Spine deformity最新文献

Purpose: Pelvic incidence (PI) is a critical morphologic parameter influencing sagittal spinal alignment. While the PI-lumbar lordosis (LL) mismatch is well studied, the extent to which PI correlates with proximal versus distal LL remains unclear. Additionally, the L1-pelvic angle (L1PA) is emerging as a potential metric for sagittal alignment assessment. This study aimed to evaluate the associations between PI, segmental LL, and L1PA to establish goal sagittal alignment benchmarks in a symptomatic non-deformity cohort.

Methods: A retrospective analysis (STUDY-17-00660) was conducted on a large consecutive series of adults undergoing full-body biplanar radiographs. Patients with spinal deformity or prior spinal surgery were excluded. Measurements included PI, proximal LL (L1-L4), distal LL (L4-S1), global LL (L1-S1), and L1PA. Multivariable linear regression models were adjusted for age, sex, and body mass index (BMI). Correlation coefficients and Fisher's z tests were used to compare the strength of associations between PI and each alignment measure.

Results: A total of 507 patients (mean age 48.4 ± 17.2 years; 50.9% female) were included. Multivariate regression demonstrates a 10° increase in PI was associated with increases of 3.7° in proximal LL, 1.9° in distal LL, 5.6° in global LL, and 5.0° in L1PA (all p < 0.001). PI showed a stronger correlation with proximal LL (r = 0.50) than distal LL (r = 0.23) and the strongest correlation with L1PA (r = 0.79).

Conclusion: PI correlates more strongly with proximal than distal lumbar lordosis and most strongly with L1PA. These findings support greater emphasis on proximal lordosis and the utility of L1PA in the restoration of sagittal alignment in adult spinal deformity.

Purpose: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are well-known contributors to morbidity and mortality following spine surgery. The aim of this study is to evaluate the risk factors for DVT and PE and the impact on outcomes in patients with adult spinal deformity (ASD).

Methods: A retrospective cohort study was performed using the 2011-2022 ACS NSQIP database. Adults receiving corrective surgery for adult spinal deformity were identified using CPT and ICD codes. We compared patient demographics, comorbidities, and operation time between those with and without postoperative DVT or PE. We used multivariable logistic regression models to evaluate predictors for DVT/PE occurrence and the impact of DVT/PE on 30-day unplanned reoperation and 30-day mortality.

Results: Among the 4,469 patients studied, 143 (3.2%) had a 30-day postoperative occurrence of DVT/PE. There were 2,775 (62.1%) females, and 3,661 (81.9%) were non-Hispanic White. Multivariable analysis revealed age [aOR: 1.03, 95% CI: 1.01-1.04] and total operation time [aOR: 1.25, 95% CI: 1.18-1.33] as significant predictors of 30-day postoperative occurrence of DVT/PE. Occurrence of DVT/PE was significantly associated with higher odds of 30-day unplanned reoperation [OR: 2.43, 95% CI: 1.41-4.18] and 30-day mortality [OR: 5.97, 95% CI: 2.26-15.80].

Conclusion: Our study suggests that increasing age and total operation time are potential risk factors for 30-day postoperative DVT/PE in ASD patients; DVT/PE also independently predicted 30-day unplanned reoperation and mortality. Future studies should focus on further investigating the risk factors for DVT/PE in ASD patients undergoing PSF.

Introduction: Prior to surgical intervention for adolescent idiopathic scoliosis (AIS), patients with mild-to-moderate deformity and skeletal growth remaining can be treated conservatively after referral to specialists. Healthcare access may influence screening opportunities and time-to-referral and, therefore, the potential for conservative treatment. This study aimed to assess whether specific social determinants of health (SDOH) and access to care predispose patients to late presentation.

Methods: AIS patients over a 2-year period at a single institution were retrospectively reviewed, assessing the association between SDOH (race/ethnicity, ADI, COI, insurance, distance to institution, and PCP affiliation) and the odds of presenting with surgical indications (> 50°). Secondary aims assessed associations between SDOH and initial treatment type and referral-to-appointment time. Generalized linear models were used with the odds ratio (OR) or geometric mean ratio (GMR) reported.

Results: 279 patients with mean age 13.5 years and 72% female were included. No SDOH were associated with increased odds of a > 50° curve at presentation. However, patients with an institution-affiliated well-child visit had higher odds of observation vs. surgery compared to patients with a non-affiliated visit (OR 2.28, 95% CI 1.06-4.90, P = 0.035). A 10-mile increase in distance from our institution was associated with a 2.9% increase in time from referral to appointment (GMR per 10 miles 1.03, 95% CI 1.01-1.05, P = 0.009).

Discussion: Several factors related to healthcare access influenced initial treatment and referral delays, such as referrals from non-affiliated PCPs and patients from further away had delayed presentation. These findings emphasize potential barriers to healthcare access, including poor screening and delayed referrals, both which may cause patients to initially present with more severe scoliosis.

Purpose: Vertebral body tethering (VBT) is a scoliosis correction technique that purportedly leverages spinal growth modulation to correct curves over time. Therefore, measures of skeletal maturity such as Risser and Sanders stages are often used in VBT patient selection. VBT in skeletally mature patients is sometimes seen as controversial or less predictable due to their limited remaining growth. This study compares VBT outcomes in Risser 0-2 vs. 3-5 and Sanders 1-4 vs. 5-8 patients.

Methods: Single institution retrospective review of 138 post-VBT patients with minimum 2-year follow-up. Patients were grouped by preop Risser and Sanders stages. Independent t-tests (alpha = 0.05) and Fisher's exact test were used for analysis of outcomes.

Results: No significant differences were observed in BMI, number of levels instrumented, preop major curve magnitude, preop major curve flexibility, estimated blood loss (EBL), % correction at first erect (FE), % correction at 2-year follow-up, or reoperation rates, complication rates, or cord breakage rates between the skeletally mature and immature patients. Operative time was shorter in Sanders 5-8 patients compared to Sanders 1-4 patients (p = 0.0478). Length of hospital stay was slightly shorter in Risser 3-5 patients (p = 0.0080), with no difference between Sanders groups.

Conclusion: At our center, Risser and Sanders stages did not significantly affect most VBT outcomes. Curve correction, reoperation rates, and complication rates were similar, suggesting that VBT can achieve comparable 2-year outcomes across a spectrum of skeletal maturity. However, given the shorter follow-up for the more skeletally mature patients, it remains possible that they may encounter issues such as cord breakage or require reoperation/fusion at rates similar to the less mature patients with longer follow-up. Larger studies are needed to determine the required degree of growth remaining for successful long-term outcomes and explore other factors associated with long-term success following VBT.

Purpose: Longer operative time has been associated with increased postoperative complications in various surgical specialties. This has not been studied in pediatric idiopathic scoliosis surgery. The purpose of this study was to study the relationship between operative time and rates of adverse outcomes in pediatric idiopathic scoliosis surgery.

Methods: This was a retrospective cohort study using the NSQIP pediatric database years 2016-2022. Patients were included in this study if they were under 18 years of age and received posterior spinal fusion for idiopathic scoliosis. Revision surgery and anterior approaches were excluded from the study. The primary outcome was the rate of adverse events. Secondary outcomes were surgical site infection, allogeneic transfusion, and length of stay. Patient and surgical characteristics were described using descriptive statistics. Logistic regression analyses were performed to determine the association between operative time and adverse event, surgical site infection, allogeneic transfusion, and postoperative neurological deficit. Linear regression analysis was performed to determine the association between operative time and length of stay. Adverse event rate, surgical site infection rate, transfusion rate, and mean length of stay were stratified by operative time (< 3 h, 3-5 h, 5-7 h, 7-9 h, > 9 h).

Result: There were 22,888 patients included in this study. Mean age was 14.4 years. Mean operative time was 4.5 h. The rate of adverse event increased with operative time (< 3 h: 0.5%; > 9 h: 3.2%). The rate of surgical site infection increased with operative time (< 3 h: 0.2%; > 9 h: 2.3%). The rate of allogeneic transfusion increased with operative time (< 3 h: 4.9%; > 9 h: 32.9%). The rate of postoperative neurological deficit increased with operative time (< 3 h: 0.2%; > 9 h: 5.0%). The mean length of stay increased with operative time (< 3 h: 3.2; > 9 h: 6.2). In adjusted regression analyses, controlling for number of surgical levels, three-column osteotomies, and pelvic instrumentation, each operative hour was associated with higher odds of adverse event (OR 1.18, p < 0.001), higher odds of surgical site infection (OR 1.14, p = 0.012), higher odds of allogeneic transfusion (OR = 1.41, p < 0.001), higher odds of postoperative neurological deficit (OR = 1.45, p < 0.001), and longer length of stay (B = 0.26, p < 0.001).

Conclusion: Increasing operative time is associated with higher risk of adverse event, surgical site infection, transfusion, and longer length of stay. Surgical strategies that reduce operative time should be utilized to optimize outcomes.

Purpose: To compare surgical site infection (SSI), reoperation, and readmission proportions following posterior spinal fusion (PSF) with pelvic instrumentation for pediatric nonidiopathic scoliosis between plastic multilayered closure (PMC) and standard orthopaedic closure (SOC).

Methods: This study retrospectively reviewed patients ≤18 years with nonidiopathic scoliosis undergoing primary PSF with pelvic instrumentation at two institutions from 2018-2023. Exclusions were prior spinal fusion, staged procedures, and scoliosis associated with spina bifida, neoplasia, or congenital spondyloptosis. Outcome measures included SSI per CDC criteria, 90-day reoperation, and 30-day readmission. Patient risk was estimated with the NSQIP Pediatric Surgical Risk Calculator. Firth-penalized logistic regression modeled the association between closure technique and SSI.

Results: Of 195 patients, 121 underwent SOC and 74 PMC. BMI was similar (p = 0.14), but SOC patients had higher mean surgical risk scores for any complication (p = 0.02) and SSI (p = 0.01). PMC had longer procedures, hospital stays, and greater drain use (all p < 0.001). SSI was lower with PMC (3% vs. 12%; absolute difference 9%, p = 0.03), whereas reoperation (5% vs. 13%, p = 0.08) and readmission (7% vs. 15%, p = 0.09) did not differ significantly. In multivariable analysis, PMC was associated with lower SSI odds (OR 0.12, 95% CI: 0.02-0.64, p = 0.01), and higher surgical risk scores were associated with increased SSI odds (OR 1.18, 95% CI: 1.04-1.33, p = 0.01).

Conclusion: PMC was associated with an absolute 9% lower SSI proportion. This association remained significant after adjustment for patient- and procedure-specific factors. Reoperation and readmission proportions were similar, but PMC involved longer surgical time, hospital stay, and greater drain use. Given these trade-offs, PMC may be most appropriate for high-risk patients or those with limited soft-tissue coverage. Prospective studies should refine patient selection and assess its broader impact.

Level of evidence: Level III-Therapeutic.

Study design: Single-arm meta-analysis and systematic review.

Objectives: To evaluate the safety and efficacy of pelvic fixation in the surgical treatment of neuromuscular scoliosis (NMS).

Methods: A comprehensive search on PubMed, Embase and the Cochrane Library was performed to identify studies that included NMS treated with surgery. Changes in mean coronal curve angle (Cobb angle), pelvic obliquity (PO), thoracic kyphosis (TK), lumbar lordosis (LL), and other important surgical outcomes were evaluated and analyzed at baseline, postoperatively, and final follow-up. Surgical-related parameters and postoperative major complications were collected.

Results: A total of 29 studies comprising 1595 NMS patients were included in the meta-analysis. The mean operative time was 311.75 min, and the estimated blood loss was 1787.69 ml. The results demonstrated a significant reduction in the Cobb angle after surgery with pelvic fixation (mean reduction: 47.57°, 95% CI 43.04-52.10). PO was also significantly corrected (mean reduction: 13.71°, 95% CI 12.26-15.16). In addition, there was an improvement in TK (mean reduction: 7.42°, 95% CI 0.47-14.36) and an increase in LL (mean increase: 4.79°, 95% CI 9.73-0.16). Among the cohort of 1489 patients, 262 patients (17.6%) experienced implant-related complications, while 225 patients (15.1%) developed infections, neurological complications were observed in 7 patients (0.5%), revision surgeries were required for 86 patients (5.8%) and the overall mortality rate reached 0.7% (10 cases in total). These pooled radiographic corrections are clinically relevant to wheelchair sitting balance and overall spino-pelvic alignment in NMS, supporting pre-operative counseling about the functional value of pelvic fixation.

Conclusions: Pelvic fixation provides effective deformity and pelvic obliquity correction with acceptable complication rates. These pooled data offer benchmark reference values to guide surgical counseling and trial design.