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Hori Y, Kaymaz B, da Silva LCA, Rogers KJ, Yorgova PK, Gabos PG, Shah SA. Differences in spine growth potential for Sanders maturation stages 7A and 7B have implications for treatment of idiopathic scoliosis. Spine Deform 2024; 12:621-628. [PMID: 38372941 PMCID: PMC11068661 DOI: 10.1007/s43390-024-00829-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/13/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE This study aimed to clarify the differences in spine and total body height growth and curve progression between Sanders maturation stage (SMS) 7A and 7B in patients with adolescent idiopathic scoliosis (AIS). METHODS This retrospective case-control study involving patients with AIS at SMS 7 evaluated the differential gains in the spine (T1-S1) and total body height and curve progression between SMS 7A and 7B. A validated formula was used to calculate the corrected height, accounting for height loss due to scoliosis. A multivariable non-linear and logistic regression model was applied to assess the distinct growth and curve progression patterns between the SMS 7 subtypes, adjusting for potential confounders. RESULTS A total of 231 AIS patients (83% girls, mean age 13.9 ± 1.2 years) were included, with follow-up averaging 3.0 years. Patients at SMS 7A exhibited larger gains in spine height (9.9 mm vs. 6.3 mm) and total body height (19.8 mm vs. 13.4 mm) compared with SMS 7B. These findings remained consistent even after adjustments for curve magnitude. Non-linear regression models showed continued spine and total body height increases plateauing after 2 years, significantly greater in SMS 7A. More SMS 7A patients had curve progression over 10°, with an adjusted odds ratio of 3.31. CONCLUSION This study revealed that patients staged SMS 7A exhibited more spine and total body growth and a greater incidence of substantial curve progression than those at 7B. These findings imply that delaying brace discontinuation until reaching 7B could be beneficial, particularly for those with larger curves. LEVEL OF EVIDENCE Level III (Case-control study).
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Affiliation(s)
- Yusuke Hori
- Department of Orthopaedic Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Burak Kaymaz
- Department of Orthopaedic Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | | | - Kenneth J Rogers
- Department of Orthopaedic Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Petya K Yorgova
- Department of Orthopaedic Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Peter G Gabos
- Department of Orthopaedic Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA.
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Cahill PJ, Miyanji F, Lullo BR, Samdani AF, Lonner BS, Pahys JM, Hwang SW, Haber LL, Alanay A, Shah SA, Parent S, Blakemore LC, Hoernschemeyer DG, Neal KM, Newton PO. Incidence of Tether Breakage in Anterior Vertebral Body Tethering. J Pediatr Orthop 2024; 44:e323-e328. [PMID: 38251438 DOI: 10.1097/bpo.0000000000002619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Thoracic anterior vertebral body tethering (TAVBT) is an emerging treatment for adolescent idiopathic scoliosis. Tether breakage is a known complication of TAVBT with incompletely known incidence. We aim to define the incidence of tether breakage in patients with adolescent idiopathic scoliosis who undergo TAVBT. The incidence of tether breakage in TAVBT is hypothesized to be high and increase with time postoperatively. METHODS All patients with right-sided, thoracic curves who underwent TAVBT with at least 2 and up to 3 years of radiographic follow-up were included. Tether breakage between 2 vertebrae was defined a priori as any increase in adjacent screw angle >5 degrees from the minimum over the follow-up period. The presence and timing of tether breakage were noted for each patient. A Kaplan-Meier survival analysis was performed to calculate expected tether breakage up to 36 months. χ 2 analysis was performed to examine the relationship between tether breakage and reoperations. Independent t test was used to compare the average final Cobb angle between cohorts. RESULTS In total, 208 patients from 10 centers were included in our review. Radiographically identified tether breakage occurred in 75 patients (36%). The initial break occurred at or beyond 24 months in 66 patients (88%). Kaplan-Meier survival analysis estimated the cumulative rate of expected tether breakage to be 19% at 24 months, increasing to 50% at 36 months. Twenty-one patients (28%) with a radiographically identified tether breakage went on to require reoperation, with 9 patients (12%) requiring conversion to posterior spinal fusion. Patients with a radiographically identified tether breakage went on to require conversion to posterior spinal fusion more often than those patients without identified tether breakage (12% vs. 2%; P =0.004). The average major coronal curve angle at final follow-up was significantly larger for patients with radiographically identified tether breakage than for those without tether breakage (31 deg±12 deg vs. 26 deg±12 deg; P =0.002). CONCLUSIONS The incidence of tether breakage in TAVBT is high, and it is expected to occur in 50% of patients by 36 months postoperatively. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Patrick J Cahill
- Children's Hospital of Philadelphia
- Perelman School of Medicine at the University of Pennsylvania
| | | | | | | | | | | | | | | | - Ahmet Alanay
- Acibadem Maslak Hospital, Maslal, Istanbul, Turkey
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Shah SA, Kraft DB, Miyanji F. Anterior Vertebral Body Tethering: A Review of the Available Evidence. J Am Acad Orthop Surg 2024; 32:247-256. [PMID: 38271681 DOI: 10.5435/jaaos-d-23-00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
Idiopathic scoliosis is a complex three-dimensional deformity of the spine with anterior overgrowth (hypokyphosis), coronal curvature, and axial rotation. Scoliosis treatment in the skeletally immature spine is therapeutically challenging because of growth and was commonly limited to observation, bracing treatment, or fusion. Fusion accomplishes powerful deformity correction at the expense of future growth and mobility of the involved segments, increasing the risk of adjacent segment degeneration and intervertebral disk disease later in life. Anterior vertebral body tethering is a motion-preserving technique that exploits the Hueter-Volkmann principle by applying compression at the anterior and convex aspects of the curve to stimulate differential vertebral growth for gradual deformity reduction without fusion. The appropriate timing, curve magnitude, tensioning, growth prediction, indications, and limitations of tethering are being refined as this technique becomes more prevalent. Early outcome studies show that growth modulation with vertebral body tethering is safe, can achieve good results, and preserve motion in select patients.
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Affiliation(s)
- Suken A Shah
- From the Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE (Shah), the Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC (Dr. Kraft), and the Department of Orthopaedic Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada (Dr. Miyanji)
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Levy KH, Yaszay B, Abel MF, Shah SA, Samdani AF, Sponseller PD. Baclofen pumps do not increase risk of complications following spinal fusion. Spine Deform 2024; 12:473-480. [PMID: 38006455 DOI: 10.1007/s43390-023-00786-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/21/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE To assess the complication risks associated with intrathecal baclofen (ITB) pumps in cerebral palsy (CP) patients undergoing posterior spinal fusion (PSF) and to determine if timing of pump implantation before or during PSF impacts the risk of complications. METHODS A prospectively collected multicenter database was retrospectively reviewed to identify CP patients undergoing PSF from 2008 to 2023. Patients were divided into 2 cohorts: those with an ITB pump (ITB cohort) and those without (non-ITB cohort). The ITB cohort was further categorized by placement of the pump prior to or during PSF. Cohorts were then compared in terms of postoperative complications, perioperative complications, and need for revision surgery. RESULTS Four hundred six patients (ITB n = 79 [53 prior to, 26 during PSF], non-ITB n = 326) were included in this analysis. At an average follow-up of 4.0 years (range 2-10 years), there were no significant differences between the ITB and non-ITB cohorts in the rate of perioperative complications (5.0% vs 6.5%, p = 0.80), revision surgeries (2.5% vs 4.6%, p = 0.54), or any complication type, regardless of whether pumps were placed prior to or during PSF, aside from longer surgical times in the latter group. CONCLUSION Complication rates are similar for ITBs placed prior to and during PSF. Patients with spastic CP may safely be treated with ITB pumps without increased risks of complication or further reoperation/revision following PSF. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kenneth H Levy
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital University, Baltimore, MD, USA
| | - Burt Yaszay
- Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, CA, USA
| | - Mark F Abel
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours Children's Clinic, Wilmington, DE, USA
| | - Amer F Samdani
- Department of Orthopaedic Surgery, Shriners Hospital for Children, Philadelphia, PA, USA
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital University, Baltimore, MD, USA.
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Asma A, Fralinger D, da Silva LCA, Mackenzie WGS, Gabos PG, Mackenzie WG, Shah SA. Predictors of Rod Length Gain and Sagittal Alignment Change After Magnetically Controlled Growing Rod Lengthening. Spine (Phila Pa 1976) 2024; 49:349-355. [PMID: 36856517 DOI: 10.1097/brs.0000000000004616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/05/2023] [Indexed: 03/02/2023]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE There are preoperative characteristics that predict rod lengthening of magnetically controlled growing rods (MCGR). The lengthening of MCGR will lead to increased kyphosis. SUMMARY OF BACKGROUND DATA The amount of length gained by MCGR is variable, and predictors are lacking. Similarly, sagittal plane changes over the MCGR lengthening period have not been investigated. MATERIALS AND METHODS Patients with MCGR and a minimum 2-year follow-up were identified and those with previous spine surgery were excluded. Preimplantation, postimplantation, and last follow-up postlengthening radiographs were examined. Multiple linear regression analyses were used for rod length gain predictors. RESULTS Fifty-six patients with early-onset scoliosis met inclusion criteria: nine idiopathic, five congenital, 14 neuromuscular, 20 syndromic, and eight skeletal dysplasia patients. No difference was seen between subtypes of early-onset scoliosis for rod length gain ( P =0.62). Shorter preoperative T1-T12 height and higher curve correction rate after implantation were significant predictors for rod length gain ( P <0.001). Preoperative major curve magnitude and kyphosis were not significant predictors. Flattening of the spine around the actuator and compensative increase in T1-T5 kyphosis were seen secondarily after MCGR implantation. Maximum sagittal kyphosis, T1-T5 kyphosis, and T5-T12 kyphosis did not change during lengthening. Lumbar lordosis significantly decreased postimplantation (first erect) but then increased during lengthening. Pelvic incidence and sacral slope both increased during lengthening, but this may be age related. CONCLUSION Patients who gained the most rod length with MCGR were those with an initially shorter T1-T12 height and better initial curve correction at implantation, likely representing that implants work best in small patients with flexible curves. Diagnosis, preoperative curve magnitude, and thoracic kyphosis were not related to rod length gain. Thoracic kyphosis did not deteriorate over the lengthening phase. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Affiliation(s)
- Ali Asma
- Nemours Children's Health, Delaware Valley, Wilmington, DE
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Badin D, Shah SA, Narayanan UG, Cahill PJ, Marrache M, Samdani AF, Yaszay B, Hunsberger JB, Marks MC, Sponseller PD. Fifteen Years of Spinal Fusion Outcomes in Children With Cerebral Palsy: Are We Getting Better? Spine (Phila Pa 1976) 2024; 49:247-254. [PMID: 37991210 DOI: 10.1097/brs.0000000000004792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/21/2023] [Indexed: 11/23/2023]
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVE We reviewed 15-year trends in operative factors, radiographic and quality of life outcomes, and complication rates in children with cerebral palsy (CP)-related scoliosis who underwent spinal fusion. SUMMARY OF BACKGROUND DATA Over the past two decades, significant efforts have been made to decrease complications and improve outcomes of this population. MATERIALS AND METHODS We retrospectively reviewed a multicenter registry of pediatric CP patients who underwent spinal fusion from 2008 to 2020. We evaluated baseline and operative, hospitalization, and complication data as well as radiographic and quality of life outcomes at a minimum 2-year follow-up. RESULTS Mean estimated blood loss and transfusion volume declined from 2.7±2.0 L in 2008 to 0.71±0.34 L in 2020 and 1.0±0.5 L in 2008 to 0.5±0.2 L in 2020, respectively, with a concomitant increase in antifibrinolytic use from 58% to 97% (all, P <0.01). Unit rod and pelvic fusion use declined from 33% in 2008 to 0% in 2020 and 96% in 2008 to 79% in 2020, respectively (both, P <0.05). Mean postoperative intubation time declined from 2.5±2.6 to 0.42±0.63 days ( P< 0.01). No changes were observed in preoperative and postoperative coronal angle and pelvic obliquity, operative time, frequency of anterior/anterior-posterior approach, and durations of hospital and intensive care unit stays. Improvements in the Caregiver Priorities and Child Health Index of Life with Disabilities postoperatively did not change significantly over the study period. Complication rates, including reoperation, superficial and deep surgical site infection, and gastrointestinal and medical complications remained stable over the study period. CONCLUSIONS Over the past 15 years of CP scoliosis surgery, surgical blood loss, transfusion volumes, duration of postoperative intubation, and pelvic fusion rates have decreased. However, the degree of radiographic correction, the rates of surgical and medical complications (including infection), and health-related quality of life measures have broadly remained constant.
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Affiliation(s)
- Daniel Badin
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Unni G Narayanan
- Department of Orthopaedic Surgery, University of Toronto and The Hospital for Sick Children, Toronto, ON, Canada
| | - Patrick J Cahill
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Majd Marrache
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Amer F Samdani
- Department of Orthopaedic Surgery, Shriners Hospitals for Children, Philadelphia, PA
| | - Burt Yaszay
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital and University of Washington, Seattle, WA
| | - Joann B Hunsberger
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Larson AN, Polly DW, Sponseller PD, Kelly MP, Richards BS, Garg S, Parent S, Shah SA, Weinstein SL, Crawford CH, Sanders JO, Blakemore LC, Oetgen ME, Fletcher ND, Kremers WK, Marks MC, Brearley AM, Aubin CE, Sucato DJ, Labelle H, Erickson MA. The Effect of Implant Density on Adolescent Idiopathic Scoliosis Fusion: Results of the Minimize Implants Maximize Outcomes Randomized Clinical Trial. J Bone Joint Surg Am 2024; 106:180-189. [PMID: 37973031 DOI: 10.2106/jbjs.23.00178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Severe adolescent idiopathic scoliosis (AIS) can be treated with instrumented fusion, but the number of anchors needed for optimal correction is controversial. METHODS We conducted a multicenter, randomized study that included patients undergoing spinal fusion for single thoracic curves between 45° and 65°, the most common form of operatively treated AIS. Of the 211 patients randomized, 108 were assigned to a high-density screw pattern and 103, to a low-density screw pattern. Surgeons were instructed to use ≥1.8 implants per spinal level fused for patients in the high-implant-density group or ≤1.4 implants per spinal level fused for patients in the low-implant-density group. The primary outcome measure was the percent correction of the coronal curve at the 2-year follow-up. The power analysis for this trial required 174 patients to show equivalence, defined as a 95% confidence interval (CI) within a ±10% correction margin with a probability of 90%. RESULTS In the intention-to-treat analysis, the mean percent correction of the coronal curve was equivalent between the high-density and low-density groups at the 2-year follow-up (67.6% versus 65.7%; difference, -1.9% [95% CI: -6.1%, 2.2%]). In the per-protocol cohorts, the mean percent correction of the coronal curve was also equivalent between the 2 groups at the 2-year follow-up (65.0% versus 66.1%; difference, 1.1% [95% CI: -3.0%, 5.2%]). A total of 6 patients in the low-density group and 5 patients in the high-density group required reoperation (p = 1.0). CONCLUSIONS In the setting of spinal fusion for primary thoracic AIS curves between 45° and 65°, the percent coronal curve correction obtained with use of a low-implant-density construct and that obtained with use of a high-implant-density construct were equivalent. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | - Sumeet Garg
- Children's Hospital of Colorado, Aurora, Colorado
| | | | | | | | | | | | | | | | | | | | - Michelle C Marks
- Harms Study Group/Setting Scoliosis Straight Foundation, El Cajon, California
| | | | - Carl-Eric Aubin
- Ecole Polytechnique, St. Justine Hospital, Montreal, Quebec, Canada
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Henstenburg J, Hori Y, Rogers KJ, Petfield JL, Shah SA, Gabos PG. Do Pedicle Screws That Terminate in the Costovertebral Joint Compromise Proximal Anchor Fixation in a Dual Growing Rod Construct? J Pediatr Orthop 2024; 44:e151-e156. [PMID: 37916773 DOI: 10.1097/bpo.0000000000002559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Growing rods (GRs) are used to treat early-onset scoliosis (EOS) recalcitrant to bracing and casting. Proximal anchor pullout, a known complication of GR constructs, can result in spinal cord injury if pedicle screw anchors are placed with a lateral-to-medial trajectory. To mitigate this risk, a more straightforward and potentially safer trajectory may result in screws that terminate within the costovertebral joint (CVJ). We asked, how often does CVJ placement occur and does this technique increase the rate of failure in GR constructs? METHODS We retrospectively reviewed 35 patients with EOS treated with dual GR with >2-year follow-up excluding patients with skeletal dysplasia or history of previous posterior instrumentation. Patient demographics, radiographic parameters, and implant constructs were assessed. RESULTS Of patients meeting the inclusion criteria, 18/35 (51%) were females with an average age of 7.96 (range: 4.0 to 15.2) years at surgery with a follow-up of 3.7 (range: 2.0 to 7.7) years. Five (14%) patients had idiopathic EOS, 5 (14%) had congenital EOS, 12 (34%) had neuromuscular EOS, 10 (29%) had syndromic scoliosis, and 3 (9%) had another etiology for EOS. Among 195 proximal pedicle screws placed, 19 (10%) terminated within the CVJ, and 13 patients (37%) had at least 1 CVJ screw. Two patients (6%) experienced unilateral proximal pullout. In both patients, the anchors on the affected side included 1 of 2 screws within the CVJ. Both patients had constructs that included 2 screws on the side that pulled out and 3 screws on the side that did not. None of the remaining 17 CVJ screws led to implant failure. CONCLUSION Pedicle screw placement within the CVJ is common and does not appear to significantly contribute to proximal screw pullout; however, it may contribute to unilateral implant failure in constructs employing only 2 proximal screws, where 1 of those 2 screws terminates within the CVJ. Construct modifications should be considered in this scenario. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Yusuke Hori
- Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE
| | - Kenneth J Rogers
- Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE
| | - Joseph L Petfield
- Department of Orthopaedic Surgery, Penn State Hershey Medical Center, Hershey, PA
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE
| | - Peter G Gabos
- Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE
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Dolan LA, Weinstein SL, Dobbs MB, Flynn JMJ, Green DW, Halsey MF, Hresko MT, Krengel WF, Mehlman CT, Milbrandt TA, Newton PO, Price N, Sanders JO, Schmitz ML, Schwend RM, Shah SA, Song K, Talwalkar V. BrAIST-Calc: Prediction of Individualized Benefit From Bracing for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2024; 49:147-156. [PMID: 37994691 PMCID: PMC10841822 DOI: 10.1097/brs.0000000000004879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
STUDY DESIGN Prospective multicenter study data were used for model derivation and externally validated using retrospective cohort data. OBJECTIVE Derive and validate a prognostic model of benefit from bracing for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) demonstrated the superiority of bracing over observation to prevent curve progression to the surgical threshold; 42% of untreated subjects had a good outcome, and 28% progressed to the surgical threshold despite bracing, likely due to poor adherence. To avoid over-treatment and to promote patient goal setting and adherence, bracing decisions (who and how much) should be based on physician and patient discussions informed by individual-level data from high-quality predictive models. MATERIALS AND METHODS Logistic regression was used to predict curve progression to <45° at skeletal maturity (good prognosis) in 269 BrAIST subjects who were observed or braced. Predictors included age, sex, body mass index, Risser stage, Cobb angle, curve pattern, and treatment characteristics (hours of brace wear and in-brace correction). Internal and external validity were evaluated using jackknifed samples of the BrAIST data set and an independent cohort (n=299) through estimates of discrimination and calibration. RESULTS The final model included age, sex, body mass index, Risser stage, Cobb angle, and hours of brace wear per day. The model demonstrated strong discrimination ( c -statistics 0.83-0.87) and calibration in all data sets. Classifying patients as low risk (high probability of a good prognosis) at the probability cut point of 70% resulted in a specificity of 92% and a positive predictive value of 89%. CONCLUSION This externally validated model can be used by clinicians and families to make informed, individualized decisions about when and how much to brace to avoid progression to surgery. If widely adopted, this model could decrease overbracing of AIS, improve adherence, and, most importantly, decrease the likelihood of spinal fusion in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kit Song
- Carelon Health Services and the University of California, Los Angeles, CA
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Thornley P, Garner S, Rogers KJ, Yorgova P, Gabos PG, Shah SA. Socioeconomic, Racial, and Insurance Disparities in Clinical Outcomes After Surgery Among Patients With Idiopathic Scoliosis. J Pediatr Orthop 2024; 44:e163-e167. [PMID: 37867376 DOI: 10.1097/bpo.0000000000002551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Socioeconomic status (SES), race, and insurance type correlate with initial curve severity for patients with idiopathic scoliosis, but less is known regarding how these variables impact surgical outcomes. The objectives of this study were to determine the influence of SES, race, and insurance on preoperative appointment attendance, likelihood of obtaining a preoperative second opinion, brace prescription, missed 6 or 12-month postsurgical appointments, incidence of emergency department visits 0 to 90 days after surgery, and major complications within a year of surgery. METHODS A review of 421 patients diagnosed with idiopathic scoliosis who underwent surgery at a single high-volume pediatric spinal deformity institution between May 2015 and October 2021 was conducted. Area Deprivation Index, a quantitative measure of SES, was collected. Scores were stratified by quartile; higher scores indicated a lower SES. χ 2 tests for correlation were performed to determine whether clinical outcomes were dependent upon Area Deprivation Index, race, or insurance type; P ≤0.05 was significant. RESULTS The sample was 313 Caucasian (74%), 69 (16%) black, and 39 (9.3%) other patients. More patients had private versus public insurance (80% vs 20%) and were of higher SES. The likelihood of missing preoperative appointments was higher for black patients ( P = 0.037). Those with lower SES missed more postoperative appointments and received less bracing and second opinions ( P = 0.038, P = 0.017, P = 0.008, respectively). Being black and publicly insured correlated with fewer brace prescriptions ( P < 0.001, P = 0.050) and decreased rates of obtaining second opinions ( P = 0.004, P = 0.001). CONCLUSION Patients with idiopathic scoliosis surgery who were Caucasian, privately insured, and of higher SES were more likely to seek preoperative second opinions, be prescribed a brace, and attend postoperative appointments. Recognition of the inherent health care disparities prevalent within each pediatric spine surgery referral region is imperative to better inform local and national institutional level programs to educate and assist patients and families most at risk for disparate access to scoliosis care. LEVEL OF EVIDENCE Level III; retrospective case-control study.
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Affiliation(s)
- Patrick Thornley
- Department of Orthopaedics, Nemours Children's Health, Wilmington, DE
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Changoor S, Giakas A, Sacks K, Asma A, Lang RS, Yorgova P, Rogers K, Gabos PG, Shah SA. The Role of Liposomal Bupivacaine in Multimodal Pain Management Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: Faster and Farther With Less Opioids. Spine (Phila Pa 1976) 2024; 49:E11-E16. [PMID: 37159268 DOI: 10.1097/brs.0000000000004702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023]
Abstract
STUDY DESIGN Retrospective controlled cohort. OBJECTIVE To evaluate the effect of intraoperative liposomal bupivacaine (LB) infiltration on postsurgical pain management in adolescent idiopathic scoliosis (AIS) patients by analyzing postoperative opioid consumption, ambulation, and length of stay (LOS). SUMMARY OF BACKGROUND DATA Optimal postoperative pain control for AIS patients undergoing posterior spinal fusion (PSF) is challenging. Multimodal pain management protocols provide adequate analgesia while decreasing opioid consumption. LB was recently approved for pediatric patients; however, use in AIS patients is understudied. METHODS 119 consecutive patients with AIS who underwent PSF were included. Patients were divided into 2 groups: patients who received LB as erector spinae block in addition to the standard postoperative pain management protocol (Group A), and patients who received only the standard postoperative pain protocol (Group B). Oral morphine equivalents, intravenous opioid and valium consumption, pain scores (VAS), nausea/vomiting, ambulation distance and LOS were assessed. RESULTS Group A experienced significantly lower total opioid consumption compared to Group B (44.5 mg vs. 70.2 mg). Morphine use was lower in Group A on postoperative day (POD) 0, and oxycodone use was lower in Group A on PODs 1 and 2. There was a higher proportion of patients who used only oral opioids in Group A (81% vs. 41%). Of patients requiring any intravenous opioids, 79% did not receive LB. A significantly higher proportion of LB patients were discharged on POD 2 (55% vs. 27%); therefore, LOS was shorter for Group A. Group A ambulated further postoperatively. There were no differences in pain scores, valium requirements or nausea/vomiting. CONCLUSIONS LB was associated with decreased total opioid use, shorter LOS, and improved ambulation in AIS patients undergoing PSF. Including LB in multimodal pain management protocols proved effective in reducing opioid use while increasing mobilization in the immediate postoperative period. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Stuart Changoor
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, Paterson, NJ
| | - Alec Giakas
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Jefferson Health, Philadelphia, PA
| | - Karen Sacks
- Department of Anesthesia, Nemours Children's Health, Wilmington, DE
| | - Ali Asma
- Department of Orthopedic Surgery, Nemours Children's Health, Wilmington, DE
| | - R Scott Lang
- Department of Anesthesia, Nemours Children's Health, Wilmington, DE
| | - Petya Yorgova
- Department of Orthopedic Surgery, Nemours Children's Health, Wilmington, DE
| | - Kenneth Rogers
- Department of Orthopedic Surgery, Nemours Children's Health, Wilmington, DE
| | - Peter G Gabos
- Department of Orthopedic Surgery, Nemours Children's Health, Wilmington, DE
| | - Suken A Shah
- Department of Orthopedic Surgery, Nemours Children's Health, Wilmington, DE
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Gupta MC, Lenke LG, Gupta S, Farooqi AS, Boachie-Adjei O, Erickson MA, Newton PO, Samdani AF, Shah SA, Shufflebarger HL, Sponseller PD, Sucato DJ, Kelly MP. Intraoperative neuromonitoring predicts postoperative deficits in severe pediatric spinal deformity patients. Spine Deform 2024; 12:109-118. [PMID: 37555880 DOI: 10.1007/s43390-023-00745-3] [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: 02/02/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE To evaluate intraoperative monitoring (IOM) alerts and neurologic deficits during severe pediatric spinal deformity surgery. METHODS Patients with a minimum Cobb angle of 100° in any plane or a scheduled vertebral column resection (VCR) with minimum 2-year follow-up were prospectively evaluated (n = 243). Preoperative, immediate postoperative, and 2-year postoperative neurologic status were reported. Radiographic data included preoperative and 2-year postoperative coronal and sagittal Cobb angles and deformity angular ratios (DAR). IOM alert type and triggering event were recorded. SRS-22r scores were collected preoperatively and 2-years postoperatively. RESULTS IOM alerts occurred in 37% of procedures with three-column osteotomy (n = 36) and correction maneuver (n = 32) as most common triggering events. Patients with IOM alerts had greater maximum kyphosis (101.4° vs. 87.5°) and sagittal DAR (16.8 vs. 12.7) (p < 0.01). Multivariate regression demonstrated that sagittal DAR independently predicted IOM alerts (OR 1.05, 95% CI 1.02-1.08) with moderate sensitivity (60.2%) and specificity (64.8%) using a threshold value of 14.3 (p < 0.01). IOM alerts occurred more frequently in procedures with new postoperative neurologic deficits (17/24), and alerts with both SSEP and TCeMEP signals were associated with new postoperative deficits (p < 0.01). Most patients with new deficits experienced resolution at 2 years (16/20) and had equivalent postoperative SRS-22r scores. However, patients with persistent deficits had worse SRS-22r total score (3.8 vs. 4.2), self-image subscore (3.5 vs. 4.1), and function subscore (3.8 vs. 4.3) (p ≤ 0.04). CONCLUSION Multimodal IOM alerts are associated with sagittal kyphosis, and predict postoperative neurologic deficits. Most patients with new deficits experience resolution of their symptoms and have equivalent 2-year outcomes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Munish C Gupta
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 S. Euclid, Campus, Box 8233, Saint Louis, MO, 63110, USA.
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center New York, New York, USA
| | - Sachin Gupta
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ali S Farooqi
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Mark A Erickson
- Department of Orthopaedic Surgery, Children's Hospital Colorado, Aurora, USA
| | - Peter O Newton
- Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, USA
| | - Amer F Samdani
- Department of Orthopaedic Surgery, Shriners Hospitals for Children Philadelphia, Philadelphia, USA
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours/Alfred I duPont Hospital for Children, Wilmington, USA
| | - Harry L Shufflebarger
- Department of Orthopaedic Surgery, Paley Orthopedic and Spine Institute at St. Mary's Medical Center, West Palm Beach, USA
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, USA
| | - Daniel J Sucato
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, USA
| | - Michael P Kelly
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 S. Euclid, Campus, Box 8233, Saint Louis, MO, 63110, USA
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Lau D, Samdani AF, Pahys JM, Miyanji F, Shah SA, Lonner BS, Sponseller PD, Yaszay B, Hwang SW. Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis: A Comparative Analysis With 2-year Minimum Follow-up. Spine (Phila Pa 1976) 2023; 48:E374-E381. [PMID: 37000681 DOI: 10.1097/brs.0000000000004655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/31/2022] [Indexed: 04/01/2023]
Abstract
STUDY DESIGN Retrospective review of a prospectively collected multicenter database. OBJECTIVE To compare outcomes of patients with cerebral palsy (CP) who undergo surgery for scoliosis with normal lordosis (NL) versus hyperlordosis. SUMMARY OF BACKGROUND DATA Surgical correction of scoliosis with lumbar hyperlordosis is challenging. Hyperlordosis may confer higher perioperative morbidity, but this is not well understood. MATERIALS AND METHODS A multicenter database was queried for CP patients who underwent surgery from 2008 to 2017. The minimum follow-up was 2 years. Two groups were identified: lumbar lordosis <75° (NL) versus ≥ 75° hyperlordosis (HL). Perioperative, radiographic, and clinical outcomes were compared. RESULTS Two hundred seventy-five patients were studied: 236 NL and 39 HL (-75 to -125°). The mean age was 14.1 years, and 52.4% were male. Patients with hyperlordosis had less cognitive impairment (76.9% vs. 94.0%, P =0.008) and higher CPCHILD scores (59.4 vs. 51.0, P =0.003). Other demographics were similar between the groups. Patients with hyperlordosis had greater lumbar lordosis (-90.5 vs. -31.5°, P <0.001) and smaller sagittal vertical axis (-4.0 vs. 2.6 cm, P <0.001). Patients with hyperlordosis had greater estimated blood loss (2222.0 vs. 1460.7 mL, P <0.001) but a similar perioperative complication rate (20.5% vs. 22.5%, P =0.787). Significant correction of all radiographic parameters was achieved in both groups. The HL group had postoperative lumbar lordosis of -68.2° and sagittal vertical axis of -1.0 cm. At a 2-year follow-up, patients with hyperlordosis continued to have higher CPCHILD scores and gained the greatest benefit in overall quality of life measures (20.0 vs. 6.1, P =0.008). The reoperation rate was 10.2%: implant failure (3.6%), pseudarthrosis (0.7%), and wound complications (7.3%). There were no differences in the reoperation rate between the groups. CONCLUSION Surgical correction of scoliosis with hyperlordosis is associated with greater estimated blood loss but similar radiographic results, perioperative morbidity, and reoperation rate as normal lordosis. Patients with hyperlordosis gained greater overall health benefits. Correction of ≥25% of hyperlordosis seems satisfactory. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Darryl Lau
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY
| | | | | | - Firoz Miyanji
- Department of Orthopaedics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Suken A Shah
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Baron S Lonner
- Department of Orthopaedic Surgery, Mount Sinai Beth Israel Medical Center, New York, NY
| | - Paul D Sponseller
- Department of Orthopaedics, Johns Hopkins Children's Center, Baltimore, MD
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14
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Hosseini P, Akbarnia BA, Pawelek JB, Tran S, Zhang J, Johnston CE, Shah SA, Emans JB, Mundis GM, Yaszay B, Samdani AF, Sponseller PD, Sturm PF. Is spinal height gain associated with rod orientation and the use of cross-links in magnetically controlled growing rods in early-onset scoliosis? J Pediatr Orthop B 2023; 32:531-536. [PMID: 37278283 DOI: 10.1097/bpb.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Optimal orientation for magnetically controlled growing rods (MCGRs) is unclear. The objective of this study was to investigate associations of rod orientation with implant-related complications (IRCs) and spinal height gains. Using an international early-onset scoliosis (EOS) database, we retrospectively reviewed 57 patients treated with dual MCGRs from May 2013 to July 2015 with minimum 2-year follow-up. Outcomes of interest were IRCs and left/right rod length gains and thoracic (T1-T12) and spinal (T1-S1) heights. We compared patients with two rods lengthened in the cephalad ( standard; n = 18) versus opposite ( offset; n = 39) directions. Groups did not differ in age, sex, BMI, duration of follow-up, EOS cause, ambulatory status, primary curve magnitude, baseline thoracic height, or number of distractions/year. We compared patients whose constructs used ≥1 cross-link (CL group; n = 22) versus no CLs (NCL group; n = 35), analyzing thoracic height gains per distraction ( α = 0.05). Offset and standard groups did not differ in left or right rod length gains overall or per year or in thoracic or spinal height gain. Per distraction, the CL and NCL groups did not differ significantly in left or right rod length or thoracic or spinal height gain. Complications did not differ significantly between rod orientation groups or between CL groups. MCGR orientation and presence of cross-links were not associated with differences in rod length gain, thoracic height, spinal height, or IRCs at 2-year follow-up. Surgeons should feel comfortable using either MCGR orientation. Level of evidence: 3, retrospective.
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Affiliation(s)
| | - Behrooz A Akbarnia
- San Diego Spine Foundation, San Diego, California
- Department of Orthopaedic Surgery, University of California, San Diego School of Medicine, La Jolla, California
| | | | - Stacie Tran
- San Diego Spine Foundation, San Diego, California
| | - Justin Zhang
- San Diego Spine Foundation, San Diego, California
| | - Charles E Johnston
- Department of Orthopedics, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Suken A Shah
- Spine & Scoliosis Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - John B Emans
- Division of Spine Surgery, Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Gregory M Mundis
- San Diego Spine Foundation, San Diego, California
- Division of Spine Surgery, Department of Orthopedics, Scripps Clinic, La Jolla, California
| | - Burt Yaszay
- Department of Orthopedics, Rady Children's Hospital, San Diego, California
| | - Amer F Samdani
- Department of Orthopedics, Shriners Hospitals for Children, Philadelphia, Pennsylvania
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter F Sturm
- Department of Orthopaedics, Crawford Spine Center, Cincinnati Children's Hospital Medical Center, Crawford Spine Center, Cincinnati, Ohio, USA
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15
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Shrader MW, DiCindio S, Kenny KG, Franco AJ, Zhang R, Theroux MC, Rogers KJ, Shah SA. Transcranial electric motor evoked potential monitoring during scoliosis surgery in children with cerebral palsy and active seizure disorder: is it feasible and safe? Spine Deform 2023; 11:1461-1466. [PMID: 37458896 DOI: 10.1007/s43390-023-00730-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/21/2022] [Accepted: 06/24/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Use of spinal cord monitoring in children with cerebral palsy (CP) and neuromuscular scoliosis is challenging. The previous reports suggest low success rates in the setting of CP, and it is unclear if transcranial electric motor evoked potentials (TcMEP) monitoring is contraindicated in patients with an active seizure disorder. The purpose of this study was to determine (1) are patients with CP able to be appropriately monitored with TcMEP? and (2) does TcMEP cause an increase in seizure activity? METHODS This was an institutional review board-approved retrospective cohort study observing 304 patients from 2011 to 2020. Inclusion criteria included all patients with CP undergoing posterior spinal fusion during this time. Intraoperative data were examined for the ability to obtain monitoring and any intraoperative events. Patients were followed for 3 months postoperatively to determine any increase in seizure activity that could have been attributed to the TcMEP monitoring. RESULTS Of the 304 patients who were observed, 21% (20.8%) were unable to be monitored due to lacking baseline signals from the extremities. Seventy-seven percent (77.5%) were successfully monitored with TcMEP. For these patients, no increased seizure activity was documented either intra- or postoperatively. CONCLUSION A high percentage of children (77.5%) with CP were able to be successfully monitored with TcMEP during posterior spinal fusion. Furthermore, the concerns about increased seizure activity after TcMEP were not supported by the data from this cohort. Technical details of successful neuromonitoring in these patients are important and included increased stimulation voltage requirements and latency times. LEVEL OF EVIDENCE III retrospective comparative study.
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Affiliation(s)
- M Wade Shrader
- Department of Orthopaedics, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - Sabina DiCindio
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Alier J Franco
- Greater Delaware Valley Specialty Care, Philadelphia, PA, USA
| | - Ran Zhang
- Department of Orthopaedics, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Mary C Theroux
- Department of Orthopaedics, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Kenneth J Rogers
- Department of Orthopaedics, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Suken A Shah
- Department of Orthopaedics, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
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16
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Gupta MC, Lenke LG, Gupta S, Farooqi AS, Asghar JK, Boachie-Adjei O, Cahill PJ, Erickson MA, Garg S, Newton PO, Samdani AF, Shah SA, Shufflebarger HL, Sponseller PD, Sucato DJ, Bumpass DB, McCarthy RE, Yaszay B, Pahys JM, Ye J, Kelly MP. Perioperative Complications and Health-related Quality of Life Outcomes in Severe Pediatric Spinal Deformity. Spine (Phila Pa 1976) 2023; 48:1492-1499. [PMID: 37134134 DOI: 10.1097/brs.0000000000004696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
STUDY DESIGN Prospective multicenter cohort study. OBJECTIVE To evaluate perioperative complications and mid-term outcomes for severe pediatric spinal deformity. SUMMARY OF BACKGROUND DATA Few studies have evaluated the impact of complications on health-related quality of life (HRQoL) outcomes in severe pediatric spinal deformity. METHODS Patients from a prospective, multicenter database with severe pediatric spinal deformity (minimum of 100 degree curve in any plane or planned vertebral column resection (VCR)) with a minimum of 2-years follow-up were evaluated (n=231). SRS-22r scores were collected preoperatively and at 2-years postoperatively. Complications were categorized as intraoperative, early postoperative (within 90-days of surgery), major, or minor. Perioperative complication rate was evaluated between patients with and without VCR. Additionally, SRS-22r scores were compared between patients with and without complications. RESULTS Perioperative complications occurred in 135 (58%) patients, and major complications occurred in 53 (23%) patients. Patients that underwent VCR had a higher incidence of early postoperative complications than patients without VCR (28.9% vs. 16.2%, P =0.02). Complications resolved in 126/135 (93.3%) patients with a mean time to resolution of 91.63 days. Unresolved major complications included motor deficit (n=4), spinal cord deficit (n=1), nerve root deficit (n=1), compartment syndrome (n=1), and motor weakness due to recurrent intradural tumor (n=1). Patients with complications, major complications, or multiple complications had equivalent postoperative SRS-22r scores. Patients with motor deficits had lower postoperative satisfaction subscore (4.32 vs. 4.51, P =0.03), but patients with resolved motor deficits had equivalent postoperative scores in all domains. Patients with unresolved complications had lower postoperative satisfaction subscore (3.94 vs. 4.47, P =0.03) and less postoperative improvement in self-image subscore (0.64 vs. 1.42, P =0.03) as compared to patients with resolved complications. CONCLUSION Most perioperative complications for severe pediatric spinal deformity resolve within 2-years postoperatively and do not result in adverse HRQoL outcomes. However, patients with unresolved complications have decreased HRQoL outcomes.
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Affiliation(s)
- Munish C Gupta
- Department of Orthopaedic Surgery, Washington University in St Louis, St. Louis, MO
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center New York, New York, NY
| | - Sachin Gupta
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ali S Farooqi
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jahangir K Asghar
- Department of Orthopaedic Surgery, Miami Children's Hospital Miami, Miami, FL
| | | | - Patrick J Cahill
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mark A Erickson
- Department of Orthopaedic Surgery, Children's Hospital Colorado, Aurora, CO
| | - Sumeet Garg
- Department of Orthopaedic Surgery, Children's Hospital Colorado, Aurora, CO
| | - Peter O Newton
- Department of Orthopaedic Surgery, Rady Children's Hospital - San Diego, San Diego, CA
| | - Amer F Samdani
- Department of Orthopaedic Surgery, Shriners Hospitals for Children Philadelphia, Philadelphia, PA
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours/Alfred I duPont Hospital for Children, Wilmington, DE
| | - Harry L Shufflebarger
- Department of Orthopaedic Surgery, Paley Orthopedic and Spine Institute at St. Mary's Medical Center, West Palm Beach, FL
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Daniel J Sucato
- Texas Scottish Rite Hospital for Children, Department of Orthopaedic Surgery, Dallas, TX
| | - David B Bumpass
- Department of Orthopaedic Surgery, Arkansas Children's Hospital, Little Rock, AR
| | - Richard E McCarthy
- Department of Orthopaedic Surgery, Arkansas Children's Hospital, Little Rock, AR
| | - Burt Yaszay
- Department of Orthopaedic Surgery, Seattle Children's Hospital, Seattle, WA
| | - Joshua M Pahys
- Department of Orthopaedic Surgery, Shriners Hospitals for Children Philadelphia, Philadelphia, PA
| | - Jichao Ye
- Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Washington University in St Louis, St. Louis, MO
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Shah SA, Salehi H, Cavaillès V, Fernandez F, Cuisinier F, Collart-Dutilleul PY, Desoutter A. Characterization of rat vertebrae cortical bone microstructures using confocal Raman microscopy combined to tomography and electron microscopy. Ann Anat 2023; 250:152162. [PMID: 37774934 DOI: 10.1016/j.aanat.2023.152162] [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] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The rat vertebrae is a good model to study bone regeneration after implantation of biomaterials used to treat bone loss, a major problem in oral and dental surgery. However, the precise characterization of bone microstructures in the rat vertebrae has not been reported. Therefore, the aim of this study was to achieve the complete analysis of such bone, at different scales, in order to have a clear model of healthy bone for comparison with regenerated bone. METHODS In order to image the cortical bone of rat caudal vertebra, confocal Raman microscopy was combined with high resolution X-ray micro computed tomography (micro-CT), with scanning electron microscopy (SEM) using backscatter electron imaging and with more conventional histology coloration techniques. SEM and Raman microscopy were done in various regions of the cortical bone corresponding to external, middle and internal areas. The spongy bone was imaged in parallel. Micro-CT was performed on the whole vertebra to monitor the network of haversian canals in the cortical bone. Osteonic canals characteristics, and relative chemical composition were analysed in several regions of interest, in cortical and spongy bone. Five rats were included in this study. RESULTS On micro-CT images, differences in intensity were observed in the cortical bone, substantiated by SEM. Chemical analysis with Raman spectra confirmed the difference in composition between the different regions of the cortical and spongy bone. PCA and k-mean cluster analysis separated these groups, except for the external and middle cortical bone. Peak intensity ratio confirmed these results with a CO3 to ν2 PO4 ratio significantly different for the internal cortical bone. Grayscale images stack extracted from micro-CT showed that global architecture of cortical bone was characterized by a dense and complex network of haversian osteonic canals, starting from the surface towards the vertebrae center. The mean diameter of the canals was 18.4 µm (SD 8.6 µm) and the mean length was 450 µm (SD 152 µm). Finally, Raman reconstructed images of the lamellar bone showed an enlargement of the lamellar layer width, both in circumferential lamellar bone and around haversian canals. CONCLUSIONS Micro-CT and confocal Raman microscopy are good tools to complete classical analysis using optical and electron microscopy. The results and measurements presented in a rat model known for its small inter-individual differences provide the main characteristics of a mature bone. This study will allow the community working on this rat vertebrate model to have a set of characteristics, in particular on the structure of the haversian canals.
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Affiliation(s)
- S A Shah
- LBN, Univ. Montpellier, Montpellier, France
| | - H Salehi
- LBN, Univ. Montpellier, Montpellier, France
| | - V Cavaillès
- IRCM, INSERM U1194, Univ. Montpellier, Montpellier, France
| | | | - F Cuisinier
- LBN, Univ. Montpellier, Montpellier, France; UFR Odontologie, Univ. Montpellier, Montpellier, France
| | - P-Y Collart-Dutilleul
- LBN, Univ. Montpellier, Montpellier, France; UFR Odontologie, Univ. Montpellier, Montpellier, France; Service Odontologie, CHU de Montpellier, Montpellier, France
| | - A Desoutter
- LBN, Univ. Montpellier, Montpellier, France.
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Henstenburg J, Heard J, Jaynes L, Gnam A, Laughter K, Townsend W, Smyly A, Sukkarieh H, Shah SA, Brooks JT, McDonald TC. The Sanders Classification and Obesity: Do Obese Kids With AIS Present With More Advanced Skeletal Maturity? J Pediatr Orthop 2023; 43:e747-e750. [PMID: 37522471 DOI: 10.1097/bpo.0000000000002487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Obese and overweight (OOW) patients with adolescent idiopathic scoliosis (AIS) have been shown to initially present with a more advanced Risser score compared to normal weight (NW) patients. The Sanders Maturity Scale (SMS) is now more commonly used by surgeons to assist with treatment decisions because it more reliably predicts skeletal maturity. However, the relationship between SMS and obesity has not been described. We hypothesize that in patients with AIS, OOW patients will have a higher SMS score on initial presentation when compared to NW patients. METHODS Billing data from 2 different institutions were used to identify patients with AIS presenting to a pediatric orthopaedic spine surgeon for an initial visit between July 2012 and March 2020. We excluded those without height/weight data, spine radiographs, or left-hand radiographs for measuring SMS stage. Body mass index-for-age percentiles were calculated and used to group patients into NW (<85th percentile) or OOW (85th percentile and above) per Centers for Disease Control guidelines. After collecting preliminary data, a power analysis was performed using average SMS scores between NW and OOW patients with an alpha of 0.5, determining a needed sample size of approximately 300 male and 300 female subjects. RESULTS Five hundred ninety patients (296 female, 294 male) were identified. The SMS stage at presentation was significantly greater in OOW compared to NW patients for both females (5.9±1.8 vs. 5.2±1.7; P =0.003) and males (4.9±1.9 vs. 4.1±1.8; P =0.002). The major curve magnitude for OOW females was significantly different from NW females (36±16 degrees vs. 30±16 degrees; P =0.004). The major curve magnitude was not different for OOW and NW males ( P =0.3). CONCLUSION At initial presentation, OOW patients present at a greater skeletal maturity as measured by the SMS compared with NW patients. OOW female patients present with a greater major curve magnitudes than NW female patients. These results highlight negative implications of the pediatric obesity epidemic as it relates to the AIS population. These findings can be used to counsel families and provide anticipatory guidance for the AIS treatment plan. LEVEL OF EVIDENCE Level III-cross-sectional study.
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Affiliation(s)
| | - Jeremy Heard
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Lance Jaynes
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Ashley Gnam
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Kirk Laughter
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Will Townsend
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Aubrey Smyly
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Hamdi Sukkarieh
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE
| | - Jaysson T Brooks
- Department of Orthopaedic Surgery, Scottish Rite for Children/UT-Southwestern, Dallas, TX
| | - Tyler C McDonald
- Department of Orthopaedic Surgery, University of South Alabama Health, Mobile, AL
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Grabala P, Helenius IJ, Grabala M, Shah SA. Influences of Increasing Pedicle Screw Diameter on Widening Vertebral Pedicle Size during Surgery in Spinal Deformities in Children and Adolescents without Higher Risk of Pedicle and Vertebral Breaches. J Clin Med 2023; 12:5368. [PMID: 37629410 PMCID: PMC10455094 DOI: 10.3390/jcm12165368] [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] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND A very common technique for treating spinal deformities in children and adolescents is the use of segmental screws. In order to obtain proper stability and the best possible correction, the screws must first be precisely inserted. Additional factors influencing the quality and success of the operation are the size and quality of the bone, the skills of the surgeon, and biomechanical factors, i.e., the width and length of the screws used during surgery. Our study was focused on evaluating the effect of increasing the diameter of the instrumented pedicles by pedicle screws and assessing the safety of expanding these pedicles with screws of various sizes in children with spinal deformities during the growth period, using preoperative magnetic resonance imaging and postoperative computed tomography (CT) to assess and compare preoperative size measurements from MRI to postoperative CT measurements. METHODS We obtained data for evaluation from the available medical records and treatment histories of patients aged 2 to 18 who underwent surgical treatment of spinal deformities in the years 2016-2023. In 230 patients (28 male and 202 female), 7954 vertebral bodies were scanned by preoperative MRI, and 5080 pedicle screws were inserted during surgery, which were then assessed by postoperative CT scan. For the most accurate assessment, patients were classified into three age groups: 2-5 years (Group 1), 6-10 years (Group 2), and 11-18 years (Group 3). In addition, we studied implant subgroups: vertebral bodies with inserted pedicles of screw sizes 5.0 mm and 5.5 mm (Group S), and pedicles of screw sizes 6.0 mm, 6.5 mm, and 7.0 mm (Group L). RESULTS The morphology of pedicles (Lenke classification) analyzed before surgery using MRI was 55.2% type A, 33.8% type B, 4.7% type C, and 6.3% type D. The postoperative lateral and medial breaches were noted, and these did not cause any complications requiring revision surgery. The mean pedicle diameter before surgery for T1-L5 vertebral pedicles was between 3.79 (1.44) mm and 5.68 (1.64) mm. The mean expanding diameter of pedicles after surgery for T1-L5 vertebral pedicles ranged from 1.90 (0.39) mm to 2.92 (0.28) mm, which corresponds to the extension of the pedicle diameter in the mean range of 47% (4.1)-71% (3.0). We noted that the mean vertebral pedicle expansion was 49% in Group 1, 52% in Group 2, and 62% in Group 3 (N.S.), and the mean expansion for 7.0 mm screw pedicles was 78%. CONCLUSIONS Our study confirms that there is a wide range of expansion of the vertebral pedicle during screw insertion (up to 78%) with a low risk of lateral or medial breaches and without an increased risk of complications. The larger the diameter of the screw inserted into the pedicle, the more the pedicle expands. Pedicle measurements by preoperative MRI may be helpful for sufficient reliability in preoperative planning.
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Affiliation(s)
- Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, University Children’s Hospital, Waszyngtona 17, 15-274 Bialystok, Poland
| | - Ilkka J. Helenius
- Department of Orthopedics and Traumatology, Helsinki University Hospital, 00260 Helsinki, Finland;
| | - Michal Grabala
- 2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok, ul. M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland;
| | - Suken A. Shah
- Department of Orthopaedic Surgery, Nemours Children’s Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE 19803, USA;
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Hori Y, Kaymaz B, Almeida da Silva LC, Rogers KJ, Yorgova P, Gabos PG, Shah SA. Subclassification of Sanders Maturation Stage 3 Demonstrates Differences in Spine and Total Height Velocity Between 3A and 3B in Patients with Idiopathic Scoliosis. Spine (Phila Pa 1976) 2023:00007632-990000000-00411. [PMID: 37417724 DOI: 10.1097/brs.0000000000004772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
STUDY DESIGN A single-center retrospective case-control study. OBJECTIVE To compare the spine and total height velocity between Sanders maturation stage (SMS) 3A and 3B. SUMMARY OF BACKGROUND DATA Identifying SMS 3 is critical for treating growing children because it represents the early phase of rapid adolescent growth. However, there is limited literature available that clearly describes the growth differences between 3A and 3B. METHODS The current study included consecutive patients with idiopathic scoliosis staged SMS 3 from January 2012 to December 2021. T1-S1 spine height, total body height, and curve magnitude were measured at the initial and follow-up visits. In addition to the spine and total height velocity calculated per month, corrected height velocity was estimated for curve magnitude using a validated formula. Mann-Whitney U test was used to compare SMS 3A and 3B outcomes, followed by a multiple linear regression model to evaluate the association of the SMS subclassifications to growth velocity adjusted for confounding factors. RESULTS A total of 204 patients (66% girls, mean age: 12.3±1.3 y) met the inclusion criteria. Patients staged SMS 3A had higher spine height velocity (mm/month) in both girls (2.3 vs. 1.5, P<0.001) and boys (2.6 vs. 1.7, P<0.001), as well as total height velocity (mm/month; (5.8 vs. 4.3, P<0.001 for girls; 6.6 vs. 4.5, P<0.001 for boys). Corrected velocity showed similar results with greater spine and total height velocity in SMS 3A. Multivariate analysis indicated a significant association of the SMS subclassification to the spine and total height velocity. The scoliosis curve progression was comparable between SMS 3A and 3B. CONCLUSION SMS 3A and 3B had differential growth velocity in the spine and total body height. These results advocated the significance of SMS 3 subclassification for managing scoliosis treatment, including observation, bracing, and surgical interventions with fusion and growth modulation. LEVEL OF EVIDENCE Level III (Case-control study).
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Affiliation(s)
- Yusuke Hori
- Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE
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21
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Grabala P, Helenius IJ, Kowalski P, Grabala M, Zacha S, Deszczynski JM, Albrewczynski T, Galgano MA, Buchowski JM, Chamberlin K, Shah SA. The Child's Age and the Size of the Curvature Do Not Affect the Accuracy of Screw Placement with the Free-Hand Technique in Spinal Deformities in Children and Adolescents. J Clin Med 2023; 12:3954. [PMID: 37373646 DOI: 10.3390/jcm12123954] [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] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The current method of treatment of spinal deformities would be almost impossible without pedicle screws (PS) placement. There are only a few studies evaluating the safety of PS placement and possible complications in children during growth. The present study was carried out to evaluate the safety and accuracy of PS placement in children with spinal deformities at any age using postoperative computed tomography (CT) scans. METHODS 318 patients (34 males and 284 females) who underwent 6358 PS fixations for pediatric spinal deformities were enrolled in this multi-center study. The patients were divided into three age groups: less than 10 years old, 11-13 years old, and 14-18 years old. These patients underwent postoperative CT scans and were analyzed for pedicle screw malposition (anterior, superior, inferior, medial, and lateral breaches). RESULTS The breach rate was 5.92% for all pedicles. There were 1.47% lateral and 3.12% medial breaches for all pedicles with tapping canals, and 2.66% lateral and 3.84% medial breaches for all pedicles without a tapping canal for the screw. Of the 6358 screws placed in the thoracic, lumbar, and sacral spine, 98% of the screws were accurately placed (grade 0, 1, and juxta pedicular). A total of 56 screws (0.88%) breached more than 4 mm (grade 3), and 17 (0.26%) screws were replaced. No new and permanent neurological, vascular, or visceral complications were encountered. CONCLUSIONS The free-hand technique for pedicle screw placement in the acceptable and safety zone in pedicles and vertebral bodies was 98%. No complications associated with screw insertion in growth were noted. The free-hand technique for pedicle screw placement can be safely used in patients at any age. The screw accuracy does not depend on the child's age nor the size of the deformity curve. Segmental instrumentation with posterior fixation in children with spinal deformities can be performed with a very low complication rate. Navigation of the robot is only an auxiliary tool in the hands of the surgeons, and the result of the work ultimately depends on the surgeons.
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Affiliation(s)
- Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, University Children's Hospital, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
| | - Ilkka J Helenius
- Department of Orthopedics and Traumatology, Helsinki University Hospital, 00260 Helsinki, Finland
| | - Piotr Kowalski
- Department of Neurosurgery, Regional Specialized Hospital, Ul. Dekerta 1, 66-400 Gorzow Wielkopolski, Poland
| | - Michal Grabala
- 2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok, Ul. Marii Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Slawomir Zacha
- Department of Pediatric Orthopedics and Oncology of the Musculoskeletal System, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
| | - Jaroslaw M Deszczynski
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
- Department of Orthopedics and Rehabilitation, Warsaw Medical University, 02-091 Warsaw, Poland
| | | | - Michael A Galgano
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Jacob M Buchowski
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA
| | - Kelly Chamberlin
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours Children's Health, Delaware Valley,1600 Rockland Road, Wilmington, DE 19803, USA
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22
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Benes G, Shufflebarger HL, Shah SA, Yaszay B, Marks MC, Newton PO, Sponseller PD. Late Infection After Spinal Fusion for Adolescent Idiopathic Scoliosis: Implant Exchange Versus Removal. J Pediatr Orthop 2023:01241398-990000000-00293. [PMID: 37253710 DOI: 10.1097/bpo.0000000000002440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Late infection after posterior spinal arthrodesis for adolescent idiopathic scoliosis (AIS) is the leading cause of late revision. While implant removal and antibiotic therapy are usually curative, patients may experience deformity progression. The goal of this study was to compare outcomes after implant exchange (IE) or removal (IR) to treat late-onset (≥1 y postoperative) deep surgical site infection (SSI) after spinal arthrodesis in patients with AIS. METHODS Using a multicenter AIS registry, patients who underwent posterior spinal fusion between 2005 and 2019 and developed late deep SSI treated with IE or IR were identified. Radiographic, surgical, clinical, and patient-reported outcomes at most recent follow-up were compared. RESULTS Of 3,705 patients, 47 (1.3%) developed late infection 3.8±2.2 years (range 1 to 9.7 y) after index surgery. Mean follow-up after index surgery was 6.1 years, with 2.8 years (range 25 to 120 mo) of follow-up after revision surgery. Twenty-one patients were treated with IE and 26 with IR. At the latest follow-up, average major-curve loss of correction (1° vs 9°, P<0.001) and increase in kyphosis (1° vs. 8°, P=0.04) were smaller in the IE group than in the IR group. Two IR patients but no IE patients had reoperation. Patients who underwent IE had higher Scoliosis Research Society 22-Item Patient Questionnaire (SRS-22) total scores (4.38 vs. 3.81, P=0.02) as well as better subscores for self-image, function, and satisfaction at the latest follow-up than those who underwent IR only. There were no significant between-group differences in operative duration, estimated blood loss, length of hospital stay, or changes in SRS-22 total scores. No patient had a subsequent infection during the follow-up period. CONCLUSIONS When treating late-onset deep SSI after posterior spinal fusion for AIS, single-stage IE is associated with better maintenance of major curve correction, sagittal profile, and patient-reported outcomes and fewer reoperations compared with IR, with no significant differences in blood loss, operative duration, or length of stay. No time interval from index surgery to IR was observed where the corrected deformity remained stable. Both techniques were curative of infection. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Gregory Benes
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | | | - Suken A Shah
- Department of Orthopedic Surgery, Nemours Children's Health, Wilmington, DE
| | - Burt Yaszay
- Department of Orthopedics, Rady Children's Hospital of San Diego, San Diego, CA
| | | | - Peter O Newton
- Department of Orthopedics, Rady Children's Hospital of San Diego, San Diego, CA
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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23
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Stone LE, Upasani VV, Pahys JM, Fletcher ND, George SG, Shah SA, Bastrom TP, Bartley CE, Lenke LG, Newton PO, Kelly MP. SRS-22r Self-Image After Surgery for Adolescent Idiopathic Scoliosis at 10-year Follow-up. Spine (Phila Pa 1976) 2023; 48:683-687. [PMID: 36917707 DOI: 10.1097/brs.0000000000004620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/13/2023] [Indexed: 03/16/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To examine SRS-Self Image scores at up to 10 years after surgery for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Self-image is complex with implications for surgical and patient-reported outcomes after AIS surgery. Surgically modifiable factors that impact self-image are inconsistently reported in the literature with few longer-term reports. We examined the rate and durability of self-image improvement. MATERIALS AND METHODS An AIS registry was queried for patients with up to 10 years of follow-up after AIS surgery. A mixed effects model estimated change in SRS-22 Self Image from baseline to 6 weeks, 1 year, 2 years, 5 years, and 10 years. All enrolled patients contributed data to the mixed effects models. A sub-analysis of patients with 1-year and 10-year follow-up evaluated worsening/static/improved SRS-22 Self Image scores examined stability of scores over that timeline. Baseline demographic data and 1-year deformity magnitude data were compared between groups using parametric and nonparametric tests as appropriate. RESULTS Data from 4608 patients contributed data to the longitudinal model; 162 had 1-year and 10-year data. Mean SRS-Self Image improvement at 10-year follow-up was 1.0 (95% CI: 0.9-1.1) point. No significant changes in Self-Image domain scores were estimated from 1-year to 10-year (all P >0.05) postoperative. Forty (25%) patients had SRS-Self Image worsening from 1 year to 10 years, 36 (22%) improved, and 86 (53%) were unchanged. Patients who worsened over 10 years had lower SRS-Self Image at baseline than those unchanged at enrollment (3.3 vs. 3.7, P =0.007). Neither radiographic parameters nor SRS-Mental Health were different at baseline for the enrolled patients. CONCLUSION Ten years after surgery, 75% of patients reported similar or better SRS-Self Image scores than one year after surgery. Nearly 25% of patients reported worsening self-image at 10 years. Patients who worsened had lower baseline SRS-Self Image scores, without radiographic or mental health differences at baseline or follow-up.
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Affiliation(s)
- Lauren E Stone
- Department of Neurological Surgery, University of California, San Diego, San Diego, CA
| | - Vidyadhar V Upasani
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, CA
| | - Joshua M Pahys
- Department of Orthopedic Surgery, Shriners Hospitals for Children, Philadelphia, PA
| | | | - Stephen G George
- Department of Orthopedic Surgery, Nicklaus Children's Hospital, Miami, FL
| | - Suken A Shah
- Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Tracey P Bastrom
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, CA
| | - Carrie E Bartley
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, CA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University, New York, NY
| | - Peter O Newton
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, CA
| | - Michael P Kelly
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, CA
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24
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Badin D, Baldwin KD, Cahill PJ, Spiegel DA, Shah SA, Yaszay B, Newton PO, Sponseller PD. When to Perform Fusion Short of the Pelvis in Patients with Cerebral Palsy?: Indications and Outcomes. JB JS Open Access 2023; 8:JBJSOA-D-22-00123. [PMID: 37073271 PMCID: PMC10106181 DOI: 10.2106/jbjs.oa.22.00123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Patients with scoliosis secondary to cerebral palsy (CP) are often treated with posterior spinal fusion (PSF) with or without pelvic fixation. We sought to establish criteria to guide the decision of whether or not to perform fusion "short of the pelvis" in this population, and to assess differences in outcomes. Methods Using 2 prospective databases, we analyzed 87 pediatric patients who underwent PSF short of the pelvis from 2008 to 2015 to treat CP-related scoliosis and who had ≥2 years of follow-up. Preoperative radiographic and clinical variables were analyzed for associations with unsatisfactory correction (defined as pelvic obliquity of ≥10°, distal implant dislodgement, and/or reoperation for increasing deformity at 2- or 5-year follow-up). Continuous variables were dichotomized using the Youden index, and a multivariable model of predictors of unsatisfactory correction was created using backward stepwise selection. Finally, radiographic, health-related quality-of-life, and clinical outcomes of patients with fusion short of the pelvis who had neither of the 2 factors associated with unsatisfactory outcomes were compared with those of 2 matched-control groups. Results Deformity correction was unsatisfactory in 29 of 87 patients with fusion short of the pelvis. The final model included preoperative pelvic obliquity of ≥17° (odds ratio [OR], 6.8; 95% confidence interval [CI], 2.3 to 19.7; p < 0.01) and dependent sitting status (OR, 3.2; 95% CI, 1.1 to 9.9; p = 0.04) as predictors of unsatisfactory correction. The predicted probability of unsatisfactory correction increased from 10% when neither of these factors was present to a predicated probability of 27% to 44% when 1 was present and to 72% when both were present. Among matched patients with these factors who had fusion to the pelvis, there was no association with unsatisfactory correction. Patients with independent sitting status and pelvic obliquity of <17° who had fusion short of the pelvis had significantly lower blood loss and hospital length of stay, and better 2-year health-related quality-of-life scores compared with matched controls with fusion to the pelvis. Conclusions In patients with scoliosis secondary to CP, pelvic obliquity of <17° and independent sitting status are associated with a low risk of unsatisfactory correction and better 2-year outcomes when fusion short of the pelvis is performed. These may be used as preoperative criteria to guide the decision of whether to perform fusion short of the pelvis in patients with CP. Level of Evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel Badin
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Keith D. Baldwin
- Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Patrick J. Cahill
- Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David A. Spiegel
- Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Suken A. Shah
- Department of Orthopedic Surgery, Nemours Children’s Hospital, Wilmington, Delaware
| | - Burt Yaszay
- Department of Orthopedics and Sports Medicine, Seattle Children’s Hospital and University of Washington, Seattle, Washington
| | - Peter O. Newton
- Department of Orthopedics, Rady Children’s Hospital and University of California-San Diego Medical Center, San Diego, California
| | - Paul D. Sponseller
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
- Email for corresponding author:
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25
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Li H, Shah SA, Srimath Kandada AR, Silva C, Piryatinski A, Bittner ER. The Optical Signatures of Stochastic Processes in Many-Body Exciton Scattering. Annu Rev Phys Chem 2023; 74:467-492. [PMID: 36854178 DOI: 10.1146/annurev-physchem-102822-100922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
We review our recent quantum stochastic model for spectroscopic lineshapes in the presence of a coevolving and nonstationary background population of excitations. Starting from a field theory description for interacting bosonic excitons, we derive a reduced model whereby optical excitons are coupled to an incoherent background via scattering as mediated by their screened Coulomb coupling. The Heisenberg equations of motion for the optical excitons are then driven by an auxiliary stochastic population variable, which we take to be the solution of an Ornstein-Uhlenbeck process. Here, we present an overview of the theoretical techniques we have developed as applied to predicting coherent nonlinear spectroscopic signals. We show how direct (Coulomb) and exchange coupling to the bath give rise to distinct spectral signatures and discuss mathematical limits on inverting spectral signatures to extract the background density of states. Expected final online publication date for the Annual Review of Physical Chemistry, Volume 74 is April 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Hao Li
- Department of Chemistry, University of Houston, Houston, Texas, USA;
| | - S A Shah
- Department of Chemistry, University of Houston, Houston, Texas, USA;
| | - Ajay Ram Srimath Kandada
- Department of Physics and Center for Functional Materials, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Carlos Silva
- School of Chemistry and Biochemistry, School of Physics, and School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Andrei Piryatinski
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Eric R Bittner
- Department of Chemistry, University of Houston, Houston, Texas, USA;
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Catanzano AA, Sponseller PD, Newton PO, Bastrom TP, Bartley CE, Shah SA, Cahill PJ, Group HS, Yaszay B. Beware of open triradiate cartilage: 1 in 4 patients will lose > 10° of correction following posterior only fusion. Spine Deform 2023; 11:133-138. [PMID: 35978156 DOI: 10.1007/s43390-022-00565-x] [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: 02/17/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE As 2-year follow-up may not be sufficient to assess the risk of curve progression following fusion in immature patients with adolescent idiopathic scoliosis (AIS), this study reports on 5-year outcomes of AIS patients, factoring in maturity and surgical approach, to determine whether immature patients are at risk of continued curve progression beyond 2 years. METHODS A multicenter database was reviewed for AIS patients who underwent spinal fusion with pedicle screw fixation and who had both 2 and 5-year follow-up. Radiographic and SRS-22 scores were compared between three groups: open triradiate cartilage-posterior fusion (OTRC-P), OTRC-combined anterior/posterior fusion (OTRC-APSF), and closed TRC (CTRC, matched to OTRC-P group). RESULTS 142 subjects were included (67 OTRC-P, 8 OTRC-APSF, 67 CTRC). Main curve type (p = 0.592) and size (p = 0.117) were not different between groups at all timepoints. Compensatory curve size was similar at all timepoints for OTRC-P and CTRC, with a slight increase for OTRC-APSF from immediate postoperative to 5 years. At 5 years, OTRC-P had > 10° loss of correction in 25% of patients, which was greater than in the CTRC (6%) and OTRC-APSF (0%) groups (p = 0.002). No significant differences were found in loss of correction of the compensatory curve or in SRS-22 scores between groups. CONCLUSIONS Compared to those with CTRC and those treated with anterior/posterior fusion, patients with OTRC treated with posterior fusion had an increased risk of main curve progression greater than 10°, with some continued loss of correction after 2 years. This did not appear to affect patient-reported outcomes.
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Affiliation(s)
- Anthony A Catanzano
- Department of Orthopedics, Duke Children's Hospital and Health Center, Durham, NC, USA
| | - Paul D Sponseller
- Department of Orthopedics, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - Peter O Newton
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA.,Department of Orthopedics, University of California, San Diego, CA, USA
| | - Tracey P Bastrom
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA
| | - Carrie E Bartley
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA
| | - Suken A Shah
- Department of Orthopedics, Nemours Children's Hospital, Wilmington, DE, USA
| | - Patrick J Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Burt Yaszay
- Division of Orthopedics and Sports Medicine, Seattle Children's Hospital, M/S OA.9.120, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.
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27
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Newton PO, Parent S, Miyanji F, Alanay A, Lonner BS, Neal KM, Hoernschemeyer DG, Yaszay B, Blakemore LC, Shah SA, Bastrom TP. Anterior Vertebral Body Tethering Compared with Posterior Spinal Fusion for Major Thoracic Curves. J Bone Joint Surg Am 2022; 104:2170-2177. [PMID: 37010479 DOI: 10.2106/jbjs.22.00127] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Anterior vertebral body tethering (AVBT) is an alternative to posterior spinal fusion (PSF) for the surgical treatment of scoliosis. The present study utilized a large, multicenter database and propensity matching to compare outcomes of AVBT to PSF in patients with idiopathic scoliosis. METHODS Patients with thoracic idiopathic scoliosis who underwent AVBT with a minimum 2-year follow-up retrospectively underwent 2 methods of propensity-guided matching to PSF patients from an idiopathic scoliosis registry. Radiographic, clinical, and Scoliosis Research Society 22-Item Questionnaire (SRS-22) data were compared preoperatively and at the ≥2-year follow-up. RESULTS A total of 237 AVBT patients were matched with 237 PSF patients. In the AVBT group, the mean age was 12.1 ± 1.6 years, the mean follow-up was 2.2 ± 0.5 years, 84% of patients were female, and 79% of patients had a Risser sign of 0 or 1, compared with 13.4 ± 1.4 years, 2.3 ± 0.5 years, 84% female, and 43% Risser 0 or 1 in the PSF group. The AVBT group was younger (p < 0.001), had a smaller mean thoracic curve preoperatively (48 ± 9°; range, 30° to 74°; compared with 53 ± 8°; range, 40° to 78° in the PSF group; p < 0.001), and had less initial correction (41% ± 16% correction to 28° ± 9° compared with 70% ± 11% correction to 16° ± 6° in the PSF group; p < 0.001). Thoracic deformity at the time of the latest follow-up was 27° ± 12° (range, 1° to 61°) for AVBT compared with 20° ± 7° (range, 3° to 42°) for PSF (p < 0.001). A total of 76% of AVBT patients had a thoracic curve of <35° at the latest follow-up compared with 97.4% of PSF patients (p < 0.001). A residual curve of >50° was present in 7 AVBT patients (3%), 3 of whom underwent subsequent PSF, and in 0 PSF patients (0%). Forty-six subsequent procedures were performed in 38 AVBT patients (16%), including 17 conversions to PSF and 16 revisions for excessive correction, compared with 4 revision procedures in 3 PSF patients (1.3%; p < 0.01). AVBT patients had lower median preoperative SRS-22 mental-health component scores (p < 0.01) and less improvement in the pain and self-image scores between preoperatively and the ≥2-year follow-up (p < 0.05). In the more strictly matched analysis (n = 108 each), 10% of patients in the AVBT group and 2% of patients in the PSF group required a subsequent surgical procedure. CONCLUSIONS At a mean follow-up of 2.2 years, 76% of thoracic idiopathic scoliosis patients who underwent AVBT had a residual curve of <35° compared with 97.4% of patients who underwent PSF. A total of 16% of cases in the AVBT group required a subsequent surgical procedure compared with 1.3% in the PSF group. An additional 4 cases (1.3%) in the AVBT group had a residual curve of >50° that may require revision or conversion to PSF. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Peter O Newton
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, California
| | - Stefan Parent
- Department of Orthopaedics, CHU Sainte-Justine, Montreal, Québec, Canada
- Department of Surgery, University of Montreal, Montréal, Québec, Canada
| | - Firoz Miyanji
- Department of Orthopaedics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Baron S Lonner
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY
| | - Kevin M Neal
- Department of Orthopedic Surgery, Nemours Children's Health, Jacksonville, Florida
| | | | - Burt Yaszay
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Laurel C Blakemore
- Division of Pediatric Orthopedics, Pediatric Specialists of Virginia, Virginia
| | - Suken A Shah
- Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Tracey P Bastrom
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, California
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Howard R, Sponseller PD, Shah SA, Miyanji F, Samdani AF, Newton PO, Yaszay B. Definitive fusion for scoliosis in late juvenile cerebral palsy patients is durable at 5 years postoperatively. Spine Deform 2022; 10:1423-1428. [PMID: 35713874 DOI: 10.1007/s43390-022-00530-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/21/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Given the challenges associated with managing progressive scoliosis in patients with cerebral palsy (CP), the purpose of this study was to evaluate deformity correction and HRQOL 5 years post-spinal fusion in CP patients who were skeletally immature at the time of surgical correction. METHODS CP patients who underwent definitive fusion before age 11 with minimum 5-years follow-up from a prospective, multicenter registry were included. Preoperative, initial postoperative, and 5-years radiographic data were collected. Preoperative and 5-years demographic, surgical data, complications, and CPCHILD outcome scores were analyzed. Repeated measures ANOVA with Bonferroni adjustment were used to analyze radiographic measures. Paired t test was utilized to compare outcomes. Significance was set at p = 0.05. RESULTS Twenty patients met inclusion-17 females, 3 males. The mean age was 9 (range 8-10) years. Eight-five percent had spastic CP with GMFCS Level V. Eighteen patients underwent posterior fusion; distal fixation was to the ilium in 80% and to L4-S1 in 20%. Significant correction of the primary curve (p ≤ 0.001) and pelvic obliquity (p ≤ 0.001) were obtained. From initial postoperative to 5-years follow-up there were no significant changes in major curve magnitude (p = 0.638), thoracic kyphosis (p = 0.09) or pelvic obliquity (p = 0.28). CPCHILD personal care, mobility, comfort, and total scores improved from preoperative to 5-years (p < 0.05). One patient needed a reoperation. CONCLUSION Surgical decision making for scoliosis in patients with CP can be difficult given the desire to maximize growth while minimizing adverse events. Performing a definitive fusion is a viable option that achieves good correction which remains stable 5 years postoperatively.
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Affiliation(s)
- Roland Howard
- Department of Orthopedics, University of California, San Diego, CA, USA
| | - Paul D Sponseller
- Department of Orthopedics, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - Suken A Shah
- Nemours Children's Hospital, Wilmington, DE, USA
| | - Firoz Miyanji
- Department of Orthopedics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Amer F Samdani
- Department of Orthopedics, Shriners Hospitals for Children-Philadelphia, Philadelphia, PA, USA
| | - Peter O Newton
- Department of Orthopedics, University of California, San Diego, CA, USA
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA
| | - Burt Yaszay
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, M/S OA.9.120, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.
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Ulusaloğlu AC, Asma A, Bowen JR, Shah SA, Shah SA. Three different techniques for pelvic fixation in the management of neuromuscular scoliosis in nonambulatory spastic cerebral palsy: A comparative study of Galveston Rod, iliac screw, and sacroiliac screw. Acta Orthop Traumatol Turc 2022; 56:372-376. [PMID: 36567539 PMCID: PMC9885728 DOI: 10.5152/j.aott.2022.22080] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to compare the clinical and radiographic results of three different pelvic fixation techniques, i.e., Galveston Rod, Iliac Screw, and Sacroiliac Screw, in managing neuromuscular scoliosis in nonambulatory children with spastic cerebral palsy (CP). METHODS This retrospective study included nonambulatory children aged < 18 years with neuromuscular scoliosis secondary to CP, undergoing a spinal fusion and pelvic fixation by either Galveston rod, iliac screw, or sacroiliac screw techniques. The primary outcome variable was to determine the stability of the major curve angle and pelvic obliquity over timeline intervals for each pelvic fixation tech nique. The two radiographic parameters were measured at five timeline intervals and were compared to define stability among the groups. RESULTS One hundred and one patients (54 females [53%]) with spastic nonambulatory CP met the inclusion criteria; the mean age at sur gery was 13.5±3.1 years. Mean follow-up intervals were first-year (12.9±1.5) and second-year (25.8±2.5). Forty-one patients had minimum five-year (81.5±23 months) postoperative follow-up. Groups were based on pelvic fixation techniques: 25 patients with the Galveston rod, 24 with the iliac screw, and 52 with the sacroiliac screw. Of the 41 patients with a minimum five-year follow-up, 10 had the Galveston rod, 11 had an iliac screw, and 20 had sacroiliac screw fixation. Gross Motor Function Classification System level, medical comorbidities, intra thecal baclofen pump, and vitamin D level were compared with each pelvic fixation technique (P > .05). Major curve angle parameters were measured at the five timelines as 70.5°±21.1°, 15.7°±13°, 15.7°±12°, 17.5°±12.7°, and 15.1°±9.6°, and pelvic obliquity as 14.8°±10.4°, 4.9°±4.2°, 5.7°±4.6°, 5°±4.4°, and 7.2°±4.4°, respectively. After the surgery, corrected major curve angle and pelvic obliquity showed no sta tistically significant difference between pelvic fixation techniques (P > .05) and remained stable over timeline intervals (P > .05). Fifteen patients had complications requiring additional surgery. The iliac screw group (nine patients) had the highest rate of complications. CONCLUSION All three pelvic fixation techniques can provide equivalent correction for major curve angle and pelvic obliquity in managing neuromuscular scoliosis in nonambulatory CP children. Pelvic obliquity after surgery may remain stable regardless of pelvic fixation type. A higher rate of postoperative complication can be encountered with the iliac screw. LEVEL OF EVIDENCE Level III, Retrospective Study.
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Catanzano AA, Newton PO, Bastrom TP, Bartley CE, Parent S, Miyanji F, Hoernschemeyer DG, Alanay A, Blakemore L, Neal K, Lonner B, Haber L, Shah SA, Yaszay B. Spontaneous Lumbar Curve Correction Following Vertebral Body Tethering of Main Thoracic Curves. J Bone Joint Surg Am 2022; 104:1629-1638. [PMID: 35852153 DOI: 10.2106/jbjs.21.01500] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Growth modulation through anterior vertebral body tethering (AVBT) has emerged as a fusionless option for the treatment of progressive scoliosis. When tethering the main thoracic curve, the compensatory thoracolumbar/lumbar curve must correct indirectly as a result. The present study evaluated the response of these lumbar curves following AVBT of the main thoracic curves. METHODS Patients who underwent thoracic AVBT and who had a minimum follow-up of 2 years were included. Magnitudes of the thoracic and lumbar curves were recorded preoperatively and at the first-erect and 2-year postoperative visits. Lumbar curves were further stratified according to their lumbar modifier (A, B, or C). Analysis of variance (ANOVA) and repeated-measures ANOVA were performed to compare correction rates, and the Pearson coefficient was utilized to determine the correlation between the tethered thoracic curve and uninstrumented lumbar curve magnitudes. RESULTS A total of 218 patients were included. Thoracic curve correction was 40% at the first-erect visit and 43% at 2 years (p = 0.012). Lumbar correction was 30%, 26%, and 18% at the first-erect visit (p < 0.001 for all compared with preoperatively) and minimally changed at 31%, 26%, and 24% at 2 years for lumbar modifiers A, B, and C, respectively. A total of 118 patients (54%) showed thoracic curve improvement between the first-erect and 2-year visits. In a subgroup analysis, these patients had a correction in lumbar curve magnitude from preoperatively to the first-erect visit of 30%, 22%, and 16% for lumbar modifiers A, B, C, respectively, that increased to 42%, 34%, and 31% at 2 years, with strong correlation to thoracic correction at 2-year follow-up (r = 0.557, p < 0.001). CONCLUSIONS Although there was immediate lumbar correction following AVBT of a main thoracic curve, further improvement following initial correction was only observed among patients with growth modulation of the thoracic curve. Considering all patients, the uninstrumented lumbar curve corrected 30% at 2 years and the instrumented thoracic curve corrected 40%. As indications for AVBT are refined, these data will provide insight into the response of the uninstrumented lumbar curve. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anthony A Catanzano
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, California
| | - Peter O Newton
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, California
| | - Tracey P Bastrom
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, California
| | - Carrie E Bartley
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, California
| | - Stefan Parent
- Department of Orthopaedics, CHU Sainte-Justine, Montreal, Quebec, Canada
- Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Firoz Miyanji
- Department of Orthopaedics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Laurel Blakemore
- Division of Pediatric Orthopedics, Pediatric Specialists of Virginia, Fairfax, Virginia
| | - Kevin Neal
- Department of Orthopedic Surgery, Nemours Children's Health, Jacksonville, Florida
| | - Baron Lonner
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY
| | - Lawrence Haber
- Department of Orthopedics, Ochsner Hospital for Children, Ochsner Medical Center, New Orleans, Louisiana
| | - Suken A Shah
- Department of Orthopedics, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Burt Yaszay
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington
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Lindgren AM, Bastrom TP, Bartley CE, Samdani AF, Shah SA, Miyanji F, Cahill PJ, Upasani VV, Newton PO, Yaszay B, Jain A, Lonner B, Roye B, Yaszay B, Reilly C, Hedequist D, Sucato D, Clements D, Miyanji F, Shufflebarger H, Flynn J, Asghar J, Mac Thiong JM, Pahys J, Harms J, Bachmann K, Lenke L, Karol L, Abel M, Erickson M, Glotzbecker M, Kelly M, Vitale M, Marks M, Gupta M, Fletcher N, Larson N, Cahill P, Sponseller P, Gabos P, Newton P, Sturm P, Betz R, Parent S, George S, Hwang S, Shah S, Garg S, Errico T, Upasani V, Yaszay B. Preoperative factors associated with optimal outcomes of selective thoracic fusion at 5 years. Spine Deform 2022; 10:1117-1122. [PMID: 35380352 DOI: 10.1007/s43390-022-00500-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/31/2021] [Accepted: 03/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Prior work identified optimal outcomes at 2 years following selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS) but it is unclear whether these published predictors represent what is required to achieve an optimal outcome with further time and potential growth. The purpose of this study was to determine the preoperative factors associated with optimal outcome of STF for AIS at 5 years. METHODS Patients with primary thoracic AIS (Lenke 1-4C curves) who underwent a STF and had minimum 5 years of follow-up were included. Optimal postoperative outcomes for a STF included a deformity-flexibility quotient (DFQ) < 4, lumbar curve < 26°, lumbar correction > 37%, C7-CSVL < 2 cm, lumbar prominence < 5°, and trunk shift < 1.5 cm. These outcomes were used to determine whether adhering to published recommendations for STF increased the likelihood of obtaining an optimal outcome at 5 years, which included: preoperative lumbar curve < 45°, lumbar bend < 25°, apical vertebral translation ratio > 1.2, and thoracic/thoracolumbar Cobb ratio > 1.2. RESULTS 127 patients met inclusion. A preoperative lumbar curve < 45° was associated with an increased likelihood of achieving three of the optimal outcomes: DFQ < 4, lumbar curve < 26°, and lumbar prominence < 5°. Following the 25° bend rule resulted in two optimal outcomes, while Cobb ratio > 1.2 was only associated with one optimal outcome. AVT > 1.2 was not significantly associated with any optimal outcome measures. CONCLUSION This study found that at 5 years, performing a STF when there is a preoperative lumbar Cobb < 45° remained the best guideline for increasing the likelihood of an optimal outcome.
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Affiliation(s)
- Amelia M Lindgren
- Department of Orthopedics, University of California, San Diego, CA, USA
| | - Tracey P Bastrom
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, USA
| | - Carrie E Bartley
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, USA
| | - Amer F Samdani
- Department of Orthopedics, Shriners Hospital for Children, Philadelphia, PA, USA
| | - Suken A Shah
- Spine and Scoliosis Center, Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Firoz Miyanji
- Department of Orthopedics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Patrick J Cahill
- Department of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Vidyadhar V Upasani
- Department of Orthopedics, University of California, San Diego, CA, USA.,Division of Orthopedics and Scoliosis, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, USA
| | - Peter O Newton
- Department of Orthopedics, University of California, San Diego, CA, USA.,Division of Orthopedics and Scoliosis, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, USA
| | | | - Burt Yaszay
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, M/S OA.9.120, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.
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Ulusaloglu AC, Asma A, Bowen JR, Yorgova P, Howard JJ, Shrader MW, Shah SA. Prevalence and Risk Factors Associated With Pelvic Rod/Screw Radiographic Lucency Following Scoliosis Surgery in Spastic Cerebral Palsy: A Longitudinal Study. J Pediatr Orthop 2022; 42:e736-e741. [PMID: 35650685 DOI: 10.1097/bpo.0000000000002173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radiographic lucency around a smooth pelvic rod (Galveston/unit rod technique) or sacroiliac/iliac screw following spinal fusion in children with nonambulatory spastic cerebral palsy (CP) has been described as a "windshield wiper" phenomenon. We evaluated demographics, radiographs, and complications in 101 cases from a single center to determine prevalence, risk factors, and complications associated with persistent radiographic lucency from 1 to 5 years following spinal fusion. METHODS Inclusion criteria were diagnosis of nonambulatory spastic quadriplegic CP [Gross Motor Function Classification System (GMFCS) IV-V], under 18 years of age, scoliosis treated by posterior fusion from upper thoracic to sacrum with pelvic fixation (Galveston rod, iliac screw, or sacroiliac screw), adequate radiographs (preoperative, immediate postoperative, first-year, and second-year), and minimum 5-year follow-up. We evaluated demographics, radiographic parameters, comorbidities, scoliosis curve type, type of pelvic screw/rod, use of off-set connector, screw width, associated with posterior column osteotomy and/or additional anterior spinal release concurrent with posterior spine fusion, and infection over the follow-up period. Specific attention was given to the area and shape of the radiographic lucency. The logistic regression analysis was performed for continuous and categorical variables to define risk factors ( P =0.05). RESULTS In 101 patients, data were collected at mean intervals of 1-year, 2-year, and >5-year follow-up and were 12.9±1.5, 25.8±2.5, and 81.5±23.0 months, respectively. Prevalence of pelvic rod/screw radiographic lucency was unchanged at 33%, 35%, and 24% at 1-year, 2-year, and >5-year follow-up, respectively, and radiographic parameters did not change ( P >0.05). Furthermore, no risk factors or complications were associated with radiographic lucency around pelvic rods/screws ( P >0.05). CONCLUSION In patients with spastic nonambulatory CP who had scoliosis treated with posterior spinal fusion from upper thorax to pelvis, the prevalence of pelvic rod/screw lucency is high. Persistent lucency >2 mm around pelvic implants is not clinically significant, does not warrant advanced imaging, or indicate a complication if stable over time and wider distally than proximally. LEVEL OF EVIDENCE Level III.
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Kang Y, Jamison K, Jaywant A, Dams-O’Connor K, Kim N, Karakatsanis NA, Butler T, Schiff ND, Kuceyeski A, Shah SA. Longitudinal alterations in gamma-aminobutyric acid (GABAA) receptor availability over ∼ 1 year following traumatic brain injury. Brain Commun 2022; 4:fcac159. [PMID: 35794871 PMCID: PMC9253887 DOI: 10.1093/braincomms/fcac159] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/24/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
Longitudinal alterations of gamma-aminobutyric acid (GABAA) receptor availability following traumatic brain injury have remained uncharacterized and may reflect changes in neuronal structure and function linked to cognitive recovery. We measured GABAA receptor availability using the tracer [11C]flumazenil in nine adults with traumatic brain injury (3–6 months after injury, subacute scan) and in 20 non-brain-injured individuals. A subset of subjects with traumatic brain injury (n = 7) were scanned at a second chronic time-point, 7–13 months after their first scan; controls (n = 9) were scanned for a second time, 5–11 months after the first scan. After accounting for atrophy in subjects with traumatic brain injury, we find broad decreases in GABAA receptor availability predominantly within the frontal lobes, striatum, and posterior-medial thalami; focal reductions were most pronounced in the right insula and anterior cingulate cortex (p < 0.05). Greater relative increase, compared to controls, in global GABAA receptor availability appeared between subacute and chronic scans. At chronic scan (>1 year post-injury), we find increased pallidal receptor availability compared to controls. Conversely, receptor availability remained depressed across the frontal cortices. Longitudinal improvement in executive attention correlated with increases in receptor availability across bilateral fronto-parietal cortical regions and the anterior-lateral aspects of the thalami. The specific observations of persistent bi-frontal lobe reductions and bilateral pallidal elevation are consistent with the anterior forebrain mesocircuit hypothesis for recovery of consciousness following a wide range of brain injuries; our results provide novel correlative data in support of specific cellular mechanisms underlying persistent cognitive deficits. Collectively, these measurements support the use of [11C]flumazenil to track recovery of large-scale network function following brain injuries and measure response to therapeutics.
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Affiliation(s)
- Y Kang
- Department of Mathematics, Howard University , Washington, DC 20059 , USA
| | - K Jamison
- Department of Radiology, Weill Cornell Medicine , 407 E. 61 St., Rm 208, New York, NY 10065 , USA
| | - A Jaywant
- Department of Rehabilitation Medicine, Weill Cornell Medicine , New York, NY 10065 , USA
- Department of Psychiatry, Weill Cornell Medicine , New York, NY 10065 , USA
| | - K Dams-O’Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai , New York, NY 10029 , USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai , New York, NY 10029 , USA
| | - N Kim
- Department of Radiology, Weill Cornell Medicine , 407 E. 61 St., Rm 208, New York, NY 10065 , USA
| | - N A Karakatsanis
- Department of Radiology, Weill Cornell Medicine , 407 E. 61 St., Rm 208, New York, NY 10065 , USA
| | - T Butler
- Department of Radiology, Weill Cornell Medicine , 407 E. 61 St., Rm 208, New York, NY 10065 , USA
| | - N D Schiff
- Department of BMRI & Neurology, Weill Cornell Medicine , New York, NY 10065 , USA
| | - A Kuceyeski
- Department of Radiology, Weill Cornell Medicine , 407 E. 61 St., Rm 208, New York, NY 10065 , USA
| | - S A Shah
- Department of Radiology, Weill Cornell Medicine , 407 E. 61 St., Rm 208, New York, NY 10065 , USA
- Department of BMRI & Neurology, Weill Cornell Medicine , New York, NY 10065 , USA
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McDonald TC, Shah SA, Hargiss JB, Varghese J, Boeyer ME, Pompliano M, Neal K, Lonner BS, Larson AN, Yaszay B, Newton PO, Hoernschemeyer DG. When successful, anterior vertebral body tethering (VBT) induces differential segmental growth of vertebrae: an in vivo study of 51 patients and 764 vertebrae. Spine Deform 2022; 10:791-797. [PMID: 35064912 DOI: 10.1007/s43390-022-00471-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 06/11/2021] [Accepted: 01/08/2022] [Indexed: 01/16/2023]
Abstract
PURPOSE This study aimed to determine (1) does vertebral body tethering (VBT) produce differential growth modulation in individual vertebrae in patients with idiopathic scoliosis, (2) does VBT change disc shape, and (3) does VBT affect total spine length? METHODS Patients with idiopathic scoliosis treated with VBT of the main thoracic curve and minimum 2-year follow-up were included. Vertebrae and discs were categorized as uninstrumented proximal thoracic, instrumented main thoracic, or uninstrumented thoracolumbar-lumbar. The left- and right-sided heights of each vertebra and disc were measured on subsequent radiographs to assess for differential growth. T1-T12 thoracic and T1-S1 thoracolumbar growth velocities were compared with standardized reference data. RESULTS Fifty-one patients (764 vertebrae and 807 discs) were analyzed. The average major curve magnitude improved from 46° ± 11° to 17° ± 11° at 2-year follow-up. Differential growth was observed in MT vertebrae, in which the left/concave side grew 2.0 ± 2.2 mm compared with 1.5 ± 2.3 mm on the right/convex (tethered) side (p < 0.001). Differential height changes were observed for all discs, but were most pronounced in instrumented MT discs, in which the right/convex sides decreased by an average of 1.2 mm each, compared with no significant height change on the left/concave side. Total spinal growth velocities were not significantly different from standard reference data. CONCLUSION Vertebral body tethering limits convex spinal growth as designed while permitting concave growth. Curve correction results from differential vertebral growth and decreased convex disc height. Overall spinal growth continues at the expected rate. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
- Tyler C McDonald
- Department of Orthopaedics, Nemours Children's Hospital, Delaware, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Suken A Shah
- Department of Orthopaedics, Nemours Children's Hospital, Delaware, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | | | - Jeffrey Varghese
- Department of Orthopaedics, Nemours Children's Hospital, Delaware, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | | | - Michael Pompliano
- Department of Orthopaedics, Nemours Children's Hospital, Delaware, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Kevin Neal
- Nemours Children's Clinic, Jacksonville, FL, USA
| | | | | | - Burt Yaszay
- Rady Children's Hospital, San Diego, CA, USA
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Ali I, Salah KBH, Sher H, Ali H, Ullah Z, Ali A, Alam N, Shah SA, Iqbal J, Ilyas M, Al-Quwaie DAH, Khan AA, Mahmood T. Drought stress enhances the efficiency of floral dip method of Agrobacterium-mediated transformation in Arabidopsis thaliana. BRAZ J BIOL 2022; 84:e259326. [PMID: 35703626 DOI: 10.1590/1519-6984.259326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/30/2022] [Indexed: 11/22/2022] Open
Abstract
The Agrobacterium-mediated floral dip protocol is the most extensively used transformation method for a model plant Arabidopsis thaliana. Several useful methods for Agrobacterium tumefaciens-mediated transformations of Arabidopsis are existing, but they are time consuming and with low transformation efficiency. Here, we developed a transgenic Arabidopsis lines TET12p::TET12-RFP in a short period of time and enhanced transformation efficiency by using a modified transformation method by applying drought stress after floral dip. In this protocol, Agrobacterium cells carrying TET12p::TET12-RFP recombinant vectors were resuspended in a solution of 5% sucrose, 0.05% (v/v) silwet L-77 to transform female gametes of developing Arabidopsis inflorescences. Treated Arabidopsis were then applied with different levels of drought stresses to stimulate plants for the utilization of maximum plant energy in seed maturation process. The applied stresses achieved the fast maturation of already treated inflorescences while stopped the growing of newly arising untreated inflorescence, thus decreased the chances of wrong collection of untransformed seeds. Consequently, the collected seeds were mostly transgenic with a transformation frequency of at least 10%, thus the screening for positive transformants selection was more advantageous on a selective medium as compared to a classical floral dip method. Within 2-3 months, two hundred of individual transgenic plants were produced from just 10 infiltrated plants. This study concludes that application of drought stresses in a specific stage of plant is a beneficial strategy for achieving the transgenic Arabidopsis in a short period of time with high transformation efficiency.
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Affiliation(s)
- I Ali
- University of Swat, Centre for Plant Science and Biodiversity, Charbagh, Pakistan.,Chinese Academy of Sciences, Institute of Genetics and Developmental Biology, State Key Laboratory of Molecular Developmental Biology, Beijing, China
| | - K B H Salah
- King Abdulaziz University, College of Science & Arts, Biological Sciences Department, Rabigh, Saudi Arabia.,University of Monastir, Faculty of Pharmacy, Laboratory of Transmissible Diseases and Biologically Active Substances, Monastir, Tunisia
| | - H Sher
- University of Swat, Centre for Plant Science and Biodiversity, Charbagh, Pakistan
| | - H Ali
- University of Swat, Centre for Plant Science and Biodiversity, Charbagh, Pakistan
| | - Z Ullah
- University of Swat, Centre for Plant Science and Biodiversity, Charbagh, Pakistan
| | - A Ali
- University of Swat, Centre for Plant Science and Biodiversity, Charbagh, Pakistan
| | - N Alam
- University of Swat, Centre for Agricultural Sciences and Forestry, Charbagh, Pakistan
| | - S A Shah
- National University of Medical Sciences, Department of Biological Sciences, Rawalpindi, Pakistan
| | - J Iqbal
- Bacha Khan University, Department of Botany, Charsadda, Khyber Pakhtunkhwa, Pakistan
| | - M Ilyas
- Kohsar University Murree, Department of Botany, Murree, Pakistan
| | - D A H Al-Quwaie
- King Abdulaziz University, College of Science & Arts, Biological Sciences Department, Rabigh, Saudi Arabia
| | - A A Khan
- Nankai University, College of Life Sciences, Department of Plant Biology and Ecology, Tianjin, China
| | - T Mahmood
- Quaid-i-Azam University, Department of Plant Sciences, Islamabad, Pakistan
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Wan Daud WR, Abdul Rani R, Wong Z, Shah SA, Mahadzir H, Raja Ali RA. Endoscopic findings among geriatric patients with anaemia and chronic kidney disease at a tertiary teaching hospital in Malaysia. Med J Malaysia 2022; 77:284-291. [PMID: 35638483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Older people with chronic kidney disease (CKD) may be anaemic due to various reasons, and they are vulnerable to various consequences. One of the most important causes of anaemia to be recognised in this population is gastrointestinal loss. The outcome can be improved by early detection, careful investigation, and suitable therapies. There is currently no standardised grading scale or reliable indicators to assist clinicians on handling gastrointestinal workup in elderly CKD patients who are anaemic. METHODS A cross-sectional study of 171 people aged 60 and over who had CKD (stages 3-5), including those on Renal Replacement Therapy (RRT) and anaemia. Using oesophagogastroduodenoscopy, colonoscopy, and double balloon endoscopy, we analysed the endoscopic findings and calculated the prevalence of anaemia secondary to gastrointestinal disease. Haemoglobin, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), mean cell haemoglobin (MCH), iron panels, and immuno-faecal occult blood test (iFOBT) were evaluated to predict the diagnostic utility of each parameter in relation to gastrointestinal disorder in the elderly CKD population. RESULTS Abnormal endoscopic findings were obtained by upper and lower endoscopy in 98 individuals (57.3%). Upper endoscopy revealed the most prevalent lesions to be gastritis, gastric ulcer, and duodenal ulcer. The upper and lower endoscopies revealed a total of 14.0% malignant and pre-malignant lesions. T-test and receiver-operating characteristic (ROC) curve were performed on all haematological parameters and iron panels. Low ferritin level (less than 100 ng/mL) and combination with low transferrin saturation (less than 20%) have a significant p value less than 0.05. None of these variables had a significant area under the curve (AUC) of more than 0.75. CONCLUSION Positive endoscopic findings of anaemia are common in the older population at various stages of CKD, regardless of age, gender, or race. Malignant and premalignant lesions are not uncommon in older CKD patients. In the older CKD population, GI inflammation and ulceration are common lesions. Serum ferritin and TSAT levels are useful indicators of GI disorder in this population. Endoscopic evaluation as part of anaemia workup in the older people with CKD should not be ruled out.
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Affiliation(s)
- W R Wan Daud
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Nephrology Unit, Kuala Lumpur, Malaysia
| | - R Abdul Rani
- Universiti Teknologi MARA, Faculty of Medicine, Gastroenterology Unit, Sungai Buloh, Selangor, Malaysia
| | - Z Wong
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Gastroenterology Unit, Kuala Lumpur, Malaysia
| | - S A Shah
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Community Health, Kuala Lumpur, Malaysia
| | - H Mahadzir
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Geriatric Unit, Kuala Lumpur, Malaysia.
| | - R A Raja Ali
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Gastroenterology Unit, Kuala Lumpur, Malaysia
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Boachie-Adjei O, Duah HO, Sackeyfio A, Yankey KP, Lenke LG, Sponseller PD, Samdani AF, Sucato DJ, Sides BA, Newton PO, Shah SA, Akoto H, Gupta MC. Surgical outcomes of severe spinal deformities exceeding 100° or treated by vertebral column resection (VCR). Does implant density matter?: an observational study of deformity groupings. Spine Deform 2022; 10:595-606. [PMID: 35305251 DOI: 10.1007/s43390-021-00460-x] [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: 10/12/2020] [Accepted: 12/11/2021] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Prospective multicenter international observational study. OBJECTIVE To investigate the effect of implant density on clinical outcomes in complex pediatric spine reconstruction. Implant density in spine deformity surgery has been a subject of much debate with some authors advocating higher density for better correction. Few studies have looked at the effect of implant density on severe curves > 100 deg or treated with vertebral column resection (VCR). METHODS 250/311 pts with 2-year f/u enrolled in the FOX pediatric database from 17 international sites were queried for the impact of implant density and surgical outcomes. Patients were grouped into three implant density categories for comparative analysis Group 1 (density ≤ 1), Group 2 (1 < density < 1.5) and Group 3 (density; 1.5-2). RESULTS 250 pts: 47 (Grp1)/99 (Grp2) /104 (Grp3); Pre-op age and etiology and curve types were similar in all groups, but body mass index (BMI) was higher in Grp3. Grps 1 and 2 had significantly higher sagittal deformity angular ratio (S-DAR) compared to Grp 3 (p < 0.001). Pre-op Halo Gravity Traction (HGT) was used in 55.3%/44.4%/31.7%, p = 0.017; Grp1/Grp2/Grp3, respectively. Average duration of surgery (min) was higher in Grp3 relative to Grp1 only: 352.5/456.5/515.0, p = 0.0029. Blood loss was similar in all Grps. Rate of VCR, PSO and SPO was similar in all Grps. Pre-op Coronal Cobb avg 96.1/83.6/88.6, p = 0.2342, attained similar correction after HGT (24.6%/27.2%/23.2%, p = 0.4864. Coronal Cobb corrections at 2-year follow-up (FU) were (37.1%/40.3%/53.5%, p = 0.0004). Pre-op sagittal Cobb was (105.4/101.9/75.9, p < 0.01.), achieved similar %correction in HGT (19.1%/22.3%/22.5%, p = 0.6851) and at 2-year FU (39.6%/41.4%/29.8%, p = 0.1916). After adjusting for C-DAR, S-DAR, pre-op coronal and sagittal Cobb, etiology, curve types, age, BMI and number of rods in multivariate analysis, the odds of developing post-operative implant complication was 11 times greater in group 1 compared to group 3 (OR = 11.17,95% CI 2.34-53.32). There was significant improvement in SRS scores in all Grps at 2-year FU. CONCLUSION Although higher implant density was observed to be associated with greater curve correction and lower rates of post-operative implant-related complication and revision in heterogeneous case groups, the results may not imply causality of implant density on the outcomes in severe pediatric spine reconstruction.
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Affiliation(s)
| | - Henry Ofori Duah
- FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana
| | - Arthur Sackeyfio
- FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana
| | | | | | | | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, Philadelphia, PA, USA
| | | | - Brenda A Sides
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Suken A Shah
- Spine and Scoliosis Center, Nemours/Alfred I. du Pont Pediatrics, Wilmington, DE, USA
| | | | - Munish C Gupta
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA
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Henstenburg J, Shah SA, Carrion R, Josephson G. The Role of Satisfaction Surveys: Offering an Enhanced Patient Experience for Optimum Outcomes in the Pediatric Orthopaedic Practice. J Pediatr Orthop 2022; 42:S13-S17. [PMID: 35405695 DOI: 10.1097/bpo.0000000000002050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As we navigate to provide the best patient care and outcomes, the patient experience has shown to be a driver that improves quality. Patient experience surveys are the primary means of measuring the perception of the care received. Positive patient experience has been linked to better patient compliance, decreased health care costs, decreased liability, and improved outcomes. Physician wellbeing and improved job satisfaction is a recognized additional benefit. Strategies have been developed to achieve these goals, enhance our practice and improve our work satisfaction and the patient experience.
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Affiliation(s)
- Jeffrey Henstenburg
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours Children's Health - Delaware, Wilmington, DE
| | - Rose Carrion
- Department of Patient Experience, Nemours Children's Health, Orlando
| | - Gary Josephson
- Division of Otolaryngology, Department of Surgery, Nemours Children's Health, Jacksonville, FL
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Akbarnia BA, Pawelek JB, Hosseini P, Salari P, Kabirian N, Marks D, Shah SA, Skaggs DL, Emans JB, Elsebaie H, Thompson GH, Sponseller PD. Treatment of Early-onset Scoliosis: Similar Outcomes Despite Different Etiologic Subtypes in Traditional Growing Rod Graduates. J Pediatr Orthop 2022; 42:10-16. [PMID: 34739435 DOI: 10.1097/bpo.0000000000001985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is unclear whether traditional growing rod (TGR) treatment outcomes vary by early-onset scoliosis (EOS) subtype. The goal of this study was to compare radiographic outcomes and complications of TGR treatment by EOS subtype. METHODS We queried an international database of EOS patients from 20 centers to identify "graduates" who had (1) undergone primary TGR treatment from 1993 to 2014; (2) completed TGR treatment; and (3) had an uneventful clinical examination within 6 months after completion of TGR treatment with no anticipated further intervention. We included 202 patients in 4 etiologic subgroups: neuromuscular (n=65), syndromic (n=57), idiopathic (n=52), and congenital (n=28). Mean age at surgery was 7.1 years (range, 1.6 to 14.9 y); mean duration of follow-up was 8 years (range, 2 to 18.6 y). The groups did not differ by mean age, body mass index, sex, number of lengthenings, or duration of follow-up. The following preoperative differences were significant: (1) greater mean major curve in the neuromuscular versus idiopathic subgroup; (2) shorter spinal height (T1-S1) in the congenital versus idiopathic subgroup; and (3) smaller proportion of ambulatory patients in the neuromuscular subgroup versus all other subgroups. RESULTS We found no significant differences among subgroups in mean major curve correction or changes in thoracic height (T1-T12), spinal height, or global kyphosis at any point. Rates of deep surgical site infection, implant-related complications, and neurological complications were not different among subgroups. The medical complication rate was significantly lower in the idiopathic group compared with the other groups. CONCLUSIONS Major curve correction and spinal and thoracic height increases did not differ significantly at any point by EOS subtype. Rates of deep surgical site infection, implant-related complications, and neurological complications did not differ by subtype. Except for the lower rate of medical complications in the idiopathic group, our findings suggest that, after TGR treatment, patients can expect similar outcomes regardless of their EOS subtype. LEVEL OF EVIDENCE Level III, therapeutic.
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Affiliation(s)
- Behrooz A Akbarnia
- San Diego Spine Foundation, San Diego
- Department of Orthopaedic Surgery, University of California San Diego School of Medicine, La Jolla
| | | | | | | | | | - David Marks
- Birmingham Children's Hospital, Birmingham, UK
| | - Suken A Shah
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - David L Skaggs
- Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - John B Emans
- Division of Spine Surgery, Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
| | | | - George H Thompson
- Department of Orthopaedic Surgery, Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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40
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Rushton PRP, Aldebeyan S, Ghag R, Sponseller P, Yaszay B, Samdani AF, Lonner B, Shah SA, Newton PO, Miyanji F. What is the effect of intraoperative traction on correction of adolescent idiopathic scoliosis (AIS)? Spine Deform 2021; 9:1549-1557. [PMID: 34133013 DOI: 10.1007/s43390-021-00369-5] [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: 12/29/2020] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Determine the efficacy of intraoperative traction (IOT) on curve correction in AIS. METHODS A prospective, multicenter, longitudinal database identified patients with major thoracic AIS (Lenke 1-4) treated with surgery using IOT and follow-up of 2 years. These cases were matched to comparable cases treated without traction (non-IOT). All patients were treated with single-stage posterior only surgery with pedicle screw constructs. Perioperative, radiographic and clinical outcome data at 2 years post-op were compared between the groups. RESULTS 104 cases treated with IOT were matched to 104 treated without IOT. Operating room time was significantly greater in the IOT group (339 vs. 306 min, p = < 0.001). Neuromonitoring alerts were more frequent in the IOT group (23% vs. 5%, p < 0.001). There were no postoperative neurological deficits in either group. The IOT group showed significantly greater MT curve correction (IOT 71% vs. non-IOT 66.7%, p < 0.003), with the effect most pronounced in curves > 70° (IOT 72% vs. non-IOT 64%, p = 0.04). IOT was associated with a significant reduction in 2D T5-T12 kyphosis measurements (IOT - 6.5° vs non-IOT + 0.48°, p < 0.001), yet significant improvements in estimated 3D thoracic kyphosis were made in both groups, with the non-IOT group making greater improvement when compared to the IOT group (IOT + 18.1° vs. non-IOT + 22.3° vs., p = 0.008). CONCLUSIONS IOT is associated with modestly enhanced coronal deformity correction. Surgeons should be aware of the increased rates of neuromonitoring alerts when using this technique and its affect on the sagittal profile. Given this IOT may be best suited to larger curves. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | | | - Ravi Ghag
- British Columbia Children's Hospital, Vancouver, BC, Canada
| | | | - Burt Yaszay
- Rady Children's Hospital and Health Center, San Diego, CA, USA
| | | | | | - Suken A Shah
- Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Peter O Newton
- Rady Children's Hospital and Health Center, San Diego, CA, USA
| | - Firoz Miyanji
- British Columbia Children's Hospital, Vancouver, BC, Canada
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Clement RC, Yaszay B, McClung A, Bartley CE, Nabizadeh N, Skaggs DL, Thompson GH, Boachie-Adjei O, Sponseller PD, Shah SA, Sanders JO, Pawelek J, Mundis GM, Akbarnia BA. Growth-preserving instrumentation in early-onset scoliosis patients with multi-level congenital anomalies. Spine Deform 2021; 9:1491. [PMID: 34152580 DOI: 10.1007/s43390-021-00370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/31/2021] [Indexed: 12/01/2022]
Affiliation(s)
- R Carter Clement
- Department of Orthopaedics, Children's Hospital of New Orleans, New Orleans, LA, USA
| | - Burt Yaszay
- Department of Orthopedics, Rady Children's Hospital, San Diego, CA, USA.
| | | | - Carrie E Bartley
- Department of Orthopedics, Rady Children's Hospital, San Diego, CA, USA
| | - Naveed Nabizadeh
- Department of Orthopedics, Rady Children's Hospital, San Diego, CA, USA
| | - David L Skaggs
- Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - George H Thompson
- Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland, OH, USA
| | | | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Suken A Shah
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - James O Sanders
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
| | | | - Gregory M Mundis
- Department of Orthopaedics, Children's Hospital of New Orleans, New Orleans, LA, USA
| | - Behrooz A Akbarnia
- Department of Orthopeadics, University of California, San Diego, San Diego, CA, USA
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Patel A, Pahys JM, Samdani AF, Newton PO, Bastrom TP, Shah SA, Miyanji F, Hwang SW. Early and late hospital readmissions in adolescent idiopathic scoliosis. Spine Deform 2021; 9:1041-1048. [PMID: 33939169 DOI: 10.1007/s43390-021-00294-7] [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: 08/31/2020] [Accepted: 01/18/2021] [Indexed: 10/21/2022]
Abstract
STUDY DESIGN Retrospective review of a prospectively collected multicenter database. OBJECTIVES To identify risk factors for early and late readmission of surgically treated patients with adolescent idiopathic scoliosis (AIS). Specific risk factors associated with readmission in patients with AIS remain poorly understood. METHODS Patients with AIS who were operatively treated from 19 centers specializing in the treatment of pediatric spinal deformity were studied. Data from a minimum 2 years of clinical follow-up and any readmission were available for analysis. Characteristics of patients with no readmission, early readmission (< 90 days), and late readmission (> 90 days) were evaluated. Both univariate and multivariate analyses of risk factors for readmission were performed. RESULTS 2049 patients were included in our cohort, with 1.6% requiring early readmission and 3.3% late readmission. In the multivariate analysis, greater preoperative coronal imbalance was associated with early readmission. Longer operative time was associated with late readmission. Finally, greater preoperative pain (SRS-22 pain scale) was associated with both early and late readmission. GI complications accounted for a higher proportion of early readmissions than previously reported in the literature. CONCLUSIONS Preoperative counseling of patients with higher levels of pain and coronal imbalance and the implementation of a thorough postoperative bowel regimen may help optimize patient outcomes. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Akul Patel
- Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Joshua M Pahys
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA
| | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA
| | | | | | - Suken A Shah
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | - Steven W Hwang
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA.
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Grivas P, Khaki AR, Wise-Draper TM, French B, Hennessy C, Hsu CY, Shyr Y, Li X, Choueiri TK, Painter CA, Peters S, Rini BI, Thompson MA, Mishra S, Rivera DR, Acoba JD, Abidi MZ, Bakouny Z, Bashir B, Bekaii-Saab T, Berg S, Bernicker EH, Bilen MA, Bindal P, Bishnoi R, Bouganim N, Bowles DW, Cabal A, Caimi PF, Chism DD, Crowell J, Curran C, Desai A, Dixon B, Doroshow DB, Durbin EB, Elkrief A, Farmakiotis D, Fazio A, Fecher LA, Flora DB, Friese CR, Fu J, Gadgeel SM, Galsky MD, Gill DM, Glover MJ, Goyal S, Grover P, Gulati S, Gupta S, Halabi S, Halfdanarson TR, Halmos B, Hausrath DJ, Hawley JE, Hsu E, Huynh-Le M, Hwang C, Jani C, Jayaraj A, Johnson DB, Kasi A, Khan H, Koshkin VS, Kuderer NM, Kwon DH, Lammers PE, Li A, Loaiza-Bonilla A, Low CA, Lustberg MB, Lyman GH, McKay RR, McNair C, Menon H, Mesa RA, Mico V, Mundt D, Nagaraj G, Nakasone ES, Nakayama J, Nizam A, Nock NL, Park C, Patel JM, Patel KG, Peddi P, Pennell NA, Piper-Vallillo AJ, Puc M, Ravindranathan D, Reeves ME, Reuben DY, Rosenstein L, Rosovsky RP, Rubinstein SM, Salazar M, Schmidt AL, Schwartz GK, Shah MR, Shah SA, Shah C, Shaya JA, Singh SRK, Smits M, Stockerl-Goldstein KE, Stover DG, Streckfuss M, Subbiah S, Tachiki L, Tadesse E, Thakkar A, Tucker MD, Verma AK, Vinh DC, Weiss M, Wu JT, Wulff-Burchfield E, Xie Z, Yu PP, Zhang T, Zhou AY, Zhu H, Zubiri L, Shah DP, Warner JL, Lopes G. Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium. Ann Oncol 2021; 32:787-800. [PMID: 33746047 PMCID: PMC7972830 DOI: 10.1016/j.annonc.2021.02.024] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies. PATIENTS AND METHODS Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients). RESULTS A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality. CONCLUSIONS Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies. CLINICAL TRIAL IDENTIFIER NCT04354701.
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Affiliation(s)
- P Grivas
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA.
| | - A R Khaki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA; Stanford University, Stanford, USA
| | | | - B French
- Vanderbilt University Medical Center, Nashville, USA
| | - C Hennessy
- Vanderbilt University Medical Center, Nashville, USA
| | - C-Y Hsu
- Vanderbilt University Medical Center, Nashville, USA
| | - Y Shyr
- Vanderbilt University Medical Center, Nashville, USA
| | - X Li
- Vanderbilt University School of Medicine, Nashville, USA
| | | | - C A Painter
- Broad Institute, Cancer Program, Cambridge, USA
| | - S Peters
- Lausanne University, Lausanne, Switzerland
| | - B I Rini
- Vanderbilt University Medical Center, Nashville, USA
| | | | - S Mishra
- Vanderbilt University Medical Center, Nashville, USA
| | - D R Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - J D Acoba
- University of Hawaii Cancer Center, Honolulu, USA
| | - M Z Abidi
- University of Colorado School of Medicine, Aurora, USA
| | - Z Bakouny
- Dana-Farber Cancer Institute, Boston, USA
| | - B Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | | | - S Berg
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, USA
| | | | - M A Bilen
- Winship Cancer Institute of Emory University, Atlanta, USA
| | - P Bindal
- Beth Israel Deaconess Medical Center, Boston, USA
| | - R Bishnoi
- University of Florida, Gainesville, USA
| | - N Bouganim
- McGill University Health Centre, Montréal, Canada
| | - D W Bowles
- University of Colorado School of Medicine, Aurora, USA
| | - A Cabal
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - P F Caimi
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - D D Chism
- Thompson Cancer Survival Center, Knoxville, USA
| | - J Crowell
- St. Elizabeth Healthcare, Edgewood, USA
| | - C Curran
- Dana-Farber Cancer Institute, Boston, USA
| | - A Desai
- Mayo Clinic Cancer Center, Rochester, USA
| | - B Dixon
- St. Elizabeth Healthcare, Edgewood, USA
| | - D B Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - E B Durbin
- Markey Cancer Center, University of Kentucky, Lexington, USA
| | - A Elkrief
- McGill University Health Centre, Montréal, Canada
| | - D Farmakiotis
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - A Fazio
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - L A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - D B Flora
- St. Elizabeth Healthcare, Edgewood, USA
| | - C R Friese
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - J Fu
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - S M Gadgeel
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - D M Gill
- Intermountain Healthcare, Salt Lake City, USA
| | | | - S Goyal
- George Washington University, Washington DC, USA
| | - P Grover
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gulati
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | | | - B Halmos
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D J Hausrath
- Vanderbilt University School of Medicine, Nashville, USA
| | - J E Hawley
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - E Hsu
- Hartford HealthCare, Hartford, USA; University of Connecticut, Farmington, USA
| | - M Huynh-Le
- George Washington University, Washington DC, USA
| | - C Hwang
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - C Jani
- Mount Auburn Hospital, Cambridge, USA
| | | | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - A Kasi
- University of Kansas Medical Center, Kansas City, USA
| | - H Khan
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - V S Koshkin
- University of California, San Francisco, San Francisco, USA
| | - N M Kuderer
- Advanced Cancer Research Group, LLC, Kirkland, USA
| | - D H Kwon
- University of California, San Francisco, San Francisco, USA
| | | | - A Li
- Baylor College of Medicine, Houston, USA
| | | | - C A Low
- Intermountain Healthcare, Salt Lake City, USA
| | | | - G H Lyman
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - R R McKay
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - C McNair
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - H Menon
- Penn State Health/Penn State Cancer Institute/St. Joseph Cancer Center, Hershey, USA
| | - R A Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - V Mico
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - D Mundt
- Advocate Aurora Health, Milwaukee, USA
| | - G Nagaraj
- Loma Linda University Cancer Center, Loma Linda, USA
| | - E S Nakasone
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - J Nakayama
- Case Western Reserve University, Cleveland, USA; University Hospitals Cleveland Medical Center, Cleveland, USA
| | - A Nizam
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | - N L Nock
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - C Park
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - J M Patel
- Beth Israel Deaconess Medical Center, Boston, USA
| | - K G Patel
- University of California Davis Comprehensive Cancer Center, Sacramento, USA
| | - P Peddi
- Willis-Knighton Cancer Center, Shreveport, USA
| | - N A Pennell
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | - M Puc
- Virtua Health, Marlton, USA
| | | | - M E Reeves
- Loma Linda University Cancer Center, Loma Linda, USA
| | - D Y Reuben
- Medical University of South Carolina, Charleston, USA
| | | | - R P Rosovsky
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - M Salazar
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | | | - G K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - M R Shah
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - S A Shah
- Stanford University, Stanford, USA
| | - C Shah
- University of Florida, Gainesville, USA
| | - J A Shaya
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - S R K Singh
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M Smits
- ThedaCare Regional Cancer Center, Appleton, USA
| | | | - D G Stover
- The Ohio State University, Columbus, USA
| | | | - S Subbiah
- Stanley S. Scott Cancer Center, LSU Health Sciences Center, New Orleans, USA
| | - L Tachiki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - E Tadesse
- Advocate Aurora Health, Milwaukee, USA
| | - A Thakkar
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - M D Tucker
- Vanderbilt University Medical Center, Nashville, USA
| | - A K Verma
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D C Vinh
- McGill University Health Centre, Montréal, Canada
| | - M Weiss
- ThedaCare Regional Cancer Center, Appleton, USA
| | - J T Wu
- Stanford University, Stanford, USA
| | | | - Z Xie
- Mayo Clinic Cancer Center, Rochester, USA
| | - P P Yu
- Hartford HealthCare, Hartford, USA
| | - T Zhang
- Duke University, Durham, USA
| | - A Y Zhou
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA
| | - H Zhu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - L Zubiri
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - D P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - J L Warner
- Vanderbilt University Medical Center, Nashville, USA
| | - GdL Lopes
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, USA
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Iqbal MO, Samdani AF, Pahys JM, Newton PO, Shah SA, Bastrom TP, Sponseller PD, Miyanji F, Hwang SW. What happens to the unfused upper thoracic curve after posterior spinal fusion for adolescent idiopathic scoliosis? J Neurosurg Pediatr 2021; 27:725-731. [PMID: 33892473 DOI: 10.3171/2020.10.peds20671] [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: 08/08/2020] [Accepted: 10/26/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS. METHODS The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1-4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)-22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model. RESULTS The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement. CONCLUSIONS Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1-4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.
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Affiliation(s)
- M Omar Iqbal
- 1Department of Neurosurgery, Rutgers University, Newark, New Jersey
| | - Amer F Samdani
- 2Department of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Pennsylvania
| | - Joshua M Pahys
- 2Department of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Pennsylvania
| | - Peter O Newton
- 3Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California
| | - Suken A Shah
- 4Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Tracey P Bastrom
- 3Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California
| | - Paul D Sponseller
- 5Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland; and
| | - Firoz Miyanji
- 6Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Steven W Hwang
- 2Department of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Pennsylvania
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Hughes J, Yaszay B, Bastrom TP, Bartley CE, Parent S, Cahill PJ, Lonner B, Shah SA, Samdani A, Newton PO. Long-term Patient Perception Following Surgery for Adolescent Idiopathic Scoliosis if Dissatisfied at 2-year Follow-up. Spine (Phila Pa 1976) 2021; 46:507-511. [PMID: 33273434 DOI: 10.1097/brs.0000000000003828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Longitudinal. OBJECTIVES To evaluate whether the rate of patients who report low health-related quality of life (HRQOL) scores at 2 years following surgical correction of adolescent idiopathic scoliosis (AIS) improves by 5 years postoperatively. SUMMARY OF BACKGROUND DATA HRQOL scores are dependent upon a number of factors and even in instances of good surgical correction of a spinal deformity, are not guaranteed to be high postoperatively. Understanding how a low HRQOL score varies over the postoperative period can help surgeons more effectively counsel patients and temper expectations. METHODS A multicenter database was reviewed for patients with both 2 and 5-year follow-up after spinal fusion and instrumentation for AIS. From a cohort of 916 patients, 52 patients with low HRQOL scores at their 2-year follow-up were identified and reevaluated at 5-year follow-up. A low HRQOL outcome was defined as having SRS-22 domain or total scores less than 2 standard deviations below the mean score. Reoperations were also evaluated to determine if they were associated with HRQOL scores. RESULTS Of those patients with low SRS-22 HRQOL scores at 2 years postoperatively, improvements were seen in all SRS-22 domains and total scores at the 5-year time point. The greatest change was seen in the satisfaction category where 41 patients showed improvement. The rate of reoperations during this period did not significantly impact patient-reported outcomes. CONCLUSIONS Having a low HRQOL score 2 years after surgery for AIS does not guarantee a low score 5 years after surgery. Promisingly, most patients demonstrate some improvement in all domains for patient-reported SRS-22 scores at 5-year compared to 2-year follow-up. Understanding the longer term postoperative evolution in patient-reported outcomes may help surgeons to effectively manage and counsel patients who are dissatisfied in the short term.Level of Evidence: 3.
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Affiliation(s)
| | | | | | | | | | | | | | - Suken A Shah
- Nemours Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Amer Samdani
- Shriners Hospitals for Children, Philadelphia, PA
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Lonner B, Jain A, Sponseller P, Eaker L, Samdani A, Kelly M, Castillo A, Marrache M, Ames CP, Shah SA. What are parents willing to accept? A prospective study of risk tolerance in AIS surgery. Spine Deform 2021; 9:381-386. [PMID: 33048337 DOI: 10.1007/s43390-020-00216-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/21/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Surgical treatment of Adolescent Idiopathic Scoliosis (AIS) involves healthy individuals with spinal deformity. Parents are responsible for surgical consent on behalf of their children, a burden which causes trepidation and concern. Therefore, explanation of operative risk is a critical component of informed consent and parent decision-making. We set out to quantify parental risk aversion (RA). METHODS RA questionnaires were administered preoperatively to parents of 58 AIS patients undergoing spinal fusion (SF). RA is the likelihood of a parent to consent to their child's SF (1- least likely, 10- most) with increasing allotments of data about potential complications at each stage (S1-complication named, S2-explained, S3-incidence given, S4-all information). A statistically significant mean difference in answers for each stage was assessed using paired sample t test or Wilcoxon rank t test. Normality was assessed by performing Shapiro-Wilk test. RESULTS AIS patients (age 14.2 years, 85% female, major curve 61°) were included. Mean scores for each of the stages were 4.4 ± 3.1, 4.9 ± 3.1, 6.5 ± 3.0, 6.6 ± 3.0, respectively. Highest and lowest RA were reported for death and infection, respectively. The greatest increase in likelihood to proceed with surgery was seen after education on malposition of implants and on death, 2.6 and 2.5, respectively (p < 0.001). The lowest increase in likelihood to proceed with surgery was seen after education on infection, 1.5 (p < 0.001). For all complications, there was an increase in parent willingness to proceed after providing descriptions and occurrence rate with a mean increase from S1 to S4 of 2.1 (95% CI 1.4-2.4), p < 0.001. CONCLUSION As more detailed information was made available regarding potential complications with SF for AIS, parental RA toward surgery decreased and their willingness to proceed with surgery for their child improved.
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Affiliation(s)
- Baron Lonner
- Department of Orthopedic Surgery, Minimally Invasive Scoliosis Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA.
| | - Amit Jain
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Paul Sponseller
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Lily Eaker
- Department of Orthopedic Surgery, Minimally Invasive Scoliosis Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Amer Samdani
- Shriners Hospitals for Children, Philadelphia, PA, USA
| | - Michael Kelly
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Andrea Castillo
- Department of Orthopedic Surgery, Minimally Invasive Scoliosis Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Majd Marrache
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Christopher P Ames
- Department of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, USA
| | - Suken A Shah
- Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
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Verhofste BP, Berry JG, Miller PE, Crofton CN, Garrity BM, Fletcher ND, Marks MC, Shah SA, Newton PO, Samdani AF, Abel MF, Sponseller PD, Glotzbecker MP. Risk factors for gastrointestinal complications after spinal fusion in children with cerebral palsy. Spine Deform 2021; 9:567-578. [PMID: 33201495 DOI: 10.1007/s43390-020-00233-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/28/2020] [Accepted: 10/15/2020] [Indexed: 01/20/2023]
Abstract
DESIGN Prospective cerebral palsy (CP) registry review. OBJECTIVES (1) Evaluate the incidence/risk factors of gastrointestinal (GI) complications in CP patients after spinal fusion (SF); and (2) investigate the validity of the modified Clavien-Dindo-Sink classification. BACKGROUND Perioperative GI complications result in increased length of stay (LOS) and patient morbidity/mortality. However, none have analyzed the outcomes of GI complications using an objective classification system. METHODS A prospective/multicenter CP database identified 425 children (mean, 14.4 ± 2.9 years; range, 7.9-21 years) who underwent SF. GI complications were categorized using the modified Clavien-Dindo-Sink classification. Grades I-II were minor complications and grades III-V major. Patients with and without GI complications were compared. RESULTS 87 GI complications developed in 69 patients (16.2%): 39 minor (57%) and 30 major (43%). Most common were pancreatitis (n = 45) and ileus (n = 22). Patients with preoperative G-tubes had 2.2 × odds of developing a GI complication compared to oral-only feeders (OR 2.2; 95% CI 0.98-4.78; p = 0.006). Similarly, combined G-tube/oral feeders had 6.7 × odds compared to oral-only (OR 6.7; 95% CI 3.10-14.66; p < 0.001). The likelihood of developing a GI complication was 3.4 × with normalized estimated blood loss (nEBL) ≥ 3 ml/kg/level fused (OR 3.41; 95% CI 1.95-5.95; p < 0.001). Patients with GI complications had more fundoplications (29% vs. 17%; p = 0.03) and longer G-tube fasting periods (3 days vs. 2 days; p < 0.001), oral fasting periods (5 days vs. 2 days; p < 0.001), ICU admissions (6 days vs. 3 days; p = 0.002), and LOS (15 days vs. 8 days; p < 0.001). LOS correlated with the Clavien-Dino-Sink classification. CONCLUSION Gastrointestinal complications such as pancreatitis and ileus are not uncommon after SF in children with CP. This is the first study to investigate the validity of the modified Clavien-Dindo-Sink classification in GI complications after SF. Our results suggest a correlation between complication severity grade and LOS. The complexity of perioperative enteral nutritional supplementation requires prospective studies dedicated to enteral feeding protocols. LEVEL OF EVIDENCE Therapeutic-level III.
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Affiliation(s)
- Bram P Verhofste
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jay G Berry
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Patricia E Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Charis N Crofton
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brigid M Garrity
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas D Fletcher
- Department of Orthopaedic Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Suken A Shah
- Department of Orthopaedic Surgery, A. I. DuPont Institute, Wilmington, DE, USA
| | - Peter O Newton
- Department of Orthopaedic Surgery, UC San Diego University of California, San Diego, CA, USA
| | - Amer F Samdani
- Department of Orthopaedic Surgery, Shriner's Hospital for Children, Philadelphia, PA, USA
| | - Mark F Abel
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, John Hopkins Hospital, Baltimore, MD, USA
| | | | - Michael P Glotzbecker
- Department of Orthopaedic Surgery, University Hospital Cleveland Medical Center, Rainbow Babies and Children's Hospital, 201 Adelbert Road, Cleveland, OH, 44106, USA.
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Schlösser TP, Abelin-Genevois K, Homans J, Pasha S, Kruyt M, Roussouly P, Shah SA, Castelein RM. Comparison of different strategies on three-dimensional correction of AIS: which plane will suffer? Eur Spine J 2021; 30:645-652. [PMID: 33355708 DOI: 10.1007/s00586-020-06659-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/17/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE There are distinct differences in strategy amongst experienced surgeons from different 'scoliosis schools' around the world. This study aims to test the hypothesis that, due to the 3-D nature of AIS, different strategies can lead to different coronal, axial and sagittal curve correction. METHODS Consecutive patients who underwent posterior scoliosis surgery for primary thoracic AIS were compared between three major scoliosis centres (n = 193). Patients were treated according to the local surgical expertise: Two centres perform primarily an axial apical derotation manoeuvre (centre 1: high implant density, convex rod first, centre 2: low implant density, concave rod first), whereas centre 3 performs posteromedial apical translation without active derotation. Pre- and postoperative shape of the main thoracic curve was analyzed using coronal curve angle, apical rotation and sagittal alignment parameters (pelvic incidence and tilt, T1-T12, T4-T12 and T10-L2 regional kyphosis angles, C7 slope and the level of the inflection point). In addition, the proximal junctional angle at follow-up was compared. RESULTS Pre-operative coronal curve magnitudes were similar between the 3 cohorts and improved 75%, 70% and 59%, from pre- to postoperative, respectively (P < 0.001). The strategy of centres 1 and 2 leads to significantly more apical derotation. Despite similar postoperative T4-T12 kyphosis, the strategy in centre 1 led to more thoracolumbar lordosis and in centre 2 to a higher inflection point as compared to centre 3. Proximal junctional angle was higher in centres 1 and 2 (P < 0.001) at final follow-up. CONCLUSION Curve correction by derotation may lead to thoracolumbar lordosis and therefore higher risk for proximal junctional kyphosis. Focus on sagittal plane by posteromedial translation, however, results in more residual coronal and axial deformity.
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Affiliation(s)
- Tom P Schlösser
- Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 35084 GA, Utrecht, The Netherlands.
| | | | - Jelle Homans
- Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 35084 GA, Utrecht, The Netherlands
| | - Saba Pasha
- Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Moyo Kruyt
- Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 35084 GA, Utrecht, The Netherlands
| | - Pierre Roussouly
- Orthopaedic Department, Centre medico chirurgical Les Massues, Lyon, France
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - René M Castelein
- Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 35084 GA, Utrecht, The Netherlands
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Boachie-Adjei O, Duah HO, Yankey KP, Lenke LG, Sponseller PD, Sucato DJ, Samdani AF, Newton PO, Shah SA, Erickson MA, Akoto H, Sides BA, Gupta MC. New neurologic deficit and recovery rates in the treatment of complex pediatric spine deformities exceeding 100 degrees or treated by vertebral column resection (VCR). Spine Deform 2021; 9:427-433. [PMID: 33034889 DOI: 10.1007/s43390-020-00211-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/08/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Prospective multicenter international observational study. OBJECTIVE To investigate incidence of new neurologic deficit (NND) and the long-term recovery patterns following complex pediatric spine deformity surgery. The SRS M&M reports identify pediatric patients as having higher rate of new neurologic deficit compared with adults, while congenital and neuromuscular deformities are associated with higher new neurologic risks. Very few studies have had the large numbers of pediatric patients with curves exceeding 100 deg to ascertain the new neurologic deficit (NND) rates and recovery patterns as it relates to curve laterality and diagnosis. METHOD The FOX pediatric database from 17 international sites was queried for New Neurologic Deficit (NND) as characterized by change in American Spinal Injury Association (ASIA) Lower or Upper Extremity Motor Score. Recovery rates at specific intervals were recorded and related to the curve type and etiology. RESULTS Data of 286 consecutive patients with normal pre-operative neurologic exams were reviewed. There were 160 females vs 125 males with an average age of 14.6 years. NND occurred in 27 patients (9.4%) in the immediate post-operative period. Diagnostic categories included idiopathic scoliosis (3 patients); idiopathic kyphoscoliosis(5 patients); congenital scoliosis (7 patients); congenital kyphoscoliosis (4 patients); congenital kyphosis (6 patients), other kyphosis (1 patient) and syndromic (1 patient). 1 patient was lost to follow-up (f/u) after discharge; 1 had chronic deficits at the first post-operative erect visit (from discharge to 9 months f/u) and was subsequently lost to follow-up; 2 patients were improving at 1-year f/u but lost to subsequent f/u. 16 patients had normal neurologic function by the time of the first post-operative erect visit, 21 patients at 1-year f/u and 21 patients at the 2-year f/u. 2 patients (0.69%) had improved NND at 2-year mark. CONCLUSION A significant proportion of patients with complex spine deformity experience NND. However, significant improvement in neurologic function can be expected over time as seen in this study without additional surgical intervention in most cases. Congenital deformities accounted for 63% of the patients experiencing NND.
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Affiliation(s)
| | | | | | | | | | | | - Amer F Samdani
- Shriners Hospitals for Children- Philadelphia, Philadelphia, PA, USA
| | | | - Suken A Shah
- Spine and Scoliosis Center, Nemours/Alfred I. duPont Pediatrics, Wilmington, Delaware, USA
| | | | | | - Brenda A Sides
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA
| | - Munish C Gupta
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA
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Shah SA, Mehmood MH, Khan M, Bukhari IA, Alorainey BI, Vohra F. Inhibition of soluble epoxide hydrolase offers protection against fructose-induced diabetes and related metabolic complications in rats. J Physiol Pharmacol 2021; 71. [PMID: 33475089 DOI: 10.26402/jpp.2020.5.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/30/2020] [Indexed: 11/03/2022]
Abstract
Stabilization of epoxyeicosatrienoic acids (EETs) levels via soluble epoxide hydrolase (sEH) deletion or its pharmacological inhibition have been shown to have beneficial effects on inflammation, ischemia, hypertension and diabetes. Owing to the diverse role of EETs, current study was designed to evaluate the therapeutic potential of 1-trifluoromethoxyphenyl-3-(1-propionylpiperidine-4-yl) urea (TPPU), a novel sEHI against fructose-induced diabetes and related complications in rats. Sprague-Dawley rats (200 - 230 g) were divided into four different groups, each containing 10 animals. One group served as a normal control and received standard diet and drinking water. The second group served as a diseased control and received standard diet, 25% fructose in drinking water and was treated with vehicle only. The third and fourth groups received standard diet, 25% fructose in drinking water and TPPU (2 mg/kg) or metformin (150 mg/kg), respectively. All treatments were given orally for 12 weeks. At the end of the study, blood samples were collected to measure serum insulin levels and other biochemical parameters. Animals were dissected to collect tissue specimens for histological and immunohistochemistry analysis. Animals fed on fructose and treated with vehicle demonstrated elevated blood insulin and glucose levels as well as high levels (P < 0.001) of triglycerides (TGs), cholesterol, low-density lipoprotein (LDL) and homeostatic model assessment of insulin resistance (HOMA-IR) compared to naive rats. Similarly, the levels of alkaline phosphatase (ALP), alanine aminotransferase (ALT), urea and uric acid were significantly (P < 0.001) increased in vehicle treated fructose fed animals. TPPU (2 mg/kg p.o.) and simultaneously fed on fructose for 12 weeks substantially decreased HOMA-IR levels, lowered blood glucose, serum cholesterol, LDLs and TGs) while high-density lipoproteins (HDL) levels were increased compared to untreated animals. Metformin, a standard reference drug showed similar results. Microscopic studies of liver and pancreatic sections of TPPU treated animals showed marked improvement in cellular architecture compared to untreated animals. Current study demonstrated profound therapeutic potential of TPPU against fructose induced-diabetes and related metabolic complications which was evident by its attenuating effect fructose-induced hyperglycemia, hyperlipidemia and impaired renal and hepatic serum markers.
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Affiliation(s)
- S A Shah
- Natural Product Research Unit, Department of Biological and Biomedical, Sciences, The Aga Khan University Medical College, Karachi, Pakistan.,Department of Pharmaceutical Sciences, Superior University Lahore, Punjab, Pakistan.,Department of Pharmacy, University of Malakand, Chakdara, Dir (L), Pakistan
| | - M H Mehmood
- Natural Product Research Unit, Department of Biological and Biomedical, Sciences, The Aga Khan University Medical College, Karachi, Pakistan.,Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - M Khan
- Department of Pharmacy, University of Malakand, Chakdara, Dir (L), Pakistan
| | - I A Bukhari
- Pharmacology Section, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - B I Alorainey
- Pharmacology Section, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - F Vohra
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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