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Courtney E Baker, Tanya Marvi, Thomas M Austin, Shelby Payne, Megan E Mignemi, David Gailani, Allison P Wheeler, Thanh T Nguyen, Steven A Lovejoy, Jeffrey E Martus, Gregory A Mencio, Jonathan G Schoenecker
BACKGROUND: Children undergoing posterior spinal fusion experience high blood loss often necessitating transfusion. An appropriately activated coagulation system provides hemostasis during surgery, but pathologic dysregulation can cause progressive bleeding and increased transfusions. Despite receiving antifibrinolytics for clot stabilization, many patients still require transfusions. AIMS: We sought to examine the association of dilutional coagulopathy with blood loss and blood transfusion in posterior spinal fusion for pediatric scoliosis patients...
October 8, 2018: Paediatric Anaesthesia
Tarush Rustagi, Richard A Tallarico, William F Lavelle
Background: Three-column osteotomy is an effective means of correcting fixed sagittal plane deformities. Deformity correction surgeries may be associated with early postoperative neurological deficits often presenting as palsies involving the lumbar roots. The objective was to retrospectively assess a subset of our series of adult deformity correction surgeries and analyze neurological deficits and associated patient and surgical factors. Methods: Hospital records of 17 patients from a single center were examined...
April 2018: International Journal of Spine Surgery
Oussama Abousamra, Paul D Sponseller, Baron S Lonner, Suken A Shah, Michelle C Marks, Patrick J Cahill, Joshua M Pahys, Peter O Newton
BACKGROUND: Intraoperative blood loss during posterior spinal fusion for adolescent idiopathic scoliosis (AIS) has been reportedly associated with multiple factors. This study aims to investigate the effect of thoracic kyphosis on blood loss in AIS spinal fusion. METHODS: Patients with AIS who underwent posterior-only procedures for Lenke I and II type curves were identified. All included patients had intraoperative tranexamic acid. Difference in estimated blood loss per blood volume (EBL/BV) was identified between hypokyphotic curves (-), normal curves (N), and hyperkyphotic curves (+) classified based on Lenke sagittal modifier...
September 26, 2018: Journal of Pediatric Orthopedics
Graham T Fedorak, John T Smith, John A Heflin
CASE: We utilized a novel staged approach for an adolescent with severe kyphoscoliosis; it involved 8 weeks of initial halo-gravity traction as well as implantation and expansion (every 2 weeks) of a magnetically controlled growing rod over 6 months, followed by spinal fusion. The patient was a 13-year-old girl with an untreated idiopathic deformity (thoracic scoliosis with a curve of 145° and kyphosis with a curve of 120°). No osteotomies other than inferior facetectomies were required at the final fusion, and the final scoliosis curve was 57°, a correction of 60...
July 2018: JBJS Case Connector
John M Flynn, Brendan M Striano, Wallis T Muhly, Blair Kraus, Wudbhav N Sankar, Vaidehi Mehta, Michael Blum, Barbara DeZayas, Jeffrey Feldman, Ron Keren
BACKGROUND: As high-quality health care becomes increasingly expensive, improvement projects are focused on reducing cost and increasing value. To increase value by reducing operating room (OR) utilization, we studied the effect of a dedicated team approach for posterior spinal fusion (PSF) for scoliosis. METHODS: With institutional support, an interdisciplinary, dedicated team was assembled. Members developed standardized protocols for anesthetic management and patient transport, positioning, preparation, draping, imaging, and wake-up...
September 19, 2018: Journal of Bone and Joint Surgery. American Volume
Masafumi Kashii, Sadaaki Kanayama, Taichi Kitaoka, Takahiro Makino, Takashi Kaito, Motoki Iwasaki, Takuo Kubota, Takehisa Yamamoto, Keiichi Ozono, Hideki Yoshikawa
The purpose of this study was to clarify the prevalence of scoliosis and determine risk factors for the development of scoliosis in young children with osteogenesis imperfecta (OI) who underwent intravenous pamidronate (PAM) therapy. Thirty-four young children with OI who had no scoliosis at the first PAM administration underwent cyclic PAM therapy alone. The medical records and radiographs of these patients were retrospectively reviewed. We examined the relationship between scoliosis (Cobb angle ≥ 10) and type of OI (Sillence classification: types I, III, and IV), physical mobility, Z-scores of bone mineral density in L2-4 of the lumbar spine (L2-4 BMD Z-scores), age of patients at first treatment with PAM, pelvic frontal tilt and leg-length discrepancy...
September 5, 2018: Journal of Bone and Mineral Metabolism
Sebastien Pesenti, Tejbir Pannu, Jessica Andres-Bergos, Renaud Lafage, Justin S Smith, Steve Glassman, Marinus de Kleuver, Ferran Pellise, Frank Schwab, Virginie Lafage
PURPOSE: Although many risk factors for surgical site infection (SSI) following spinal fusion have been described in the literature, methodologies and study cohorts vary widely. Patient- and procedure-specific risk factors for (SSI) can be identified via a meta-analysis. We sought to review the existing data and isolate significant risk factors for SSI in patients undergoing thoracolumbar spinal fusion. METHODS: The literature was searched through December of 2016...
August 20, 2018: European Spine Journal
Leo Fradet, Xiaoyu Wang, Dennis Crandall, Carl-Eric Aubin
STUDY DESIGN: Computer biomechanical simulations to analyze risk factors of proximal junctional failure (PJF) following adult scoliosis instrumentation. OBJECTIVE: To evaluate the biomechanical effects on the proximal junctional spine of the proximal implant type, tissue dissection, and lumbar lordosis (LL) restoration. SUMMARY OF BACKGROUND DATA: PJF is a severe proximal junctional complication following adult spinal instrumentation requiring revision surgery...
September 2018: Spine Deformity
Y Qiu
This review mainly focused on the etiology and the surgical strategy for adolescent idiopathic scoliosis (AIS) treatment. Genome-wide association study on the etiology of AIS using samples from more than 5 000 patients and 6 000 normal controls showed two genes: LBX1-AS1 on 10q24.32 and TNIK on 3q26.2 highly related to AIS initiation and progression. Regarding the conservative treatment of AIS, bracing is the only well-documented effective non-operative management in the early stage of AIS. For the patients with Cobb angle smaller than 80°, balancing spine, saving fusion level and restoring thoracic kyphosis are the basic objectives in surgical management...
August 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Mehmet Nuri Erdem, Ismail Oltulu, Sinan Karaca, Seçkin Sari, Mehmet Aydogan
STUDY DESIGN: A retrospective clinical study. PURPOSE: To analyze the surgical outcomes of intraoperative halo-femoral traction (HFT) in patients with adolescent idiopathic scoliosis (AIS) with Cobb angles between 70° and 90° and flexibility <35%. OVERVIEW OF LITERATURE: Numerous methods have been described to achieve adequate correction and successful results in the surgical treatment of AIS patients with a Cobb angle >70°...
August 2018: Asian Spine Journal
Zifang Huang, Xueshi Li, Yaolong Deng, Wenyuan Sui, Hengwei Fan, Jingfan Yang, Junlin Yang
BACKGROUND: Single-stage spine-shortening osteotomy without treating spinal cord malformations may have potential advantages for the treatment of severe congenital scoliosis (CS) with type I split spinal cord malformation (SSCM); however, the study of this technique was limited. OBJECTIVE: To evaluate the safety and efficacy of a single-stage spine-shortening osteotomy in the treatment of severe CS associated with type I SSCM. METHODS: A retrospective study was designed to compare 2 case series including 12 severe CS patients with type I SSCM and 26 patients with type A cord function (without spinal cord malformations, evoked potential abnormalities, and neurological dysfunctions preoperatively) treated with a single-stage spine-shortening posterior vertebral column resection (PVCR)...
July 27, 2018: Neurosurgery
Robert K Eastlack, Justin B Ledesma, Stacie Tran, Amrit Khalsa, Paul Park, Praveen V Mummaneni, Dean Chou, Adam S Kanter, Neel Anand, Pierce Nunley, Frank La Marca, Richard G Fessler, Juan S Uribe, Gregory M Mundis
BACKGROUND: Minimally invasive surgery (MIS) correction for adult spinal deformity (ASD) may reduce the need the need for postoperative skilled nursing facility (SNF) or inpatient rehabilitation (IR) placement following surgery. The likelihood of requiring placement in a facility rather than home disposition may be influenced by various factors. In addition, the associations between discharge location and outcomes and complication rates have not been elucidated in these patients. In this study, we aimed to define factors predicting disposition to an SNF/IR and to elucidate the rates of complications occurring in patients sent to home versus to a facility...
October 2018: World Neurosurgery
Aaron J Buckland, John Y Moon, Randal R Betz, Baron S Lonner, Peter O Newton, Harry L Shufflebarger, Thomas J Errico
STUDY DESIGN: Observational cohort study of prospective database registry. OBJECTIVE: To determine the incidence of neurological complications in AIS patients undergoing surgical treatment with PO. SUMMARY OF BACKGROUND DATA: Despite the widespread use of Ponte Osteotomies (PO) in adolescent idiopathic scoliosis (AIS) correction, outcomes and complications in patients treated with this technique have not been well characterized. METHODS: A multicenter prospective registry of patients undergoing surgical correction of AIS was queried at 2-year follow up for patient demographics, surgical data, deformity characteristics and peri-operative complications...
July 12, 2018: Spine
Z K Xu, G Chen, F C Li, Q X Chen
Objective: To investigate the surgical outcome of minimally invasive surgery(MIS) for severe degenerative lumbar scoliosis(DLS) and put forward a two-stage MIS surgical strategy. Methods: Prospective study of MISDEF Ⅲ DLS patients from June 2016 to August 2017 in the Second Affiliated Hospital of Zhejiang University was carried out, excluding the patients whose apex vertebrae of scoliosis was above L(1/2) level or whose facet joint got spontaneous fusion. Fifty-three patients were included in this study for staging evaluation and MIS surgical treatment...
July 3, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Tianhao Wang, Yongfei Zhao, Guoquan Zheng, Yao Wang, Chunguo Wang, Zheng Wang, Yan Wang
BACKGROUND: Defining the postoperative pelvic tilt (PT) individually can help to reconstruct sagittal balance. However, the postoperative actual PT is hardly restored to theoretical value. Some cases with theoretical postoperative PT was overcorrected and still did not have normal horizontal visual field after surgery. The objective of this study is to describe the pelvic tilt change after spinal osteotomy in ankylosing spondylitis (AS) kyphotic deformity and evaluate the effect on clinical outcomes...
July 9, 2018: Journal of Orthopaedic Surgery and Research
Liang Xu, Xi Chen, Jun Qiao, Zhonghui Chen, Benlong Shi, Song Li, Changzhi Du, Qingshuang Zhou, Zezhang Zhu, Yong Qiu, Xu Sun
STUDY DESIGN: Retrospective radiographical clinical study. OBJECTIVE: To investigate the incidence and risk factors of coronal imbalance (CI) after three-column osteotomy (3-CO) in patients with thoracolumbar congenital kyphoscoliosis (CKS). SUMMARY OF BACKGROUND DATA: The incidence and risk factors of postoperative CI have been reported in adolescent idiopathic and degenerative lumbar scoliosis. However, limited data exists for patients with CKS after 3-CO...
July 2, 2018: Spine
Thomas J Buell, Avery L Buchholz, John C Quinn, Jeffrey P Mullin, Juanita Garces, Marcus D Mazur, Mark E Shaffrey, Chun-Po Yen, Christopher I Shaffrey, Justin S Smith
Pedicle subtraction osteotomy (PSO) is an effective technique to correct fixed sagittal malalignment. A variation of this technique, the "trans-discal" or "extended" PSO (Schwab grade IV osteotomy), involves extending the posterior wedge resection of the index vertebra to include the superior adjacent disc for radical discectomy. The posterior wedge may be resected in asymmetric fashion to correct concurrent global coronal malalignment.This video illustrates the technical nuances of an extended asymmetrical lumbar PSO for adult spinal deformity...
June 16, 2018: Operative Neurosurgery (Hagerstown, Md.)
Raphael de Rezende Pratali, Samuel Machado Martins, Francisco Prado Eugenio Dos Santos, Carlos Eduardo Gonçales Barsotti, Carlos Eduardo Algaves Soares de Oliveira
Objective: To analyze and characterize data about clinical outcome and complication rates in three-column osteotomies (3 CO) for treatment of rigid adult spine deformity (ASD). Methods: Baseline and postoperative clinical outcomes, considering the Oswestry Disability Index (ODI) and Scoliosis Research Society-22 (SRS-22) questionnaires, radiographic parameters, and demographic data of patients who underwent 3 CO procedure for fixed ASD treatment were collected. Surgical characteristics and reports of perioperative complications were recorded, as well as those that occurred at a minimum follow-up of 12 months...
March 2018: Revista Brasileira de Ortopedia
Xi-Nuo Zhang, Xiang-Yao Sun, Yong Hai, Xiang-Long Meng, Yun-Sheng Wang
Adult degenerative scoliosis (ADS) surgery is known for its high incidence of complications. The propose of this study was to determine current complication rates and the predictors of medical complications in surgical ASD patients. A retrospective study of 153 ADS patients who underwent long level spinal fusion with 2-year follow-up between 2012 and 2017. The patient- and surgical-related risk factors for each individual medical complication were identified by using univariate testing. All patients were divided into groups with and without medical complication, infection, neurological complications, and cardiopulmonary complications, respectively...
August 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Yogesh Kishorkant Pithwa
STUDY DESIGN: Retrospective analysis of prospectively collected data. PURPOSE: To assess the relative advantages of implant constructs with and without pedicle screws in the concave apex for correcting scoliosis. OVERVIEW OF LITERATURE: Concave apical pedicles in scoliosis can be narrow and dysplastic. Neural structures also migrate toward concavity, leaving little room for error while inserting pedicle screws into the concave apex. METHODS: Patients (n=35) undergoing scoliosis surgery from September 2004 to September 2009 with minimum 5-year follow-up period were included...
June 2018: Asian Spine Journal
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