Correction Rate Research Articles

Clinical Results after Release of Sternocleidomastoid Muscle Surgery for Neglected Congenital Muscular Torticollis-Unipolar vs. Bipolar Release Surgery.

Although the surgical release of the sternocleidomastoid muscle (SCM) is required for residual congenital muscular torticollis (CMT), the surgical outcomes between bipolar and unipolar SCM release remained unclear. The purpose of the present study was to assess surgical outcomes after bipolar and unipolar release of SCM in adolescent/adult patients with neglected CMT. Twenty-one consecutive adolescent/adult patients with neglected CMT who underwent surgical treatment were enrolled. Clinical and radiographic outcomes were evaluated at preoperative and final follow-up. The bipolar release of SCM was performed in 3 patients (B group; males, n = 1, females, n = 2) and the unipolar release of SCM in 18 patients (U group; males, n = 6, females, n = 12). The mean age at surgery was 40.0 ± 17.0 years in Group B, and that was 32.3 ± 13.1 years in Group U (p = 0.47). The mean follow-up period was 16.0 ± 5.7 months in Group B and 10.4 ± 7.6 months in Group U (p = 0.22). Cervicomandibular angle correction rates were comparable at 75.4 ± 2.4% for the B group and 73.1 ± 11.7% for the U group (p = 0.62). There was no significant difference in clinical outcome according to the modified Cheng and Tang score between the two groups (p = 0.89). No major complications arose, although one patient exhibited a transient neurological deficit of the greater auricular nerve, and one patient developed a hematoma in the B group. The unipolar SCM release appeared to be a non-inferiority and less invasive procedure, minimizing surgical scars and avoiding potential auricular nerve damage in adolescent/adult patients with neglected CMT.

Personalized Rehabilitation of Patients with Prostate Cancer after Radical Prostatectomy: a Comparative Analysis of Urodynamic Parameters

INTRODUCTION. Applying a personalized approach in the treatment of urinary incontinence in patients after RP can significantly improve the rates of correction of postoperative incontinence.
 AIM. To study the effect of personalized rehabilitation of patients with prostate cancer (PCa) after radical prostatectomy on the state of functional indicators of the lower urinary tract.
 MATERIALS AND METHODS. The study included 60 patients with verified primary resectable prostate cancer who underwent laparoscopic nerve-sparing prostatectomy. Patient ages ranged between 46 and 77 years (median 62.8 years). The patients were divided into main and control groups of 30 people each. The patients of the main group received rehabilitation using a personalized approach. The rehabilitation programs for the patients in the control group were formed on the basis of a syndromic-pathogenetic approach. Functional parameters of the lower urinary tract were assessed using a 24-hour pad test and a comprehensive urodynamic study before and after surgery, after a course of rehabilitation and 1 year after surgery.
 RESULTS. Assessment of the degree of urinary incontinence in patients with prostate cancer using a 24-hour pad test showed similar clinical pictures in both groups in the postoperative period in the form of mild or moderate disorders. After the rehabilitation course, a positive trend was observed, however, in the observation group, 66.7 % of patients completely retained urine, while in the comparison group only 40%. Similar trends were observed in a year after a surgical treatment. According to a comprehensive urodynamic study (CUDS), after rehabilitation in the observation group, 76.7 % of patients showed signs of restoration of detrusor activity to the preoperative level with retention of the effect a year after the intervention (p 0.05). A peak decrease in maximum detrusor pressure was observed in the postoperative period with a partial recovery of the indicator after rehabilitation and after 1 year in both groups. In the comparison group, a more pronounced decrease in detrusor pressure was observed, but the difference was statistically insignificant (p 0.05).
 DISCUSSION. This study tested a personalized approach in the rehabilitation of patients with urological oncology. This concept allows the use of physical and rehabilitation medicine technologies with maximum efficiency by identifying a specific patient model. The results of functional research methods (pad test, KUDI) are one of the potential determinants of the effectiveness of the use of rehabilitation technologies.
 CONCLUSION. The results of rehabilitation of patients in the group with a personalized approach can significantly improve the rates of correction of postoperative incontinence.

Successful Correction by Prime Editing of a Mutation in the RYR1 Gene Responsible for a Myopathy.

We report the first correction from prime editing a mutation in the RYR1 gene, paving the way to gene therapies for RYR1-related myopathies. The RYR1 gene codes for a calcium channel named Ryanodine receptor 1, which is expressed in skeletal muscle fibers. The failure of this channel causes muscle weakness in patients, which leads to motor disabilities. Currently, there are no effective treatments for these diseases, which are mainly caused by point mutations. Prime editing allows for the modification of precise nucleotides in the DNA. Our results showed a 59% correction rate of the T4709M mutation in the RYR1 gene in human myoblasts by RNA delivery of the prime editing components. It is to be noted that T4709M is recessive and, thus, persons having a heterozygous mutation are healthy. These results are the first demonstration that correcting mutations in the RYR1 gene is possible.

Anterior Distal Femoral Hemiepiphysiodesis in Children With Fixed Knee Flexion Deformities: Does Screw Position Matter?

Anterior distal femoral hemiepiphysiodesis (ADFH) using 2 percutaneous screws is an effective technique for the treatment of fixed knee flexion deformities in children with neuromuscular disorders. The role of sagittal screw position on the outcome of the procedure is unknown. This is a retrospective case series of patients who underwent ADFH at a single pediatric hospital from 2013 to 2020. Radiographs were evaluated for sagittal screw position and the associated change in lateral distal femoral physeal angle over time. The position of the 2 screws was classified as either being both in the anterior third of the physis (AA), one screw in the anterior third and the other screw in the middle third (AM), or both screws in the middle third of the physis (MM). The study population included 68 knees in 36 patients. The mean physeal angle at the time of surgery was 93 degrees (SD 4.0 degrees), which increased to 102.4 degrees (SD 5.7 degrees) at 12 months, for a change of 9.4 degrees ( P <0.001). At 24 months, the mean physeal angle was 104.6 degrees (SD 6.3 degrees) for a further change of 2.9 degrees ( P <0.001). When stratified by screw position all screw configurations resulted in an increase in the physeal angle at 12 months. At the 24-month follow-up, the physeal angle in knees with AA screws continued to increase another 3.5 degrees ( P <0.05), there was a minimal change in knees with AM screws (1.47°, P >0.05) and knees with MM screws saw a reversal of physeal angle change (-7.1 degrees, P <0.05). ADFH using percutaneous screws results in an increase in the lateral distal femoral physeal angle. The rate of correction is largest in the first 12 months after the procedure. As such, this procedure should be considered in patients with less than 2 years of growth remaining. However, initial screw positioning influences the amount of change over time, and close postoperative surveillance until physeal closure is essential for all patients. Level IV-retrospective case series.

Comparison of traction, side-bending and dead-hang radiographs in preoperative evaluation and postoperative correction prediction in adolescent idiopathic scoliosis: A retrospective analysis of a novel flexibility radiograph.

A retrospective study comparing traction, dead-hang, and side-bending radiographs in adolescent idiopathic scoliosis to compare the effectiveness of dead-hang radiography in structural and nonstructural curves and evaluate it in terms of postoperative correction prediction. In the surgical correction of adolescent idiopathic scoliosis, flexibility radiographs have an important role in determining fusion levels and in surgical decision-making. Supine bending radiographs are presently considered the gold standard, but their reliability, reproducibility, and standardization along with traction films, are a subject of debate. In our clinic, dead-hang radiographs are also used as an alternative flexibility film. The role of dead-hang radiography against other flexibility radiographs is unknown. A total of 33 patients with adolescent idiopathic scoliosis were evaluated with preoperative standing, lateral, supine traction, dead-hang, supine side-bending, and postoperative standing films. Flexibility and correction rates were assessed. In structural main thoracic (MT) and thoracolumbar/lumbar (TL/L) curves, dead-hang showed significantly higher flexibility compared with traction (P < .001). In MT curves > 60°, dead-hang was superior to side-bending and traction, whereas in MT curves < 50°, side-bending showed more improvement (P < .05). Side-bending showed higher flexibility in TL/L curves < 50° (P < .05). No predictive value was found in structural curves for all 3 radiographs. In nonstructural curves, side-bending films showed over-correction while traction radiographs remained below postoperative correction. Dead-hang radiographs showed very similar flexibility to postoperative correction. Dead-hang radiograph is superior to traction. In MT curves > 60°, dead hang shows greater flexibility than side-bending. Dead-hang technique, which shows equal results with side-bending except in TL/L curves < 50°, is a successful flexibility radiograph and provides predictive value for nonstructural curves in terms of postoperative correction.

Hemiepiphysiodesis using tension band plates: does the insertion technique or screw length influence the rate of correction?

We retrospectively studied the effect of certain characteristics of the insertion technique and the construct of tension band plates on its angular correction rates. The study included 68 physes in 28 children. The following preoperative radiological parameters were measured: interscrew angle; the length of the epiphyseal screw, its distance and angle (screw trajectory angle) with respect to the physis. Additionally, changes in the mechanical lateral distal femoral angle and medial proximal tibial angle were calculated from the follow-up radiographs. The statistical calculations involved correlating the above-mentioned parameters and correction rates using a correlation coefficient. The mean patient age at the time of surgery was 8.6 years and the follow-up was 12.1 months. The mean screw trajectory angle was 13.4 degrees, the interscrew angle 18.9 degrees and the proportion of screw length was 41.3%. The mean correction rate recorded was 1.1 degrees/ month. The child's age (R = -0.13), screw trajectory angle (R = -0.13), interscrew angle (R = -0.02), distance of screw from physis (R = 0.04), and length of screw (R = 0.07) did not show statistically significant correlation with the angular correction rates. The correction rate produced by the tension band plate was found nearly independent of the parameters recorded for insertion technique (screw trajectory angle, interscrew angle, distance of screw from the physis) or construct (length of the epiphyseal screw). It functions as long as the physis is tethered by a side plate adequately secured by appropriate length screws.

Feasibility and safety of minimally invasive calcaneal osteotomy (MICO) through amedial approach: acase-control study.

Minimally invasive calcaneal osteotomy (MICO) is already an established surgical procedure for correcting hindfoot deformities using alateral approach. So far, no description of amedial approach for MICO has been published. Between August 2022 and March 2023, 32consecutive patients (MICO with medial approach, MMICO: n = 15; MICO with lateral approach, LMICO: n = 17) underwent MICO as part of complex reconstructive surgery of the foot and ankle with concomitant procedures. The amount of correction in the axial view of the calcaneus and consolidation rates were evaluated radiographically. Subjective satisfaction, stiffness of the subtalar joint, and pain level (numeric rating scale, NRS) at the level of the heel were assessed clinically. The last follow-up was at 6months. All osteotomies consolidated within 6months after surgery. Displacement of the tuber was 9 mm on average in either group. Relevant subtalar joint stiffness was detected in 5MMICO and 6LMICO patients. No relevant differences between the groups were detected for wound healing problems, nerve damage, heel pain or patient satisfaction. In this study lateral and medial approaches for MICO were performed. Similar degrees of correction and low complication rates were found in both groups. The medial approach for MICO is safe and can be beneficial regarding patient positioning and arrangement of the C‑arm.

Error Correction Method of Platform Displacement for Large Load Static Test

The test platform is an indispensable supporting bearing structure in static tests, which is mainly used to fix test products, simulate the real loading boundary, and provide better operation space for measurement. With the large-scale and complicated spacecraft structure, the static test platform tends to be large-scale, and the displacement measurement error of the static test platform under large load conditions cannot be ignored. The conventional error correction method only uses the displacement value of the monitoring point at the corresponding position of the platform to compensate, ignoring the comprehensive influence of the six degrees of freedom displacement for the test platform on the displacement measurement of the specimen. When it is used for the error correction of the static test of large spacecraft structures, there is a large measurement error affected by the structural size. In view of this, according to the static test requirements of a large spacecraft, a large bearing static test platform with a lateral load of 22 T and a longitudinal load of 52 T is designed, and a displacement measurement error correction method based on six degrees of freedom is proposed. Through the static test of a large spacecraft structure, the method can effectively reduce the displacement measurement error caused by the displacement of the test platform, and the error correction rate can reach 20%.

A Novel Multiple Screw Distraction Reducer System in the Treatment of Scoliosis with a Severe Rib Hump.

The treatment of scoliosis with a severe rib hump remains a major challenge. Traditional vertebral rotation techniques are not satisfactory, and thoracoplasty has many pulmonary complications that limit its application. A novel surgical device, the multiple screw distraction reducer (MSDR) system, provides longitudinal distraction during the corrective operation while at the same time providing lateral translation and axial derotation, which may facilitate the correction of a rib hump. This study was performed to investigate the effectiveness of the MSDR system for adolescent idiopathic scoliosis (AIS) with a severe rib hump. This was a case-matched study of patients with retrospectively collected data from our hospital between January 2017 and December 2021. Sixty-eight patients who underwent one-stage posterior pedicle screw-instrumented spinal fusion were matched by the Cobb angle of the main curve and rib hump. All patients underwent a minimum of 2 years of follow-up. The patients were divided into two groups: the MSDR group (using the MSDR system, n = 34) and the DVR group (using direct vertebral derotation, n = 34). The patients were evaluated for the height of the rib hump, deformity correction, complications, and SRS-30 scores. The unpaired Student's t-test and Pearson's χ2 -test were used to compare the outcome measures between the two groups. Multiple linear regression analysis was used to examine the variables that affected the correction of a rib hump. The rib hump was 30.21 ± 6.21 mm versus 29.35 ± 6.52 mm (p = 0.583) preoperatively and 9.18 ± 4.06 mm versus 13.82 ± 5.54 mm (p < 0.001) at the last follow-up in the MSDR and DVR groups, respectively. The correction rates were 70.83% and 53.56%, respectively (p < 0.001). Preoperatively, the main thoracic curve was 58.43° ± 7.97° and 57.84° ± 6.32° (p = 0.736) and was corrected to 10.92° ± 5.47° and 19.14° ± 5.32° (p < 0.001) at last follow-up in the MSDR and DVR group, respectively. Thoracic kyphosis was restored from 18.24° ± 5.19° and 17.98° ± 5.28° (p = 0.836) in the MSDR and DVR group to 24.59° ± 4.41° and 19.32° ± 4.96° (p < 0.001), respectively. Correction of apical vertebra rotation and translation in the main thoracic curve were significantly better in the MSDR group than in the DVR group (p < 0.05). There was no significant difference in the Lenke type, implant density, estimated blood loss, or follow-up duration between the two groups, whereas the operation time in the DVR group was significantly less than that in the MSDR group. There were only two minor pulmonary complications in the MSDR group. At the last follow-up, the MSDR group scored higher in terms of appearance and satisfaction (p < 0.05). The MSDR system, enabling better coronal alignment, thoracic kyphosis, and axial derotation, could be a safe and effective technique for severe rib hump correction in AIS.

Does correction of carpal malalignment influence the union rate of scaphoid nonunion surgery?

IV.

Approach to Hyponatremia in the Elderly Population

Hyponatremia is the most common electrolyte disorder in both hospitalized patients and the normal population. The prevalence of hyponatremia is approximately 8% in the population and increases significantly with age. In older patients, more than one factor often plays a role in the development of hyponatremia. The tendency of the elderly to develop hyponatremia is mainly attributed to impaired water excretion capacity associated with aging and frequent exposure to drugs and diseases associated with hyponatremia. In acute symptomatic hyponatremia, hypertonic saline solution is commonly used to acutely increase serum sodium levels and prevent severe neurological symptoms. In chronic hyponatremia, the rate of correction of serum sodium concentration should be limited to 10 mEq/L/24 h and more safely to 6–8 mEq/L/24 h. Since both the evaluation and treatment of hyponatremia are difficult in the older population, very careful evaluation is required.

Posterior concave reconstruction with cage in the surgical treatment of complex lumbar deformity caused by lumbosacral hemivertebrae.

To identify the clinical and radiological outcomes in the coronal and sagittal planes after treatment of congenital complex lumbosacral hemivertebrae (LSHV) with or without posterior concave reconstruction. We retrospectively reviewed a consecutive series of patients with congenital LSHV deformities treated by posterior-only hemivertebra resection. The minimum follow-up was 2years. The patients were divided into a concave-cage group and a non-cage group. The radiographic and clinical results were compared between the two groups. Forty patients were categorized into the cage group (n = 14) and non-cage group (n = 26). At the end of the propensity score matching analysis, 14 patients from the cage group were matched to 14 patients in the non-cage group. The lumbosacral curve and thoracolumbar/lumbar curve improved significantly in both groups at the final postoperative follow-up (P < 0.001), and the lumbosacral curve at the final follow-up was remarkably lower in the cage than non-cage group. The correction rates of the lumbosacral curve and thoracolumbar/lumbar curve were significantly higher in the cage than non-cage group. The lower lumbar lordosis improved significantly in both groups at the final postoperative follow-up (P < 0.05), and the lower lumbar lordosis at the final follow-up and its correction were remarkably higher in the cage than non-cage group (both P < 0.05). Posterior column reconstruction with insertion of a concave cage may achieve a higher correction rate of large lower lumbar lordosis and lumbosacral coronal deformity, attain better sagittal balance, and have fewer complications related to implant failure than posterior-only hemivertebra resection in patients with congenital LSHV.

Genome editing without nucleases confers proliferative advantage to edited hepatocytes and corrects Wilson disease.

Application of classic liver-directed gene replacement strategies is limited in genetic diseases characterized by liver injury due to hepatocyte proliferation resulting in decline of therapeutic transgene expression and potential genotoxic risk. Wilson disease (WD) is a life-threating autosomal disorder of copper homeostasis caused by pathogenic variants in copper transporter ATP7B and characterized by toxic copper accumulation, resulting in severe liver and brain diseases. Genome editing holds promise for the treatment of WD, nevertheless to rescue copper homeostasis ATP7B function must be restored in at least 25% of the hepatocytes, which surpasses by far genome editing correction rates. We applied a liver-directed nuclease-free genome editing approach, based on adeno-associated viral vector (AAV) -mediated targeted integration of a promoterless mini-ATP7B cDNA into the Alb locus. Administration of AAV-Alb-mini-ATP7B in two WD mouse models resulted in extensive liver repopulation by genome edited hepatocytes holding a proliferative advantage over non-edited ones, and ameliorated liver injury and copper metabolism. Furthermore, combination of genome editing with a copper chelator currently used for WD treatment, achieved greater disease improvement compared to chelation therapy alone. Nuclease-free genome editing provided therapeutic efficacy and may represent a safer and longer lasting alternative to classic gene replacement strategies for WD.

What Do Patients Report Regarding Their Real-World Function Following Concurrent Arthrodesis of the First Tarsometatarsal and First Metatarsophalangeal Joints

First metatarsal phalangeal joint and the first Tarsometatarsal arthrodesis have both been used for deformity correction and treatment of pain and arthritis. Concomitant arthrodesis of the first metatarsophalangeal and first tarsometatarsal joints (Double First Ray Arthrodesis) has rarely been described. We surveyed 29 patients who underwent double first-ray arthrodesis for primary or revision correction of hallux valgus. A custom questionnaire was used to assess their activities of daily living and sports activity at a mean follow-up of 19.6 months (median 18.4 months). Secondary endpoints were return to activity, deformity correction, and arthrodesis healing rate. The primary outcomes showed an excellent return to activities of daily living with 96.6% of patients capable of walking as much as they liked after surgery at a normal pace. About 96.6% reported they felt that their surgery was successful, they had no pain, and the loss of motion at the joint fusion sites did not affect their ability to perform daily activities. Protected walking in a fracture boot was initiated at a mean (SD) of 9.8 (9.9) days. Return to an athletic shoe occurred at a mean (SD) of 44.2 (11.7) days. Full unrestricted activity was at a mean (SD) of 105.2 (19.3) days with 65% of the patient group reporting that their recovery was easier than expected. There was 1 nonunion and no other complications. This data set supports the hypothesis that patients undergoing double first-ray arthrodesis can return to activities of daily living and sports with and low complication rate.

Rod Rotation with Outrigger Is Substantial for Correcting Apical Hypokyphosis in Patients with Adolescent Idiopathic Scoliosis: Novel Outrigger Device for Concave Rod Rotation

The apical hypokyphosis of scoliotic patients is thought to lead to decreased lung capacity and cause shortness of breath. Additionally, concave rod curve reduction is a problem in the correction of apical hypokyphosis in posterior spinal fusion surgery in adolescent idiopathic scoliosis (AIS). We investigated the contributions of rod rotation (RR) with an outrigger device, followed by differential rod contouring (DRC) with the outrigger attached to the concave rod, designed to prevent concave rod curve-flattening. We analyzed and compared the results of segmental pedicle screw fixation without the outrigger in 41 AIS patients with thoracic curves (Lenke type I, 25; type II, 16) to those corrected using the outrigger in 36 patients (Lenke type I, 24; type II,12). The changes in the Cobb angle, apical kyphosis of five vertebrae, thoracic kyphosis (TK, T4–12), correction rate, correction angle of apical vertebral rotation, spinal penetration index (SPi), and rib hump index (RHi) before and after surgery were measured, and the contribution of the outrigger was analyzed. The mean scoliosis correction rates without and with the outrigger were 72.1° and 75.6°, respectively (p = 0.03). Kyphosis of the five apical vertebrae and TK were significantly greater in the surgery with the outrigger (p = 0.002). Significantly greater improvements in SPi and RHi were also noted in the surgery with the outrigger (p &lt; 0.05). The use of concave RR and convex DRC with the outrigger appear to be advantageous for correcting apical hypokyphosis, followed by the subsequent formation of TK. As a result, breathing problems are less likely to occur during daily life because of improvements in SPi and RHi.

Multi-rod posterior correction only with halo-femoral traction for the management of adult neuromuscular scoliosis (> 100°) with severe pelvic obliquity: a minimum 5-year follow-up

BackgroundMany patients with neuromuscular scoliosis (NMS) experience a variety of difficult medical problems that aggravate the development effects of progressive scoliosis and pelvic obliquity (PO). The objective of the current study was to assess the safety and effectiveness of multi-rod posterior correction only (MRPCO) with halo-femoral traction (HFT) for the management of adult NMS (> 100°) with severe PO.MethodsFrom 2012 to 2017, 13 adult patients who suffered from NMS (> 100°) with severe PO underwent MRPCO with HFT. The radiography parameters in a sitting position, such as the coronal Cobb angle of the main curve, the PO and the trunk shift (TS), were measured at the preoperative, postoperative and final follow-up stages. The preoperative and final follow-up assessment of the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) was taken.ResultsThe average follow-up span was 68.15 ± 6.78 months. There was decreased postoperative coronal Cobb angle with an average mean of 125.24° ± 11.78° to 47.55° ± 12.10°, with a correction rate of 62.43%; the PO was reduced to 6.25° ± 1.63° from 36.93° ± 4.25° with a correction rate of 83.07%; the TS was reduced to 2.41 cm ± 1.40 cm from 9.19 cm ± 3.07 cm. There was significant improvement in all parameters compared to the preoperative data. The VAS score reduced from 4.77 ± 0.93 to 0.69 ± 0.75, and the ODI score reduced from 65.38 ± 16.80 to 28.62 ± 12.29 at the final follow-up.ConclusionsTreatment of adult NMS (> 100°) with severe PO could be safe and effective with MRPCO with HFT. In order to obtain the optimum sitting balance, this could reduce the prevalence of complications and rectify the curvature and the correction of PO.

Masculinizing chest-wall surgeries in transgender patients, a retrospective single-center study

Masculinizing chest-wall contouring surgery is an important surgical intervention for most transmasculine patients; a vast improvement in quality of life for this group of patients has been documented as a result of receiving surgery. The aim of this study was to evaluate the results of such surgeries performed at our university hospital between 2008 and 2020, as well as the current quality of life of the patients. All 16 patients operated between 2008 and 2020 were sent a questionnaire consisting of both BREAST-Q and BODY-Q modules, considered fitting for our study purposes, as well as the BECK Depression Index and a short two-question form with space for feedback. Patients were divided into groups called double incision (DI) and periareolar (PA) depending on the surgical technique used. We found an overall complication percentage of 31.3%, with the DI group scoring 33.3% and PA 28.6%, while secondary aesthetic corrections were necessary for 50% of all patients. The questionnaires yielded 6 responses (37.5%). Participants rated on a scale of 1 to 10 their willingness to undergo the operation again if given the choice; the DI group averaged 10/10, and the PA group 9/10, despite the statistically significant complication and correction rates. Masculinizing chest-wall contouring surgery has significant complication risks. In our study, frequency of complications did not appear to depend on the surgical technique used. Additionally, the complication rates found in our low volume centre seem to be comparable with those reported from bigger units.

Can We Control Lateral Shoulder Balance Through Proximal Thoracic Curve Correction in Lenke Type 2 Adolescent Idiopathic Scoliosis?

Proximal thoracic curve (PTC) correction has been considered to prevent lateral shoulder imbalance in Lenke Type 2 adolescent idiopathic scoliosis (AIS) patients; however, postoperative shoulder imbalance (PSI) commonly occurs despite these strategies with PTC correction. We investigated the hypothesis that PTC correction would not directly affect PSI in the majority of Lenke type 2 AIS cases. Furthermore, we investigated the risk factors for lateral PSI after corrective surgery. This study examined the records for AIS patients with Lenke type 2 who underwent corrective surgery and followed up for >2 years. Patients were categorized into PSI (-); radiologic shoulder height (RSH)<15mm, and PSI (+); RSH≥15mm. Repeated measures analysis of variance was performed at preoperatively, postoperatively, 1 month, and final follow-up. Postoperative lateral shoulder imbalance was predicted by the identification of univariate analysis and multivariate analysis. Among the 151 patients reviewed, 29 (19.2%) showed PSI at final follow-up. Lateral shoulder balance parameters showed different directionalities between PSI (-) and (+) groups at postoperatively, 1 month, and final follow-up (P<0.01 each). Preoperative PTC, middle thoracic curve (MTC) curve and MTC correction showed strong correlations with the RSH (P=0.01, 0.03, and 0.04, respectively). However, PTC correction did not show a significant correlation with the RSH. Moreover, only a smaller MTC curve and larger MTC correction rate were related to lateral PSI in multivariate analysis. In Lenke type 2 AIS curves, the MTC curve and its correction predominantly influence lateral shoulder imbalance after corrective surgery, irrespective of the PTC correction extent. Consequently, overemphasizing the correction of the PTC curve may not necessarily lead to an improved lateral shoulder balance. When MTC curve is smaller, surgeons should be more careful for MCT overcorrection leading to a lateral shoulder imbalance. Level III.

A novel uniplanar clamp-hinge correction system for vertebral column resection of severe angular kyphosis: an experimental study using a sawbone model.

To introduce a novel uniplanar clamp-hinge (Uni-CH) correction system designed for vertebral column resection (VCR) of severe angular kyphosis and test its efficacy using a sawbone simulating model. The Uni-CH was introduced and its functionality was demonstrated on a sawbone model simulating severe angular kyphosis. An 83° thoracolumbar angular kyphosis with the apex at T11 was simulated in the sawbone spine model. The deformity was then corrected using the Uni-CH to identify the optimal hinge position for VCR reduction of severe angular kyphosis. The thoracolumbar angular kyphosis, initially measuring a mean of 82.7 ± 0.5°, was corrected to 0°, achieving a 100% correction rate. The optimal hinge position was identified to be at the level of the posterior vertebral body wall (PVBW), which allowed for the maintenance of the spinal cord with a slight shortening of 3%. In contrast, hinge positions located more posteriorly to the PVBW resulted in a greater 42% lengthening of the spinal cord, while positions located more anteriorly led to a greater 27% shortening of the spinal cord. The Uni-CH proves its efficacy in providing consistent stability to the spinal segments and acts as an adjustable and controllable hinge for VCR correction of severe angular kyphosis in the sawbone model. Placing the hinge pivot at the level of the PVBW preserves the spinal cord, preventing excessive shortening or lengthening during VCR reduction of severe angular kyphosis.

Rate of Correction and All-Cause Mortality in Patients With Severe Hypernatremia

Hypernatremia is common among hospitalized patients and is associated with high mortality rates. Current guidelines suggest avoiding fast correction rates but are not supported by robust data. To investigate whether there is an association between hypernatremia correction rate and patient survival. This retrospective cohort study examined data from all patients admitted to the Tel Aviv Medical Center between 2007 and 2021 who were diagnosed with severe hypernatremia (serum sodium ≥155 mmol/L) at admission or during hospitalization. Statistical analysis was performed from April 2022 to August 2023. Patients were grouped as having fast correction rates (>0.5 mmol/L/h) and slow correction rates (≤0.5 mmol/L/h) in accordance with current guidelines. All-cause 30-day mortality. A total of 4265 patients were included in this cohort, of which 2621 (61.5%) were men and 343 (8.0%) had fast correction rates; the median (IQR) age at diagnosis was 78 (64-87) years. Slow correction was associated with higher 30-day mortality compared with fast correction (50.7% [1990 of 3922] vs 31.8% [109 of 343]; P < .001). These results remained significant after adjusting for demographics (age, gender), Charlson comorbidity index, initial sodium, potassium, and creatinine levels, hospitalization in an ICU, and severe hyperglycemia (adjusted odds ratio [aOR], 2.02 [95% CI, 1.55-2.62]), regardless of whether hypernatremia was hospital acquired (aOR, 2.19 [95% CI, 1.57-3.05]) or documented on admission (aOR, 1.64 [95% CI, 1.06-2.55]). There was a strong negative correlation between absolute sodium correction during the first 24 hours following the initial documentation of severe hypernatremia and 30-day mortality (Pearson correlation coefficient, -0.80 [95% CI, -0.93 to -0.50]; P < .001). Median (IQR) hospitalization length was shorter for fast correction vs slow correction rates (5.0 [2.1-14.9] days vs 7.2 [3.5-16.1] days; P < .001). Prevalence of neurological complications was comparable for both groups, and none were attributed to fast correction rates of hypernatremia. This cohort study of patients with severe hypernatremia found that rapid correction of hypernatremia was associated with shorter hospitalizations and significantly lower patient mortality without any signs of neurologic complications. These results suggest that physicians should consider the totality of evidence when considering the optimal rates of correction for patients with severe hypernatremia.