Proximal junctional kyphosis and rates of fusion following posterior instrumentation and spinal fusion for adolescent idiopathic scoliosis

Showing Some Spine on Reddit: Neurosurgical Spinal Cord Conditions in Adults

BACKGROUND

A crowdsourcing resource used by patients with spinal disease has yet to be thoroughly investigated: the Internet. One such platform is Reddit, a virtual, anonymous meeting place. Analyzing how patients use spinal condition "subreddits" may enable a greater understanding of the questions that patients do not ask their doctors.

METHODS

Up to 50 posts in each subreddit's "hot" tab were retroactively screened from June 1, 2022. Posts written by those who had the condition or those interested in knowing more were included. Redditors self-identifying as younger than 18 years were excluded. Posts were subcategorized into questions related to social advice, health advice, providing health education or suggesting equipment, detailing their personal experience, or researchers recruiting patients for research.

RESULTS

Eight subreddits with 398 posts were identified related to spinal conditions, including scoliosis, herniated disks, spondylolisthesis, kyphosis, spina bifida, and degenerative disk disease, and 2 subreddits for spinal cord injury. Most patients sought out health advice (59.8%), specifically related to questions regarding their treatments (33.6%), followed by social advice (14.1%) relating to activities in their daily lives. Six posts from the spinal cord injury subreddits discussed the inability to achieve or maintain an erection.

DISCUSSION

Patients with spinal conditions congregate on Reddit. Analysis of subreddits allows for a more robust fund of knowledge, granting providers an opportunity to address the main health concerns of patients and caregivers.

Use of graft materials and biologics in spine deformity surgery: a state-of-the-art review

PURPOSE

The aim of the current review is to summarize the current evidence on graft materials used in fusion procedures for spinal deformity corrections.

METHODS

PubMed, Embase, and Cochrane Library were searched for relevant published observational studies and clinical trials using osteobiologics and biomaterials in spinal deformity surgery.

RESULTS

The use of autograft in deformity correction surgeries has been reported in a limited number of studies, with the harvest sites including iliac crest, ribs, and local bone. Various allografts and biologics have been used in the treatment of spinal deformities including idiopathic and degenerative scoliosis, either as stand alone or in combination with autograft. Limited number of studies reported no differences in fusion rates or outcomes. Use of rh-BMP2 in anterior, posterior or front/back approaches showed higher fusion rates than other graft materials in patients with spinal deformities. Due to the limited number of quality studies included in the review, as well as alternative factors, such as costs, availability, and surgeon expertise/preference, no definitive conclusion or recommendations can be made as to the ideal graft choice in spinal deformity surgery.

CONCLUSIONS

Most commonly used grafts included autograft, allograft and rh-BMP2, with new biologics and biomaterials constantly emerging in the market. Limited number of high-quality comparative studies and heterogeneity in study design prevented direct comparisons that can lead to meaningful recommendations. Further studies are needed to prove superiority of any single graft material and/or biologic that is also cost-effective and safe.

Long-Term Follow-up of Posterior Selective Thoracolumbar/Lumbar Fusion in Patients With Lenke 5C Adolescent Idiopathic Scoliosis: An Analysis of 10-Year Outcomes

STUDY DESIGN

Retrospective study.

OBJECTIVE

The aim of this study was to assess long-term radiographic and clinical outcomes in Lenke 5C adolescent idiopathic scoliosis (AIS) patients after posterior selective fusion.

METHODS

Lenke 5C AIS patients who underwent posterior selective thoracolumbar/lumbar (TL/L) fusion in our hospital from January 2007 to January 2010 were recruited. Radiographic parameters were measured preoperatively and at the 3-month, 1-year, 2-year, 5-year, and 10-year follow-ups. The SRS-22 (Scoliosis Research Society) questionnaire was used to assess the clinical outcomes.

RESULTS

We included 37 patients who underwent posterior selective TL/L fusion surgery in our study, and the mean follow-up time was 11.26 ± 0.85 years. The average preoperative Cobb angles of the thoracic and TL/L curves were 24.0 ± 9.0° and 45.4 ± 6.3°, respectively, which were corrected to 12.2° and 12.4° at the 3-month follow-up postoperatively, with correction losses of 2.2° and 1.5° at the 10-year follow-up. In the sagittal plane, the degree of thoracic kyphosis (TK) gradually increased over the follow-up period. The proximal junctional angle (PJA) also gradually increased from 6.7 ± 4.6 to 13.7 ± 5.6 during the follow-up period. For the clinical outcomes, correction surgery improved the SRS-22 scores in each domain, especially in the self-image domain.

CONCLUSIONS

Posterior selective TL/L fusion can effectively correct spinal deformities, leading to stable outcomes for 10 years postoperatively. During the follow-up period, the degree of TK presented an increasing trend that remained almost constant after the 1-year follow-up. Moreover, the variation in the PJA was highly significant in the postoperative period, and it showed an increasing trend until the 2-year follow-up.