Radiographic Parameters Research Articles

What Radiographic and Spinopelvic Parameters do Spine Surgeons Consider in Decision-Making for Treatment of Degenerative Lumbar Spondylolisthesis?

Cross-sectional survey. Surgical treatment of degenerative lumbar spondylolisthesis is remarkably varied due to heterogeneity of clinical-radiological presentations. This study aimed to assess which spinopelvic radiological parameters were considered for decision-making. Survey distributed to International AO Spine members to analyze surgeons' considerations for treatment. Data collected includes demographics, training background, years of experience, and treatment decisions based on various radiographical findings, including segmental and global spinopelvic parameters. From 479 responses, the most frequently radiological parameter considered was slippage on dynamic X-rays (79.1%), followed by disc height (78.9%), global sagittal balance SVA (71.4%), and PI-LL mismatch (69.7%), while the least important was absolute spondylolisthesis on static lateral radiograph (22.8%). Fellowship-trained surgeons were likelier to use SVA (OR = 1.73, 95% CI = 1.02-2.99, P = 0.049), and disc height (2.13, 1.14-3.98, P < 0.05). There was no difference between orthopedics and neurosurgery in applying SVA and PI-LL mismatch. Surgeons from Asia Pacific emphasizes segmental lordosis (2.39, 1.11-5.15, P = 0.026) as from Latin America (2.55, 1.09-5.95, P = 0.030) and Middle East (4.33, 1.66-11.28, P = 0.003). However, surgeons from Latin America and Middle East also significant consider disc height (2.95, 1.07-8.15, P = 0.037) and (3.03, 1.04-8.83, P = 0.043), respectively. Additionally, the surgeons' age was associated with using angular motion on flexion-extension radiographs, and volume of treated cases yearly with consideration for disc height. Treatment of degenerative lumbar spondylolisthesis was influenced by slippage on dynamic radiographs, disc height, global alignment, and PI-LL mismatch. Surgeons' age and Region, fellowship-trained, and volume of treated cases were significantly associated to apply these radiological parameters.

Comparative Analysis of Outcomes and Kyphotic Risk Factors After Cervical Laminoplasty in 2 Different Ossification of the Posterior Longitudinal Ligament Groups and Cervical Spondylotic Myelopathy.

Cervical laminoplasty is commonly used to treat cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL). Postoperative kyphotic changes can restrict spinal cord dorsal shift, leading to poor neurological outcomes. This study analyzes risk factors for loss of cervical lordosis (LCL) after laminoplasty in 3 groups: CSM, continuous OPLL, and other OPLL. It also evaluates postoperative changes in cervical spine parameters: C2-7 sagittal vertical axis, C2-7 Cobb angle (CA), T1 slope, and C2 slope. This retrospective study included 154 patients who underwent cervical laminoplasty from January 2018 to January 2023. Patients were categorized into 3 groups: CSM (Group 1), continuous OPLL group (Group 2), and noncontinuous OPLL group (Group 3). Preoperative and postoperative radiographic parameters were measured. Analysis of variance and Tukey HSD post hoc tests identified significant differences among the groups. Receiver operating characteristic analysis determined the cutoff value of K-line tilt. Kyphotic changes (>10°) were observed in 18.2% of patients postoperatively: 23.8% in Group 1, 1.7% in Group 2, and 28.3% in Group 3. Significant differences were found among the groups in preoperative K-line, C2-7 CA, extension C2-7 CA, and C2 slope (P < .05). Univariate and multivariate analyses revealed that greater age, higher K-line tilt, lower preoperative CA-extensor CA, and lower extensor muscle volume were significant risk factors of LCL in Groups 1 and 3. In Group 2, higher preoperative K-line tilt and K-line negative status were associated with greater LCL. Receiver operating characteristic analysis showed that K-line tilt is a strong predictive parameter with a threshold of 15.15°. The continuous OPLL group had a lower likelihood of postoperative kyphosis due to structural support. K-line tilt, dynamic extension reserve, and extensor muscle volume were significant predictors of LCL in CSM and segmental OPLL groups. K-line tilt is a valuable radiographic parameter for predicting outcomes and guiding surgical decisions in cervical laminoplasty patients.

Clinical Outcomes and Cytokine Profile of Standard and Short Implant-supported Prostheses in Diabetics Treated for Periodontal Disease: A 5-year Study.

The present cross-sectional study aimed to assess the clinico-radiographic parameters as well as salivary levels of receptor activator of nuclear factor kappa-Β ligand (RANKL), osteoprotegerin (OPG), interleukin (IL)-6, and tumor necrosis factor-alpha (TNF-α) around standard and short dental implants (SDIs)-supported fixed partial denture in partially dentate type-II diabetes mellitus (T2DM) patients treated for periodontitis. The study comprised 4 groups: group 1 included T2DM patients with standard implants (n = 20); group II included non-T2DM patients with standard implants (n = 20); group III included T2DM patients with SDIs (n = 20); and group IV included non-T2DM patients with SDIs (n = 20). Participants eligible for the study included medically diagnosed T2DM patients with glycated hemoglobin (HbA1c) levels ≥ 6.5%, and non-T2DM participants with HbA1c levels between 4.0% and 5.0%. All had undergone previous periodontal therapy and had at least one standard implant and one SDI in the posterior maxillary or mandibular region. Exclusions were subjects with systemic conditions other than T2DM, recent use of steroids or antimicrobials, pregnancy or lactation, edentulism, misaligned dentition, or alcohol/tobacco use. Treatment involved non-surgical periodontal therapy, implant placement, and prosthetic procedures, with assessments including clinical (plaque index [PI], bleeding on probing [BOP], probing depth [PD]), radiographic (crestal bone loss [CBL]) parameters, and salivary cytokine levels including RANKL, OPG, IL-6, and TNF-α. The study groups, each comprising 20 participants, showed no significant differences in demographics, restoration type, T2DM duration, family history, body mass index, or brushing routine (p>0.05). At baseline and 5-year follow-up, T2DM participants exhibited poorer periodontal parameters compared to non-T2DM, with higher PI (baseline: 62.2 ± 5.8% vs 29.6 ± 3.7%; 5-year follow-up: 69.2 ± 6.1% vs 32.8 ± 3.8%), BOP (baseline: 30.5 ± 3.2% vs 18.2 ± 2.6%; 5-year follow-up: 35.5 ± 3.9% vs 20.5 ± 2.5%), PD (baseline: 5.5 ± 1.1 mm vs 3.1 ± 0.9 mm; 5-year follow-up: 4.2 ± 0.8 mm vs 2.4 ± 0.7 mm), and CBL (baseline: 4.4 ± 0.4 mm vs 2.0 ± 0.2 mm; 5-yearfollow-up: 4.9 ± 0.5 mm vs 2.3 ± 0.3 mm), regardless of implant type. Salivary cytokine levels (RANKL, OPG, IL-6, TNF-α) were consistently higher in T2DM groups than non-T2DM across both implant types. Participants with SDIs showed comparable clinico-radiographic outcomes and salivary levels of cytokines to standard implants. The application of SDI-supported rehabilitation in T2DM and non-diabetics showed comparable clinico-radiographic outcomes and salivary levels of cytokines to standard dental implants. Furthermore, T2DM patients exhibit poorer periodontal health and elevated inflammatory markers in patients with standard implants and SDIs.

Parotid sialolithiasis - Long term follow-up analyzing surgical approaches.

Present follow-up data comparing transoral and transfacial parotid gland procedures for stone removal to offer insight addressing technical considerations and complications. Retrospective study of a consecutive series of surgical treatments for parotid sialolithiasis from 2013 to 2018 at an academic institution by one surgeon provided review of 16 transoral and 10 transfacial procedures supplemented by long-term follow-up through telephone or mail. Clinical and radiographic parameters, additional treatment, and persistence of symptoms were evaluated. Four of 10 patients treated with the transfacial approach had parotid-cutaneous fistulas addressed with transdermal scopolamine patches and pressure dressings (one also with intraductal steroid infusion) with closure at a median of 12.5 days. A fifth fistula failed to resolve at 23 days and was addressed with parotidectomy. All 8 patients who were contacted (median: 106 months) reported complete resolution of symptoms. None had facial weakness.Six of 16 patients treated by a transoral approach had persistent stone fragments at the conclusion of operation. Four of these 6 patients underwent subsequent procedures (two transoral, one transfacial, one parotidectomy). Among the 11 patients who responded to long-term follow-up (median: 107 months), one reported mild symptoms insufficient to request treatment. Larger stone size coupled with proximal location correlated with the conversion from transoral to include transfacial approach. Patients with retained stone remnants at the conclusion of transoral stone removal are more likely to require additional procedures that result in long-term favorable results. The transfacial approach to stone removal offers long-term favorable results following the common short-term complication of salivary fistula. OCEBM Level 4.

Modified Distalization Shoulder Angle and Lateralization Shoulder Angle show weakly correlation with clinical outcomes following reverse shoulder arthroplasty

IntroductionThe focus in reverse shoulder arthroplasty (RSA) has been on the lateralization and distalization of prosthesis positioning, influenced by implant design and surgical technique. There's no consensus on the optimal amount of lateralization and distalization or the best radiographic parameters for evaluating placement. This study examines the correlation and the predictive value between previously described modified distalization shoulder angle (DSA) and lateralization shoulder angle (LSA) with postoperative outcomes, which aim to differentiate the contributions of the humeral and glenoid components in the global distalization and lateralization of the RSA. The LSA was divided into the glenoid lateralization angle (GLA) and the humeral lateralization angle (HLA); the modified distalization shoulder angle (mDSA) was divided into the glenoid distalization angle (GDA) and the humeral distalization angle (HDA). Our hypothesis was that these new angles play a marginal role in predicting clinical outcomes. Materials and MethodsRetrospective analysis of 83 RSA patients from 2017-2021 at San Pietro Fatebenefratelli Hospital, Rome. Angles were measured using true anteroposterior radiographs. Clinical outcomes were assessed using the Constant-Murley Score (CS), a visual analogue scale (VAS) for pain, and range of motion (ROM). ResultsA weak correlation was found between the modified angles and clinical outcomes. Modified DSA (mDSA) correlated positively with internal rotation and negatively with VAS score. Glenoid distalization angle (GDA) correlated positively with abduction, forward flexion, and CS. Humeral distalization angle (HDA) correlated positively with internal rotation and negatively with VAS. Glenoid lateralization angle (GLA) and humeral lateralization angle (HLA) showed negative correlation with internal rotation and positive correlation with VAS. ConclusionModified DSA and LSA show marginal correlation with postoperative outcomes and have limited predictive value. Further research with larger, diverse populations is needed to refine these metrics and their clinical utility.

Modified scarf osteotomy has a possible capability to be indicated against very severe hallux valgus deformity

BackgroundGenerally, scarf osteotomy is recommended for moderate-severe hallux valgus (HV) deformity. Although severe HV deformity is defined to be more than 40 degree (°), this definition of angular setting includes broad range of HV angle (HVA). Actually, very severe HV deformity such as more than 60° of the HVA is often seen. At present, whether scarf osteotomy would truly contribute to maintaining the correction status against such very severe deformity is elusive. Then, in this study corrective effectiveness of modified scarf osteotomy including very severe deformity (HVA ≥ 60°) was evaluated.MethodsA retrospective, observational study of 93 feet [mean follow-up: 56.0 months after the surgery] was performed. Hallux scores of the Japanese Society for Surgery of the Foot (JSSF), a self-administered foot evaluation questionnaire (SAFE-Q), and pre-postoperative radiographic parameters were evaluated. The patients were categorized into three groups [44 feet: (mildly severe) 40° ≤ HVA < 50°, 30 feet: (moderately severe) 50° ≤ HVA < 60°, 19 feet: (very severe) HVA ≥ 60°].ResultsBoth JSSF hallux and SAFE-Q score showed significant improvement in all groups, except social activity score in SAFE-Q, in very severe cases (P = 0.08). HVA also significantly improved in all groups without significant change of the HVA between post 1-month and final follow-up in each groups. No difference was seen among the three groups in complications after surgery and frequency of recurrence of HV deformity.ConclusionModified scarf osteotomy has sufficient potential to be indicated for very severe (HVA ≥ 60°) deformity, but it might be recommended before the HVA reaches > 60° from the perspective of clinical score improvement.Level of evidenceLevel III.

Comparative study between unilateral biportal endoscopic discectomy and percutaneous interlaminar endoscopic discectomy for the treatment of L5/S1 disc herniation

To compare the clinical outcomes of unilateral biportal endoscopic discectomy (UBED) and percutaneous interlaminar endoscopic discectomy (PIED) for treating L5/S1 disc herniation. Patients with L5/S1 disc herniation treated with UBED (n=46) and PIED (n=50) in our hospital during the same period were retrospectively reviewed. Clinical outcome, radiographic parameters and complications of each group were collected and evaluated. The mean follow-up period was 14.11±3.47 months in UBED group, and 14.52±5.37 months in PIED group. There was no significant difference in VAS leg (P=0.836) or lumbar scores (P=0.335) between PIED and UBED group at preoperative, 1-day postoperative, and last follow-up point. Within the same group, there were significant differences in VAS leg (P<0.001) and lumbar scores (P<0.001) compared pairwise at three time points. ODI scores of both groups showed significant improvement at the last follow-up (P<0.001) (P<0.001). And there was no significant difference in patient satisfaction rates (97.8% vs 96%) between two groups based on MacNab criteria. The percentage of facet joint preservation was 96.74±9.10% in UBED group, and 99.22±1.52% in PIED group. The total blood loss and hospitalization cost was more in the UBED Group. One patient in both groups showed postoperative hematoma. A dural tear occurred in UBED group and a never root injury occurred in PIED group. UBED indicates similar short-term efficacy compared with PIED for treating L5/S1 disc herniation. No difference was found in facet joint preservation between two groups. The increased cost of UBED due to surgical consumables is believed to be resolved in the future.

Fractures in Oxford unicompartmental knee arthroplasty are associated with a decreased medial keel-cortex distance of the tibial implant

PurposeThis retrospective single-center study aimed to investigate incidence and risk factors influencing tibial periprosthetic fractures (TPF) in Oxford unicompartmental knee arthroplasty (UKA), with a specific focus on tibial component positioning and sizing.MethodsA total of 2063 patients with medial UKA using the Oxford® mobile partial knee implant were analyzed between July 2014 and September 2022. Various preoperative and postoperative radiographic parameters determining pre- and postoperative alignment and implant positioning, incidence and characteristics of periprosthetic fractures, and patient demographics were assessed. Statistical analyses, including Mann–Whitney U test and logistic regression, were conducted to identify significant associations and predictors of tibial fractures.ResultsOf the 1853 cases that were finally included in the study, 19 (1%) patients experienced TPF. The fracture group presented with a significantly shorter relative mediolateral and posteroanterior distance between the keel and cortex [mediolateral: 23.3% (23.2–24.8%) versus 27.1% (25.7–28.3%), p < 0.001; posteroanterior: 8.4% (6.3–10.3%) versus 10.0% (9.8–10.1%), p = 0.004]. Additionally, an increased posterior tibial slope in pre- and postoperative radiographs [preoperative: 10.4° (8.6–11.1°) versus 7.7° (5.4–10.0°), p < 0.001; postoperative 9.1° ± 3.1° versus 7.5° (5.9–9.0°), p = 0.030] was observed in the fracture group. Furthermore, the use of smaller-sized implants (AA) was associated with higher fracture rates (p < 0.001). Anatomical variants, such as a medial overhanging tibial plateau, were not observed.ConclusionsIn UKA, type Oxford TPF are linked to shorter mediolateral and posteroanterior keel-cortex distances, increased pre- and postoperative PTS, and small implant sizes (AA). Fracture lines often extend from the distal keel to the medial tibial cortex. These findings emphasize the importance of precise implant positioning and sizing to minimize fracture risk.Level of evidence Retrospective single-center study, III.

Permissive weight bearing versus restrictive weight bearing in surgically treated trauma patients with displaced intra-articular calcaneal fractures (the PIONEER study): study protocol for a multicenter randomized controlled trial

BackgroundFollowing successful treatment, displaced intra-articular calcaneal fractures (DIACFs) necessitate an extensive rehabilitation regimen, significantly influencing functional and socio-economic outcomes. Apart from surgical intervention, the implementation of a comprehensive rehabilitation protocol is crucial to optimize foot stability and functional recovery. The objective of this study is to ascertain the optimal rehabilitation protocol for patients with surgically treated DIACFs, either permissive weight bearing (PWB) or Restricted Weight Bearing, focusing on functional outcomes, health-related quality of life (HRQoL), radiographic parameters, cost-effectiveness, and incidence of complications.MethodsStudy design: A prospective multicenter randomized controlled trial. Study population: Presence of surgically (extended lateral, sinus tarsi, or percutaneous approach) treated unilateral DIACFs (Sanders type II to IV), aged 18–67 years (labor force). Patients must be able to understand and follow weight bearing instructions. N = 115 patients with DIACFs will be included. Interventions: Patients with DIACFs will be randomly allocated to one of the rehabilitation protocols, either PWB or RWB. Primary outcome measure: Functional outcome, measured with the American Orthopaedic Foot & Ankle Society Score (AOFAS)). Secondary outcomes: Functional outcome (Maryland Foot Score, MFS), HRQoL (EuroQol-5D, EQ-5D), differences in radiographic parameters, cost-effectiveness, and complications. Nature and extent of burden: The PWB protocol is aimed to be non-inferior to the RWB protocol. Previous analysis of this protocol in other lower extremity fractures has shown a safe complication rate. Follow-up is standardized according to current trauma guidelines, namely at time points 2, 6, 12 weeks, and 6 months. The radiation exposure for both groups will differ from standard care (one extra CT scan of the foot will be made). Therefore, the burden for participants is considered minimal, with no significant health risks.DiscussionThis study will be the first study to define an optimal rehabilitation regime for surgically treated patients with DIACFs. The limitations of this study include the absence of patient blinding, as this is impossible in rehabilitation. Additionally, the primary outcome measure (AOFAS) has limited validity for DIACFs. However, it is the most commonly used questionnaire in the literature on DIACFs. There is an apparent need since current literature is lacking on this specific topic.Trial registrationClinicalTrials.gov NCT05721378, accepted on February 7, 2023.

HOW DOES VERTICAL LAMINAR FRACTURE IMPACT THE DECISION-MAKING IN THORACOLUMBAR FRACTURES?

Objective Although vertical laminar fracture (VLF) is generally considered a severity marker for thoracolumbar fractures (TLFs), its exact role in decision-making has never been established. This scoping review aims to synthesize the research on VLF’s role in TLF decision-making. Methods A systematic review was conducted following PRISMA guidelines. We searched PubMed, Scopus, and Web of Science from inception to 11 June 2023 for studies examining the association of VLF in thoracolumbar fractures with dural lacerations, neurological deficits, radiographic parameters, or treatment outcomes. Additionally, experimental studies that analyze the biomechanics of burst fractures with VLF were included. The studies extracted key findings, objectives, and patient population. A meta-analysis was performed for the association of VLF with dural laceration and neurological deficit, and ORs were pooled with a 95% confidence interval (CI). Results Twenty-eight studies were included in this systematic review, encompassing 2,021 patients, and twelve were included in the meta-analysis. According to the main subject of the study, the association of VLF with a dural laceration (n=14), neurological deficit (n=4), radiographic parameters (n=3), thoracolumbar fracture classification (n=2), treatment outcome (n=2). Seven studies with a total of 1010 patients reported a significant association between VLF and neurological deficit (OR= 7.35, 95% CI [3.97, 14.25]; P&lt; 0.001). The pooled OR estimates for VLF predicting dural lacerations was 7.75, 95% CI [2.41, 24.87]; P&lt; 0.001). Conclusion VLF may have several important diagnostic and therapeutic implications in managing TLFs. VLF may help to distinguish AO type A3 from A4 fractures. VLF may help to predict preoperatively the occurrence of dural laceration, thereby choosing the optimal surgical strategy. Clinical and biomechanical data suggest VLF may be a valuable modifier to guide the decision-making in burst fractures; however, more studies are needed to confirm its prognostic importance regarding treatment outcomes.

Clinical and radiographic assessment of the association between orthodontic mini-screws and periodontal health

ObjectivesProper anchorage control is crucial for predictable tooth movement and preventing inadequate torque during orthodontic treatment. Through clinical and radiographic parameters; this study assesses the association between mini-screws and periodontal health.Materials and methodsA prospective observational study included 16 systemically healthy non-smoking individuals requiring mini-screws. Mini-screws with a rough, titanium oxide-coated surface were placed. Periodontal assessments (Plaque index, gingival index, probing pocket depth, gingival recession, bleeding on probing, mucosal discomfort, mucosal redness, keratinized tissue width, supracrestal tissue height, and transmucosal soft tissue thickness) were performed at 2nd week and 3 months post-placement. Radiographic evaluations measured distances between mini-screws and adjacent teeth using Image J software.ResultsThe study included 13 females and 3 males (mean age 21.9 ± 1.8 years) with 24 mini-screws. Early mini-screw loss was not observed. Significant reductions in site-level Gingival Index and bleeding on probing (p < 0.05) and full-mouth bleeding on probing (p < 0.05) were noted over time. Absence of significant differences was found in mucosal discomfort and redness, keratinized tissue width, or transmucosal soft tissue thickness, but supracrestal tissue height decreased significantly (p < 0.05). Radiographically, significant bone reduction around mini-screws was observed at 3 months, with torque gauge values significantly decreased as well (p < 0.05).ConclusionsOrthodontic mini-screws can be effectively utilized in orthodontic treatment with proper planning and monitoring. While improvements in gingival health were observed with targeted oral care, the study underscores the need for careful consideration of potential risks to periodontal tissues, such as reductions in supracrestal tissue height and bone levels. A balanced approach that integrates preventive strategies with precise screw placement is essential to maximize the benefits of mini-screws while minimizing potential periodontal complications.Clinical relevanceWhile proper oral hygiene can help control inflammation around mini-screw sites, clinicians must also be mindful of potential risks, such as reductions in bone levels and tissue height. Careful patient selection, precise placement, and regular follow-up are crucial to ensure the stability of mini-screws’ stability and to prevent complications, ultimately contributing to better treatment outcomes in orthodontic care.Trial registrationThis study was registered on ClinicalTrials.gov with the registration number NCT06491849 on June 28, 2024.

Impact of Enhanced Recovery After Surgery (ERAS) Protocols on Outcomes Up to Two Years After Adult Structural Spine Disorder Surgery

Study Design. Retrospective cohort study of prospectively enrolled database Objective. We analyze the recovery pattern of Adult Structural Spine Disorder (ASD) patients who underwent corrective surgery with Enhanced Recovery After Surgery protocol (ERAS+), including physical and psychological prehabilitation components, compared to non-ERAS protocol (ERAS-) up to 2-years after surgery. Summary of Background Data. Spine surgery for ASD is often highly invasive, which can contribute to prolonged recovery. The trajectory of recovery may be accelerated by the application of enhanced recovery principles. Methods. Inclusion criteria were operative patients with ASD&gt;18yrs with complete baseline, 90 days perioperative, and 2-year postoperative data. We assessed differences in baseline demographics, surgical details, baseline Health-Related Quality of Life (HRQL), and surgical outcomes between ERAS+ and ERAS- patients. Outcomes included adverse events, reoperations, and radiographic parameters such as sacral slope (SS), pelvic tilt (PT), pelvic incidence-lumbar lordosis (PI-LL) mismatch, sagittal vertical axis (SVA), lumbar lordosis (LL), T2–T12 kyphosis, and maximum Cobb angle. Additionally, HRQL measures included the PCS, ODI, NDI, EQ-5D, SRS-22r total and domain scores, NRS-Back, and NRS-Leg. We used multivariable logistic regression and ANCOVA to adjust for confounding. Results. 471 patients with ASD met inclusion criteria, with 59 designated ERAS+. Those individuals ERAS+ were older (64.1±13.0 vs. 58.0±16.0;P=0.005), had a higher CCI, (2.4±1.8 vs. 1.4±1.6;P&lt;0.001), and exhibited a higher modified ASD frailty index (8.2±5.4 vs. 6.3±4.9;P=0.019). Adjusted analysis demonstrated the ERAS+ cohort demonstrated lower likelihood of overall reoperations (OR:0.3; 95%CI:0.13-0.89), and a lower likelihood of overall adverse events (OR:0.4;CI95%:0.19-0.93). ERAS+ was more likely to achieve the MCID in the SRS-22r Total scores at 6 months(OR:3.1;CI95%:1.2-8.4), self-image domain at 6 months (OR:9.0;CI95%:1.6-50.0), in the pain domain at 6 months (OR:3.5;CI95%:1.01-11.9) and 1 year postoperatively (OR:2.6;CI95%:1.03-6.7), and in the SF-36’s physical component summary scores (PCS) at 1 year (OR:2.1;CI95%:1.05-4.2). No other statistically significant differences in HRQL were observed at the remaining time points (P&gt;0.05). Conclusion. Our work is the first to evaluate HRQL metrics and complication over two-years following ASD correction with ERAS. Despite presenting with more severe baseline frailty and higher comorbidity profiles, patients with ASD who underwent corrective surgery with an ERAS protocol experienced fewer short-term adverse events, and improved HRQL. We believe ERAS following ASD surgery leads to faster functional recovery, reduced postoperative deconditioning, and improved quality of life.

Changes in Physical Function After Long Corrective Fusion to the Ilium for Adult Spinal Deformity

Study Design. Prospective cohort study. Objective. To investigate longitudinal changes in physical functional status after long corrective fusion in patients with adult spinal deformity (ASD) during 2 years of follow-up. Summary of Background Data. In ASD surgery, reports assessing physical functional status in long-term observations for more than a year are lacking. Assessing whether patients maintain significant improvements in their physical status with a longer follow-up duration is crucial. Methods. A total of 70 female patients with ASD who underwent long corrective fusion of ≥ 7 segments between June 2016 and June 2022 were included in this study. Preoperative and postoperative assessments (at 6 months, 1 year, and 2 years) included radiographic spinopelvic parameters, health-related quality of life (HRQOL) using the Scoliosis Research Society Outcome Instrument-22 (SRS-22) questionnaire, and physical function tests conducted by a physical therapist. Results. All domains of the SRS-22 improved the most in the first 6 months after surgery (P &lt;0.0001); however, the Pain and Function domains continued to improve gradually until 2 years postoperatively. Regarding trunk dynamic balance, the timed up-and-go test score improved gradually until 2 years postoperatively (P &lt;0.0001). Regarding gait performance, gait speed and the 6-minute walking test improved the most in the first 6 months after surgery (P &lt;0.01) and almost reached a plateau 1 year postoperatively. Conclusions. Long corrective fusion for ASD significantly enhanced physical function and HRQOL within 2 years, with the greatest improvement in the first 6 months after surgery. These findings underscore the importance of increasing activities of daily living through early exercise instruction, as well as preventive measures to avoid early surgery-related complications. Level of Evidence. 3

Factors contributing to severe scoliosis after open chest surgery for congenital heart disease: a case-control analysis.

Previous reports have identified factors associated with open chest surgery for congenital heart disease (CHD) and scoliosis. However, these reports included conditions such as Down syndrome and Marfan syndrome, which involve both cardiac disease and scoliosis. The relationships between these factors and open chest surgery remain unclear. This study aimed to identify factors contributing to severe scoliosis in CHD patients who have undergone open chest surgery. Seventy-four post-CHD surgery patients with severe scoliosis (Scoliosis group) and 30 post-CHD surgery patients without scoliosis (NS group), excluding those with any syndrome or intellectual disability, were retrospectively analyzed. Patient background characteristics and radiographic parameters were compared between the NS and Scoliosis groups. Furthermore, the patients in the Scoliosis group were classified into three categories, namely, mild scoliosis, moderate scoliosis, and severe scoliosis, and the results were compared among the four groups. Eighteen patients in the NS group and 63 in the Scoliosis group met the inclusion criteria. Compared with the NS group, the Scoliosis group included significantly more girls and patients who had younger ages at first CHD surgery and multiple open chest surgeries. Severe scoliosis progression was observed in patients who underwent multiple surgeries for severe CHD with cardiomegaly. Progression to severe scoliosis was noted in patients with younger ages at first CHD surgery and those who underwent multiple surgeries for severe CHD. Assessing spinal deformities should be a key aspect of postoperative care for CHD, particularly in patients with severe CHD who are undergoing multiple chest surgeries. III.

Pediatric Orthopaedic Surgeons Manage Pediatric Diaphyseal Clavicle Fractures Differently Than Nonpediatric Orthopaedic Specialists.

Pediatric clavicle fractures are often managed by physicians with and without pediatric subspecialty training. The aim of this study is to identify if variability of practice exists between pediatric orthopaedic surgeons versus nonpediatric orthopaedic specialists during management of pediatric diaphyseal clavicle fractures. Patients ≤18 years of age with an acute, closed diaphyseal clavicle fracture treated between January 2018 and July 2023 by a large hospital-employed multispecialty orthopaedic practice (in a regional and academic health network) were retrospectively reviewed. The study involved 26 orthopaedic surgeons (including 3 pediatric, 8 sports medicine, and 6 general) and 11 nonoperative sports medicine physicians, all of which accept patients ranging 0 to 18 years of age. Exclusion criteria included open or impending open fractures and insufficient data. Demographic, radiographic, and outpatient treatment parameters were recorded. Age groups were separated into <10 and ≥10 years old to control for age-associated differences. Among 560 pediatric clavicle fractures, 385 met inclusion criteria (43.6% of which were treated by a pediatric orthopaedic surgeon), and 361 were treated nonoperatively. Follow-up averaged 48.8 days until orthopaedic discharge and 16.9 months until the most recent well-child visit (80% had a well-child visit after orthopaedic discharge). No patient <10 years of age had elective surgery, but pediatric orthopaedic surgeons demonstrated lower surgical rates in adolescent patients than nonpediatric specialties (4.3% vs. 14.4%, OR=3.8, P=0.027). Among the 169 nonoperative patients <10 years of age, pediatric orthopaedic surgeons completed fewer outpatient visits (2.1±0.8 vs. 2.4±0.8, P<0.037), shorter follow-up durations (28.5±18.9 vs. 41.8±22.6d, P<0.001), less radiographic series (2.1±0.8 vs. 2.4±1.0, P<0.047), and less total radiographs (4.3±1.8 vs. 5.0±2.3, P<0.013) than nonpediatric specialists. The surgical rate of acute, closed diaphyseal clavicle fractures is lower among pediatric versus nonpediatric orthopaedic surgeons in adolescents. During nonoperative management of pediatric clavicle fractures, pediatric orthopaedic surgeons treat young patients (but not adolescents) with less outpatient visits and radiographs than nonpediatric orthopaedic physicians. Level III.

Association Between Postoperative Medial-Middle Intercuneiform Joint Widening and Recurrence Rates in Hallux Valgus Treated With Modified Lapidus Procedure.

Although an association between intercuneiform (C1-C2) joint instability and the recurrence of hallux valgus (HV) deformity after the modified Lapidus procedure has been suggested, there is currently no radiographic evidence to support it. This study aims to investigate radiographic changes in the C1-C2 joint after the modified Lapidus procedure for HV correction, using weightbearing computed tomography (WBCT). This retrospective cohort study included 52 feet (50 patients) with HV who underwent modified Lapidus procedure and had preoperative and postoperative WBCT. Patients who had an additional transfixation screw between the first and second ray were excluded. The preoperative and average 6.5 months postoperative C1-C2 distance, C1-C2 angle, and C1-ground angle were measured on coronal multiplanar reconstructed WBCT images. Radiographic parameters between the recurrence group (n = 9) and nonrecurrence group (n = 43) were compared. Recurrence of HV deformity was characterized by a postoperative hallux valgus angle (HVA) greater than 20 degrees. Nine of 52 patients (17.3%) had recurrence of their HV deformity. The recurrence group had greater changes in the C1-C2 distance; the median widening in the recurrence group was 0.7 mm (IQR, 0.6-0.8), whereas the nonrecurrence group was 0.3 mm (IQR, 0.1-0.4, P < .001). Regression analysis showed that increase in the C1-C2 distance were significantly associated with recurrence (odds ratio, 1.79; 95% CI, 1.18-3.77; P = .0015). Although no preoperative imaging parameters were associated with a change in the C1-C2 distance, increasing postoperative sesamoid position (r = 0.32, P = .022) and HVA (r = 0.28, P = .046) were correlated with a greater change in the C1-C2 joint gapping. Our study results suggest a possible association between early postoperative widening of the C1-C2 joint and the recurrence of the HV deformity following a modified Lapidus procedure. This raises, but does not answer, the question as to whether the routine stabilization of intercuneiform joint directly or indirectly may help reduce the rate of hallux valgus recurrence when performing the modified Lapidus procedure.

Clinical Comparison of Endoscopic Posterior Lumbar Interbody Fusion and Open Posterior Lumbar Interbody Fusion for Treating Lumbar Spondylolisthesis.

A retrospective case-control study. To compare the clinical efficacy of endoscopic (Endo) and open posterior lumbar interbody fusion (PLIF) in treating lumbar spondylolisthesis. Endo-PLIF has emerged as a new technique for treating lumbar spondylolisthesis. We propose Endo-PLIF as an alternative method. Sixty-four patients with single-segment lumbar spondylolisthesis underwent Endo-PLIF (n = 39) or open PLIF (n = 25) treatment. Demographic data, perioperative parameters, and radiographic parameters were recorded. Clinical results were evaluated by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. The fusion rate was evaluated by computed tomography at 12 months postoperatively. In addition, a case-control process was included to ensure unbiased comparisons. The average operation time was longer in the Endo-PLIF group. Endo-PLIF showed advantages in reducing blood loss, shortening hospital stay, and early ambulation, but with a longer x-ray exposure time. Both VAS and ODI scores significantly improved in both groups, but the VAS for back pain was lower in the Endo-PLIF group. The radiographic results were similar in both groups. Three patients in the Endo-PLIF group had minor complications. Two patients in the open PLIF group experienced cerebrospinal fluid leakage. Both VAS and ODI scores significantly improved in both groups compared with preoperative scores, but the Endo-PLIF group showed more significant improvement at early follow-up (P < 0.05). There was no significant difference in interbody fusion rate between the two groups. Both Endo-PLIF and open PLIF are effective for treating single-segment lumbar spondylolisthesis. Endo-PLIF shows advantages in reducing blood loss, shortening hospital stays, and promoting early ambulation, with comparable fusion rates and patient satisfaction to open PLIF. Despite minor complications in the Endo-PLIF group and cerebrospinal fluid leakage in the open PLIF group, both procedures lead to significant improvements in pain and disability scores, with Endo-PLIF demonstrating more significant early improvements.

Decreases in lung volume and lung height among ankylosing spondylitis patients with pulmonary function impairment: a 3D CT investigation

BackgroundRespiratory compromise among ankylosing spondylitis (AS) patients is characterized by restrictive pulmonary function, leading to the need for a meticulous assessment of lung volume. Compared with conventional pulmonary function tests (PFTs), CT-based lung volume measurements have superior accuracy and are crucial for understanding functional limitations in AS. This study investigated the correlation between CT lung volume and PFT parameters in AS patients, with a focus on changes in CT parameters and lung volume in patients with compromised pulmonary function.MethodsA total of 79 AS patients were included, and their full-length radiographs, thoracic CT scans, and PFT data were analysed. Specialized software was used to estimate the total and lobar lung volumes from the CT scans. The relationship between lung volume and PFT results was examined, and a multiple linear regression model was constructed to determine the influence of radiographic and CT parameters on total lung volume (TLV). Patients were classified into normal or impaired pulmonary function groups based on PFT outcomes, thus facilitating comparative analyses of radiographic and CT parameters and lung volumes between these groups.ResultsAmong the 79 AS patients, 19 had normal function, 4 had mixed dysfunction, and 56 experienced restrictive dysfunction. PFT parameters, including FVC, FEV1, TLC, FEV1%, and TLC%, showed varying correlations with TLV and individual lobe volume. Patients with compromised pulmonary function exhibited more pronounced spinal kyphosis and experienced a decline in TLV. Multiple regression analysis revealed that lung height and horizontal and vertical lung diameters independently influenced TLV. Notably, a decrease in lung height was observed in patients with impaired pulmonary function, whereas the horizontal and vertical diameters of the lungs remained stable.ConclusionsIn AS patients, TLV was found to be correlated with pulmonary function, particularly parameter such as FVC, FEV1, and TLC. A significant reduction in TLV was observed in those with impaired pulmonary function, with the primary contributing factor being a decrease in lung height.

Does the positioning of the patient in the EOS machine affect the validity of cervical and head parameters calculated on whole-spine radiographs?

The aim was to study the validity of free-standing position using modifiers for assessing cervical spine alignment. A total of 26 asymptomatic subjects (45 ± 11years) and 13 with spinal deformities (30 ± 21years) underwent lateral radiographs using EOS®, while adopting 3 different positions, in 2 sequences, without mirror and then with mirror (m) placed in front of them: first, the neutral standing position (upper extremities positioned on the sides of the body, P1 and P1m), then free-standing (P2 and P2m) and modified free-standing (P3 and P3m) positions (shoulders flexed at 90° and fingers placed on clavicles then cheeks, respectively). Participants were asked not to move their trunk and shoulders when moving from P1 to P2 and then P3. Eighteen cervical radiographic parameters were calculated from the 6 radiographs. The effects of shoulder flexion, mirror placement, and finger positioning on cervical alignment were studied using a repeated-measures ANCOVA. Mirror placement had no effect on cervical alignment. Concerning the effect of shoulder flexion, C2-C7 and T1 slopes were significantly decreased in P2 and P2m (C2-C7 = 10° and 8°; T1 slope = 26° and 24°, respectively) and P3 and P3m (C2-C7 = 9° and 9°; T1 slope = 25° and 26°, respectively) compared to P1 and P1m (C2-C7 = 14°and 14°; T1 slope = 29°and 30°, respectively), without exceeding the uncertainty level. Assessment of cervical alignment is valid on whole-spine radiographs when the shoulders are flexed (free-standing position). Clear instructions regarding the shoulder position at 90°, without moving the trunk, neck, and head before placing the fingers on the clavicles or cheeks, can ensure a cervical alignment comparable to that obtained with the neutral position, which is considered the most physiological one.

Higher Posterior Tibial Slope and Lower Medial Proximal Tibial Angle of the Knee Are Associated with Delayed Graft Maturation after ACL Reconstruction Surgery with Hamstring Autograft

PurposeThis study aims to relate bone shape with anterior cruciate ligament (ACL) graft maturation, as evaluated by quantitative magnetic resonance imaging (MRI). MethodsWe retrospectively evaluated patients aged 18-60 years who underwent ACL reconstruction with a hamstring autograft with doubled semitendinosus and gracilis at our institution between 2018 and 2020 with isolated ACL injuries. All patients had a minimum follow-up period of 2 years. To evaluate alignment, radiographs of the knee were taken preoperatively. Postoperative 3T magnetic resonance imaging (MRI) and patient-reported outcomes (PRO) scores were acquired at 2 years after surgery. A combined T1ρ/T2 quantification sequence and a 3D multi-echo ultrashort echo-time (UTE) Cones sequence were obtained in a sagittal-oblique plane for better assessment of the ACL graft. After acquiring images, a manual segmentation for ACL graft was performed to assess T1ρ, T2 and UTE T2* relaxation times. Correlations between radiographic parameters or PRO scores and T1ρ, T2 and UTE T2* values were tested with Pearson correlation coefficients. Significance was defined as p<0.05. ResultsSubjects were 28 patients (12 males and 16 females) and had an average age of 34.3 years (SD=8.5 years) and a BMI of 24.4 kg/m2 (SD=4.5 kg/m2). A significant correlation was found between the preoperative PTS and the T1ρ, T2 and UTE T2* relaxation times (r=0.41; p=0.033, r =0.47; p=0.014 and r =0.41; p=0.030), indicating inferior graft maturation in patients with higher PTS. Furthermore, a negative correlation was identified between the preoperative MPTA and the T1ρ, T2 and UTE T2* relaxation times (r=-0.39; p=0.039, r =-0.46; p=0.018 and r =-0.43; p=0.024), indicating inferior graft maturation in patients with greater varus knee alignment. ConclusionThe study findings suggest that an increased PTS and lower MPTA are associated with inferior graft maturation as per T1ρ, T2 and UTE T2* imaging at 2 years post-ACL reconstruction. Level of EvidenceLevel IV retrospective case series