Spine deformity最新文献

{"title":"Back pain disability and PROMIS scores in children with hyperkyphosis are worse than children with idiopathic scoliosis.","authors":"Karina Amani Zapata, Caitlin Nadolny, Eliza Lovrich, Yuhan Ma, Brandon A Ramo","doi":"10.1007/s43390-024-01028-1","DOIUrl":"10.1007/s43390-024-01028-1","url":null,"abstract":"<p><strong>Purpose: </strong>To compare health-related quality-of-life (HRQOL) between children with hyperkyphosis and idiopathic scoliosis using 9-item Oswestry Disability Index (ODI-9) and Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference, Mobility, and Anxiety.</p><p><strong>Methods: </strong>Children with hyperkyphosis, idiopathic scoliosis, and controls with no structural diagnosis ages 10-18 years who completed the PROMIS Pediatric Pain Interference, Mobility, and Anxiety domains were retrospectively evaluated from April 2021 to June 2023. Comparisons were made between hyperkyphosis, idiopathic scoliosis, and control groups. Within the hyperkyphosis group, comparisons were made between Scheuermann kyphosis and postural kyphosis subgroups.</p><p><strong>Results: </strong>304 children with hyperkyphosis, 1134 with idiopathic scoliosis, and 1493 controls were included. Children with hyperkyphosis had increased age, male sex, BMI percentile, Spanish than English speakers, and public insurance type. They also had worse ODI-9, PROMIS Pain Interference and Mobility scores which remained significant after multivariate regression analysis included age, sex, BMI percentile, language, insurance type, and race/ethnicity (p < 0.01). The Scheuermann kyphosis (n = 67) subgroup had increased age, male sex, area deprivation index (ADI), BMI percentile, concern by their appearance, and worse PROMIS Pain Interference and Mobility scores than the postural kyphosis (n = 237) subgroup. However, Scheuermann kyphosis subgroup score differences did not remain significant after considering age, sex, ADI, and BMI percentile.</p><p><strong>Conclusion: </strong>Children with hyperkyphosis (both Scheuermann and postural kyphosis subtypes) have worse HRQOL scores than their peers with idiopathic scoliosis. Worse ODI-9, PROMIS Pain Interference and Mobility scores remained significant only in the hyperkyphosis group as a whole after adjusting for confounding variables, but not between hyperkyphosis subgroups.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"801-809"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971087","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":"Congenital scoliosis presenting in teenage years outcomes without hemivertebra excision.","authors":"Vishal Sarwahi, Sayyida Hasan, Keshin Visahan, Effat Rahman, Katherine Eigo, Jesse Galina, Jeffrey Goldstein, Thomas J Dowling, Jordan Fakhoury, Yungtai Lo, Terry Amaral","doi":"10.1007/s43390-025-01039-6","DOIUrl":"10.1007/s43390-025-01039-6","url":null,"abstract":"<p><strong>Purpose: </strong>In congenital scoliosis, the surgical strategy approach of hemivertebra excision, with or without instrumentation and fusion, is a common approach to correction of scoliosis. However, hemivertebra excisions are technically challenging, with potential complications including spinal cord injury, nerve root injury and cerebrospinal fluid leak. The purpose of this study was to determine whether correction of congenital scoliosis can be achieved using a posterior instrumentation/fusion-only approach without the need for hemivertebra excision.</p><p><strong>Methods: </strong> 35 patients with congenital scoliosis and hemivertebra operated between 2007 and 2024 were matched to 35 AIS patients by BMI, levels fused, and preoperative Cobb. Wilcoxon rank-sum tests, chi-square tests, and Fisher's Exact tests were utilized.</p><p><strong>Results: </strong>Age (p = 0.22), BMI (p = 0.25) and preoperative Cobb (p = 0.79) were similar between hemivertebra and AIS patients. Cobb correction (HV: 71.8% vs. AIS: 70.4%; p = 0.92) and EBL (500 cc vs. 400 cc; p = 1.0) were similar. Operative time (310.0 min vs. 242.0 min; p < 0.001) and length of stay (7.0 days vs. 5.0 days; p < 0.001) were statistically different. Patients operated on after 2018, when the Rapid Recovery Protocol was implemented, had a similar length of stay (4.5 vs. 5.0; p = 0.92). Patients in both cohorts had similar SRS-22 scores.</p><p><strong>Conclusion: </strong> Choosing fusion levels in congenital patients, on similar principles to AIS, leads to avoidance of hemivertebra excision, including lumbosacral hemivertebrae. This approach is safer than hemivertebra excision and has similar, or better, curve correction than previously reported.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"835-843"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060638","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":"Comparison of postoperative and outpatient opioid use in adolescent idiopathic scoliosis patients treated with posterior spinal fusion surgery and vertebral body tethering.","authors":"Natalie S Pulido, Todd A Milbrandt, A Noelle Larson","doi":"10.1007/s43390-024-01014-7","DOIUrl":"10.1007/s43390-024-01014-7","url":null,"abstract":"<p><strong>Purpose: </strong>Surgical treatments for adolescent idiopathic scoliosis (AIS) include posterior spinal fusion (PSF) and vertebral body tethering (VBT), but there is limited data that compares pain between these groups. We aimed to compare postoperative pain between these patients through inpatient opioid use and opioid prescriptions post-discharge.</p><p><strong>Methods: </strong>A retrospective review of patients diagnosed with AIS who underwent PSF or VBT surgery was reviewed to determine LOS, inpatient opioid use, and opioids prescribed post-discharge. Only PSF patients who received liposomal bupivacaine and intrathecal (IT) hydromorphone, and VBT patients who received a paravertebral catheter of lidocaine and in addition to IT hydromorphone were included. Opioid amounts were reported as oral morphine equivalents (OMEs).</p><p><strong>Results: </strong>Of 198 AIS patients that met inclusion, there were 89 PSF and 109 VBT patients. PSF patients had an increased LOS by 0.6 days compared to VBT patients (p < 0.001). Patients in the PSF group were administered a mean of 30.0 OMEs/day compared with the VBT group who received 12.5 OMEs/day (p < 0.001). At discharge, PSF patients were initially prescribed a mean of 227.7 OMEs while VBT patients' mean prescription was 139.7 (p < 0.001). PSF patients received more refills (Χ² (1, n = 198) = 26.8, p < .001) and had a higher mean total of outpatient OMEs prescribed when compared to VBT patients (359.4 vs 185.8, p < 0.001).</p><p><strong>Conclusion: </strong>In AIS patients undergoing surgical correction, those who underwent PSF had longer LOS, received more inpatient OMEs, and were prescribed more OMEs both at initial discharge and total as an outpatient, when compared to VBT patients.</p><p><strong>Level of evidence: </strong>Level III: (retrospective cohort study).</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"729-735"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772046","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":"Kyphectomy followed by self-sliding pedicle screw and translumbosacral rod impaction and fixation: a novel growth-friendly technique in myelomeningocele patients.","authors":"Alderico Girão Campos Barros, Diogo R Noronha, Luis E Carelli, David L Skaggs","doi":"10.1007/s43390-024-01036-1","DOIUrl":"10.1007/s43390-024-01036-1","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital lumbar kyphosis is present in about 15% of patients with myelomeningocele. Worsening of deformity with complications such as chronic skin ulcers and bone exposure is common. In patients under 8 years of age, treatment becomes even more challenging: in addition to resecting the apex of the kyphotic deformity, we should ideally stabilize the spine with fixation methods that do not interrupt the growth of the rib cage, associated with the challenging pelvic fixation in this population. The emergence of growth-friendly techniques has greatly benefited patients with early-onset deformity, allowing for correction and control of deviation without interrupting trunk growth, which is often already compromised in these patients. We describe the surgical technique and present preliminary clinical outcomes for a novel approach which combines self-sliding screws that allow for trunk growth with impaction of translumbosacral rods for distal fixation.</p><p><strong>Methodology: </strong>Candidates for the technique were patients with myelomeningocele and congenital lumbar kyphosis, inability to assume supine position, and a history of skin ulcers, recurrent osteomyelitis and poor weight gain. They all lacked sensory or motor function below the level of the myelomeningocele. They underwent the same reconstruction technique after kyphectomy which combines self-sliding screws that allow for trunk growth with impaction of the translumbosacral rods for distal fixation.</p><p><strong>Results: </strong>Case 1: Female; 4.5 years old at surgery; 5 year follow-up. 1 complication: loosening of one blocker. The child is doing well and did not require surgical revision. Mean growth per year: 9.5 mm. Case 2: Male; 7.4 Years old at surgery; 4 year follow-up. 1 complication: post-surgical infection which required 2 debridements in the operating room and prolonged antibiotic therapy. Mean growth per year: 6 mm. Case 3: Female; 5.5 Years old at surgery; 27 month follow-up. No complications reported so far. Mean growth per year: 9.42 mm. None of the cases showed signs of sacral osteolysis or rod migration.</p><p><strong>Discussion / conclusion: </strong>To our knowledge, this is the first study that combines sliding screws with translumbosacral rod impaction. Although this technique has proven to be safe and effective, we are aware that the number of cases is limited and the follow-up is short. Further studies are necessary to confirm the method.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"877-885"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-density and moderate-density implant constructs for adolescent idiopathic scoliosis have equivalent clinical and radiographic outcomes at 2 years.","authors":"Taylor J Jackson, Suken A Shah, Harry L Shufflebarger, Daniel J Sucato, Sumeet Garg, Paul Sponseller, David Clements, Nicholas D Fletcher, Peter O Newton, Amer F Samdani, A Noelle Larson","doi":"10.1007/s43390-024-01016-5","DOIUrl":"10.1007/s43390-024-01016-5","url":null,"abstract":"<p><strong>Purpose: </strong>Implant density for posterior spinal fusion in AIS remains controversial. As limited data exist to guide surgeons, we aimed to evaluate the effect of implant density on radiographic and patient reported outcomes (PROMs).</p><p><strong>Methods: </strong>This is a retrospective review of prospectively collected multicenter data. Radiographic, perioperative, and PROMs were compared for patients treated with high-density (> 1.8) and moderate-density (≤ 1.8-1.4) screw constructs. Patients were stratified according to the Lenke classification.</p><p><strong>Results: </strong>1865 patients met inclusion criteria: 1225 high-density and 640 moderate-density screw construct patients. The groups had similar mean age (14.7 vs 14.6, p > 0.05) and sex (81.5% vs 79.5% female, p > 0.05). There were similar radiographic outcomes between groups [final curve magnitude (19° vs 19°, p = 0.540)] with only small differences in the percent correction for Lenke 2 curves (66% vs 61%, p = 0.001) producing a 1° difference in curve correction (19° vs 20°, p = 0.001) in the high-density group at 2 years. Excluding thoracoplasty patients, 2-year rib rotation was similar between the two groups (4.5° vs 6.3°, p < 0.05). The mean time to follow-up was shorter in the high-density group (4.5 vs 5 years, p < 0.001), but no statistically significant differences in the two-year SRS-22 scores.</p><p><strong>Conclusion: </strong>Patients treated with both high and moderate-density constructs had similar SRS scores and radiographic results at 2-year follow-up. High-density constructs produced marginally better axial, sagittal, and coronal correction. However, these differences are small and not clinically meaningful with no difference in PROMs in curves ≤ 70°. The use of a moderate-density construct should be considered for routine AIS surgery.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"773-787"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807923","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":"Longitudinal impact of a perioperative pathway for spinal fusion in adolescent idiopathic scoliosis: a quality improvement project.","authors":"Lorena V Floccari, Michael T Bigham, Matthew Holloway, Kenzie D Lundqvist, Alexandria Rundell, Richard P Steiner, Kenneth T Bono, Todd F Ritzman","doi":"10.1007/s43390-024-01032-5","DOIUrl":"10.1007/s43390-024-01032-5","url":null,"abstract":"<p><strong>Objective: </strong>Prior studies show that recovery pathway implementation after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) reduces length of stay (LOS) without increasing complications, but little is known about the sustainability and longitudinal outcomes of these initiatives. This study aimed to establish and continually improve a perioperative pathway for AIS patients undergoing PSF while tracking long-term LOS performance with iterative improvements.</p><p><strong>Methods: </strong>Implementation of the AIS care pathway at a single freestanding tertiary children's hospital was initiated in January 2016 (Phase 1) with iterative annual changes and a comprehensive update in September 2021 (Phase 2). The pathway involves preoperative optimization, standardized protocols, multi-modal pain regimen, early transition to oral pain medications, and early and frequent mobilization. Outcomes were tracked longitudinally using quality-improvement methodology, and comparisons between each group were performed.</p><p><strong>Results: </strong>Four hundred thirty six AIS patients (86 pre-implementation, 257 Phase 1, 93 Phase 2) who underwent PSF were included. Baseline patient demographics and Cobb angles were similar. Hospital LOS decreased from 5.1 days pre-implementation to 2.3 days in a stepwise fashion corresponding with pathway modifications. Intensive care unit (ICU) admissions decreased from 100% pre-implementation to 0% during Phase 2. Perioperative order set compliance increased from 0% pre-implementation to 100%. There were no significant increases in readmissions or reoperations. Direct hospitalization costs decreased by $5854.95 per case.</p><p><strong>Conclusions: </strong>A multidisciplinary perioperative pathway for AIS patients undergoing PSF significantly reduced hospital LOS by 55% and direct costs by 11.3%. Continuous improvement and data monitoring led to sustained positive outcomes over eight years.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"789-799"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711155","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":"Prevalence of metal hypersensitivity in pediatric spine surgery.","authors":"A Scott Emmert, Tiffany Ruan, Michael G Sherenian, Amal H Assa'ad, Nichole Leitsinger, Lindsay Schultz, Viral V Jain, Peter F Sturm, Alvin C Jones","doi":"10.1007/s43390-024-01030-7","DOIUrl":"10.1007/s43390-024-01030-7","url":null,"abstract":"<p><strong>Purpose: </strong>Delayed metal hypersensitivity reactions can cause complications in spine surgery. Currently, there is no information on the prevalence of metal hypersensitivity in pediatric patients undergoing spine surgery. The objective of this study is to determine the prevalence of metal hypersensitivity in pediatric patients undergoing spinal instrumentation.</p><p><strong>Methods: </strong>Retrospective chart review of patients who underwent spinal instrumentation with or without fusion at a single institution, from January 1, 2014, to December 31, 2020, was performed. Patients were pre-screened for history of allergic diseases, including previous reaction to metals, prior to surgery. Patch metal allergy testing (PMAT) for metal hypersensitivity was also performed.</p><p><strong>Results: </strong>Of the 796 pediatric patients who underwent spinal instrumentation procedures from 2014 to 2020, 118 (15%) screened positive for metal hypersensitivity. However, the number of patients with documented evidence of metal hypersensitivity diminished to 26 (3%) after PMAT verification. Nickel hypersensitivity was most prevalent, with 20 patients (16.9% of positive screening; 2.5% of all instrumented patients) demonstrating positive skin patch tests. The other most prevalent metal hypersensitivities included cobalt in 9 patients (7.6%; 1.1%), manganese in 3 patients (2.5%; 0.4%), and copper in 1 patient (0.8%; 0.1%). with a number needed to treat (NNT) of 5.</p><p><strong>Conclusions: </strong>This study suggests that routine pre-operative PMAT is not necessary in all pediatric spine patients yet should be considered if patients report a history of prior metal hypersensitivity reactions.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"667-671"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which Lenke type curve is most appropriate for vertebral body tethering in adolescent idiopathic scoliosis?","authors":"Abel De Varona-Cocero, Djani Robertson, Camryn Myers, Fares Ani, Constance Maglaras, Tina Raman, Themistocles Protopsaltis, Juan C Rodriguez-Olaverri","doi":"10.1007/s43390-025-01049-4","DOIUrl":"10.1007/s43390-025-01049-4","url":null,"abstract":"<p><strong>Purpose: </strong>Clinical trials have studied the effects of curve magnitude and flexibility, age, and skeletal immaturity on the outcomes of VBT. No studies have assessed the effect of Lenke curve type on the outcomes of VBT. This study compares outcomes in patients who underwent VBT with Lenke type 1, 3, 5, and 6 curves.</p><p><strong>Methods: </strong>Single center retrospective review of patients undergoing mini-open thoracoscopic-assisted two row vertebral body tethering (2RVBT) for the correction of AIS with a minimum 2-year follow-up were included. Patients were grouped by Lenke type, which yielded 4 groups; types 1, 3, 5, or 6. Analysis included preoperative demographic parameters, as well as radiographic and clinical outcome measures.</p><p><strong>Results: </strong>156 2RVBT (Lenke 1, N = 61; Lenke 3, N = 35; Lenke 5, N = 37; Lenke 6, N = 23) patients met inclusion criteria. The mean preoperative apex Cobb angle in the Lenke type 1, 3, 5, and 6 groups were 50.2 ± 9.1, 50.5 ± 10.1, 45.0 ± 8.6, and 49.0 ± 10.8, respectively. This corrected to 21.2 ± 10.2, 19.2 ± 8.5, 13.6 ± 7.2, 18.5 ± 8.3 in Lenke type 1, 3, 5, and 6 groups, respectively, demonstrating that Lenke type 5 saw greatest correction following 2RVBT. With regards to revision recommendation following tether breakage, Lenke type 3 curves were most frequently indicated for fusion, whereas Lenke type 1 curves were most frequently not indicated for revision surgery.</p><p><strong>Conclusion: </strong>Lenke type 5 curves are the most amenable to correction via 2RVBT, as evident by their lower post-operative apex Cobb angles and lowest rate of recommendation for revision to posterior spinal fusion.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"705-716"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010976","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":"Residual T1 tilt could lead to poor self-image for patients with Lenke type 1 adolescent idiopathic scoliosis.","authors":"Tomohiro Banno, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Hideyuki Arima, Shin Oe, Koichiro Ide, Tomohiro Yamada, Kenta Kurosu, Yukihiro Matsuyama","doi":"10.1007/s43390-024-01020-9","DOIUrl":"10.1007/s43390-024-01020-9","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Purpose: </strong>We aimed to investigate the clinical impact and risk factors for residual T1 tilt in patients with adolescent idiopathic scoliosis (AIS).</p><p><strong>Methods: </strong>We retrospectively analyzed data of patients with AIS and Lenke type 1 curves who underwent posterior fusion. Residual T1 tilt was defined as T1 tilt > 5° at 2 years postoperatively. Patients were classified based on the presence of residual T1 tilt: residual T1 tilt ( +) and residual T1 tilt (-) groups. Radiographic parameters and clinical outcomes were compared between the two groups.</p><p><strong>Results: </strong>Among 128 patients, 44 (34.4%) had residual T1 tilt. The residual T1 tilt ( +) group had a significantly greater preoperative proximal thoracic (PT) curve, greater preoperative T1 tilt, and main thoracic (MT) curve correction rate than the residual T1 tilt (-) group. Shoulder imbalance and neck tilt rates at 2 years postoperatively were significantly higher in the residual T1 tilt ( +) group. The residual T1 tilt ( +) group had a significantly worse postoperative self-image score. Multivariate analysis identified the preoperative PT curve magnitude as an independent risk factor for residual T1 tilt. Receiver operating characteristic curve analysis identified a preoperative PT curve cutoff value of 26.5°.</p><p><strong>Conclusion: </strong>Achieving horizontalization of T1 tilt is vital to improve the self-image of patients with Lenke type 1 AIS. The study highlights the clinical impact of T1 tilt and identifies the preoperative PT curve magnitude as a significant independent risk factor.</p><p><strong>Level of evidence: </strong>Level 4.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"811-819"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807925","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":"Surgical site infection risk in neuromuscular scoliosis patients undergoing posterior spinal fusion.","authors":"Ryan Sefcik, Michael Kreft, Kenzie Lundqvist, Richard Steiner, Todd Ritzman, Lorena Floccari","doi":"10.1007/s43390-024-01015-6","DOIUrl":"10.1007/s43390-024-01015-6","url":null,"abstract":"<p><strong>Purpose: </strong>Scoliosis in neuromuscular scoliosis (NMS) is a spinal deformity often treated with posterior spinal fusions (PSF). There is a relatively high risk to develop surgical site infection (SSI) after PSF in NMS compared to adolescent idiopathic scoliosis (AIS) patients. The purpose of this retrospective cohort study was to determine perioperative risk factors for NMS patients undergoing PSF.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database was queried for patients who underwent PSF for NMS and/or cerebral palsy from 2015 to 2020. Statistical analysis of patient characteristics was completed utilizing likelihood ratio chi-squared test for categorical factors and median test or Wilcoxon rank sum test for quantitative factors. Logistic regression was used for odds ratios for quantitative factors.</p><p><strong>Results: </strong>4145 patients underwent PSF for NMS, and 102 developed an SSI (2.5%). Identified risk factors include American Society of Anesthesiologists (ASA) ≥ 3 (p = 0.030, odds ratio 2.4), preoperative corticosteroids (p = 0.049, odds ratio 2.4), preoperative ostomy (p = 0.026, odds ratio 1.6), prolonged anesthetic time (p = 0.045, odds ratio 1.09 per 60 min), prolonged operative time (p = 0.043, odds ratio 1.1 per 60 min), and postoperative development of urinary tract infection (UTI) (p < 0.001, odds ratio 4.5). Patients with SSI had higher body mass index (p = 0.047, odds ratio 1.3 per 5 kg/m²).</p><p><strong>Conclusion: </strong>The prevalence of deep SSI was 2.5% in this cohort, and risk factors include ASA ≥ 3, preoperative ostomy, prolonged anesthetic or operative time, and postoperative UTI. Large multicenter database studies can help identify and stratify risk factors for SSI in this high-risk patient population.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"869-876"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468954","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}