Posterior Spinal Fusion Surgery Research Articles

Trend of unplanned reoperation rates after lumbar degenerative surgery from 2011 to 2019: a large patient population study.

Unplanned reoperation is commonly performed due to postoperative complications. Previous studies have reported the incidence of unplanned reoperation following lumbar spinal surgery. But few study focused on the trend of reoperation rates, and the reasons of unplanned reoperation were not clear. In this study, we conducted a retrospective study to determine the trend of unplanned reoperation rates after degenerative lumbar spinal surgery from 2011 to 2019, and the reasons and risk factors of unplanned reoperation were also determined. Data of patients who were diagnosed with degenerative lumbar spinal disease and underwent posterior lumbar spinal fusion surgery in our institution from January 2011 to December 2019 were reviewed. Those who received unplanned reoperation during the primary admission were identified. The demographics, diagnosis, surgical segments and postoperative complications of these patients were recorded. The rates of unplanned reoperation from 2011 to 2019 were calculated, and the reasons of unplanned reoperation were statistically analysed. A total of 5289 patients were reviewed. Of them, 1.91% (n = 101) received unplanned reoperation during the primary admission. The unplanned reoperation rates of degenerative lumbar spinal surgery firstly increased from 2011 to 2014, with a peak rate in 2014 (2.53%). Then, the rates decreased from 2014 to 2019, with the lowest one in 2019 (1.46%). Patients with lumbar spinal stenosis have a higher rate of unplanned reoperation (2.67%) compared with those diagnosed as lumbar disc herniation (1.50%) and lumbar spondylolisthesis (2.04%) (P < 0.05). The main reasons for unplanned reoperation were wound infection (42.57%), followed by wound hematoma (23.76%). Patients who underwent 2-segment spinal surgery had a higher unplanned reoperation rate (3.79%) than those receiving other segments surgery (P < 0.001). And different spine surgeons had different reoperation rates. The rates of unplanned reoperation after lumbar degenerative surgery increased at first and then decreased during past 9 years. Wound infection was the major reason for unplanned reoperation. 2-segment surgery and surgeon's surgical skills were related to the reoperation rate.

Determination of the relationship between radiographic parameters and patient-reported outcomes in Lenke type-1 adolescent idiopathic scoliosis

Purpose: This study aims to examine sagittal alignment and spinopelvic parameters in patients with surgically treated Lenke type-1 AIS and to determine the relationship between radiographic outcomes and body image, self-esteem, disability and anxiety.&#x0D; Materials and methods: Twenty-five patients who underwent posterior spinal fusion surgery and followed up for more than 1 years were eveluated (mean age 14.20±1.63 years) retrospectively. Radiographic analysis of A/P and lateral full spine standing radiographs was carried out with the Surgimap software. The patient-reported outcomes were evaluated with Walter Reed Visual Assessment Scale, Rosenberg Self-Esteem Scale, Oswestry Disability Index and Beck Anxiety Inventory. Correlations between deformity measures and patient-reported outcomes were evaluated by the Pearson’s correlation test. &#x0D; Results: There was a significant decrease in Cobb angle, AVT, trunk shift, T1 tilt and pelvic incidence at early postoperative and final follow up compared with the preoperative measurement (p0.05). &#x0D; Conclusion: Patient-reported outcomes are important in terms of evaluating the physical and psychosocial effects of scoliosis-related deformity from the patient's perspective. However, low or no correlation was found between radiographic evaluation and patient-reported outcomes. This result indicates that objective and patient-reported results should be interpreted separately.

Intraoperative Blood Loss at Different Surgical-Procedure Stages during Posterior Spinal Fusion for Idiopathic Scoliosis.

Background and Objectives: Several predictive factors have been reportedly associated with intraoperative total blood loss (TBL) during posterior spinal fusion (PSF) for idiopathic scoliosis (IS). To reduce TBL, preoperative factors and interoperative factors are considered important. However, there are few reports that have evaluated bleeding patterns according to surgical stages. This study aimed to elucidate bleeding patterns at different surgical stages and determine the predictive factors for TBL during PSF surgery in patients with IS. Materials and Methods: Preoperative data, radiographic parameters, and intraoperative data of patients undergoing PSF for IS were retrospectively collected. We divided the patients into six stages: stage 1, exposure; stage 2, implant placement; stage 3, release; stage 4, correction; stage 5, bone grafting; and stage 6, closure; then we reviewed the blood loss and bleeding speed. Multiple-regression analysis was performed to generate a predictive formula for blood loss using preoperative and intraoperative factors, including blood loss at stage 1, as explanatory variables. Results: Forty-five patients (mean age: 17.6 years) were included. The mean operative time and TBL were 287.9 min and 756.5 mL, respectively. Blood loss was the highest at stage 3, followed by stage 4. Bleeding speed was the highest at stage 4, followed by stage 3. Bleeding speeds at stages 3 and 4 were significantly higher than those at stages 1 and 2. Preoperative Cobb angle, activated partial thromboplastin time (aPTT), number of fused vertebrae, and blood loss at stage 1 were significant contributing factors. Conclusions: Blood loss and bleeding speed during the release and correction stages were high. Specifically, bleeding speed significantly increased during and after the release procedure. The preoperative Cobb angle, aPTT, number of fixed vertebrae, and blood-loss volume during PSF were significantly associated with TBL. Our findings would be helpful for reducing TBL in patients undergoing PSF for IS.

Development and design of a mobile application for prescription opioid clinical decision-making: a feasibility study in New York City, USA

ObjectivesExcessive opioid prescribing is a contributing factor to the opioid epidemic in the USA. We aimed to develop, implement and evaluate the usability of a clinical decision-making mobile application (app)...

Incidence of radiographic pulmonary abnormalities after posterior spinal fusion surgery for pediatric scoliosis.

Pulmonary complications are the most common non-neurologic complications following surgical correction of scoliosis. These can affect postoperative recovery by increasing the length of stay and/or the need for ventilatory support. The aim of this retrospective study is to determine the incidence of radiographic abnormalities reported in chest radiography after posterior spinal fusion surgery for the treatment of scoliosis in children. A retrospective chart review of all patients who underwent posterior spinal fusion surgery in our center between January 2016 and December 2019 was attempted. Radiographic data including chest and spine radiographs were reviewed on the national integrated medical imaging system using medical record numbers for all patients in the 7 postoperative days. Seventy-six (45.5%) of the 167 patients developed radiographic abnormalities in the postoperative period. There was evidence of atelectasis in 50 (29.9%) patients, pleural effusion in 50 (29.9%) patients, pulmonary consolidation in 8 (4.8%) patients, pneumothorax in 6 (3.6%) patients, subcutaneous emphysema in 5 (3%) patients, and rib fracture in 1 (0.6%) patient. Four (2.4%) patients were noted to have an intercostal tube inserted postoperatively, three for treating pneumothorax, and one for pleural effusion. A large number of radiographic pulmonary abnormalities were encountered in children following surgical treatment of pediatric scoliosis. Although not all radiographic findings may be clinically significant, early recognition may guide clinical management. The incidence of air leak (pneumothorax, subcutaneous emphysema) was significant and could influence local protocol formulation with regards to obtaining immediate postoperative chest radiograph and intervention if clinically necessary.

Validation of the Critical-Care Pain Observation Tool (CPOT) in pediatric patients undergoing orthopedic surgery

ABSTRACT Background Postoperative pain cannot be measured accurately among many children with intellectual and developmental disabilities, resulting in underrecognition or delay in recognition of pain. The Critical-Care Pain Observation Tool (CPOT) is a pain assessment tool that has been widely validated in critically ill and postoperative adults. Aims The objective of this study was to validate the CPOT for use with pediatric patients able to self-report and undergoing posterior spinal fusion surgery. Methods Twenty-four patients (10–18 years old) scheduled to undergo surgery were consented to this repeated-measure, within-subject study. To examine discriminative and criterion validation, CPOT scores and patients’ self-reports of pain intensity were collected prospectively by a bedside rater before, during, and after a nonnociceptive and nociceptive procedure on the day following surgery. Patients’ behavioral reactions were video recorded at the bedside and retrospectively viewed by two independent video raters to examine interrater and intrarater reliability of CPOT scores. Results Discriminative validation was supported with higher CPOT scores during the nociceptive procedure than during the nonnociceptive procedure. Criterion validation was supported with a moderate positive correlation between the CPOT scores and the patients’ self-reported pain intensity during the nociceptive procedure. A CPOT cutoff score of ≥2 was associated with the maximum sensitivity (61.3%) and specificity (94.1%). Reliability analyses revealed poor to moderate agreement between bedside and video raters and moderate to excellent consistency within video raters. Conclusions These findings suggest that the CPOT may be a valid tool to detect pain in pediatric patients in the acute postoperative inpatient care unit after posterior spinal fusion.

Introduction of an enhanced recovery program for young adults undergoing posterior spinal fusion surgery for idiopathic scoliosis: a single-centre pilot study evaluating short term outcomes

Background: The large surgical incision and extensive tissue trauma in posterior spinal fusion for adolescent idiopathic scoliosis causes severe acute postoperative pain. Furthermore, posterior spinal fusion is associated with a risk of persistent postsurgical pain. Six months after posterior spinal fusion, the incidence of persistent postsurgical pain is as high as 22% of the patients. Optimizing pain management therefore remains crucial, but challenging. Objective: The study objective is to design and implement an enhanced recovery pathway for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion integrating all aspects of biopsychosocial care. Its outcomes are assessed, including its effect on postoperative pain and early mobilization. Design and settings: A prospective cohort study was performed at the Antwerp University Hospital. Methods: In December 2019, a prospective cohort study was set up in which an enhanced recovery pathway substitutes more than the patient controlled intravenous analgesia containing morphine postoperatively. This pathway consists of m/eHealth based psychological screening questionnaires, patient education, early mobilization, and a multimodal analgesia protocol consisting of preemptive gabapentin, an intraoperatively given single dose of methadone (0.2 mg kg-1), non-steroidal anti-inflammatory drugs, and acetaminophen. Results: We treated 25 adolescents (10 males and 15 females) with the developed enhanced recovery pathway with a mean age of 16.5 years (range 12-22). The mean number of spinal levels fused was 10 (range 6-13). Mean numerical rating scale scores were 4.17 at postoperative day 1, 4.46 at postoperative day 2, and 3.74 at postoperative day 3 in enhanced recovery pathway treated patients. Mean bladder catheterization duration was 3.04 days and enhanced recovery pathway patients stayed in the hospital for an average of 7.4 days. Conclusions: Using an enhanced recovery pathway for patients undergoing posterior spinal fusion could not only reduce the acute and chronic opioid consumption and its side effects, but could also result in less postoperative pain, shorter hospital stay and higher patient satisfaction. Further reevaluation and improvement focused on these variables will likely further improve the effectiveness of enhanced recovery pathways. Trial registration: ClinicalTrials.gov NCT04038229.

Anterior lumbar spinal fusion surgery associated with lower risk of stroke, pneumonia, and infection compared to posterior lumbar spinal fusion surgery

BackgroundPrior studies, comparing anterior and posterior approaches to lumbar fusion surgery, found similar fusion rates and clinical outcomes, but are limited by sample size. Further evaluation of the postoperative complications of each approach is necessary. MethodsThe MSpine database by PearlDiver was queried using ICD-9, ICD-10, and CPT codes to identify patients who had undergone single-level anterior or posterior lumbar interbody fusion surgery. Readmission rates, ileus, lower extremity DVT, infection, pneumonia, and stroke were used to compare post-operative complications of an anterior vs. posterior approach. Results112,023 patients were included in this study, with 38,529 (34.4%) in the anterior group (ALIF/LLIF) and 73,494 (65.6%) in the posterior group (PLIF/TLIF). At both 30 and 90-days postoperative, patients undergoing an anterior approach to lumbar interbody fusion had a higher odds ratio of lower extremity DVT (30-day OR: 1.19, 90-day OR: 1.16; P<0.05) and ileus complication (30-day OR: 1.87, P= <.05; 90-day OR: 1.81, P<.05). At both 30 and 90-days postoperative, patients undergoing a posterior approach had a higher odds ratio of stroke (30-day: OR: 0.79, 90-day OR: 0.87; P<0.05), transfusion (30-day OR: 0.66, 90-day OR: 0.69; P<.05), infection (30-day OR: 0.88, 90-day OR: 0.91; P <.05), and pneumonia (30-day OR: 0.85, 90-day OR: 0.90; P<.05). There was no statistically significant difference in myocardial infarction or pulmonary embolism between both approaches at 30 and 90-days postoperative. ConclusionsAnterior and posterior approaches for lumbar interbody fusion were associated with differences in postoperative complications at 30 and 90-days. The complication profiles associated with each approach can inform surgeon treatment decisions based on patient profiles.

The Extension of Surgery Predicts Acute Postoperative Pain, While Persistent Postoperative Pain Is Related to the Spinal Pathology in Adolescents Undergoing Posterior Spinal Fusion.

Persistent pain after posterior spinal fusion affects 12 to 42% of patients with adolescent idiopathic scoliosis. The incidence of persistent pain among surgically treated children with Scheuermann kyphosis and spondylolisthesis is not known. The aim of our study was to determine the predictors and incidence of acute and chronic postoperative pain in adolescents undergoing posterior spinal fusion surgery. The study was a retrospective analysis of a prospectively collected pediatric spine register data. The study included 213 consecutive patients (158 AIS, 19 Scheuermann kyphosis, and 36 spondylolisthesis), aged 10-21 years undergoing posterior spinal fusion at a university hospital between March 2010 and March 2020. The mean (SD) daily postoperative opioid consumption per kilogram was significantly lower in the spondylolisthesis patients 0.36 mg/kg/day (0.17) compared to adolescent idiopathic scoliosis 0.51 mg/kg/day (0.25), and Scheuermann kyphosis 0.52 mg/kg/day (0.25) patients after surgery (p = 0.0004). Number of levels fused correlated with the daily opioid consumption (rs = 0.20, p = 0.0082). The SRS-24 pain domain scores showed a statistically significant improvement from preoperative levels to two-year follow-up in all three groups (p ≤ 0.03 for all comparisons). The spondylolisthesis patients had the lowest SRS pain domain scores (mean 4.04, SD 0.94), reporting more pain two years after surgery, in comparison to AIS (mean 4.31, SD 0.60) (p = 0.043) and SK (mean 4.43, SD 0.48) patients (p = 0.049). Persistent postoperative pain in adolescents undergoing posterior spinal fusion is related to disease pathology while higher acute postoperative pain is associated with a more extensive surgery. Spondylolisthesis patients report more chronic pain after surgery compared to AIS and SK patients.

Lower Hounsfield Units and Severe Multifidus Sarcopenia Are Independent Predictors of Increased Risk for Proximal Junctional Kyphosis and Failure Following Thoracolumbar Fusion.

Retrospective cohort study. The purpose of the present study was to assess the impact of sarcopenia on the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following thoracolumbar spine fusion surgery using opportunistic evaluation of paraspinal fatty degeneration on preoperative magnetic resonance imaging. While paraspinal sarcopenia has been shown to have detrimental consequences following posterior cervicothoracic fusions, the impact of paraspinal sarcopenia on PJK and PJF following thoracolumbar spine fusion surgery remains unknown. We performed a retrospective review of patients who underwent posterior spine fusion surgery that extended caudally to the pelvis and terminated cranially between T10 and L2 between 2010 and 2017. The cohort was divided into three groups: (1) patients without PJK or PJF, (2) patients with PJK but no PJF, and (3) patients with PJF. Univariate and multivariate analyses were performed to determine risk factors for the development of proximal junctional complications. We identified 150 patients for inclusion in this study. Mean Hounsfield Units at the upper instrumented vertebra (UIV) was 148.3±34.5 in the cohort of patients without PJK or PJF, which was substantially higher than values recorded in the PJK (117.8±41.9) and PJF (118.8±41.8) subgroups (P<0.001). Severe multifidus sarcopenia was identified at a much higher rate in the subgroups of patients who developed PJK (76.0%) and PJF (78.9%) than in the subgroup of patients who developed neither PJK nor PJF (34.0%; P<0.001). Multivariate analysis demonstrated both low HU at the UIV and moderate-severe multifidus sarcopenia to be risk factors for the development of PJK and PJF. The results of this study suggest severe paraspinal sarcopenia and diminished bone density at the UIV impart an increased risk of developing PJK and PJF, while markers of systemic frailty such as modified Frailty Index and Charlson Comorbidity Index are not associated with an increased risk of these complications. III.

Application of Topical Tranexamic Acid Reduces Postoperative Blood Loss after Posterior Spinal Fusion with Instrumentation in Patients with Adolescent Idiopathic Scoliosis

Purpose: There is limited literature regarding the topical use of tranexamic acid (TXA) to control postoperative bleeding during spinal deformity correction and fusion procedures, which often require blood transfusions. This study aimed to evaluate the effect of topical TXA on postoperative blood loss in patients undergoing deformity correction and posterior spinal fusion (PSF) surgeries. Methods: A retrospective study was conducted between January 2011 and April 2017 in 51 patients with adolescent idiopathic scoliosis who underwent long-segment PSF with hybrid thoracic-hook pedicle screw instrumentation or pedicle-screw-alone constructs. Twenty-five patients were assigned to receive topical TXA (1 g/20 mL), and the drain was clamped for 2 h. Twenty-six patients in the control group were treated with antifibrinolytic agents. Results: Median drainage blood loss, median day of drain removal, and median postoperative hospitalization were significantly lower in the topical TXA group (all p &lt;0.05). The postoperative packed red cell transfusion rate was significantly lower in the topical TXA group than that in the control group (15 of 25, 60% vs. 23 of 26, 88.5%; p=0.02; risk ratio, 0.68; 95% confidence interval, 0.48–0.96). Conclusions: The use of topically administered 1 g TXA in AIS patients undergoing instrumented PSF effectively reduced postoperative transfusion requirements, decreased the total amount of drainage blood loss, reduced the time till drain removal, and shortened the length of postoperative hospitalization.

The outcome of enhanced recovery after surgery vs. a traditional pathway in adolescent idiopathic scoliosis surgery: A retrospective comparative study.

ObjectivesThe optimized enhanced recovery after surgery (ERAS) pathway for adolescent idiopathic scoliosis (AIS) patients has not been comprehensively described. The purpose of the study was to explore the feasibility and efficacy of an integral process of ERAS protocol in posterior spinal fusion (PSF) surgery for AIS patients without three-column osteotomy.MethodsBased on the inclusion and exclusion criteria, a total of 90 AIS patients who underwent PSF were enrolled in the study. Forty-five patients followed a traditional pathway (TP) perioperative care and 45 were treated with an ERAS protocol designed and implemented by a multidisciplinary team. Patient demographic, clinical information, surgical data, and radiographic parameters were collected and analyzed retrospectively.ResultsThere is no significant difference in age, gender, body mass index, preoperative hemoglobin level, Cobb angle, curve type, average correction rate, fusion segments, and screw number between ERAS group and TP group. Regarding the estimated blood loss (EBL), surgical duration, pain intensity, drainage duration, drainage volume, first ambulation time, postoperative length of stay (LOS), and the incidence of blood transfusion, they were significantly less in ERAS group than those of TP group.ConclusionsBased on our findings, we found that the implementation of a standard ERAS protocol in AIS correction surgery could result in less EBL, lower pain intensity, early ambulation, shorter LOS, and rapid rehabilitation. We recommend the widespread adoption of ERAS protocols in AIS surgery.

Utility of the Modified 5-Items Frailty Index to Predict Complications and Mortality After Elective Cervical, Thoracic and Lumbar Posterior Spine Fusion Surgery: Multicentric Analysis From ACS-NSQIP Database.

Retrospective review of multicentric data. The modified 5-item frailty index is a relatively new tool to assess the post-operative complication risks. It has been recently shown a good predictive value after posterior lumbar fusion. We aimed to compare the predictive value of the modified 5-item frailty index in cervical, thoracic and lumbar surgery. The American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Database 2015-2020 was used to identify patients who underwent elective posterior cervical, thoracic, or lumbar fusion surgeries for degenerative conditions. The mFI-5 score was calculated based on the presence of 5 co-morbidities: congestive heart failure within 30days prior to surgery, insulin-dependent or noninsulin-dependent diabetes mellitus, chronic obstructive pulmonary disease or pneumonia, partially dependent or totally dependent functional health status at time of surgery, and hypertension requiring medication. Multivariate analysis was used to assess the independent impact of increasing mFI-5 score on the postoperative morbidity while controlling for baseline clinical characteristics. 53252 patients were included with the mean age of 64.2 ± 7.2. 7946 suffered medical complications (14.9%), 1565 had surgical complications (2.9%), and 3385 were readmitted (6.3%), 363 died (.68%) within 30days postoperative (6.3%). The mFI-5 items score was significantly associated with higher rates of complications, readmission, and mortality in cervical, thoracic, and lumbar posterior fusion surgery. The modified 5-item frailty score is a reliable tool to predict complications, readmission, and mortality in patients planned for elective posterior spinal fusion surgery.

The effect of intraoperative lidocaine administration in a disrupted erector spinae fascial plane on intercostal transcranial motor evoked potentials

Study objectiveErector spinae plane (ESP) blocks have been recently described for postoperative pain management following spine surgery but their effects on intraoperative neuromonitoring are unknown. DesignRetrospective cohort study. SettingPediatric patients at a tertiary care center. Patients26 pediatric patients who received bilateral surgically-placed ESP catheters for single-stage posterior spine fusion (PSF) from August 2020 to June 2021. InterventionsPatients in this study did not receive any special interventions as part of this observational retrospective study. MeasurementsThis retrospective study investigated the effects of local anesthesia administration through bilateral surgically-placed ESP catheters on intraoperative intercostal transcranial motor evoked potentials (tcMEPs) in the setting of a disrupted erector spinae fascial plane in pediatric patients undergoing single-stage posterior spine fusion. Main resultsOf the 26 patients that received bilateral surgically-placed ESP catheters for pediatric posterior spine fusion surgery, none exhibited any changes in intercostal tcMEPs attributable to intraoperative lidocaine administration through the ESP catheters. ConclusionsThe administration of a local anesthetic into a disrupted erector spinae fascial plane does not appear to interfere with intraoperative neuromonitoring of posterior spine fusion surgeries.

The impact of stratified hypoalbuminemia and dialysis on morbidity/mortality after posterior spinal fusion surgery: An ACS-NSQIP study.

Background: Preoperative optimization in patients undergoing posterior spinal fusion is essential to limit the number and severity of postoperative complications. Here, we, additionally, evaluated the impact of hypoalbuminemia on morbidity and mortality after posterior spinal fusion surgery.Methods: This retrospective analysis was performed using data from a prospective multicentric database (ACSNSQIP:2015–2020) regarding patients undergoing posterior spinal fusions. Factors studied included; baseline demographics and 30-day postoperative complications (i.e., reoperations, readmissions, and mortality rates).Results: There were 6805 patients who met the inclusion criteria. They averaged 62 years of age and had an average BMI of 30.2. Within the 30-day postoperative period, 634 (9.3%) sustained complications; 467 (6.9%) were readmitted, 263 (3.9%) required reoperations, and 37 (0.5%) expired. Although multiple preoperative risk factors were analyzed, hypoalbuminemia, severe hypoalbuminemia, and dialysis were the strongest independent risk factors associated with complications (i.e., reoperations, readmissions, and mortality).Conclusion: Hypoalbuminemia, severe hypoalbuminemia, and dialysis were significant predictors for morbidity and mortality after posterior spinal fusion surgery.

The Influence of High Blood Pressure on Developing Symptomatic Lumbar Epidural Hematoma after Posterior Lumbar Spinal Fusion Surgery: Clinical Data Warehouse Analysis.

Background: Determining the risk factors for symptomatic lumbar epidural hematoma (SLEH) is important for preventing postoperative SLEH. However, the relationship between blood pressure and SLEH is still debatable. The purpose of our study was to determine the risk factors for postoperative SLEH, to assess the influence of high blood pressure on developing SLEH after posterior lumbar spinal fusion surgery, and to evaluate the usefulness of big data analysis utilizing a clinical data warehouse (CDW). Methods: The clinical data of patients who had undergone posterior lumbar spinal fusion surgery were acquired from the CDW of Hallym University Medical Center. The acquired clinical data were compared between patients without postoperative SLEH and with postoperative SLEH. Results: Postoperative SLEH that required hematoma evacuation surgery within 72 h after posterior lumbar spinal fusion surgery occurred in 17 (1.3%) of 1313 patients. According to the multivariate logistic regression analysis, the risk factors for postoperative SLEH are platelet count difference (OR 1.28, p = 0.03), postoperative international normalized ratio (INR) difference (OR 31.4, p = 0.028), and postoperative systolic blood pressure (SBP) difference (≥10 mmHg) (OR 1.68, p = 0.048). An increase in postoperative SBP (OR 1.68, p = 0.048) had a statistically significant influence on the occurrence of postoperative SLEH. Conclusions: Big data analysis utilizing a CDW could be useful for extending our knowledge of the risk factors for postoperative SLEH and preventing postoperative SLEH after posterior lumbar spinal fusion surgery.

Efficacy of Halo-Gravity Traction in the Perioperative Treatment of Severe Scoliosis and Kyphosis: A Comparison of Adolescent and Adult Patients

The objective of the study was to compare the efficacy of halo-gravity traction (HGT) with subsequent surgical treatment in adolescent and adult patients with severe scoliosis by evaluating the radiographic outcomes and clinical complications. We performed a retrospective analysis of 51 patients with severe scoliosis who underwent a posterior spinal instrumented fusion with HGT during the perioperative period between March 2010 and June 2017. The patients were divided into 2 groups: adults (age >18years) and adolescents (age 10-18years). All patients were followed with full posteroanterior and lateral spine radiographs, bending films, neurological complications, and lung function tests for a minimum of 2years. Deformity correction, pulmonary function testing, and clinical complications were compared between the 2 groups. We identified 29 adults (8 males and 21 females, mean age= 23.7±8.7years) and 22 adolescents (10 males and 12 females, mean age= 13.0±4.5years). In the adult group, the mean Cobb angle of the main curve before HGT was 141.7±18.2°, which improved to 126.4±8.6° and 67.5±10.2° after traction and operation, respectively. The kyphotic angle was corrected from 137.1±15.6° before traction to 122.5±11.3° after traction to 67.6±13.8° after operation. The mean functional vital capacity% and forced expiratory volume in one second% were 43.1% and 37.5%, which improved to 46.7% and 41.7% after traction, respectively. In the adolescent group, the mean correction of the main curve improved from 139.3±12.6° before traction to 112.1±8.3° after traction to 59±13.1° after surgical intervention. The kyphotic angle was corrected from 130.7±9.4° before traction to 101.5±12.2° after traction and then to 48.2±10.1° after surgical intervention. Overall, patients in both groups showed significant improvement in their main scoliosis and kyphosis (P < 0.05), while the correction rate of the main curve and kyphosis was significantly higher in the adolescent group than that in the adult group (P < 0.05). The functional vital capacity% increased from 44.8% to 55.0% and the forced expiratory volume in one second% increased from 44.0% to 51.0% after using HGT. In terms of surgical outcomes, the incidence of postoperative neurological complications was 27.6% and 18.2% in the 2 groups, respectively. HGT is an effective and safe method to correct spinal deformities and improve lung function, especially in adolescent patients with severe scoliosis. In addition, it can potentially reduce the risk of neurological complications and the level of osteotomy in posterior spinal instrumented fusion surgery.

Drug eruptions in posterior spinal fusion for adolescent idiopathic scoliosis

ObjectiveAn important issue in adolescent idiopathic scoliosis (AIS) correction surgery is postoperative pain management due to the procedure’s relatively high invasiveness. Although celecoxib is widely used as an analgesic for post-surgical pain, there have been several reports of drug eruptions. Such side effects may similarly occur in AIS patients following posterior spinal fusion (PSF). However, no studies have specifically addressed perioperative rash from analgesics in scoliosis surgery. We investigated the incidence of drug eruptions in PSF for AIS and their patient-related risk factors. MethodsWe retrospectively reviewed the medical records of 134 consecutive patients who underwent PSF for AIS. Sixty-six patients had received celecoxib and 68 had taken NSAIDs, acetaminophen, or other painkillers after surgery. We investigated the incidence of drug eruptions between patients who took celecoxib (celecoxib group) or other painkillers (others group) and searched for factors associated with rash after surgery by means of a logistic regression model. ResultsThe overall incidence of drug eruptions after PSF for AIS was 11.9%. The incidence of eruptions in the celecoxib group (18.2%) was significantly higher than in the others group (5.9%) (p = 0.034). The patient-related factors of celecoxib intake and allergic history had significant associations with drug eruptions in multivariate analysis, with odds ratios of 3.88 and 3.53, respectively. ConclusionIn PSF surgery for AIS, patients who receive celecoxib and/or have a history of allergies are significantly more likely to exhibit a rash and should be observed closely for drug eruptions.

Predictors of postoperative systemic inflammatory response syndrome after scoliosis surgery in adolescents with cerebral palsy: A retrospective analysis

BackgroundSystemic inflammatory response syndrome (SIRS) is known to complicate postsurgical intensive care patients. We noticed that roughly half children with cerebral palsy who undergo posterior spinal fusion (PSF) for neuromuscular scoliosis developed SIRS in the intensive care unit. There is a paucity of literature detailing the impact of intraoperative causes of postoperative SIRS and downstream consequences in these patients. Study purpose was to understand the factors associated with SIRS in children who undergo PSF for neuromuscular scoliosis. MethodsThis retrospective, case control study included children who underwent PSF for neuromuscular scoliosis. Patients with idiopathic scoliosis, osteogenesis imperfecta, and tracheotomy were excluded. Subjects were divided into two study groups based on the diagnosis of SIRS in the intensive care unit. Descriptive statistical analysis was used to identify factors associated with SIRS; a regression analysis was used to further evaluate the independent and significant influence of these factors. ResultsThere was no significant difference in the demographic and other preoperative variables. However, total blood products (ml/kg) administered was significantly higher among the SIRS group compared with the non-SIRS group (54.4±41.0 vs 34.1±21.5 P <0.034). Percent of patients remaining intubated was greater in the SIRS group compared with the non-SIRS group (44.1% vs 7.0%, P < 0.001). The regression model revealed that the odds to develop SIRS in patients who were not extubated were 7.467-fold higher (CI: 1.534-36.347) compared with those who were extubated (p=0.013). ConclusionsThe incidence of SIRS is significantly higher among the patients who were not extubated at the end of PSF surgery. Further prospective studies are needed to look at the factors that impede the ability to extubate these patients at the end of surgery.

Statistical changes of lung morphology in patients with adolescent idiopathic scoliosis after spinal fusion surgery-a prospective nonrandomized study based on low-dose biplanar X-ray imaging.

Adolescent idiopathic scoliosis (AIS) patients suffer from restrictive impairment of pulmonary function (PF) as a consequence of spinal and ribcage deformity. Statistic modelling of scoliotic geometry has been well-established based on low-dose biplanar X-ray device (EOS) imaging. However, the postoperative lung morphology change derived from EOS has not yet been studied adequately till now. Twenty-five female AIS patients with severe right-sided major thoracic curve (aged 13-31 years; Cobb angle 45°-92°) underwent posterior spinal fusion (PSF) were prospectively recruited for standing EOS imaging at preoperative, postoperative, and 1-year follow-up (1Y-FU) stages. EOS-based lung morphology at frontal and lateral view was measured respectively to assess serial statistical changes in area and height. At frontal view, left lung area significantly increased postoperatively (104.7 vs. 125.1 cm2; P<0.001) but without continuous increase at 1Y-FU (125.1 vs. 124.5 cm2; P=0.084), whereas right lung area showed a slight but insignificant interval increase (median: 143.8, 146.5, 148.4 cm2 at preoperative, postoperative, 1Y-FU stage, respectively; all P>0.05). At lateral view, the increase in left lung area was slight without statistically difference (median: 175.8, 178.4, 182.5 cm2 at preoperative, postoperative, 1Y-FU stage, respectively; all P>0.05), while right lung area did not significantly change postoperatively (median: 209.9, 206.7, 212.4 cm2 at preoperative, postoperative, 1Y-FU stage, respectively; all P>0.05). At both frontal and lateral view, left lung height significantly improved at both postoperative and 1Y-FU stage (all P<0.05), while preoperative right lung height was not significantly different from postoperative and 1Y-FU value (all P>0.05). EOS imaging demonstrates that left lung area in severe AIS may improve after PSF surgery. EOS may provide useful information about lung morphology change after PSF in severe AIS.