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Zapata KA, Virostek D, Ma Y, Datcu AM, Gunselman MR, Herring JA, Johnson ME. Outcomes for nighttime bracing in adolescent idiopathic scoliosis based on brace wear adherence. Spine Deform 2024:10.1007/s43390-024-00835-w. [PMID: 38457029 DOI: 10.1007/s43390-024-00835-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/27/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND This study determined brace wear adherence for patients treated with nighttime braces and evaluated the effect of brace adherence on curve progression. METHODS One hundred twenty-two patients with AIS ages 10-16 years, Risser stages 0-2, major curves 20°-40° treated with Providence nighttime braces prescribed to be worn at least 8 h per night were prospectively enrolled and followed until skeletal maturity or surgery. Brace adherence was measured using iButton temperature sensors after 3 months of brace initiation and at brace discharge. RESULTS Curve types were single thoracolumbar/lumbar (62%, n = 76), double (36%, n = 44), and single thoracic (2%, n = 2). Brace adherence averaged 7.8 ± 2.3 h after 3 months (98% adherence) and 6.7 ± 2.6 h at brace discharge (84% adherence). Curves that progressed ≥ 6° had decreased brace adherence than non-progressive curves after 3 months (7.0 h vs. 8.1 h, p = 0.010) and at brace discharge (5.9 h vs. 7.1 h, p = 0.017). Multivariate logistic regression analysis showed that increased hours of brace wear [odds ratio (OR) 1.23, 95% confidence interval (CI) 1.06-1.46], single curves (OR 3.11, 95% CI 1.35-7.53), and curves < 25° (OR 2.61, 95% CI 1.12-6.44) were associated with non-progression at brace discharge. CONCLUSIONS Patients treated with nighttime bracing have a high rate of brace adherence. Lack of curve progression is associated with increased brace wear. Nighttime bracing is effective at limiting curve progression in AIS single thoracolumbar/lumbar and double curves. LEVEL OF EVIDENCE Prognostic Level 2.
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Affiliation(s)
| | - Donald Virostek
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Yuhan Ma
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Anne-Marie Datcu
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | | | - John A Herring
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Megan E Johnson
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
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Reddy Y, Jamnik A, Thornberg D, Datcu AM, Lachmann E, Johnson M, Ramo B, McIntosh AL. The effect of antibiotic-impregnated calcium sulfate beads and Medical Optimization Clinic attendance on the acute surgical site infection rate in high-risk pediatric neuromuscular and syndromic scoliosis patients. Spine Deform 2024:10.1007/s43390-024-00837-8. [PMID: 38457028 DOI: 10.1007/s43390-024-00837-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/01/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Neuromuscular and syndromic (NMS) scoliosis patients are at higher risk of acute surgical site infections (SSIs). Despite following POSNA's endorsed consensus-based guidelines for SSI prevention, our institutional rates of acute SSI have varied dramatically. This variability drove simultaneous strategies to lower SSI rates: the creation of a preoperative Medical Optimization Clinic (MOC) and use of antibiotic-impregnated (Abx-I) calcium sulfate beads. METHODS Patients undergoing index PSF at a single institution between 2016 and 2022 were retrospectively reviewed. Patients with ≥ 2 risk factors were included: (1) BMI < 18.5 or > 25; (2) incontinence; (3) instrumentation to pelvis; (4) non-verbal; (5) GMFCS IV/V. SSI was defined as deep infection within 90 days. We compared patients who attended MOC and received Abx-I (MOC + Abx-I) to those receiving neither intervention (control) nor a single intervention. RESULTS 282 patients were included. The overall infection rate was 4.26%. Higher GMFCS (p = 0.0147), non-verbal status (p = 0.0048), and longer fusions (p = 0.0298) were independently associated with infection rate. Despite the MOC + Abx-I group having larger Cobb angles (88° ± 26°), higher GMFCS levels (4.5 ± 0.9), ASA class (3 ± 0.4), and more frequent instrumentation to the pelvis (85%), they had the lowest infection rate (2.13%) when compared to the control (4.2%) or single intervention groups (5.7%, 4.6%) (p = 0.9). CONCLUSION The study examined the modern infection rate of NMS patients following the implementation of two interventions: MOC and Abx-I. Despite having higher risk factors (curves (88°), GMFCS level (4.5), ASA class (3), higher % instrumentation to the pelvis (85%)), the patients treated with both interventions demonstrated the lowest infection rate (2.13%).
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Affiliation(s)
- Yashas Reddy
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital, 1015, Walnut Street, Philadelphia, PA, 19107, United States
| | - Adam Jamnik
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, United States
| | - David Thornberg
- Scottish Rite for Children, Dept of Orthopedics, 2222 Welborn St, Dallas, TX, 75219, United States
| | - Anne-Marie Datcu
- School of Medicine, Texas A&M University, 8447 Riverside Parkway, Byran, TX, 77807, United States
| | - Emily Lachmann
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, United States
| | - Megan Johnson
- Scottish Rite for Children, Dept of Orthopedics, 2222 Welborn St, Dallas, TX, 75219, United States
| | - Brandon Ramo
- Scottish Rite for Children, Dept of Orthopedics, 2222 Welborn St, Dallas, TX, 75219, United States
| | - Amy L McIntosh
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital, 1015, Walnut Street, Philadelphia, PA, 19107, United States.
- Scottish Rite for Children, Dept of Orthopedics, 2222 Welborn St, Dallas, TX, 75219, United States.
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Jamnik AA, Datcu AM, Lachmann E, Patibandla SD, Thornberg D, Jo CH, Morris WZ, Ramo B, Johnson M. Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis: a 30-year update. Spine Deform 2024; 12:99-107. [PMID: 37572225 DOI: 10.1007/s43390-023-00742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/22/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Although spinal fusion (SF) is considered "definitive" treatment in juvenile/adolescent idiopathic scoliosis (JIS/AIS), complications requiring reoperation continue to occur. The purpose of this study was to characterize the evolving rates of reoperation following SF in JIS/AIS. METHODS Single-center retrospective review of patients who underwent SF for JIS/AIS as their index surgical treatment between 2013 and 2019. Patient data were collected to identify complications requiring reoperation and factors associated with reoperation. Complication rates from 2013 to 2019 were compared to patients from 1988 to 2012 at the same institution. RESULTS This study analyzed 934 patients (81.7% female, mean age at surgery 14.5 ± 2.1). Thirty-eight patients (4.1%) required a total of 47 reoperations, a > 50% decrease in overall complication rate from the 2008-2012 population (4.1% vs 9.6%, respectively, p < 0.001). The decrease stemmed mainly from decreases in rates of infection (1.1% vs 4.1%, p < 0.001) and symptomatic implants (0.4% vs 2.1%, p = 0.004). There were, however, non-significant increases in implant failures (0.6% vs 0.2%, p = 0.4367) and pseudoarthrosis (1.0% vs 0.4%, p = 0.5202). Both of these complications were associated with patients with a higher mean weight (implant failure: 70.4 kg ± 21.1 vs 56.1 kg ± 14.9, p = 0.002; pseudoarthrosis: 85.8 kg ± 27.9 vs 55.9 ± 14.5, p = 0.001). CONCLUSIONS Reoperation following SF for JIS/AIS has decreased over the past 7 years when compared to 25 years of historical controls. The changing landscape of reoperation demands further research into the risk factors for those reoperations that have become more common.
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