Spine deformity最新文献

{"title":"The impact of the social determinants of health on adolescent idiopathic scoliosis: a systematic review.","authors":"Rohit Paradkar, Ria Paradkar, Manjot Singh, Ashley Knebel, Mariah Balmaceno-Criss, Jinseong Kim, Joseph E Nassar, Michael J Farias, Bassel G Diebo, Alan H Daniels","doi":"10.1007/s43390-025-01065-4","DOIUrl":"10.1007/s43390-025-01065-4","url":null,"abstract":"<p><strong>Purpose: </strong>Adolescent idiopathic scoliosis (AIS) has been associated with significant physical and psychosocial burdens. Social determinants of health play a well-documented role in treatment and outcomes of various conditions, including AIS. As such, it is crucial to understand the multifaceted socioeconomic factors that may affect its prevalence and severity.</p><p><strong>Methods: </strong>A comprehensive search of major bibliographic databases such as Medline, Embase, and Cochrane Library was conducted from inception to August 2024 for studies examining AIS in marginalized populations. Demographical and clinical outcomes data were extracted for quantitative and qualitative analyses.</p><p><strong>Results: </strong>Our initial search identified 479 articles, of which 14 met the eligibility criteria. The mean age was 14.1 years, 76.8% were females, 59.6% were White, and 73.6% had private insurance. Black adolescents with AIS presented with more severe forms of the condition that necessitated surgical management. Furthermore, lower socioeconomic status, along with residence in socioeconomically disadvantaged neighborhoods and enrollment in public insurance programs, often contributed to delayed clinical presentation, more severe curves at initial presentation, and delayed treatment.</p><p><strong>Conclusion: </strong>This systematic review revealed disparities in the diagnosis and management of AIS based on race, ethnicity, language, insurance status, and socioeconomic status. These disparities highlight the urgent need for a multifaceted approach to improve equity in AIS care. Addressing these challenges requires systemic reforms targeted towards enhancing access and treatment for marginalized populations. Focused interventions should consider the unique social determinants that contribute to these disparities, ultimately promoting a more equitable healthcare system for all adolescents affected by idiopathic scoliosis.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"997-1006"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568084","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":"Is there any difference in the perioperative outcome between male and female adolescent idiopathic scoliosis patients undergoing posterior spinal fusion? A propensity score matching analysis study of 570 patients.","authors":"Chee Kidd Chiu, Siti Mariam Abd Gani, Yuki Mihara, Mohd Shahnaz Hasan, Chris Yin Wei Chan, Mun Keong Kwan","doi":"10.1007/s43390-025-01057-4","DOIUrl":"10.1007/s43390-025-01057-4","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the perioperative outcome differences between male and female AIS patients who underwent posterior spinal fusion (PSF) surgeries.</p><p><strong>Methods: </strong>This was a retrospective study of 570 patients (84 male, 486 female). Patients were divided into male and female groups. A propensity score matching analysis was performed with match tolerance of 0.005. Preoperative data collected were age, height, weight, body mass index (BMI), Lenke curve classification, preoperative Cobb angle, and preoperative flexibility. Intraoperative data collected were operation duration, intraoperative blood loss, amount of salvaged blood, number of patients required transfusion, number of screws and fusion level. Postoperative data collected were postoperative hemoglobin, postoperative Cobb angle, correction rate, length of postoperative hospital stay and perioperative complications.</p><p><strong>Results: </strong>Before matching, age, height, weight, and fusion level showed significant difference between genders (p < 0.05). After matching, there was no difference in the perioperative outcome parameters. When matched patients excluding height and weight, males had significantly longer wound, higher intraoperative blood loss and more blood salvaged from cell saver. When matched patients excluding fusion levels, males had significantly higher intraoperative blood loss. When matched patients excluding age, we found no significant differences.</p><p><strong>Conclusion: </strong>Male AIS patients who underwent PSF surgeries were older, taller, heavier and had longer fusion levels but there was no difference in perioperative outcomes between matched male and female patients.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1143-1152"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441989","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":"Body mass index adjustments in children with early onset scoliosis: arm span BMI.","authors":"Michael Trask, Scott Yang, Apeksha Gupta, Burt Yaszay, Jennifer M Bauer, Gregory Redding","doi":"10.1007/s43390-025-01056-5","DOIUrl":"10.1007/s43390-025-01056-5","url":null,"abstract":"<p><strong>Purpose: </strong>Body mass index (BMI), is a nutritional index based on standing height and weight. Children with early onset scoliosis (EOS) have shorter height due to their spine curvature. In these patients' pulmonary function tests, which are also based off height, arm span is standardly used as a surrogate for height to allow for normative comparisons. Arm span has not been used for nutritional assessments in children with EOS.</p><p><strong>Methods: </strong>We used both arm span and measured height to calculate BMI, and BMI as a percent of predicted published norms (BMI%ile) to assess the error produced using height in this population of children. We used a Wilcoxon signed-rank test to compare standard height BMI (BMI) vs arm span BMI (asBMI) and BMI%iles, Spearman correlation to assess the influence of age or coronal curve angle on any differences, and an adjusted linear model for the coronal curve's impact on BMI.</p><p><strong>Results: </strong>BMI and BMI%ile consistently over-estimated nutritional status compared to asBMI with substitution of arm span for height. 15.6% of patients had a BMI%ile of < 1% using height compared to 44.4% using arm span. The difference between BMI and asBMI correlated with the coronal curve magnitude but not with age. The adjusted linear model showed that for each degree of Cobb angle, the difference between BMI and asBMI increased by 0.0294 kg/m² (p = 0.0062).</p><p><strong>Conclusion: </strong>Arm span BMI reveals lower, more accurate nutritional status in children with EOS than standard height BMI.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1263-1267"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484011","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":"Impact of preoperative lumbosacral takeoff flexibility on postoperative correction following spinal fusion for adolescent idiopathic scoliosis: a new consideration for selective thoracic fusion.","authors":"Richard E Campbell, Theodore Rudic, Alexander Hafey, Elizabeth Driskill, Peter O Newton, Keith R Bachmann","doi":"10.1007/s43390-025-01063-6","DOIUrl":"10.1007/s43390-025-01063-6","url":null,"abstract":"<p><strong>Purpose: </strong>Nonselective fusion for adolescent idiopathic scoliosis results in greater correction of the Lumbosacral Takeoff Angle (LSTOA); however, there are patients selectively fused that still have considerable change in their LSTOA. We sought to identify the relationship between preoperative LSTOA flexibility and postoperative correction of the LSTOA.</p><p><strong>Methods: </strong>This was a retrospective analysis of Lenke 1-6, lumbar B and C modifier patients in the Harms Study Group with 2-year follow-up. Only patients with a lumbar Cobb angle ≥ 38 and ≤ 56 were included. The cases were divided into selective (SF: 177) and nonselective fusions (NSF: 324). Multivariate regression analysis was used to identify independent preoperative factors associated with postoperative LSTOA, and postoperative LSTOA correction in the NSF and SF groups.</p><p><strong>Results: </strong>The mean postoperative LSTOA correction was 6.1 ± 3.8, with 75 (15%) patients experiencing postoperative worsening of their LSTOA. Among other variables, larger LSTOA (p < 0.001) and smaller bending LSTOA correction (p < 0.001) were predictors of larger postoperative LSTOAs in both groups. Among other variables, larger LSTOA (p < 0.001), and larger bending LSTOA correction (p < 0.01) were predictors of greater LSOTA correction in both groups. Satisfactory LSTOA correction in the selective fusion group was associated with larger preoperative LSTOA (p < 0.001), larger bending LSTOA correction (p < 0.001), larger lumbar Cobb angle bending correction (p: 0.034), and smaller lumbar apex to LIV distance (p: 0.003).</p><p><strong>Conclusions: </strong>Preoperative static and bending LSTOA measurements may help surgeons decide between selective and non-selective fusion in patients with AIS.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1169-1177"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626169","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":"Seventeen-year outcome of surgical management of severe early onset kyphoscoliosis in a patient with arthrochalasia-type Ehlers-Danlos.","authors":"Ronan McKeogh, Sashin Ahuja, John Howes","doi":"10.1007/s43390-025-01071-6","DOIUrl":"10.1007/s43390-025-01071-6","url":null,"abstract":"<p><p>We report on the surgical management of severe early onset kyphoscoliosis in a 5-year-old patient with the rare arthrochalasia subtype of Ehlers-Danlos syndrome, who we have followed for 17 years post-operatively. Successful correction of the deformity with an excellent outcome was achieved with minimal morbidity using MAGEC™ (MAGnetic Expansion Control) growth rods instead of traditional growth rods, undertaken with the close involvement of plastic surgical colleagues. Our patient suffered only one minor surgical complication (thought to be allergic rather than traumatic in origin), despite having skin so fragile that rubbing his skin with a disinfectant wipe was sufficient to cause skin breakdown. The non-invasive lengthening that the MAGEC rods allowed enabled us to avoid repeated open surgeries which would have had a high risk of complications, most notably wound breakdown with poor healing, and we advocate their use in similar cases.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1277-1282"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993480","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":"Navigation is associated with lower risk of neurological injury and transfusion in pediatric idiopathic scoliosis surgery.","authors":"Vivien Chan, Suhas Etigunta, Adeesya Gausper, Andy M Liu, Kenneth D Illingworth, Grant D Hogue, Daniel J Hedequist, David L Skaggs","doi":"10.1007/s43390-025-01140-w","DOIUrl":"https://doi.org/10.1007/s43390-025-01140-w","url":null,"abstract":"<p><strong>Background: </strong>Spinal navigation has been shown to improve accuracy with pedicle screw placement and reduce complications in adult spine patients. It remains understudied in the pediatric spine population.</p><p><strong>Purpose: </strong>The purpose of this study was to assess the impact of spinal navigation on rates of neurological injury, allogeneic transfusion, and reoperation in pediatric idiopathic scoliosis.</p><p><strong>Methods: </strong>This was a retrospective cohort study using the NSQIP pediatric database, years 2016-2022. Patients were included in this study if they were under 18 years of age and received posterior spinal fusion with seven or more surgical levels for idiopathic scoliosis. Anterior approaches were excluded from the study. The study cohort was divided into (1) no navigation cohort and (2) navigation cohort. The primary outcome was rate of postoperative neurological injury. Secondary outcomes were 30 day reoperation, allogeneic blood transfusion, and operative time. Rates of neurological injury, reoperation, and allogeneic transfusion were compared using Chi-square test. Operative time was compared using Student's T test. Logistic regression analyses were performed to determine the association between use of spinal navigation and the outcomes of interest.</p><p><strong>Results: </strong>There were 22,384 patients included in this study. Mean age was 14.4 years. Spinal navigation was used in 1879 (8.4%). Spinal navigation was associated with a reduced rate of postoperative neurological injury (no navigation: 1.2% vs. navigation: 0.6%, p = 0.02). The navigation cohort had a lower rate of allogeneic transfusion (no navigation: 12.2% vs. navigation: 8.4%, p < 0.001). There was no difference in 30 day reoperation rate (no navigation: 1.4% vs. navigation: 1.5%, p = 0.56). The navigation cohort had longer operative time (no navigation: 4.6 h vs. navigation: 5.0 h, p < 0.001). In the multivariable regression analysis, use of spinal navigation was associated with reduced odds of postoperative neurological injury (OR = 0.51, p = 0.03) and allogeneic transfusion (OR = 0.68, p < 0.001).</p><p><strong>Conclusion: </strong>Spinal navigation was associated with significantly decreased rates of postoperative neurological injury and allogeneic transfusion in pediatric idiopathic scoliosis surgery, with an average of 0.4 h longer operative time.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529519","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":"Risk of proximal junctional kyphosis after revision of growing rod constructs.","authors":"Chidebelum Nnake, Ritt Givens, Matthew Weintraub, Omar Taha, Alondra Concepción-González, Matan Malka, Kevin Lu, Simon Blanchard, Ron El-Hawary, Michael G Vitale, Benjamin D Roye","doi":"10.1007/s43390-025-01135-7","DOIUrl":"https://doi.org/10.1007/s43390-025-01135-7","url":null,"abstract":"<p><strong>Introduction: </strong>For early-onset scoliosis (EOS) patients with growth-friendly implants, posterior distraction is a known contributor to proximal junctional kyphosis (PJK). Rib-based proximal fixation is thought to potentially reduce the risk of PJK compared to spine-based anchors. However, the effect of revising proximal rib-based implants to rib vs. spine-based implants on PJK has not yet been investigated.</p><p><strong>Hypotheses: </strong>(1) Patients converted from rib-based to spine-based proximal anchors (RTS) have a higher risk of PJK two years post-revision compared to those revised to rib-based anchors (RTR). (2) Revising the upper instrumented vertebra (UIV) to a lower level increases the risk of PJK at two years post-revision compared to revising to a higher or same level.</p><p><strong>Methods: </strong>In this retrospective cohort study of EOS patients with rib-based growing constructs undergoing revision surgery with a minimum 2-year follow-up, we assessed pre-revision, post-revision, and 2-year follow-up radiographs. We excluded patients lacking lateral radiographs and attachment data and conducted descriptive analyses.</p><p><strong>Results: </strong>280 subjects were included, with an average age of 7.2 years at revision; RTS patients were slightly older (8.6y vs 7.2y), and 51% female. At 2 years, 32% of all patients developed PJK. This risk was higher in RTS patients compared to RTR patients (42.8% vs 30.2%, p = 0.17). RTS patients had a greater pre-revision total spine height (p = 0.02), a more negative sagittal balance at 2 years (p = 0.01) and were predominantly male (p = 0.08) compared to RTR. Of the factors associated with a greater risk of PJK, proximal anchor conversion from rib-to-spine had the highest predictive value of PJK development (OR 2.23, p = 0.04). While statistically significant, there was no clinical difference in risk at 2 years of developing PJK among patients revised to a lower level compared to those revised to a higher or same level (32.1% vs 32.5% vs 30.9%, respectively; p = 0.05).</p><p><strong>Conclusion: </strong>32% of all subjects developed PJK at a 2-year follow-up. The risk of PJK in RTS patients was 40% higher than in RTR patients. While this did not reach statistical significance to the 0.05 level, due to the associations of risk established by literature and replicated in this study, and the magnitude of this difference, we believe these results to be clinically significant. We intend to re-evaluate this population in the future as more data becomes available. With no demonstrated risk in revision levels, these results should guide providers in revision decision-making in growing rods.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508273","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":"Immediate chest tube removal at the completion of anterior vertebral tethering is well-tolerated without an increased risk of pulmonary complication.","authors":"John T Braun, Sofia C Federico, Cornelia Griggs, David M Lawlor, Daniel P Croitoru, Brian E Grottkau","doi":"10.1007/s43390-025-01132-w","DOIUrl":"https://doi.org/10.1007/s43390-025-01132-w","url":null,"abstract":"<p><strong>Introduction: </strong>Though chest tube removal at the completion of an endoscopic thoracic procedure is well accepted in the pediatric and adult general surgery literature, this practice has never been studied in pediatric patients treated with anterior vertebral tethering (AVT) for AIS. This study retrospectively analyzed pulmonary complications in a large series of AIS patients consecutively treated with chest tube removal at the completion of AVT. The rate of pulmonary complication in this series was then compared with the published rate of pulmonary complication in patients managed with chest tube retention after AVT.</p><p><strong>Methods: </strong>A retrospective review of all AIS patients treated with AVT over a twelve year period yielded 257 consecutive patients (248 primary/9 revision) with 349 curves. Out of a total of 349 chest tubes placed intraoperatively, as a routine step of the procedure, 323 were removed at procedure completion while 26 were maintained for 2-5 days post-operatively as warranted. Patient charts, radiographs, and CT scans were reviewed to confirm any pulmonary complications.</p><p><strong>Results: </strong>In 257 AIS patients treated with AVT, 233 had chest tube removal at the completion of AVT with 4 (1.7%) peri-operative and 8 (3.4%) delayed pulmonary complications. Peri-operative complications included one symptomatic pneumothorax noted in the operating room that required chest tube reinsertion; one static pneumothorax that resolved without intervention; and two significant pleural effusions that resolved over time without intervention. Delayed complications included seven pleural effusions that occurred 2-6 weeks post-operatively and one chylothorax that occurred 1 week post-operatively. Several clinically significant pleural effusions (4/7) required thoracentesis or chest tube drainage but subsequently resolved. The chylothorax required chest tube drainage, dietary fat restriction, and treatment with octreotide. In 24 patients, 26 chest tubes were retained for 2-5 days post-op for a persistent air leak with presumed parenchymal injury (14), revision with significant adhesions (6), bleeding disorder (2), or diaphragmatic repair related to renal eventration (1) or congenital diaphragmic hernia (1).</p><p><strong>Conclusion: </strong>This study demonstrated the relative safety of immediate chest tube removal at the completion of AVT in AIS patients. The rate of pulmonary complication in 233 patients with chest tube removal at the completion of AVT was 5.1% which compared favorably with a published rate of 10-11% after chest tube retention. In 24 patients with an indication for chest tube retention at the completion of AVT, chest tube retention for 2-5 days resulted in no pulmonary complications.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485695","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":"Neural network-based multi-task learning to assist planning of posterior spinal fusion surgery for adolescent idiopathic scoliosis.","authors":"Caroline Constant, A Noelle Larson, David W Polly, Carl-Eric Aubin","doi":"10.1007/s43390-025-01125-9","DOIUrl":"https://doi.org/10.1007/s43390-025-01125-9","url":null,"abstract":"<p><strong>Purpose: </strong>Posterior spinal instrumentation and fusion (PSF) is the gold standard for severe adolescent idiopathic scoliosis (AIS), yet instrumentation strategies vary widely, often leading to suboptimal results. Deep learning's potential in AIS planning is underexplored.</p><p><strong>Methods: </strong>This study trained and validated an artificial neural network multi-task learning model (NNML) using preoperative clinical and radiographic data from 189 AIS patients with Lenke 1A and 2A curves enrolled in the MIMO Clinical Trial (NCT01792609). The model mimics experienced spine surgeons' decision-making for selecting the upper and the lower instrumented vertebrae (UIV, LIV), determining rod curvature, and predicting screw density based on the study's randomized allocation. Models were trained with data from 179 patients, utilizing tenfold cross-validation, and externally validated on 10 patients from a separate hospital and surgeons outside the training set. For UIV and LIV selection, accuracy within the top two predictions was used as a classification performance metric, ensuring that other clinically relevant alternatives were considered.</p><p><strong>Results: </strong>The NNML, which comprised 83 inputs and multiple hidden layers, led to significant gains over ST-NN and proved more robust during the internal validation (loss 6.2 vs. 9.3; p ≤ 0.01). It showed 82-95% and 80-100% accuracy for UIV and LIV predictions and 70-90% accuracy for predicting the rod curvatures ± 5°. The RMSE for the screw density and rod curvature predictions was 0.2-0.3 and 3.7-5.6°, respectively.</p><p><strong>Conclusion: </strong>An NNML can better use the features of relevant AIS patients for mixed task prediction pertinent to PSF surgery planning than ST-NN. In addition, NNML was capable of mimicking experienced spine surgeons' decision-making process when designing the instrumentation.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476677","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":"Assessing malnutrition in cerebral palsy patients and its impact on complications following spinal fusion.","authors":"Haseeb E Goheer, Phillip T Yang, Yasmine S Ghattas, Gabriel Ramirez, Ram Haddas, Andrew G Dubina, Susan E Nelson, Varun Puvanesarajah","doi":"10.1007/s43390-025-01129-5","DOIUrl":"https://doi.org/10.1007/s43390-025-01129-5","url":null,"abstract":"<p><strong>Background: </strong>Cerebral palsy (CP) patients with severe scoliosis are frequently malnourished. However, there is a paucity of literature focusing on the impact of pediatric malnutrition indicators on post-operative surgical complications. This study aims to examine the relationship between measures of nutritional status and their ability to predict post-operative complications in patients with CP undergoing spinal fusion for neuromuscular scoliosis.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program Pediatric was queried retrospectively to identify pediatric CP patients who had undergone spinal fusions for neuromuscular scoliosis between 2016 and 2022 using the Current Procedural Terminology Code 22804. Univariate and multivariate regression were employed to assess differences in preoperative patient characteristics as well as postoperative complications across malnutrition definitions (stunting, wasting, and requiring nutritional support).</p><p><strong>Results: </strong>A total of 2017 patients were identified between 2016 and 2022, of which 1124 received nutritional support and 893 did not. Among all patients, 93.3% (n = 1882) met at least one definition of malnutrition, 58.1% (n = 1172) met two or more definitions, and 9.3% (n = 187) met all three definitions of malnutrition. After adjustment, requiring nutritional support independently increased the risk for an extended intensive care unit stay (OR:1.35; 95 CI [1.01-1.83]; p = 0.047). Wasting independently increased the risk for unplanned intubation (OR:1.77; 95 CI [1.02-3.02]; p = 0.038) while stunting increased the risk for deep/organ space surgical site infection (OR:2.50; 95 CI [1.20-6.10]; p = 0.025).</p><p><strong>Conclusion: </strong>Patients with malnutrition (defined as nutritional support) are at increased risk for an extended intensive unit care stay in the postoperative period. Personalized postoperative management with multidisciplinary teams, guided by risk assessment, may help mitigate postoperative complications and address the challenges associated with malnutrition.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476676","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}