Scoliosis Surgery Research Articles

A team approach to improve outcomes in pediatric scoliosis surgery: a review of the current literature.

Review article. To review the literature on the effect of specialized pediatric spine teams on clinical outcomes. Thirty-eight studies were identified in the review. There were 11 studies discussing the efficacy of the dual-surgeon strategy, 5 studies discussing the benefits of adult dedicated spine teams, 3 studies discussing the benefits of dedicated pediatric spine teams, 8 studies discussing the healthcare professional composition of multidisciplinary spine teams, and 20 studies discussing various clinical markers evaluating the efficacy of new team- or protocol-based interventions. Pediatric spinal deformity surgery is a highly invasive procedure with room for intervention to minimize surgical complications and enhance patient outcomes. The use of standardized spine teams, comprising surgeons and various healthcare professionals from diverse disciplines, has proven to be an effective strategy for improving both quality and efficiency of care. Furthermore, implementing uniform protocols among these teams has led to reductions in surgical duration, hospitalization periods, and risks such as infections at the surgical site and excessive bleeding. Further studies are necessary to evaluate additional benefits that specialized pediatric spine teams can offer in terms of clinical outcomes.

Elevated hospital floor-based HDU (POPUP-HDU): a new safe alternative to PICU for high-risk neuromuscular and syndromic children undergoing scoliosis surgery.

Children undergoing either posterior spinal fusion (PSF) or index insertion of growing rods for neuromuscular or genetic/syndromic scoliosis may require post-operative care on the paediatric intensive care unit (PICU). Demands on this limited resource result in frequent bed shortage related cancellations. In response, an ad-hoc or 'pop-up' ward-based high-dependency unit (POPUP-HDU) was developed. This converts a ward bed to POP-HDUbed for the required time. This study assesses the safety and efficacy of postoperative management that utilises POPUP-HDU as an alternative to a PICU bed. Retrospective review of 111 consecutive children undergoing posterior surgery for scoliosis between June 2016 and April 2023. The inclusion criteria included a diagnosis of genetic/syndromic or neuromuscular scoliosis; PSF or primary insertion of distraction-based growth rods and requirement for postoperative care in a PICU. We excluded those children that were mandated to go to PICU post-operatively for any reason by the anaesthetic team. 49 patients (mean age 13.0years) were managed on PICU, and 62 (mean age 11.4years) on POPUP-HDU. The groups were matched with respect to body weight, curve magnitude, operative duration, type of fusion procedure performed, the presence of cardiac malformations, the use of home breathing support, the number of operated levels, pelvic instrumentation and intraoperative blood loss. 8 patients in the PICU, and 16 in the POP-HDU groups were readmitted back to PICU following step-down to the hospital ward (p = 0.27). The median PICU length of stay was 1day in the PICU group and less than a day in POPUP-HDU (for those that needed to be subsequently admitted to PICU). The median total length of hospital stay was 10days in the PICU group, and 8days in POPUP-HDU (p < 0.05). 14 patients developed medical complications in the PICU group, compared to 19 in POPUP-HDU. There were no bedshortage cancellations in POPUP-HDU, compared to 23 in PICU. For children with neuromuscular, genetic or syndromic scoliosis undergoing PSF or growth rods that are not deemed suitable for immediate ward-level post-operative care, POPUP-HDU provided a safe alternative to PICU for appropriate patients and was associated with shorter hospital stay and fewer cancellations for lack of PICU beds. Therapeutic Level III.

GROWTH-FRIENDLY SPINAL SURGERY: REVIEW OF THE EFFECT ON TRUNCAL GROWTH

BackgroundPediatric spinal deformity surgery affects ultimate spinal height in the growing child. This effect on ultimate spinal height has also been shown to affect pulmonary development and ultimately pulmonary function. There has been an increasing trend toward growth-friendly spinal surgery in early onset scoliosis to minimize the negative consequences of early spinal fusion surgery. Such growth-friendly techniques include VEPTR, MCGR, and Shilla. Which technique allows for the most growth after initial implantation is still not clear. MethodsAn extensive literature review on the topic of pediatric spinal growth was undertaken. Topics reviewed include: normal growth, growth after intervention by various methods, and the effect on pulmonary function. We have summarized the literature for the techniques identified and compared these with normal population data.. ResultsThe data for various surgical techniques were reviewed. These included VEPTR, standard growing rods, and MCGR. The measurement techniques for determining ultimate spinal growth varied based upon the technique for measurement and the timing of initial and final measurements. The results of attained spinal growth were not directly correlated to pulmonary function values. ConclusionsThere is still no standardized ideal time or technique for assessing the best results in this area. We suggest that some of what is called growth from growth-friendly techniques is lengthening from the initial deformity correction. This nomenclature needs to be clarified. In addition, how and when to determine ultimate spinal growth from each surgical technique and by which radiographic technique needs to be standardized.

Incidental Finding of Breast Tumor After Scoliosis Surgery: A Case Report.

Breast asymmetry (BA) is a common condition in patients with adolescent idiopathic scoliosis (AIS). Physicians may misdiagnose a patient with a unilateral breast tumor as a normal condition related to scoliosis. The present report describes the case of a patient with a breast tumor that was detected incidentally after surgical correction of scoliosis. A 21-year-old woman was diagnosed as having AIS and reported to our institute for management. Thoracic third to lumbar second vertebra instrumented spine de-rotation and associated fusion surgery were performed to correct the deformity. After the operation, enlargement of left breast volume and obvious BA were noted. Breast sonography was performed, and a large tumor was found. Finally, the biopsy revealed a fibroadenoma of the left breast. In managing patients with scoliosis and BA, comprehensive consideration of other possible etiologies is crucial to prevent misdiagnosis. This article reminds physicians that breast tumors can be concealed by BA related to AIS.

Management of scoliosis in a pediatric patient with lysyl hydroxylase-3 deficiency: a case report

BackgroundA rare case report of lysyl hydroxylases deficiency undergoing scoliosis surgery.Case presentationAn 8-year-old Persian patient with a known case of lysyl hydroxylases deficiency presented with scoliosis. On physical examination, he had course facial hair, elbow flexion contracture, and knee flexion contracture. He had a history of eye surgery, clubfoot, and hearing problems. He underwent scoliosis surgery with growing rod instrumentation.ConclusionSurgery can be done in these patients with caution, and the surgeon and anesthesiologist should be aware of potential complications during and after surgery.

Analysis on the related factors of misplacement of freehand pedicle screws via posterior approach in degenerative scoliosis

BackgroundTo study the risk factors associated with misplacement of freehand pedicle screws through a posterior approach for degenerative scoliosis.MethodsA total of 204 patients who underwent posterior pedicle screw-rod system surgery for degenerative scoliosis in our hospital from December 2020 to December 2023 were retrospectively analyzed. Patient demographics, radiographic accuracy, and surgery-related information were recorded.ResultsA total of 204 patients were included. A total of 2496 screws were placed. 2373 (95.07%) were in good position. Misplacement screws were 123 (4.93%). None of the patients had postoperative spinal nerve symptoms due to screw malposition. The misplacement rate of thoracic (T10-T12) pedicle screws was 11.11% (60/540). Misplacement of pedicle screws in the lumbar spine (L1-L5) was 3.22% (63/1956). Age, gender, surgeon, and operation time had no significant effect on misplacement of pedicle screws (P>0.05). Body mass index, Hu value, number of screw segments, Cobb angle, vertebral rotation, and spinal canal morphology had some correlation with pedicle screw misplacement. Among them, BMI, Hu value, number of screw segments, Cobb angle, and vertebral rotation grade were independent risk factors for PS misplacement (P<0.05). The height of the posterior superior iliac spine had a significant effect on pedicle screw misplacement in the lower lumbar spine (L4/5) (P<0.05).ConclusionBMI, Hu value, number of screw levels, Cobb angle, and vertebral rotation grade were independent risk factors for pedicle screw misplacement in patients with degenerative scoliosis. Posterior superior iliac spine height has a large impact on PS placement in the lower lumbar spine. Patients with degenerative scoliosis should be preoperatively planned for the size and direction of the placed screws by X-ray and CT three-dimensional, to reduce the misplacement rate of pedicle screws.

Matched comparison of non-fusion surgeries for adolescent idiopathic scoliosis: posterior dynamic distraction device and vertebral body tethering.

Two non-fusion devices for adolescent idiopathic scoliosis (AIS) received HDE approval for clinical use in 2019: posterior dynamic distraction device (PDDD) and vertebral body tethering system (VBT). Although indications are similar, there is no comparative study of these devices. We hypothesize that curve correction will be comparable, but PDDD will have better perioperative metrics. AIS PDDD patients were prospectively enrolled in this matched multicenter study. Inclusion criteria were Lenke 1 or 5 curves, preoperative curves 35°-60°, correction to ≤30° on bending radiographs, and kyphosis <55°. Patients were matched by age, sex, Risser, curve type and curvemagnitude to a single-center cohort of VBT patients. Results were compared at 2years. 20 PDDD patients were matched to 20 VBT patients. Blood loss was higher in the VBT cohort (88 vs. 36ml, p < 0.001). Operative time and postoperative length of stay were longer in the VBT cohort, 177 vs. 115min (p < 0.001) (2.9 vs. 1.2days, p < 0.001). Postoperative curve measurement and correction at 6months were better in the PDDD cohort (15° vs. 24°, p < 0.001; 68% vs. 50%, p < 0.001). At 1-year, PDDD patients had improved Cobb angles (14° vs. 21°, p = 0.001). At 2years, a correction was improved in the PDDD cohort, with a curve measurement of 17° for PDDD and 22° for VBT (p = 0.043). At the latest follow-up, 3 PDDD patientsand 1 VBT patient underwent revision surgery. Early results showPDDD demonstrates better index correction, reduced operative time, less blood loss, and shorter length of stay but higher rates of revision compared to a matched cohort of VBT patients at two-year follow-up. Level II, prospective cohort matched comparative study.

Analysis of the accuracy between orthopedic robot-assisted and traditional manual pedicle screw placement techniques in adult degenerative scoliosis posterior surgery

Objective: To comparing the accuracy of pedicle screw placement in posterior surgery for adult degenerative scoliosis (ADS) between robotic-assisted and traditional freehand techniques. Methods: This retrospective study included 92 patients with ADS who underwent posterior spinal surgery at the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) between March 2019 and December 2023. There were 19 males and 73 females with a mean age of (63.6±9.8) years. The patients were divided into two groups based on the technique used for pedicle screw placement: robot-assisted group (34 cases) and manual group (58 cases). Operative duration, intraoperative blood loss, facet joint violation, postoperative complications, magnitude of curve correction, visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores preoperatively, 1 week postoperatively, and 1 month postoperatively were compared and analyzed between the two groups. The Gertzbein-Robbins classification criteria was used to assess the accuracy of screw placement. Results: Differences in baseline data, operative duration, intraoperative blood loss, magnitude of curve correction, and VAS and ODI scores preoperatively, 1 week postoperatively, and 1 month postoperatively between the two groups exhibited no statistically significant differences (all P>0.05). The accuracy of pedicle screw placement in the robot-assisted group was significantly higher than that in the manual group [90.9% (416/458) vs 80.1% (697/870), P<0.001]. In terms of surgical segments, in T1-T12 and L1-S1 segments, the accuracy of pedicle screw placement in the robot group were both significantly higher than those in the control group [91.5% (130/142) vs 77.8% (186/239), P=0.001; 90.3% (271/300) vs 80.8% (502/621), P<0.001]. However, no significant differences was observed in the accuracy of S2-alar-iliac (S2AI) screw placement between the two groups [90.0%(9/10) vs 93.8%(15/16), P=0.727]. Moreover, no significant differences was found in the deviation direction of the cortical screw penetration between both groups (P=0.133). Significant differences were observed in the accuracy of screw placement between the Nash Moe 2 and 3 vertebral bodies in the robot group compared with those in the control group [88.9% (88/99) vs 71.0% (115/162), P=0.001; 89.2% (83/93) vs 60.2% (68/113), P<0.001]. Additionally, the incidence and grade of facet joint violation in the manual group were both significantly higher than those in the robot-assisted group (both P<0.001). No statistically significant differences was identified in postoperative complications between the two groups (P=0.841). Conclusion: It suggests that robot-assisted pedicle screw placement in posterior surgery for patients with ADS can significantly improve the accuracy of screw placement and reduce the incidence of facet joint violation.

Pediatric obesity and adverse outcomes following deformity correction surgery for adolescent idiopathic scoliosis: A cross-sectional analysis using 2015-2019 NIS data.

Obesity in the pediatric population has been a growing medical concern over the last few decades with a prevalence of 19.7% as of 2017-2020. Obesity is a risk factor for greater scoliotic curves and failure of conservative therapy for adolescent idiopathic scoliosis (AIS). Establishing a correlation between obesity and a wide variety of adverse outcomes following scoliosis surgery can assist in the preoperative consultation with the family and proper optimization of the patient for scoliosis fusion surgery. The National Inpatient Sample (NIS) was used to access inpatient data from 2015 to 2019. Pediatric patients with idiopathic scoliosis admitted for spinal deformity correction via posterior spinal fusion of over 8 levels were identified. Patients were stratified based on the comorbid diagnosis of obesity. Variables that were significantly associated with outcomes (p < 0.05) were used in a multivariable logistic regression to control for confounders. Backwards stepwise p-value removal was used to build the final model and model fit was assessed using the area under the curve. A total of 855 obese and 17,285 non-obese pediatric patients undergoing posterior instrumented fusion for scoliotic deformity correction were identified. The obese group was associated with a higher rate of SSI (0.6% vs 0.1%, p < 0.001), UTI (1.2% vs. 0.3%, p < 0.001), and AKI (0.6% vs 0.1%, p = 0.12) compared to the normal BMI group. Obese patients were also more likely to have a non-routine discharge when compared to non-obese (4.7% vs. 2.3%, p < 0.001). The rate of having more than one complication occurring postoperatively was higher in the obese group, however, this finding was not significant (0.6%, vs 0.4%, p = 0.385). On multivariate regression analysis, obesity was positively associated with SSI (OR = 2.758, CI = 0.999-7.614, p = 0.050), UTI (OR = 2.221, CI = 1.082-4.560, p = 0.030), non-routine discharge (OR = 1.515, CI = 1.070-2.147, p = 0.019), and an extended LOS (OR = 1.869, CI = 1.607-2.174, p < 0.001). Obesity was associated with postoperative blood transfusion, SSI, UTI, increased length of stay, and non-routine discharge after pediatric AIS deformity surgery. In addition to the increased morbidity seen in obese patients, we also identified the significantly increased cost of care for this group when compared to non-obese patients. These data should be used for a robust preoperative risk assessment and evidence for BMI optimization prior to deformity correction for AIS.

Impact of landmark crater creation on improving accuracy of pedicle screw insertion in robot-assisted scoliosis surgery.

This study evaluated the impact of the Landmark Crater (LC) method on pedicle perforation rates in robot-guided surgery for pediatric scoliosis for each pedicle diameter. Seventy-six scoliosis patients underwent robot-assisted posterior spinal fusion. The cohort consisted of 19 male and 57 female patients, with a mean ± standard deviation age of 17.5 ± 7.7 years and a preoperative Cobb angle of 57.0 ± 18.5°. The LC method is a method in which craters that serves as a landmark are created in advance at the planned PS insertion site of all pedicles within the intraoperative CT imaging area. The patients were divided into the LC group, in which PS insertion was performed using the LC method, and the control group using the conventional PS insertion method. Overall and pedicle perforation rates for each pedicle outer diameter were compared between the groups by Fisher's exact test. The LC group exhibited a significantly lower pedicle major perforation rate than did the control group (2.7% vs. 6.2%, P = 0.001). The perforation rates in pedicles with a pedicle outer diameter > 6mm, 4-6mm, 2-4mm, and < 2mm were 0.61%, 1.6%, 5.1%, and 21%, in the LC group and 0.75%, 4.1%, 12%, and 50% in the control group, respectively. In robot-assisted surgery for pediatric scoliosis, the LC method enabled significantly lower pedicle perforation rates over the conventional method. Both the LC and conventional methods exhibited higher perforation rates for smaller pedicle diameters.

Comparison between the intraoperative CT O-arm and C-arm related to radiation dose and accuracy in scoliosis surgery: A review study

Pedicle screw placement is a vital scoliosis therapy operation that aims to address spinal abnormalities while avoiding consequences including neurological damage caused by misplaced screws. Accurate imaging is required for precise screw insertion, with intraoperative CT (O-arm) and fluoroscopy (C-arm) being the principal modalities used. This review assesses various modalities based on their radiation dosages and accuracy. It comprises research published between 2012 and 2020 that evaluates both effective dose and accuracy for pediatric and adult patients. According to the review, the O-arm outperforms the C-arm in terms of accuracy, resulting in shorter procedure times for both pediatric and adult patients. The O-arm's sophisticated 3-D imaging capacity enhances screw insertion accuracy, reducing the likelihood of problems and the need for additional procedures. Furthermore, using pediatric low-dose protocols and techniques like the Detachable Pedicle Marker and Probe (DPMPs) with pulsed fluoroscopy can reduce radiation exposure while still ensuring precise screw placement. The review suggests that the O-arm has considerable advantages over the C-arm, such as improved image quality and lower radiation risk. This leads to enhanced patient safety and procedural outcomes. Overall, the O-arm's capacity to produce high-quality 3-D pictures makes it an invaluable tool in pedicle screw insertion, resulting in more accurate surgical outcomes and reducing the risk of problems associated with spinal deformity repairs.

ID: 335829 Peripheral Nerve Stimulation for Intractable Back Pain after Spinal Fusion Surgery for Scoliosis

ID: 335829 Peripheral Nerve Stimulation for Intractable Back Pain after Spinal Fusion Surgery for Scoliosis

A retrospective study of anesthesia management in patients operated for neuromuscular scoliosis

Objective: Scoliosis frequently develops as a complication of neuromuscular diseases, often progressing and necessitating surgical intervention. Although complications can arise in spinal fusion surgery for all types of scoliosis, they are more frequent during and after the procedure in cases of neuromuscular scoliosis. This retrospective study aims to explore the preoperative characteristics, anesthesia protocols, as well as intra- and postoperative complications and associated conditions in patients who underwent surgery for neuromuscular scoliosis at our hospital.Material and Methods: After receiving approval from the ethics committee of our hospital, this study conducted a retrospective review of patient files from individuals who underwent surgery for neuromuscular scoliosis at Ankara Training and Research Hospital between 2008 and 2012. A total of 26 patient files were analyzed. Patient parameters including age (years), gender (female (F), male (M)), weight (kg), presence of neuromuscular disease, concomitant cardiovascular and respiratory conditions, as well as other systemic anomalies and diseases, spirometry findings (FEV1, FVC, FEV1/FVC), nutritional status (total protein, albumin), pre-operative hemoglobin (Hg) and hematocrit (Htc) levels, Cobb angle index, angle direction, type of surgical approach (anterior or posterior), muscle relaxants utilized, additional dosage requirements, operation duration, intraoperative bleeding volume (ml), transfusion volume (ml), and intraoperative complications were documented. Results: As the Cobb angle increased, several factors were affected: the duration of the operation was extended (p &lt; 0.05), there was an increase in blood loss (p = 0.012), and more blood transfusions were required (p = 0.32). Furthermore, there was a correlation between increasing age and the amount of blood transfused (p = 0.035). Conclusion: It has been concluded that a comprehensive preoperative assessment is crucial, as it can offer valuable insights into anesthesia management both before and after surgery for scoliosis. Therefore, conducting a detailed preoperative evaluation is essential for patients undergoing these procedures

Association of single bolus versus bolus followed by infusion of tranexamic acid with blood loss in adolescent idiopathic scoliosis surgery

BackgroundAdolescent idiopathic scoliosis (AIS) corrective surgery may involve significant blood loss and blood transfusion requirements. Antifibrinolytic agents such as tranexamic acid (TXA) have been used to reduce blood loss, but its optimal dose is uncertain. The objective of this study is to determine the estimated blood loss and rate of blood transfusion between two groups of AIS patients receiving TXA as a single bolus versus bolus followed by infusion in scoliosis surgery.MethodsThis was a retrospective analysis of a single bolus versus bolus followed by infusion of TXA in AIS surgery. AIS patients undergoing posterior spinal fusion (PSF) from December 2018 to September 2019 at a tertiary university hospital were identified. Inclusion criteria were patients aged between 10 and 21 years who received either a single bolus of 30 mg/kg TXA (Group A) or a single bolus of 30 mg/kg followed by continuous infusion of 10 mg/kg/h of TXA (Group B). Patient demographics, operative data, estimated blood loss, blood transfusion rate, and complications were recorded.ResultsA total of 129 AIS patients were included. All operative surgeries were performed by two senior consultants. The mean age was 14.8 ± 3.4 years old, and 89.1% were female. The Cobb angle, number of fusion levels, number of screws, length of skin incision, and duration of surgery were comparable between the two groups. There was no difference in the total estimated blood loss between the two groups: 723.3 ± 279.4 mL (range: 175.0–1607.0 mL) in Group A and 819.4 ± 302.6 mL (range: 330.0–1556.0 mL) in Group B (p = 0.065). There were no complications, and none received blood transfusion.ConclusionTXA when administered as a single bolus or bolus followed by infusion in AIS patients undergoing PSF surgery was associated with similar estimated total surgical blood loss and blood transfusion requirement.

Controlling the Apex in Early Onset Scoliosis Through Active Apex Correction (APC) Non Fusion Growth Modulating Technique, Is It a Myth?

A multicenter retrospective study. To determine the rate of Apex facet fusion in children with Early Onset Scoliosis treated surgically with the Active Apex Correction (APC) technique. Seventeen patients were treated with the APC technique as index surgery for Early Onset Scoliosis with more than 1year of follow-up. A 3D CT scan was done to determine the facet fusion rate in the deformity's apex controlled with posterior tethering. The average follow-up time was 26.4months (12-56), Average age at index surgery was 81.2months (30-132), and average number of surgeries done 1.3. Apical vertebrae studied for facet fusion were the 3 vertebrae in the apex in each patient that were subjected to posterior tethering according to the APC technique. In total they were 86 apical vertebrae (172 Facets studied with 86 convex side, 86 concave side). Our observations showed that 29 facet joints were fused (16% of the total facets studied),15 were on the convex, 14 on the concave side (no statistically significant difference). Regarding the facet joint distance in the non-fused facets was 0.99mm on the convex side and 1.08mm on the concave side with no statistical significance difference. APC for Early Onset Scoliosis achieves apical growth modulation and control utilizing posterior tethering without inducing fusion. This study demonstrated that APC is an effective non-fusion technique through the low incidence of facet fusion levels at the Apex, limiting the crankshaft phenomena seen in cases with apex control through arthrodesis.

Risk-Adapted Use of Vancomycin in Secondary Scoliosis Surgery May Normalize SSI Risk in Surgical Correction of High-Risk Patients.

Introduction: Intrawound application of vancomycin is becoming increasingly controversial for the prevention of surgical site infection (SSI). As children undergoing spinal fusion for secondary scoliosis are at high risk for SSIs, evidence regarding the impact of intraoperative vancomycin installation on SSI rates in these patients is of utmost importance. Methodology: A single surgeon cohort of patients under 18 years of age undergoing surgery for secondary scoliosis in 2017 was analyzed with regard to the development of SSIs requiring surgical revision and adverse events. Use of vancomycin was restricted to cases with higher risk of infection. Patients undergoing distraction surgery for growing devices were excluded. Results: After exclusions, 64 patients remained (vancomycin n = 39, control n = 25). The SSI rates were 12.8% in patients receiving vancomycin (n = 5/39) and 4% in the control group (n = 1/25, p = 0.785). None of the patients suffered from adverse events. Univariable logistic regression revealed younger age (p = 0.03) and meningomyelocele as predictors for SSI (p = 0.006), while the high-risk group receiving vancomycin was not at higher odds for SSI, also after adjustment for possible confounders such as age or MMC (p = 0.031; p = 0.009). Discussion: SSI rates were comparable between groups, suggesting a normalization of SSI risk in the vancomycin-treated patients with a preoperatively increased risk of SSI. Future, larger studies in these rare diseases are needed to confirm these results.

Racial and ethnic differences in transfusion rates in adolescent scoliosis surgery: Preoperative anemia as a mediator of disparity

AbstractBackgroundPediatric patients from minoritized racial and ethnic groups receive red blood cell (RBC) transfusions more frequently while undergoing major surgical procedures. Our objective was to identify the contribution of preoperative anemia to racial and ethnic differences in RBC transfusion rates in adolescent spine surgery.Study Design and MethodsThis is a multicenter, retrospective cohort study of the National Surgical Quality Improvement Program Pediatric database, 2016 to 2021 for patients in the United States and Canada.ResultsAdolescents identifying as non‐Hispanic Black, Hispanic, and other race/ethnicity presented with higher rates of preoperative anemia than non‐Hispanic White adolescents (16.3%, 10.6%, and 9.9%, vs. 7.8%, respectively; p &lt; .0001) and were transfused at higher rates (14.4%, 11.9%, 16.5%, vs. 10.0%, respectively; p &lt; .0001). Minoritized groups demonstrated higher adjusted odds of RBC transfusion compared with non‐Hispanic Whites (non‐Hispanic Black: aOR 1.45 95% CI 1.26–1.65, Hispanic: aOR 1.17 95% CI 0.96–1.41, other race/ethnicity: aOR 1.63 95% CI 1.26–2.09). Of the total effect of minoritized race and/or ethnicity on RBC transfusion, 13.9% was attributed to the indirect effect through preoperative anemia.DiscussionIn this cohort study, patients from minoritized racial and ethnic groups received RBC transfusions at a higher rate than non‐Hispanic White patients, and the difference was partially mediated by preoperative anemia. Future efforts to minimize transfusions and improve health equity should target this modifiable risk factor alongside other sources of disparity and discrimination.

Letter to the Editor Regarding “Effectiveness of the Bilateral and Bilevel Erector Spinae Plane Block in Pediatric Idiopathic Scoliosis Surgery: A Randomized, Double-blinded, Controlled Trial”

Letter to the Editor Regarding “Effectiveness of the Bilateral and Bilevel Erector Spinae Plane Block in Pediatric Idiopathic Scoliosis Surgery: A Randomized, Double-blinded, Controlled Trial”

Spinal deformity surgery in Scheuermann's kyphosis versus adolescent idiopathic scoliosis: meta-analysis of complications and clinical outcomes.

Surgical management of adolescent idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) may be associated with several complications including extended length of stay and unplanned reoperations. Several studies have previously compared postoperative complications and functional outcomes for AIS and SK patients with mixed results. However, a meta-analysis compiling the literature on this topic is lacking. Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1-20) were accessed and explored until April 2024. The extracted data consisted of complications (overall and surgical-site infections [SSI]), readmissions, reoperations, and Scoliosis Research Society-22 (SRS-22) score. Mean differences (MD) with 95% CI were used for continuous data and odds ratio (OR) was utilized for dichotomous data were calculated across studies. Seven retrospective articles were included in the meta-analysis, including 4866 patients, with 399 in the SK group and 4467 in the AIS group. SK patients were found to have statistically significantly higher rates of overall complications (OR = 5.41; 95% CI 3.69-7.93, p < .001), SSI (OR = 11.30; 95% CI 6.14-20.82, p < .001), readmissions (OR = 2.81; 95% CI 1.21-6.53, p = 0.02), and reoperations (OR = 7.40; 95% CI 4.76-11.51, p < .001) than AIS patients. However, they had similar SRS-22 scores postoperatively (MD = -0.06; 95% CI -0.16 to 0.04, p = 0.26) despite the SK group having lower SRS-22 scores preoperatively (MD = -0.30; 95% CI -0.42 to -0.18, p < .001). In this meta-analysis of studies comparing spinal deformity surgery outcomes in AIS and SK patients, SK was associated with more complications, readmissions, and reoperations. SK did have equivalent SRS-22 scores postoperatively to AIS patients, highlighting the benefit of surgical treatment despite higher complication rates. This data may help inform healthcare institutions, payors, and quality monitoring organizations who examine outcomes of pediatric and adult spinal deformity surgery.

Characterization of SMA type II skeletal muscle from treated patients shows OXPHOS deficiency and denervation.

Spinal muscular atrophy (SMA) is a recessive developmental disorder caused by the genetic loss or mutation of the gene SMN1 (survival of motor neuron 1). SMA is characterized by neuromuscular symptoms and muscle weakness. Several years ago, SMA treatment underwent a radical transformation, with the approval of 3 different SMN-dependent disease-modifying therapies. This includes 2 SMN2 splicing therapies - risdiplam and nusinersen. One main challenge for type II SMA patients treated with these drugs is ongoing muscle fatigue, limited mobility, and other skeletal problems. To date, few molecular studies have been conducted on SMA patient-derived tissues after treatment, limiting our understanding of what targets remain unchanged after the spinal cord-targeted therapies are applied. Therefore, we collected paravertebral muscle from 8 type II patients undergoing spinal surgery for scoliosis and 7 controls. We used RNA-seq to characterize their transcriptional profiles and correlate these molecular changes with muscle histology. Despite the limited cohort size and heterogeneity, we observed a consistent loss of oxidative phosphorylation (OXPHOS) machinery of the mitochondria, a decrease in mitochondrial DNA copy number, and a correlation between signals of cellular stress, denervation, and increased fibrosis. This work provides new putative targets for combination therapies for type II SMA.