Surgical Treatment Of Scoliosis Research Articles

Surgical treatment of scoliosis in patients with osteogenesis imperfecta: a single institution case series.

Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by skeletal deformities, bone fragility, and spinal complications. Various studies' insights underscored the impact of scoliosis on pulmonary function, positive outcomes with spinal fusion, and improved functional abilities post-surgery. However, partial loss of correction remains inevitable. This study examines six surgically treated OI patients with scoliosis. Surgical intervention using a posterior approach with pedicle screws and hooks aimed to correct spinal deformities. Preoperative, postoperative, and follow-up radiological assessments were conducted, revealing significant reductions in scoliotic angles post-surgery. Complications included infections and proximal junctional kyphosis requiring revision surgeries. Despite the challenges posed by poor bone quality and implant stability, no implant failures occurred in this series. Ponte osteotomies at the apex of deformity aided in corrective maneuvers. Surgical treatment of scoliosis in patients affected by OI is challenging and may be associated with perioperative and postoperative complications. Ponte osteotomy may improve the correction and reduce necessary force at the time of correction.

New technique based on artificial intelligence and custom-made instrumentation for scoliosis surgical treatment

New technique based on artificial intelligence and custom-made instrumentation for scoliosis surgical treatment

The Value of Plastic Surgery Closure in Adults Undergoing Scoliosis Surgery

Introduction: Surgical treatment for scoliosis can be done for functional and esthetic concerns. Surgical intervention may be associated with a complication rate of up to 40% in patients with non-idiopathic scoliosis, and 3% in patients with idiopathic scoliosis. In the present study, the authors sought to evaluate patients undergoing surgery for scoliosis with closure by the plastic and reconstructive surgery service. Methods: A retrospective cohort study was performed by extracting data, including demographics, surgical characteristics, and outcomes, from the electronic medical records of a single, large, tertiary care hospital and from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Data was collected for patients aged 18 to 75 undergoing spinal surgery for scoliosis from 2012 to 2020. Data collected from institutional records included only patients whose incision was closed by plastic and reconstructive surgery, while data from NSQIP was collected from all scoliosis surgery patients regardless of closure type. Results: A total of 98 scoliosis patients were identified who underwent closure by the plastic and reconstructive surgery service. These were compared to 1390 scoliosis patients in NSQIP for whom no specific closure details were noted. At 30-day post-operatively, readmission rates were 2.04% and 7.34% for the institutional and NSQIP cohorts, respectively ( P = 0.041), reoperation rates were 1.04% and 5.83% for the institutional and NSQIP cohorts, respectively ( P = 0.0384), and overall complication rates were 2.04% and 12.52% for the institutional and NSQIP cohorts, respectively ( P = 0.0005). Conclusion: Surgical intervention for scoliosis may benefit from closure by the plastic and reconstructive surgery service, which may yield potential lower rates of readmission, reoperation, and post-operative complication.

Posterior spinal fusion in patients with spinal muscular atrophy: a surgical technique to allow intrathecally inject nusinersen.

Nusinersen, the recently approved medical therapy in the treatment of spinal muscular atrophy (SMA), has revolutionized the natural history of this disease. Until now, surgical treatment of scoliosis in SMA patients was an exclusion criterion for drug therapy. In fact, the bone graft positioned posteriorly during surgery, in order to obtain a solid fusion, prevented the lumbar puncture necessary for the intrathecal administration of the drug. The aim is to describe a surgical technique that allows for safe and easy intrathecal administration of nusinersen. We present a single-center, single-surgeon case series descriptive study. From 2019 to 2021 seven consecutive patients affected by genetically confirmed SMA suitable for treatment with nusinersen and suffered from neuromuscular scoliosis needing posterior spinal fusion surgery were included in the present study. During posterior spinal fusion surgery a L3-L4 or L2-L3 laminectomy was performed to provide safer access to intrathecal injection. The drainage scar was used as a skin landmark so as to facilitate future procedures. The median of operative time was 250 min (range: 200-370 min). The median correction rate was 57% (range: 43.5-68). The median of intraoperative blood loss was 650 mL (range 320-940 mL). The median value of the correction loss at the last follow-up was 10% (range: 4.5-15%). The surgical procedure allowed all patients to receive nusinersen therapy without complications. The procedure described is simple and effective in providing safe intrathecal access to make these patients suitable for undertaking or continuing the protocol of treatment with nusinersen.

Traditional versus magnetically controlled growing rods in early onset scoliosis surgical treatment.

Growing rod surgeries are common methods in the treatment of early onset scoliosis. Magnetic growing rod (MGR) surgery, in particular, has become more widespread in the last 10years. The aim of this study was to compare the effects of traditional and magnetically controlled growing rod techniques on efficacy, safety, spinal growth, and lung development. A retrospective analysis was made of 24 TGR and 17 MGR patients. Inclusion criteria were patients aged < 10years, curvature > 40° or a progression of > 10° in the 4-6month follow-up for curves between 25 and 40°. There were 9 males and 15 females in the TGR cohort and 7 males and 10 females in the MGR cohort. The mean age at first surgery was 6.1years and 7.1years, respectively. Major curve Cobb angles of TGR were preop. 51.5°, postop. 21.4° and 18.1° at the final follow-up. In the MGR cohort, these values were 60.4°, 41.8°, and 36.4°, respectively. The mean T1-S1 lengthening velocity was calculated as 1.12cm/year (0.9318mm/month) in the TGR group and 1.27cm/year (1.0571mm/month) in the MGR group. In the TGR cohort, a total of 99 procedures were performed as 24 initial surgeries and 75 additional procedures (5 lengthening during unplanned surgery due to complications; 4 revision, 1 debridement). In the MRG cohort, a total of 25 surgical procedures were performed as 17 initial surgeries and 7 additional procedures (3 debridements, 5 revisions). The results of this study showed that the TGR system provided better correction in the coronal plane and was superior in kyphosis restoration than the MGR system. Both methods were successful in lengthening, but complication rates were slightly higher in the MGR cohort. The most common complication was the pullout of the proximal anchors, and this was more common in the MGR. Both TGR and MGR were found to be effective treatments. Lengthening without surgery is a significant advantage of the MGR system, but it has a high revision rate, and Cobb angle correction was found to be less effective than with TGR.

166. Lumbar total disc replacement as a part of adult scoliosis surgical treatment of 205 patients with minimum of 2 years of follow-up

<h3>BACKGROUND CONTEXT</h3> Surgical scoliosis treatment in adults must face beyond the curve correction, degeneration disc disease, dislocations, spondylolisthesis with sagittal and frontal unbalance and lumbar kyphosis. Two technical components of the surgery have been used to resolve those difficult problems: the fixation through the pelvis, with a complete loss of lumbar mobility and its consequences. The higher rate of pseudarthrosis, despite complex contracts, on one hand, and the necessity of posterior lumbar osteotomies to restore an acceptable lordosis with severe risk of complications on the other hand. <h3>PURPOSE</h3> To explore the capacity to maintain or restore part of mobility and lumbar lordosis, using total disc replacement TDR), by anterior approach (with or without ALIF) in association with the posterior reduction, fixation. <h3>STUDY DESIGN/SETTING</h3> Retrospective clinical study. <h3>PATIENT SAMPLE</h3> A total of 205 patients, 40M, 165F, 18-82 year old (average age 57 yo). Of these, 112 idiopathic scoliosis never operated before, 43 degenerative scoliosis in adults never operated on, and 50 cases already operated on by posterior approach (below prior surgery). A total of 286 TDR Prodisc were implanted (129 - 1 level, 71 - 2 levels, 5 – 3 levels). <h3>OUTCOME MEASURES</h3> The patients' analysis includes the perioperative, preop and postop VAS and ODI (3, 6, 12, 24, late follow-up), mobility of the disc replacement and the evolution of the curve (Cobb, sagittal parameters). <h3>Methods</h3> Between 2000 and 2018, 123 patients with scoliosis and lumbar disc degeneration have received one or more TDR and eventually ALIF, before or after their posterior fixation reduction. The posterior device associated classically hooks, screws, and the rods. The choice of the TDR is one of the key points as with the deformity, there is a need for semi-constrained (fixed center) prosthesis, to neutralize the shear forces and compensate the deficit of anterior and posterior longitudinal ligaments. <h3>Results</h3> ODI preop was 24/50 and declined to 10 in 24 months, VAS lumbar 7.2, radicular 5.7 prep went to 2.6 and 2.1 at 24 months and stabilized at latest follow-up. The mobility measurement at 24 months showed: 151 of 205 patients had a ROM at the TDR level more than 10° in flexion-extension at 24 months. The lordosis capacity of the implants eventually associated to and ALIF with appropriated angulation, allowed the sagittal balance restoration, with T1 axe correction and pelvic tilt reduction. There were no major complications, 4 anterior hematomas (2 drainages, 2 surgical treatments), 2 partial neurological deficits (1 L4, 1 L5). We had no implant TDR complications, no displacements, no explantation required. 2 cases of screw revised, 6 Posterior device removal (2 total, 4 partial), 2 complementary laminectomies, and 2 extension of posterior instrumentation. <h3>Conclusions</h3> The choice of TDR, with a semi – constrained prosthesis and loss restoration of motion and sagittal balance in adult scoliosis. It shows interest in the results, as a clinical and mobility point of view that is maintained in long-term follow up. That allows to avoid the pelvic fixation in majority of cases, escaping for the clinical bad results and complications of the lawn posterior constructions extend it to the pelvis and also illuminates the risks of posterior transpedicular osteotomies. In elderly people, there is a need for osteodensitometry measurement and eventually cementopalsty of the vertebrae that receive the prosthesis. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Surgical treatment of scoliosis in Ullrich Congenital Muscular Dystrophy: a case series of 3 patients.

Scoliosis in Ullrich Congenital Muscular Dystrophy (UCMD) is very common, with a reported incidence of more than 50%, and it is rapidly progressive. There are no previous studies which specifically focus on scoliosis surgery in UCMD patients. This article reports three cases of scoliosis surgery in UCMD, focusing on operative course, clinical and radiological results achieved, fusion area and complications, with a 2-year follow-up. The surgical technique adopted for vertebral arthrodesis included: high-density pedicle screw systems, asymmetric rods contouring and direct vertebral rotation. The summary results shown a significative correction of the coronal deformity, with a reduction of the mean Cobb angle from 49° to 25° post-operatively. Mean pelvic tilt remained stable, while L5-tilt showed a decrease from 10° to 6°. Mean screw density was 1.92. None of the patients required extended fixation to S2. No major complications were reported, and patients maintained their pre-operative walking ability. All the patients reported a subjective improvement in quality of life, with a better sitting comfort. In conclusion, posterior spinal fusion with high-density pedicle screw systems and direct vertebral rotation may be safe and effective in surgical correction of scoliosis in UCMD. If pelvic obliquity and L5-tilt are less than 15°, could be possible to achieve an optimal spinal and pelvic balance even without sacral or pelvic fixation.

The Correlation Between Cobb’s Angle and Pedicle Rotation in Adolescent Idiopathic Scoliosis After Surgical Treatment

Background: Adolescent Idiopathic Scoliosis (AIS) is a 3-dimensional deformity that involves not only curve in the coronal and sagittal planes but also rotation of vertebrae based on pedicle rotation. The Cobb’s angle is the gold standard for measuring the lateral curve that could show severity of the spine deformity. The Cobb’s method only evaluate the lateral curve,and the method to determine the pedicle rotation can be used the Nash and Moe’s method.The higher pedicle rotation grade had higher Cobb’s angle. Surgical treatment for scoliosis is indicated for the curve exceeding 40o. Posterior spinal fusion is the most commonly used technique in scoliosis surgery.Objective: To identify the correlation between the Cobb’s Angle and pedicle rotation in AIS after surgical treatment.Methods: The research design used in this study was Cross Sectional. The sample size of this study were 22 subjects using purposive sampling, the independent variable of this study was Cobb’s angle while the dependent variable was pedicle rotation. Spearman’s rank correlation was used to analyze the correlation between variable.Results: The spearman’s rank correlation revealed a significant correlation between the Cobb’s Angle and pedicle rotation in AIS after surgical treatment with the p 0,005 and r 0,462.Conclusion: This study demonstrates there is a significant correlation between Cobb’s angle and pedicle rotation in AIS after surgical treatment with medium strength.

Estimated cumulative X-ray exposure and additional cancer risk during the evaluation and treatment of scoliosis in children and young people requiring surgery

IntroductionClinicians and patients must weigh the benefits of radiological imaging against the risks of radiation exposure in the diagnosis and treatment of scoliosis. This report aims to estimate the cumulative absorbed and equivalent dose of radiation in patients undergoing surgical treatment for scoliosis, and to present this as an estimated risk of cancer compared to background radiation levels.MethodsRetrospective review of estimated absorbed dose on the Computerised Radiology Information System (CRIS®). Patients undergoing surgical correction of scoliosis (age ≤ 25) from August 2010 to August 2015 investigated. Estimated absorbed dose [milligrays (mGy)] recorded. Pedicle screws inserted using image intensification. Equivalent dose [millisieverts (mSv)] and additional cancer risk calculated from the National Research Council document ‘Health risks from exposure to low levels of ionising radiation’ (2006).Results271 patients identified. Mean age 15 (range 2–25). Mean total absorbed dose 2136 mGy [standard deviation (SD) 1700 mGy]. Mean number of plain spine radiographs was 8 (SD 3) with total 1884 mGy exposure (SD 1609 mGy). Additional dose provided by CT (mean 0.17 episodes), plain chest and abdominal radiographs and image intensification. Mean number of image intensification episodes was 1.1 with mean estimated exposure 180 mGy (SD 238 mGy). Image intensification accounted for 8% of the estimated absorbed dose during treatment. Estimated mean effective dose delivered was 20.952 mSv equating to an additional cancer risk of 0.27–0.45%.ConclusionAdditional cancer risk from cumulative imaging is small and equivalent to approximately 8 years of natural background radiation. Use of image intensification for pedicle screw insertion is a minor contribution (8%) to the total patient dose.

The Current Practice of Adult Idiopathic Scoliosis Surgical Treatment Among Spine Surgeons in Saudi Arabia.

Background: Scoliosis is a spinal deformity consisting of lateral curvature and rotation of the vertebrae. The goal of corrective scoliosis surgery is to restore alignment of the spine and maintain motion. However, there is no global agreement among spine surgeons on the best method of surgical intervention, and little is known about the variations in practice among spine surgeons in Saudi Arabia.Objectives: The aim of this study is to examine the current surgical practices relating to adolescent idiopathic scoliosis and to establish the degree of variation and consensus among spine surgeons in Saudi Arabia.Methods: This was a cross-sectional study conducted among spine surgeons in Saudi Arabia, using a self-administered questionnaire. The questionnaire addressed four areas: surgeons’ demographics, pre-operative assessment, operative assessment, and infection control practices. There were a total of 27 questions. Data was analyzed using statistical package for social sciences (SPSS) software (SPSS Inc., Chicago, IL, USA).Results: A total of 150 surgeons were included in this study. Of these, 73 responded to the questionnaire (response rate: 48.6%), 46 (63.01%) of whom were fellows. All respondents were males, and 37 (51.39%) were aged between 30 and 40 years. Fifty five (75.34%) were orthopedic surgeons. The most commonly used pre-operative health assessment test was an echocardiogram. Sixty six (90%) surgeons requested scoliosis anteroposterior (AP) view and lateral radiograph for curvature between 40 degrees and 90 degrees, and 65 (89%) requested it for curvature greater than 90 degrees. For the posterior construct, 29 (45.31%) did not use cross-links for fewer than 10 levels, and 23 (35.94%) did not use cross-links for more than 10 levels. In addition to a local bone graft, the most commonly used transplant method was allograft 37 (50.68%). Fifty five (85.94%) respondents favored an all-screw pedicle construct over a hybrid construct.Conclusion: A large variation in surgical practices was observed. This was especially apparent in practices including the use of cross-links, intra-operative cell salvage, and the intra-operative use of traction. Some degree of variation was observed in pre-operative imaging assessment practices. Surgical guidelines should be developed to build a consensus among surgeons. A unified surgical training curriculum may help in achieving this goal.

P65. Total disc replacement as a part of adult scoliosis surgical treatment of 205 patients with minimum of two years of follow-up

BACKGROUND CONTEXT Surgical scoliosis treatment in adults must face beyond the curve correction, degeneration disc disease, dislocations, spondylolisthesis with sagittal and frontal unbalance and lumbar kyphosis. Two technical components of the surgery have been used to resolve those difficult problems: the fixation through the pelvis, with a complete loss of lumbar mobility and its consequences. The higher rate of pseudarthrosis, despite complex contracts, on one hand, and the necessity of posterior lumbar osteotomies to restore an acceptable lordosis with severe risk of complications on the other hand. PURPOSE To explore the capacity to maintain or restore part of mobility and lumbar lordosis, using total disc replacement TDR), by anterior approach (with or without ALIF) in association with the posterior reduction, fixation. STUDY DESIGN/SETTING Retrospective clinical study. PATIENT SAMPLE A total of 205 patients, 40M, 165F, 18-82 years old (average age 57 yo). Of them, 112 idiopathic scoliosis never operated before, 43 degenerative scoliosis in adults never operated on, and 50 cases already operated on by posterior approach (below prior surgery). Of them, 286 TDR Prodisc implanted (129 - 1 level, 71 - 2 levels, 5 – 3 levels). OUTCOME MEASURES The patients’ analysis includes the perioperative, preop and postop VAS and ODI (3, 6, 12, 24, late follow-up), mobility of the disc replacement and the evolution of the curve (Cobb, sagittal parameters), radiographic analysis. METHODS Between 2000 and 2018, 123 patients with scoliosis and lumbar disc degeneration have received one or more TDR and eventually ALIF, before or after their posterior fixation reduction. The posterior device associated classically hooks, screws and the rods. The choice of the TDR is one of the key points as with the deformity, there is a need for semi-constrained (fixed center) prosthesis, to neutralize the shear forces and compensate the deficit of anterior and posterior longitudinal ligaments. RESULTS ODI preop was 24/50 and declined to 10 in 24 months, VAS lumbar 7.2, radicular 5.7 prep went to 2.6 and 2.1 at 24 months and stabilized at latest follow-up. The mobility measurement at 24 months showed: 151 of 205 patients had a ROM at the TDR level more than 10° in flexion-extension at 24 months. The lordosis capacity of the implants eventually associated to and ALIF with appropriated angulation, allowed the sagittal balance restoration, with T1 axe correction and pelvic tilt reduction. There were no major complications, 4 anterior hematomas (2 drainages, 2 surgical treatments), 2 partial neurological deficits (1 L4, 1 L5). We had no implant TDR complications, no displacements, no explanation required. Two cases of screw revised, 6 posterior device removal (2 total, 4 partial), 2 complementary laminectomies, and 2 extension of posterior instrumentation. CONCLUSIONS The choice of TDR, with a semi–constrained prosthesis and loss restoration of motion and sagittal balance in adult scoliosis. It shows interest in the results, as a clinical and mobility point of view that is maintained in long term follow-up. That allows to avoid the pelvic fixation in majority of cases, escaping for the clinical bad results and complications of the lawn posterior constructions extend it to the pelvis and also illuminates the risks of posterior transpedicular osteotomies. In elderly people, there is a need for osteodensitometry measurement and eventually cementopalsty of the vertebra that receive the prosthesis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Surgical treatment of scoliosis in neurofibromatosis type I: A retrospective study on posterior-only correction with third-generation instrumentation.

Background:Scoliosis is the most common orthopedic complication of neurofibromatosis type I. Scoliosis can be occurred with two patterns: dystrophic or idiopathic-like. In adolescence, in consideration of bone dystrophy, osteopenia, and often associated hyperkyphosis, most of the authors recommend an anterior-posterior approach. According to other authors, modern instrumentations could be sufficient to sustain a solid posterior arthrodesis.Materials and Methods:Ten patients were diagnosed with scoliosis in neurofibromatosis type I aged between 8 and 25 years, Cobb angle of the thoracic curve >45°, and minimum follow-up (FU) of 1 year and treated with posterior-only approach with third-generation high-density instrumentations. Radiographic measurements were performed on the coronal and sagittal planes. Nonparametric tests (Friedman test and Wilcoxon test) were applied to evaluate the reducibility of the preoperative curve (T0), the postoperative surgical correction (T1), and its maintenance on FU.Results:Statistics showed results compared to those evaluated in the literature with a combined approach regarding surgical correction and its maintenance on FU. On T1, a median correction of 53.5% of the scoliotic curve and of 33.7% of the thoracic hyperkyphosis was observed. On FU, the correction was maintained. A global improvement in balance was appreciated. The curves, despite rigid, showed a relative reducibility to bending tests and traction. No significant complications occurred.Conclusions:The posterior-only approach produces a satisfactory correction of the dystrophic neurofibromatosis scoliosis if associated with the use of high-density third-generation instrumentations. We are confident in recommending posterior-only approach in dystrophic neurofibromatosis scoliosis with coronal curves till 110° and coexisting thoracic kyphosis till 80°

Idiopathic scoliosis surgical treatment. Results in Mexico’s National Rehabilitation Institute. 24-month follow-up

Idiopathic scoliosis surgical treatment. Results in Mexico’s National Rehabilitation Institute. 24-month follow-up

The application of a new intraoperative assessment method of coronal balance in surgical treatment of scoliosis

Objective To introduce a new method for assessing coronal balance in surgical treatment of scoliosis, and to explore its effectiveness in preventing postoperative coronal imbalance. Methods The data of forty-six consecutive patients, who underwent posterior surgery for spine deformity correction from January 2016 to December 2016, were retrospectively analyzed. The series included 19 males and 27 females with an average age of 28.24±21.16 years (7-76 years), and with lower instrumented vertebra (LIV) located at the level of L3 or below. Point-line method was used to evaluate coronal balance by determining whether the center of upper instrumented vertebra was located at the measuring rod passing through the centers of symphysis pubis and LIV among all patients during surgery. Preoperative, postoperative 1 week and 3 months Cobb angle, coronal balance distance (CBD), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and Scoliosis Research Society Questionnaires-22 (SRS-22) were measured and recorded, and statistical analysis was conducted. And then, subgroup analysis was performed according to preoperative coronal imbalance classification to further evaluate the effectiveness of the new method. Results Among 46 patients in this study, the prevalence of preoperative coronal imbalance was 47.82% (22/46). Of them, ten patients were type B coronal imbalance and eleven patients were type C coronal imbalance. The prevalence of coronal imbalance at one week after operation was 17.39% (8/46), and the prevalence of coronal imbalance at final follow-up was 10.87% (5/46). The results showed that the mean main Cobb angle was 57.24°±26.51° and 14.71°±10.17° at pre-operation and immediate post-operation, respectively. The difference was statistically significant compared to preoperative value (t=13.211, P=0.000), and the average improvement rate was 73.53%±1.88%. Preoperative coronal balance distance CBD ranged from 2.76 mm to 66.73 mm, with an average of 22.54±13.97 mm; the mean CBD was 16.00±14.85 mm at immediate post-operation. The difference was statistically significant (t=3.665, P=0.001), with an average correction rate of 25.58%±52.39%. Our clinical outcome analysis showed that among 46 patients, the preoperative VAS was 8.11±0.89, and the final follow-up VAS was 4.15±0.79. There was a significant difference between pre-operation and the last follow-up (t=21.529, P=0.000). The preoperative ODI score was 49.76±5.84, and the final follow-up ODI score was 25.74±3.92. The difference was statistically significant (t=44.434, P=0.000). The preoperative SRS-22 was 10.57±2.13, and the final follow-up SRS-22 was 21.89±2.35. Compared to pre-operation, the difference was statistically significant (t=24.023, P=0.000). The subgroup analysis showed that in patients with type B coronal imbalance, the mean Cobb angle correction rate was 70.34%±6.02% at immediate post-operation, and there was a significant difference compared to pre-operation (t=5.437, P=0.000); the average CBD correction rate was 37.45%±29.03%, and significant difference was found (t=2.607, P=0.028). In type C patients, the average Cobb angle and CBD correction rate at immediate post-operation was 72.92%±3.67% and 44.79%±5.63%, respectively, and significant difference was found (t=7.319, P=0.000; t=7.545, P=0.000). Conclusion Point-line method was a simple and effective technique for intraoperative assessment of coronal balance, which could assist surgeons to objectively evaluate the result of restoration of the coronal alignment. The use of point-line method is contributed to improve clinical outcomes of spinal deformity correction surgery, and to prevent the occurrence of postoperative coronal imbalance. Key words: Scoliosis; Intervertebral disc degeneration; Spinal fusion; Treatment outcome

Perioperative nursing after stage I surgical treatment for scoliosis complicated with intraspinal lesion

Objective To explore the effects of perioperative nursing care after stage I surgical treatment for scoliosis complicated with intraspinal lesion. Methods Totally 12 patients with scoliosis complicated with intraspinal lesion who received stage I surgical treatment from October 2016 to December 2017 were selected by retrospective analysis. These patients received targeted nursing care and functional exercise guidance perioperatively to prevent the incidence of surgical complications. Results The stage I surgical treatment for the 12 patients with scoliosis complicated with intraspinal lesion was successful. Their lower limb muscle strength improved and their muscular tension reduced; and urination disorder was mitigated post operation. The length of hospital stay was (14.91±2.90) d, ranging from 9 to 20 d. No perioperative infection, cerebrospinal fluid leakage or other surgical complications were found in any patient. The duration of postoperative follow-up visits was (11.75±3.42) months, ranging from 3 to 17 months. No loss or deterioration of neurological function, delayed infection, pseudarthrosis or orthopaedic loss was found. Conclusions Stage I surgical treatment for scoliosis complicated with intraspinal lesion can improve the treatment effects in patients. Better perioperative observation and specialized nursing care can help to reduce the incidence of relevant complications. Key words: Perioperative nursing; Scoliosis; Intraspinal lesion; Stage I surgery; Complication; Specialized nursing

Surgical Treatment for Scoliosis

Recently, patients with spinal deformities, particularly scoliosis, could be handled well through surgical pathways. Generally, surgery is indicated in patients with scoliosis curve exceeding 45 degrees (COBB angle&gt; 45). The ultimate goal is to reduce the curve as optimally as possible without disturbing spinal cord. Whether the result is straight or not, it also depends on the patient's spine flexibility before surgery.Surgical indications are for improving appearance, preventing increasing degrees of the curve, preventing interference to other organs such as the lungs, and preventing neurological deficits. Correction of Cobb angle below 25 degrees had already makes the patient feel more comfortable. The amount of screw and instrumentation length depends on the number of spines involved. After surgery treatment, 2-4 weeks of rest are required before returning to daily activity.Fusion principle states that the spine will be slightly stiff in order to be corrected but it is believed that patient's activity could still be done with the remaining flexibility. Surgical treatment of scoliosis that does meet the indications is imperative and relatively safe with advances in medical technology today.

Proximal junctional kyphosis in thoracic adolescent idiopathic scoliosis: risk factors and compensatory mechanisms in a multicenter national cohort.

Proximal junctional kyphosis (PJK) is a frequent complication, up to 46%, in adolescent idiopathic scoliosis surgical treatment (AIS). Several risk factors have been evoked but remain controversial. The purpose of this study was to analyze the incidence of PJK in a multicenter cohort of AIS patient and to determine risk factor for PJK. Lenke I and II AIS patients operated between 2011 and 2015 (minimum of 2-years follow-up) were included. On fullspine X-rays, coronal and sagittal radiographic parameters were measured preoperatively, postoperatively and at final follow-up. Occurrence of radiological PJK corresponding to a 10° increase in the sagittal Cobb angle, measured between the upper instrumented vertebra (UIV) and UIV + 2, between postoperative and 2-years follow-up X-rays, was reported. Among the 365 patients included, 15.6% (n = 57) developed a PJK and only 10 patients required a revision surgery. Preoperatively, PJK patients had significantly larger pelvic incidence (57° ± 13° vs. 51° ± 12°), larger lumbar lordosis (LL) (63° ± 12° vs. 57° ± 11°) and bigger C7 slope. Postoperatively (3months), in the non-PJK group, thoracic kyphosis (TK) was increased and LL was not significantly different. However, postoperatively, in the PJK group, no significant change was observed in TK, whereas C7 slope decreased and LL significantly increased. There was also a postoperative change in inflection point which was located at a more proximal level in the PJK group. Between postoperative time and final follow-up, TK and LL significantly increased in the PJK group. PJK is a frequent complication in thoracic AIS, occurring 16%, but remains often asymptomatic (less than 3% of revisions in the entire cohort). An interesting finding is that patients with high pelvic incidence and consequently large LL and TK were more at risk of PJK. As demonstrated in ASD, one of the causes of PJK might be postoperative posterior imbalance that can be due to increased LL, insufficient TK or inflection point shift during surgery. These slides can be retrieved under Electronic Supplementary Material.

Surgical Treatment for Scoliosis

Surgical Treatment for Scoliosis

Интраоперационный мониторинг при операционном лечении сколиоза у детей

Интраоперационный мониторинг при операционном лечении сколиоза у детей

Posterior spinal fusion for scoliosis after Fontan procedure: Acaseseries.

As the surgical treatment of scoliosis after a Fontan procedure is very challenging due to the risk of various perioperative complications, case reports are scarce. We herein describe three patients who were successfully treated for scoliosis following a Fontan procedure and discuss their clinical and radiological outcomes. We retrospectively reviewed three cases of scoliosis treated by posterior spinal fusion after a Fontan procedure. Mean preoperative major curve Cobb angle was 83.7°, mean surgical time was 233.0min, and mean blood loss was 1167g. The mean correction rate of the major curve was 48.0%. Surgical outcome as evaluated by Scoliosis Research Society-22 patient questionnaires revealed acceptable results without any severe complications. Corrective surgery for scoliosis after a Fontan procedure becomes a stronger option if cardiac insufficiency is prevented during the perioperative period and a conservative plan is carried out with minimal invasiveness and operation time.