Treatment Of Spinal Deformity Research Articles

236. Rod failures continue to plague the surgical treatment of adult spinal deformity (ASD)

<h3>BACKGROUND CONTEXT</h3> Rod failure and pseudarthrosis are common complications following the surgical treatment of adult spinal defomity (ASD). Many strategies have been employed in mitigating these problems, such as interbody fusion, multiple rods, use of more effective biologics, and optimizing spinal alignment. We aimed to study the frequency and type of rod failures in a large ASD population over time. <h3>PURPOSE</h3> To study the frequency and type of rod failures in a large ASD population over time. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospective data. <h3>PATIENT SAMPLE</h3> This study included 647 adult spinal deformity patients surgically treated between 2008 and 2018. <h3>OUTCOME MEASURES</h3> Rod failures. <h3>METHODS</h3> ASD patients with a fusion extended from minimum L1 to pelvis and min 2-year follow-up were included. Radiographs and records were examined to identify characteristics of the rod failures: timing, unilateral vs bilateral, vertebral level, unilateral progressing to bilateral failure, revision and failure rates over time. <h3>RESULTS</h3> Among the study population, 647/1052 patients met inclusion criteria (age: 64±10 yrs., 78% F, BMI: 28.3±5.7, Mean follow-up: 37 months ±13). Surgeries for these patients were performed from 2008 to 2018. The UIV was T7 or above in 306 and T8 or below in 338 patients, most frequent UIV: T4 (121) and T10 (208). A total of 146 patients had a 3COs; 435 had interbody fusion with 187 ALIF, 202 TLIF,135 XLIF; 286 patients had BMP use post only and 203 had BMP use interbody and posteriorly. Overall rod failure rate was 135/647 (21%), of which 9.3% occurred before by 2 years postop. Mean days to failure was 795 day +/- 485 (Median 733). Most frequent failures were in the lower lumbar spine L3-4 (32) 24%, L4-5 (34) 25% and L5-S1 (44) 32%. Of the 97 Unilateral failures, 35 (36.1%) were revised and only 8 progressed to bilateral failure of which 6/8 were revised; 46 Bilateral failure, 24 (52.2%) were revised.Kaplan-Meier analysis shows a survival rate of 89.7% at 2 years with decrease of 5% per year. No significant difference was found between the first 5 years and last 5 years. Comparison of primary vs revision index procedures did not reveal any differences in time to failure nor time to revision. Use of BMP improved survival rate to 91.2% compared to no BMP 83.4% at 2 years. <h3>CONCLUSIONS</h3> Rod failures remain a common complication when treating ASD with a rate of 21%. Among those rod failures, 9.3% occurred within 2 years. The most frequent sites of failure were in the lower lumbar spine. Unilateral failures underwent a lower rate of revision than bilateral. BMP increased rod survivability. Kaplan-Meier analysis demonstrated a survival rate of 89.7% at 2 years with a decrease of 5% per year. The failure rate has not improved when comparing the first 5 years. to last 5 years. We must continue to seek solutions to improve rod durability challenges to improve long-term outcomes. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

67. The value of overall assessment in adult degenerative scoliosis patients: short- and long-term effect of surgical intervention on static and dynamic balance, gait and pain level

<h3>BACKGROUND CONTEXT</h3> In the diagnosis and treatment of adult spinal deformities, static radiographic measurements in the sagittal and coronal anatomical planes and patient-reported outcome measures (PROMs) serve as the gold standard for assessment of spinal alignment and deformity. However, there is a lack of published literature on their relation to objective functional outcome measures (FOMs) among patients afflicted with adult spinal deformity. Adult spinal deformity (ASD) is due to degeneration, functional decline is partly due to loss of postural stability and neuromuscular capacity and coordination. Objective functional measures (eg, static standing and walking alignment) cover more information than just radiographic alignment in the ASD population. Gait and dynamic balance analysis can reveal functional compensatory alignment changes where static imaging is limited. Previous studies have shown improvement in postoperative gait, approximating non-ASD control cohorts but still symptomatic. Many studies have shown surgical reconstruction in ASD patients has improved patient outcomes, but not overall assessment of objective function along with psychological factors. Therefore, a more comprehensive standard outcome measurement is needed. <h3>PURPOSE</h3> To determine the one-year effects of spinal alignment on function in ASD patients following surgical treatment using radiographic parameters, 3D gait and balance analysis, PROMs, and psychological tests and compared to healthy control. <h3>STUDY DESIGN/SETTING</h3> Nonrandomized, prospective study. <h3>PATIENT SAMPLE</h3> Forty-three symptomatic ASD patients, 24 age-matched control. <h3>OUTCOME MEASURES</h3> Gait spatiotemporal parameters, dynamic balance as measurement by balance effort and Cone of Economy (CoE) dimensions, radiograph alignment measurements, PROMs, and psychological factors. <h3>METHODS</h3> Patients performed dynamic balance and gait evaluations prior to surgery (Pre), 3 months (Post3), and 12 months (Post12) postoperatively. Patients also completed full-length, head-to-toe, micro-dose X-rays along with PROMs, and psychological questionnaires. Balance effort and CoE dimensions were measured by total sway and range of sway, respectively. Repeated measurement analysis of variance (ANOVA) and one-way ANOVA were used to determine differences in radiographic, dynamic balance, gait, and PROMs parameters at Post3 and Post12 and to the match control group. <h3>RESULTS</h3> Significant improvements in radiographic alignment were found in Cobb angle (<0.001), sagittal (<0.009) and coronal (<0.003) vertical axes and pelvic incidence-lumbar lordosis mismatch (<0.001) at Post3 and Post12. There were significant improvements in all PROMs after surgery (VAS mid-back, low back, and leg, ODI and SRS). Surgical intervention resulted in a significant decrease in balance effort (head: p<0.017 and center of mass: p<0.042) and reduced in the CoE dimensions (sagittal: p<0.004; and coronal: p=0.029). Gait was also enhanced after surgery as seen with a faster walking speed (p<0.024) and longer stride length (p<0.024). Psychological factors showed significant improvements in Tampa Scale for Kinesiophobia and Fear Avoidance Belief Questionnaire scores (p<0.050). <h3>CONCLUSIONS</h3> This is the first study to provide insight into a comprehensive global assessment of ASD surgery patients' function which includes complete objective functional and psychological outcomes in addition to standard PROMs and radiographic alignment. Balance effort and CoE limits improved at all time points post-operatively and ultimately matched the controls at 12 months. Similar to the significant improvement in static and dynamic balance in these patient groups, gait parameters also improved Post3 and Post12 to closely resemble the control group and continued to improve over time. Our findings present a more comprehensive set of outcome metrics, which, once combined, provide a more detailed and sensitive assessment of overall treatment outcomes. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

27. Achievement of minimum clinically important differences in patient reported outcomes does not imply outright improvements in objective functional outcome measures for surgical treatment of adult spinal deformities

27. Achievement of minimum clinically important differences in patient reported outcomes does not imply outright improvements in objective functional outcome measures for surgical treatment of adult spinal deformities

210. Cost-utility analysis of bracing vs observation for adolescent idiopathic scoliosis

<h3>BACKGROUND CONTEXT</h3> High quality evidence has shown that bracing can prevent radiographic progression of spinal curvature in skeletally immature adolescent idiopathic scoliosis (AIS) patients with curves between 25° -45°. Despite popular use, the cost-utility of bracing has not been established. <h3>PURPOSE</h3> This study aimed to determine the cost-utility of bracing in AIS. <h3>STUDY DESIGN/SETTING</h3> Cost-utility analysis. <h3>PATIENT SAMPLE</h3> Hypothetical cohort of skeletally immature (Risser 1) AIS patient with a 35° right main thoracic curve. <h3>OUTCOME MEASURES</h3> Incremental cost utility ratio (ICUR) and incremental net monetary benefit were calculated. <h3>METHODS</h3> A decision-analysis model comparing bracing vs observation was developed for a hypothetical skeletally immature AIS patients. We estimated the probability, cost, and quality-adjusted life years (QALY) for each event based on comprehensive review of the AIS literature. Costs were adjusted for inflation based on Consumer Price Index and reported in terms of 2020 real dollars. QALYs were discounted at 3%. Incremental net monetary benefit (INMB) was calculated based on a probabilistic sensitivity analysis using Monte Carlo simulations of 1,000 hypothetical patients. One-way sensitivity analyses were performed by varying cost, probability, and QALY estimates. <h3>RESULTS</h3> Our decision-analysis model revealed that bracing was the dominant treatment choice over observation at $50,000/QALY willingness to pay threshold. The net lifetime costs were $57,908 ± $5,443 with bracing and $79,079 ± $4,281 with observation. The net lifetime QALYs were 24.1 ± 1.9 with bracing and 23.8 ± 1.8 with observation. Bracing was favored in 99.6% of the simulations with a median INMB of $32,854 (95% CI, $13,695 to $45,689). The model was most sensitive to the impact of bracing vs observation on the probability of requiring surgical treatment as an adolescent or adult spinal deformity treatment later in life. <h3>CONCLUSIONS</h3> Cost-utility analysis demonstrates that bracing for AIS is dominant over observation, with a positive INMB. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Implant-Related Complications Using Uniaxial Implants In Pediatric Spinal Deformity Surgery.

Introduction: The successful surgical treatment of paediatric spinal deformity relies on robust anchors to achieve correction. Uniaxial pedicle screws are designed with articulation between the screw head and screw shaft, thus reducing the risk of anchor failure whilst permitting corrective manoeuvres. The purpose of this study was to describe the incidence, nature, and chronology of implant-related complications in pediatric spinal deformity treated with uniaxial pedicle screws.Methods: A retrospective radiographic analysis was carried out on paediatric patients treated for spinal deformity with more than two years of follow-up. Each was treated with posterior instrumented spinal fusion (PISF) using a uniaxial pedicle screw system by a single surgeon at a single institution. Surgical records, post-operative radiographs, and follow-up documentation were scrutinised for details of the implants used, implant failure, and revision procedures.Results: Three hundred and eighty-nine eligible patients with a mean follow-up of 3.3 years were identified. The mean anchor density was 1.7. Seven implant complications were observed. Early complications (<12 months) occurred in four cases and late (>12 months) in three cases. None of the early complications were associated with non-union. Two early and two late complications required revision surgery to manage implant failure and non-union. Patients who underwent fusion across the lumbosacral junction showed a higher than expected rate of implant-related complication (P=0.02).Conclusion: This study shows that there is a rate of implant-related failure of 1.8% after PISF with uniaxial implants in pediatric spinal deformities. There is a distinction between early and late implant-related complications, with early failure being due to loss of construct integrity, whereas late failure is due to pseudarthrosis and construct fatigue.

Use of modern spinal braces in the treatment of idiopathic scoliosis

This review presents an analysis of scientific papers on the conservative treatment of idiopathic scoliosis with spinal braces.&#x0D; Insufficient awareness of brace treatment for spinal deformities is often the reason for the negative attitude of orthopedists toward brace therapy and the conservative treatment of scoliosis in general.&#x0D; In world practice, braces have been the primary and scientifically proven technique for conservative treatment of intermediate forms (grades IIIII) of scoliosis in children and adolescents for over 50 years. Modern spinal braces are active orthopedic products that provide three-dimensional correction of the existing deformity and prevent the progression of scoliosis. The main goal of using braces is to eliminate the pathological displacement of the vertebrae, ribs, and pelvis to a physiological state by applying pressure to specific body areas and actively correcting the deformity. Using a brace is the only non-surgical method to treat scoliosis with scientifically proven efficiency. The poor results of using braces to treat scoliosis are primarily due to insufficient correction in the brace, non-compliance with the wearing time, and the lack of adjunctive therapy. The efficiency of brace therapy depends on three main factors that require the personal involvement of the patient: the time of wearing the corset per day, the degree of correction in the corset, and constant (daily) training of the back muscles. The results of recent multicenter studies confirm the efficiency of using braces to treat idiopathic adolescent scoliosis.

Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older: a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS)

BACKGROUND CONTEXTPatients with adult spinal deformity suffer from disease related disability as measured by the Oswestry Disability Index (ODI) for which surgery can result in significant improvements. PURPOSEThe purpose of this study was to show the change in overall and individual components of the ODI in patients aged 60 years or older following multi-level spinal deformity surgery. STUDY DESIGNProspective, multicenter, multi-continental, observational longitudinal cohort study PATIENT SAMPLEPatients ≥60 years undergoing primary spinal fusion surgery of ≥5 levels for coronal, sagittal or combined deformity. OUTCOME MEASURESOswestry Disability Index (ODI) METHODS: Patients completed the ODI pre-operatively for baseline, then at 10 weeks, 12 months and 24 months post-operatively. ODI scores were grouped into deciles, and change was calculated with numerical score and improvement or worsening was further categorized from baseline as substantial (≥20%), marginal (≥10–<20%) or no change (within 10%). RESULTSTwo-hundred nineteen patients met inclusion criteria for the study. The median number of spinal levels fused was 9 [Q1=5.0, Q3=12.0]. Two-year mean (95% CI) ODI improvement was 19.3% (16.7%; 21.9%; p<.001) for all age groups, with mean scores improved from a baseline of 46.3% (44.1%; 48.4%) to 41.1% (38.5%; 43.6%) at 10 weeks (p<.001), 28.1% (25.6%; 30.6%) at 12 months (p<.001), and 27.0% (24.4%; 29.5%) at 24 months (p<.001). At 2 years, 45.5% of patients showed 20% or greater improvement in ODI, 23.7% improved between 10% and 20%, 26.3% reported no change (defined as±10% from baseline), 4.5% of patients reported a worsening between 10% to 20%, and none reported worsening greater than 20%. 59.0% of patients were severely disabled (ODI >40%) pre-operatively, which decreased to 20.2% at 2 years. Significant improvement was observed across all 10 ODI items at 12 and 24 months. The largest improvements were seen in pain, walking, standing, sex life, social life and traveling. CONCLUSIONSIn this prospective, multicenter, multi-continental study of patients 60 years or older undergoing multi-level spinal deformity surgery, almost 70% of patients reported significant improvements in ODI without taking into account surgical indications, techniques or complications. Clear data is presented demonstrating the particular change from baseline for each decile of pre-operative ODI score, for each sub-score, and for each age group.

Use of torso orthoses in the treatment of congenital spinal deformities: A literature review

BACKGROUND: Congenital malformations of the spine require urgent treatment, despite the popularity of this problem. The choice of the term and method of surgical treatment of congenital spinal deformities with vertebral malformations does not have diametrically opposed views in the domestic and foreign literature, but the scientific discussion continues regarding the use of orthotics. Currently, several designs of orthoses on the trunk are known worldwide, which can be used not only for idiopathic but also for congenital scoliosis. А unified view of the use of this type of complex treatment is necessary, but there are opposite opinions in the scientific literature.&#x0D; AIM: This study aimed to analyze publications that present the use of torso orthoses in the treatment of congenital malformations of the spine.&#x0D; MATERIALS AND METHODS: We searched for data in the open electronic databases of PubMed and e-LIBRARY using the following keywords and phrases: congenital deformity of the spine, congenital scoliosis, orthosis, and effectiveness of orthosis. The search covered 30 years of literature.&#x0D; RESULTS: Several authors have reported a significant correction of the congenital curves using orthotics, but this issue has not been sufficiently studied and is still at the research stage. Some specialists consider the formation or progression after the operation of compensatory counter-curve above or below the established metal structure, which can be corrected not only by repeated surgery, but also by using orthoses.&#x0D; CONCLUSIONS: There is a clear trend toward complex treatment of children with isolated congenital malformations of the spine, including a reasonable combination of surgical treatment and orthotics. In Europe and Russia, preference is given to the Rigo system Cheneau brace.

Comparative analysis of the quality of life of children with congenital scoliosis after surgical treatment: Extirpation of the hemivertebra from dorsal and combined access

BACKGROUND: Congenital scoliosis with disorders of the formation of the vertebrae is the most common cause of pronounced deformities of the spine in early childhood. This pathology can be treated surgically using various techniques that differ in invasiveness, severity of the condition in the postoperative period, achieved result of deformity correction, and nature of the long-term prognosis. Numerous studies have assessed the quality of life of patients who underwent surgery for acquired deformities, trauma, and degenerative and neoplastic diseases of the spine in adults. However, features of the childs quality of life following surgical technique for congenital scoliosis have not been sufficiently studied.&#x0D; AIM: This study aimed to compare the quality of life of children with congenital scoliosis of the thoracolumbar localization after extirpation of the hemivertebra from the dorsal and combined approaches.&#x0D; MATERIALS AND METHODS: An intergroup prospective analysis of the results of a survey of 60 patients with congenital deformity of the spine against the background of an isolated violation of the formation of the thoracic or lumbar vertebra was carried out. Patients underwent standard surgical treatment. Patients were divided into two groups according to the surgical approach to the abnormal vertebral body: dorsal group (n = 28) and combined group (n = 32). The average age of the patients was 75 (minmax, 26196) months. The follow-up period was 18 months after surgery. To assess the quality of life, a specialized Russian version of the PedsQL v4.0 questionnaire and a modified visual analog scale were used.&#x0D; RESULTS: After surgical treatment of congenital spinal deformity, quality of life indicators decreased more than two times than the results of a preoperative survey. At 18 months postoperatively, the physical activity and psychoemotional state were restored to the preoperative level, while patients of the combined group had a higher satisfaction score on the quality of life (p 0.05).&#x0D; CONCLUSIONS: The combined approach provides the best correction of congenital deformity of the spine and allows maintaining of the achieved result throughout the observation period. In the early postoperative period, the combined group demonstrated a significant decrease in the level of satisfaction with the quality of life, while the pain syndrome was higher than that in the dorsal group. Dynamic observation revealed the leveling of these differences and a subsequent increase in the level of satisfaction with the quality of life of these patients.

Oblique lateral interbody fusion to treat lumbar spinal stenosis in a patient with situs inversus totalis: a case report

Oblique lateral interbody fusion (OLIF) is a minimally invasive spinal surgery that is popular for lumbar degeneration and spinal deformity treatment because it causes minimal damage to the stability of the intervertebral structures. However, when encountering abnormal anatomical structures caused by situs inversus, surgical routes must be adjusted to avoid serious complications. A 42-year-old woman with lumbar spinal stenosis presented to our hospital. Preoperative X-ray and computed tomography indicated situs inversus totalis, with the abdominal aorta and inferior vena cava reversed. We established an appropriate surgical approach for OLIF via the right abdomen according to the characteristics of the anatomical structures. Postoperative X-rays showed adequate positioning of the interbody fusion cage and internal fixation screws. At the 3-month follow-up, the patient reported resolution of her symptoms. Vascular variations caused by situs inversus totalis can affect the course of OLIF. Understanding the unique anatomical structure in such patients is crucial for successful surgery and to avoid intraoperative complications.

The surgical treatment of spinal deformity in children with non-ambulatory myelomeningocele.

To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele. We reviewed 12 consecutive patients (7M:5F; mean age 12.4 years (9.2 to 16.8)) including demographic details, spinopelvic parameters, surgical correction, and perioperative data. We assessed the impact of surgery on patient outcomes using the Spina Bifida Spine Questionnaire and a qualitative questionnaire. The mean follow-up was 5.4 years (2 to 14.9). Nine patients had kyphoscoliosis, two lordoscoliosis, and one kyphosis. All patients had a thoracolumbar deformity. Mean scoliosis corrected from 89.6° (47° to 151°) to 46.5° (17° to 85°; p < 0.001). Mean kyphosis corrected from 79.5° (40° to 135°) to 49° (36° to 65°; p < 0.001). Mean pelvic obliquity corrected from 19.5° (8° to 46°) to 9.8° (0° to 20°; p < 0.001). Coronal and sagittal balance restored to normal. Complication rate was 58.3% (seven patients) with no neurological deficits, implant failure, or revision surgery. The degree of preoperative spinal deformity, especially kyphosis and lordosis, correlated with increased blood loss and prolonged hospital/intensive care unit stay. The patients reported improvement in function, physical appearance, and pain after surgery. The parents reported decrease in need for everyday care. Anterior spinal fusion achieved satisfactory deformity correction with high perioperative complication rates, but no long-term sequelae among children with high level myelomeningocele. This resulted in physical and functional improvement and high reported satisfaction. Cite this article: Bone Joint J2021;103-B(6):1133-1141.

The Value of Three-Dimensional Printing Spine Model in Severe Spine Deformity Correction Surgery.

Retrospective case-control study. We aimed to evaluate the value of 3-dimensional printing (3DP) spine model in the surgical treatment of severe spinal deformity since the prosperous development of 3DP technology. Severe scoliosis or hyper-kyphosis patients underwent posterior fixation and fusion surgery using the 3DP spine models were reviewed (3DP group). Spinal deformity surgeries operated by free-hand screw implantation during the same period were selected as the control group after propensity score matching (PSM). The correction rate, pedicle screw accuracy, and complications were analyzed. Class A and B screws were defined as accurate according to Gertzbein and Robbins criteria. 35 patients were enrolled in the 3DP group and 35 matched cases were included in the control group. The perioperative baseline data and deformity correction rate were similar between both groups (P > .05). However, the operation time and blood loss were significantly less in the 3DP group (296.14 ± 66.18 min vs. 329.43 ± 67.16 min, 711.43 ± 552.28 mL vs. 1322.29 ± 828.23 mL, P < .05). More three-column osteotomies (Grade 3-6) were performed in the 3DP group (30/35, 85.7% vs. 21/35, 60.0%. P = .016). The screw placement accuracy was significantly higher in the 3DP group (422/582, 72.51% vs. 397/575, 69.04%. P = .024). The screw misplacement related complication rate was significantly higher in the free-hand group (6/35 vs. 1/35, P = .046). The study provided solid evidence that 3DP spine models can enhance surgeons' confidence in performing higher grade osteotomies and improve the safety and efficiency in severe spine deformity correction surgery. 3D printing technology has a good prospect in spinal deformity surgery.

Coronal Plane Gap Increases Postoperative Pseudoarthrosis after Lateral Interbody Fusion for Adult Spinal Deformity.

Study DesignThis is a retrospective study.PurposeThis study aims to evaluate the risk factor associated with pseudoarthrosis after placement of lateral interbody fusion (LIF) cages for adult spinal deformity (ASD) treatment.Overview of LiteratureLIF technique is widely used for ASD correction. Furthermore, pseudoarthrosis is a major complication of fusion surgery required for revision surgery.MethodsThis study included 42 patients with ASD (two men and 40 women; 112 segments; mean, 68.5±8.4 years; and mean follow-up, 31.6±17.0 months) who underwent LIF and posterior correction surgery. The concave slot of the LIF cage was filled with an autologous iliac crest bone graft (IBG), and the convex slot with a porous hydroxyapatite/collagen (HAp/Col) composite was soaked with bone marrow aspirate. Endplate injury, the gap between vertebral endplate and cage in the coronal or sagittal plane, and fusion status were evaluated using computed tomography multiplanar reconstruction at 12 months after surgery. Moreover, the associated risk factors for pseudoarthrosis were analyzed.ResultsFusion at LIF segments were observed in 71.4% segments at 12 months after surgery. Fusion on the concave slot (autologous IBG side), convex slot (porous HAp/Col composite side), and both concave and convex slots were observed in 66.1%, 37.5%, and 36.6% of patients, respectively. Moreover, pseudoarthrosis was observed in 28.6% at 12 months after surgery. Consequently, logistic regression analysis of the fusion at the LIF segment revealed that the gap between the LIF cage and endplate in the coronal plane (p=0.030; odds ratio, 0.183; 95% confidence interval, 0.030–0.183) was significantly associated with pseudoarthrosis at the LIF segments.ConclusionsASD surgery fusion rate using LIF cages was 71.4% at 12 months after surgery. The fusion rate was higher on the concave slot filled with autologous IBG than on the convex slot filled with a porous HAp/Col composite. The gap in the coronal plane was a risk factor for pseudoarthrosis at the LIF segment.

Nonfusion procedures in pediatric scoliosis

The treatment of early onset scoliosis (EOS) in children is acomplex and demanding challenge in the treatment of spinal deformities. Conservative treatment with physiotherapy is indicated in mild forms with a Cobb angle from 10°and additionally a corset treatment with a Cobb angle of more than 20°. After exhaustion of the conservative measures or a progression of spinal scoliosis of 10° or deformities of more than 35°, asurgical approach should be considered in order to prevent respiratory insufficiency as well as severe postural and thoracic deformities. In situations where growth is still ongoing fusion operations can lead to stunted growth, a crankshaft phenomenon or degeneration of alignment. Meaningful alternatives to a fusion are so-called growing rods as a distraction-based nonfusion technique, e.g. traditional growing rods (TGR) and magnetically controlled growing rods (MCGR) or as a further method a vertical expandable prosthetic titanium rib (VEPTR) device. The advantages and disadvantages of each operative procedure must be considered with respect to the risk profile of each patient and the experience of the surgeon in order to guarantee the best possible treatment.

Early and late hospital readmissions in adolescent idiopathic scoliosis.

Retrospective review of a prospectively collected multicenter database. To identify risk factors for early and late readmission of surgically treated patients with adolescent idiopathic scoliosis (AIS). Specific risk factors associated with readmission in patients with AIS remain poorly understood. Patients with AIS who were operatively treated from 19 centers specializing in the treatment of pediatric spinal deformity were studied. Data from a minimum 2years of clinical follow-up and any readmission were available for analysis. Characteristics of patients with no readmission, early readmission (< 90days), and late readmission (> 90days) were evaluated. Both univariate and multivariate analyses of risk factors for readmission were performed. 2049 patients were included in our cohort, with 1.6% requiring early readmission and 3.3% late readmission. In the multivariate analysis, greater preoperative coronal imbalance was associated with early readmission. Longer operative time was associated with late readmission. Finally, greater preoperative pain (SRS-22 pain scale) was associated with both early and late readmission. GI complications accounted for a higher proportion of early readmissions than previously reported in the literature. Preoperative counseling of patients with higher levels of pain and coronal imbalance and the implementation of a thorough postoperative bowel regimen may help optimize patient outcomes. 3.

Deformed Complex Vertebral Osteotomy Technique for Management of Severe Congenital Spinal Angular Kyphotic Deformity.

ObjectivesTo (i) introduce the deformed complex vertebral osteotomy (DCVO) technique for the treatment of severe congenital angular spinal kyphosis; (ii) evaluate the sagittal correction efficacy of the DCVO technique; and (iii) discuss the advantages and limitations of the DCVO technique.MethodsMultiple malformed vertebrae were considered a malformed complex, and large‐range and angle wedge osteotomy was performed within the complex using the DCVO technique. Patients with local kyphosis greater than 80° who were treated with DCVO and did not have tumors, infections, or a history of surgery were included. A retrospective case study was performed in these patients with severe angular kyphosis who underwent the DCVO technique from 2008 to 2016. Demographic data, the operating time, and the volume of intraoperative blood loss were collected. Spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], and sacral slope [SS]), local and global sagittal parameters (deformity angle, thoracic kyphosis [TK], and lumbar lordosis [LL]), visual analog scale (VAS) score, and Oswestry disability index (ODI) score were recorded pre‐ and postoperatively. Paired t‐tests (α = 0.05) were used for all data (to compare the mean preoperative value with the mean postoperative and most recent follow‐up values). P < 0.05 was considered statistically significant.ResultsTwenty‐nine patients with a mean age of 34 years (range, 15–55) were included in the final analysis. Seventeen patients were male, and 12 were female. The mean follow‐up was 44 months (range, 26–62). The mean operating time was 299 min (range, 260–320 min). The mean blood loss was 2110 mL (range, 1500–2900 mL). Three patients had T7–T8 deformities (3/29, 10.3%), six had T8–T9 deformities (6/29, 20.7%), six had T9–T10 deformities (6/29, 20.7%), 10 had T10–T11 deformities (10/29, 34.5%), three had T11–T12 deformities (3/29, 10.3%), and one had T9–T11 deformities (1/29, 3.4%). The mean local deformity angle significantly improved from 94.9° ± 10.8° to 24.0° ± 2.3° through the DCVO technique, with no significant loss at the follow‐up. Moreover, the global sagittal parameters and spinopelvic parameters exhibited ideal magnitudes of improvement; TK decreased from 86.1° ± 12.1° to 28.7° ± 2.5°, LL improved from 94.5° ± 4.1° to 46.1° ± 3.0°, and PI minus LL improved from −60.9° ± 6.5° to −13.7° ± 2.6°. Both the VAS and ODI scores significantly improved at the last follow‐up. CSF fistula and neural injury did not occur during the perioperative period. At the last follow‐up, fixation failure was not observed.ConclusionThe DCVO technique provides an alternative and effective method for the treatment of congenital severe angular spinal kyphotic deformities and may decrease the occurrence of perioperative complications.

Significance of various risk factors for proximal junctional kyphosis and instability of instrumentation in surgical treatment for adult spinal deformities

Objective. To analyze the significance of the influence of various risk factors on the development of proximal junctional kyphosis (PJK) and instability of instrumentation.Material and Methods. The results of surgical treatment of 382 patients with scoliotic deformities of the lumbar spine of type I and IIIb according to Aebi were analyzed. Patients were operated on through the posterior approach using the TLIF-PLIF technique with extended rigid transpedicular instrumentation. Potential risk factors influencing the development of proximal junctional kyphosis and instability of instrumentation were analyzed.Results. It was found that only three risk factors significantly affect the development of PJK: correction of lumbar lordosis more than 30° (p = 0.036) increases the likelihood of its development by 1.5 times, osteoporosis (p = 0.001) – by 2.5 times, and proximal junctionalangle ≥10° (p = 0.001) – by 3.5 times. Three factors showed a statistically significant effect on the incidence of instrumentation instability: correction of lumbar lordosis more than 30° (p = 0.034) increases the likelihood of its occurrence by 1.7 times, osteoporosis (p = 0.018) – by 1.8 times, and deviation of the sagittal vertical axis by more than 50 mm (p = 0.001) – by 3.3 times.Conclusion. The most significant risk factors for the occurrence of PJK and instability of instrumentation are osteoporosis, correction of lumbar lordosis more than 30°, an increase in the proximal junctional angle ≥10°, and an anterior deviation of sagittal vertical axis more than 50 mm. Consideration of these factors in the preoperative period, as well as during surgery, can decrease likelihood of the occurrence of PJK and instability of instrumentation.

Stage results of the use of orthoses in children after surgical treatment of congenital spine deformity (Preliminary report)

BACKGROUND: After surgical treatment of congenital spinal deformities, we can see the progression of deformities of the spinal column segments free from metal structures, which leads to the need for reoperation. Without sufficient scientific evidence, several specialists after surgical treatment use various orthoses on the body to prevent scoliotic compensatory changes.&#x0D; AIM: This study aims to assess the results of body orthosis after surgical treatment of children with congenital spinal deformity with the impaired formation of the vertebrae, using orthoses, compensatory deformity after one year of treatment.&#x0D; MATERIALS AND METHODS: Twenty-five patients aged 2 to 12 years (10 boys and 15 girls) after surgical treatment of congenital deformity of the spine in the thoracic regions (13) and lumbar regions (12), wearing body orthoses. The results were assessed at 3, 6, and 12 months using thermal sensors for the orthosis wearing time by X-ray and statistical methods.&#x0D; RESULTS: After three months of wearing the brace, we saw a correction of about 50% of the value of the initial compensatory deformity. After six months, both thoracic and lumbar, the correction was 60%. After one year, when performing an X-ray image without an orthosis, in thoracic deformities without a brace, the correction stabilized and remained at the level of 40%. In lumbar deformities without a brace, the original deformity returned, i.e., the correction occurred but was not fixed without the orthosis. Only one of 25 patients (4%) required a second operation to increase the fixations duration.&#x0D; CONCLUSION: The results of observing a group of patients (25 children) for one year after surgical treatment of congenital spine deformity showed a positive effect of a functionally corrective orthosis on the body to correct secondary deformities.

BEZOLD JARISCH REFLEX DURING HALO-GRAVITY TRACTION: CASE REPORT

ABSTRACT Halo-gravity traction is an option that can be used in the treatment of severe spinal deformities. The author reports a complication not yet described in the literature in which rapid correction of the deformity triggered the Bezold Jarisch reflex. Level of evidence IV; Case Series.

Multicenter assessment of surgical outcomes in adult spinal deformity patients with severe global coronal malalignment: determination of target coronal realignment threshold.

The impact of global coronal malalignment (GCM; C7 plumb line-midsacral offset) on adult spinal deformity (ASD) treatment outcomes is unclear. Here, the authors' primary objective was to assess surgical outcomes and complications in patients with severe GCM, with a secondary aim of investigating potential surgical target coronal thresholds for optimal outcomes. This is a retrospective analysis of a prospective multicenter database. Operative patients with severe GCM (≥ 1 SD above the mean) and a minimum 2-year follow-up were identified. Demographic, surgical, radiographic, health-related quality of life (HRQOL), and complications data were analyzed. Of 691 potentially eligible operative patients (mean GCM 4 ± 3 cm), 80 met the criteria for severe GCM ≥ 7 cm. Of these, 62 (78%; mean age 63.7 ± 10.7 years, 81% women) had a minimum 2-year follow-up (mean follow-up 3.3 ± 1.1 years). The mean ASD-Frailty Index was 3.9 ± 1.5 (frail), 50% had undergone prior fusion, and 81% had concurrent severe sagittal spinopelvic deformity with GCM and C7-S1 sagittal vertical axis (SVA) positively correlated (r = 0.313, p = 0.015). Surgical characteristics included posterior-only (58%) versus anterior-posterior (42%) approach, mean fusion of 13.2 ± 3.8 levels, iliac fixation (90%), 3-column osteotomy (36%), operative duration of 8.3 ± 3.0 hours, and estimated blood loss of 2.3 ± 1.7 L. Final alignment and HRQOL significantly improved (p < 0.01): GCM, 11 to 4 cm; maximum coronal Cobb angle, 43° to 20°; SVA, 13 to 4 cm; pelvic tilt, 29° to 23°; pelvic incidence-lumbar lordosis mismatch, 31° to 5°; Oswestry Disability Index, 51 to 37; physical component summary of SF-36 (PCS), 29 to 37; 22-Item Scoliosis Research Society Patient Questionnaire (SRS-22r) Total, 2.6 to 3.5; and numeric rating scale score for back and leg pain, 7 to 4 and 5 to 3, respectively. Residual GCM ≥ 3 cm was associated with worse SRS-22r Appearance (p = 0.04) and SRS-22r Satisfaction (p = 0.02). The minimal clinically important difference and/or substantial clinical benefit (MCID/SCB) was met in 43%-83% (highest for SRS-22r Appearance [MCID 83%] and PCS [SCB 53%]). The severity of baseline GCM (≥ 2 SD above the mean) significantly impacted postoperative SRS-22r Satisfaction and MCID/SCB improvement for PCS. No significant partial correlations were demonstrated between GCM or SVA correction and HRQOL improvement. There were 89 total complications (34 minor and 55 major), 45 (73%) patients with ≥ 1 complication (most commonly rod fracture [19%] and proximal junctional kyphosis [PJK; 18%]), and 34 reoperations in 22 (35%) patients (most commonly for rod fracture and PJK). Study results demonstrated that ASD surgery in patients with substantial GCM was associated with significant radiographic and HRQOL improvement despite high complication rates. MCID improvement was highest for SRS-22r Appearance/Self-Image. A residual GCM ≥ 3 cm was associated with a worse outcome, suggesting a potential coronal realignment target threshold to assist surgical planning.