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Bipolar hybrid posterior instrumentation tecnique for the correction of Scheuermann's kyphosis. 用于矫正谢尔曼后凸的双极混合后方器械技术。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-18 DOI: 10.1007/s43390-024-00928-6
María Coro Solans Lopez, Jose María Hernández Mateo, Alejandro Barrios Ayuso, Cristina Igualada Blázquez, Tania Quevedo Narciso, Azucena García Martín, Oscar Gabriel Riquelme García, Luis Alejandro Esparragoza Cabrera

Scheuermann´s kyphosis (SK) is the most common cause of painful and progressive structural hyperkyphosis in adolescents. Surgical treatment should be considered in cases of refractory pain or progressive deformities. We present the clinical and radiological results obtained using a bipolar, hybrid posterior instrumentation tecnique. We analysed 12 males and 6 females, with mean age of 15.8 years. Minimum follow-up was 2 years. We used transverse process hooks at the cranial level and polyaxial screws for the remaining levels. We did not instrument the periapical segment. We used the sagittal stable vertebra (SSV) as the lower instrumented vertebra (LIV) in most cases, the "barely touched SSV" if the above disc space is lordotic. The mean preoperative kyphosis was 73.6º, mean postoperative kyphosis 44.7º, and mean correction of 28.9º (p = 0.0002). The mean reduction in lumbar lordosis (LL) was 8.9º (p = 0.0018). There were no significant differences in the spinopelvic parameters or sagittal balance. The mean number of instrumented levels was 8.9. Type II osteotomies were necessary in only three patients. Three patients had a cranial sagittal angle greater than 10°, all of them asymptomatic. Postoperatively, all patients had VAS scores less than 2 and SRS-22 scores greater than 4. Hybrid bipolar posterior instrumentation offers adequate curve correction, less operative time, implant density, bleeding, material protrusion and risk of spinal cord injury, leaving a large periapical bed for graft supply. We propose to measure the flexibility of the curve in MRI. In flexible curves (those that correct at least 20% in the supine decubitus position), wide facetectomies offer adequate correction of the deformity.

谢尔曼氏脊柱后凸(SK)是导致青少年疼痛和进行性结构性脊柱后凸的最常见原因。对于难治性疼痛或进行性畸形,应考虑手术治疗。我们介绍了使用双极混合后路器械技术获得的临床和放射学结果。我们对 12 名男性和 6 名女性进行了分析,他们的平均年龄为 15.8 岁。最短随访时间为 2 年。我们在颅骨水平使用了横突钩,在其余水平使用了多轴螺钉。我们没有在根尖周围使用器械。在大多数病例中,我们使用矢状稳定椎体(SSV)作为下部器械椎体(LIV),如果椎间盘间隙上方有前凸,则使用 "勉强触及的SSV"。术前的平均后凸度为 73.6º,术后的平均后凸度为 44.7º,平均矫正度为 28.9º(P = 0.0002)。腰椎前凸(LL)平均减少了 8.9º(p = 0.0018)。脊柱骨盆参数和矢状平衡无明显差异。平均器械水平数为 8.9。只有三名患者需要进行 II 型截骨。三名患者的头颅矢状角大于 10°,均无症状。术后,所有患者的 VAS 评分均小于 2 分,SRS-22 评分均大于 4 分。 混合双极后路器械治疗可提供充分的曲线矫正,减少手术时间、种植体密度、出血、材料突出和脊髓损伤的风险,并为移植物供应留出较大的根尖周床。我们建议通过核磁共振成像来测量曲线的柔韧性。对于灵活的曲线(在仰卧位至少矫正 20% 的曲线),宽面切除术可充分矫正畸形。
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引用次数: 0
Improving prediction of progression of idiopathic scoliosis based on curve size and skeletal maturity. 根据曲线大小和骨骼成熟度改进对特发性脊柱侧弯进展的预测。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-12 DOI: 10.1007/s43390-024-00939-3
Kevin M Neal, Melanie Boeyer, Emily C Craver, Julia E Crook, Gary M Kiebzak

Purpose: To define the risk of curve progression of idiopathic scoliosis (IS) to 35°, 40°, 45°, and 50° based on current curve magnitude and Sanders stage for boys and girls, using a large cohort of patients and encounters, to improve granularity and allow more accurate estimations to guide treatment.

Methods: Retrospective analysis of a prospectively collected scoliosis database. Generalized estimation equation logistic regression models estimated probabilities of curve progression to 35°, 40°, 45°, and 50° based on starting curve size and Sanders stage. Probabilities and their 95% confidence intervals were calculated for each combination of variables to each endpoint separately for boys and girls.

Results: A total of 309 patients (80% girls) were included. Starting curve size and Sanders stage were significant predictors for progression in both sexes (all P ≤ 0.04). Higher starting curve sizes and lower Sanders stages were associated with greater odds of progression. Risk of progression was still present even at higher Sanders stages.

Conclusion: IS curves follow a predictable pattern, having more risk for progression when curves are larger and Sanders stages are smaller. Risk of curve progression is a spectrum based on these factors, indicating some risk of progression exists even for many smaller curves with higher Sanders stages. The improved granularity of this analysis compared to prior efforts may be useful for counseling patients about the risks of curve progression to various curve size endpoints and may aid shared decision-making regarding treatments.

Level of evidence or clinical relevance: Level III: retrospective cohort study.

目的:根据男孩和女孩目前的曲线幅度和桑德斯分期,利用大型患者队列和会诊,确定特发性脊柱侧弯(IS)曲线发展到35°、40°、45°和50°的风险,以提高精细度,并进行更准确的估计,从而指导治疗:方法:对前瞻性收集的脊柱侧凸数据库进行回顾性分析。方法:对前瞻性收集的脊柱侧弯数据库进行回顾性分析。广义估计方程逻辑回归模型根据起始曲线大小和桑德斯阶段估算出曲线发展到 35°、40°、45° 和 50°的概率。分别计算了男孩和女孩每个变量组合到每个终点的概率及其 95% 的置信区间:共纳入 309 名患者(80% 为女孩)。起始曲线大小和桑德斯分期对男女患者的病情进展均有显著的预测作用(P 均小于 0.04)。起始曲线尺寸越大、桑德斯分期越低,病情恶化的几率越大。结论:IS曲线遵循一种可预测的模式,当曲线越大、桑德斯分期越小时,曲线恶化的风险越大。根据这些因素,曲线恶化的风险是一个频谱,表明即使是桑德斯分期较高的许多较小曲线也存在一定的恶化风险。与之前的研究相比,该分析的颗粒度有所提高,这可能有助于向患者提供有关各种曲线大小终点的曲线进展风险的咨询,并有助于共同做出治疗决策:III级:回顾性队列研究。
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引用次数: 0
Growth modulation response in vertebral body tethering depends primarily on magnitude of concave vertebral body growth. 椎体系留的生长调节反应主要取决于椎体凹陷生长的幅度。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-06-04 DOI: 10.1007/s43390-024-00909-9
Craig R Louer, Vidyadhar V Upasani, Jennifer K Hurry, Hui Nian, Christine L Farnsworth, Peter O Newton, Stefan Parent, Ron El-Hawary

Purpose: There is variability in clinical outcomes with vertebral body tethering (VBT) partly due to a limited understanding of the growth modulation (GM) response. We used the largest sample of patients with 3D spine reconstructions to characterize the vertebra and disc morphologic changes that accompany growth modulation during the first two years following VBT.

Methods: A multicenter registry was used to identify idiopathic scoliosis patients who underwent VBT with 2 years of follow-up. Calibrated biplanar X-rays obtained at longitudinal timepoints underwent 3D reconstruction to obtain precision morphological measurements. GM was defined as change in instrumented coronal angulation from post-op to 2-years.

Results: Fifty patients (mean age: 12.5 ± 1.3yrs) were analyzed over a mean of 27.7 months. GM was positively correlated with concave vertebra height growth (r = 0.57, p < 0.001), 3D spine length growth (r = 0.36, p = 0.008), and decreased convex disc height (r = - 0.42, p = 0.002). High modulators (patients experiencing GM > 10°) experienced an additional 1.6 mm (229% increase) of mean concave vertebra growth during study period compared to the Poor Modulators (GM < - 10°) group, (2.3 vs. 0.7 mm, p = 0.039), while convex vertebra height growth was similar (1.3 vs. 1.4 mm, p = 0.91).

Conclusion: When successful, VBT enables asymmetric vertebra body growth, leading to continued postoperative coronal angulation correction (GM). A strong GM response is correlated with concave vertebral body height growth and overall instrumented spine growth. A poor GM response is associated with an increase in convex disc height (suspected tether rupture). Future studies will investigate the patient and technique-specific factors that influence increased growth remodeling.

目的:椎体拴系(VBT)的临床结果存在差异,部分原因是对生长调节(GM)反应的了解有限。我们使用了最大的三维脊柱重建患者样本,以描述椎体和椎间盘在 VBT 术后头两年内伴随生长调节的形态变化:方法:我们利用一个多中心登记册来确定接受过 VBT 并随访两年的特发性脊柱侧凸患者。在纵向时间点获得的校准双平面 X 光片经过三维重建,以获得精确的形态测量结果。GM定义为术后至2年期间器械冠状角的变化:对 50 名患者(平均年龄:12.5 ± 1.3 岁)进行了分析,平均时间为 27.7 个月。GM与凹椎体高度增长呈正相关(r = 0.57,p 10°),在研究期间,凹椎体的平均增长速度比调制不良者(GM)增加了1.6毫米(229%):如果成功,VBT 可使椎体不对称生长,导致术后持续的冠状角矫正(GM)。椎体成角矫正反应强与凹椎体高度增长和整体器械脊柱增长相关。GM反应差则与凸椎间盘高度增加(怀疑系带断裂)有关。未来的研究将调查影响生长重塑增加的患者和特定技术因素。
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引用次数: 0
Characteristics of sagittal spinopelvic alignment in Thai population: a cross-sectional study. 泰国人口脊柱矢状排列的特征:一项横断面研究。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-31 DOI: 10.1007/s43390-024-00997-7
Tinnakorn Pluemvitayaporn, Wachirawit Penrat, Sombat Kunakornsawat, Suttinont Surapuchong, Warot Ratanakoosakul, Kitjapat Tiracharnvut, Chaiwat Piyasakulkaew, Piyabuth Kittithamvongs

Background: The prevalence of spinal deformity is a significant health concern often associated with the aging process. It is primarily attributed to the thickening of spinal joints, ligament pathologies, or the narrowing of the spinal canal, leading to compression of the spinal cord and nerve roots, and subsequently causing musculoskeletal problems. When considering corrective surgery for adult spinal deformities, it is crucial for spine surgeons to take into account the standard values of sagittal spinopelvic alignment. Notably, there is currently a lack of specific data on this aspect within the Thai population. Therefore, our study was focused on evaluating the alignment in the Thai population.

Objectives: To analyze sagittal spinopelvic alignment parameters in the asymptomatic Thai population and compare them with other populations.

Materials and methods: This study was designed as a cross-sectional analysis involving 194 participants, wherein the sagittal spinopelvic parameters were evaluated utilizing radiographic images. The measurements of the sagittal vertical axis (SVA), pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT) were determined by averaging the assessments conducted by two orthopedic residents and a spine surgeon. In addition, participants' demographic information was obtained through questionnaires, and further analysis was performed on age, gender, and body mass index data. The study also encompassed the determination of correlations between various parameters and the comparison of these parameters with other populations.

Results: The body mass index (BMI) of the study participants demonstrated significant associations with several spinal parameters. Specifically, BMI showed significant correlations with sagittal vertical axis (SVA) (r = 0.2, p = 0.09), pelvic incidence (PI) (r = 0.4, p < 0.01), lumbar lordosis (LL) (r = 0.2, p = 0.02), sacral slope (SS) (r = -0.2, p = 0.02), and pelvic tilt (PT) (r = 0.2, p = 0.02). The SS exhibited a statistically significant decline with increasing age (p = 0.04). Furthermore, the mean SVA, PI, LL, SS, and PT differed significantly between the study participants and the Indian population. In addition, the SS was notably lower when compared to the European population.

Conclusion: The study revealed the spinopelvic parameters in a cohort of healthy Thai population and observed a correlation between their body mass index (BMI) and pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT). Notably, the average SS among Thai adults was found to be statistically lower than that of individuals from Indian, European Caucasian, Asian, and Mexican populations. These insights hold potential value as a reference when strategizing surgical interventions for Thai patients with spinal deformities.

背景:脊柱畸形是与衰老过程相关的一个重要健康问题。其主要原因是脊柱关节增厚、韧带病变或椎管狭窄,导致脊髓和神经根受压,进而引起肌肉骨骼问题。在考虑对成人脊柱畸形进行矫正手术时,脊柱外科医生必须考虑到矢状脊柱对齐的标准值。值得注意的是,目前在泰国人群中缺乏这方面的具体数据。因此,我们的研究重点是评估泰国人群的对位情况:分析泰国无症状人群的矢状脊柱排列参数,并与其他人群进行比较:本研究设计为横断面分析,涉及 194 名参与者,利用放射影像对矢状脊柱参数进行评估。矢状纵轴(SVA)、骨盆内陷(PI)、腰椎前凸(LL)、骶骨斜度(SS)和骨盆倾斜(PT)的测量值是由两名骨科住院医师和一名脊柱外科医生评估后得出的平均值。此外,还通过问卷调查获得了参与者的人口统计学信息,并对年龄、性别和体重指数数据进行了进一步分析。研究还包括确定各种参数之间的相关性,并将这些参数与其他人群进行比较:结果:研究参与者的体重指数(BMI)与多个脊柱参数之间存在显著关联。该研究揭示了一批健康泰国人的脊柱骨盆参数,并观察到他们的体重指数(BMI)与骨盆内陷(PI)、腰椎前凸(LL)、骶骨斜度(SS)和骨盆倾斜(PT)之间存在相关性。值得注意的是,泰国成年人的平均骶骨斜度在统计学上低于印度、欧洲白种人、亚洲人和墨西哥人。这些见解对泰国脊柱畸形患者制定手术干预策略具有潜在的参考价值。
{"title":"Characteristics of sagittal spinopelvic alignment in Thai population: a cross-sectional study.","authors":"Tinnakorn Pluemvitayaporn, Wachirawit Penrat, Sombat Kunakornsawat, Suttinont Surapuchong, Warot Ratanakoosakul, Kitjapat Tiracharnvut, Chaiwat Piyasakulkaew, Piyabuth Kittithamvongs","doi":"10.1007/s43390-024-00997-7","DOIUrl":"https://doi.org/10.1007/s43390-024-00997-7","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of spinal deformity is a significant health concern often associated with the aging process. It is primarily attributed to the thickening of spinal joints, ligament pathologies, or the narrowing of the spinal canal, leading to compression of the spinal cord and nerve roots, and subsequently causing musculoskeletal problems. When considering corrective surgery for adult spinal deformities, it is crucial for spine surgeons to take into account the standard values of sagittal spinopelvic alignment. Notably, there is currently a lack of specific data on this aspect within the Thai population. Therefore, our study was focused on evaluating the alignment in the Thai population.</p><p><strong>Objectives: </strong>To analyze sagittal spinopelvic alignment parameters in the asymptomatic Thai population and compare them with other populations.</p><p><strong>Materials and methods: </strong>This study was designed as a cross-sectional analysis involving 194 participants, wherein the sagittal spinopelvic parameters were evaluated utilizing radiographic images. The measurements of the sagittal vertical axis (SVA), pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT) were determined by averaging the assessments conducted by two orthopedic residents and a spine surgeon. In addition, participants' demographic information was obtained through questionnaires, and further analysis was performed on age, gender, and body mass index data. The study also encompassed the determination of correlations between various parameters and the comparison of these parameters with other populations.</p><p><strong>Results: </strong>The body mass index (BMI) of the study participants demonstrated significant associations with several spinal parameters. Specifically, BMI showed significant correlations with sagittal vertical axis (SVA) (r = 0.2, p = 0.09), pelvic incidence (PI) (r = 0.4, p < 0.01), lumbar lordosis (LL) (r = 0.2, p = 0.02), sacral slope (SS) (r = -0.2, p = 0.02), and pelvic tilt (PT) (r = 0.2, p = 0.02). The SS exhibited a statistically significant decline with increasing age (p = 0.04). Furthermore, the mean SVA, PI, LL, SS, and PT differed significantly between the study participants and the Indian population. In addition, the SS was notably lower when compared to the European population.</p><p><strong>Conclusion: </strong>The study revealed the spinopelvic parameters in a cohort of healthy Thai population and observed a correlation between their body mass index (BMI) and pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT). Notably, the average SS among Thai adults was found to be statistically lower than that of individuals from Indian, European Caucasian, Asian, and Mexican populations. These insights hold potential value as a reference when strategizing surgical interventions for Thai patients with spinal deformities.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Role of spinal MRI for pre-operative work up in patients with adolescent idiopathic scoliosis: a retrospective case study and narrative review. 脊柱核磁共振成像在青少年特发性脊柱侧凸患者术前检查中的作用:回顾性病例研究和叙述性综述。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-29 DOI: 10.1007/s43390-024-00991-z
Sassan Keshavarzi, Griffin Harris, Subaraman Ramchandran, Noah Gabor, Jeffrey Spardy, Thomas Errico, John Ragheb, Stephen George

Introduction: There remains variability in the acquisition of whole-spine MRI prior to surgical correction in patients with adolescent idiopathic scoliosis (AIS). In this study, we take a retrospective look at the clinical impact of uniformly obtaining spinal MRI on all patients with a diagnosis of AIS.

Methods: Three hundred thirty four patients with presumed AIS who underwent surgery between 2017 and 2022 were identified; 283 of these patients who were asymptomatic and had a preoperative MRI in the database were included. We investigated radiographic, demographic, and clinical risk factors for the presence of neural axis anomalies. Radiologists' reports were reviewed to determine the level of the conus medullaris and the presence of any intra-spinal dysraphisms. The utility of known risk factors for neural axis anomalies and the utility of MRI identifying anomalies on clinical decision-making, intra-operative neuromonitoring (IONM) alerts, and postoperative neurologic insult in asymptomatic AIS patients were investigated.

Results: There were 283 patients with a mean age of 14.1 years, 67 males (22.6%) and 26 (9.2%) left-sided thoracic curves. MRI identified nine patients with central cord dilations, four patients with low cerebellar tonsils, four patients with Chiari Malformations, five patients with low-lying conus, one patient with a tethered cord, and five patients with arachnoid cysts. Six (2.1%) of the 283 patients underwent a neurosurgical intervention and 3 (50%) of the 6 went on to have IONM alerts. Eighteen (6.4%) of the 283 patients had IONM alerts and 5 (28%) of the 18 had neural axis anomalies. None of the patients with IONM alerts had a permanent neurologic deficit post-operatively.

Conclusion: In asymptomatic patients presumed to have AIS, 9.9% had a neuro-axis anomaly, 2.1% needed a neurosurgical intervention, and 6.4% of the patients had an IONM alert. We did not find known risk factors for identifying neural axis anomalies to have statistically significant application in asymptomatic AIS patients. Presence of neuroaxis anomalies increased the chance of having IONM alerts, however, we were unable to demonstrate if neurosurgical interventions in these patients with anomalies were preventative for IONM alerts or have statistically significant protection against clinical complications.

简介:在对青少年特发性脊柱侧弯症(AIS)患者进行手术矫正前,全脊柱核磁共振成像的采集仍存在差异。在本研究中,我们对所有确诊为AIS的患者统一进行脊柱核磁共振成像的临床影响进行了回顾性研究:我们对2017年至2022年期间接受手术的334例推测为AIS的患者进行了鉴定;纳入了其中283例无症状并在数据库中进行了术前核磁共振成像的患者。我们调查了出现神经轴异常的影像学、人口统计学和临床风险因素。我们对放射科医生的报告进行了审查,以确定圆锥髓质的水平和脊柱内是否存在发育不良。研究了神经轴异常的已知风险因素的作用,以及核磁共振成像发现异常对无症状AIS患者的临床决策、术中神经监测(IONM)警报和术后神经系统损伤的作用:283 名患者的平均年龄为 14.1 岁,67 名男性(22.6%),26 名患者(9.2%)左侧胸廓弯曲。核磁共振检查发现,9 名患者有中央脊髓扩张,4 名患者有小脑扁桃体低位,4 名患者有Chiari畸形,5 名患者有低位锥体,1 名患者有脊髓系带,5 名患者有蛛网膜囊肿。在283名患者中,有6人(2.1%)接受了神经外科干预,其中3人(50%)接受了IONM警报。283名患者中有18名(6.4%)出现了IONM警报,18名患者中有5名(28%)出现了神经轴异常。在出现IONM警报的患者中,没有人在术后出现永久性神经功能缺损:结论:在推测患有AIS的无症状患者中,9.9%有神经轴异常,2.1%需要神经外科干预,6.4%的患者有IONM警报。我们没有发现识别神经轴异常的已知风险因素在无症状AIS患者中的应用具有统计学意义。神经轴异常会增加出现 IONM 警报的几率,但是我们无法证明对这些神经轴异常患者进行神经外科干预是否可以预防 IONM 警报或对临床并发症有统计学意义的保护作用。
{"title":"Role of spinal MRI for pre-operative work up in patients with adolescent idiopathic scoliosis: a retrospective case study and narrative review.","authors":"Sassan Keshavarzi, Griffin Harris, Subaraman Ramchandran, Noah Gabor, Jeffrey Spardy, Thomas Errico, John Ragheb, Stephen George","doi":"10.1007/s43390-024-00991-z","DOIUrl":"https://doi.org/10.1007/s43390-024-00991-z","url":null,"abstract":"<p><strong>Introduction: </strong>There remains variability in the acquisition of whole-spine MRI prior to surgical correction in patients with adolescent idiopathic scoliosis (AIS). In this study, we take a retrospective look at the clinical impact of uniformly obtaining spinal MRI on all patients with a diagnosis of AIS.</p><p><strong>Methods: </strong>Three hundred thirty four patients with presumed AIS who underwent surgery between 2017 and 2022 were identified; 283 of these patients who were asymptomatic and had a preoperative MRI in the database were included. We investigated radiographic, demographic, and clinical risk factors for the presence of neural axis anomalies. Radiologists' reports were reviewed to determine the level of the conus medullaris and the presence of any intra-spinal dysraphisms. The utility of known risk factors for neural axis anomalies and the utility of MRI identifying anomalies on clinical decision-making, intra-operative neuromonitoring (IONM) alerts, and postoperative neurologic insult in asymptomatic AIS patients were investigated.</p><p><strong>Results: </strong>There were 283 patients with a mean age of 14.1 years, 67 males (22.6%) and 26 (9.2%) left-sided thoracic curves. MRI identified nine patients with central cord dilations, four patients with low cerebellar tonsils, four patients with Chiari Malformations, five patients with low-lying conus, one patient with a tethered cord, and five patients with arachnoid cysts. Six (2.1%) of the 283 patients underwent a neurosurgical intervention and 3 (50%) of the 6 went on to have IONM alerts. Eighteen (6.4%) of the 283 patients had IONM alerts and 5 (28%) of the 18 had neural axis anomalies. None of the patients with IONM alerts had a permanent neurologic deficit post-operatively.</p><p><strong>Conclusion: </strong>In asymptomatic patients presumed to have AIS, 9.9% had a neuro-axis anomaly, 2.1% needed a neurosurgical intervention, and 6.4% of the patients had an IONM alert. We did not find known risk factors for identifying neural axis anomalies to have statistically significant application in asymptomatic AIS patients. Presence of neuroaxis anomalies increased the chance of having IONM alerts, however, we were unable to demonstrate if neurosurgical interventions in these patients with anomalies were preventative for IONM alerts or have statistically significant protection against clinical complications.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Spine deformity surgery in patients with Beals syndrome can be effectively performed but does risk revision surgery. 比尔斯综合症患者的脊柱畸形手术可以有效实施,但存在翻修手术的风险。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-28 DOI: 10.1007/s43390-024-00993-x
Anne-Marie Datcu, David Thornberg, Anna Booth, Daniel J Sucato

Purpose: Beals syndrome or congenital contractual arachnodactyly is a rare disorder characterized by multiple joint contractures, Marfanoid body habitus and crumpled ears and has been associated with scoliosis. This study reports a clinical series of patients with Beals syndrome who have had surgical treatment for their spinal deformity.

Methods: A retrospective review of all patients at a single institution who had a genetically-confirmed diagnosis of Beals syndrome and had surgical treatment for their scoliosis were reviewed for surgical outcome and complications.

Results: There were eight patients who had surgery at an average age of 11.5 years, four were female and four had cardiovascular abnormalities requiring treatment. The preoperative coronal Cobb was 82.3° which improved to 42.1°(46.8% correction), and 46.5° (43.5% correction) at final follow-up. Preoperative halo-gravity-traction was used in three patients. Three patients had a posterior instrumentation and fusion (PSFI), 2 a combined anterior/PSFI, 1 had tethering, 1 with PSFI with posteriorly-approached discectomy, and 1 with a PSFI and vertebral column resection. One of the eight patients had a critical intraoperative neuromonitoring event but was normal following appropriate responses and no patient awoke with neurologic deficits. Two had an unplanned return to the operating room for implant dislodgement and each had a successful revision.

Conclusions: Scoliosis associated with Beals syndrome can have large curves at the time of surgery and require a variety of surgical approaches to achieve a good result. Revision surgery with return to the operating room is necessary in 25% of patients.

目的:比尔斯综合征或先天性挛缩性蛛网膜挛缩症是一种罕见的疾病,以多发性关节挛缩、马凡诺德体型和皱缩耳为特征,并与脊柱侧弯有关。本研究报告了一系列因脊柱畸形而接受手术治疗的比尔斯综合征患者的临床资料:方法:对一家医疗机构中所有经基因确诊为比尔斯综合征并接受脊柱侧弯手术治疗的患者进行回顾性研究,以了解手术效果和并发症:共有八名患者接受了手术治疗,平均年龄为11.5岁,其中四名为女性,四名患有需要治疗的心血管异常。术前冠状面Cobb为82.3°,术后改善至42.1°(矫正率46.8%),最后随访时为46.5°(矫正率43.5%)。有三名患者在术前使用了半重力牵引。3名患者进行了后路器械植入和融合术(PSFI),2名患者进行了前路/PSFI联合术,1名患者进行了拴系术,1名患者进行了PSFI和后路椎间盘切除术,1名患者进行了PSFI和椎体切除术。八名患者中有一名患者术中出现了严重的神经监测事件,但在采取适当的应对措施后恢复正常,没有患者醒来时出现神经功能缺损。两名患者因植入物脱落而意外返回手术室,但都成功进行了翻修:结论:与比尔斯综合征相关的脊柱侧弯在手术时可能会有较大的弯曲,需要采用多种手术方法才能达到良好的效果。25%的患者需要返回手术室进行翻修手术。
{"title":"Spine deformity surgery in patients with Beals syndrome can be effectively performed but does risk revision surgery.","authors":"Anne-Marie Datcu, David Thornberg, Anna Booth, Daniel J Sucato","doi":"10.1007/s43390-024-00993-x","DOIUrl":"https://doi.org/10.1007/s43390-024-00993-x","url":null,"abstract":"<p><strong>Purpose: </strong>Beals syndrome or congenital contractual arachnodactyly is a rare disorder characterized by multiple joint contractures, Marfanoid body habitus and crumpled ears and has been associated with scoliosis. This study reports a clinical series of patients with Beals syndrome who have had surgical treatment for their spinal deformity.</p><p><strong>Methods: </strong>A retrospective review of all patients at a single institution who had a genetically-confirmed diagnosis of Beals syndrome and had surgical treatment for their scoliosis were reviewed for surgical outcome and complications.</p><p><strong>Results: </strong>There were eight patients who had surgery at an average age of 11.5 years, four were female and four had cardiovascular abnormalities requiring treatment. The preoperative coronal Cobb was 82.3° which improved to 42.1°(46.8% correction), and 46.5° (43.5% correction) at final follow-up. Preoperative halo-gravity-traction was used in three patients. Three patients had a posterior instrumentation and fusion (PSFI), 2 a combined anterior/PSFI, 1 had tethering, 1 with PSFI with posteriorly-approached discectomy, and 1 with a PSFI and vertebral column resection. One of the eight patients had a critical intraoperative neuromonitoring event but was normal following appropriate responses and no patient awoke with neurologic deficits. Two had an unplanned return to the operating room for implant dislodgement and each had a successful revision.</p><p><strong>Conclusions: </strong>Scoliosis associated with Beals syndrome can have large curves at the time of surgery and require a variety of surgical approaches to achieve a good result. Revision surgery with return to the operating room is necessary in 25% of patients.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Elevated hospital floor-based HDU (POPUP-HDU): a new safe alternative to PICU for high-risk neuromuscular and syndromic children undergoing scoliosis surgery. 医院地面高架加护病房(POPUP-HDU):为接受脊柱侧弯手术的高风险神经肌肉和综合征患儿提供了一种替代 PICU 的新的安全方式。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-27 DOI: 10.1007/s43390-024-00992-y
E Bada, J Gouda, M D Sewell, M Jones, G McKay, N Canchi-Murali, J B Spilsbury, D S Marks, A Gardner, J S Mehta

Purpose: Children undergoing either posterior spinal fusion (PSF) or index insertion of growing rods for neuromuscular or genetic/syndromic scoliosis may require post-operative care on the paediatric intensive care unit (PICU). Demands on this limited resource result in frequent bed shortage related cancellations. In response, an ad-hoc or 'pop-up' ward-based high-dependency unit (POPUP-HDU) was developed. This converts a ward bed to POP-HDU bed for the required time. This study assesses the safety and efficacy of postoperative management that utilises POPUP-HDU as an alternative to a PICU bed.

Methods: Retrospective review of 111 consecutive children undergoing posterior surgery for scoliosis between June 2016 and April 2023. The inclusion criteria included a diagnosis of genetic/syndromic or neuromuscular scoliosis; PSF or primary insertion of distraction-based growth rods and requirement for postoperative care in a PICU. We excluded those children that were mandated to go to PICU post-operatively for any reason by the anaesthetic team.

Results: 49 patients (mean age 13.0 years) were managed on PICU, and 62 (mean age 11.4 years) on POPUP-HDU. The groups were matched with respect to body weight, curve magnitude, operative duration, type of fusion procedure performed, the presence of cardiac malformations, the use of home breathing support, the number of operated levels, pelvic instrumentation and intraoperative blood loss. 8 patients in the PICU, and 16 in the POP-HDU groups were readmitted back to PICU following step-down to the hospital ward (p = 0.27). The median PICU length of stay was 1 day in the PICU group and less than a day in POPUP-HDU (for those that needed to be subsequently admitted to PICU). The median total length of hospital stay was 10 days in the PICU group, and 8 days in POPUP-HDU (p < 0.05). 14 patients developed medical complications in the PICU group, compared to 19 in POPUP-HDU. There were no bedshortage cancellations in POPUP-HDU, compared to 23 in PICU.

Conclusions: For children with neuromuscular, genetic or syndromic scoliosis undergoing PSF or growth rods that are not deemed suitable for immediate ward-level post-operative care, POPUP-HDU provided a safe alternative to PICU for appropriate patients and was associated with shorter hospital stay and fewer cancellations for lack of PICU beds.

Level of evidence: Therapeutic Level III.

目的:因神经肌肉或遗传/综合症脊柱侧凸而接受后路脊柱融合术(PSF)或植入生长棒的儿童可能需要在儿科重症监护病房(PICU)接受术后护理。对这一有限资源的需求导致经常出现因床位短缺而取消手术的情况。为此,我们开发了一种基于病房的临时或 "弹出式 "高依赖性病房(POPUP-HDU)。它能在所需时间内将病房床位转换为 POP-HDU 床位。本研究评估了利用 POPUP-HDU 代替 PICU 病床进行术后管理的安全性和有效性:方法:回顾性分析2016年6月至2023年4月期间连续接受脊柱侧弯后路手术的111名儿童。纳入标准包括:遗传/综合症或神经肌肉性脊柱侧凸诊断;PSF或牵引式生长棒的初次插入,以及需要在PICU进行术后护理。我们排除了那些因任何原因被麻醉团队强制要求术后进入PICU的儿童:49 名患者(平均年龄 13.0 岁)在 PICU 接受治疗,62 名患者(平均年龄 11.4 岁)在 POPUP-HDU 接受治疗。两组患者在体重、曲线幅度、手术时间、融合术类型、是否存在心脏畸形、是否使用家庭呼吸支持、手术层面数、骨盆器械和术中失血量等方面均相匹配。PICU组和POP-HDU组分别有8名和16名患者在下到医院病房后再次被送回PICU(P = 0.27)。PICU 组患者的 PICU 中位住院时间为 1 天,而 POPUP-HDU 组患者的 PICU 中位住院时间不到 1 天(对于那些随后需要入住 PICU 的患者)。PICU 组的总住院时间中位数为 10 天,POPUP-HDU 组为 8 天(P 结论:POPUP-HDU 组的总住院时间中位数为 10 天,POPUP-HDU 组为 8 天):对于接受 PSF 或生长棒手术的神经肌肉型、遗传型或综合型脊柱侧凸患儿,如果不适合立即接受病房级术后护理,POPUP-HDU 可为合适的患者提供 PICU 以外的安全替代方案,而且住院时间更短,因缺乏 PICU 床位而取消手术的情况更少:证据等级:治疗 III 级。
{"title":"Elevated hospital floor-based HDU (POPUP-HDU): a new safe alternative to PICU for high-risk neuromuscular and syndromic children undergoing scoliosis surgery.","authors":"E Bada, J Gouda, M D Sewell, M Jones, G McKay, N Canchi-Murali, J B Spilsbury, D S Marks, A Gardner, J S Mehta","doi":"10.1007/s43390-024-00992-y","DOIUrl":"https://doi.org/10.1007/s43390-024-00992-y","url":null,"abstract":"<p><strong>Purpose: </strong>Children undergoing either posterior spinal fusion (PSF) or index insertion of growing rods for neuromuscular or genetic/syndromic scoliosis may require post-operative care on the paediatric intensive care unit (PICU). Demands on this limited resource result in frequent bed shortage related cancellations. In response, an ad-hoc or 'pop-up' ward-based high-dependency unit (POPUP-HDU) was developed. This converts a ward bed to POP-HDU bed for the required time. This study assesses the safety and efficacy of postoperative management that utilises POPUP-HDU as an alternative to a PICU bed.</p><p><strong>Methods: </strong>Retrospective review of 111 consecutive children undergoing posterior surgery for scoliosis between June 2016 and April 2023. The inclusion criteria included a diagnosis of genetic/syndromic or neuromuscular scoliosis; PSF or primary insertion of distraction-based growth rods and requirement for postoperative care in a PICU. We excluded those children that were mandated to go to PICU post-operatively for any reason by the anaesthetic team.</p><p><strong>Results: </strong>49 patients (mean age 13.0 years) were managed on PICU, and 62 (mean age 11.4 years) on POPUP-HDU. The groups were matched with respect to body weight, curve magnitude, operative duration, type of fusion procedure performed, the presence of cardiac malformations, the use of home breathing support, the number of operated levels, pelvic instrumentation and intraoperative blood loss. 8 patients in the PICU, and 16 in the POP-HDU groups were readmitted back to PICU following step-down to the hospital ward (p = 0.27). The median PICU length of stay was 1 day in the PICU group and less than a day in POPUP-HDU (for those that needed to be subsequently admitted to PICU). The median total length of hospital stay was 10 days in the PICU group, and 8 days in POPUP-HDU (p < 0.05). 14 patients developed medical complications in the PICU group, compared to 19 in POPUP-HDU. There were no bedshortage cancellations in POPUP-HDU, compared to 23 in PICU.</p><p><strong>Conclusions: </strong>For children with neuromuscular, genetic or syndromic scoliosis undergoing PSF or growth rods that are not deemed suitable for immediate ward-level post-operative care, POPUP-HDU provided a safe alternative to PICU for appropriate patients and was associated with shorter hospital stay and fewer cancellations for lack of PICU beds.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anatomical landmark detection on bi-planar radiographs for predicting spinopelvic parameters. 在双平面X光片上检测解剖地标,以预测脊柱骨盆参数。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-23 DOI: 10.1007/s43390-024-00990-0
Stefan Lang, Moritz Jokeit, Ji Hyun Kim, Lukas Urbanschitz, Luca Fisler, Carlos Torrez, Frédéric Cornaz, Jess G Snedeker, Mazda Farshad, Jonas Widmer

Introduction: Accurate landmark detection is essential for precise analysis of anatomical structures, supporting diagnosis, treatment planning, and monitoring in patients with spinal deformities. Conventional methods rely on laborious landmark identification by medical experts, which motivates automation. The proposed deep learning pipeline processes bi-planar radiographs to determine spinopelvic parameters and Cobb angles without manual supervision.

Methods: The dataset used for training and evaluation consisted of 555 bi-planar radiographs from un-instrumented patients, which were manually annotated by medical professionals. The pipeline performed a pre-processing step to determine regions of interest, including the cervical spine, thoracolumbar spine, sacrum, and pelvis. For each ROI, a segmentation network was trained to identify vertebral bodies and pelvic landmarks. The U-Net architecture was trained on 455 bi-planar radiographs using binary cross-entropy loss. The post-processing algorithm determined spinal alignment and angular parameters based on the segmentation output. We evaluated the pipeline on a test set of 100 previously unseen bi-planar radiographs, using the mean absolute difference between annotated and predicted landmarks as the performance metric. The spinopelvic parameter predictions of the pipeline were compared to the measurements of two experienced medical professionals using intraclass correlation coefficient (ICC) and mean absolute deviation (MAD).

Results: The pipeline was able to successfully predict the Cobb angles in 61% of all test cases and achieved mean absolute differences of 3.3° (3.6°) and averaged ICC of 0.88. For thoracic kyphosis, lumbar lordosis, sagittal vertical axis, sacral slope, pelvic tilt, and pelvic incidence, the pipeline produced reasonable outputs in 69%, 58%, 86%, 85%, 84%, and 84% of the cases. The MAD was 5.6° (7.8°), 4.7° (4.3°), 2.8 mm (3.0 mm), 4.5° (7.2°), 1.8° (1.8°), and 5.3° (7.7°), while the ICC was measured at 0.69, 0.82, 0.99, 0.61, 0.96, and 0.70, respectively.

Conclusion: Despite limitations in patients with severe pathologies and high BMI, the pipeline automatically predicted coronal and sagittal spinopelvic parameters, which has the potential to simplify clinical routines and large-scale retrospective data analysis.

简介准确的地标检测对于精确分析解剖结构、支持脊柱畸形患者的诊断、治疗计划和监测至关重要。传统方法依赖于医学专家费力的地标识别,因此需要实现自动化。所提出的深度学习管道可处理双平面射线照片,在无需人工监督的情况下确定脊柱骨盆参数和 Cobb 角:用于训练和评估的数据集由 555 张来自未接受仪器检查的患者的双平面放射照片组成,这些照片由医疗专业人员手动标注。管道执行预处理步骤以确定感兴趣区域,包括颈椎、胸腰椎、骶骨和骨盆。对于每个感兴趣区,都会训练一个分割网络来识别椎体和骨盆地标。使用二元交叉熵损失对 455 张双平面射线照片进行了 U-Net 架构训练。后处理算法根据分割输出确定脊柱排列和角度参数。我们使用注释地标和预测地标之间的平均绝对差值作为性能指标,在由 100 张之前未见过的双平面射线照片组成的测试集上对该管道进行了评估。使用类内相关系数(ICC)和平均绝对偏差(MAD)将管道的脊柱骨盆参数预测结果与两位经验丰富的医学专家的测量结果进行比较:结果:在所有测试案例中,管道能够成功预测 61% 的 Cobb 角,平均绝对偏差为 3.3° (3.6°),平均 ICC 为 0.88。对于胸椎后凸、腰椎前凸、矢状垂直轴、骶骨斜度、骨盆倾斜和骨盆内陷,该管道分别在 69%、58%、86%、85%、84% 和 84% 的病例中产生了合理的输出结果。MAD分别为5.6°(7.8°)、4.7°(4.3°)、2.8 mm(3.0 mm)、4.5°(7.2°)、1.8°(1.8°)和5.3°(7.7°),ICC分别为0.69、0.82、0.99、0.61、0.96和0.70:尽管在严重病变和高体重指数患者中存在局限性,但该管道能自动预测冠状面和矢状面的脊柱骨盆参数,具有简化临床常规和大规模回顾性数据分析的潜力。
{"title":"Anatomical landmark detection on bi-planar radiographs for predicting spinopelvic parameters.","authors":"Stefan Lang, Moritz Jokeit, Ji Hyun Kim, Lukas Urbanschitz, Luca Fisler, Carlos Torrez, Frédéric Cornaz, Jess G Snedeker, Mazda Farshad, Jonas Widmer","doi":"10.1007/s43390-024-00990-0","DOIUrl":"https://doi.org/10.1007/s43390-024-00990-0","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate landmark detection is essential for precise analysis of anatomical structures, supporting diagnosis, treatment planning, and monitoring in patients with spinal deformities. Conventional methods rely on laborious landmark identification by medical experts, which motivates automation. The proposed deep learning pipeline processes bi-planar radiographs to determine spinopelvic parameters and Cobb angles without manual supervision.</p><p><strong>Methods: </strong>The dataset used for training and evaluation consisted of 555 bi-planar radiographs from un-instrumented patients, which were manually annotated by medical professionals. The pipeline performed a pre-processing step to determine regions of interest, including the cervical spine, thoracolumbar spine, sacrum, and pelvis. For each ROI, a segmentation network was trained to identify vertebral bodies and pelvic landmarks. The U-Net architecture was trained on 455 bi-planar radiographs using binary cross-entropy loss. The post-processing algorithm determined spinal alignment and angular parameters based on the segmentation output. We evaluated the pipeline on a test set of 100 previously unseen bi-planar radiographs, using the mean absolute difference between annotated and predicted landmarks as the performance metric. The spinopelvic parameter predictions of the pipeline were compared to the measurements of two experienced medical professionals using intraclass correlation coefficient (ICC) and mean absolute deviation (MAD).</p><p><strong>Results: </strong>The pipeline was able to successfully predict the Cobb angles in 61% of all test cases and achieved mean absolute differences of 3.3° (3.6°) and averaged ICC of 0.88. For thoracic kyphosis, lumbar lordosis, sagittal vertical axis, sacral slope, pelvic tilt, and pelvic incidence, the pipeline produced reasonable outputs in 69%, 58%, 86%, 85%, 84%, and 84% of the cases. The MAD was 5.6° (7.8°), 4.7° (4.3°), 2.8 mm (3.0 mm), 4.5° (7.2°), 1.8° (1.8°), and 5.3° (7.7°), while the ICC was measured at 0.69, 0.82, 0.99, 0.61, 0.96, and 0.70, respectively.</p><p><strong>Conclusion: </strong>Despite limitations in patients with severe pathologies and high BMI, the pipeline automatically predicted coronal and sagittal spinopelvic parameters, which has the potential to simplify clinical routines and large-scale retrospective data analysis.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development of the scoliosis research society spinal deformity surgery safety checklist. 脊柱侧凸研究学会脊柱畸形手术安全清单的开发。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-23 DOI: 10.1007/s43390-024-00973-1
Rafael De la Garza Ramos, Justin K Scheer, Nabil Matmati, Lloyd A Hey, Douglas C Burton, Marinus de Kleuver, Christopher P Ames, Vijay Yanamadala

Purpose: Spine deformity surgery is a complex multi-step procedure that has a relatively high complication rate. The use of surgical safety checklists has been shown to reduce perioperative adverse events, but existing lists are varied and non-specific for spinal deformity surgery. Thus, the purpose of this study was to develop a comprehensive surgical checklist for complex spinal corrective surgery.

Methods: An electronic survey consisting of 187 surgical checklist items that had been developed and used by a group of SRS members over a 5-year period was distributed to the Scoliosis Research Society Safety and Value Committee membership. The survey sections included: (1) pre-operative area, (2) initial operating room visit, (3) before turning, (4) positioning, (5) prepare and drape, (6) pre-incision timeout, (7) intraoperative, (8) finishing implant placement and confirming imaging, (9) final rods and locking, (10) prior to closure, (11) closure, (12) turn to supine, and (13) checkout/debriefing. Respondents graded each item on a five-point Likert scale based on their perceived importance and feasibility for inclusion in the checklist. Features graded as "moderately important" or "very important" to include by at least 70% of respondents were considered to meet the cutoff for inclusion-based standard Delphi practices. Study data were collated using REDCap.

Results: A total of 25 surgeons completed the survey in its entirety. The overall checklist "package" was shortened to 9 individual checklist modules, with 2 to 16 items per checklist. In terms of individual checklist items, 40% of items (74 of 187) met the cutoff for inclusion; 17 of these items were graded as "very important," which included verifying the presence of implantable devices, reviewing the surgical plan and positioning with the surgical staff, securing the endotracheal tube, bite block confirmation, prone and lateral positioning, neuromonitoring baseline readings, double-checking that the implant screw caps were locked prior to closure, and confirming that the patient was moving bilateral lower extremities before leaving the operating room when possible.

Conclusion: This study has led to the development of a specific spinal deformity surgical checklist of 74 (many specific to spine surgery) items that were considered important for inclusion; 17 were considered "very important".

目的:脊柱畸形手术是一种复杂的多步骤手术,并发症发生率相对较高。手术安全清单的使用已被证明可以减少围手术期的不良事件,但现有的清单五花八门,且不针对脊柱畸形手术。因此,本研究旨在为复杂的脊柱矫正手术制定一份全面的手术清单:方法:向脊柱侧弯研究学会安全与价值委员会成员分发了一份电子调查表,其中包含 187 个手术核对表项目,这些项目是由一组脊柱侧弯研究学会成员在 5 年内开发和使用的。调查内容包括(1)术前区域,(2)手术室初诊,(3)翻身前,(4)定位,(5)准备和铺巾,(6)切口前超时,(7)术中,(8)完成植入物置入并确认成像,(9)最终杆和锁定,(10)关闭前,(11)关闭,(12)转为仰卧,以及(13)结账/简报。受访者根据其认为纳入核对表的重要性和可行性,用五点李克特量表对每个项目进行评分。被至少 70% 的受访者评为 "适度重要 "或 "非常重要 "的特征被认为符合基于标准德尔菲实践的纳入临界值。研究数据使用 REDCap 进行整理:共有 25 名外科医生完成了整个调查。整个核对表 "包 "缩短为 9 个单独的核对表模块,每个核对表包含 2 到 16 个项目。就单个核对表项目而言,40%的项目(187 项中的 74 项)达到了纳入的临界值;其中 17 项被评为 "非常重要",包括核实是否存在植入装置、与手术人员一起审查手术计划和定位、固定气管插管、咬合阻滞确认、俯卧位和侧卧位、神经监测基线读数、在关闭手术室前仔细检查植入物螺帽是否锁定,以及在可能的情况下,确认患者在离开手术室前活动了双侧下肢:通过这项研究,我们制定了一份专门的脊柱畸形手术核对表,其中包含 74 个被认为重要的项目(许多项目专门针对脊柱手术);17 个项目被认为 "非常重要"。
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引用次数: 0
Cervical kyphoscoliosis due to substance abuse: a case series on introduction and neurosurgical treatment. 药物滥用导致的颈椎脊柱侧弯:介绍和神经外科治疗的系列病例。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-22 DOI: 10.1007/s43390-024-00989-7
Majid Rezvani, Mohammadreza Mehrabanian, Omid R Hariri, Colin Son, Noushin Vahdat, Mina Foroughi, Ariel Takayanagi, Sara Mirza, Sadegh Baradaran Mahdavi, Arman Sourani

Study design: A prospective case series.

Objective: To investigate the possible associations of multi-directional cervical kyphoscoliosis (CKS) with substance abuse and evaluate treatment outcomes. CKS is a rare medical situation without a well-established pathology. Still there are many obscurities in treatment paradigms and outcomes. To our knowledge, there is no published report on the association between CKS with addiction. Besides the novel report of such a rare etiology for CSK, the complexity of the neurosurgical treatment makes this report the first of its kind.

Methods: In this series, we presented three patients with a history of crack cocaine addiction who suffered CKS due to prolonged hand-over-neck posture and treated all of them with a complex neurosurgical protocol.

Results: All cases were operated on and restored their normal spine alignment. Their long-term outcomes showed independent neurological status with no major surgical complications.

Conclusion: Crack cocaine addiction might be associated with CKS in long-term cocaine abuse. A complex neurosurgical approach can achieve a sustainable clinical outcome.

研究设计前瞻性病例系列:调查多向性颈椎脊柱侧弯症(CKS)与药物滥用的可能关联,并评估治疗效果。颈椎脊柱侧弯症是一种罕见的病症,没有明确的病理机制。在治疗范例和结果方面仍有许多模糊之处。据我们所知,目前还没有关于 CKS 与成瘾关系的公开报道。除了对 CSK 这种罕见病因的新颖报道外,神经外科治疗的复杂性也使本报告成为同类报告中的首例:在这组病例中,我们介绍了三位有快克可卡因成瘾史的患者,他们因长时间的手捂颈姿势而患上了 CKS,我们采用了复杂的神经外科方案对他们进行了治疗:结果:所有病例均接受了手术治疗,恢复了正常的脊柱排列。结果:所有病例均接受了手术治疗,恢复了正常的脊柱排列,其远期疗效显示神经功能状态良好,无重大手术并发症:结论:长期吸食可卡因可能与快克可卡因成瘾有关。复杂的神经外科手术方法可实现可持续的临床疗效。
{"title":"Cervical kyphoscoliosis due to substance abuse: a case series on introduction and neurosurgical treatment.","authors":"Majid Rezvani, Mohammadreza Mehrabanian, Omid R Hariri, Colin Son, Noushin Vahdat, Mina Foroughi, Ariel Takayanagi, Sara Mirza, Sadegh Baradaran Mahdavi, Arman Sourani","doi":"10.1007/s43390-024-00989-7","DOIUrl":"https://doi.org/10.1007/s43390-024-00989-7","url":null,"abstract":"<p><strong>Study design: </strong>A prospective case series.</p><p><strong>Objective: </strong>To investigate the possible associations of multi-directional cervical kyphoscoliosis (CKS) with substance abuse and evaluate treatment outcomes. CKS is a rare medical situation without a well-established pathology. Still there are many obscurities in treatment paradigms and outcomes. To our knowledge, there is no published report on the association between CKS with addiction. Besides the novel report of such a rare etiology for CSK, the complexity of the neurosurgical treatment makes this report the first of its kind.</p><p><strong>Methods: </strong>In this series, we presented three patients with a history of crack cocaine addiction who suffered CKS due to prolonged hand-over-neck posture and treated all of them with a complex neurosurgical protocol.</p><p><strong>Results: </strong>All cases were operated on and restored their normal spine alignment. Their long-term outcomes showed independent neurological status with no major surgical complications.</p><p><strong>Conclusion: </strong>Crack cocaine addiction might be associated with CKS in long-term cocaine abuse. A complex neurosurgical approach can achieve a sustainable clinical outcome.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Spine deformity
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