Corrective Spinal Surgery Research Articles

Is it possible to return to skiing following long-construct spinal deformity surgery?

Alpine skiing requires flexibility, endurance, strength and rotational ability, which may be lost after long fusions to the pelvis for adult spinal deformity (ASD). ASD patients may worry about their ability to return to skiing (RTS) postoperatively. There is currently insufficient data for spine surgeons to adequately address questions about when, or if, their patients might RTS. Patients with a history of spinal fusion to pelvis from T10 or higher were screened for skiing participation during the November 2023-April 2024 season. Adolescent and adult patients ≥12years old with >2-year minimum follow-up who were recreational skiers (skied ≥5 times in their life and ≥1 time in the 5years prior to their surgery) provided the following metrics: visual analogue scale (VAS) pain level, self-perceived ski ability, highest slope difficulty comfort level, ski runs completed per day, days skied per year, pain while skiing, participation in pre- or postoperative physical therapy (PT), and satisfaction. Predictive factors for ability to RTS were evaluated. Scoliosis Research Society-22 (SRS-22) and Oswestry Disability Index (ODI) scores were collected at baseline, one year postoperatively, and final follow-up (FFU). Twenty six skiers from 2015-2023 were included (age 56.5 ± 15.2years, BMI 23.8 ± 4.2kg/m2, female composition 85.6%, follow-up 5.3 ± 1.8years). 42.3% (n = 11) patients returned to ski at an average of 2.6 ± 1.6years. Patients who returned to ski maintained or improved their performance in the following metrics: 72.7% (n = 8) in self-assessed ski ability, 72.7% (n = 8) in slope difficulty comfort level, 63.6% (n = 7) in number of ski runs per day, 81.8% (n = 9) in number of days skied per year, and 81.8% (n = 9) in pain while skiing. Pain scores improved from baseline to FFU: VAS (7.1 ± 1.9 vs 1.8 ± 1.9; p < 0.01), SRS (71.8 ± 8.6 vs 89.9 ± 14.5; p < 0.01), ODI (30.8 ± 13.1 vs 13.4 ± 14.1; p < 0.01). Age, sex, BMI, surgical history, self-assessed ski ability, baseline pain scores and PT participation were not predictive of ability to RTS. This was the first in-depth analysis of RTS after corrective spine surgery. Almost half of the skiers returned to skiing after long-construct fusion to pelvis, and the majority reported similar or improved performance based on their slope ratings, runs skied per day, days skied per year, pain while skiing, and overall self-assessment. Mean pain and quality of life scores improved significantly for the whole group. ASD patients who RTS can reasonably expect equal or improved performance following spine surgery compared to their presurgical ability.

Understanding the pros and cons of spine surgery for ankylosing spondylitis: experience from a single institution study

IntroductionAnkylosing Spondylitis (AS) presents a complex inflammatory condition with significant impact on patients’ lives. Despite advancements in understanding its pathogenesis, comprehensive elucidation remains elusive. This study investigates the outcomes of corrective spine surgery in AS patients, aiming to optimize management strategies.MethodsA retrospective cohort study was conducted, including 28 AS patients undergoing corrective surgery from 2016 to 2021. Surgical procedures primarily targeted realignment of the spine to alleviate deformities.ResultsRadiological evaluations pre- and post-operatively revealed substantial improvements in sagittal balance and kyphosis correction. The mean correction of local kyphosis at the osteotomy site was 30.9 degrees. Minor surgical complications, though present, were managed effectively.ConclusionWhile acknowledging surgical complexities and potential complications, meticulous patient selection and appropriate techniques mitigate risks. This study emphasizes the pivotal role of surgical intervention in improving quality of life, particularly by addressing sagittal vertical axis and forward gaze disorders.

Effect of romosozumab administration on proximal junctional kyphosis in corrective spinal fusion surgery.

The effect of romosozumab administration in patients undergoing corrective spinal fusion surgery has not yet been analyzed. To examine the effect of romosozumab administration on reducing the incidence of proximal junctional kyphosis (PJK), particularly PJK due to fractures (PJK-Fx), in patients undergoing spinal corrective fusion surgery. Retrospective cohort study PATIENT SAMPLE: A total of 111 patients aged >50 years underwent corrective fusion surgery (>2 vertebrae) for adult spinal deformity or vertebral compression fracture between June 2010 and July 2023. The primary outcome was the incidence of PJK, whereas the secondary outcomes were changes in Hounsfield unit (HU) values, surgical complications, and clinical outcomes measured using the Japanese Orthopaedic Association (JOA) and visual analog scale scores. The patients were divided into the romosozumab (n=32) and non-romosozumab groups (n=79). Romosozumab was typically administered 2 months before surgery in the romosozumab group. Demographic data, surgery-related factors, and radiographic parameters were analyzed. HU values at the upper instrumented vertebra+1 (UIV+1) were measured preoperatively and at 1 year postoperatively. After the univariate analysis of preoperative factors associated with PJK, multivariate logistic regression was used to identify factors associated with PJK. Romosozumab significantly increased the HU values at UIV+1 (-1.22% vs. 13.60%, p<0.001) and reduced the incidence of PJK (39.24% vs. 18.75%, p=0.046), particularly PJK-Fx (26.58% vs. 6.25%, p=0.019) and osteoporosis-related complications (55.70% vs. 34.38%, p=0.011). The multivariate analysis showed a significantly lower incidence of PJK (adjusted odds ratio = 0.32, p=0.033), particularly PJK-Fx (adjusted odds ratio = 0.15, p=0.018). There was a tendency for better JOA scores at 1 year postoperatively in the romosozumab group (21.49 vs. 23.62, p=0.071). Romosozumab administration effectively increased bone density and reduced the risk of PJK, particularly PJK-Fx, and osteoporosis-related complications in patients undergoing corrective spinal fusion surgery. Administration of romosozumab 2 months before surgery enhanced bone mineral density and strength, leading to better surgical outcomes and fewer complications. Further long-term studies are needed to confirm these findings and optimize treatment protocols.

A comparative study of the data of intraoperative neurophysiological monitoring in the surgical correction of severe scoliosis with and without preoperative halo-traction

BACKGROUND: The use of intraoperative neurophysiological monitoring (IONM) during corrective spinal surgery is the gold standard. Maintaining the integrity of the nervous system during surgery is importance. We use various types of halo-traction in the preoperative period in patients with severe scoliotic spinal deformities also to reduce the risk of neurological complications. A comparative study of changes in IONM during operations to correct scoliosis in patients who underwent preoperative halo-gravity training and without it was conducted. AIM: A comparative analysis of the results of IONM during surgery to correct scoliosis with and without preoperative halo-gravity traction. MATERIALS AND METHODS: An observational monocenter retrospective uncontrolled study of the results of IONM was conducted in 88patients with severe scoliotic deformities who received surgical treatment to correct scoliosis using halo-traction. The patients were divided into 2groups. GroupI (52people) received halo-gravity traction as preoperative preparation. GroupII (36people) was operated under conditions of intraoperative halo-traction. A comparative analysis of signaling criteria with the threat of developing neurological deficit of the lower extremities during surgery, the values of the deformation angles before and after surgery, mobility indicators, the volume of blood loss and the time of surgery was performed. RESULTS: An intergroup comparison of the obtained parameters of changes in deformation angles, IONM data revealed that in group I patients had a more pronounced deformation in terms of the angles, their greater rigidity and a smaller number of patients with a normal indicator of the level of MEP, which is statistically reliably confirmed (p0.05). In 12patients signaling criteria with the threat of developing neurological deficits were registered: 7 in groupI, 5 in groupII. In two patients of group II, the recovery of the MEP indicators of the lower extremities did not occur and permanent neurological deficit could not be avoided. CONCLUSION: Preoperative halo-traction makes it possible to prepare nerve structures for the correction of severe deformities and reduce intraoperative effects on the nervous system, reducing the risks of neurological complications in patients with severe spinal deformities compared with simultaneous correction in conditions of intraoperative traction.

Risk factors for postoperative ileus after corrective spinal surgery: association with reduction in the retrocrural space area.

The objective of this study was to determine whether a reduction in the retrocrural space (RCS) area is a risk factor for postoperative ileus (POI) in patients with adult spinal deformity (ASD) treated with spinal corrective surgery. In total, 100 patients (mean age 67.5 ± 8.3 years, 9 males and 91 females) with ASD treated with spinal corrective surgery were included in this study. Spinal parameters, including thoracolumbar kyphosis (TLK), and RCS area were measured pre- and postoperatively. The change (Δ) in spinal parameters was calculated. The percent change between pre- and postoperative RCS areas was calculated as ΔRCS. Patients were identified as having POI if they exhibited both gastrointestinal symptoms and radiographic findings. Each parameter was compared between patients with and without POI. Multivariable logistic regression analysis was performed with development of POI as the dependent variable. The incidence of POI was 11.0%. The RCS area was significantly smaller in the POI group than in the non-POI group (p < 0.001). Multivariable logistic regression analysis revealed that ΔTLK and ΔRCS were risk factors for POI (p = 0.029 and p = 0.033, respectively). A reduction in the RCS area is a risk factor for the development of POI after corrective spinal surgery in patients with ASD. Overcorrection of the thoracolumbar junction should be avoided to prevent POI.

Visual Loss after Scoliosis Surgery: What Do Surgeons and Patients Need to Know? Three Case Reports.

Visual deficit after spinal surgery is rare but tragic. The main causes include external eye injury, cortical blindness, central retinal artery occlusion, and ischemic optic neuropathy. In scoliosis surgery, this complication potentially arises from prolonged surgical time, high blood loss, prone position, hydroelectrolytic imbalance, and cerebrospinal fluid loss. In 849 scoliosis correction surgeries, 3 patients developed postoperative visual deficits: 2 achieved complete visual acuity recovery, but 1 remained with partial sequelae. There are four causes of postoperative amaurosis: ischemic optic neuropathy, central retinal artery occlusion, external eye injury, and cortical blindness. Since the prevention of this complication cannot be assured, it is essential to explain the risk of visual deficits to patients undergoing scoliosis surgery, who must sign the informed consent form. Visual loss after spinal surgery for scoliosis correction is a rare but severe and, sometimes, irreversible complication. The surgical team must know about this possibility in order to adopt preventive measures and reduce its incidence.

Development of the scoliosis research society spinal deformity surgery safety checklist.

Spine deformity surgery is a complex multi-step procedure that has a relatively high complication rate. The use of surgical safety checklists has been shown to reduce perioperative adverse events, but existing lists are varied and non-specific for spinal deformity surgery. Thus, the purpose of this study was to develop a comprehensive surgical checklist for complex spinal corrective surgery. An electronic survey consisting of 187 surgical checklist items that had been developed and used by a group of SRS members over a 5-year period was distributed to the Scoliosis Research Society Safety and Value Committee membership. The survey sections included: (1) pre-operative area, (2) initial operating room visit, (3) before turning, (4) positioning, (5) prepare and drape, (6) pre-incision timeout, (7) intraoperative, (8) finishing implant placement and confirming imaging, (9) final rods and locking, (10) prior to closure, (11) closure, (12) turn to supine, and (13) checkout/debriefing. Respondents graded each item on a five-point Likert scale based on their perceived importance and feasibility for inclusion in the checklist. Features graded as "moderately important" or "very important" to include by at least 70% of respondents were considered to meet the cutoff for inclusion-based standard Delphi practices. Study data were collated using REDCap. A total of 25 surgeons completed the survey in its entirety. The overall checklist "package" was shortened to 9 individual checklist modules, with 2 to 16 items per checklist. In terms of individual checklist items, 40% of items (74 of 187) met the cutoff for inclusion; 17 of these items were graded as "very important," which included verifying the presence of implantable devices, reviewing the surgical plan and positioning with the surgical staff, securing the endotracheal tube, bite block confirmation, prone and lateral positioning, neuromonitoring baseline readings, double-checking that the implant screw caps were locked prior to closure, and confirming that the patient was moving bilateral lower extremities before leaving the operating room when possible. This study has led to the development of a specific spinal deformity surgical checklist of 74 (many specific to spine surgery) items that were considered important for inclusion; 17 were considered "very important".

Factors Associated with Early Postoperative Pain after Lateral Lumbar Interbody Fusion

Despite that lateral lumbar interbody fusion (LLIF) is a minimally invasive surgery, some patients complain of severe site pain immediately after the surgery. This study aimed to explore the extent of perioperative pain after LLIF, compare the degree of perioperative pain after LLIF with that after other surgical procedures, and evaluate the factors associated with severe pain in the early postoperative period. In this study, 93 patients who underwent lumbar spine surgeries for lumbar degenerative diseases were analyzed. The patients were categorized into three groups based on the surgical procedure: Group L, LLIF with percutaneous pedicle screw (PPS); Group P, posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF); and Group D, posterior decompression (fenestration). The extent of low back pain was evaluated using the visual analog scale (VAS) preoperatively and from postoperative days 1 to 14. The VAS score for postoperative pain decreased in a time-dependent manner in all three groups (P<0.01). Repeated measures analysis of variance (ANOVA) showed that the VAS in Group L was significantly higher than that in Group D (P<0.01). Time point analysis revealed that the VAS scores from postoperative days 1 to 9 in Group L were significantly higher than those in Group D (P<0.05). No significant difference was observed in the VAS scores of postoperative pain between Groups L and P on all postoperative days. The VAS score for early postoperative pain in Group L was significantly correlated with the change in disc height index (P<0.05, r=0.43) and tended to be associated with the grade of preoperative disc degeneration and the VAS score of preoperative low back pain (P=0.076-0.19). This study is the first to evaluate the factors associated with pain during the early postoperative period of LLIF. Although LLIF is a minimally invasive surgery, severe pain may develop in patients with significant preoperative disc degeneration or following spinal correction surgery.

Clinical Significance of Pose Estimation Methods Compared with Radiographic Parameters in Adolescent Patients with Idiopathic Scoliosis

Human pose estimation, a computer vision technique that identifies body parts and constructs human body representations from images and videos, has recently demonstrated high performance through deep learning. However, its potential application in clinical photography remains underexplored. This study aimed to establish photographic parameters for patients with adolescent idiopathic scoliosis (AIS) using pose estimation and to determine correlations between these photographic parameters and corresponding radiographic measures. We conducted a study involving 42 patients with AIS who had undergone spinal correction surgery and conservative treatment. Preoperative photographs were captured using an iPhone 13 Pro mounted on a tripod positioned at the head of an X-ray tube. From the outputs of pose estimation, we derived five photographic parameters and subsequently conducted a statistical analysis to assess their correlations with relevant conventional radiographic parameters. In the sagittal plane, we identified significant correlations between photographic and radiographic parameters measuring trunk tilt angles. In the coronal plane, significant correlations were found between photographic parameters measuring shoulder height and trunk tilt and corresponding radiographic measurements. The results suggest that pose estimation, achievable with common mobile devices, offers potential for AIS screening, early detection, and continuous posture monitoring, effectively mitigating the need for X-ray radiation exposure. Level of Evidence: 3.

Magnetic resonance imaging evaluation of the cerebellar tonsil position before and after posterior spinal fusion in adolescent idiopathic scoliosis.

Chiari malformation type I(CM-I) is one of the most common neurological malformations observed in patients with adolescent idiopathic scoliosis (AIS). It remains uncertain whether AIS patients without neurological symptoms require CM-I decompression before undergoing spinal corrective surgery to prevent cerebellar tonsil herniation and potential neurological complications. This study aims to assess variations in the position of the cerebellar tonsil after posterior spinal fusion (PSF) in neurologically intact patients with AIS. We retrospectively evaluated 40 patients with AIS who underwent posterior spinal fusion (PSF) without neurological symptoms. Sagittal hindbrain MRIs were performed before and after spinal surgery. The cerebellar tonsil's position relative to the foramen magnum was measured using the method described by Aboulezz (J Comput Assist Tomogr 1985). We assessed variations in the cerebellar tonsil position concerning spinal correction and elongation after PSF. The average preoperative magnitude of the scoliotic curve was 53.15 degrees (SD 10.46 degrees), and that of thoracic kyphosis was 35.42 degrees (SD 12.38 degrees). In the immediate postoperative period, the average magnitudes were 7.45 degrees (SD 7.33 degrees) and 27.87 degrees (SD 9.03 degrees), respectively. The average correction achieved with PSF was 86% in the coronal plane (p < 0.00001). The average length of the spine in the coronal plane was 44.5cm (SD 5.25cm) preoperatively and 48.27cm (SD 4.40cm) postoperatively (p < 0.00001). The average length of the vertebral column in the sagittal plane was 50.87cm (SD 4.47cm) preoperatively and 55.13cm (SD 3.27cm) postoperatively (p < 0.00001). No significant difference was observed in the position of the cerebellar tonsil in the measurements taken before and after spinal deformity correction (p = 0.6042). In 10 out of 40 patients, caudal displacement of the cerebellar tonsil was observed after PSF. In 28 patients, no variation in the position of the cerebellar tonsil was observed, and in 2, cephalic displacement was noted. In AIS patients with a normal position of the cerebellar tonsil undergoing posterior spinal fusion, there is no significant change in their positionafter surgery. Our analysis did not reveal any correlation between curve correction, spine elongation, and variations in the cerebellar tonsil position. The position of the cerebellar tonsil remained largely unchanged after PSF in AIS patients without neurological symptoms. Further studies would be necessary to determine whether surgical decompression is required in asymptomatic patients with CM-I before undergoing surgery to correct spinal deformity.

Severe stress cardiomyopathy following spinal corrective surgery for scoliosis complicated with pectus excavatum: a case report

BackgroundStress cardiomyopathy (SCM) is an acute heart failure syndrome characterized by transient, usually reversible left ventricular systolic dysfunction with normal or enhanced basal compensatory wall motion abnormalities involving the left ventricular anterior septum and apex, resulting in a “ballooning” appearance. However, it has rarely been reported in patients undergoing spinal surgery.Case presentationWe report a case of severe stress cardiomyopathy in a scoliosis patient with pectus excavatum who underwent spinal corrective surgery. During the wake-up period, circulatory collapse occurred. After multidisciplinary consultation, the patient was diagnosed with stress cardiomyopathy. At last, she had a good prognosis after a series of treatments including ECMO.ConclusionStress cardiomyopathy is a reversible but uncommon condition. It can cause death if it is not diagnosed in time. Consequently, this report should improve the awareness of orthopedists and anesthesiologists for timely identification and management. For patients with potential risk factors, timely preoperative intervention should be performed to reduce the occurrence of stress cardiomyopathy.

Patient-perceived factors on treatment satisfaction in early onset scoliosis treated surgically with a minimum of ten years

BackgroundThe prognosis of surgically treated subjects with early onset scoliosis (EOS) into adulthood has been lacking. We aimed to investigate the patients’ perspectives on satisfaction with surgical treatment.MethodologyWe included all surgical candidates with EOS who had undergone index spinal surgery for scoliosis correction between 2009 and 2013. The minimum duration of postoperative follow-up was 10 years at the time of survey completion. Three questionnaires were used in this study, comprising the revised Scoliosis Research Society questionnaire (SRS-22r), the Patient-Reported Outcomes Measurement Information System (PROMIS-29), and the World Health Organization Quality of Life (WHOQOL-BREF). Measures of treatment satisfaction were retrieved from SRS-22r.ResultsThere were 29 participants who completed the survey, and thereby included in the study (i.e., a response rate of 43% and a dropout rate of 6%). Amongst them, 14, 11, and 4 individuals received posterior spinal fusion (PSF), magnetically controlled growing rods (MCGR), and traditional growing rods, respectively. The average duration after the index spinal surgery was 12.6 ± 2.2 years. Our findings revealed that self-image (across all treatment groups), sleep disruption (only in PSF), and social aspects (in both PSF and MCGR) were significantly worse when compared to the normative values. According to the multivariable linear regression model (R-square = 0.690, p < .001), an increase in SRS-22r mental health (p = .008) and PROMIS-29 social participation scores (p = .004) corresponded to 0.511 and 0.055 points increases in satisfaction. Every unit increase in PROMIS-29 fatigue (p = .043) and WHOQOL-BREF physical domain scores (p = .007) was in conjunction with 0.019 and 0.040 points decreases in satisfaction. SRS-22r self-image (p = .056) and WHOQOL-BREF environmental domain scores (p = .076) were included in the model but did not reach statistical significance.ConclusionsTo improve the long term quality of life in surgical candidates with EOS, we demonstrated that mental health, social participation, fatigue, and physical health were significant factors associated with treatment satisfaction. Interestingly, demographic and radiographic parameters did not have a significant effect in our cohort.

Optimizing preoperative bone health assessment for adult spinal deformity: a prospective correlation analysis of intraoperative pedicle screw insertion torque and imaging modalities in Japan.

Prospective cohort study. This study aimed to identify the optimal preoperative bone health assessment for adult spinal deformity (ASD) surgery through correlation analysis between intraoperative pedicle screw (PS) insertion torque and various bone quality measures, including bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DEXA), Hounsfield unit (HU) by computed tomography (CT), and vertebral bone quality (VBQ) score by magnetic resonance imaging. Existing data on optimal assessment tools for ASD surgery are limited. The study included patients with ASD aged >60 years who underwent spinal corrective fusion surgery from the lower thoracic spine to the pelvis. The intraoperative PS insertion torque was measured using a torque meter. Pearson correlation coefficients were calculated between the PS insertion torque and the BMD, HU, and VBQ score. Preoperative bone quality was compared between the proximal junctional failure (PJF) and non-PJF groups. Thirty-one patients with 177 PS at T10, T11, and T12 were analyzed. The PS insertion torque showed a moderate positive correlation with lumbar spine BMD (r=0.59-0.69, p<0.01), total hip BMD (0.58-0.62, p<0.01), and HU value (r=0.58-0.66, p<0.01). However, the VBQ score did not show significant correlation (r=-0.28 to -0.23, p >0.05). Notably, a strong correlation was found between the PS insertion torque and the HU value for screws of the same size (r=0.71 and 0.74, p<0.01). The HU value at T12 and the PS insertion torque at T10 were significantly lower in the PJF group than in the non-PJF group. This study demonstrates a positive correlation between the PS insertion torque and HU value in the lower thoracic spine and a moderate correlation with BMD but not the VBQ score. Preoperative assessment using DEXA and CT is crucial for optimizing bone health management in ASD surgery.

The Utility of the Surgical Apgar Score in Assessing the Risk of Perioperative Complications Following Spinal Fusion Surgery for Pediatric Patients With Scoliosis and Cerebral Palsy.

Cohort study. Validate the Surgical Apgar Score (SAS) as a means of predicting perioperative major complications occurring within 30 days after scoliosis surgery in pediatric patients with cerebral palsy (CP). A patient's SAS, which is composed of three commonly recorded intraoperative variables, predicts postoperative complications after various types of spine surgery. This has not; however, been studied in pediatric patients with scoliosis and CP, a population that experiences a high incidence of complications after corrective spinal surgery. Pediatric CP patients who underwent spinal correction surgery were included in this study. Patient background, surgical variables, and perioperative complications occurring within 30 days after surgery were collected. Patients were divided into 4 groups based on their SAS: SAS 0 to 4, SAS 5 to 6, SAS 7 to 8, and SAS 9 to 10. The incidences of perioperative complications for each group were compared using a receiver operating characteristic analysis. The area under the curve (AUC) is reported. A total of 111 patients met the inclusion criteria. There were no death cases. There were 44 (39.6%) perioperative major complications in 37 (33.3%) patients that occurred within 30 days after spine surgery. The most frequent perioperative complications were pulmonary issues (13.5%). The incidence of perioperative major complication in each SAS group was as follows: SAS 0 to 4; 51.6%, SAS 5 to 6; 30.2%, SAS 7 to 8; 18.5%, SAS 9 to 10; 0/0. When the SAS 7 to 8 group was set as the reference, there was no significant difference compared to SAS 5 to 6 ( P =0.34), while the incidence rate was significantly increased in SAS 0 to 4 ( P =0.02). The AUC was 0.65 (95% CI: 0.54-0.75). Overall, there were 37 (33.3%) patients with CP who had a major complication within 30 days after spinal surgery. Lower SAS, with the 0 to 4 group being the cutoff, were associated with significantly higher complication rates than higher SAS groups.

The impact of spinal fusion of adolescent idiopathic scoliosis in Salah (Islamic Prayer) movement: a retrospective case-control study

Background: Corrective spine surgery is widely accepted for treating severe adolescent idiopathic scoliosis (AIS). Postoperative spinal range of motion (ROM) could be affected after such surgery. In certain populations, such as Muslims, this ROM change can impact daily life, as it may affect the five-times-a-day prayer (Salah). This study aims to assess the influence of spinal fusion (SF) in Adolescent Idiopathic Scoliosis (AIS) during the daily Islamic prayer (Salah). Methods: SF-AIS patients were videoed while performing Salah prayer. The kinematic documentation was assessed and compared to Salah movements of a control group of age-matched Muslim AIS patients, who had not had surgery. The prayer quality changes were subjectively classified into improved, no change/remained, and worsened, according to the Global Perceived Effect (GPE). Functional outcome and pain were assessed by the Scoliosis Research Society Questionnaire Version 30 (SRS-30). Results: Thirty-nine women and five men (mean age±SD: 14.8±2.3 years) met the inclusion criteria, and unoperated AIS patients were used as control (twenty-two women, mean age±SD: 15.32±1.43 years). The prostrations ROM of the SF-AIS group differed significantly from the control group (p&lt;0.05). The GPE of the prayer movement showed improvement in 36.4%, no change in 59.1%, and worsening in 4.5% of the SF-AIS patients. The worsened group had a significantly lower bowing ROM and higher prostrations ROM compared to all groups of prayer quality changes (p&lt;0.05). SRS-30 scores showed good outcomes (function 4.0±0.2, pain 4.2±0.5), along with the overall bowing ROM and prostrations ROM (84.2±12.0° and 53.4±9.6°, respectively). Moreover, a significant moderate positive correlation between the bowing ROM and pain (r=0.417, p=0.007) was also found. Conclusion: Spinal fusion positively affects AIS Islamic patients in maintaining their daily Salah movement, ROM and prayer quality. Prayer quality assessment should be given extra attention as an adjuvant of the SRS-30 questionnaire to evaluate Muslim patients.

Correlation between Acetabular Anteversion with a False-Profile View and Spinopelvic Parameters in Adult Spinal Deformity after Long-Segment Corrective Spinal Surgery

Studies describing the relationship between the hip and spine have reported that corrective spinal surgery for adult spinal deformity (ASD) affects the orientation of the acetabulum. However, the extent to which spinal correction in ASD affects acetabular anteversion in the standing position is unclear, especially after total hip arthroplasty, for which dislocation is a concern. The purpose of this study was to evaluate changes in anterior acetabular coverage in the upright position due to extensive correction surgery for ASD. Thirty-six consecutive patients who had undergone spinal corrective surgery from the thoracolumbar region to the pelvis were enrolled and evaluated. The ventral-central-acetabular (VCA) angle and anterior acetabular head index (AAHI) were measured with a false-profile view to evaluate the relationship between acetabular anteversion in the standing position and spinopelvic parameters before and after surgery. The spinopelvic parameters measured included thoracic kyphosis, pelvic incidence, pelvic tilt (PT), sacral slope, lumbar lordosis (LL), sagittal vertical axis, and global tilt. The VCA angle and AAHI were significantly increased after spinal deformity correction (p<0.001). The changes in LL and PT were correlated with the VCA angle (LL: right, ρ=0.56; left, ρ=0.55, p<0.001; PT: right, ρ=-0.59; left, ρ=-0.64, p<0.001) and AAHI (LL: right, ρ=0.51; left, ρ=0.58, p<0.01; PT: right, ρ=-0.52; left, ρ=-0.59, p<0.01), respectively. Linear regression analysis revealed that a 10° increase in LL results in 1.4°-1.9° and 1.6%-2% increases in the VCA angle and AAHI, respectively. Surgical correction for ASD significantly affects sagittal spinopelvic parameters, resulting in increased acetabular anteversion. The anterior coverage of the acetabulum in the postoperative standing position could be predicted with the intraoperatively measured LL, and evaluation using a false-profile was considered useful for treating ASD, particularly in patients after total hip arthroplasty.

Effectiveness of the Bilateral and Bilevel Erector Spinae Plane Block (ESPB) in Pediatric Idiopathic Scoliosis Surgery: A Randomized, Double-Blinded, Controlled Trial.

This study aimed to compare the effect of the ultrasound-guided bilateral and bilevel erector spinae plane block (ESPB) on pain scores, opioid requirement, intraoperative motor-evoked potentials (MEPs), and stress response to surgery expressed by the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) versus standard analgesia methods following idiopathic scoliosis surgery. This was a prospective, double-blinded, randomized controlled trial. Sixty patients aged 10 to 18 years and physical status ASA 1 or 2 were randomized into 2 equal groups, each receiving an ESPB or sham block. The primary outcome was the pain scores (Numerical Rating Scale, NRS) within 48 hours after spinal correction and fusion surgery for idiopathic thoracic scoliosis. The secondary outcomes were total opioid consumption, NLR, and PLR levels at 12 and 24 hours postoperatively and intraoperative MEPs. ESPB patients presented lower NRS scores, signifying less pain, at all time points (30, 60, 90, 120 min; and 6, 12, 24, and 48 h after surgery), all P <0.0001. The total opioid consumption, the incidence of nausea or vomiting, and the need for remifentanil and propofol during surgery were significantly lower in the ESPB group. The surgery-induced stress response expressed by NLR and PLR was considerably lower in the ESPB group. ESPB did not affect the intraoperative MEP's amplitude. ESPB is effective for postoperative analgesia, can reduce opioid consumption in patients undergoing scoliosis surgery, and reduces the stress response to surgery. ESPB does not interfere with neuromonitoring. Level I.

The effect of spinal correction surgery on the tractography data of the pain pathway in scoliosis patients: a preliminary report

Study designCross-sectional study. ObjectivePain in individuals with opered scoliosis is usually evaluated with a postural analysis or questionnaire. In this study, we evaluated pain in individuals with scoliosis who underwent spinal correction surgery by tractography and compared it with individuals with non-opered scoliosis and healthy individuals. DesignFifteen healthy individuals, 15 non-operated scoliosis patients and 15 operated scoliosis patients were included in the study. MethodsAll female participants in this prospectively planned study used their right hand as the dominant hand. Bilateral tractography analysis of the pain pathways was performed with DSI Studio software using brain magnetic resonance images (MRI) of the participants. Statistical analysis of the study was performed with IBM SPSS 23.0 and p<0.05 values were considered significant. ResultsIt was observed that the tractography values of the operated scoliosis group were similar to the control group (p˃0.05). In the non-operated scoliosis group, tractography findings related to nerve conduction velocity such as fiber count, fiber ratio and axial diffusivity (AD) were found to be higher than the other two groups (p<0.05). Fractional anisotropy (FA) values of the unoperated scoliosis group were significantly different between the pain pathways projected from the right/left side of the body (p<0.05). ConclusionThe fact that the pain path tractography values of patients with scoliosis who underwent surgery were similar to those of healthy individuals may be evidence of decreased pain sensation reaching the brain. Surgery may be a good choice in the treatment of pain in patients with scoliosis.

Dysregulation of Inflammatory Pathways in Adult Spinal Deformity Patients with Frailty.

Background/Objectives: An important aspect of the pathophysiology of frailty seems to be the dysregulation of inflammatory pathways and the coagulation system. However, an objective assessment of the impact of frailty on the recovery from surgery is not fully studied. This study sought to assess how frailty affects the recovery of adult spinal deformity (ASD) surgery using blood biomarkers. Methods: 153 consecutive ASD patients (age 64 ± 10 yr, 93% female) who had corrective spine surgery in a single institution and reached 2y f/u were included. The subjects were stratified by frailty using the modified frailty index-11 (robust [R] group or prefrail and frail [F] group). Results of commonly employed laboratory tests at baseline, 1, 3, 7, and 14 post-operative days (POD) were compared. Further comparison was performed in propensity-score matched-39 paired patients between the groups by age, curve type, and baseline alignment. A correlation between HRQOLs, major complications, and biomarkers was performed. Results: Among the propensity-score matched groups, CRP was significantly elevated in the F group at POD1,3(POD1; 5.3 ± 3.1 vs. 7.9 ± 4.7 p = 0.02, POD3; 6.6 ± 4.6 vs. 8.9 ± 5.2 p = 0.02). Transaminase was also elevated in the F group at POD3(ASD: 36 ± 15 vs. 51 ± 58 U/L, p = 0.03, ALT: 32 ± 16 vs. 47 ± 55 U/L, p = 0.04). Interestingly, moderate correlation was observed between transaminase at POD1 and 2 y SRS22 (AST; function r = -0.37, mental health r = -0.39, satisfaction -0.28, total r = -0.40, ALT; function r = -0.37, satisfaction -0.34, total r = -0.39). Conclusions: Frailty affected the serum CRP and transaminase differently following ASD surgery. Transaminase at early POD was correlated with 2 y HRQOLs. These findings support the hypothesis that there is a specific physiological basis to the frailty that is characterized in part by increased inflammation and that these physiological differences persist.

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

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