Instrumentation For Scoliosis Research Articles

Perioperative Risk Factors for Bleeding in Adolescents Undergoing Pedicle Screw Instrumentation for Scoliosis.

Progressive scoliosis eventually leads to extensive spinal fusion surgery, which carries a risk for significant bleeding. Neuromuscular scoliosis (NMS) patients have an additional inherent risk of major perioperative bleeding. The purpose of our research was to investigate the risk factors for measured (intraoperative, drain output) and hidden blood loss related to pedicle screw instrumentation in adolescents, divided into adolescent idiopathic scoliosis (AIS) and NMS patient groups. A retrospective cohort study with prospectively collected data of consecutive AIS and NMS patients undergoing segmental pedicle screw instrumentation at a tertiary level hospital between 2009 and 2021 was conducted. In total, 199 AIS (mean age 15.8 years, 143 females) and 81 NMS patients (mean age 15.2 years, 37 females) were included in the analysis. In both groups, levels fused, increased operative time, and smaller or larger size of erythrocytes were associated with perioperative blood loss (p < 0.05 for all correlations). In AIS, male sex (p < 0.001) and the number of osteotomies correlated with more drain output. In NMS, levels fused correlated with drain output, p = 0.00180. In AIS, patients' lower preoperative MCV levels (p = 0.0391) and longer operation times, p = 0.0038, resulted into more hidden blood loss, but we did not find any significant risk factors for hidden blood loss in NMS patients.

Plastic multilayered closure versus orthopedic surgeon closure after spinal instrumentation in pediatric neuromuscular scoliosis

ObjectiveTo compare wound complication rates between orthopedic closure (OC) and plastic multilayered closure (PMC) in patients undergoing primary posterior spinal fusion for neuromuscular scoliosis (NMS). We hypothesize that multilayered closure...

The Outcome of Posterior Spinal Fusion and Instrumentation of Adolescent Idiopathic Scoliosis without Wound Suction Drainage

Background: In spine surgery postoperative closed suction drainage is used to decrease the potential risks of wound hematoma formation, and reduces the risk of infection, cord compression and neurologic deficit. However, the efficacy of drains used for this purpose in adolescent idiopathic scoliosis is controversial. The purpose of this study is to evaluate outcomes of patients after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis without wound suction drainage. Methods: A total of 66 Patients who underwent posterior spinal fusion and instrumentation for the correction of Adolescent idiopathic scoliosis without the use of drain from January 2012 to January 2021 were included. Wound dehiscence, wound hematoma, infection, preoperative and postoperative hemoglobin levels and need for transfusion were described as frequency and mean values. Results: The average age was 15.06 years. Hospital stay was 2.2 days. Patients were followed-up over 50.21 months. There was no deep infection, wound hematoma. The difference between just postoperative and three days after operation hemoglobin levels was not significant and no need for transfusion. Only 3 (4.5%) cases with superficial skin infection and 4 (6%) cases with skin and Wound dehiscence were treated with dressing and antibiotics with full recovery. Conclusion: Without using drain for patients with idiopathic scoliosis who underwent posterior spinal fusion and instrumentation, no increase in blood loss, transfusion requirements, wound infection, skin dehiscence, and wound hematoma was observed.

A retrospective cohort study of bleeding characteristics and hidden blood loss after segmental pedicle screw instrumentation in neuromuscular scoliosis as compared with adolescent idiopathic scoliosis

BackgroundProgressive scoliosis in neuromuscular patients often requires a long instrumented spinal fusion. Previous studies have shown larger intraoperative blood loss in these patients than those with adolescent idiopathic scoliosis (AIS), but the total blood loss composed of visible and hidden blood loss has not been described in this patient population. The aim of our study was to investigate the bleeding characteristics and hidden blood loss related to spinal fusion in neuromuscular scoliosis (NMS) as compared to AIS patients. MethodsA retrospective cohort study with prospective data collection of NMS patients undergoing segmental pedicle screw instrumentation at a university hospital between 2009 and 2021. A comprehensive statistical analysis was performed regarding intra- and postoperative blood loss compared to patient characteristics such as age and diagnosis. Hidden blood loss was estimated and compared to the total blood loss. We standardized amount of bleeding with patient weight and fusion level for further analysis. Consecutive AIS patients served as a control population. Eighty-one consecutive patients with NMS (mean age 15.2 years, 37 females) were included and their bleeding characters were compared with 199 AIS patients (mean age 15.8 years, 143 females). The primary outcome was total blood loss including intraoperative, 24-hour drain output and hidden blood loss. Secondary outcome measures included requirement for blood transfusion. ResultsNeuromuscular patients had a significantly larger total blood loss with mean values of 1914 mL in the NMS and 1357 mL in the AIS groups, respectively (p<0.001). The hidden blood loss was also significantly larger in NMS than in AIS group (566 ± 533 mL vs. 398 ±411 mL, p=0.0332). Neuromuscular scoliosis was also associated with significantly greater weight and levels of fused adjusted intraoperative bleeding (1.79 ml/kg/fused level in NMS vs. 0.87 ml/kg/fused level in AIS vs. p< 0.0001) and hidden blood loss (1.00 ml/kg/levels fused vs. 0.65 ml/kg/fused levels, p=0.053). NMS diagnosis was also a risk factor for greater hidden blood loss in multivariable analysis (p=0.0011). 24-hour drain output was similar in the NMS and AIS groups. Male gender was a risk factor for greater hidden blood loss in the NMS group (p=0.0429). Fifty-nine (73%) NMS and 27 (14%) AIS patients received allogenic red blood cell infusions perioperatively (p<0.001). ConclusionsHidden blood loss constitutes one-third of total blood loss in children undergoing segmental pedicle screw instrumentation for neuromuscular scoliosis. Hidden blood loss is significantly greater in the neuromuscular as compared with idiopathic scoliosis. Hidden blood loss should be considered in the perioperative management of NMS.

Beam-Like rods do not Provide Additional Improvement to Thoracic Kyphosis Restoration when Compared to Sagittal Reinforced rods in Adolescents Undergoing Spinal Fusion with Pedicle Screw Instrumentation for Idiopathic Scoliosis

Operative treatment of adolescent idiopathic scoliosis (AIS) with posterior spinal fusion aims for three-dimensional correction of coronal curve and thoracic kyphosis. Our aim was to compare two different designs of asymmetrical rods in adolescents who underwent a posterior spinal fusion with pedicle screw instrumentation for AIS with an emphasis on thoracic kyphosis restoration. This study was made with 76 consecutive adolescents (mean age 15.6 years, SD 2.0). Thirty-nine patients were operated with sagittal reinforced rods and 37 patients were operated with beam-like rods. The clinical and radiological results were assessed preoperatively, postoperatively, and during the follow-up visits at the outpatient clinic 6 months and 2 years after the surgery. At the last follow-up, the mean (SD) major thoracic curves were 13° (6.2°) and 13° (6.0°) (P= 0.717). Correction percentages were 75% in the sagittal reinforced group and 73% in the beam-like rod group (P= 0.517). The mean (SD) thoracic kyphosis was 24° (11°) and 22° (7.8°) at the two year follow-up in the sagittal reinforced rod group and beamlike rod group (P= 0.517). There was a slight negative correlation between the major curve correction and thoracic kyphosis change in both groups, although this was not statistically significant (R=-0.19, P= 0.094 in the sagittal reinforced rod group, R=-0.16, P= 0.180 in the beam like rod group). There are no significant differences in the coronal or sagittal deformity restoration in adolescent patients who underwent a posterior spinal fusion with sagittal reinforced rods and beam-like rods for adolescent idiopathic scoliosis.

Postoperative outcomes of pedicle screw instrumentation for adolescent idiopathic scoliosis with and without a subfascial wound drain: a multicentre randomized controlled trial.

The aim of this study was to evaluate whether, after correction of an adolescent idiopathic scoliosis (AIS), leaving out the subfascial drain gives results that are no worse than using a drain in terms of total blood loss, drop in haemoglobin level, and opioid consumption. Adolescents (aged between 10 and 21 years) with an idiopathic scoliosis (major curve ≥ 45°) were eligible for inclusion in this randomized controlled noninferiority trial (n = 125). A total of 90 adolescents who had undergone segmental pedicle screw instrumentation were randomized into no-drain or drain groups at the time of wound closure using the sealed envelope technique (1:1). The primary outcome was a drop in the haemoglobin level during first three postoperative days. Secondary outcomes were 48-hour postoperative oxycodone consumption and surgical complications. All 90 patients were included in the primary outcome analysis (no drain = 43; drain = 47). The mean total postoperative blood loss (intraoperative and drain output) was significantly higher in the group with a subfascial drain than in the no-drain group (1,008 ml (SD 520) vs 631 ml (SD 518); p < 0.001). The drop in haemoglobin level did not differ between the study groups over the postoperative timepoints (p = 0.290). The 48-hour opioid consumption was significantly higher in the no-drain group (2.0 mg/kg (SD 0.9) vs 1.4 (SD 0.6); p = 0.005). Two patients in the no-drain and one patient in the drain group developed a surgical site infection. Leaving the subfascial drain out after pedicle screw instrumentation for AIS is not associated with higher postoperative haemoglobin levels. Patients treated without a subfascial drain needed 30% more opioids during the first 48 hours than those who had a drain.Cite this article: Bone Joint J2022;104-B(9):1067-1072.

Ultralong Follow-Up of Spinal Fusion for Adolescent Idiopathic Scoliosis: Harrington Instrumentation vs Uninstrumented Fusion.

Harrington instrumentation for adolescent idiopathic scoliosis (AIS) was revolutionary and allowed patients to mobilize faster as compared with patients treated with uninstrumented fusion. However, Harrington instrumentation provided correction of the deformity in 1 plane, resulting in limited sagittal plane control. Patients who received these 2 surgeries are aging, and to date, ultralong follow-up of these patients has not been reported. The purpose of this study was to evaluate long-term patient-reported outcomes and radiographic parameters after Harrington nonsegmental distraction instrumentation vs uninstrumented fusion in the treatment of AIS. Fourteen adult patients with AIS who were previously instrumented (n = 7) or uninstrumented (n = 7) were identified. Recent x-ray image measurements such as pelvic incidence (PI), sagittal vertical axis (SVA), pelvic tilt (PT), lumbar lordosis (LL), and pelvic incidence minus lumbar lordosis (PI-LL) were used to analyze deformities. Scoliosis Research Society-7 (SRS-7), Neck Disability Index (NDI), and Oswestry Disability Index (ODI) were used to evaluate patient-reported outcomes. Complications and rates of revision surgery were also evaluated. The mean age was 67.1 ± 5 years in the instrumented group and 64.1 ± 9 years in the uninstrumented group. There were no significant differences between instrumented and uninstrumented in SRS-7 (23.4 ± 2.9 vs 23.6 ± 2.6, P = 0.93), NDI (5.7 ± 4.5 vs 10.6 ± 4.5, P = 0.08), and ODI (9.7 ± 13.7 vs 9.4 ± 8.7, P = 0.99). Radiographic measurements of instrumented vs uninstrumented resulted in comparable PT (24.0 ± 7.9 vs 30.5 ± 4.7, P = 0.09), PI (61.3 ± 16.9 vs 67.2 ± 9.5, P = 0.47), LL (34.9 ± 14.4 vs 42.8 ± 11.0, P = 0.29), PI-LL (26.4 ± 25.1 vs 24.3 ± 10.4, P = 0.43), and SVA (38.1 ± 30.1 vs 52.3 ± 21.6, P = 0.37). There were 2 patients in the instrumented group who developed adjacent segment disease that required operative intervention compared with none in the uninstrumented group (P = 0.46). In long-term follow-up of instrumented and uninstrumented fusion, patients had similar patient-reported outcomes and radiographic parameters, although the instrumented cohort had higher rates of adjacent segment disease.

Carbon fibre instrumentation for scoliosis surgery in children with spinal cord intramedullary tumours: a novel technical note.

Scoliosis in children is the most common spinal deformity seen by general practitioners, paediatricians and spinal surgeons. Progressive scoliosis can result in the development of a worsening deformity and cosmesis. Patients usually present with aesthetic concerns. Progressive scoliosis that fails conservative management may require or be offered surgical intervention. Intramedullary tumours may be associated with scoliosis. Management of patients with these dual pathologies can be challenging. Classical scoliosis instrumentation utilising titanium implants impairs post-operative MRI evaluation with metal artefacts. Carbon fibre instrumentations has the potential to reduce the imaging metal artefacts but has not been described in scoliosis correction. Surgical technical note describing correction of scoliosis in two adolescents' with intradural tumours utilising carbon fibre implants. We developed a hybrid approach where we initially used titanium implants to manipulate the deformity then replaced the construct with carbon fibre implants in the same setting to maintain the deformity correction with good follow up outlook. Our technique is robust, safe and replicable. It enabled appropriate post-operative MRI evaluation of the neural structures with a reduced risk of metal artefacts.

Comparison of baseline characteristics and postoperative complications in neuromuscular, syndromic and congenital scoliosis.

Nonidiopathic scoliosis encompasses a group of diagnoses, including neuromuscular scoliosis, syndromic scoliosis and congenital scoliosis. The objective of this study was to compare the preoperative and postoperative clinical differences in pediatric nonidiopathic scoliosis patients with neuromuscular scoliosis vs. syndromic scoliosis/congenital scoliosis. This is a single-center retrospective review of all pediatric patients undergoing spinal instrumentation for nonidiopathic scoliosis during a 5-year period. Neuromuscular scoliosis patients ( n = 144), syndromic scoliosis patients ( n = 44) and congenital scoliosis patients ( n = 52) were compared. Demographics, patient characteristics and outcomes were compared. Neuromuscular scoliosis patients had lower BMI z-scores and were more likely to have pulmonary disease, technology dependence and seizure disorder. Additionally, neuromuscular scoliosis patients underwent bigger procedures with more levels fused and a higher rate of pelvis fixation. By direct comparison, neuromuscular scoliosis patients tended to have more complications including deep surgical site infections, readmission in 30 days, return to operating room in 90 days and emergency care visits in 90 days. When controlling for the differences in their preexisting conditions and surgical procedure, we found that pelvic fixation was a major confounding factor, whereas the others had no effect. We further subanalyzed cerebral palsy patients and found this group to exhibit no difference in complications compared to other neuromuscular scoliosis subtypes. Neuromuscular scoliosis patients have different characteristics and subsequent postoperative complications than those with syndromic scoliosis and congenital scoliosis. The difference in complication profile is mainly due to differences in surgical procedure and a higher rate of pelvic fixation. This should be considered when planning nonidiopathic scoliosis surgery among multidisciplinary teams.

Long-Term Health-Related Quality of Life After Harrington Instrumentation and Fusion for Adolescent Idiopathic Scoliosis: A Minimum 40-Year Follow-up.

Despite its importance for clinical decisions, the long-term consequences of posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS), particularly in the lower lumbar spine, remain unclear. This study evaluates the long-term health-related quality of life and the need for a further surgical procedure in patients treated with Harrington instrumentation from 1961 to 1977 according to the lowest instrumented vertebra (LIV) and in comparison with age-matched norms. A search was performed to identify and contact the 314 identified patients with AIS treated with PSIF by Dr. L.A. Goldstein. The assessment included identified subsequent spine surgery, the Oswestry Disability Index (ODI), Scoliosis Research Society-7 (SRS-7), EuroQol-5 Dimensions (EQ-5D), and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29). The health-related quality of life was compared with U.S. norms and, within the cohort, was compared by patient factors, LIV, and subsequent spine surgery. In this study, 134 patients (42.7%) were identified; 24 (7.6%) had died, 81 (25.8%) consented to participate in the study, and 29 (9.2%) declined participation. The mean follow-up was 45.4 years (range, 40 to 56 years). There were 81 patients who completed the surveys, 77 patients who completed the SRS-7, 77 patients who completed the ODI, and 76 patients who completed the PROMIS-29 and EQ-5D. There were 12.8% of patients with LIV L3 or proximal and 36.4% with LIV L4 or distal who had an additional surgical procedure (odds ratio, 3.98). Comparing the ODI of patients who had undergone an additional surgical procedure with those who had not showed 42% and 73% minimal disability, 53% and 23% moderate disability, and 5% and 2% severe disability. Of the patients who had not undergone an additional surgical procedure, those with LIV L3 or proximal had mean scores of 14.12 points for the ODI and 23.3 points for the SRS-7 and those with LIV L4 or distal had mean scores of 17.9 points for the ODI and 22.7 points for the SRS-7; these differences were not significant. The mean PROMIS-29 and EQ-5D scores were not different from normal U.S. age-based means. Patients with AIS treated with PSIF at a mean 45-year follow-up and LIV L4 or distal had a higher rate of undergoing an additional surgical procedure than those with LIV L3 or proximal. Patients undergoing an additional surgical procedure had lower health-related quality of life than those who did not. Despite this, there was no difference in health-related quality of life for patients with LIV L4 or distal compared with patients with LIV L3 or proximal. This cohort of patients with AIS treated with PSIF demonstrates normal self-reported health-related quality of life compared with the age-matched general population. These long-term outcomes of PSIF for AIS are encouraging. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Assessment of Average Correction of Cobb’s Angle Post Instrumentation in Adolescent Ideopathic Scoliosis in Lenknee Type 1 Curve

Introduction: Preferred instrumentation for adolescent idiopathic scoliosis (AIS) remains controversial. Surgical correction is classically indicated for progressive curves more than 40° in the skeletally immature patient. Aims and objectives: The basic aim of the study is to analyse the average correction of Cobb’s angle post instrumentation in adolescent ideopathic scoliosis in lenknee type 1 curve. Material and methods: This descriptive study was conducted in Services hospital, Lahore during 2020 to 2021. This study was done with the approval of ethical committee of hospital. There are 27 patients that were included in this study. The age range for the selected patients was 14-20 years from which 15 female and 12 male. The total duration of the study was 2 years. Results: The data was collected from 27 patients. In three patients with Lenke type 1 curve, the apex of curve was the disc at T8/9 or the vertebral body at T9. The mean coronal Cobb angle of the main thoracic curve was 43.7° and the Cobb angles of the compensatory curves on thoracolumbar or lumbar region were less than 20°. On scoliometer measurement of the rib hump averaged 18.5°. On the lateral bending film the mean Cobb angle of main thoracic curve was corrected to 15.7°. Conclusion: It is concluded that patients with Lenke 1 increasing the cost density of instrumentation does not translate into improving the Cobb angle of the uninstrumented spine and does not change any of the cosmetic parameters measured on clinical patient photographs.

Assessment of Average Correction of Cobb's Angle Post Instrumentation in Adolescent Ideopathic Scoliosis in Lenknee Type 1 Curve

Assessment of Average Correction of Cobb's Angle Post Instrumentation in Adolescent Ideopathic Scoliosis in Lenknee Type 1 Curve

Back pain and quality of life 10 years after segmental pedicle screw instrumentation for adolescent idiopathic scoliosis (AIS). Comparison to age and gender matched untreated AIS patients and healthy controls

Back pain and quality of life 10 years after segmental pedicle screw instrumentation for adolescent idiopathic scoliosis (AIS). Comparison to age and gender matched untreated AIS patients and healthy controls

Closed suction subfascial drain reduces postoperative opioid consumption in adolescents undergoing pedicle screw instrumentation for idiopathic scoliosis. A randomized clinical trial

Closed suction subfascial drain reduces postoperative opioid consumption in adolescents undergoing pedicle screw instrumentation for idiopathic scoliosis. A randomized clinical trial

Anaesthetic considerations in posterior instrumentation of scoliosis due to spinal muscular atrophy: Case series of 56 operated patients.

Spinal muscular atrophy (SMA) is a rare illness that often leads to severe kyphoscoliosis. This case series adds to the heretofore sparse information as regards the anaesthetic management of SMA scoliosis patients. This retrospective study reviewed the charts of 79 SMA patients (type II n=34 and type III n=45) presenting for possible scoliosis surgery during the time period 2007-2019. Special attention focused on preoperative assessment and clearance requirements, anaesthesia protocol and postoperative handling. Out of 79 patients, 17 did not receive clearance for the procedure mostly due to grave respiratory insufficiency. Out of 62 patients with clearance for both surgery and anaesthesia, 56 patients [44 females, 12males; age mean±SD (range) 22±7.3 (10-40) years] underwent the procedure. Their forced vital capacity and forced expiratory volume in 1s were mean±SD (range) 1.41±0.53 (0.61-2.65) L and 1.26±0.47 (0.52-2.27) L, respectively. Intubation difficulties and their resolution, e.g. with the help of fibreoptic technique and video laryngoscopy, are described. All 56 patients were extubated in the operating room postoperativley. Patients stayed at the postanaesthesia care unit for one (n=48) or two (n=8) nights. A considerable amount of the patients (19/56) developed hypokalaemia postoperatively. This analysis is one of the bigger series of its kind and adds insight into the preoperative clearance process, the anaesthetic protocol and some of the postoperative complications, e.g. the tendency for developing postoperative hypokalaemia which has not been reported previously.

Baclofen Pump Use: Complications After Growth-friendly Instrumentation for Early-onset Scoliosis.

Patients with early-onset scoliosis (EOS) and spasticity may receive treatment with an intrathecal baclofen pump. We assessed how baclofen pumps are associated with the odds of complications and secondary interventions after growth-friendly (GF) spine surgery for EOS and analyzed infectious complications within the pump cohort. Using a prospectively maintained, international multicenter database, we studied patients with neuromuscular EOS with baclofen pumps who underwent GF spine surgery from 2002 through 2019 (n=25). Baclofen pumps were implanted before GF instrumentation in 18 patients, during in 2 patients, and after in 5 patients. Patients with existing pumps at initial GF spine surgery were matched 1:3 with 54 patients (control group) without pumps according to treatment center, year of surgery, diagnosis, surgery type, and preoperative curve magnitude. Univariate analysis and multivariate logistic regression were performed to compare complications and secondary interventions between the 2 cohorts. Patients with baclofen pumps had 4.8 times the odds [95% confidence interval (CI): 1.5-16] of experiencing any complication within 1 year after initial GF spine surgery compared with controls. During mean follow-up of 6.9±4.3 years, they had 4.7 times the odds (95% CI: 1.3-16) of deep surgical site infection and 5.6 times the odds (95% CI: 1.2-26) of spinal rod removal after any complication. Differences in rates of mechanical complication, such as rod migration and breakage, were nonsignificant between the 2 groups. For the 9 patients (50%) with pumps who experienced infections, the most common microorganisms were Staphylococcus aureus (4 patients) and Pseudomonas aeruginosa (2). The pump/catheter was revised or removed, in addition to antibiotic therapy or surgical irrigation and debridement, in 2 patients. Among patients with neuromuscular EOS, those with baclofen pumps are much more likely to experience complications within 1 year after GF spine surgery. They are also more likely to have deep surgical site infections, with S. aureus and P. aeruginosa being the most common causative organisms, and to require spinal rod removal. Level III-retrospective comparative study.

Concurrent and overlapping surgery: perspectives from surgeons on spinal posterior instrumented fusion for adolescent idiopathic scoliosis.

PurposeThe purpose of this study was to determine perspectives of surgeons regarding simultaneous surgery in patients undergoing posterior spine instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS).MethodsA survey was administered to orthopaedic trainees and faculty regarding simultaneous surgery for primary PSIF for AIS. A five-point Likert scale (1: ‘Strongly Disagree’ to 5: ‘Strongly Agree’) was used to assess agreement with statements about simultaneous surgery. We divided simultaneous surgery into concurrent, when critical portions of operations occur at the same time, and overlapping, when noncritical portions occur at the same time.ResultsThe 72 respondents (78.3% of 92 surveyed) disagreed with concurrent surgery for ‘one of my patients’ (response mean 1.76 (sd 1.03)) but were more accepting of overlapping surgery (mean 3.94 (sd 0.99); p < 0.0001). The rating difference between concurrent and overlapping surgery was smaller for paediatric and spine surgeons (-1.25) than for residents or those who did not identify a subspecialty (-2.17; p = 0.0246) or other subspecialty surgeons (-2.57; p = 0.0026). Respondents were more likely to agree with explicit informed consent for concurrent surgery compared with overlapping (mean 4.32 (sd 0.91) versus 3.44 (sd 1.14); p < 0.001).ConclusionOrthopaedic surgeons disagreed with concurrent but were more accepting of overlapping surgery and anaesthesia for PSIF for AIS. Respondents were in greater agreement that patients should be explicitly informed of concurrence than of overlap. The surgical community’s evidence and position regarding simultaneous surgery, in particular overlapping, must be more effectively presented to the public in order to bridge the gap in perspectives.Level of EvidenceIV

The Effect of Surgeon Experience on Outcomes Following Growth Friendly Instrumentation for Early Onset Scoliosis.

The purpose of this study was to utilize a multicenter, multisurgeon cohort to assess the effect of surgeon experience on outcomes of growth friendly instrumentation (GFI) in early onset scoliosis (EOS). We hypothesized that unplanned return to the operating room (UPROR), estimated blood loss (EBL), and surgical time would be greater amongst early career surgeons (ECSs) when compared with advanced career surgeons (ACSs). An international pediatric spine database was queried for patients ages 2 to 10 years treated by posterior distraction-based GFI with at least of 2-year follow up. Two groups were created for analysis based on surgeon experience: ECSs (with ≤10 y of experience) and ACSs (with >10 y of experience). The primary outcome was UPROR. Additional outcomes included: operating room time, EBL, neurological deficits, infection rate, hardware failure, and the Early Onset Scoliosis Questionnaire (EOSQ-24). Subgroup analysis was performed for further assessment based on procedure type, superior anchor type, etiology, and curve severity. A total of 960 patients met inclusion criteria including 243 (25.3%) treated by ECS. Etiology, sex, superior anchor, and EOSQ-24 scores were similar between groups (P>0.05). There were no clinically significant differences in patient age or preoperative major coronal curve. UPROR (35.8% vs. 32.7%, P=0.532), infection (17.0% vs. 15.6%, P=0.698), operating room time (235 vs. 231 min, P=0.755), and EBL (151 vs. 155 mL, P=0.833) were comparable between ECS and ACS groups. The frequency of having at least 1 complication was relatively high but comparable among groups (60.7% vs. 62.6%, P=0.709). EOSQ-24 subdomain scores were similar between groups at 2-year follow-up (P>0.05). Subgroup analysis revealed that ECS had increased surgical time compared with ACS in severe curves >90 degrees (270 vs. 229 min, P=0.05). This study represents the first multicenter assessment of surgeon experience on outcomes in EOS. Overall, surgeon experience did not significantly influence UPROR, complication rates, EBL, or surgical time associated with GFI in this cohort of EOS patients. Level III.

Determination of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Correction Fusion using Pedicle Screw Versus Hook Plus Screw Pedicle Instrumentation

Introduction: Spinal instrumentation in idiopathic adolescent scoliosis (AIS) aims to correct spinal deformity, and maintain spinal stability. Proximal junctional kyphosis (PJK) is a relatively common postoperative complication. Posterior-only fusion using diverse instruments such as pedicle screw and hybrid hook plus screw is favored to correct spinal deformity. The current study aims to compare PJK incidence between pedicle screw versus hybrid hook plus screw.&#x0D; Methods: This non-randomized clinical trial has been conducted on 71 AIS patients undergone posterior-only spinal deformity fusion using pedicle screw only (n=42) or hook plus pedicle (n=29) implantation in 2015-20. The proximal thoracic (PT), main thoracic (MT), T5-T12 sagittal Cobb angles and proximal junctional angle (PJA) were evaluated through radiographies taken at baseline, immediately postoperative, within 6 and 18 months. PJK was defined as PJA &gt;10 degrees. &#x0D; Results: Using both pedicle screw only and hook plus pedicle have led to significant improvement in MT, PT, PJA and T5-T12 angles (P-value&lt;0.05); however, the two groups were not statistically different (P-value&gt;0.05). Seventeen cases (23.9%) presented PJK among which 11 (26.2%) and 6 (20.7%) ones were in the predicle screw versus hook plus screw implantation groups, respectively (P-value=0.54). The comparison of PJA and T5-T12 Cobb angles revealed significant difference between the PJK versus non-PJK cases (P-value&lt;0.05).&#x0D; Conclusion: AIS instrumentation was accompanied by satisfying outcomes using pedicle screw or hook plus screw. However, none of the applied instruments was superior over the other; PJK occurred in fewer cases undergone posterior-only approach of AIS correctional surgery using hook and screw.

Post-marketing surveillance on safety and efficacy of posterior spinal correction and fusion with the CD Horizon Solera instrumentation for adolescent idiopathic scoliosis. A retrospective cohort study

BackgroundPost-Market Clinical Follow-Up has been integrated into the new Medical Device Regulations since 2020. The CD Horizon Solera 4.75 mm instrumentation (CD-Solera) was introduced worldwide in 2009, and specifically intended for surgical treatment of pediatric and adolescent scoliosis patients. The objective of this study was to evaluate the safety and efficacy of the CD-solera 4.75 instrumentation in surgical treatment of adolescent idiopathic scoliosis (AIS). Methods94 consecutive AIS patients, 82 female, 12 male, who underwent posterior correction with CD-Solera instrumentation between 2010 and 2016 at age 14.8 ± 1.6 years, were retrospectively included. The minimum follow-up was two years. On pre- and postoperative biplanar full spine radiographs Cobb angles of the primary and secondary curves and sagittal profile were measured before surgery, immediately postoperative, and at two-year follow-up. Medical records were reviewed for complications. Clinical outcome was analyzed using theSRS-22r questionnaire. ResultsIn this study 77% of the patients had a structural thoracic curve (type Lenke 1 or 2), and 23% had a structural (thoraco-)lumbar curve (Lenke 3-6). A correction of 55.1% and 51.7% was achieved respectively immediately post-operative, and at last-year follow up for the primary curve. The mean loss of correction was 2°. Health related quality of life was 4.0 (good) on the SRS-22r-questionnaire. In total six revision operations were executed, of which one was related to the material (rod breakage). Other reasons for revision operation were not due to the material. No neurological problems were encountered. ConclusionIn patients with AIS the initial correction and maintenance of correction as achieved by posterior spinal fusion using the CD-Solera instrumentation, is comparable to other reported devices. Complication rates are low and health related quality of life comparable to literature. The CD-Solera can be regarded as a safe and effective instrumentation in surgical treatment of AIS.