Spine deformity最新文献

{"title":"Evaluating the impact of multiple sclerosis on 2 year postoperative outcomes following long fusion for adult spinal deformity: a propensity score-matched analysis.","authors":"Neil V Shah, Ryan Kong, Chibuokem P Ikwuazom, George A Beyer, Hallie A Tiburzi, Frank A Segreto, Juhayer S Alam, Adam J Wolfert, Daniel Alsoof, Renaud Lafage, Peter G Passias, Frank J Schwab, Alan H Daniels, Virginie Lafage, Carl B Paulino, Bassel G Diebo","doi":"10.1007/s43390-024-00956-2","DOIUrl":"https://doi.org/10.1007/s43390-024-00956-2","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>The impact of neuromuscular disorders such as multiple sclerosis (MS) on outcomes following long segment fusion is underreported. This study evaluates the impact of MS on two-year (2Y) postoperative complications and revisions following ≥ 4-level fusion for adult spinal deformity (ASD).</p><p><strong>Methods: </strong>Patients undergoing ≥ 4-level fusion for ASD were identified from a statewide database. Patients with a baseline diagnosis of MS were also identified. Patients with infectious/traumatic/neoplastic indications were excluded. Subjects were 1:1 propensity score-matched (MS to no-MS) based on age, sex and race and compared for rates of 2Y postoperative complications and reoperations. Logistic regression models were utilized to determine risk factors for adverse outcomes at 2Y.</p><p><strong>Results: </strong>86 patients were included overall (n = 43 per group). Age, sex, and race were comparable between groups (p > 0.05). MS patients incurred higher charges for their surgical visit ($125,906 vs. $84,006, p = 0.007) with similar LOS (8.1 vs. 5.3 days, p > 0.05). MS patients experienced comparable rates of overall medical complications (30.1% vs. 25.6%) and surgical complications (34.9% vs. 30.2%); p > 0.05. MS patients had similar rates of 2Y revisions (16.3% vs. 9.3%, p = 0.333). MS was not associated with medical, surgical, or overall complications or revisions at minimum 2Y follow-up.</p><p><strong>Conclusion: </strong>Patients with MS experienced similar postoperative course compared to those without MS following ≥ 4-level fusion for ASD. This data supports the findings of multiple previously published case series' that long segment fusions for ASD can be performed relatively safely in patients with MS.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five days of inpatient scoliosis-specific exercises improve preoperative spinal flexibility and facilitate curve correction of patients with rigid idiopathic scoliosis.","authors":"Yunli Fan, Michael K T To, Guan-Ming Kuang, Nan Lou, Feng Zhu, Huiren Tao, Guangshuo Li, Eric H K Yeung, Kenneth M C Cheung, Jason P Y Cheung","doi":"10.1007/s43390-024-00965-1","DOIUrl":"10.1007/s43390-024-00965-1","url":null,"abstract":"<p><p>Preoperative spine flexibility plays a key role in the intraoperative treatment course of severe scoliosis. In this cohort study, we examined the effects of 5 day inpatient scoliosis-specific exercise (SSE) on the spinal flexibility of patients with adolescent idiopathic scoliosis before surgery. A total of 65 patients were analyzed. These patients were divided into a prospective cohort (n = 43, age: 15 ± 1.6 years, 36 girls and 7 boys, Lenke class 1 and 2, Cobb angle: 64 ± 11°) who underwent spinal fusion in 2020, and a retrospective cohort (n = 22, age: 15 ± 1.5 years, 17 girls and 5 boys, Lenke class 1 or 2, Cobb angle: 63 ± 10°), who underwent surgery between 2018 and 2019 and did not receive preoperative SSE. Rigid scoliosis was defined as a reduction of less than 50% in Cobb angle between the preoperative fulcrum bending and initial standing curve magnitude. In the prospective cohort, 21 patients (Cobb angle: 65 ± 11°) presented with rigid thoracic scoliosis (pre-SSE fulcrum bending: 40 ± 9°, 39% reduction), and therefore received 5-day SSE to improve their preoperative spinal flexibility (SSE group), whereas 22 patients (Cobb angle: 63 ± 12°) presented with flexible thoracic scoliosis (pre-SSE fulcrum bending: 27 ± 8°, 58% reduction), and therefore underwent surgery without preoperative SSE (non-SSE group). For patients who received 5-day preoperative SSE for 4 h every day, the International Schroth Three-Dimensional Scoliosis Therapy technique was implemented with an inpatient model. After 5 days of SSE, improvements in Cobb angle with post-SSE fulcrum-bending radiography (23 ± 7°, 66% reduction) and pulmonary function (forced expiratory volume in 1 s/forced expiratory volume: 87% before SSE and 92% after SSE, p < 0.01) were observed. At the postoperative day 5, the degree of scoliosis had reduced from 44 ± 6.6° to 22 ± 6° in the SSE group, which is 1° less than the Cobb angle obtained on post-SSE fulcrum-bending radiography. In the non-SSE group, the degree of scoliosis decreased to 26 ± 5.7°. In the retrospective cohort, the degree of scoliosis decreased to 35 ± 5°, with the group also having higher postoperative pain (Visual Analog Scale score = 7, range = 5-10) and an extended hospitalization duration (11 ± 3 days). At 2-year follow-up, curve correction was found to be maintained without adding-on or proximal junctional kyphosis. Compared with the non-SSE group, the SSE group exhibited a greater curve correction (66%) with a shorter hospitalization duration (5 ± 1 days) and a lower degree of postoperative pain (Visual Analog Scale score = 4, range = 3-8). Taken together, our findings indicate that 5 day SSE improves preoperative spinal flexibility and facilitates curve correction.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rib-on-pelvis deformity: a modifiable driver of pain and poor health-related quality of life in cerebral palsy.","authors":"Vineet M Desai, Margaret Bowen, Jason B Anari, John M Flynn, Burt Yaszay, Paul Sponseller, Mark Abel, Joshua Pahys, Patrick J Cahill","doi":"10.1007/s43390-024-00974-0","DOIUrl":"https://doi.org/10.1007/s43390-024-00974-0","url":null,"abstract":"<p><strong>Purpose: </strong>Cerebral Palsy (CP) often presents with a sweeping thoracolumbar scoliosis and pelvic obliquity. With severe pelvic obliquity, the ribs come into contact with the high side of the oblique pelvis, termed rib-on-pelvis deformity (ROP). ROP can result in costo-iliac impingement, or pain associated with ROP, and can also adversely affect breathing and sitting balance. The goal of this study was to evaluate whether CP patients with ROP have worse health-related quality of life (HRQOL) before surgery and a greater improvement in HRQOL after surgery.</p><p><strong>Methods: </strong>A retrospective analysis of a prospectively collected, multicenter, international registry was performed for all nonambulatory patients with CP treated with spinal fusion with at least two-year follow-up. HRQOL was measured via the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD) questionnaire domains (0 = most disability, 100 = least disability). ROP was defined as having a rib distal to the superior portion of the iliac crest on preop upright radiographs. The ROP group and control group without ROP were compared regarding six domain scores and total score of CPCHILD. Multiple linear regression was used to control for curve apex location, major coronal Cobb angle, type of tone, and pelvic obliquity.</p><p><strong>Results: </strong>340 patients met inclusion criteria (52% female, mean age 14.0 years). The mean major coronal Cobb angle was 81 degrees and mean pelvic obliquity was 22 degrees. 176 patients (51.8%) had ROP while 164 patients (48.2%) did not. ROP was independently associated with worse preoperative Positioning/Transfers/Mobility (PTM), Comfort & Emotions (C&E), and total CPCHILD score via the CPCHILD questionnaire (p < 0.05). Patients with preoperative ROP experienced a greater improvement in the C&E and PTM domains as well as total CPCHILD score than patients without ROP (p < 0.05).</p><p><strong>Conclusion: </strong>CP patients with rib-on-pelvis deformity experience more pain and worse HRQOL than patients without this deformity. These patients experienced a greater improvement in HRQOL after spinal fusion measured via the CPCHILD questionnaire.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning in Cobb angle automated measurement on X-rays: a systematic review and meta-analysis.","authors":"Yuanpeng Zhu, Xiangjie Yin, Zefu Chen, Haoran Zhang, Kexin Xu, Jianguo Zhang, Nan Wu","doi":"10.1007/s43390-024-00954-4","DOIUrl":"https://doi.org/10.1007/s43390-024-00954-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to provide an overview of different deep learning algorithms (DLAs), identify the limitations, and summarize potential solutions to improve the performance of DLAs.</p><p><strong>Methods: </strong>We reviewed eligible studies on DLAs for automated Cobb angle estimation on X-rays and conducted a meta-analysis. A systematic literature search was conducted in six databases up until September 2023. Our meta-analysis included an evaluation of reported circular mean absolute error (CMAE) from the studies, as well as a subgroup analysis of implementation strategies. Risk of bias was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). This study was registered in PROSPERO prior to initiation (CRD42023403057).</p><p><strong>Results: </strong>We identified 120 articles from our systematic search (n = 3022), eventually including 50 studies in the systematic review and 17 studies in the meta-analysis. The overall estimate for CMAE was 2.99 (95% CI 2.61-3.38), with high heterogeneity (94%, p < 0.01). Segmentation-based methods showed greater accuracy (p < 0.01), with a CMAE of 2.40 (95% CI 1.85-2.95), compared to landmark-based methods, which had a CMAE of 3.31 (95% CI 2.89-3.72).</p><p><strong>Conclusions: </strong>According to our limited meta-analysis results, DLAs have shown relatively high accuracy for automated Cobb angle measurement. In terms of CMAE, segmentation-based methods may perform better than landmark-based methods. We also summarized potential ways to improve model design in future studies. It is important to follow quality guidelines when reporting on DLAs.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High inpatient-opioid consumption predicts extended length of hospital stay in patients undergoing spinal fusion for adolescent idiopathic scoliosis.","authors":"Mani Ratnesh S Sandhu, Samuel Craft, Benjamin C Reeves, Sumaiya Sayeed, Astrid C Hengartner, Dominick A Tuason, Michael DiLuna, Aladine A Elsamadicy","doi":"10.1007/s43390-024-00960-6","DOIUrl":"https://doi.org/10.1007/s43390-024-00960-6","url":null,"abstract":"<p><strong>Objectives: </strong>Opioids are common medications used following spine surgery. However, few studies have assessed the impact of increased inpatient-opioid consumption on outcomes following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The aim of this study was to determine the impact of increased inpatient-opioid consumption on hospital length of stay (LOS) following PSF for AIS.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using the Premier Healthcare Database (2016-2017). Adolescent patients (11-17 years old) who underwent PSF for AIS, identified using ICD-10-CM coding, were stratified by inpatient MME (morphine milligram equivalent) consumption into Low (< 25th percentile for the cohort), Medium (25-75th percentile), and High (> 75th percentile) cohorts. Demographics, comorbidities, intraoperative procedures, perioperative adverse events (AEs), length of hospital stay (LOS), non-routine discharge rates, cost of admission, and 30-day readmission rates were assessed. A logistic multivariate regression analysis was performed to determine the association between inpatient MME consumption and extended LOS.</p><p><strong>Results: </strong>Of the 1042 study patients, 260 (24.9%) had Low-MME consumption, 523 (50.2%) had Medium-MME consumption, and 259 (24.9%) had High-MME consumption. A greater proportion of patients in the High cohort identified as non-Hispanic white (Low: 46.5% vs Medium: 61.4% vs High: 65.3%, p < 0.001), while the proportion of patients reporting any comorbidity did not vary across the cohorts (p = 0.940). The number of post-operative AEs experienced also did not vary across the cohorts (p = 0.629). A greater proportion of patients in the High cohort had an extended LOS (Low: 6.5% vs Medium: 8.6% vs High: 19.7%, p < 0.001), while a greater proportion of patients in the Low cohort had an increased cost of admission (Low: 33.1% vs Medium: 20.3% vs High: 26.6%, p < 0.001). The High cohort had increased 30-day readmission rates relative to the Low and Medium cohorts (Low: 0.8% vs Medium: 0.2% vs High: 1.5%, p = 0.049). Non-routine discharge rates did not vary among the cohorts (p = 0.441). On multivariate analysis, High-MME consumption was significantly associated with extended LOS, while Medium-MME consumption was not [Medium: aOR: 1.48, CI (0.83, 2.74), p = 0.193; High: aOR: 4.43, CI (2.47, 8.31), p < 0.001].</p><p><strong>Conclusions: </strong>Our study showed that high post-operative-MME consumption was significantly associated with extended LOS in patients undergoing PSF for AIS. In light of these findings, changes to existing protocols that decrease the reliance on opioids for post-operative analgesia are merited to improve patient outcomes and reduce health-care expenditures.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do teams of strangers create health care dangers? The effect of OR team consistency on operative times in adolescent idiopathic scoliosis.","authors":"Ritt R Givens, Melanie Brown, Matan S Malka, Kevin Lu, Thomas M Zervos, Benjamin D Roye, Teeda Pinyavat, John M Flynn, Michael G Vitale","doi":"10.1007/s43390-024-00964-2","DOIUrl":"https://doi.org/10.1007/s43390-024-00964-2","url":null,"abstract":"<p><strong>Purpose: </strong>Teamwork and communication are important components of any surgical team. This study uses a simple, reproducible, and quantitative \"team consistency score\" and a nodal-based model for examining prior interactions amongst team members to represent and quantify the regularity of an OR team for a specific surgical case.</p><p><strong>Methods: </strong>The electronic medical record (EMR) at our institution was queried for pediatric patients undergoing spinal surgery from January 2021 through December 2023. The number of prior interactions between individuals filling distinct roles in the OR for each case was recorded. A metric coined the consistency score was developed representing the sum total of these prior interactions standardized to a reference case. Spearman's Correlation as well as the Mann-Whitney comparison test were used to analyze the associations between case team consistency score and efficiency measures.</p><p><strong>Results: </strong>154 cases were included for analysis. There was a statistically significant negative correlation between case consistency score and both anesthesia time (rho = -0.159; p < 0.05) and patient preparation time (rho = -0.218; p < 0.01). When looking at the consistent (above median consistency score of 0.46) vs. inconsistent cohorts, the inconsistent cohort had a higher mean patient preparation time (53.3 ± 14.0 min vs. 49.0 ± 9.3 min; p < 0.05), as well as a higher overall mean case length (336.6 ± 47.4 min vs. 321.9 ± 42.4 min; p < 0.05).</p><p><strong>Conclusion: </strong>The findings suggest that increased team consistency, as measured by a \"team consistency score\" metric, is related to heightened efficiency and reduced intraoperative times.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful management of idiopathic early-onset scoliosis: effect of curve correction and bracing after Mehta casting.","authors":"Tiffany Thompson, Michael O'Sullivan, Carlos Monroig-Rivera, Charles E Johnston","doi":"10.1007/s43390-024-00957-1","DOIUrl":"https://doi.org/10.1007/s43390-024-00957-1","url":null,"abstract":"<p><strong>Study design: </strong>Patients with idiopathic EOS treated by Mehta casting followed by bracing or observation from a single institution.</p><p><strong>Objectives: </strong>To determine casting protocol parameters leading to successful management; to determine efficacy of bracing vs. observation after cast discontinuance.</p><p><strong>Background: </strong>Previous studies have not precisely defined parameters for cast discontinuance (amount of correction, number of casts), nor have documented the efficacy of brace treatment.</p><p><strong>Methods: </strong>73 patients undergoing Mehta casting were braced (n = 56) or observed (n = 17) after casting with follow-up for a mean of 51-58 months. 57 patients had ≥ 4 casts applied; 39 had ≥ 5 casts. Success was defined as no further treatment required. Curve magnitude was measured at time points pre-casting, at cast discontinuance, and last follow up.</p><p><strong>Results: </strong>There was no difference in success rate between braced patients (79% success) and observed (71%). Curve correction to < 30° at cast discontinuance was crucial parameter for success, as 95% (45/47) of patients with this correction achieved success, braced or not, while only 42% (11/26) with residual curves ≥ 30° achieved success (p < .001) and 14 of these required surgery compared to 0/47 successful patients. The number of casts (over/under 4 or 5) made no difference in achieving success. 10/26 patients who had residual curves ≥ 30° and were braced achieved success due to further curve diminution during bracing.</p><p><strong>Conclusions: </strong>Cast correction to < 30° followed by bracing achieved 100% success in 34 patients compared to 85% (13 patients) who were observed (p = .07). For residual curves ≥ 30° bracing can produce some correction and succeed in delaying further treatment.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic resonance imaging evaluation of the cerebellar tonsil position before and after posterior spinal fusion in adolescent idiopathic scoliosis.","authors":"Bosio Santiago, Carolina Halliburton, Maenza Rubén, Puigdevall Miguel","doi":"10.1007/s43390-024-00958-0","DOIUrl":"https://doi.org/10.1007/s43390-024-00958-0","url":null,"abstract":"<p><strong>Background: </strong>Chiari malformation type I(CM-I) is one of the most common neurological malformations observed in patients with adolescent idiopathic scoliosis (AIS). It remains uncertain whether AIS patients without neurological symptoms require CM-I decompression before undergoing spinal corrective surgery to prevent cerebellar tonsil herniation and potential neurological complications. This study aims to assess variations in the position of the cerebellar tonsil after posterior spinal fusion (PSF) in neurologically intact patients with AIS.</p><p><strong>Methods: </strong>We retrospectively evaluated 40 patients with AIS who underwent posterior spinal fusion (PSF) without neurological symptoms. Sagittal hindbrain MRIs were performed before and after spinal surgery. The cerebellar tonsil's position relative to the foramen magnum was measured using the method described by Aboulezz (J Comput Assist Tomogr 1985). We assessed variations in the cerebellar tonsil position concerning spinal correction and elongation after PSF.</p><p><strong>Results: </strong>The average preoperative magnitude of the scoliotic curve was 53.15 degrees (SD 10.46 degrees), and that of thoracic kyphosis was 35.42 degrees (SD 12.38 degrees). In the immediate postoperative period, the average magnitudes were 7.45 degrees (SD 7.33 degrees) and 27.87 degrees (SD 9.03 degrees), respectively. The average correction achieved with PSF was 86% in the coronal plane (p < 0.00001). The average length of the spine in the coronal plane was 44.5 cm (SD 5.25 cm) preoperatively and 48.27 cm (SD 4.40 cm) postoperatively (p < 0.00001). The average length of the vertebral column in the sagittal plane was 50.87 cm (SD 4.47 cm) preoperatively and 55.13 cm (SD 3.27 cm) postoperatively (p < 0.00001). No significant difference was observed in the position of the cerebellar tonsil in the measurements taken before and after spinal deformity correction (p = 0.6042). In 10 out of 40 patients, caudal displacement of the cerebellar tonsil was observed after PSF. In 28 patients, no variation in the position of the cerebellar tonsil was observed, and in 2, cephalic displacement was noted.</p><p><strong>Conclusion: </strong>In AIS patients with a normal position of the cerebellar tonsil undergoing posterior spinal fusion, there is no significant change in their position after surgery. Our analysis did not reveal any correlation between curve correction, spine elongation, and variations in the cerebellar tonsil position.</p><p><strong>Significance: </strong>The position of the cerebellar tonsil remained largely unchanged after PSF in AIS patients without neurological symptoms. Further studies would be necessary to determine whether surgical decompression is required in asymptomatic patients with CM-I before undergoing surgery to correct spinal deformity.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of distraction-based growing rods at graduation: a comparison of traditional growing rods and magnetically controlled growing rods.","authors":"Jwalant Mehta, Suken Shah, Harry Hothi, Martina Tognini, Adrian Gardner, Charles E Johnston, Robert Murphy, George Thompson, Paul Sponseller, John Emans, Francisco Javier-Grueso, Peter Strum","doi":"10.1007/s43390-024-00969-x","DOIUrl":"https://doi.org/10.1007/s43390-024-00969-x","url":null,"abstract":"<p><strong>Introduction: </strong>Distraction-based growing rods have been considered as an alternative surgical option for the operative treatment of EOS. TGR has been challenged by MCGR, which is reported to have the advantage of non-invasive lengthening with fewer planned returns to theatre. This study explores the radiographic outcomes, Unplanned Returns to the Operating Room (UPROR) and complication profile of both the procedures at the end of the planned growing rod treatment with either TGR or MCGR.</p><p><strong>Methods: </strong>We included all the EOS cases from the PSSG database that underwent either TGR or MCGR with spine-based proximal anchors, followed up to the time of graduation. Any crossover or hybrid procedures were excluded. 549 patients (409 TGR and 140 MCGR) were eligible for review. We measured the coronal curve magnitude, Kyphosis, T1-T12, T1-S1 and L1-S1 lengths at 4 time points (before and after the index surgery and before and after the definitive surgery).</p><p><strong>Results: </strong>The TGR group were slightly younger at the time of the index procedure (7 years for TGR vs. 8.5 years for MCGR, p < 0.001). We noted an improvement in all radiological parameters after the growing rod implantation. The spinal lengths increased through the lengthening period, while the coronal curve magnitude and the kyphosis increased. The kyphosis normalized following the final fusion, the coronal curve magnitude reduced further with a further increase in spinal lengths. The final follow-up from the time of the index implantation to the definitive surgery was 5.1 years (IQR 3.8) in TGR and 3.5 years (IQR 1.65) in the MCGR groups. The total number of complications was fewer in the MCGR group. The overall risk of UPROR was lower in the MCGR group and implant breakage was less in the MCGR group by 4.7 times.</p><p><strong>Conclusions: </strong>This study confirms the equivalence of both the distraction-based growing rods systems from the radiological stand-point, during the lengthening phase and at the time of the definitive surgery. The TGR was more kyphogenic during the lengthening period. The complications and UPROR were fewer in the MCGR groups.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting abdominal wall \"morbidity\" of the extensile anterolateral approach to the thoracolumbar spine.","authors":"Alekos A Theologis, Andrew P Collins, Kanwar Parhar, Munish C Gupta","doi":"10.1007/s43390-024-00971-3","DOIUrl":"https://doi.org/10.1007/s43390-024-00971-3","url":null,"abstract":"<p><strong>Purpose: </strong>To assess patients' perceptions of their abdominal wall following extensile anterolateral approaches to the thoracolumbar spine for adult spinal deformity (ASD) using validated questionnaires.</p><p><strong>Methods: </strong>Adults who underwent anterior-posterior thoracolumbar spinal operations to the pelvis for ASD in which the anterior fusion was performed through an extensile anterolateral approach were reviewed. Three questionnaires were administered at least 1 year following surgery and included The Abdominal Core Health Quality Collaborative Survey (AHS-QC), The Patient Scar Assessment Scale (PSAS), and The Anterior Abdominal Incision Questionnaire (AAIQ).</p><p><strong>Results: </strong>Fifty-one patients (80.4% female, median age 65 years) were included. Average follow-up was 2.8 ± 1.7 years. Average number of anterior fusion levels was 3.5 ± 1.4. Patients achieved high satisfaction rates from surgery (74.5%). AAIQ responses included postoperative pain (33.3%), bulging (41.7%), and limitations in daily activities (18.8%) with only 15.7% experienced moderate-severe pain related to their incisions and only 6.3% seeking treatment for their scars. Post-operatively, 63.2% had a neutral or improved self-image of their torso and trunk, while only 10.2% stating it was much worse. Patients' overall opinion of their scar compared to their normal skin was very positive [average 2.75 ± 2.93 (10 = worst possible scar)]. Favorable scores were also reported for color difference, stiffness, change in thickness, and irregularity in their abdominal scar compared to normal skin.</p><p><strong>Conclusions: </strong>Following extensile anterolateral approaches to the thoracolumbar spine for ASD, the majority of patients reported mild pain, mild functional limitations, good cosmesis, and high satisfaction rates with their anterior incisions based on validated questionnaires.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}