Spine deformity最新文献

Introduction: There is a paucity of data on the use, efficacy, and safety of antifibrinolytic agents (AF) in patients with neuromuscular scoliosis undergoing growth-friendly instrumentation. Previous studies have shown mixed results of AF agents in young patients with neuromuscular conditions, and other authors have expressed concerns regarding adverse effects in this medically fragile population. The purpose of this study was to investigate the rate of use of AF agents for growth-friendly surgery in patients with neuromuscular scoliosis, and assess its impact on blood loss and transfusion requirements.

Methods: This is a retrospective cohort study of patients from a multicenter spine study group with neuromuscular scoliosis that underwent an index growth-friendly procedure. Patients with a history of venous thromboembolism and those undergoing revision surgery or lengthening surgery were excluded. Perioperative data were collected including patient demographics, type of instrumentation, use and type of AF agent, estimated blood loss (EBL), use and volume of cell saver, and intraoperative blood transfusion. Univariate statistics were used to determine differences.

Results: This study included 335 patients with a mean age of 7 years (SD: 2.6). Of these patients, 176 patients were managed with VEPTR/TGR instrumentation and 159 patients were managed with MCGR instrumentation. AF agents were used in 36% of index cases. In cases with AF use, TXA was the most frequently used agent (TXA:68%, ACA:21%). The use of AF increased over the study period from less than 10% before 2010 to 75% in 2020 (R² = 0.31). There was no statistical difference in EBL between patients who received AF agents compared to patients that did not receive AF agents (AF = 184.9 ml, no AF = 103 ml, p = 0.23). In addition, there was no difference in cell saver volume (AF = 127 ml, no AF = 145 ml, p = 0.88). The overall rate of intraoperative blood transfusion was low (8.5%). In this cohort, there was no significant difference in transfusion rates between groups (AF = 7.6%, no AF = 8.7%, p = 0.7). There was a high rate of postoperative blood transfusion (51.4%) in this cohort; however, there was no significant difference in postoperative transfusion rates between groups (AF = 62.1%, no AF = 50.5%, p = 0.62).

Conclusion: AF agents are being used for patients undergoing growth-friendly procedures with TXA being the most commonly used AF. However, there is no significant difference in EBL, cell saver volume, and intraoperative or postoperative transfusion rates between patients that do or do not receive AF agents for these procedures. Additional studies are needed to validate these results, as well as determine their efficacy, safety, and value in this medically fragile group.

Purpose: To demonstrate the utility of routine preoperative magnetic resonance imaging (MRI) in detecting neural axis abnormalities in presumed adolescent idiopathic scoliosis (AIS) patients.

Methods: A retrospective analysis of pediatric patients who underwent posterior spinal instrumentation and fusion (PSIF) for presumed AIS at a single institution over 14 years. Patients with syndromic, congenital, or neuromuscular scoliosis were excluded. MRI findings, history and exam findings, and neurosurgery consultation/intervention were documented.

Results: Among 233 patients with presumed AIS who underwent routine preoperative MRI, 24 (10.3%) had positive findings, including Arnold-Chiari malformations, syringomyelia, and tethered cords. Five patients (2.1%) required neurosurgical intervention before PSIF; only one exhibited an atypical curve pattern before MRI. The remaining cases did not alter surgical plans but required consultation with neurosurgery.

Conclusion: Routine MRI in presumed AIS patients identified neural axis abnormalities in a subset of patients who otherwise lacked neurological indicators. These findings support the consideration of preoperative MRI in AIS management to optimize surgical planning and patient safety.

Purpose: The United States (US) adult population's baseline knowledge and perceptions of adult spinal deformity (ASD) are unknown. This study employs crowdsourcing to evaluate public perceptions regarding ASD.

Methods: This is a survey-based study comprising a representative sample. A multiple-choice survey was administered through the CloudResearch platform and participants were matched for age, sex, and other demographics to reflect the current US census.

Results: 1000 participants were included with a mean age of 45.3 ± 16.1 years. Respondents ≥ 65 years old were significantly more likely to never have been screened for scoliosis compared to the 18-64 cohort (62% vs. 38%; p < 0.05). The majority of respondents (54%) correctly responded that X-ray is the typical diagnostic tool. Primary treatment modalities thought most useful by participants were physical therapy (80%) followed by spinal braces (66%). In terms of surgical treatment, 61% stated that fusion surgery was the typical treatment whereas 51% felt that motion-preserving surgery with disc replacement was a viable treatment option. Participants were most likely to identify orthopedic surgeons (81%) as most likely to treat ASD, followed by physical therapists (75%). The majority (80%) believed that surgery was effective treatment and only 4% believed that surgery was ineffective. Respondents ≥ 65 years old were significantly more likely to rely on primary-care referral (95% vs. 89%; p < 0.05) for selecting a surgeon and less likely to rely on health insurance, hospital name, and social media. The majority of respondents (73%) expected to return to baseline after surgery with only some minor limitations. Only 2% of respondents thought that the rate of any complication or likelihood of reoperation was ≥ 50%.

Conclusion: This study is the first of its kind to utilize an online crowd-sourced survey to comprehensively investigate perceptions of ASD and demonstrates a trend toward significantly lower scoliosis screening rates in respondents > 65 years old. While awareness was relatively high in domains, such as symptoms, diagnosis, and treatment, common misconceptions persisted regarding disease pathophysiology, expected recovery, complications, and pain; areas where perceptions underestimated risks compared with published outcomes. These findings highlight important knowledge gaps that may influence care-seeking behavior, referral patterns, and expectation management, demonstrating the need for targeted educational initiatives.

Background: Accurate assessment of spinopelvic alignment is essential for managing adult spinal deformities. This study validates the Brainlab Elements Spine Planning software for automated measurement of spinopelvic parameters, comparing it with manual methods.

Methods: Spinopelvic parameters were measured manually and with the software in 21 patients with degenerative spinal disease, including instrumented and non-instrumented spines. Accuracy, intraobserver, and interobserver reliability were evaluated using Bland-Altman plots and intraclass correlation coefficients (ICCs). Measurement times were also compared.

Results: The software showed high reliability (ICC = 1), while manual measurements ranged from fair to excellent reliability (ICC 0.44-0.99). Bland-Altman plots indicated strong agreement between automated and manual measurements, though variability was noted for certain parameters. Automated measurements were significantly faster, averaging 62 s versus 227 s in manual measurements (p < 0.001), though 76.2% of cases had at least one parameter that could not be measured automatically, most frequently the sagittal vertical axis (SVA) and several coronal parameters.

Conclusion: The Brainlab Elements software provides accurate, reproducible, and time-efficient spinopelvic measurements for parameters it successfully captures. However, frequent failures in assessing SVA and coronal plane parameters automatically suggest that further refinement of the software is necessary.

Purpose: Rate of neurological deficits in patients with PJK/F after adult spinal deformity (ASD) surgery is understudied. In patients undergoing reoperation for proximal junctional kyphosis/failure (PJK/F) after adult spinal deformity (ASD) surgery, we sought to: 1) report the rate of neurological deficit, 2) describe these deficits, and 3) discuss improvement rates after reoperation.

Methods: A retrospective cohort study (2009-21) included ASD patients with: ≥ five-level fusion, sagittal/coronal deformity, and > 2-year follow-up. PJK was defined as 10º Cobb angle of the upper instrumented vertebra (UIV)-UIV + 2, and 10º increase from preoperative, while PJF was catastrophic PJK requiring reoperation due to screw pullout/fracture. Primary outcome was the presence of neurological deficits and/or worsened motor exam at the time of PJK/F diagnosis, description of deficits, and improvement after reoperation.

Results: Of 238 ASD patients, 47(19.7%) underwent reoperation for PJK/F (mean age: 69.6 ± 9.4 years; mean instrumented levels: 9.4 ± 2.7) at a median of 15.6 months (IQR: 9.8-25.5). New motor deficits were seen in 15/47(31.9%) patients at the time of PJK/F diagnosis, and 3 (6.4%) endorsed incontinence. Neurological deficits occurred in 8/29 (24.1%) PJK and 7/18 (44.4%) PJF patients (p = 0.147). Distal motor strength was 0/5 in 1 (6.7%), 3/5 in 5 (33.3%), and 4/5 in 9 (60.0%). Of 15 patients with new motor deficits, 5 (33%) immediately returned-to-baseline, 5 (33%) improved but not to baseline, 3 (20%) remained unchanged, and 2 (13%) worsened within 3 months of reoperation. At the most recent follow-up (median: 3.9 years), 13/15 (86.7%) patients had no deficits, and 2 (13.3%) improved but not to baseline. Notably, 1 patient without neurological deficit preoperatively developed 4/5 motor exam following PJK surgery.

Conclusions: Among patients reoperated for PJK/F, 32% had motor deficits and 6% had bladder incontinence. Immediately post-surgery, 33% returned-to-baseline, at last follow-up, 87% returned-to-baseline. These results can help patients, families, and surgeons appreciate long-term neurologic function after reoperation for PJK/F.

Introduction: Growing construct expansion surgeries in the setting of early-onset scoliosis (EOS) involve surgeon's feel to determine the optimal amount of distraction force to maximize correction and spinal length gained without compromising anchor integrity. Growing construct designs may require different amounts of distraction force to lengthen the spine or chest wall depending on the device used and various patient factors. Understanding these variations could guide appropriate force levels for the rational design for next-generation remote/external distraction devices and ultimately patient/deformity-specific lengthening forces.

Aim/objectives: The purpose of this study was to determine distraction force levels for expansion events in traditional growing rods (TGRs) and vertical expandable prosthetic titanium rib (VEPTR) constructs across patients with various anchor attachment points and etiologies of EOS.

Methods: With IRB approval, two different distraction devices (VEPTR distractor and TGR/rod distractor) were outfitted with electronic strain gauges to measure distraction force. Force data were recorded at a rate of 40 Hz during each surgery via a laptop connected to a PowerLab 8/35 data acquisition system. After each surgery, the distractor was validated on a custom calibration device. The data collected were then analyzed to determine the maximum force and average force during every distraction.

Results: From February 2019 to June 2023, a total of 146 in vivo distractions were collected on 52 patients with VEPTRs and 28 in vivo distractions were collected on 9 patients with traditional growing rods. TGR procedures required significantly higher forces than VEPTR (437.89 N vs 349.10 N, p < 0.001).

Conclusion: Modification of two different distraction devices with electronic strain gauges identified differences in distraction force between traditional growing rods and VEPTR constructs during expansion surgeries in children with EOS. Our findings highlight that implant type and potentially other factors may play significant roles in the amount of force required for lengthening the spine and chest wall. Current market implant technology (MCGR maximum force of 187 N) is likely underpowered compared to traditional technology across all construct types and disease classifications. These insights should inform the development of next-generation remote lengthening construct design.

Purpose: Though the use of anabolic bone agents has proven effective in adult spinal deformity (ASD) surgery, prescription and approval of these medications remains a challenge. In osteopenic/osteoporotic patients undergoing ASD surgery, we sought to determine the impact of a bone optimization clinic on: (1) prescription patterns of anabolic agents, (2) mechanical complications, and (3) reoperation.

Methods: A retrospective cohort study (2009-23) was performed for osteopenic/osteoporotic patients undergoing ASD surgery with ≥ 2-year follow-up. The study period was binarized into before/after a bone optimization clinic was established (2009-19 vs. 2020-23). The primary outcomes were: (1) use of anabolic agents prior to surgery (Teriparatide, Abaloparatide, and Romosozumab-aqqg), (2) mechanical complications, and (3) reoperation. Multivariable regression controlling for age, sex, body mass index, and operative time was performed.

Results: Of 126 patients (mean age 68 ± 10yrs; 86% female) undergoing ASD surgery with osteopenia (80%) or osteoporosis (20%), 91 (72%) were before the bone optimization clinic and 35 (28%) were after. Similar rates of osteoporosis in both groups were seen (pre-21% vs. post-17%, p = 0.638). After the bone optimization clinic, more patients received preoperative anabolic therapy (54% vs. 23%, p < 0.001) and for a longer duration (98 ± 156 vs. 40 ± 109 days, p = 0.027). Overall mechanical complications decreased significantly (49% vs 81%, p < 0.001) as did reoperation for mechanical complications (6% vs. 44%, p < 0.001). Multivariable regression showed that a bone optimization clinic independently improved the use of preoperative anabolic agents (OR = 5.3, 95%CI:2.1-13.4, p < 0.001) and reduced the risk of mechanical complications (OR = 0.2 95%CI:0.1-0.5, p < 0.001) and reoperation for mechanical complications (OR = 0.1, 95%CI:0.1-0.4, p < 0.001).

Conclusion: In osteopenic/osteoporotic patients undergoing ASD surgery, a bone optimization clinic was independently associated with increased prescription rates and duration of anabolic bone agents, reduced mechanical complications, and reduced reoperation for mechanical complications.