Spine deformity最新文献

{"title":"High incidence of dural tears with 3-column osteotomies: a systematic review of adult spinal deformity surgery literature for the past decade.","authors":"Anna Martin, Jamal Zahir, Nathan Smith, Oluwatodimu Raji, David Nelles, Dimitriy Kondrashov","doi":"10.1007/s43390-024-00916-w","DOIUrl":"10.1007/s43390-024-00916-w","url":null,"abstract":"<p><strong>Purpose: </strong>Dural tear (DT) is a well-known complication of spinal surgery. We aimed to systematically review the literature from the past decade and determine the incidence and risk factors for DT in the adult spinal deformity (ASD) population to improve both the surgical strategy and counseling of patients undergoing ASD correction.</p><p><strong>Methods: </strong>A systematic review from 2013 to 2023 utilizing PRISMA guidelines was performed. The MEDLINE database was used to collect primary English language articles. The inclusion criterion for patients was degenerative ASD. Pediatric studies, animal studies, review articles, case reports, studies investigating minimally invasive surgery (MIS), studies lacking data on DT incidence, and articles pertaining to infectious, metastatic or neoplastic, traumatic, or posttraumatic etiologies of ASD were excluded.</p><p><strong>Results: </strong>Our results demonstrate that the incidence of DT in ASD surgery ranges from 2.0% to 35.7%, which is a much broader range than the reported incidence for non deformity surgery. Moreover, the average rate of DT during ASD surgery stratified by surgical technique was greater for osteotomy overall (19.5% +/- 7.9%), especially for 3-column osteotomy (3CO), and lower for interbody fusion (14.3% +/- 9.9%). Risk factors for DT in the ASD surgery cohort included older age, revision surgery, chronic severe compression, higher-grade osteotomy, complexity of surgery, rheumatoid arthritis (RA), and higher Anesthesiology Society of America (ASA) grade.</p><p><strong>Conclusion: </strong>To our knowledge, this is the first systematic review discussing the incidence of and risk factors for DT in the ASD population. We found that the risk factors for DT in ASD patients were older age, revision surgery, chronic severe compression, a greater degree of osteotomy, complexity of surgery, RA, and a higher ASA grade. These findings will help guide spine surgeons in patient counseling as well as surgical planning.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446898","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":"A multicenter evaluation of the time and travel burden on families with children treated for early-onset scoliosis.","authors":"Ryan J McFadden, Lucas Hauth, Mathew Gregoski, Jason B Anari, Jaysson T Brooks, Jeffrey R Sawyer, Maxwell Marshall, Robert F Murphy","doi":"10.1007/s43390-024-00895-y","DOIUrl":"10.1007/s43390-024-00895-y","url":null,"abstract":"<p><strong>Purpose: </strong>Patients who undergo growth-friendly (GF) treatment for early-onset scoliosis (EOS) undergo multiple clinical and surgical encounters. We sought to quantify the associated temporal and travel burden and estimate subsequent cost.</p><p><strong>Methods: </strong>Four centers in an international study group combined data on EOS patients who underwent surgical GF treatment from 2006 to 2021. Data collected included demographics, scoliosis etiology, GF implant, encounter type, and driving distance. We applied 2022 IRS and BLS data or $0.625/mile and $208.2/day off work to calculate a relative financial burden.</p><p><strong>Results: </strong>A total of 300 patients were analyzed (55% female). Etiologies were: congenital (33.3%), idiopathic (18.7%), neuromuscular (30.7%), and syndromic (17.3%). The average age at the index procedure was 5.5 years. For the 300 patients, 5899 encounters were recorded (average 18 encounters/patient). Aggregate encounter types were 2521 clinical office encounters (43%), 2045 surgical lengthening encounters (35%), 1157 magnetic lengthening encounters (20%), 149 spinal fusions (3%), and 27 spinal fusion revisions (0.5%). When comparing patients by scoliosis etiology or by GF implant type, no significant differences were noted in the total number of encounters or average travel distance. Patients traveled a median round trip distance of 158 miles/encounter between their homes and treating institutions (range 2.4-5654 miles), with a cumulative median distance of 2651 miles for the entirety of their treatment (range 29-90,552 miles), at an estimated median cost of $1656.63. The mean number of days off work was 18 (range 3-75), with an associated loss of $3643.50 in income.</p><p><strong>Conclusion: </strong>Patients with EOS averaged 18 encounters for GF surgical treatment. These patients and their families traveled a median distance of 158 miles/encounter, with an estimated combined mileage and loss of income of $5300.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155547","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":"Hybrid vs all pedicle screws constructs in adolescent idiopathic scoliosis: a metaanalysis of clinical and radiological outcomes.","authors":"Mohammad Daher, Marven Aoun, Gaby Kreichati, Khalil Kharrat, Amer Sebaaly","doi":"10.1007/s43390-024-00886-z","DOIUrl":"10.1007/s43390-024-00886-z","url":null,"abstract":"<p><strong>Background: </strong>Adolescent idiopathic scoliosis (AIS) affects around 1 to 3% of young individuals, leading to spinal deformities typically exceeding a Cobb angle of 10 degrees without congenital or neuromuscular causes. Advances in treatment now include various surgical techniques such as posterior fusion utilizing all-pedicle screw constructs or hybrid constructs.</p><p><strong>Methods: </strong>PubMed, Cochrane, and Google Scholar (pages 1-20) were searched up until February 2024. Comparative studies in which the cohort was separated into two groups (HC and PSC) were included. Data consisting of, surgery-related outcomes, sagittal radiographic outcomes, coronal radiographic outcomes, and patient-reported outcomes, was extracted and compared.</p><p><strong>Results: </strong>Twenty-eight studies including 3435 patients were included. Higher rates of complications (Odds-Ratio = 1.99, p < 0.00001) and reoperations (Odds-Ratio = 2.82, p < 0.00001) were seen in the hybrid group. Better radiographic coronal correction was seen in the PSC group in both the major curve (Mean Difference = 5.97, p < 0.00001) and the secondary curve (Mean Difference = - 10.73, p < 0.0001). However, restoration of sagittal alignment was better in the HC group when assessing thoracic kyphosis (Mean Difference = 2.97, p = 0.02) and lumbar lordosis (Mean Difference = 3.17, p = 0.005).</p><p><strong>Conclusion: </strong>While all-pedicle screw constructs demonstrated greater stability in AIS compared to hybrid constructs, resulting in reduced rates of reoperations and complications, as well as improved correction of major and secondary curves, they were unable to fully restore optimal sagittal alignment.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857981","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":"Variation in thoracic inlet measurements and its correlation with pulmonary dysfunction in kyphoscoliotic deformities: a prospective case-control study.","authors":"Vyom Sharma, Dilip Chand Raja Soundararajan, Ajoy Prasad Shetty, Rishi Mugesh Kanna, Rajasekaran Shanmuganathan","doi":"10.1007/s43390-024-00881-4","DOIUrl":"10.1007/s43390-024-00881-4","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary dysfunction in thoracic kyphoscoliosis has been correlated with chest wall distortion, uneven trunk growth and restrictive pattern. The study aims to analyse the variation in thoracic inlet measurements on pulmonary dysfunction with varying curve magnitude and thoracic cage parameters.</p><p><strong>Methods: </strong>In a non-randomised, prospective case-control study, 80 consecutive patients with thoracic kyphoscoliosis were divided into 3 groups based on Cobb angle: Group 1 (31-50), Group 2 (51-80) and Group 3 (> 80). Thoracic inlet measurement was calculated by thoracic inlet index (TI) on MRI at the sternal level. Pulmonary function and thoracic cage parameters [hemi thorax height, rib-apex distance, AP chest diameter at sternal level and transverse thoracic diameter] were documented. TI values were compared with 20 age-matched asymptomatic controls. Multivariate correlation and regression analysis were performed to investigate the correlations.</p><p><strong>Results: </strong>The mean age of the study cohort was 14.1 ± 4.4 years, including Group 1 (6 patients), Group 2 (55 patients) and Group 3 (19 patients) versus 12.9 ± 2.2 years in controls. The mean TI was 2.8 ± 0.56 in Group 1, 3.7 ± 0.9 in Group 2 and 4.0 ± 1.12 in Group 3 versus 2.6 ± 0.43 in controls. Pulmonary dysfunction was severe with TI > 7.1 (p < 0.001) in Group 3 patients with thoracic hypokyphosis. Multivariate regression for thoracic parameters and TI > 5.6 showed significant correlation of pulmonary dysfunction in Group 2 and 3 curves with apex between T1 and T4, whereas transverse thoracic diameter, rib-apex distance and hemi thorax height were weakly associated.</p><p><strong>Conclusion: </strong>Thoracic inlet index (TI), a neglected pre-operative variable associated with pulmonary dysfunction in thoracic kyphoscoliosis, can be evaluated on MRI without an additional cost and radiation.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897906","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":"Back pain in adolescent idiopathic scoliosis: frequency and risk factors.","authors":"Stefan Sarkovich, Claudia Leonardi, Matthew Darlow, Davis Martin, Peter Issa, Tara Soria, Amy Bronstone, Carter Clement","doi":"10.1007/s43390-024-00904-0","DOIUrl":"10.1007/s43390-024-00904-0","url":null,"abstract":"<p><strong>Purpose: </strong>Although back pain is commonly reported in patients with adolescent idiopathic scoliosis (AIS), factors that influence the presence and severity of back pain in AIS, including curve-specific variables, have not been well studied. This study aims to describe the prevalence and severity of back pain in AIS patients and determine the extent to which patient characteristics, including curve-specific factors, are associated with a higher risk of back pain in AIS.</p><p><strong>Methods: </strong>The study was a retrospective medical records review of adolescents (aged 10-17 years) diagnosed with AIS between 01/01/2018 and 12/31/2021 at an academic tertiary children's hospital. Patients with previous spine surgery were excluded. Variables collected included demographics (age, sex, race, insurance), Lenke classification, major coronal curve, back pain-related information, Risser stage, vitamin D levels, post-diagnosis brace utilization, physical therapy or chiropractic treatment, and surgery.</p><p><strong>Results: </strong>A total of 891 AIS patients were included in the analysis. The sample was predominantly female (73.3%) and insured by Medicaid (57.8) with a mean age of 12.8 years. The mean major coronal curve was 26.3 degrees. Most patients had Lenke type 1 (47%) and type 5 (41%) curves. Nearly half of patients reported back pain (48.5%) with average pain severity in the low-to-moderate range (4.7) on FACES pain scale (0-10). Among those who reported back pain, 63.2% specified a location with the majority reporting pain in the lumbar region (56%) and, less commonly, in the thoracic (39%) and scapular (8%) regions. Lumbar pain was associated with significantly higher pain intensity (p = 0.033). Additionally, the location of pain reported was associated with location of major coronal curve (p < 0.0001). No association was observed between pain presence and vitamin D deficiency (p = 0.571, n = 175), major coronal curve magnitude (p = 0.999), Lenke curve type (p = 0.577), and sex (p = 0.069). Older patients, those insured by Medicaid, and those with higher Risser scores were more likely to report pain scores (p = 0.001 for all).</p><p><strong>Conclusion: </strong>Nearly half (48%) of newly diagnosed AIS patients experience back pain which is higher than the prevalence of 33% seen in the general adolescent population. Pain was more prevalent among patients over the age of 13, with heavier body weight, and those insured by Medicaid. Pain was most commonly reported in the lumbar region, especially among patients with lumbar curves. This information can be helpful in counseling AIS patients, though further investigations are needed, especially to determine the underlying causes of back pain in AIS and to elucidate the discrepancy in pain between patients with Medicaid and commercial insurance.</p><p><strong>Level of evidence: </strong>Prognostic Study Level II.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443308","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":"How do implants overlying the spine influence \"The Law of Diminishing Returns\" in early-onset scoliosis patients?","authors":"Stuart L Mitchell, Jessica H Heyer, Jason B Anari, Keith D Baldwin, Pranav Kodali, Brandon S Ramo, Jack M Flynn, Ryan Fitzgerald, Walter Truong, Ying Li, Lindsay Andras, Jaysson Brooks, Patrick J Cahill","doi":"10.1007/s43390-024-00885-0","DOIUrl":"10.1007/s43390-024-00885-0","url":null,"abstract":"<p><strong>Purpose: </strong>The \"law of diminishing returns\" (LODR) in early-onset scoliosis (EOS) is well-known. We hypothesized that previously observed variations between constructs may be related to the lateral distance that each construct lies from the spine. We therefore sought to determine whether the curve magnitude improvement and spinal length gains for distraction-based constructs in EOS are positively correlated with the collinearity of the spine and the convex-sided implant on posteroanterior radiographs.</p><p><strong>Methods: </strong>A prospectively-collected, multicenter EOS registry was queried for all patients who underwent non-fusion, distraction-based instrumentation surgery. Post-index radiographs were graded from 1 to 5 based on amount of overlap between the convex-sided rod and the apical vertebra. Grade 1: convex rod is lateral to convex-sided pedicle; Grade 2: overlaps the convex-sided pedicle; Grade 3: lies between pedicles; Grade 4: overlaps concave-sided pedicle; Grade 5: medial to concave-sided pedicle. ANOVA assessed the correlations between post-index overlap grade and change in (a) curve magnitude and (b) T1-T12 height. Multivariable regression modeling further assessed these associations.</p><p><strong>Results: </strong>284 patients met all selection criteria and were included. On ANOVA, post-index grade was associated with curve magnitude (p <0.001) and T1-12 height (p = 0.028) change. Better curve correction and height change were associated with higher grade. On regression modeling, curve correction (R = 0.574) and T1-T12 height change (R = 0.339) remained significantly associated with grade when controlling for time, anchor locations, age, underlying diagnosis, and pre-index curve magnitude.</p><p><strong>Conclusion: </strong>More apical overlap by the convex rod was associated with better spinal deformity control and improved height gain.</p><p><strong>Level of evidence iii: </strong>Therapeutic.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11343778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877257","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":"Pre-operative carbohydrate drink in pediatric spine fusion: randomized control trial.","authors":"Jennifer M Bauer, Michael Trask, Grace Coughlin, Maya Gopalan, Apeksha Gupta, Burt Yaszay, Scott Yang, Eliot Grigg","doi":"10.1007/s43390-024-00890-3","DOIUrl":"10.1007/s43390-024-00890-3","url":null,"abstract":"<p><strong>Purpose: </strong>As rapid discharge protocols for pediatric spine fusion shorten stays, gastrointestinal (GI) complications are uncovered and cause delays in discharge. A pre-operative carbohydrate (CHO) drink has been shown to improve perioperative GI symptoms and functional return but has not been examined in pediatric spine patients. We aimed to determine if a preoperative CHO drink is safe in pediatric spine fusion patients, and if it improves their comfort scores and return of bowel function.</p><p><strong>Methods: </strong>We prospectively randomized ASA-1 and -2 pediatric spine fusion patients to either a pre-anesthesia carbohydrate drink 2 h prior to surgery or to a control group (standard 8 h NPO), blinded to surgical team. We documented time to return to flatus, bowel movement, GI symptoms, and comfort scores for 72 h post-operatively or until discharge.</p><p><strong>Results: </strong>62 patients were randomized. There was no significant differences between the groups' pre-operative characteristics, surgical details, nor post-operative morphine dose equivalents, except for EBL (405 cc control, 340 cc CHO drink, p = 0.044). There were no perioperative complications related to ingestion of the CHO drink. CHO group had a positive trend for earlier return of flatus (21% vs. 3% return at 12 h), and comfort scores for anxiety and abdominal pain, but no statistically significant differences. There was no difference in length of stay or time to first bowel movement.</p><p><strong>Conclusion: </strong>There were no complications related to ingestion of a CHO drink 2 h prior to pediatric spinal fusion surgery. Further studies are needed to develop a study blinded to the participants with larger sample size. Level of evidence I.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071685","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":"Autofusion is underrated, or is it?","authors":"Blake K Montgomery, Simon Tang","doi":"10.1007/s43390-024-00947-3","DOIUrl":"https://doi.org/10.1007/s43390-024-00947-3","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081466","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":"Machine learning identifies clusters of the normal adolescent spine based on sagittal balance.","authors":"Dion G Birhiray, Srikhar V Chilukuri, Caleb C Witsken, Maggie Wang, Jacob P Scioscia, Martin Gehrchen, Lorenzo R Deveza, Benny Dahl","doi":"10.1007/s43390-024-00952-6","DOIUrl":"https://doi.org/10.1007/s43390-024-00952-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study applied a machine learning semi-supervised clustering approach to radiographs of adolescent sagittal spines from a single pediatric institution to identify patterns of sagittal alignment in the normal adolescent spine. We sought to explore the inherent variability found in adolescent sagittal alignment using machine learning to remove bias and determine whether clusters of sagittal alignment exist.</p><p><strong>Methods: </strong>Multiple semi-supervised machine learning clustering algorithms were applied to 111 normal adolescent sagittal spines. Sagittal parameters for resultant clusters were determined.</p><p><strong>Results: </strong>Machine learning analysis found that the spines did cluster into distinct groups with an optimal number of clusters ranging from 3 to 5. We performed an analysis on both 3 and 5-cluster groups. The 3-cluster groups analysis found good consistency between methods with 96 of 111, while the analysis of 5-cluster groups found consistency with 105 of 111 spines. When assessing for differences in sagittal parameters between the groups for both analyses, there were differences in T4-12 TK, L1-S1 LL, SS, SVA, PI-LL mismatch, and TPA. However, the only parameter that was statistically different for all groups was SVA.</p><p><strong>Conclusions: </strong>Based on machine learning, the adolescent sagittal spine alignments do cluster into distinct groups. While there were distinguishing features with TK and LL, the most important parameter distinguishing these groups was SVA. Further studies may help to understand these findings in relation to spinal deformities.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018514","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":"Axial rod slip at the end-of-construct screw in scoliosis surgery: relevance, occurrence and prevention.","authors":"T P Schlösser, I Blaauw, M R van der Valk, Guido van Solinge, C Faber, M C Kruyt","doi":"10.1007/s43390-024-00925-9","DOIUrl":"https://doi.org/10.1007/s43390-024-00925-9","url":null,"abstract":"<p><strong>Purpose: </strong>Despite standardized biomechanical tests for spinal implants, we recently recognized pedicle screw failure to maintain the rod fixated as a clinical concern in scoliosis surgery. This occurrence study investigates the risk and magnitude of axial rod slip (ARS), its relation with technique and preventive measures.</p><p><strong>Methods: </strong>Retrospective multicenter review of all primary scoliosis cases (2018-2020) with > 1 year FU from three centers, instrumented with uniplanar screws and 5.5 mm CoCr rods (Mesa 2, Stryker Corporation, Kalamazoo, MI, USA). ARS was defined as > 1 mm change in residual distal rod length from the screw in the lowest instrumented vertebra (LIV) and assessed by two independent observers. Slip distance, direction, relation to distal screw density and time of observation were recorded, as well as the effect of ARS on caudal curve increase. To prevent slip, more recent patients were instrumented with a different end-of-construct screw (Reline, NuVasive Inc. San Diego, CA, USA) and analyzed for comparison.</p><p><strong>Results: </strong>ARS risk was 27% (56/205) with a distance of 3.6 ± 2.2 mm, predominantly convex. 42% occurred before 4 months, the rest before 1 year. The caudal curve substantially increased three times more often in patients with ARS. Interobserver reliability was high and slip was in the expected direction. ARS was unrelated to distal screw density. Remarkable variation in ARS rates (53%, 31%, 13%) existed between the centers, while there was no difference in mean screw density (≈1.3 screws/level) or curve correction (≈60%). Revision surgery for ARS was required in 2.9% (6/207). Using the different end-of-construct screw, ARS risk was only 2% (1/56) and no revisions were required.</p><p><strong>Conclusion: </strong>This study demonstrates the prevalence of axial rod slip at the end of construct in scoliosis surgery and its clinical relevance. While minimal ARS can be subclinical, ARS should not be mistaken for adding on. The most severe ARS predominantly occurred convex at the high-loaded distal screw when L3 was the LIV. Longer constructs (LIV L3 or L4) have a higher risk of ARS. The minimal risk of ARS with another end-of-construct screw underscores the influence of screw type on ARS occurrence in our series. Further research is essential to refine techniques and enhance patient outcomes.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009405","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}