T.O.); (T.E.); (D.U.); (M.T.); (N.I.)
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N15W7, Sapporo 060-8638, Hokkaido, Japan
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Van Halm-Lutterodt NI, Al-Saidi NN, Mandalia K, Mesregah MK, Ghanem KM, Storlie NR, Huang WH, Chen WC, Bartels-Mensah M, Chen XY, Ye Z, Zhang Y, Pan A, Kim SS, Lonner B, Alanay A, Hai Y. Comparison of Overall Complication Rates in VCR-Based vs Non-VCR-Based Corrective Techniques in Severe Rigid Kyphoscoliosis Patients: A Systematic Review and Meta-Analysis. Global Spine J 2023; 13:1646-1657. [PMID: 36548436 PMCID: PMC10448105 DOI: 10.1177/21925682221146502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Compilation of complication outcomes data from the surgical management of severe rigid kyphoscoliosis patients using VCR-based vs non-VCR-based corrective maneuvers is lacking. This meta-analysis aimed to compare complication outcomes between those classified osteotomy approaches. METHODS Thorough literature review and meta-analysis were conducted between January 2000 and September 2021. The selection criteria were studies: i) reporting major curve Cobb angle of ≥80° and flexibility of <25% or 30%; ii) comparing VCR or ≥ Type V Schwab osteotomy defined as VCR-based vs [non-VCR-based] techniques, (any osteotomy or technique other than VCR); iii) published in English with ≥10 patients; iv) reporting complication rates; and v) having minimum of 2-year follow-up. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Significance level was set at (P < .05). RESULTS Of the 174 patients included, 52.30% (n = 91) and 47.70% (n = 83) were VCR-based and non-VCR-based, respectively. The incidence of dural tears/nerve injuries/significant intraoperative-neuromonitoring changes was significantly higher; [OR = 6.78, CI= (1.75 to 26.17), I2 = 0%, (P = .006)] in the VCR-based group than the non-VCR-based group. The 'overall surgical and medical' complication rate was significantly higher in the VCR-based group, [OR = 1.94, CI= (1.02 to 3.67), I2 = 31%, (P = .04)]. CONCLUSION Both VCR-based and non-VCR-based surgical techniques for management of severe rigid scoliosis and kyphoscoliosis patients pose comparable overall surgical complication rates, while a significantly higher perioperative neurological complication incidence was associated with VCR-based technique compared to the non-VCR-based techniques. The VCR-based technique was associated with 6.78 times higher incidence of neurological complications compared to non-VCR-based techniques.
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Affiliation(s)
- Nicholas Ishmael Van Halm-Lutterodt
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China
- Department of Orthopedics Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
| | | | | | - Mohamed Kamal Mesregah
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
| | | | | | - Wei-Hsun Huang
- Beijing Friendship Hospital Affiliated-Capital Medical University, China
| | - Wei-Cheng Chen
- Beijing Tongren Hospital Affiliated-Capital Medical University, China
| | | | - Xin Yuan Chen
- Department of Arts and Sciences, Concordia University, Montreal, QC, Canada
| | - Ziyang Ye
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
- Department of Business Analytics, University of Chicago, IL, USA
- Tristate Brain, and Spine Institute, Alexandria, MN, USA
| | - Yangpu Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
| | - Sunny Sik Kim
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
- Tristate Brain, and Spine Institute, Alexandria, MN, USA
| | - Baron Lonner
- Department of Orthopedics Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
| | - International Spinal Deformity Review Study Group (ISDRSG)
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China
- Department of Orthopedics Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
- Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
- Tufts University School of Medicine, Boston, MA, USA
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
- Creighton University School of Medicine, Omaha, NE, USA
- Beijing Friendship Hospital Affiliated-Capital Medical University, China
- Beijing Tongren Hospital Affiliated-Capital Medical University, China
- University of Debrecen School of Medicine, Hungary
- Department of Arts and Sciences, Concordia University, Montreal, QC, Canada
- Department of Business Analytics, University of Chicago, IL, USA
- Tristate Brain, and Spine Institute, Alexandria, MN, USA
- Department of Orthopedics Surgery, The Mount Sinai Hospital, New York, NY, USA
- Department of Orthopedics and Traumatology, Acibadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
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5
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Shah NV, Coste M, Wolfert AJ, Gedailovich S, Ford B, Kim DJ, Kim NS, Ikwuazom CP, Patel N, Dave AM, Passias PG, Schwab FJ, Lafage V, Paulino CB, Diebo BG. The Impact of Prematurity at Birth on Short-Term Postoperative Outcomes Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. J Clin Med 2023; 12:jcm12031210. [PMID: 36769858 PMCID: PMC9917850 DOI: 10.3390/jcm12031210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Prematurity is associated with surgical complications. This study sought to determine the risk of prematurity on 30-day complications, reoperations, and readmissions following ≥7-level PSF for AIS which has not been established. Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)-Pediatric dataset, all AIS patients undergoing ≥7-level PSF from 2012-2016 were identified. Cases were 1:1 propensity score-matched to controls by age, sex, and number of spinal levels fused. Prematurity sub-classifications were also evaluated: extremely (<28 weeks), very (28-31 weeks), and moderate-to-late (32-36 weeks) premature. Univariate analysis with post hoc Bonferroni compared demographics, hospital parameters, and 30-day outcomes. Multivariate logistic regression identified independent predictors of adverse 30-day outcomes. 5531 patients (term = 5099; moderate-to-late premature = 250; very premature = 101; extremely premature = 81) were included. Premature patients had higher baseline rates of multiple individual comorbidities, longer mean length of stay, and higher 30-day readmissions and infections than the term cohort. Thirty-day readmissions increased with increasing prematurity. Very premature birth predicted UTIs, superficial SSI/wound dehiscence, and any infection, and moderate-to-late premature birth predicted renal insufficiency, deep space infections, and any infection. Prematurity of AIS patients differentially impacted rates of 30-day adverse outcomes following ≥7-level PSF. These results can guide preoperative optimization and postoperative expectations.
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Affiliation(s)
- Neil V. Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Marine Coste
- Department of General Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Adam J. Wolfert
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Samuel Gedailovich
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Brian Ford
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - David J. Kim
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Nathan S. Kim
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Chibuokem P. Ikwuazom
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Neil Patel
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Amanda M. Dave
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Peter G. Passias
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY 10010, USA
| | - Frank J. Schwab
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA
| | - Carl B. Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY 11203, USA
- Department of Orthopaedic Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
- Correspondence:
| | - Bassel G. Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY 11203, USA
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, East Providence, RI 02903, USA
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6
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Dwarakanath LV, Sewell MD, Leung E, Knight T, Jones M, McKay G, Newton-Ede M, Marks D, Spilsbury J, Mehta J, Gardner A. Systematic Review and Meta-analysis: Does Anterior-Posterior Spinal Fusion Still have a Role in Severe Thoracic Adolescent Idiopathic Scoliosis? Indian J Orthop 2023; 57:167-176. [PMID: 36777133 PMCID: PMC9880087 DOI: 10.1007/s43465-022-00747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/06/2022] [Indexed: 02/14/2023]
Abstract
Background Debate exists as to whether anterior-posterior spinal fusion (APSF), rather than posterior-only spinal fusion (PSF), provides benefit for treating severe thoracic adolescent idiopathic scoliosis (AIS). This systematic review and meta-analysis compare (1) Cobb angle correction, (2) complication and reoperation rate, (3) pulmonary function, (4) number of fused segments, and 5) patient-reported outcome measures (PROMs) in both groups. Methods Electronic databases were searched to identify studies that met the following inclusion criteria: comparative studies (level 3 or above), severe thoracic curves (≥ 70°), age ≤ 16, AIS aetiology, Lenke 1-4 curves and follow-up ≥ 1 year for ≥ 95% of patient population. Literature was graded for quality and bias using GRADE and MINORS criteria. Results Eight studies were included, defined by GRADE as low or moderate level evidence. Three studies showed superior curve correction in the APSF group; however, the meta-analysis showed no significant difference in curve correction between groups (95% CI - 3.45-12.96, P = 0.26). There were more complications in the APSF group, without statistical significance (95% CI 0.53-3.39, P = 0.54; I 2 = 0%, P = 0.78). There were no re-operations in either group. Two studies reported pulmonary function; one showed better function in the APSF group, the other better function in the PSF group. One study showed fewer fused segments in the APSF group, however, no significance was observed in the meta-analysis (95%CI - 1.65-0.31, P = 0.18). Three studies reported PROMs with no differences reported between groups. Conclusions APSF and PSF have been found to have comparable results. The present evidence cannot support recommendations for guidelines on future practice with regards to effect on curve correction, complications, re-operations, pulmonary function or PROMs. Level of evidence Level III, Systematic review of Level-III studies.
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Affiliation(s)
| | | | - Enid Leung
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
| | - Timothy Knight
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
| | - Morgan Jones
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
| | - George McKay
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
| | | | - David Marks
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
| | | | - Jwalant Mehta
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
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7
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Zaydman AM, Strokova EL, Pahomova NY, Gusev AF, Mikhaylovskiy MV, Shevchenko AI, Zaidman MN, Shilo AR, Subbotin VM. Etiopathogenesis of adolescent idiopathic scoliosis: Review of the literature and new epigenetic hypothesis on altered neural crest cells migration in early embryogenesis as the key event. Med Hypotheses 2021; 151:110585. [PMID: 33932710 DOI: 10.1016/j.mehy.2021.110585] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/28/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) affects 2-3% of children. Numerous hypotheses on etiologic/causal factors of AIS were investigated, but all failed to identify therapeutic targets and hence failed to offer a cure. Therefore, currently there are only two options to minimize morbidity of the patients suffering AIS: bracing and spinal surgery. From the beginning of 1960th, spinal surgery, both fusion and rod placement, became the standard of management for progressive adolescent idiopathic spine deformity. However, spinal surgery is often associated with complications. These circumstances motivate AIS scientific community to continue the search for new etiologic and causal factors of AIS. While the role of the genetic factors in AIS pathogenesis was investigated intensively and universally recognized, these studies failed to nominate mutation of a particular gene or genes combination responsible for AIS development. More recently epigenetic factors were suggested to play causal role in AIS pathogenesis. Sharing this new approach, we investigated scoliotic vertebral growth plates removed during vertebral fusion (anterior surgery) for AIS correction. In recent publications we showed that cells from the convex side of human scoliotic deformities undergo normal chondrogenic/osteogenic differentiation, while cells from the concave side acquire a neuronal phenotype. Based on these facts we hypothesized that altered neural crest cell migration in early embryogenesis can be the etiological factor of AIS. In particular, we suggested that neural crest cells failed to migrate through the anterior half of somites and became deposited in sclerotome, which in turn produced chondrogenic/osteogenic-insufficient vertebral growth plates. To test this hypothesis we conducted experiments on chicken embryos with arrest neural crest cell migration by inhibiting expression of Paired-box 3 (Pax3) gene, a known enhancer and promoter of neural crest cells migration and differentiation. The results showed that chicken embryos treated with Pax3 siRNA (microinjection into the neural tube, 44 h post-fertilization) progressively developed scoliotic deformity during maturation. Therefore, this analysis suggests that although adolescent idiopathic scoliosis manifests in children around puberty, the real onset of the disease is of epigenetic nature and takes place in early embryogenesis and involves altered neural crest cells migration. If these results confirmed and further elaborated, the hypothesis may shed new light on the etiology and pathogenesis of AIS.
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Affiliation(s)
- Alla M Zaydman
- Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan, Novosibirsk, Russia
| | - Elena L Strokova
- Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan, Novosibirsk, Russia
| | - Nataliya Y Pahomova
- Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan, Novosibirsk, Russia
| | - Arkady F Gusev
- Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan, Novosibirsk, Russia
| | - Mikhail V Mikhaylovskiy
- Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan, Novosibirsk, Russia
| | - Alexander I Shevchenko
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences", Novosibirsk, Russia
| | | | - Andrey R Shilo
- Novosibirsk Zoo named after R.A. Shilo, Novosibirsk, Russia
| | - Vladimir M Subbotin
- Arrowhead Pharmaceuticals Inc., Madison WI, USA; University of Pittsburgh, Pittsburgh PA, USA; University of Wisconsin, Madison WI, USA.
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8
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Li S, Mao S, Du C, Zhu Z, Shi B, Liu Z, Qiao J, Qiu Y. Assessing the unique characteristics associated with surgical treatment of dystrophic lumbar scoliosis secondary to neurofibromatosis type 1: a single-center experience of more than 10 years. J Neurosurg Spine 2021; 34:413-423. [PMID: 33254143 DOI: 10.3171/2020.6.spine20898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dystrophic lumbar scoliosis secondary to neurofibromatosis type 1 (DLS-NF1) may present an atypical, unique curve pattern associated with a high incidence of coronal imbalance and regional kyphosis. Early surgical intervention is complicated and risky but necessary. The present study aimed to assess the unique characteristics associated with the surgical treatment of DLS-NF1. METHODS Thirty-nine consecutive patients with DLS-NF1 treated surgically at a mean age of 14.4 ± 3.9 years were retrospectively reviewed. Patients were stratified into three types according to the coronal balance classification: type A (C7 translation < 30 mm), 22 patients; type B (concave C7 translation ≥ 30 mm), 0 patients; and type C (convex C7 translation ≥ 30 mm), 17 patients. Types B and C were considered to be coronal imbalance. The diversity of surgical strategies, the outcomes, and the related complications were analyzed. RESULTS The posterior-only approach accounted for 79.5% in total; the remaining 20.5% of patients received either additional anterior supplemental bone grafting (12.8%) to strengthen the fixation or convex growth arrest (7.7%) to reduce growth asymmetry. The lower instrumented vertebra (LIV) being L5 accounted for the largest share (41%), followed by L4 and above (35.9%), the sacrum (15.4%), and the pelvis (7.7%). Type C coronal imbalance was found in 23 patients (59%) postoperatively, and the incidence was significantly higher in the preoperative type C group (14/17 type C vs 9/22 type A, p = 0.020). All the patients with postoperative coronal imbalance showed ameliorative transition to type A at the last visit. The rate of screw malposition was 30.5%, including 9.9% breached medially and 20.6% breached laterally, although no serious neurological impairment occurred. The incidence of rod breakage was 16.1% (5/31) and 0% in patients with the posterior-only and combined approaches, respectively. Four revisions with satellite rods and 1 revision with removal of iliac screw for penetration into the hip joint were performed. CONCLUSIONS Surgical strategies for DLS-NF1 were diverse across a range of arthrodesis and surgical approaches, being crucially determined by the location and the severity of dystrophic changes. The LIV being L5 or lower involving the lumbosacral region and pelvis was not rare. Additional posterior satellite rods or supplementary anterior fusion is necessary in cases with insufficient apical screw density. Despite a high incidence of postoperative coronal imbalance, improvement of coronal balance was frequently confirmed during follow-up. Neurological impairment was scarce despite the higher rate of screw malposition.
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The Relationship Between 3-dimensional Spinal Alignment, Thoracic Volume, and Pulmonary Function in Surgical Correction of Adolescent Idiopathic Scoliosis: A 5-year Follow-up Study. Spine (Phila Pa 1976) 2020; 45:983-992. [PMID: 32609467 DOI: 10.1097/brs.0000000000003472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of a prospective multicenter database. OBJECTIVE The aim of this study was to study the effects of thoracic kyphosis (TK) restoration in adolescent idiopathic scoliosis (AIS) Type 1 and 2 curves on postoperative thoracic volume (TV) and pulmonary function. SUMMARY OF BACKGROUND DATA Surgical correction of AIS is advocated to preserve or improve pulmonary function, prevent progressive deformity and pain, and improve self-appearance. Restoration of sagittal and 3D alignment, particularly TK, has become increasingly emphasized in efforts to improve pulmonary function, TVs, sagittal balance, and prevent adjacent-segment degeneration and deformity. METHODS AIS patients 10 to 21years undergoing surgical correction of Lenke Type 1 and 2 curves with baseline, 1-erect-postoperative, and 5-year (5Y) postoperative visits including stereoradiographic assessment and pulmonary function tests (PFTs) were included. 3D-radiographic analysis was performed to assess spinal-alignment, chest-wall, and rib-cage dimensions at each time point. Outcome variables were analyzed between time points with one-way analysis of variance and between variables with linear regression analysis. RESULTS Thirty-nine patients (37 females, 14.4 ± 2.2 years) were included. 3D-spinal-alignment analyses demonstrated significant reduction in preoperative to first-erect thoracic and lumbar Cobb-angles, an increase in TK:T2-12 (19.67°-39.69°) and TK:T5-12 (9.47°-28.05°), and reduction in apical vertebral rotation (AVR) (P < 0.001 for all). Spinal-alignment remained stable from 1-erect to 5Y. 3D rib-cage analysis demonstrated small reductions in baseline to first-erect depth (145-139 mm), width (235-232 mm), and increase in height (219-230 mm, P < 0.01), but no significant change in volume (5161-5222 cm,P = 0.184). From 1-erect to 5Y, significant increases in depth, width, height, and volume (all P < 0.001) occurred. PFTs showed preoperative to 5Y improvement in first second of Forced Expiratory Volume (FEV1) (2.74-2.98 L, P = 0.005) and forced vital capacity (FVC) (3.23-3.47 L, P = 0.008); however, total lung capacity (TLC) did not change (P = 0.517). Percent-predicted TLC decreased (Pre: 101.3% to 5Y: 89.3%, P < 0.001); however, percent-predicted forced expiratory volume and FVC did not (P = 0.112 and P = 0.068). CONCLUSION Although TK increases, coronal-Cobb and AVR decrease postoperatively; these do not directly influence TV, which increases from 1-erect to 5Y due to growth, corresponding with increases in FEV1 and FVC at 5Y; however, surgical restoration of kyphosis does not directly improve pulmonary function. LEVEL OF EVIDENCE 3.
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10
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Martucciello G, Paraboschi I, Avanzini S, Fati F. Thoraco-abdominal neuroblastoma resection: the thoracophrenolaparotomic (TPL) approach. Gen Thorac Cardiovasc Surg 2019; 68:604-608. [PMID: 31820336 DOI: 10.1007/s11748-019-01264-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the present study is to describe, for the first time in paediatric age, the technique and the outcomes of the thoracophrenolaparotomic (TPL) approach for surgical resection of thoraco-abdominal neuroblastomas (NBs) in children. METHODS A retrospective study was performed analysing clinical features and surgical outcomes of all children undergoing surgical resection of thoraco-abdominal NBs via the TPL approach in our third referral children's hospital, from January 2010 to November 2018. The details of the surgical technique were also reported. RESULTS 5 children suffering from thoraco-abdominal NBs (n = 4 stage L2, n = 1 stage M-according to the International Neuroblastoma Risk Group Staging System, INRGSS-and n = 4 stage 3, n = 1 stage 4-according to International Neuroblastoma Staging System, INSS) underwent the TPL approach at a mean age of 72 months (range 27-180 months). The surgical procedure was performed in a mean operative time of 5 h 57 min (range 2 h 56 min-9 h) without any major intraoperative or postoperative complications. Following 24 h in intensive care unit, all patients were safely discharged in a mean time of 12 days (range 4-21 days). All patients were alive, without any tumour relapse, at the last follow-up visit (mean 3.2 years, range 1-7 years). CONCLUSION This is the first study reporting the excellent surgical results we gained applying the TPL approach for surgical excision of multi-compartment tumours in children, allowing a gross total resection without intra- or post-operative complications.
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Affiliation(s)
- Giuseppe Martucciello
- DiNOGMI, University of Genova, Via G. Gaslini, 5, 16147, Genoa, Italy.
- Department of Paediatric Surgery, IRCCS Giannina Gaslini, Via G. Gaslini, 5, 16147, Genoa, Italy.
| | - Irene Paraboschi
- DiNOGMI, University of Genova, Via G. Gaslini, 5, 16147, Genoa, Italy
- Department of Paediatric Surgery, IRCCS Giannina Gaslini, Via G. Gaslini, 5, 16147, Genoa, Italy
| | - Stefano Avanzini
- Department of Paediatric Surgery, IRCCS Giannina Gaslini, Via G. Gaslini, 5, 16147, Genoa, Italy
| | - Federica Fati
- DiNOGMI, University of Genova, Via G. Gaslini, 5, 16147, Genoa, Italy
- Department of Paediatric Surgery, IRCCS Giannina Gaslini, Via G. Gaslini, 5, 16147, Genoa, Italy
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Rüwald JM, Eymael RL, Upenieks J, Zhang L, Jacobs C, Pflugmacher R, Schildberg FA. An Overview of the Current State of Pediatric Scoliosis Management. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 158:508-516. [PMID: 31416110 DOI: 10.1055/a-0965-7760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Historically pediatric scoliosis represents a condition deeply rooted within the origins of orthopedic surgery. Today only a few subspecialized surgeons treat pediatric scoliosis patients. In severe cases surgery can hold progression of and correct pathologic spinal curvature. The goal of this article is to provide an overview of the current state of pediatric scoliosis management. It aims to increase the attention of general physicians and orthopedic surgeons to a niched but rather frequently encountered pediatric pathology to facilitate early recognition and diagnosis. A thorough research of literature was conducted to summarize the different scoliosis types, their etiology and presentation. Classification, normal human growth phases and curve progression risk have been further elaborated. Finally, current treatment options with their benefits, shortcomings and complications were laid out and discussed. Among the etiological groups a focus was put on idiopathic scoliosis, in particular adolescent idiopathic scoliosis as the most frequently encountered subtype.
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Affiliation(s)
- Julian M Rüwald
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn
| | | | - Janis Upenieks
- Department of Pediatric Surgery, University Children's Hospital, Riga, Latvia
| | - Li Zhang
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn
| | - Cornelius Jacobs
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn
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12
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Johans SJ, Hofler RC, Nockels RP. Management of Adolescent Idiopathic Scoliosis: Institutional Experience, Integration into Neurosurgical Practice, and Impact on Resident Training. World Neurosurg 2019; 126:e181-e189. [PMID: 30797921 DOI: 10.1016/j.wneu.2019.01.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Management of adolescent idiopathic scoliosis (AIS) in neurosurgery residency training may have a significant impact on resident experience, even though few trainees are likely to pursue careers in the field of AIS. The impact of this exposure on resident knowledge in adult spinal disease management is the subject of our retrospective analysis. METHODS An analysis was performed of all adolescent patients undergoing surgical correction of spinal deformity between 2006 and 2016. Patient characteristics, including age at operation, Cobb angles, length of stay, operative time, blood loss, and complications, were collected. Objective benchmarks were created for resident education in the management of AIS. A survey was sent to the last 7 years of graduates to assess the impact of exposure to AIS during neurosurgery training on their current practice. RESULTS Nine male and 37 female patients ages 11 to 22 years were identified. Neurosurgical residents assisted in all procedures without fellows or surgical assistants. Average operative time was 336 minutes (range, 215-575 minutes), and blood loss per procedure was 603 mL (range, 200-4000 mL). The average Cobb angle correction was 72.2% (range, 35.3%-90.9%). Zero of the past 7 graduates currently treat AIS surgically. All 7 graduates agreed that exposure to AIS during residency enhanced their knowledge of adult spinal disease management. CONCLUSIONS Treatment of AIS by surgeons with specialized training can be effective and safe. Resident exposure to these patients enhances their understanding of spinal biomechanics and deformity correction, which is applicable to treating AIS and adult spinal deformity.
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Affiliation(s)
- Stephen J Johans
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Ryan C Hofler
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Russ P Nockels
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
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13
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Rustagi T, Kurra S, Sullivan K, Dhawan R, Lavelle WF. Surgical treatment of early-onset idiopathic scoliosis in the United States: a trend analysis of 15 years (1997-2012). Spine J 2019; 19:314-320. [PMID: 29802889 DOI: 10.1016/j.spinee.2018.05.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/17/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Early-onset scoliosis is a challenging problem that is defined as a curvature of the spine of more than 10 degrees identified in a child less than 10 years. Early-onset idiopathic scoliosis (EOIS) can cause substantial morbidity and may require surgical intervention. PURPOSE The aim of the present study was to identify the trends of EOIS type of surgeries, length of hospital stay, in-hospital complications, and total inpatient admission charges over a 15-year study period in the United States from 1997 to 2012. STUDY DESIGN/SETTING This retrospective study used the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes from the Healthcare Cost and Utilization Project (HCUP) Kids Inpatient's Database (KID) for a 15-year period (1997-2012). PATIENT SAMPLE We identified a total of 897 patients with EOIS over the 15-year study period. OUTCOME MEASURES The present study determines the current trends for EOIS surgeries. METHODS The present study had no funding sources or any potential conflicts of interest associated biases. Idiopathic scoliosis patients with ages between 0 and <10 years were identified from the Kids' Inpatient Database with ICD-9-CM code 737.30. Posterior, anterior, and combined spinal surgeries were identified in EOIS through the procedure codes. Patients' gender, discharge diagnosis (comorbidities), hospital length of stay (LOS), mortality rates, hospital charges, and in-hospital complication rate data were collected between 1997 and 2012. The primary grouping variable of the study was the type of surgery (posterior, anterior, and combined). The trends of each variable (female gender, mortality rates, in-hospital complications rates, discharge diagnosis, LOS, and total hospital charges) were assessed for each surgical group separately. Cost inflation of hospital charges was adjusted for the year 2012. An analysis of variance test was used to analyze continuous variables and a chi-square test was used for categorical variables. A linear regression test was used to assess the trend of changes. p≤.05 was considered statistically significant. RESULTS The study identified 897 patients, with 546 (61%) of them requiring surgery. Spine deformity surgery rates significantly decreased in patients with EOIS over time from 75% in 1997 to 47% in 2012, p=.019. In the surgery cohort, the male to female distribution was 37% and 63%, respectively. The overall mortality rate was 0.1%. The average length of hospital stay was 8 days and the average number of discharge diagnosis was 5.3. Aggregated complications were seen in 6% of the patients. The total mean hospital charge (per 2012 US dollars) was $119,613, which increased significantly for all types of surgeries. Over the 15-year study period, 62% (n=342) of the patients had posterior surgeries, 13% (n=71) of the patients had anterior surgeries, and 24% (n=133) of the patients had combined (anterior and posterior) surgeries. Posterior surgeries increased significantly from 33% in 1997 to 91% in 2012 (p<.004). Combined surgeries saw a significant decline from 50% to 4.3% (0<0.001). Anterior surgeries also decreased from 17% to 4.3% (p<.126), but this did not reach statistical significance. CONCLUSIONS From 1997 to 2012 (15 years) study period of patients with EOIS, posterior-based surgeries significantly increased. The overall surgery rate has significantly decreased for these patients. A significant increase in hospital charges were noticed in posterior, anterior, and combined surgeries.
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Affiliation(s)
- Tarush Rustagi
- Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210, USA
| | - Swamy Kurra
- Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210, USA
| | - Katherine Sullivan
- Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210, USA
| | - Ravi Dhawan
- Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210, USA
| | - William F Lavelle
- Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210, USA.
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Intraoperative Traction May Be a Viable Alternative to Anterior Surgery in Cerebral Palsy Scoliosis ≥100 Degrees. J Pediatr Orthop 2018. [PMID: 29521937 DOI: 10.1097/bpo.0000000000001151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND For large scoliosis, 2 strategies to maximize correction include intraoperative traction and/or anterior release. It is unclear which patients will benefit the most form either approach. The purpose of our study is to compare the radiographic, perioperative clinical outcomes, and health-related quality of life (HRQoL) outcomes of 2 approaches when used in severe neuromuscular scoliosis in the setting of cerebral palsy (CP). METHODS In total, 23 patients with minimum 2-year follow-up, major curves ≥100 degrees, and in whom treatment included posterior spinal fusion were evaluated. Eighteen were treated with posterior spinal fusion with intraoperative traction and 5 with anterior/posterior spinal fusion (APSF). The baseline characteristics, perioperative outcomes, and preoperative and 2-year follow-up data for HRQoL and radiographic measures were compared. RESULTS The groups had similar age, sex, nutritional and seizure status, GMFCS level, and change in CPCHILD scores. The groups had similar curve magnitude (120 vs. 105 degrees, P=0.330) and flexibility (28% vs. 40%, P=0.090), but the APSF group had less pelvic obliquity (POB) (24 vs. 42 degrees, P=0.009). There were similar postoperative major curves (37 vs. 40 degrees, P=0.350), but greater correction in POB (33.5 vs. 14 degrees of correction, P=0.007) in the traction group. The APSF group had longer anesthesia times (669 vs. 415 min, P=0.005), but similar hospital stays, intensive care unit and days intubated, estimated blood loss, cell saver, and red blood cells used. Although the APSF group had twice the rate of complications (22% vs. 40%) during the first 90 days postoperatively, this did not reach statistical significance. CONCLUSIONS Both intraoperative traction and anterior surgery were used to aid correction in severe CP scoliosis. Anterior surgery did not offer superior correction or better HRQoL, and was associated with increased operative times, whereas intraoperative traction was associated with greater correction of POB. Intraoperative traction may be a viable alternative to an anterior release in severe CP scoliosis. LEVEL OF EVIDENCE Level II.
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Abstract
BACKGROUND Quality improvement in orthopaedic surgery has received increasing attention; however, there is insufficient information available about the perioperative safety of many common pediatric orthopaedic procedures. This study aimed to characterize the incidence of adverse events in a national pediatric patient sample to understand the risk profiles of common pediatric orthopaedic procedures, and to identify patients and operations that are associated with increased rates of adverse outcomes. METHODS A retrospective cohort study was conducted using the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database. Pediatric patients who underwent 29 different orthopaedic procedures were identified in the 2012 NSQIP Pediatric database. The occurrence of any adverse event, infection, return to the operating room, and readmission within 30 days, were reported for each procedure. Multivariate regression was then used to identify the association of patient and operative characteristics with the occurrence of each adverse outcome. RESULTS A total of 8975 pediatric patients were identified. Supracondylar humerus fracture fixation was the most common procedure performed in this sample (2274 patients or 25.57% of all procedures), followed by posterior spinal fusion (1894 patients or 21.10% of all procedures). Adverse events occurred in 352 patients (3.92% of all patients). Four deaths were noted (0.04% of all patients), which only occurred in patients with nonidiopathic scoliosis undergoing spinal fusion. Infections occurred in 143 patients (1.59%), and 197 patients (2.19%) were readmitted within 30 days. Multiple patient characteristics and procedures were found to be associated with each adverse outcome studied. CONCLUSIONS Spinal fusion, multiaxial external fixation, and fasciotomy were procedures associated with increased rates of adverse outcomes within 30 days. Patients with obesity, ASA class ≥3, and impaired cognitive status also had increased rates of adverse outcomes. The results from this study of a large, national sample of pediatric orthopaedic patients are important for benchmarking and highlight areas for quality improvement. LEVEL OF EVIDENCE Level III-Prognostic.
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Chan A, Aguillon J, Hill D, Lou E. Precision and accuracy of consumer-grade motion tracking system for pedicle screw placement in pediatric spinal fusion surgery. Med Eng Phys 2017; 46:33-43. [PMID: 28602642 DOI: 10.1016/j.medengphy.2017.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/12/2017] [Accepted: 05/16/2017] [Indexed: 11/17/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a 3-dimensional spinal deformity involving lateral curvature and axial rotation. Surgical intervention involves insertion of pedicle screws into the spine, requiring accuracies of 1mm and 5° in translation and rotation to prevent neural and vascular complications. While commercial CT-navigation is available, the significant cost, bulk and radiation dose hinders their use in AIS surgery. The objective of this study was to evaluate a commercial-grade Optitrack Prime 13W motion capture cameras to determine if they can achieve adequate accuracy for screw insertion guidance in AIS. Static precision, camera and tracked rigid body configurations, translational and rotational accuracy were investigated. A 1-h camera warm-up time was required to achieve precisions of 0.13mm and 0.10°. A three-camera system configuration with cameras at equal height but staggered depth achieved the best accuracy. A triangular rigid body with 7.9mm markers had superior accuracy. The translational accuracy for motions up to 150mm was 0.25mm while rotational accuracy was 4.9° for rotations in two directions from 0° to 70°. Required translational and rotational accuracies were achieved using this motion capture system as well as being comparable to surgical-grade navigators.
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Affiliation(s)
- Andrew Chan
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta T6G 2V2, Canada
| | - Janelle Aguillon
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta T6G 1H9, Canada
| | - Doug Hill
- Department of Surgery, University of Alberta, Edmonton, Alberta T6G 2B7, Canada; Alberta Health Services - Glenrose Rehabilitation Hospital, Edmonton, Alberta T5G 0B7, Canada
| | - Edmond Lou
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta T6G 2V2, Canada; Department of Surgery, University of Alberta, Edmonton, Alberta T6G 2B7, Canada; Alberta Health Services - Glenrose Rehabilitation Hospital, Edmonton, Alberta T5G 0B7, Canada.
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Abel MF, Singla A, Feger MA, Sauer LD, Novicoff W. Surgical treatment of Lenke 5 adolescent idiopathic scoliosis: Comparison of anterior vs posterior approach. World J Orthop 2016; 7:553-560. [PMID: 27672568 PMCID: PMC5027010 DOI: 10.5312/wjo.v7.i9.553] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/01/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the posterior vs anterior approaches for fusion of Lenke 5 adolescent idiopathic scoliosis curves, matched for curve magnitude and for the distal level of fixation (dLOF) standardized to the third lumbar vertebrae (L3).
METHODS A prospectively collected multicenter database was used for this retrospective comparative study. Our dependent variables included sagittal and coronal radiographic measurements, number of fused vertebrae, estimated blood loss, length of hospitalization and SRS total and individual domain scores at the two-year follow-up. Subject demographics were similar for all group comparisons. Independent t-test was used to compare groups for all analyses at P < 0.01.
RESULTS For all matched cases of Lenke 5 curves, a selective approach was used only 50% of the time in cases undergoing a posterior fusion. When comparing a posterior selective approach to an anterior selective approach, surgeons utilizing a posterior approach fused significantly more levels than surgeons using an anterior approach with no other significant differences in radiographic or SRS outcomes (Ant = 4.8 ± 1.0 levels vs post = 6.1 ± 1.0 levels, P < 0.0001). When the dLOF was standardized to L3, the anterior approached provided significantly greater lumbar Cobb percent correction than the posterior approach (Ant = 69.1% ± 12.6% vs post = 54.6% ± 16.4%, P = 0.004), with no other significant radiographic or SRS score differences between approaches.
CONCLUSION Surgeons treating Lenke 5c curves with a posterior instrumentation and fusion vs an anterior approach include more motion segments, even with a selective fusion. When controlled for the distal level of fixation, the anterior approach provides greater correction of the thoracolumbar curve.
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Saifi C, Kang DG, Lehman RA. Decision making for upper instrumented vertebra in thoracolumbar/lumbar adolescent idiopathic scoliosis: can we stop below the end vertebra? Spine J 2016; 16:288-90. [PMID: 27063497 DOI: 10.1016/j.spinee.2015.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 10/22/2015] [Accepted: 11/10/2015] [Indexed: 02/03/2023]
Abstract
Sudo H, Kaneda K, Shono Y, Iwasaki N. Selection of the upper vertebra to be instrumented in the treatment of thoracolumbar and lumbar adolescent idiopathic scoliosis by anterior correction and fusion surgery using dual-rod instrumentation: a minimum 12-year follow-up study. Spine J. 2016:16:281-7 (in this issue).
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Affiliation(s)
- Comron Saifi
- New York-Presbyterian Healthcare System, Columbia University Medical Center, Department of Orthopedic Surgery, The Spine Hospital, 5141 Broadway, New York, NY 10034, USA
| | - Daniel G Kang
- Department of Orthopedic Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA
| | - Ronald A Lehman
- New York-Presbyterian Healthcare System, Columbia University Medical Center, Department of Orthopedic Surgery, The Spine Hospital, 5141 Broadway, New York, NY 10034, USA.
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Vigneswaran HT, Grabel ZJ, Eberson CP, Palumbo MA, Daniels AH. Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20,346 patients. J Neurosurg Pediatr 2015; 16:322-8. [PMID: 26114991 DOI: 10.3171/2015.3.peds14649] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Adolescent idiopathic scoliosis (AIS) can cause substantial morbidity and may require surgical intervention. In this study, the authors aimed to evaluate US trends in operative AIS as well as patient comorbidities, operative approach, in-hospital complications, hospital length of stay (LOS), and hospital charges in the US for the period from 1997 to 2012. METHODS Patients with AIS (ICD-9-CM diagnosis codes 737.30) who had undergone spinal fusion (ICD-9-CM procedure codes 81.xx) from 1997 to 2012 were identified from the Kids' Inpatient Database. Parameters of interest included patient comorbidities, operative approach (posterior, anterior, or combined anteroposterior), in-hospital complications, hospital LOS, and hospital charges. RESULTS The authors identified 20, 346 patients in the age range of 0-21 years who had been admitted for AIS surgery in the defined study period. Posterior fusions composed 63.4% of procedures in 1997 and 94.1% in 2012 (r = 0.95, p < 0.01). The mean number of comorbidities among all fusion groups increased from 3.0 in 1997 to 4.2 in 2012 (r = 0.92, p = 0.01). The percentage of patients with complications increased from 15.6% in 1997 to 22.3% in 2012 (r = 0.78, p = 0.07). The average hospital LOS decreased from 6.5 days in 1997 to 5.6 days in 2012 (r = -0.86, p = 0.03). From 1997 to 2012, the mean hospital charges (adjusted to 2012 US dollars) for surgical treatment of AIS more than tripled from $55,495 in 1997 to $177,176 in 2012 (r = 0.99, p < 0.01). CONCLUSIONS Over the 15-year period considered in this study, there was an increasing trend toward using posterior-based techniques for AIS corrective surgery. The number of comorbid conditions per patient and thus the medical complexity of patients treated for AIS have increased. The mean charges for the treatment of AIS have increased, with a national bill over $1.1 billion per year in 2012.
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Affiliation(s)
- Hari T Vigneswaran
- Department of Orthopaedics, Alpert Medical School of Brown University, and Rhode Island Hospital, Providence, Rhode Island
| | - Zachary J Grabel
- Department of Orthopaedics, Alpert Medical School of Brown University, and Rhode Island Hospital, Providence, Rhode Island
| | - Craig P Eberson
- Department of Orthopaedics, Alpert Medical School of Brown University, and Rhode Island Hospital, Providence, Rhode Island
| | - Mark A Palumbo
- Department of Orthopaedics, Alpert Medical School of Brown University, and Rhode Island Hospital, Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopaedics, Alpert Medical School of Brown University, and Rhode Island Hospital, Providence, Rhode Island
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