Thoracolumbar Research Articles

Advantages of Posterior Indirect Decompression Surgery in Thoracolumbar Burst Fractures with Neurologic Symptoms

Objective: Approximately 90% of spinal fractures occur at the thoracolumbar (T-L) junction and may be accompanied by neurological symptoms, in which decompression and post-fixation are generally performed. However, decompression surgery can aggravate patients’ symptoms due to adverse incidents, such as developing postoperative hematomas or iatrogenic spinal cord injury. This study compared the surgical and radiographic outcomes of patients with T-L junction burst fractures and neurological deficits who underwent direct or indirect decompression.Methods: We retrospectively reviewed all patients who had undergone posterior surgical treatment for T-L junction burst fractures with neurologic deficits. Patients were classified according to the procedure: indirect decompression (group 1) or spinal decompression through laminectomy and facetectomy (group 2). Clinical results and radiologic findings were compared between the two groups for 2 years.Results: Among 57 patients who met the inclusion criteria, 29 were categorized into group 1, and 28 were categorized into group 2. Group 1 had a statistically significantly lower Oswestry Disability Index score than group 2 at the final follow-up visit (p=0.03). In group 1, both the T-L junction angle and wedge angle of the injured vertebrae improved significantly, both immediately after surgery (p=0.02 and p=0.01, respectively) and at the final follow-up visit (p=0.01 and p=0.01, respectively). In group 2, the difference between the pelvic incidence and lumbar lordosis was significantly greater than in group 1 at the final follow-up visit (p=0.02).Conclusion: This study confirmed that symptoms could be sufficiently improved with indirect decompression, which should be kept in mind for cases where it is difficult to perform direct decompression,

Evaluation of Posterior Ligamentous Complex Injury in Thoracolumbar Burst Fractures: Correlation Analysis of CT and MRI Findings.

The goal of this study is to perform correlation analysis of Computed tomography (CT) and magnetic resonance imaging (MRI) results in posterior ligament complex (PLC) injury and define the morphological traits of thoracolumbar (TL) burst fractures connected to PLC injury. Forty patients with surgically repaired TL burst fractures between January 2013 and December 2020 were retrospectively analyzed. The patients were split into two groups for comparison based on MRI (Group P: patients with a confirmed or suspected PLC injury; Group N: patients with PLC injury denied). The radiographic morphological examination based on CT scans and clinical evaluation was performed and compared between two groups. The thoracolumbar injury classification and severity score (TLICS), the load sharing classification (LSC) scores, and the number of patients with neurological impairments were considerably greater in Group P. Loss of height of the fracture (loss height), local kyphosis of the fracture (local kyphosis), and supraspinous distance were significantly higher in Group P and significantly associated with PLC injuries indicating severe vertebral body destruction and traumatic kyphosis in multivariate logistic analysis [odds ratio: 1.90, 1.06, and 1.13, respectively]. Cutoff value for local kyphosis obtained from the receiver operating characteristic curve was 18.8. If local kyphosis is greater than 18.8 degrees on CT scans, we should take into account the probability of the highly damaged burst fracture associated with PLC injury. In this situation, we should carefully assess MRI to identify the spinal cord injury or spinal cord compression in addition to PLC injury because these instances likely present with neurological abnormalities.

Utility of computed tomography reconstructed thoracolumbar spinal imaging in blunt trauma.

Fractures of the thoracolumbar (TL) spine are common and may cause neurologic damage, pain, and reduced quality of life. Computed tomography (CT) TL reconstructions from CT chest, abdomen, and pelvis (CAP) are used to identify TL fractures; however, their benefit over CAP imaging is unclear. We hypothesized that reformatted TL images do not identify additional clinically significant injuries or change outcomes. Retrospective data were collected 2016 to 2021 from trauma patients at a level 1 trauma center. All patients 18 years or older with TL fractures on CT CAP with/without CT TL reformats were included. Clinically significant TL fractures were defined as requiring operative fixation, brace, or spinal rehabilitation. A binary classification model was created to assess the diagnostic utility of CTCAP compared with CTTL in predicting clinically significant fractures in patients who underwent CT CAP/TL. There were 828 patients with TL fractures, 634 had both CT CAP/CT TL (CAPTL) and 194 CTCAP only (CAP). There were 134 clinically significant TL fractures (16%) (14 [7.2%] CT CAP vs. 120 [18.9%] CT CAPTL, p < 0.001). There were no differences among unstable fractures, fractures on magnetic resonance imaging (MRI) only, mortality, or neurologic deficits on discharge between CAPTL and CAP ( p > 0.05). Among clinically significant fractures, CAPTL was not associated with increased MRI utilization, surgery, spinal brace, or spinal cord rehabilitation ( p > 0.05). Among clinically insignificant fractures, CAPTL was associated with increased MRIs, length of stay (LOS), and intensive care unit LOS ( p < 0.05). CAPTL was also an independent predictor of increased MRIs (odds ratio, 5.79; 95% confidence interval, 2.29-14.65; p < 0.01) and spine consultation (odds ratio, 2.39; 95% confidence interval, 1.64-3.67; p < 0.01). More CT CAP/TL were performed in those with clinically significant fractures; however, CTCAP was equivalent to CTTL for detection of fractures ( p > 0.05). CTCAP alone is sufficient to identify clinically significant TL fractures. While the addition of TL reformatted imaging minimizes missed injuries, it is associated with increased hospital LOS and MRI resource utilization. Therefore, careful consideration is needed for appropriate CT TL patient selection. Therapeutic/Care Management; Level IV.

Computer Users Sitting Posture Classification Using Distinct Feature Points and Small Scale Convolutional Neural Network for Humana Computer Intelligent Interactive System During COVID-19

The sudden change in our workplace practices from face-to-face work to work from home setup due to the pandemic has brought positive and negative impacts on our overall health. In literature, the use of deep learning and specialized cameras in the estimation of the human pose is popular even if there is a need for high computational resources and complex models. For this purpose, this study developed an intelligent and interactive system utilizing a human estimation model with the use of distinct keypoint such as thoracic, thoraco lumbar, and lumbar points in the spine. An objective type of a dataset captured in a work from home environment with the knowledge and guidance of Licensed Physical Therapists to assess proper and improper sitting posture was developed. The study developed and implemented a small-scale convolutional network and low-cost smartphone camera to recognize body key points. Once all the feature points' locations were extracted, additional features such as cosine similarity and point distances were calculated. Next, feature selection and optimization were utilized to classify proper and improper sitting postures. As a result, the study developed (2) datasets and (2) models with an accuracy of 85.18 and 92.07% and kappa of 0.691 and 0.838 respectively.

432 Enhanced Surgical Recovery for Thoracolumbar Spine Surgery is Associated With Decreased Opioid Consumption, Length of Hospital Stay, and Hospital Readmissions: Evaluation of 51,236 Cases

INTRODUCTION: Evidence-based enhanced surgical recovery (ESR) programs integrate a multidimensional approach to optimize patients during the pre-, intra-, and post-operative phases of surgery. Smaller studies suggest benefits of ESR in spine surgery, but large-scale evidence is lacking. METHODS: In this retrospective case-control study of a healthcare system ESR program, data from thoracolumbar (TL) fusions were extracted from electronic medical records. Patients were divided into two cohorts, ESR or non-ESR, based upon enrollment into an ESR program defined by (1) preoperative patient education, (2) multimodal analgesia, (3) intraoperative fluid optimization, (4) opioid-sparing anesthesia, and (5) early postoperative nutrition and ambulation. Exclusion criteria were: unknown ESR status, age &lt;18 yrs, and surgery for tumor, infection, or trauma. Impact of ESR upon postoperative daily morphine milligram equivalents (MME), length of hospital stay (LOS), and 30-day hospital readmission rates (READMIT) was evaluated for single-level TL fusions, multi-level TL fusions, and all TL fusions using regression models. RESULTS: 51,236 TL fusion cases were identified from 2018 to 2021: 24,391 participated in an ESR program and 26,845 did not. ESR and non-ESR groups were demographically similar. For single level TL fusions, ESR was associated with decreased MME (β= -8.76, p &lt; 0.001), LOS (β= -8.85, p &lt; 0.001), and READMIT (OR = 0.77, 95% CI: 0.67-0.88). For multi-level TL fusions, ESR was associated with decreased MME (β = -7.32, p &lt; 0.001) and LOS (β= -12.14, p &lt; 0.001), and for all TL fusions, ESR was associated with decreased MME (β= -7.94, p&lt;0.001), LOS (β = -10.54, p &lt; 0.001), and READMIT (OR = 0.91, 95% CI: 0.84-0.98). CONCLUSIONS: This national healthcare system analysis of 51,236 TL fusion cases by 1,352 surgeons at 138 centers confirms that ESR adoption is associated with decreased MME, LOS, and READMIT. Surgeons should consider adoption of ESR programs to improve patient care.

Outcomes of vertebral body tethering in the lumbar spine.

The use of vertebral body tethering (VBT) for the treatment of main thoracic deformities in adolescent idiopathic scoliosis patients is becoming increasingly more common, but limited data exist on its safety and efficacy in thoracolumbar deformities. We aimed to evaluate the postoperative outcomes of patients with thoracolumbar (TL) deformities that were treated with VBT. We assessed clinical and radiographic data from twenty-eight consecutive patients that were surgically managed with VBT, all of whom exhibited a TL deformity with at least two years (mean: 44.7 ± 14.5months) of postoperative follow-up. Standard radiographic parameters were extracted from left hand wrist and standing posterior-anterior and lateral spine radiographs at various timepoints. Outcome variables were assessed based on preoperative Lenke Classification and included: deformity measures, complications, surgical revisions, and postoperative success. The mean age at the time of instrumentation was 13.4 ± 1.3years, with an average preoperative Sanders Stage of 4.6 ± 1.4. A significant reduction in preoperative deformities was observed at most postoperative timepoints. A perioperative complication was observed in three patients and surgical revision was required in another four patients. A suspected broken tether was observed in sixteen patients, most of which occurred at the apex of the lumbar deformity. Only one patient required surgical revision due to a suspected broken tether. We observed an overall success rate of 57%, regardless of Lenke Classification. These data indicate that VBT can successfully correct TL deformity patterns in 57% of patients without an increase in the rate of perioperative complications, suspected broken tethers, or surgical revisions.

Thoracolumbar Injury Classification and Severity Scale Can Help Identify Intra-Abdominal Injury in Children Injured in an MVC

Background: Motor vehicle crashes (MVC) cause variable injury to the thoracolumbar (TL) region of children secondary to rapid deceleration from seatbelts. This mechanism can also predispose a child to intraabdominal injury (IAI), which necessitates early diagnosis to limit morbidity and mortality. While the maximum extent of TL spine injury can be appreciated shortly after presentation, the severity of IAI may not be appreciated until days later. It is hypothesized that a measure of TL-injury severity will identify patients at risk of concomitant IAI.Methods: Retrospective chart review identified 72 children with MVC-related TL spine injuries from 2007-2020. Patients were grouped based on the presence of IAI and TL spine injury (N=33) compared to isolated TL spine injury (no IAI, N=39). TL spine injury severity was classified according to the Thoracolumbar Injury Classification and Severity Scale (TLICS).Results: Demographics were similar in both groups. Children with concomitant IAI had primarily lumbar spine injuries, while injuries without associated IAI were more broadly distributed throughout the thoracolumbar spine. Children without concomitant IAI were more likely to sustain compression fractures (n=31, 79%), while children with IAI had more distraction injuries (n=24, 73%). TL injuries associated with IAI were significantly more severe than isolated TL injuries (median TLICS=7 [range: 1-9] vs. 1 [range: 1-10], p<0.001). As hypothesized, increasing TLICS is associated with an increased risk of concomitant IAI, such that for every point increase in TLICS, the risk of IAI increases 49% (OR: 1.492, [95% CI 1.254-1.817], AROC 0.795).Conclusions: Given the association between severe spine injury and IAI, this study examines the utility of TLICS score at presentation to establish an index of suspicion for concomitant IAI. While other clinical signs may be suggestive of the presence of IAI, our study may provide clinicians with another data point suggestive of spine injury severity in their diagnostic toolbox to optimally manage pediatric patients after MVC.Level of Evidence: III, Retrospective Cohort StudyKey Concepts•Pediatric patients are at risk for sustaining seatbelt syndrome (intraabdominal injury (IAI) associated with spinal column injury) after motor vehicle collisions when restraints are used improperly.•Occult IAIs may not be readily diagnosed with initial trauma workup and require a high index of suspicion to avoid delay in diagnosis and potential morbidity and mortality.•IAI is more frequently associated with spine fractures located in the lumbar spine.•IAI is associated with more severe spine injury (represented by Thoracolumbar Injury Classification and Severity Scale [TLICS] score >5).

Outcomes of Transpedicular Screw Fixation with Unstable Thoracolumber Spine Injury

Objective: To evaluate the role of transpedicular screw fixation of thoracolumber spinal injury in terms of postoperative pain control and neurological recovery. Study Design: Quasi experimental trial. Place and Duration: Study was conducted in the department of orthopedic and spinal surgery in Nishter Hospital Multan. Study was completed in one year duration from August 2017 to August 2018. Methodology: Study was initiated after permission from hospital academic affairs committee and written informed consent was obtained from patients. Sixty patients presented at orthopedic outpatient department with history of one week of unstable thoraco lumbar spine injury. Main variables were age, duration of surgery, duration of injury, control of pain, CSF leakage, nerv rout damage and wound infection. Results: Statistically significant between preoperative and postoperative, after one moth and after three months with regards to Frankel classification of neurological injury. Similarly, the difference was statistically significant between preoperative and postoperative, after one moth and after three months with regards to Denis pain scale at follow-up. Conclusion: Thoracolumbar junction injuries are common in young adults and Transpedicular screw fixation is useful choice for good pain control and achieving better neurological recovery in traumatic thoracolumbar fractures.

The Impact of Depression and Anxiety on Perioperative Outcomes and Patient-Reported Outcomes Measurement Information System Physical Function After Thoracolumbar Surgery.

Depression and anxiety are common within spine patient populations. The demand for surgical management of degenerative spine conditions and the prevalence of mental disorders are expected to increase as the general population ages. Concurrently, there is increasing pressure to demonstrate high-value care through improved perioperative outcome metrics and patient-reported outcome instruments. The purpose of this study was to evaluate the impact of common mental disorders on perioperative markers of high resource utilization and patient-reported outcomes measurement information system physical function (PROMIS-PF) following thoracolumbar (TL) spine surgery. A retrospective review of patients undergoing TL decompression alone or with fusion at a single institution. Data were collected using an administrative database for patient demographics. Outcomes of interest included length of stay, discharge disposition, 90-day return to the emergency department (ED), 90-day hospital readmission, 1-year complication rate, 1-year revision surgery rate, 1-year residual radiculopathy, and PROMIS-PF scores recorded preoperatively, at 0 to 1, 1 to 3, 3 to 6, and 6 to 12 months postoperatively. Univariate analysis and multiple linear regression were utilized to analyze results. A total of 596 patients were included in this study, of whom 205 (34%) had a history of depression or anxiety. Compared with patients with no history of a mental disorder, patients with depression or anxiety who underwent TL decompression alone had higher rates of 90-day ED visits (P = 0.019), 90-day readmissions (P = 0.031), and complications at 1 year (P = 0.012). After risk adjustment, the diagnosis of depression or anxiety had no significant effect on PROMIS-PF improvement from the preoperative to postoperative period. Our study suggests that a history of depression or anxiety is common among patients undergoing spine surgery but has no significant impact on PROMIS-PF improvement. Because some patients with depression or anxiety may be at higher risk of postoperative resource utilization, further study and effort are warranted to support at-risk groups and improve overall care value. Although patients with depression or anxiety are at risk for increased resource utilization after TL decompression or fusion, they can experience similar levels of functional improvement as patients without these conditions. Therefore depression or anxiety should not be considered contraindications to surgery, but additional attention should be paid to this population during the postoperative recovery period.

Thoracolumbar Sacral Orthosis for Spinal Fractures: What's the Evidence and Do Patients Use Them?

Introduction The general consensus regarding the non-operative management of thoracolumbar (TL) spine fractures revolves around the use of thoracolumbar spine orthosis (TLSO). The efficacy of TLSO bracing remains controversial within the current literature, with several studies showing that prolonged brace use is associated with diminished lung capacity, skin breakdown, and paraspinal muscular atrophy, with no significant difference in pain and functional outcomes between patients treated with or without TLSO. Aims The aim of this study was to identify thenumber of braces issued over the duration of the study and understand the cost implication, added length of stay, and patient satisfaction based on a questionnaire and reflect on whether we need to change our practice on the use of TLSO. Methods Data was collected retrospectively over an 18-month period with 75 patients being initially identified for the study. A total of 42 records were included in the final study after the application of inclusion/exclusion criteria. Patient-related outcomes were recorded through a questionnaire. Results Of the patients, 60% report not receiving adequate advice regarding the duration of treatment, 43% reported that the brace interfered with their activities of daily living (ADLs), and 73% came off the brace earlier than advised, with 60% of patients reporting that they would rather be without the brace if given the option. The average increase in length of stay waiting for bracing was three days, with the estimated cost incurred being approximately £114,000. Conclusion With equivalence between treatment with or without a brace, there is a need to rethink current practice and move towarda case-by-case, patient-centered approach to minimize costs and improve patient satisfaction.

Analysis of Kinematic Characteristics of Saanen Goat Spine under Multi-Slope.

In order to improve the slope movement stability and flexibility of quadruped robot, a theoretical design method of a flexible spine of a robot that was based on bionics was proposed. The kinematic characteristics of the spine were analyzed under different slopes with a Saanen goat as the research object. A Qualisys track manager (QTM) gait analysis system was used to obtain the trunk movement of goats under multiple slopes, and linear time normalization (LTN) was used to calibrate and match typical gait cycles to characterize the goat locomotion gait under slopes. Firstly, the spatial angle changes of cervical thoracic vertebrae, thoracolumbar vertebrae, and lumbar vertebrae were compared and analyzed under 0°, 5°, 10°, and 15° slopes, and it was found that the rigid and flexible coupling structure between the thoraco-lumbar vertebrae played an obvious role when moving on the slope. Moreover, with the increase in slope, the movement of the spine changed to the coupling movement of thoraco-lumbar coordination movement and a flexible swing of lumbar vertebrae. Then, the Gaussian mixture model (GMM) clustering algorithm was used to analyze the changes of the thoraco-lumbar vertebrae and lumbar vertebrae in different directions. Combined with anatomical knowledge, it was found that the motion of the thoraco-lumbar vertebrae and lumbar vertebrae in the goat was mainly manifested as a left-right swing in the coronal plane. Finally, on the basis of the analysis of the maximin and variation range of the thoraco-lumbar vertebrae and lumbar vertebrae in the coronal plane, it was found that the coupling motion of the thoraco-lumbar cooperative motion and flexible swing of the lumbar vertebrae at the slope of 10° had the most significant effect on the motion stability. SSE, R2, adjusted-R2, and RMSE were used as evaluation indexes, and the general equations of the spatial fitting curve of the goat spine were obtained by curve fitting of Matlab software. Finally, Origin software was used to obtain the optimal fitting spatial equations under eight movements of the goat spine with SSE and adjusted-R2 as indexes. The research will provide an idea for the bionic spine design with variable stiffness and multi-direction flexible bending, as well as a theoretical reference for the torso design of a bionic quadruped robot.

Prophylactic Effect of Fenestration on the Recurrence of Thoracolumbar Intervertebral Disc Disease in Dogs.

Simple SummaryThe prophylactic effect of fenestration on the recurrence of thoracolumbar (TL) intervertebral disc herniation (IVDH) in dogs that have been surgically decompressed has been a topic of ongoing debate in veterinary medicine. The aim of this study was to systematically review the existing literature and critically evaluate the evidence behind the application of prophylactic fenestration on the recurrence of TL IVDH in dogs. PubMed, Web of Science and Scopus electronic databases were searched to collect relevant articles. Twenty-nine articles met the inclusion criteria and were assessed for scientific quality, treatment plan, and recurrence incidence. Five articles were selected for a meta-analysis to test if the recurrence differs in animals treated with or without prophylactic fenestration. In the light of the low scientific quality and the amount of published literature on the topic, further research is needed to robustly support the prophylactic effect of fenestration on the recurrence of TL IVDH in dogs.This systematic review aimed to assess the effect of prophylactic fenestration (PF) on the recurrence of thoracolumbar (TL) intervertebral disc (IVD) disease in dogs. Three online databases were searched (Web of Science, MEDLINE via PubMed, SCOPUS), 115 relevant studies were thoroughly examined by the authors, 29 of which met the pre-defined inclusion criteria for this systematic review. Data about the initial treatment, the performance of PF, the incidence of recurrence, and the site of recurrence were extracted. Most of the studies were deemed to have serious to moderate risk of bias. Out of 5457 dogs, 1264 underwent prophylactic fenestration. A total of 504 cases of suspected or confirmed recurrence were recorded, in which 164 (32.54% of total recurrences and 11.02% of PF cases) were in dogs treated with PF. In order to perform quantitative analysis for the recurrence odds, we conducted a meta-analysis. Five studies were included that met the inclusion criteria. Despite a large number of relevant publications, the quality of the evidence they provide is low. This prevented us from reaching a definitive conclusion on the prophylactic effect of fenestration on recurrence in dogs surgically treated for TL IVDH.

Optimization of Spinal Reconstructions for Thoracolumbar Burst Fractures to Prevent Proximal Junctional Complications: A Finite Element Study.

The management strategies of thoracolumbar (TL) burst fractures include posterior, anterior, and combined approaches. However, the rigid constructs pose a risk of proximal junctional failure. In this study, we aim to systemically evaluate the biomechanical performance of different TL reconstruction constructs using finite element analysis. Furthermore, we investigate the motion and the stress on the proximal junctional level adjacent to the constructs. We used a T10-L3 finite element model and simulated L1 burst fracture. Reconstruction with posterior instrumentation (PI) alone (U2L2 and U1L1+(intermediate screw) and three-column spinal reconstruction (TCSR) constructs (U1L1+PMMA and U1L1+Cage) were compared. Long-segment PI resulted in greater global motion reduction compared to constructs with short-segment PI. TCSR constructs provided better stabilization in L1 compared to PI alone. Decreased intradiscal and intravertebral pressure in the proximal level were observed in U1L1+IS, U1L1+PMMA, and U1L1+Cage compared to U2L2. The stress and strain energy of the pedicle screws decreased when anterior reconstruction was performed in addition to PI. We showed that TCSR with anterior reconstruction and SSPI provided sufficient immobilization while offering additional advantages in the preservation of physiological motion, the decreased burden on the proximal junctional level, and lower risk of implant failure.

45. Enhanced surgical recovery for thoracolumbar spine surgery is associated with decreased opioid consumption, length of hospital stay and hospital readmissions: evaluation of 51,236 cases

<h3>BACKGROUND CONTEXT</h3> Evidence-based enhanced surgical recovery (ESR) programs integrate a multidimensional approach to optimize patients during the pre-, intra-, and postoperative phases of surgery. Smaller studies have shown benefits of ESR in spine surgery, but there is a lack of evidence demonstrating the effects of ESR programs related to spine surgery on a larger scale. <h3>PURPOSE</h3> This study aims to evaluate the effects of ESR adoption for thoracolumbar surgery on a national scale. <h3>STUDY DESIGN/SETTING</h3> Retrospective case-control study of a prospectively adopted health care system ESR program. <h3>PATIENT SAMPLE</h3> A total of 51,236 thoracolumbar (TL) fusion cases were identified between 2018 and 2021 across 138 centers; 24,391 participated in an ESR program and 26,845 did not. <h3>OUTCOME MEASURES</h3> Daily morphine milligram equivalents (MME), length of hospital stay (LOS, hours), and 30-day hospital readmission (READMIT) rate. <h3>METHODS</h3> Data from TL spine fusion procedures performed in a large health care system were extracted from hospital-based electronic medical records. Patients were divided into two cohorts, ESR or non-ESR, based on enrollment into an ESR program defined by (1) preoperative patient education, (2) multimodal analgesia, (3) intraoperative fluid optimization, (4) opioid-sparing anesthesia and (5) early postoperative nutrition and ambulation. Study exclusion criteria were: unknown ESR status, age <18 yrs, and/or surgery for tumor, infection or trauma. Impact of ESR upon postoperative MME, LOS and READMIT was evaluated for single-level TL fusions, multilevel TL fusions and all TL fusions using multivariable linear and logistic regression models. <h3>RESULTS</h3> ESR and non-ESR groups were demographically similar. For single level TL fusions, ESR was associated with decreased MME (β= -8.76, p <0.001), LOS (β= -8.85, p <0.001), and READMIT (OR=0.77, 95% CI: 0.67-0.88). For multilevel TL fusions, ESR was associated with decreased MME (β= -7.32, p <0.001) and LOS (β= -12.14, p <0.001), and for all TL fusions, ESR was associated with decreased MME (β= -7.94, p<0.001), LOS (β= -10.54, p<0.001), and READMIT (OR=0.91, 95% CI: 0.84-0.98). <h3>CONCLUSIONS</h3> This national healthcare system analysis of over 50,000 TL spine fusion cases by over 1,350 surgeons at 138 centers across the United States confirms that ESR adoption is associated with decreased daily MME, LOS, and READMIT. Surgeons should consider adoption of ESR programs to improve patient care. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

El Destino de la Cifosis Rotacional Toracolumbar tras Cirugía de Corrección en Escoliosis del Adulto

Objective: Adult scoliosis (AS) is often associated with rotational thoracolumbar (TL) kyphosis. The impact of surgical correction on lumbar sagittal distribution, ideal sagittal plane matching, and mechanical complications is still underexplored. Methods: In this retrospective study, prospectively collected data were analyzed from a multicenter adult deformity database. Inclusion criteria were surgical patients with AS and TL/L curves &gt; 30°, T10-L2 sagittal kyphosis (TLK) &gt; 20°, and at least a 2-year follow-up. We analyzed preoperative and postoperative variables and studied the consequences of TL sagittal change on ideal type mismatch and on mechanical complications using univariate and multivariate logistic regression analyses, and compared patients with high pelvic incidence (PI &gt; 50°) versus those with low PI (PI &lt; 50°). Results: A total of 171 patients were included. The TLK segment flattened by a mean of 20° after surgery. The residual TLK kyphosis matched that expected by PI. The TL sagittal change was not directly associated with complications or ideal shape mismatch. Mechanical complications were associated only with older age and pelvic instrumentation. Patients with low and high PI were found to have similar Cobb angle correction, TLK correction, and rate of mechanical complications. However, it was more challenging to restore an ideal sagittal profile in patients with high PI and in patients fused to the pelvis. Conclusions: Surgical correction of adult TL scoliosis flattens the TL segment by about 20°, automatically adjusting to the ideal parameters dictated by patients’ PI. The TL segment change lengthens the upper lumbar arc by one segment, shifting the inflection point cranially. However, this change has no direct impact on mechanical complications or final sagittal shape matching.

Clinical Characteristics of Pediatric Thoracolumbar Spinal Injuries: A Retrospective Study

Aim: To determine the clinical characteristics of pediatric thoracolumbar spinal injuries Study design: A retrospective study Place and Duration:This study was conducted at Pakistan Institute of Medical Sciences Islamabad from Jan 2021 to Jan 2022 Methodology:An analysis of pediatric thoracolumbar (TL) injuries was conducted to determine the epidemiology, risk factors, mechanisms, patterns, and management of pediatric TL injuries. A plain radiograph (anteroposterior and lateral view) was taken on all patients for diagnosis. In the case of surgical intervention or doubtful skeletal abnormalities observed on plain radiographs, thin-slice computerized tomography (CT) scans were obtained. In patients with neurological deficits or those who were scheduled for surgical intervention, magnetic resonance imaging (MRI) was performed. Results:A total of 90 children were treated at our institute for TL spine injuries, representing 2% of all spine injuries. Males predominate (3:1) with a mean age of 15.9 plus 3.2 years (range: 2–18 years). Falling from a height was the most common mode of injury. Most children (71.1%) sustained injuries after falling from height, 18/90 (20%) after a motor vehicle accident, and the rest after a heavy object fell over their neck. A total of 27.8% of the patients (the majority) had Grade A injuries. The most common spinal level injured was the lumbar spine (53.3%), and fractures accounted for 93.3% of all injuries. A total of 18/90 (20%) children underwent surgical fixation. There were 21 children available for follow-up, of which 13 (62%) were ambulant. Conclusion:The lumbar area is most affected by TL injuries, which are uncommon and most often occur in youth older than 10 years. When necessary, a surgical fusion of the affected vertebrae is a secure and reliable procedure. Keywords: Pediatrics, epidemiology, spine, thoracolumbar, injury

Artificial Intelligence Accurately Detects Traumatic Thoracolumbar Fractures on Sagittal Radiographs.

Background and Objectives: Commonly being the first step in trauma routine imaging, up to 67% fractures are missed on plain radiographs of the thoracolumbar (TL) spine. The aim of this study was to develop a deep learning model that detects traumatic fractures on sagittal radiographs of the TL spine. Identifying vertebral fractures in simple radiographic projections would have a significant clinical and financial impact, especially for low- and middle-income countries where computed tomography (CT) and magnetic resonance imaging (MRI) are not readily available and could help select patients that need second level imaging, thus improving the cost-effectiveness. Materials and Methods: Imaging studies (radiographs, CT, and/or MRI) of 151 patients were used. An expert group of three spinal surgeons reviewed all available images to confirm presence and type of fractures. In total, 630 single vertebra images were extracted from the sagittal radiographs of the 151 patients—302 exhibiting a vertebral body fracture, and 328 exhibiting no fracture. Following augmentation, these single vertebra images were used to train, validate, and comparatively test two deep learning convolutional neural network models, namely ResNet18 and VGG16. A heatmap analysis was then conducted to better understand the predictions of each model. Results: ResNet18 demonstrated a better performance, achieving higher sensitivity (91%), specificity (89%), and accuracy (88%) compared to VGG16 (90%, 83%, 86%). In 81% of the cases, the “warm zone” in the heatmaps correlated with the findings, suggestive of fracture within the vertebral body seen in the imaging studies. Vertebras T12 to L2 were the most frequently involved, accounting for 48% of the fractures. A4, A3, and A1 were the most frequent fracture types according to the AO Spine Classification. Conclusions: ResNet18 could accurately identify the traumatic vertebral fractures on the TL sagittal radiographs. In most cases, the model based its prediction on the same areas that human expert classifiers used to determine the presence of a fracture.

Open vs Percutaneous Pedicle Instrumentation for Kyphosis Correction in Traumatic Thoracic and Thoracolumbar Spine Injuries.

Percutaneous pedicle instrumentation (PPI) has been used for the treatment of thoracic and thoracolumbar (TL) trauma. However, the ability of PPI to correct significant post-traumatic kyphosis requires further investigation. The objective of this study is to compare the amount of kyphosis correction achieved by PPI vs the traditional open posterior approach in patients presenting with significant kyphotic deformity following traumatic thoracic and TL spine injuries. Following Institutional Review Board approval, patients who underwent surgery for thoracic (T1-T9) or TL (T10-L2) fractures with at least 15° of focal kyphosis in a 5-year period were included in this study. Patients were separated into 2 cohorts based on surgical technique: traditional open posterior approach and minimally invasive PPI. Kyphosis correction was measured using Cobb angle 1 vertebrae above and 1 below the level of injury on sagittal preoperative computed tomography image, immediate and follow-up postoperative upright lateral radiographs. Initial degree of correction and loss of correction at the final follow-up were compared. Of 91 patients included, 65 (71%) underwent open surgery and 26 (29%) underwent PPI. Open patients had 11° (95% CI, 9°-13°) of immediate correction compared with 11° (95% CI, 6°-15°) for PPI (P = 0.81). Follow-up data were available for 70 patients with a median of 105.5 days. Both groups had 1° (95% CI, 0°-2°) of loss of correction at follow-up (P = 0.82). Regardless of surgical technique, obesity (>30 kg/m2) and AO type-A compression fractures had significantly less correction. For each unit of body mass index, there was a 0.75° decrease in correction achieved (P < 0.0001). Other factors did not influence the degree of correction. PPI techniques provide equivalent postoperative angular correction and maintenance of correction compared with open surgery in thoracic and TL trauma patients. This study provides evidence for spine surgeons to utilize either technique for treating significant traumatic kyphotic deformity. Therapeutic 3.

Distal adding-on after surgery in Lenke 5C adolescent idiopathic scoliosis: clinical and radiological outcomes

BackgroundTo evaluate the incidence and risk factors of postoperative distal adding-on in patients with Lenke 5C adolescent idiopathic scoliosis (AIS). More accurate selection criteria for the lower instrumented vertebra (LIV) should be confirmed to prevent distal adding-on.MethodsForty-six patients with Lenke 5C AIS who underwent posterior fusion were enrolled in the study. Patients were allocated into adding-on and no adding-on groups. Demographic data, clinical data, and radiographic parameters were recorded and compared.ResultsPostoperative distal adding-on occurred in eight patients (17.4%) during follow-up. Demographic data, clinical data, and baseline radiographic parameters of the two groups were not significantly different. The postoperative thoracolumbar (TL) or lumbar (L) Cobb angle, LIV translation, and LIV + 1 translation were higher in the adding-on group than those in the no adding-on group, while the postoperative coronal imbalance of the adding-on group was lower than that of the no adding-on group. The level difference of last barely touched vertebra (LBTV) and last substantial touched vertebra (LSTV) with LIV were higher in the adding-on group than in the no adding-on group.ConclusionPostoperative TL/L curve, postoperative LIV translation, postoperative LIV + 1 translation, and postoperative coronal imbalance were determined as risk factors for postoperative distal adding-on in patients with Lenke 5C AIS. Moreover, LIV selection of LBTV-1 or LSTV-1 may cause a higher risk of postoperative distal adding-on.

Vertebral Body Tethering in 49 Adolescent Patients after Peak Height Velocity for the Treatment of Idiopathic Scoliosis: 2-5 Year Follow-Up.

Vertebral Body Tethering (VBT) is a non-fusion surgical treatment for Adolescent Idiopathic Scoliosis (AIS) that elicits correction via growth modulation in skeletally immature patients. VBT after peak height velocity is controversial and is the subject of this study. A retrospective review of Risser 3–5 AIS patients treated with VBT, and min. 2-year FU was performed. Pre to post-op changes in clinical outcomes were compared using Student’s t-test or the Mann-Whitney test. A total of 49 patients met criteria, age 15.0 ± 1.9 years, FU 32.5 ± 9.1 months. For thoracic (T) major curvatures, T curvature improved from 51.1 ± 6.9° to 27.2° ± 8.1° (p < 0.01) and TL from 37.2° ± 10.7° to 19.2° ± 6.8° (p < 0.01). For thoracolumbar (TL) major curvatures, T improved from 37.2° ± 10.7° to 18.8° ± 9.4° (p < 0.01) and TL from 49.0° ± 6.4° to 20.1° ± 8.5° (p < 0.01). Major curve inclinometer measurements and SRS-22 domains, except activity, improved significantly (p ≤ 0.05). At the latest FU, one (2%) patient required fusion of the T curve and revision of the TL tether due to curve progression in the previously uninstrumented T curve and tether breakage (TB) in the TL. Twenty (41%) patients experienced TB. VBT in AIS patients with limited remaining skeletal growth resulted in satisfactory clinical outcomes at the latest FU.