North American Spine Society Journal最新文献

{"title":"Genetics and pathogenesis of scoliosis","authors":"","doi":"10.1016/j.xnsj.2024.100556","DOIUrl":"10.1016/j.xnsj.2024.100556","url":null,"abstract":"<div><h3>Background</h3><div>Scoliosis is defined as a lateral spine curvature of at least 10° with vertebral rotation, as seen on a posterior-anterior radiograph, often accompanied by reduced thoracic kyphosis. Scoliosis affects all age groups: idiopathic scoliosis is the most common spinal disorder in children and adolescents, while adult degenerative scoliosis typically affects individuals over fifty. In the United States, approximately 3 million new cases of scoliosis are diagnosed annually, with a predicted increase in part due to global aging. Despite its prevalence, the etiopathogenesis of scoliosis remains unclear.</div></div><div><h3>Methods</h3><div>This comprehensive review analyzes the literature on the etiopathogenetic evidence for both idiopathic and adult degenerative scoliosis. PubMed and Google Scholar databases were searched for studies on the genetic factors and etiopathogenetic mechanisms of scoliosis development and progression, with the search limited to articles in English.</div></div><div><h3>Results</h3><div>For idiopathic scoliosis, genetic factors are categorized into three groups: genes associated with susceptibility, disease progression, and both. We identify gene groups related to different biological processes and explore multifaceted pathogenesis of idiopathic scoliosis, including evolutionary adaptations to bipedalism and developmental and homeostatic spinal aberrations. For adult degenerative scoliosis, we segregate genetic and pathogenic evidence into categories of angiogenesis and inflammation, extracellular matrix degradation, neural associations, and hormonal influences. Finally, we compare findings in idiopathic scoliosis and adult degenerative scoliosis, discuss current limitations in scoliosis research, propose a new model for scoliosis etiopathogenesis, and highlight promising areas for future studies.</div></div><div><h3>Conclusions</h3><div>Scoliosis is a complex, multifaceted disease with largely enigmatic origins and mechanisms of progression, keeping it under continuous scientific scrutiny.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326653","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":"The hidden risk: Intracranial hemorrhage following durotomies in spine surgery","authors":"","doi":"10.1016/j.xnsj.2024.100555","DOIUrl":"10.1016/j.xnsj.2024.100555","url":null,"abstract":"<div><h3>Objective</h3><div>Intracranial hemorrhage (ICH) after durotomy in elective spine surgery, though rare, can pose a significant risk to patient outcomes. Spine surgeries bear a risk of dural tears (DT) with potential of postoperative cerebrospinal fluid leakage (PCSFL). Excessive PCSFL can precipitate a decrease in intracranial pressure, potentially leading to ICH. Literature on ICH as a postoperative complication is scarce. The aim was to assess the incidence and risk factors of ICH in patients undergoing elective spine surgery.</div></div><div><h3>Methods</h3><div>Utilizing the 2020 National Impatient Sample (NIS) adults (&gt;18 years) were selected by primary procedure category codes for spine fusion, discectomy, spinal cord decompression and cervicothoracic/lumbosacral nerve decompression. Exclusion criteria were trauma and malignancy. The primary outcome was occurrence of ICH. Comparative analysis and a multivariable logistic regression were used to identify independent risk.</div></div><div><h3>Results</h3><div>In total, 40,990 patients met our criteria with an incidence of ICH at 0.08%. The ICH-group showed an increased length of stay and higher mortality compared to the control group. Spinal cord decompression, DT and PCSFL were significantly more frequent in patients with ICH. Alcohol, drug abuse and hypertension were significantly more prevalent in patients with ICH. DT, alcohol abuse and hypertension were independent risk factors for ICH.</div></div><div><h3>Conclusions</h3><div>This study underscores the rarity and severity of ICHs following elective spine surgery, emphasizing awareness and looking for possible preventive measures. Our finding suggests that DT, as a complication of surgical techniques, as well as alcohol abuse and hypertension are significant predictors of ICH.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326446","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":"Incidence of temporary intraoperative iliac artery occlusion during anterior spinal surgery","authors":"","doi":"10.1016/j.xnsj.2024.100554","DOIUrl":"10.1016/j.xnsj.2024.100554","url":null,"abstract":"<div><h3>Background</h3><div>Thromboembolic complications in anterior lumbar spinal surgery can rarely result in limb loss. Iliac vessel retraction can temporarily occlude the iliac artery risking thromboembolic sequelae. Studies estimate the incidence of iliac artery thrombosis at 0.45%. Brief intraoperative heparinization can potentially mitigate this risk. We aim to quantify the incidence of temporary iliac artery occlusion (TIAO) and examine its association with potential risk factors (sex, BMI, target disc level, and type of prosthesis).</div></div><div><h3>Methods</h3><div>Retrospective analysis of consecutive patients undergoing anterior lumbar spinal surgery by a single vascular surgeon and 5 spinal neurosurgeons between 2009 and 2022. Patients underwent single or double-level total disc replacement (TDR); single, double, or triple-level anterior lumbar interbody fusion (ALIF); or hybrid procedure (combined cranial TDR and caudal ALIF). A pulse oximeter monitored bilateral second toes perfusion. Loss of the waveform, combined with a nonpalpable external iliac artery pulse distal to the retractors was defined as TIAO of the ipsilateral artery. Heparin was administered if TIAO developed.</div></div><div><h3>Results</h3><div>Of 605 patients (318 males, 287 females), TIAO occurred in 176 patients (29.1%). TIAO occurred in 13.5% of the 377 patients who underwent single or multilevel ALIF and in 42.7% of the 110 patients who underwent single or multilevel TDR (p=.004). In single-level surgery at L5/S1, TIAO occurred in 3.1% of patients. In single-level surgery at L4/5, TIAO occurred in 65.2% of patients overall; the rate was higher for TDR than for ALIF (74.6% vs. 48.5%; p=.01). The TIAO rate was 44.3% in multilevel procedures and 66.1% in hybrid procedures. No patient developed postoperative thrombotic iliac artery occlusion or embolic complications.</div></div><div><h3>Conclusions</h3><div>TIAO occurred frequently during anterior lumbar exposure (29%). Anterior spinal exposure at L4/5 had a high incidence of TIAO, particularly for TDR, in contrast to L5/S1.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002476/pdfft?md5=38feab99b778dfb9ccecef68247ec64c&pid=1-s2.0-S2666548424002476-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314174","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":"Sequential correction of sagittal vertical alignment and lumbar lordosis in adult flatback deformity","authors":"","doi":"10.1016/j.xnsj.2024.100544","DOIUrl":"10.1016/j.xnsj.2024.100544","url":null,"abstract":"<div><h3>Background</h3><p>Flatback deformity, or lumbar hypolordosis, can cause sagittal imbalance, causing back pain, fatigue, and functional limitation. Surgical correction through osteotomies and interbody fusion techniques can restore sagittal balance and relieve pain. This study investigated sagittal vertical alignment (SVA) and lumbar lordosis correction achieved through sequential procedures on human spine specimens.</p></div><div><h3>Methods</h3><p>Human T10-sacrum specimens were stratified into 2 groups: degenerative flatback specimens had smaller L1-S1 lordosis compared to the iatrogenic group (26.1°±15.0° vs. 47.8°±19.3°, p&lt;.05). Specimens were mounted in the apparatus in simulated standing posture with a nominal sacral slope of 45 degrees and subjected to a 400N compressive follower preload. Sequential correction of degenerative lumbar flatback deformity involved: anterior lumbar interbody fusion (ALIF) at L5-S1, ALIF at L4-5, lateral lumbar interbody fusion (LLIF) at L2-3 and L3-4, and posterior column osteotomy (PCO) at L2-3 and L3-4. In iatrogenic specimens, flatback deformity was created by performing a posterior <em>in-situ</em> immobilization using pedicle screw instrumentation at L4-L5-S1 followed by distraction across the pedicle screws. We then performed LLIF at L2-3 and L3-4, followed by PCO at L2-3 and L3-4.</p></div><div><h3>Results</h3><p>Statistically significant incremental corrections were noted in SVAs and lordosis after L5-S1 ALIF, L4-5 ALIF, and PCO in degenerative flatback specimens. For the iatrogenic group, statistically significant worsening was noted in measures of standing alignment after L4-L5-S1 hypolordotic fusion. Subsequent LLIF at L2-3 and L3-4 did not significantly improve sagittal alignment. However, after PCO at L2-3 and L3-4, final alignment parameters were not significantly different than preoperative baseline values prior to hypolordotic fusion.</p></div><div><h3>Conclusions</h3><p>ALIF cages in the lower lumbar segments significantly improved sagittal alignment in degenerative flatback specimens. In the upper lumbar segments, LLIF cages alone were ineffective at enhancing lumbar lordosis. LLIF cages in conjunction with PCO improved alignment parameters in degenerative and iatrogenic flatback deformities.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002373/pdfft?md5=01ce596880a7a254dde34451a39319d3&pid=1-s2.0-S2666548424002373-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094830","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":"Psychometric analysis and the implications for the use of the scoliosis research society questionnaire (SRS-22r English) for individuals with adolescent idiopathic scoliosis","authors":"","doi":"10.1016/j.xnsj.2024.100545","DOIUrl":"10.1016/j.xnsj.2024.100545","url":null,"abstract":"<div><h3>Background</h3><p>Despite widespread usage of the SRS-22r questionnaire (Scoliosis Research Society Questionnaire-22r), the English version has only sparingly been subjected to analysis using modern psychometric techniques for patients with adolescent idiopathic scoliosis (AIS). The study purpose was to improve interpretation and clinical utility of the SRS-22r for adolescents with AIS by generating additional robust evidence, using modern statistical techniques. Questions about (1) Structure and (2) Item and Scale Functioning are addressed and interpreted for clinicians and researchers.</p></div><div><h3>Methods</h3><p>This retrospective case review analyzed SRS-22r data collected from 1823 patients (mean age 14.9±2.2years) with a primary diagnosis of AIS who clinically completed an SRS-22r questionnaire.</p><p>Individual SRS-22r questions and domain scores were retrieved through data queries. Patient information collected through chart review included diagnosis, age at assessment, sex, race and radiographic parameters. From 6044 SRS-22r assessments, 1 assessment per patient was randomly selected. Exploratory structural equation modeling (ESEM) and item response theory (IRT) techniques were used for data modeling, item calibration, and reliability assessment.</p></div><div><h3>Results</h3><p>ESEM demonstrated acceptable fit to the data: χ² (130)=343.73, p&lt;.001; RMSEA=0.035; CFI=0.98; TLI=0.96; SRMR=0.02. Several items failed to adequately load onto their assigned factor. Item fit was adequate for all items except SRSq10 (Self-Image), SRSq16 (Mental Health), and SRSq20 (Mental Health). IRT models found item discriminations are within normal levels for items in psychological measures, except items SRSq1 (pain), SRSq2 (pain), and SRSq16 (mental health). Estimated reliability of the Function domain (ρ=0.69) was low, however, Pain, Self-Image and Mental Health domains exhibited high (ρ&gt;0.80) reliability.</p></div><div><h3>Conclusions</h3><p>Modern psychometric assessment of the SRS-22r, in adolescent patients with AIS, are presented and interpreted to assist clinicians and researchers in understanding its strengths and limitations. Overall, the SRS-22r demonstrated good psychometric properties in all domains except function. Cautious interpretation of the total score is suggested, as it does not reflect a single HRQoL construct.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002385/pdfft?md5=deb143c4dbd29dd929e7e5ecc0e8a289&pid=1-s2.0-S2666548424002385-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142150522","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":"Spinal alignment and surgical correction in the aging spine and osteoporotic patient","authors":"","doi":"10.1016/j.xnsj.2024.100531","DOIUrl":"10.1016/j.xnsj.2024.100531","url":null,"abstract":"<div><h3>Background</h3><p>The aging spine often presents multifaceted surgical challenges for the surgeon because it can directly and indirectly impact a patient’s spinal alignment and quality of life. Elderly and osteoporotic patients are predisposed to progressive spinal deformities and potential neurologic compromise and surgical management can be difficult because these patients often present with greater frailty.</p></div><div><h3>Methods</h3><p>This was a literature review of spinal alignment changes, preoperative considerations, and spinal alignment considerations for surgical strategies.</p></div><div><h3>Results</h3><p>Many factors impact spinal alignment as we age including lumbar lordosis flexibility, hip flexion, deformity, and osteoporosis. Preoperative considerations are required to assess the patient’s overall health, bone mineral density, and osteoporosis medications. Careful radiographic assessment of the spinopelvic parameters using various classification/scoring systems provide the surgeon with goals for surgical treatment. An individualized surgical strategy can be planned for the patient including extent of surgery, surgical approach, extent of the constructs, fixation techniques, vertebral augmentation, ligamentous augmentation, and staging surgery.</p></div><div><h3>Conclusions</h3><p>Surgical treatment should only be considered after a thorough assessment of the patient's health, deformity, bone quality and corresponding age matched alignment goals. An individualized treatment approach is often required to tackle the deformity and minimize the risk of hardware related complications and pseudarthrosis. Anabolic agents offer a promising benefit in this patient population by directly addressing and improving their bone quality and mineral density preoperatively and postoperatively.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002245/pdfft?md5=be45b608f3e45bb917ed788f8c927520&pid=1-s2.0-S2666548424002245-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142129865","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":"Trends in management of odontoid fractures 2010–2021","authors":"","doi":"10.1016/j.xnsj.2024.100553","DOIUrl":"10.1016/j.xnsj.2024.100553","url":null,"abstract":"<div><h3>Background Context</h3><div>Odontoid fractures are relatively common. However, the literature is unclear how these fractures are best managed in many scenarios. As such, care is varied and poorly characterized.</div></div><div><h3>Purpose</h3><div>To investigate the trends and predictive factors of surgical versus nonsurgical treatment and anterior versus posterior stabilization of odontoid fractures.</div></div><div><h3>Study Design/Setting</h3><div>Retrospective database cohort study.</div></div><div><h3>Patient Sample</h3><div>Adult patients with odontoid fractures between 2010 and 2021.</div></div><div><h3>Outcome Measures</h3><div>Yearly trends and predictors of odontoid fracture management.</div></div><div><h3>Methods</h3><div>Adult patients with odontoid fractures were abstracted from the large, national, administrative M161Ortho Pearldiver dataset. For operative versus nonoperative care of odontoid fractures, yearly rates were determined (since 2016 based on coding limitations). For anterior versus posterior stabilization, yearly rates were determined (2010–2021). Univariate and multivariable analyses were performed for both sets of comparisons.</div></div><div><h3>Results</h3><div>For assessment of nonsurgical versus surgical management from 2016 to 2021, a total of 42,754 patients with odontoid fracture were identified, of which surgical intervention was done for 7.9%. Predictive factors of surgical intervention included being managed by a neurosurgeon (OR:1.29), being from Midwest United States (OR:1.35 relative to West), male sex (OR:1.20), and decreasing age (OR: 0.82 per decade) (p &lt; .001 for each). Of those undergoing surgical intervention, 33.6% had anterior surgery while 66.4% had posterior surgery (anterior surgery decreased from 36.4% in 2010 to 27.2% in 2021, p &lt; .001). Predictive factors of undergoing anterior versus posterior approach include having a neurosurgeon surgeon (OR:1.98), being from the Southern (OR:1.61 relative to Northeast), and having Medicare insurance (OR: 1.31) (p &lt; .001 for each).</div></div><div><h3>Conclusions</h3><div>The overall rate of surgery for odontoid fractures has remained similar over the past years. Of those undergoing surgery, less are being done from anterior. While these decisions were predicted by some clinical factors, both also correlated with nonclinical factors suggesting room for more consistent algorithms.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002464/pdfft?md5=351d0b32e2438d1fe9795846bf9c5729&pid=1-s2.0-S2666548424002464-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314168","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":"Rate and risk factors for inpatient falls following single-level posterior lumbar fusion: A national registry study","authors":"","doi":"10.1016/j.xnsj.2024.100549","DOIUrl":"10.1016/j.xnsj.2024.100549","url":null,"abstract":"<div><h3>Background</h3><p>Posterior lumbar fusion (PLF) is frequently considered for various spinal pathologies. While many outcome metrics have been assessed, to our knowledge, there has yet to be literature specifically investigating inpatient falls (IPFs) and its risk factors.</p></div><div><h3>Methods</h3><p>Adult patients who underwent single-level PLF were abstracted from the 2010–Q1 2022 M161Ortho PearlDiver Database. Patients who had an IPF were determined based on administrative coding. Various patient variables were extracted and variables independently associated with IPFs were assessed with multivariate logistic regression. Incidence of secondary injuries and cost incurred related to the IPF were determined.</p></div><div><h3>Results</h3><p>Of the 342,890 patients who underwent PLF, IPF was identified for 4,379 (1.4%). Independent predictors of an IPF in decreasing odds ratio (OR) order were those with: active psychosis (OR=3.35), active delirium (OR=2.83), history of falling (OR=2.47), commercial insurance (OR=1.59 relative to Medicare), Medicaid insurance (OR=1.47 relative to Medicare), dementia (OR=1.17), older age (OR=1.12 per decade), alcohol use disorder (O=1.11), higher comorbidity (OR=1.08 per Elixhauser comorbidity index point) (p&lt;.05 for each).</p><p>Of patients with IPF, 44 (1.0%) sustained a head injury, and 42 (1.0%) sustained a fracture. On average, those with IPF incurred greater inpatient costs compared to patients who did not ($36,865 vs. $33,921, p&lt;.001).</p></div><div><h3>Conclusion</h3><p>In this national sample of patients who underwent single-level PLF, postoperative IPFs were identified for 1.4% and were associated with defined patient variables. These findings have potential patient outcome, financial, and medicolegal implications and should help guide refinement of fall prevention programs.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002427/pdfft?md5=4dc80135d9daea6f6674fdf29a8dcccc&pid=1-s2.0-S2666548424002427-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230118","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":"Comparison of intraoperative and postoperative outcomes between open, wiltse, and percutaneous approach to traumatic thoracolumbar spine fractures without neurological injury: A systematic review and meta-analysis","authors":"","doi":"10.1016/j.xnsj.2024.100547","DOIUrl":"10.1016/j.xnsj.2024.100547","url":null,"abstract":"<div><h3>Background</h3><p>Traumatic thoracolumbar fracture fixation without neurological injury can be performed using the traditional open, mini-open Wiltse, and percutaneous approaches. This systematic review and meta-analysis aims to compare perioperative outcomes between these approaches.</p></div><div><h3>Methods</h3><p>PubMed, Web of Science, Scopus, Embase, and the Cochrane Library were searched for all relevant observational comparative studies.</p></div><div><h3>Results</h3><p>5 randomized trials and 22 comparative cohort studies were included. Compared to the traditional open approach (n=959), the Wiltse approach (n=410) was associated with significantly lower operative time, intraoperative estimated blood loss (EBL), and length of stay (LOS). There was no significant difference between the two in terms of postoperative visual analog scale (VAS) and Cobb angle. Compared to the percutaneous approach (n=980), the Wiltse approach was associated with shorter operative and fluoroscopy time, as well as significantly improved Cobb and vertebral body angles. The percutaneous approach was associated with improved vertebral body height. There was no significant difference between the two for blood loss, postoperative VAS, or LOS. Compared to the traditional open approach, the percutaneous approach was associated with shorter operative time, lower EBL, shorter LOS and better postoperative VAS and Oswestry Disability Index. There was no difference between the two in postoperative Cobb angle, vertebral angle, or vertebral body height. Overall study heterogeneity was high.</p></div><div><h3>Conclusions</h3><p>Utilization of minimally invasive surgical approaches holds great promise for lowering patient morbidity and optimizing care. A prospective trial is needed to assess outcomes and guide surgical decision making.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002403/pdfft?md5=90aa4b9663d58160d2f6e10f23e30dcd&pid=1-s2.0-S2666548424002403-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239946","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":"Pediatric spinal alignment and spinal development","authors":"","doi":"10.1016/j.xnsj.2024.100548","DOIUrl":"10.1016/j.xnsj.2024.100548","url":null,"abstract":"<div><h3>Background</h3><p>Knowledge of the growth spurt and remaining growth is essential for managing musculoskeletal diseases in children. Accurate prediction of curve progression and timely interventions are crucial, particularly for conditions like adolescent idiopathic scoliosis (AIS).</p></div><div><h3>Methods</h3><p>This study conducted a comprehensive review and synthesis of existing literature on spinal growth, skeletal maturity classifications, and the evolution of sagittal alignment parameters during childhood and adolescence. Key anatomical elements involved in spinal development, natural history of spinal growth, and skeletal maturity assessment systems were analyzed.</p></div><div><h3>Results</h3><p>The analysis highlighted that key parameters such as Pelvic incidence (PI), Pelvic tilt (PT), and Lumbar lordosis (LL) increase significantly with growth, especially during the pubertal growth spurt. In contrast, Sacral slope (SS) remains relatively constant, and Thoracic kyphosis (TK) shows a slight increase. Additionally, there is a posterior shift in the center of gravity as children grow, reflecting progressive postural maturation. The study also reviewed and compared various maturity classification systems, noting the reliability and clinical implications of systems like the Sanders Maturity Stage (SMS) and Tanner-Whitehouse III.</p></div><div><h3>Conclusions</h3><p>Reliable maturity classification systems, such as the Sanders Maturity Stage (SMS) and Tanner-Whitehouse III, allow for tailored treatments to individual growth patterns. Integrating these classification systems into clinical practice enables precise prediction of curve progression and timely therapeutic interventions. This includes options from bracing to surgical techniques like growing rods or vertebral body tethering (VBT), with growth modulation being a key factor in achieving successful outcomes.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002415/pdfft?md5=d1a5bb30359f694dcd10bc68dacdd988&pid=1-s2.0-S2666548424002415-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239945","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}