Canadian Spine Society: 23rd Annual Scientific Conference, Wednesday, March 1 - Saturday, March 4, Fairmont Le Château Frontenac, Québec, Que., Canada.

Abstract

s Vol. 66 (4 Suppl 1) August 11, 2023 doi: 10.1503/cjs.006523 SOCIÉTÉ CANADIENNE DU RACHIS 2023 S2 Can J Surg/J can chir 2023;66 (4 Suppl 1) ABSTRACTS FOR PRESENTATION CPSS-1 Abstract ID 108 Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy between radiologists’ reports and surgeons’ assessments? Manjot Birk, Kara Sidhu, Marina Rosa Filezio, Vishwajeet Singh, Fabio Ferri-de-Barros. From the Department of Orthopaedic Surgery, University of Calgary, Calgary, Alta. Background: Cobb angle measurement is a standard method for quantification of scoliosis in patients with adolescent idiopathic scoliosis (AIS). Clinicians rely on Cobb angle measurements to guide treatment decisions. Timely and accurate diagnosis at the primary care level is required to screen patients eligible for timesensitive brace treatment, which is typically delivered in the tertiary care setting. Therefore, accurate and reliable measurement of Cobb angle at the community level is crucial. This study investigated the agreement in Cobb angle measurement between radiologist and the treating spine surgeon. Methods: A retrospective audit of radiographs for patients with AIS was performed. A random sample of 80 patients was selected and radiographic reports (Cobb angle, Risser stage and end vertebrae) by radiologists and spine surgeons were compared. To assess interrater reliability, interclass correlation coefficients (ICC) with 95% confidence intervals (CIs) were computed. Interclass correlation coefficients < 0.70, 0.70–0.79, 0.80–89, and 0.9–0.99 were considered poor, fair, good and excellent reliability, respectively. All radiographs were assessed for quality. Results: The agreement of Cobb angle between spine surgeons was excellent (ICC 0.96, 95% CI 0.94 to 0.97). The agreement between spine surgeons and radiologists was poor (ICC 0.65, 95% CI 0.13 to 0.97). The ICC between spine surgeons and community radiologists and pediatric radiologists was poor (ICC 0.45, 95% CI 0.17 to 0.66) and good (ICC 0.87, 95% CI –0.46 to 0.96), respectively. However, 35 out of 80 radiographs performed did not meet the standard criteria. Risser stage was not reported in 56 of the 80 radiology reports. Interclass correlation coefficients between spine surgeons and radiologists for Risser stage was poor (ICC 0.625, 95% CI 0.325 to 0.794). For end vertebrae identification, there was absolute agreement of end vertebrae identification in 23 of the 80 scans. Conclusion: This study demonstrated a significant disagreement in Cobb angle measurement between radiologists and spine surgeons, which may negatively affect referral wait times and timely treatment for AIS. Quality improvement initiatives, such as continuing medical education, to improve Cobb angle measurement among community radiologists is required to improve scoliosis screening at the primary care level. CPSS-2 Abstract ID 21 Pediatric posterior spinal deformity correction: 30-day postoperative infection rate and risk factors. Vivien Chan,1,2 Geoffrey Shumilak,1,3 Andrew Nataraj,1 Holly Langston.2 From the 1Division of Neurosurgery, University of Alberta, Edmonton, Alta.; 2UCLA Health, Los Angeles, Calif.; the 3Division of Neurosurgery, University of Saskatchewan, Saskatoon, Sask. Background: Our objective was to investigate risk factors associated with 30-day postoperative infection in pediatric patients who have received posterior spinal deformity correction. Methods: The National Surgical Quality Improvement Program pediatric database for years 2016–2020 was used for this study. Patients were included if they received posterior deformity correction (CPT 22800, 22802, 22804). Anterior approaches and combined anterior–posterior approaches were excluded. The outcome of interest was 30-day postoperative infection, which included superficial incisional surgical site infection, deep incisional surgical site infection, deep wound disruption or dehiscence, and surgical space infection. Patient demographics The Canadian Spine Society is a collaborative organization of spine surgeons advancing excellence in research, education and patient care. Accreditation: This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, approved by the Canadian Orthopaedic Association. Course Objectives: The 2023 Annual Scientific Conference of the Canadian Spine Society (CSS) will be an in-person event with a program that offers ample opportunity for professional contact between spine specialists from across the country to share ideas, solve problems, exchange proposals and promote innovation. Once again held in conjunction with the Canadian Paediatric Spine Society (CPSS), the program is a mixture of didactic presentations, symposia, group discussions and proposed research. Symposia will address the spinal pathologies related to connective tissue disease and examine the lessons learned in clinical practice, combining the aspirations of new graduates with the reflections of senior spine surgeons. The transition from pediatric to adult spine care will be viewed through the changes in management of isthmic spondylolisthesis. Continuing a feature initially part of the virtual format, the 2023 conference will host a series of debates between prominent clinicians. This year, topics include the best method of neural decompression in degenerative lumbar spondylolisthesis, the optimal order of treatment in patients with concomitant hip and spine pathology, and the place for neuromonitoring during surgery for cervical myelopathy. Principal investigators with the Canadian Spine Outcome and Research Network (CSORN) will meet to review ongoing research and propose new initiatives. Clinical case studies aimed at resident and spine fellow attendees broaden the scope of the educational experience. E-posters will be displayed throughout the meeting and receive special attention during dedicated poster-review sessions. The meeting format is a continuing medical education–approved blend of selected podium lectures with in formal conversations. Its design encourages comfortable, extended contact with the exhibitors, giving surgeons the chance to inspect and assess the latest surgical implants and equipment without the distraction of aggressive marketing. After a 2-year pandemic interruption, this on-site CSS Scientific Conference will be the first opportunity for the Canadian spine fraternity to meet, mingle and learn. Content licence: This is an Open Access supplement distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NCND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc -nd/4.0/ CANADIAN SPINE SOCIETY 2023 Can J Surg/J can chir 2023;66 (4 Suppl 1) S3 and outcomes were analyzed using descriptive statistics. Multivariable logistic regression analysis using likelihood ratio backward selection method was used to identify significant risk factors for 30-day infection. Results: In total, 24 768 patients were included in the study. The mean age was 13.8 years and 68.7% were female. The 30-day infection rate was 2.2%. The reoperation rate in patients who had a postoperative infection was 59.4%. Patients who had postoperative infection had a higher likelihood of nonhome discharge (χ2 = 124.8, p < 0.001). In our multivariable regression analysis, increasing body mass index (BMI) (B = 1.01, p < 0.001), presence of open wound (B = 3.18, p < 0.001), presence of ostomy (B = 1.51, p < 0.001), neuromuscular etiology (B = 1.56, p = 0.009), previous operation (B = 1.74, p < 0.001), increasing American Society of Anesthesiologists (ASA) class (B = 1.43, p < 0.001), increasing operation time in hours (B = 1.11, p < 0.001), and use of only minimally invasive techniques (B = 4.26, p < 0.001) were associated with increased risk of 30-day postoperative infection. Idiopathic etiology (B = 0.53, p < 0.001) and intraoperative antibiotics (B = 0.71, p = 0.003) were associated with reduced risk of 30-day postoperative infection. Conclusion: Postoperative infection is associated with significantly increased risk of reoperation and nonhome discharge. High-risk factors include BMI, ASA class, presence of open wound, presence of ostomy, neuromuscular etiology, previous operation, operation time and use of minimally invasive techniques only. CPSS-3 Abstract ID 17 “Ultra-low dose” computed tomography without sedation is feasible and should be considered as part of the preoperative optimization pathway in paediatric patients with neuro muscular scoliosis. Nicholas J. Yee,1,2 Carlo Iorio,2 Nicholas Shkumat,2 Brett Rocos,2 Birgit Ertl-Wagner,2 David Lebel,1,2 Mark W. Camp.1,2 From the 1Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont.; the 2Hospital for Sick Children, Toronto, Ont. Background: A major contributor to blood loss and surgical time in neuromuscular scoliosis is the insertion of instrumentation, which can be challenging owing to the abnormal anatomy. Radiographs provide minimal information regarding pedicle diameter, length, blocks to pedicle entry, or iliac crest orientation. Therefore, we developed an “ultra-low dose” computed tomography (ULD CT) protocol without sedation for patients with neuromuscular scoliosis. Our prospective quality improvement study aimed to determine the feasibility, radiation dose and image quality of this protocol. Methods: Fifteen nonambulatory surgical patients with neuromuscular scoliosis received the standard spine x-rays and an ULD CT. The CT protocol was a high-speed, high-pitch, tube-current modulated acquisition at a fixed tube voltage. Adaptive statistical iterative reconstruction was applied to sof