Postoperative Mechanical Complications Research Articles

Preoperative low Hounsfield units in the lumbar spine are associated with postoperative mechanical complications in adult spinal deformity.

To determine the most valid bone health parameter to predict mechanical complications (MCs) following surgery for adult spinal deformity (ASD). This multicenter study retrospectively examined the records of patients who had undergone fusion of three or more motion segments, including the pelvis, with a minimum two-year follow-up period. Patients with moderate and severe global alignment and proportion scores were included in the study and divided into two groups: those who developed MCs and those who did not. Bone mineral density (BMD) of the lumbar spine and femoral neck was measured using dual-energy X-ray absorptiometry, and Hounsfield units (HUs) were measured in the lumbar spine on computed tomography. Radiographic parameters were evaluated preoperatively, immediately after surgery, and at final follow-up. Of 108 patients, 30 (27.8%) developed MCs, including 26 cases of proximal junctional kyphosis/failure, 2 of distal junctional failure, 6 of rod fracture, and 11 reoperations. HUs were significantly lower in patients who experienced MCs (113.7 ± 41.1) than in those who did not (137.0 ± 46.8; P = 0.02). BMD did not differ significantly between the two groups. The preoperative and two-year postoperative global tilt, as well as the immediately postoperative sagittal vertical axis, were significantly greater in patients who developed MCs than in those who did not (P = 0.02, P < 0.01, and P = 0.01, respectively). Patients who experienced MCs following surgery for ASD had lower HUs than those who did not. HUs may therefore be more useful than BMD for predicting MCs following surgery for ASD.

Comparison of Global Alignment and Proportion (GAP) Score and SRS-Schwab ASD Classification in the Analysis of Surgical Outcomes for Adult Spinal Deformity

Study designThe GAP score predicted post-operative mechanical complications more effectively whereas SRS-Schwab classification improved evaluation of postoperative PROMs.ObjectiveThe study compared the GAP Score and SRS-Schwab Classification in predicting surgical outcomes for adult spinal deformity (ASD) and elucidated whether both systems should be included in the preoperative planning.Materials and methodsRadiographic measurements and health-related quality of life scores at baseline, 6 weeks after surgery, and the last follow-up were collected from a cohort of 69 ASD patients subjected to long segment spinal fusion surgery after they were grouped by GAP score and SRS-Schwab classification respectively. Fisher's exact test and receiver operator characteristic (ROC) curve analysis was used to compare the incidence of mechanical complications and the discriminant capacity during revision surgery between the two groups. Postoperative patient-reported outcomes measures (PROMs) were compared by one-way ANOVA, and the proportions of MCID achieved for PROMs compared by chi-square test between the two groups.ResultsThe overall incidence of mechanical complications and revision surgery were 42% and 8.7%. Both GAP score and its categories predicted mechanical complications and revision surgery, but the GAP score system could not predict the improvements of PROMs. The SRS-Schwab classification could predict the occurrence of postoperative mechanical complications and improvements of postoperative PROMs between the aligned, moderately misaligned and severely misaligned groups (P < 0.05).ConclusionHence, a comprehensive surgical strategy for postoperative planning may improve patients’ quality of life and minimize mechanical complications.Graphical

The effect of distal locking mode on postoperative mechanical complications in intertrochanteric fractures: a retrospective cohort study of five hundred andseven patients.

The optimal choice of distal locking modes remains a subject due to limited available data, and therefore, this study aims to investigate the relationship between distal locking mode and postoperative mechanical complications in an intertrochanteric fracture (ITF) population who underwent closed reduction and intramedullary fixation with a PFNA-II. Patients aged 65years or older who underwent surgery with PFNA-II fixation in a university teaching hospital between January 2020 and December 2021 were potentially eligible. Based on the distal locking mode, patients were classified into static, dynamic, and limited dynamic groups, among which the differences were tested using univariate analysis. Multivariate logistic regression was used to examine whether the distal locking mode was independently associated with the risk of postoperative oneyear mechanical complications, adjusting for covariates and potential confounders. Subgroup analyses were performed to evaluate the robustness of the findings. Among 507 eligible patients, 33 (6.5%) developed postoperative mechanical complications. In the univariate analysis, sex (P = 0.007), fracture type (P = 0.020), LAT Parker ratio (P = 0.023), and lateral femoral (P = 0.003) wall showed that the differences were significant. Compared to the static group, the limited dynamic group and the dynamic group showed higher odds of postoperative mechanical complications (OR = 3.314, 95% CI: 1.215-9.041; and OR = 3.652, 95% CI: 1.451-9.191, respectively). These associations were robust across a series of analyses, including adjusting for confounders and subgroup analyses. Using a distal non-static locking mode significantly increases the risk of postoperative mechanical complications, and static locking could be a preferable option when treating an intertrochanteric fracture.

Influence of paraspinal muscle degeneration and postoperative Roussouly classification restoration on mechanical complications in female patients with degenerative scoliosis after surgery

Objective: To investigate the impact of lumbar paraspinal muscle degeneration and postoperative failure to restore ideal Roussouly classification on the occurrence of mechanical complications (MC) following long-segment spinal correction surgery in female patients with degenerative scoliosis (DS). Methods: The clinical data of 72 female DS patients who underwent long-segment spinal correction surgery in Gulou Hospital from June 2017 to November 2021 were retrospectively analyzed. According to whether restoring the ideal Roussouly classification after surgery, the patients were divided into R group(recovery group) (n=51) and N group(non-recovery group) (n=21). According to whether mechanical complications occurred after operation within two years, the patients were divided into MC (mechanical complications)group (n=24) and NMC(non-mechanical complications) group (n=48). The RM group (n=14) experienced mechanical complications in the R group, while the RN group (n=37) did not. The NM group (n=10) experienced mechanical complications in the N group, while the NN group (n=11) did not.Radiographic assessment included Sagittal parameters of spine and pelvis, standardized cross-sectional area (SCSA) and fat infiltration rate (FI%) of paraspinal muscle at each lumbar disc level. Results: The age of DS patients in this study was (61.4±6.2) years.The incidence of MC was 33.33%(n=24)in all patients. The incidence of MC was 27.45%(n=14)in group R and 47.62%(n=10) in group N. The correction amount of pelvic tilt angle (PT) (-11.62°±10.06° vs -7.04°±8.45°, P=0.046) and T1 pelvic angle(TPA)(-12.88°±11.23° vs -7.31°±9.55°, P=0.031)during surgery were significantly higher in MC group compared to the NMC group. In group R, the FI% of paraspinal muscles in each lumbar segment of patients with postoperative MC was higher than that in patients without MC (P<0.05). In the R and N groups, there was no significant difference inthe SCSA of the lumbar paravertebral muscles between patients with postoperative MC and those without MC at each level (all P>0.05). Multivariate logistic regression analysis showed that the average FI% of lumbar PSM was correlated with the occurrence of MC after spinal fusion in DS patients.The average FI% of lumbar PSM≥22.63% was a risk factors for MC after spinal fusion (P=0.010,OR=1.088, 95%CI:1.020-1.160). Conclusions: Female DS patients with higher degree of preoperative paraspinal muscle degeneration have a higher incidence of postoperative mechanical complications. For these patients,.there is still a higher risk of mechanical complications after surgery even if the ideal Roussouly classification is restored after surgery.

371 The Impact of Thoracolumbar Inflection Point on Outcomes and Complications in Adult Spinal Deformity

INTRODUCTION: The importance of alignment on postoperative outcomes and mechanical complications has been well established. However, the impact of alignment parameters relative to thoracolumbar inflection point remains unclear. METHODS: ASD patients with 2-year data, fused in the lower-thoracic (T7-T12) to sacrum were included. Thoracolumbar inflection-point(IP), IP differences from UIV, LLA, and theoretical-IP based on Roussouly morphology were assessed. Cases were stratified based on IP changes from baseline (BL) into Caudal(L), Same(S), or Cranial(H). Analysis controlled for invasiveness, baseline deformity, frailty, and PJK prophylaxis. RESULTS: 650 patients met inclusion. PJF or PJK with reoperation was associated with a more caudal BL-IP (L2 inferior end plate (EP) vs L1-body, p &lt; .001). In adjusted analysis, a more caudal BL IP had 25% higher odds of developing PJF by 2Y (OR:1.26, p=0.003). Postoperative normalization to theoretical Roussouly IP was associated with decreased rates of rod breakage (p = .049), but had higher rates of PJF (p = .044). Stratifying groups based on IP change from BL, rates of PJK and PJF by 2Y were higher in H (p &lt; .003), with no difference in meeting Roussouly target IP. There was 4.4x lower odds of developing PJF in L and 2.0x in S compared to H (p &lt; .05). Increased distance of UIV to IP was associated with mechanical-complications (MC) (p &lt; .05). Decreased distance between LLA-IP at BL was associated with MC (p = .04). CONCLUSIONS: Despite lower frailty and baseline deformity in the cohort with a more cranially adjusted postoperative inflection point, there were higher rates of PJK and PJF. Increased distance between lumbar lordosis apex and inflection point was associated with higher rates of PJK, PJF, and thoracic decompensation. Correspondingly, a greater distance between the upper instrumented vertebra and inflection point was predictive of development of regional decompensation. The target inflection point can be an important parameter to minimize complications associated with ASD surgery.

Adult spinal deformity correction surgery using age-adjusted alignment thresholds: clinical outcomes and mechanical complication rates. A systematic review of the literature.

Adult spinal deformity (ASD) surgery gives good clinical outcomes but has a high rate of mechanical complications (MC). In 2016, Lafage described the age-adjusted alignment thresholds (AAAT) to adapt the correction in relation to patient's age proposing less aggressive corrections for the elderly population. The aim of this review was to clarify the effectiveness of AAAT to achieve good health-related quality of life (HRQoL) and their relationship with post-operative MC. We performed a review of the literature, including articles reporting data on post-operative HRQoL and MC rates in relation to the AAAT. Data were stratified according to whether they matched the AAAT, dividing the population in undercorrected (U), matched (M) and overcorrected (O). The quality of the included studies was assessed using the GRADE and MINORS systems. Six articles reporting data from 1,825 patients were included. The different categories (U, M and O) had homogeneous pre-operative sagittal parameters (p > 0.05) that became statistically different after surgeries (p < 0.05). Proximal junctional kyphosis (PJK) was more frequent in the O group compared to U (p = 0.05). Post-operative HRQoL parameters were similar in the 3 groups (p > 0.05). The quality of the included studies was generally low with a high bias risk. The results extrapolated from this review are interesting, as for the same HRQoL the U group had a lower MC rate. Unfortunately, the results are inconsistent, mainly because of the low quality of the included studies and the lack of reporting of some important patient- and surgery-related factors.

Risk factors for mechanical complications after fusion extension surgery for lumbar adjacent segment disease.

Adjacent segment disease (ASD) is a common complication in fusion surgery. In the event of solid segmental fusion, previous implants can be removed or preserved during fusion extension for ASD. To compare the surgical outcomes of patients with and without implants and analyzes the risk factors for postoperative mechanical complications. Patients who underwent fusion extensionfor lumbar ASDfrom 2011 to 2019 with a minimum 2year follow-up were retrospectively reviewed. Spinopelvic parameters were measured preoperatively and postoperatively. Clinical outcomes and surgical complications were compared between groups with implants preserved and removed. Risk factors for mechanical complications, including clinical, surgical, and radiographic factors were analyzed. Sixty-nine patients (mean age, 69.9 ± 6.9years) were included. The mean numbers of initial and extended fused segments were 2.8 ± 0.7 and 2.7 ± 0.7, respectively. Previous implants were removed in 43 patients (R group) and preserved in 26 patients (P group). Both groups showed an improvement in clinical outcomes without between-group differences. The operation time was significantly longer in R group (260 vs 207min, p < 0.001). Mechanical complications occurred in 13 patients (12 in R group and 1 in P group) and reoperation was needed in 3 patients (R group). Implant removal, index fusion surgery including L5-S1, and postoperative sagittal malalignment were risk factors for mechanical complications. Implant removal was a risk factor for mechanical complications. Index fusion surgery including L5-S1 and postoperative sagittal malalignment were also risk factors for mechanical complications.

THREE-COLUMN OSTEOTOMY WITH COMBINATION OF COMPRESSION HOOK AND PEDICLE SCREW FIXATION FOR ADULT SPINAL DEFORMITY IN PATIENTS WITH PARKINSON’S DISEASE

Purpose: Surgical treatment for adult spinal deformity (ASD) in patients with Parkinson’s disease (PD) is challenging and is associated with a significant risk of postoperative mechanical complications, such as rod breakage, pseudoarthrosis and proximal junctional failure. We herein report the surgical results of three-column osteotomy with pedicle screw fixation combined with compression hook for ASD associated with PD. Methods: We retrospectively investigated four patients with ASD due to PD who underwent three-column osteotomy with posterior instrumentation. The compression hook system placed on the laminae was used for closure of the osteotomy site during surgery and reinforcement of pedicle screw fixation. Surgical outcomes and radiographical parameters were analyzed. Results: Lumbar lordosis was improved from −25[Formula: see text]± 18[Formula: see text] preoperatively to 51[Formula: see text]± 7[Formula: see text] postoperatively, and 48[Formula: see text]± 5[Formula: see text] at the final follow-up examination. The sagittal vertical axis was restored from 297 ± 104 mm preoperatively to 41 ± 13 mm postoperatively, and 72 ± 23 mm at the final follow-up examination. The preoperative VAS (88 ± 14 mm) for low back pain was significantly improved at the final follow-up examination (14 ± 28 mm). Walking disturbance due to low back pain was improved in all patients. No patients had mechanical failure (e.g. rod fracture, pseudarthrosis, or junctional failure) after surgery. Conclusion: The use of compression hooks to supplement pedicle screw fixation is beneficial for performing safe osteotomy closure during surgery and preventing postoperative mechanical failures, and may be a useful option when performing three-column osteotomy for ASD associated with PD.

Residual lateral wall width predicts a high risk of mechanical complications in cephalomedullary nail fixation of intertrochanteric fractures: a retrospective cohort study with propensity score matching.

The purpose of this study is to determine whether the integrity of the entry portal of head-neck implant is related to postoperative mechanical complications. We retrospectively reviewed consecutive patients with pertrochanteric fractures in our hospital treated from January 1, 2018, to September 1, 2021. Based on the integrity of the entry portal for head-neck implants on the femoral lateral wall, patients were divided into two groups, including the ruptured entry portal (REP) group and the intact entry portal (IEP) group. After 4:1 propensity score-matched analyses were used to balance the baseline of the two groups, a total of 55 patients were extracted from the original participants, including 11 patients in the REP group and 44 matched patients in the IEP group. The anterior to posterior cortex width on the mid-level of the lesser trochanter was measured and defined as the residual lateral wall width (RLWW). Compared with the IEP group, the REP group was correlated with postoperative mechanical complications (OR = 12.00, 95% CI 1.837-78.369, P = 0.002) and hip-thigh pain (OR = 26.67, 95% CI 4.98-142.86). RLWW ≤ 18.55mm indicated a high likelihood (tau-y = 0.583, P = 0.000) of becoming the REP type postoperatively and being more likely to suffer from mechanical complications (OR = 30.67, 95% CI 3.91-240.70, P = 0.000) and hip-thigh pain (OR = 14.64, 95% CI 2.36-90.85, P = 0.001). Rupture of entry portal is a high-risk factor for mechanical complications in intertrochanteric fractures. RLWW ≤ 18.55mm is a reliable predictor of the postoperative REP type.

Cervical Inclination Angle: Normative Values in an Adult Multiethnic Asymptomatic Population.

The role of the craniocervical complex in spinal sagittal alignment has rarely been analyzed but it may play a fundamental role in postoperative mechanical complications. The aim of the study is to analyze the normative value of the cervical inclination angle (CIA) in an adult asymptomatic multiethnic population. Standing full-spine EOS of adult asymptomatic volunteers from 5 different countries were analyzed. The CIA was analyzed globally and then in each decade of life. Different ethnicities were compared. Comparisons between different groups was performed using a t-test and statistical significance was considered with a p-value < 0.05. EOS of 468 volunteers were analyzed. The global mean CIA was 80.2° with a maximum difference of 9° between T1 and T12 (p < 0.001). The CIA remains constant until 60 years old then decreases significantly passing from a mean value before 20 years old of 82.25° to 73.65° after 70 years old. A statistically significant difference was found between the Arabics and other ethnicities with the formers having an inferior CIA: this was related to a mean older age (p < 0.05) and higher body mass index (p < 0.05) in the Arabics. The CIA remains constant until 60 years old and then reduces slightly but never under 70°. This angle is helpful to evaluate the lever arm at the upper instrumented vertebra after an adult spinal deformity surgery and could predict the occurrence of a proximal junctional kyphosis when its value is lower than normal. Further clinical studies must confirm this theory.

Dialysis Patients Undergoing Total Hip Arthroplasty have Higher Rates of Morbidity and Mortality and Incur Greater Healthcare Costs: A National Database Study from 367,894 Patients.

The incidence of a total hip arthroplasty (THA) is sevenfold higher in dialysed patients. Only a few have specifically studied the impact of chronic dialysis on outcomes of THA whilst comparing them with non-dialysed/controls. The present study questioned whether significant differences existed in morbidity and mortality rates after THA in dialysed and non-dialysed patients. The National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project using records for THAs performed during 2016-2019 was employed. This largest, nationwide, in-patient database in the US acquires data from > 7 million hospital stays annually from > 20% hospitals. Among 367,894 THAs performed during 2016-2019, 383 were regularly dialysed. The two groups (dialysis and controls) were compared for in-hospital mortality, demographic data, perioperative details and medical/surgical complications. Dialysed patients were younger (p < 0.001), had greater mortality (0.5% vs 0.09%, p = 0.005), lengths of stay (4.4 vs 2.3days, p < 0.001), costs ($96,824 vs $66,848, p < 0.001) and male preponderance (p < 0.001). Postoperative dislocations (3.1% vs 1.4%, p = 0.013), mechanical complications (p = 0.032) and blood loss (p = 0.031) were greater in dialysed patients. Medical postoperative complications (myocardial infarction, pneumonia, thromboembolism, acute renal failure), periprosthetic fractures, wound dehiscence, superficial and deep surgical-site infection and periprosthetic joint infections were comparable between the 2 groups. Dialysed patients had elective THAs more often (25% vs 8.6%). Controls had higher (twofold) home discharges while ~ 50% of dialysed THAs needed discharge to another facility. This large national data highlighted greater morbidity and mortality among dialysis patients following THA, something to consider preoperatively along with individual circumstances whilst making risk-benefit assessments for arthroplasty. Improvements in healthcare could bridge gaps between outcomes and expectations in dialysed patients.

Clinical Outcomes and Complications of Corrective Fusion Surgery Down to L4, L5, and the Pelvis for Adult Scoliosis in Patients Younger than 50 Years.

Corrective fusion for adult scoliosis often requires fusion from the thoracic spine to the lower lumbar spine or pelvis. However, it is often difficult to determine the lowest instrumented vertebrae (LIV), especially in younger patients. The purpose of this study was to summarize the clinical outcomes and revision surgery rates after corrective fusion for adult scoliosis at different LIV levels in patients under 50 years of age. We retrospectively analyzed 25 patients with adult scoliosis (mean age, 38 years; mean follow-up, 65 months) who underwent corrective fusion from the thoracic spine to L4, L5, or pelvis between 2010 and 2018. Preoperative and at least 2 years' postoperative radiographic parameters, patient-reported outcomes (Scoliosis Research Society-22r [SRS-22r]), mechanical complications, and revision surgery were investigated, and comparisons were made between two groups: the L4 and L5 (L) group (n=14) and the pelvic group (n=11). Both groups showed a significant improvement in the SRS-22r domains of Self-image and Subtotal postoperatively compared with the baseline (P<0.05). The incidence of rod fracture was significantly higher in the pelvic group (5 patients, 45%) than in the L group (0 patients, 0%) (P=0.001). In addition, revision surgery was performed five times in 4 patients (36%) in the pelvic group compared with 0 in the L group (P=0.068). In the L group, clinical outcomes improved in the medium term, with no patients requiring revision surgery. In the pelvic group, the rod fracture rate was higher, but the clinical outcomes improved.

83. Cervical inclination angle (CIA) normative values in an adult multiethnic asymptomatic population.

BACKGROUND CONTEXT The role of the cranio-cervical complex in spinal sagittal alignment has rarely been analyzed and described but it may play a fundamental role in postoperative mechanical complications. PURPOSE The aim of the study is to analyze the normative value of the cervical inclination angle for each thoracic vertebra in an adult asymptomatic multiethnic population. STUDY DESIGN/SETTING Observational study; multiethnic cohort study. PATIENT SAMPLE Multiethnic cohort of adult asymptomatic volunteers. OUTCOME MEASURES Measurement of the cervical inclination angle of each thoracic vertebra in adult asymptomatic volunteers using stereoradiography according to patient's age and ethnicity. METHODS Standing full-spine EOS imaging of adult asymptomatic volunteer subjects from five different countries (France, Japan, Singapore, Tunisia and USA) were analyzed. The cervical inclination angle was first analyzed globally and then in each decade of life (<20 years; 21-30 years; 31-40 years; 41-50 years; 51-60 years; 61-70 years; 71-80 years). Different ethnicities were compared. Comparisons between different age and ethnicities groups were performed using a t-test and statistical significance was considered with a p value <0.05. RESULTS EOS images of 468 volunteers were analyzed. The global mean cervical inclination angle was 80,2° with a maximum difference of 9° between T1 and T12 (p <0,001; range 77,05° to 86,05°). The CIA angle remains constant until 60 years old then it decreases significantly passing from a mean value before 20 years old of 82,25° to 73,65° after 70 years old. A statistically significant difference was found between the Arabic and all other ethnicities with the former having an inferior CIA angle: this was related to a mean older age (45,48 vs 39,35 years; p < 0,05) and higher BMI (27,13 vs 23,86 Kg/m2; p <0,05) in the Arabic population. CONCLUSIONS The cervical inclination angle remains constant through age until 60 years-old and reduces slightly but never lower under 70°. This angle might be a helpful tool to evaluate the lever arm on the thoracic spine after an ASD surgery and could predict the occurrence of a proximal junctional kyphosis when its value is lower than normal. Further clinical studies must confirm this theory, particularly in surgically treated patients with long fusion. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. The role of the cranio-cervical complex in spinal sagittal alignment has rarely been analyzed and described but it may play a fundamental role in postoperative mechanical complications. The aim of the study is to analyze the normative value of the cervical inclination angle for each thoracic vertebra in an adult asymptomatic multiethnic population. Observational study; multiethnic cohort study. Multiethnic cohort of adult asymptomatic volunteers. Measurement of the cervical inclination angle of each thoracic vertebra in adult asymptomatic volunteers using stereoradiography according to patient's age and ethnicity. Standing full-spine EOS imaging of adult asymptomatic volunteer subjects from five different countries (France, Japan, Singapore, Tunisia and USA) were analyzed. The cervical inclination angle was first analyzed globally and then in each decade of life (<20 years; 21-30 years; 31-40 years; 41-50 years; 51-60 years; 61-70 years; 71-80 years). Different ethnicities were compared. Comparisons between different age and ethnicities groups were performed using a t-test and statistical significance was considered with a p value <0.05. EOS images of 468 volunteers were analyzed. The global mean cervical inclination angle was 80,2° with a maximum difference of 9° between T1 and T12 (p <0,001; range 77,05° to 86,05°). The CIA angle remains constant until 60 years old then it decreases significantly passing from a mean value before 20 years old of 82,25° to 73,65° after 70 years old. A statistically significant difference was found between the Arabic and all other ethnicities with the former having an inferior CIA angle: this was related to a mean older age (45,48 vs 39,35 years; p < 0,05) and higher BMI (27,13 vs 23,86 Kg/m2; p <0,05) in the Arabic population. The cervical inclination angle remains constant through age until 60 years-old and reduces slightly but never lower under 70°. This angle might be a helpful tool to evaluate the lever arm on the thoracic spine after an ASD surgery and could predict the occurrence of a proximal junctional kyphosis when its value is lower than normal. Further clinical studies must confirm this theory, particularly in surgically treated patients with long fusion.

Correlation between Scoliosis Flexibility Degree on Preoperative Imaging with Postoperative Curve Correction and Mechanical Complications

(1) Background: In the preoperative planning stage of scoliosis surgery, it is routine to use radiographs obtained with and without traction to observe the curve flexibility in order to estimate curve correction, but its association with mechanical complications is not completely understood. (2) Methods: Retrospective cohort study of all patients undergoing infantile, congenital, neuromuscular or idiopathic adolescent scoliosis correction surgery at a single institution between 2015 and 2019, with a minimum follow-up of 24 months. Associations between qualitative variables were tested with the chi-square test. The association between qualitative and quantitative variables were tested with the Mann–Whitney test, and correlations between quantitative variables was tested with Spearman’s correlation. (3) Results: A total of 330 patients, 88 males and 242 females, with a mean age of 16.98 years at surgery, were included. The mean value of preoperative main curves, its flexibility and postoperative value were 54.44 degrees, 21.73 degrees and 18.08 degrees, respectively. (4) Conclusions: Preoperative spinal X-ray examination with traction or bending films is a reasonable option for assessing scoliotic curve flexibility, and patients with neuromuscular scoliosis who are not ambulatory can be informed of the increased risks of late mechanical complications.

Total versus partial posterior fundoplication in the surgical repair of para-oesophageal hernias: randomized clinical trial.

BackgroundFundoplication is an essential step in para-oesophageal hernia (POH) repair, but which type minimizes postoperative mechanical complications is controversial.MethodsThis was a randomized, double-blind clinical trial conducted between May 2009 and October 2018. Patients with symptomatic POH were allocated to either a total (Nissen) or a posterior partial (Toupet) fundoplication after hernia reduction and crural repair. The primary outcome was dysphagia (Ogilvie dysphagia scores) at 6 months postoperatively. Secondary outcomes were peri- and postoperative complications, swallowing difficulties assessed by the Dakkak dysphagia score, gastro-oesophageal reflux, quality of life (QoL), and radiologically confirmed hernia recurrence.ResultsA total of 70 patients were randomized to a Nissen (n = 32) or a Toupet (n = 38) fundoplication. Compared with baseline, Ogilvie dysphagia scores were stable at the 3- and 6-month follow-up in the Nissen group (P = 0.075 and 0.084 respectively) but significantly improved in the Toupet group (from baseline mean (s.d.): 1.4 (1.1) to 0.5 ( 0.8) at 3 months, and 0.5 (0.6) at 6 months; P = 0.003 and P = 0.001 respectively). At 6 months, Dakkak dysphagia scores were significantly higher in the Nissen group than in the Toupet group (mean (s.d.): 10.4 (7.9) versus 5.1 (7.2); P = 0.003). QoL scores improved throughout the follow-up. However, at 3 and 6 months postoperatively, the absolute median improvement (⍙) from preoperative values in the mental component scores of the Short Form-36 QoL questionnaire was significantly higher in the Toupet group (median (i.q.r.): 7.1 (−0.6 to 15.2) versus 1.0 (−5.4 to 3.3) at 3 months, and 11.2 (1.4 to 18.3) versus 0.4 (−9.4 to 7.5) at 6 months; (P = 0.010 and 0.003 respectively)). At 6 months, radiologically confirmed POH recurrence occurred in 11 of 24 patients (46 per cent) of the Nissen group and in 15 of 32 patients (47 per cent) of the Toupet group (P = 1.001).ConclusionsA partial posterior wrap (Toupet fundoplication) showed reduced obstructive complications and improved QoL compared with a total (Nissen) fundoplication following POH repair.Registration number: NCT04436159 (http://www.clinicaltrials.gov)

Restoring Theoretically Optimal Lumbar Lordosis Deduced from Pelvic Incidence and Thoracic Kyphosis has Advantages to Decrease the Risk of Postoperative Mechanical Complications in Adult Spinal Deformity.

ObjectiveTo establish a regression formula for LL based on individual PI and TK in asymptomatic population aged over 50 years and evaluate its predictive power for the occurrence of postoperative mechanical complications in patients with adult spinal deformity (ASD).MethodsA total of 178 asymptomatic adults were recruited for the study. The association between LL and PI, LL and TK, was investigated to establish a predictive formula for ideal LL based on PI and TK. Additionally, 93 ASD patients undergoing posterior correction surgery were retrospectively analyzed. The absolute value of the gap between postoperative actual LL and theoretical LL was defined as ΔLL. Patients were classified into two groups depending on the presence or absence of mechanical complications. The demographic and radiological data of patients were compared between the two groups.ResultsA significant association was found between LL and PI (r = 0.599, P < 0.001), LL and TK (r = 0.523, P < 0.001). A novel formula was developed as follows: LL = 0.7*PI + 0.4*TK + 1 (R2 = 0.524). In the validation cohort, 29 patients developed mechanical complications. Postoperative ΔLL (12.5 ± 7.6° vs. 7.0 ± 5.4°, P = 0.001) significantly increased the incidence of mechanical complications. The most appropriate threshold of ΔLL for predicting mechanical complications was 9.8°. For patients whose ΔLL were <9.8° and >9.8°, the incidence of mechanical complications was 19.4% and 54.8%, respectively.ConclusionIdeal lumbar lordosis should be matched for PI and TK. The developed prediction formula for LL based on PI and TK in asymptomatic adults may help surgeons to understand the mechanisms of lumbar alignment generation and predict occurrence of mechanical complications after ASD surgery.

Treatment of Basicervical Femoral Fracture With Retractable Talon Hip Compression Screw.

BackgroundBasicervical femoral fractures (BFFs) are rare and biomechanically unstable. The goal of this study was to evaluate the effectiveness of the Talon™ DistalFix™ (Orthopedic Designs North America, Inc., Tampa, FL, USA) nail for the treatment of BFFs with a novel design.MethodologyIn this retrospective study, 25 patients with BFFs were analyzed between January 2016 and March 2020 at our institute. All patients were treated with the Talon™ DistalFix™ nail. Patients over the age of 60 years with basicervical fractures caused by low-energy trauma were included in this study. For inclusion into the study, the minimum follow-up time had to be longer than six months. The postoperative radiographic bone union, operative time, tip-apex distance (TAD), sliding distance of the lag screw, quality of fracture reduction, and major complications such as cut-out, non-union of the fracture, femoral head collapse, and cut-through were recorded. The Harris Hip Score was used to evaluate hip function at the end of the follow-up period.ResultsThe mean follow-up period was 22 months (range, 16-28 months), and the mean age was 77.8 years (range, 61-91 years). The average sliding distance of the lag screw was 5.7 mm (range, 0.2-13.1 mm). The mean TAD of immediate postoperative view was 20.8 mm (range, 18.7-23.7 mm), and the TAD was <25 mm in all cases. Radiographic union was confirmed in most cases, and the average time for radiographic union was 18.8 weeks (range, 12-25 weeks). Most fractures (90.5%) had healed with no postoperative mechanical complications (cut-out, cut-thorough, or lateral wall fracture) at the final follow-up, except for two patients. One of the two patients had no evidence of union at six months, and mild varus reduction was observed in the other patient who had shortening of >10 mm.ConclusionsAccording to the clinical and radiological findings of this study, treatment with the Talon™ DistalFix™ nail showed satisfactory results. Hence, it can be a suitable option in the treatment of BFFs.

Hydrocephalus in children: clinical, paraclinical and therapeutic features in four medical facilities in Lubumbashi

hydrocephalus is a progressive distension of the anatomical spaces (ventricles and subarachnoid space) containing the cerebrospinal fluid. It most commonly affects children. In developed countries, its prevalence and incidence are estimated between 0.9 to 1.2 per 1000 and 0.2 to 0.6 per 1000 live births respectively and between 50 000 and 100 000 new cases develop each year in the world. The purpose of this study was to describe the clinical, paraclinical and therapeutic features of hydrocephalus in 4 medical facilities in Lubumbashi. we conducted a descriptive cross-sectional study at the University Clinics of Lubumbashi, Cinquantenaire Hospital, Sendwe General Reference Hospital and ARS Clinic from April 1st, 2015 to September 30th, 2019. Data were collected on the basis of a data collection sheet containing several study parameters including age, sex, clinical signs, birth weight, patient's history, head circumference, CT scan assessment and disease progression. Our sample consisted of 91 subjects with hydrocephalus. the age group 29 days to 24 months (infant) was most commonly affected, i.e. 57.14%, with a sex ratio of 1.67 and a male predominance. The main detecting sign was macrocrania in all patients, followed by setting-sun sign in 53.85% of patients. Brain CT scan was performed in all patients and 65.92% of them had tetraventricular hydrocephalus. Ventriculoperitoneal shunt was performed in all patients. There were no deaths in the postoperative period; postoperative infectious and mechanical complications accounted for 8.79% and 4.40% respectively. The average length of stay in the hospital was 5.65 days. hydrocephalus is the most common reason for pediatric neurosurgery. Clinicians should focus on these results which highlight the importance of early diagnosis and proper management.

Assessment of Resorbable and Non-resorbable Fixation Systems in Sagittal Split Ramus Osteotomy: An In vitro Study.

The internal fixation has been purpose of study for many years, but there is still no consensus on the best method of fixation in relation to resistance for bilateral sagittal split ramus osteotomy (BSSO) using plates. Therefore, the aim of this study was to assess five different methods of osteosynthesis using resorbable and non-resorbable plates and screws in simulated sagittal split osteotomy (SSO) of the mandibular ramus. SSO was performed in 25 polyurethane synthetic mandibular replicas. The distal segments were moved forward 5mm, and the specimens were grouped according to the fixation method: Inion resorbable plate, KLS resorbable plate, standard four-hole titanium miniplate (Medartis), two standard four-hole titanium miniplates (Medartis) and an adjustable titanium miniplate (Slider/Medartis). Mechanical evaluation was performed by applying compression loads to first molar using an Instron universal testing machine up to a 5mm displacement of the segments. Resistance forces were obtained in Newtons (N), and statistical analysis was performed using the software R v. 3.5 with significance level of 0.05. Linear mixed models were used to compare the force required to move each type of plate. The results showed that the resistance of SSO was better accomplished using two titanium miniplates and KLS resorbable plate showed the least resistance. However, both titanium and resorbable plates behaved similarly in small displacements, which are most commonly observed in BSSO postoperative time. It can be concluded that both resorbable and non-resorbable systems might offer suitable mechanical resistance in the procedures where there are no mechanical postoperative complications.

Mechanical Complications in Adult Spine Deformity Surgery: Retrospective Evaluation of Incidence, Clinical Impact and Risk Factors in a Single-Center Large Series.

The advancement of deformity-specific implants and surgical techniques has improved the surgical treatment of Adult Spine Deformity (ASD), allowing surgeons to treat more complex deformities. Simultaneously, high rates of medical and surgical complications have been reported. The aim of this study is to describe the risk factors, the rate and the clinical impact of mechanical complications in ASD surgery. A retrospective review of a large, single-center database of consecutive ASD patients was conducted. Inclusion criteria were as follows: Cobb coronal curve > 20° or alteration of at least one of sagittal vertical axis (SVA > 40 mm), thoracic kyphosis (TK > 60°), pelvic tilt (PT > 20°) and pelvic incidence minus lumbar lordosis mismatch (PI-LL > 10°), at least four levels of posterior instrumented fusion and 2-year follow-up. At the baseline and at each follow-up end point, the authors collected clinical and radiographic outcomes and recorded any mechanical complications that occurred. One hundred and two patients were enrolled. Clinical outcomes significantly were improved at the last follow-up (mean 40.9 months). Postoperative mechanical complications occurred in 15 patients (14.7%); proximal junctional disease was the most common complication (60%) and the revision rate was 53.3%. Patients who experienced mechanical complications were older (61.2 vs. 54.8 years, p = 0.04); they had also a higher rate of pelvic fusion and posterior-only approach, a lower LL (−37.9 vs. −46.2, p = 0.02) and a higher PT (26.3 vs. 19.8, p = 0.009), TK (41.8 vs. 35.7, p = 0.05), PI–LL (12.9 vs. 5.4, p = 0.03) and Global Alignment and Proportion score (6.9 vs. 4.3, p = 0.01). This study showed a significant improvement in pain and disability after ASD surgery. Regarding the risk of developing a mechanical complication, not only postoperative radiographic parameters affected the risk but also patient age and surgical features.