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Delayed neurological deficit due to a medially misplaced thoracic pedicle screw during adolescent idiopathic scoliosis correction: a complication 6 years in the making. 青少年特发性脊柱侧凸矫正过程中胸椎椎弓根螺钉内侧错位导致的延迟性神经功能缺损:长达 6 年的并发症。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-04 DOI: 10.1007/s43390-024-00951-7
Sudhir Suggala, Garrett A Dyess, Olivier Darbin, Richard P Menger

Purpose: Neurological deficits developing years after pedicle screw misplacement is a rare phenomenon. Here, we report level IV evidence of a previously asymptomatic medial thoracic pedicle screw resulting in paraparesis after a motor vehicle accident.

Methods: A 21-year-old male presented with acute onset of paraparesis following a motor vehicle collision. Six years prior this incident, the patient underwent a thoracolumbar fusion T4-L4 for AIS performed by an outside orthopedic surgeon. CT scan and CT myelogram illustrated decreased spinal canal diameter and cord compression from a medial T8 pedicle screw.

Results: Surgical removal of the misplaced pedicle screw resulted in a gradual complete recovery sustained over a period of 2 years. This case is compared to those reported in the literature review between 1981 and 2019 concerning delayed neurological deterioration related to misplaced pedicle screw.

Conclusion: This case reports a delayed neurological deficit implicating a misplaced pedicle screw. This phenomenon remains rare since 5 cases were reported in the literature over the last 4 decades. It calls into focus the need for confirmation of safe instrumentation during the intraoperative period. It also illustrates the potential difficult decision-making in regard to asymptomatic misplaced instrumentation.

Level of evidence: IV.

目的:椎弓根螺钉错位多年后出现神经功能缺损是一种罕见现象。在此,我们报告了在一起机动车事故后,先前无症状的内侧胸椎椎弓根螺钉导致截瘫的 IV 级证据:一名 21 岁的男性患者在一次机动车碰撞后出现急性截瘫。事故发生六年前,该患者因AIS接受了由外院骨科医生实施的胸腰椎T4-L4融合术。CT扫描和CT脊髓造影显示,T8内侧椎弓根螺钉导致椎管直径减小和脊髓受压:手术取出错位的椎弓根螺钉后,患者在两年内逐渐完全康复。本病例与1981年至2019年文献综述中报道的与椎弓根螺钉错位相关的延迟性神经功能衰退病例进行了比较:本病例报告了与椎弓根螺钉错位有关的延迟性神经功能缺损。过去 40 年间,文献中仅报道了 5 例,因此这种现象仍然十分罕见。该病例强调了在术中确认器械安全的必要性。它还说明了在无症状的错位器械方面潜在的决策困难:证据等级:IV。
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引用次数: 0
Spinopelvic morphology impacts on postoperative proximal junctional kyphosis in congenital scoliosis with thoracolumbar hemivertebrae. 脊柱骨形态对伴有胸腰椎半椎体的先天性脊柱侧凸术后近端交界处脊柱侧凸的影响。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-04-29 DOI: 10.1007/s43390-024-00877-0
Yang Li, Chenggui Zhang, Jianmin Sun, Guodong Wang

Purpose: It aims to investigate the lumbar and pelvic morphology in congenital scoliosis with thoracolumbar hemivertebrae and its impact on proximal junctional kyphosis (PJK) incidence after hemivertebra resection and short fusion.

Methods: 23 congenital scoliosis patients with thoracolumbar hemivertebra aged between 10 and 18 years were enrolled in the retrospective study. Spinopelvic sagittal parameters were analyzed on whole-spine standing lateral radiographs preoperatively, one-week postoperatively and at the final follow-up. Pearson correlations were calculated for local kyphosis (LK), lumbar and pelvic morphology parameters. Binary logistic regression and receiver operating characteristics (ROC) curve analysis were performed to identify the risk factors for PJK.

Results: Thoracolumbar hemivertebra caused LK of 29.2° ± 17.3°, an increased lumbar lordosis (LL) (-64.7° ± 16.3°), lower LL apex (52.2% at L5), and small pelvic incidence (PI) (36.8° ± 6.6°). LK was correlated with lumbar morphology parameters, including LL (r = - 0.837), upper arc of LL (LLUA) (r = - 0.879), thoracolumbar kyphosis (TLK) (r = 0.933), thoracic kyphosis (TK) (r = 0.762) and TK apex (TKA) (r = - 0.749). Surgical treatment improved the lumbar morphology, but not pelvic morphology. At the final follow-up, LL had returned to its preoperative value (p = 0.158). PJK occurred in 30.4% of cases as a compensatory mechanism. Preoperatively, significant differences of parameters between non-PJK and PJK groups were observed in LK and TLK. Binary logistic regression identified three independent risk factors for PJK: preoperative LLA (OR = 0.005, 95%CI = 0.000-0.287, p = 0.011), preoperative TLK (OR = 1.134, 95%CI = 1.001-1.286, p = 0.048), and preoperative lumbar lordosis morphology type (OR = 5.507, 95%CI = 1.202-25.227, p = 0.028). However, residual LK after surgery was not correlated with PJK incidence. ROC curve analysis verified that preoperative TLK > 22.59° was associated with increased PJK incidence after surgery.

Conclusions: Lumbar morphology changes as a compensatory mechanism beneath the thoracolumbar hemivertebra. However, a stable pelvis tends to allow the LL to return to its preoperative value. PJK occurred as a cranial compensatory mechanism for increasing LL and corrected TLK. A larger TLK (> 22.59°) was an independent risk factor for PJK incidence in patients with type 2 and 3A lumbar lordosis morphology.

目的:研究先天性脊柱侧弯伴胸腰椎半椎体的腰椎和骨盆形态,以及其对半椎体切除和短融合术后近交界脊柱侧弯(PJK)发生率的影响。在术前、术后一周和最终随访时,通过全脊柱立位侧位片分析脊柱矢状面参数。计算了局部驼背(LK)、腰椎和骨盆形态参数的皮尔逊相关性。为确定PJK的风险因素,进行了二元逻辑回归和接收器操作特征(ROC)曲线分析:结果:胸腰椎半椎体导致 LK 为 29.2° ± 17.3°,腰椎前凸(LL)增加(-64.7° ± 16.3°),LL 顶点降低(L5 为 52.2%),骨盆入径(PI)较小(36.8° ± 6.6°)。LK 与腰椎形态参数相关,包括 LL(r = - 0.837)、LL 上弧(LLUA)(r = - 0.879)、胸腰椎后凸(TLK)(r = 0.933)、胸椎后凸(TK)(r = 0.762)和 TK 顶点(TKA)(r = - 0.749)。手术治疗改善了腰椎形态,但没有改善骨盆形态。最后随访时,LL 已恢复到术前值(p = 0.158)。作为一种代偿机制,30.4%的病例出现了 PJK。术前观察发现,非 PJK 组和 PJK 组的 LK 和 TLK 参数存在明显差异。二元逻辑回归确定了 PJK 的三个独立风险因素:术前 LLA(OR = 0.005,95%CI = 0.000-0.287,p = 0.011)、术前 TLK(OR = 1.134,95%CI = 1.001-1.286,p = 0.048)和术前腰椎前凸形态类型(OR = 5.507,95%CI = 1.202-25.227,p = 0.028)。然而,术后残留的 LK 与 PJK 发生率无关。ROC曲线分析证实,术前TLK>22.59°与术后PJK发生率增加有关:结论:腰椎形态的改变是胸腰椎半椎体下方的一种代偿机制。结论:腰椎形态的改变是胸腰椎半椎体下方的代偿机制,但稳定的骨盆可使腰椎形态恢复到术前水平。PJK 的发生是 LL 增加和 TLK 矫正的颅骨代偿机制。较大的 TLK(> 22.59°)是 2 型和 3A 型腰椎前凸形态患者发生 PJK 的独立风险因素。
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引用次数: 0
Clinical and radiological outcomes of gradual reduction and circumferential fusion of high-grade spondylolisthesis in adolescents: a prospective cohort study of 29 young patients. 青少年高位脊柱滑脱症渐进缩窄和环形融合术的临床和放射学疗效:对 29 名年轻患者进行的前瞻性队列研究。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-02 DOI: 10.1007/s43390-024-00884-1
Antoine Dionne, Jean-Marc Mac-Thiong, Stefan Parent, Jesse Shen, Julie Joncas, Soraya Barchi, Hubert Labelle

Aim: The objective of this study was to evaluate the safety and efficacy of a novel technique of formal reduction and circumferential fusion for pediatric high-grade spondylolisthesis (HGS).

Purpose: The safety and efficacy of formal reduction for high-grade spondylolisthesis (HGS) has never been thoroughly examined. This study reports the outcomes of 29 children with HGS who underwent a procedure of gradual reduction and circumferential fusion.

Methods: 29 children (13 males, 16 females) were recruited between 2006 and 2010. Radiographic measurements (including % of slip, lumbosacral angle-LSA, pelvic incidence-PI, pelvic tilt-PT, sacral slope-SS, and proximal femoral angle-PFA) and quality of life assessment (SRS-22 questionnaire) were prospectively obtained at baseline and at the last post-operative follow-up (> 2 years post-op). Radiological measurements were used to classify patients according to the Spine Deformity Study Group (SDSG) classification.

Results: Mean baseline slip % was 69.9 ± 16.5%. There were 13 patients with a balanced pelvic (SDSG Type 4) and 16 with an unbalanced pelvis (SDSG Type 5 and 6). On average, a reduction of 45.5 ± 15.3% (range 20-86%) was achieved safely with no major complication. In particular, of the 29 patients, only 3 had a L5 radiculopathy postoperatively that was self-resolved at follow-up. From a radiological standpoint, we observed a mean improvement of LSA from 80.3 ± 17.9° to 91.7 ± 13.6°. We also observed a statistically significant improvement in global HRQOL, and in the function and body image domains.

Conclusion: This prospective study suggests that formal reduction of HGS followed by circumferential fusion is safe when using a standardized surgical technique based on gradual reduction. Performing this intervention could also help improve QOL in some patients.

目的:对高位脊柱滑脱症(HGS)进行正规缩窄术的安全性和有效性从未进行过深入研究。本研究报告了 29 名接受渐进缩窄和环形融合术的 HGS 患儿的治疗结果。方法:2006 年至 2010 年间招募了 29 名患儿(13 名男性,16 名女性)。在基线和术后最后一次随访(术后 2 年以上)时进行了放射学测量(包括滑脱率、腰骶角-LSA、骨盆内陷-PI、骨盆倾斜-PT、骶骨斜度-SS 和股骨近端角-PFA)和生活质量评估(SRS-22 问卷)。根据脊柱畸形研究小组(SDSG)的分类方法,采用放射学测量对患者进行分类:平均基线滑移率为 69.9 ± 16.5%。有 13 名患者骨盆平衡(SDSG 4 型),16 名患者骨盆不平衡(SDSG 5 型和 6 型)。平均而言,手术安全地缩小了 45.5 ± 15.3%(范围为 20-86%),没有出现重大并发症。特别值得一提的是,在 29 名患者中,只有 3 名患者术后出现了 L5 根性病变,但在随访时已自行缓解。从放射学角度来看,我们观察到 LSA 的平均值从 80.3 ± 17.9° 提高到 91.7 ± 13.6°。我们还观察到,患者的总体 HRQOL 以及功能和身体形象方面都有了统计学意义上的显著改善:这项前瞻性研究表明,在使用基于渐进缩窄的标准化手术技术时,正式缩窄 HGS 后进行周缘融合是安全的。进行这种干预还有助于改善部分患者的 QOL。
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引用次数: 0
Self-image in spinal deformity: a state-of-the-art review. 脊柱畸形的自我形象:最新综述。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-02 DOI: 10.1007/s43390-024-00875-2
Lauren E Stone, Ryan Sindewald, Michael P Kelly

Purpose: To review the current literature surrounding the assessment of self-image in pediatric and adult spinal deformity.

Methods: The literature were reviewed for studies examining patient-reported outcome measurements (PROM) and self-image in pediatric and adult spinal deformity. PROM performance metrics were collected and described. The relationships between self-image PROM and patient outcomes, including satisfaction, were described.

Results: Several self-image PROM exist, including the Scoliosis Research Society-22r (SRS-22r) self-image domain, the Body Image Disturbance Questionnaire (BIDQ), and the Spinal Appearance Questionnaire (SAQ). The most commonly used is the self-image domain of the SRS-22r. It is validated in adult and pediatric spinal deformity and is correlated with patient desire for surgery and satisfaction after surgery. This domain is limited by floor and ceiling effects.

Conclusion: Self-image assessment is critical to both pediatric and adult spinal deformity surgeries. The SRS-22r self-image domain is the most frequently reported PROM for this health domain. While valid in both surgical cohorts, this PROM is affected by floor and ceiling effects which limits the ability to discriminate between health states. Given the overall importance of this domain to patients with spinal deformity further efforts are needed to improve discrimination without gross increases in PROM question burden, which may limit broad acceptance and use.

目的:回顾目前有关评估儿童和成人脊柱畸形患者自我形象的文献:方法:查阅文献,了解有关儿童和成人脊柱畸形患者报告结果测量(PROM)和自我形象的研究。收集并描述了 PROM 的性能指标。描述了自我形象 PROM 与患者结果(包括满意度)之间的关系:结果:现有几种自我形象 PROM,包括脊柱侧凸研究学会-22r(SRS-22r)自我形象域、身体形象紊乱问卷(BIDQ)和脊柱外观问卷(SAQ)。最常用的是 SRS-22r 的自我形象领域。它已在成人和儿童脊柱畸形中得到验证,并与患者的手术愿望和术后满意度相关。该领域受到最低和最高效应的限制:结论:自我形象评估对儿童和成人脊柱畸形手术都至关重要。SRS-22r自我形象领域是该健康领域报告最多的PROM。虽然该PROM在两个手术队列中都有效,但它受到底线效应和上限效应的影响,从而限制了区分不同健康状况的能力。鉴于该领域对脊柱畸形患者的整体重要性,我们需要进一步努力提高辨别能力,同时又不增加 PROM 问题的负担,因为这可能会限制其被广泛接受和使用。
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引用次数: 0
The association between variations in the number of thoracic and lumbar vertebrae and rib morphology in adolescent idiopathic scoliosis. 青少年特发性脊柱侧凸的胸椎和腰椎数量变化与肋骨形态之间的关联。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-09 DOI: 10.1007/s43390-024-00887-y
Kotaro Sakashita, Toshiaki Kotani, Tsuyoshi Sakuma, Yasushi Iijima, Kohei Okuyama, Tsutomu Akazawa, Shohei Minami, Seiji Ohtori, Masao Koda, Masashi Yamazaki

Purpose: Preoperative counting of thoracic and lumbar vertebrae is crucial in adolescent idiopathic scoliosis (AIS) due to reported anatomical variations and potential surgical site misidentification. This study investigated characteristics associated with the vertebral number variations AIS, particularly focusing on rib morphology.

Methods: Based on three-dimensional computed tomography, patients were categorized into the non-variant number group, comprising individuals with 12 thoracic and 5 lumbar vertebrae, and the variant number group, comprising individuals with different numbers of vertebrae. Additionally, the most caudal rib morphology was classified as normal, unilateral, or hypoplastic.

Results: A total of 359 patients were included in our study (41 males, 318 females, age: 16.3 ± 3.1 years), with 44 patients (12.3%) assigned to the variant number group. Logistic regression analysis identified unilateral ribs (odds ratio [OR]: 10.50) and lumbosacral transitional vertebrae (LSTV) (OR 6.49) as significant risk factors associated with variations. Further analysis revealed hypoplastic ribs as a significant risk factor associated with LSTV (OR: 4.58). 8 CONCLUSION: Our study suggests that abnormal rib morphology may be associated with vertebral number variations. Close attention to rib morphology is, therefore, warranted in cases with atypical vertebral numbers. Accordingly, to ensure surgical safety and accuracy, spine surgeons must communicate these variations to the surgical team, standardize nomenclature for describing them, and intraoperatively verify fusion levels with them.

目的:对青少年特发性脊柱侧弯症(AIS)患者而言,术前胸椎和腰椎的计数至关重要,因为据报道存在解剖变异和潜在的手术部位识别错误。本研究调查了与 AIS 椎体数目变异相关的特征,尤其侧重于肋骨形态:方法:根据三维计算机断层扫描,将患者分为非椎体数目变异组(包括 12 个胸椎和 5 个腰椎)和椎体数目变异组(包括不同数目的椎体)。此外,最尾端的肋骨形态被分为正常、单侧或发育不良:我们的研究共纳入了 359 名患者(41 名男性,318 名女性,年龄:16.3 ± 3.1 岁),其中 44 名患者(12.3%)被归入变异编号组。逻辑回归分析发现,单侧肋骨(几率比 [OR]:10.50)和腰骶过渡椎(LSTV)(OR:6.49)是与变异相关的重要风险因素。进一步分析发现,肋骨发育不良是与 LSTV 相关的重要风险因素(OR:4.58)。8 结论:我们的研究表明,肋骨形态异常可能与椎骨数目变异有关。因此,对于椎体数目不典型的病例,应密切关注肋骨形态。因此,为确保手术的安全性和准确性,脊柱外科医生必须与手术团队沟通这些变异,规范描述这些变异的术语,并在术中与他们一起验证融合水平。
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引用次数: 0
Translation, cross-cultural adaptation and clinimetric properties of the Brazilian Portuguese version of the Brace Questionnaire. 巴西葡萄牙语版 Brace 问卷的翻译、跨文化改编和临床特性。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-04-30 DOI: 10.1007/s43390-024-00883-2
Isabela Pedrosa Fernandes, Marcella Veronnica Pereira Gomes, Rodrigo Mantelatto Andrade, Ariane Verttú Schmidt, Ana Paula Ribeiro, Mauricio Oliveira Magalhães

Purpose: To perform a cross-cultural adaptation and validation of the Brazilian-Portuguese versions of the Brace Questionnaire in adolescent idiopathic scoliosis.

Methods: A forward-backward translation process was employed to produce a Brazilian Portuguese version of the Brace Questionnaire, followed by comprehensive cross-cultural adaptation stages. The measurements of internal consistency and test-retest reliability were assessed by Cronbach's a and intraclass correlation coefficient (ICC), respectively. The Pearson's correlation coefficient was used to analyze the concurrent validity by comparison with the Scoliosis Research Society-22r questionnaire.

Results: A total of 84 scoliosis patients (age 13.4 ± 2.0 years, thoracic Cobb angle 33.3° ± 13.8°, and lumbar Cobb angle 29.8° ± 14.3°) were included. The Brace Questionnaire showed excellent internal consistency (Cronbach α = 0.93) and moderate reliability (ICC = 0.86). The correlations between the Brace Questionnaire and Scoliosis Research Society-22 were r = 0.66; p = 0.011. In addition, it was found that the Brazilian version of the Brace Questionnaire does not have ceiling and floor effects.

Conclusions: The Brazilian-Portuguese adaptation of the brace questionnaire shows excellent reliability and can be a valid tool for psychometric assessment in adolescent idiopathic scoliosis.

目的:对巴西-葡萄牙语版本的青少年特发性脊柱侧凸支撑力问卷进行跨文化改编和验证:方法:采用前向-后向翻译程序制作巴西葡萄牙语版的支架问卷,然后进行全面的跨文化改编。通过克朗巴赫 a 和类内相关系数(ICC)分别评估了内部一致性和重复测试可靠性。通过与脊柱侧凸研究学会-22r问卷的比较,使用皮尔逊相关系数分析了并发效度:共纳入 84 名脊柱侧弯患者(年龄为 13.4 ± 2.0 岁,胸椎 Cobb 角度为 33.3° ± 13.8°,腰椎 Cobb 角度为 29.8° ± 14.3°)。支具问卷显示出极佳的内部一致性(Cronbach α = 0.93)和适度的可靠性(ICC = 0.86)。支具问卷与脊柱侧凸研究协会-22 的相关性为 r = 0.66;p = 0.011。此外,研究还发现巴西版支撑力问卷不存在上限和下限效应:结论:巴西-葡萄牙语改编的支具问卷显示出极佳的可靠性,可作为青少年特发性脊柱侧凸心理测量评估的有效工具。
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引用次数: 0
Long-term reoperation rates following spinal fusion for neuromuscular scoliosis in nonambulatory patients with cerebral palsy. 行走不便的脑瘫患者因神经肌肉性脊柱侧凸而进行脊柱融合术后的长期再手术率。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-04-29 DOI: 10.1007/s43390-024-00878-z
Christopher D Seaver, Sara J Morgan, Candice S Legister, Casey L Palmer, Eduardo C Beauchamp, Tenner J Guillaume, Walter H Truong, Steven E Koop, Joseph H Perra, John E Lonstein, Daniel J Miller

Purpose: To describe the incidence of reoperation and factors contributing to surgical revision within a minimum of 10 years after spinal fusion for scoliosis in patients with nonambulatory cerebral palsy (CP).

Methods: We conducted a retrospective review of consecutive nonambulatory patients with CP who underwent primary spinal fusion at a single specialty care center with a minimum of 10 years from their index surgery (surgery dates 2001-2011). Causes of reoperation were classified as implant failure/pseudoarthrosis, surgical site infection (SSI), proximal junctional kyphosis, prominent/symptomatic implants, and implant removal. Reoperation rates with 95% confidence intervals were calculated for each time interval, and an actuarial survival curve was generated.

Results: 144 patients met inclusion criteria (mean age = 14.3 ± 2.6 years, 62.5% male); 85.4% had 5 years follow-up data; and 66.0% had 10 years follow-up data. Estimates from the actuarial analysis suggest that 14.9% (95% CI: 10.0-22.0) underwent reoperation by 5 years postsurgery, and 21.7% (95% CI: 15.4-30.1) underwent reoperation by 10 years postsurgery. The most common causes for reoperation were implant failure/pseudoarthrosis, SSI, and prominent/symptomatic implants.

Conclusions: To our knowledge, this study is the largest long-term follow-up of nonambulatory patients with CP and neuromuscular scoliosis who underwent spinal fusion. Approximately 22% of these patients required reoperation 10 years after their index surgery, primarily due to implant failure/pseudoarthrosis, SSI, and prominent/symptomatic implants. Complications and reoperations continued throughout the 10 years period after index surgery, reinforcing the need for long-term follow-up as these patients transition into adulthood.

Level of evidence: III.

目的:描述不行动的脑性瘫痪(CP)患者脊柱侧凸融合术后至少 10 年内再次手术的发生率以及导致手术翻修的因素:我们对在一家专科医疗中心接受初次脊柱融合术的连续非行动不便的 CP 患者进行了回顾性研究,这些患者接受初次脊柱融合术后至少 10 年(手术日期为 2001-2011 年)。再次手术的原因分为植入物失败/假关节、手术部位感染(SSI)、近端交界性脊柱后凸、植入物突出/无症状以及植入物移除。计算了每个时间间隔的再手术率及95%置信区间,并生成了精算生存曲线:144名患者符合纳入标准(平均年龄=14.3 ± 2.6岁,62.5%为男性);85.4%的患者有5年的随访数据;66.0%的患者有10年的随访数据。精算分析的估计结果表明,14.9%(95% CI:10.0-22.0)的患者在术后 5 年进行了再手术,21.7%(95% CI:15.4-30.1)的患者在术后 10 年进行了再手术。最常见的再手术原因是植入失败/假关节、SSI和植入物突出/无症状:据我们所知,这项研究是对接受脊柱融合术的不行动的CP和神经肌肉性脊柱侧凸患者进行的最大规模的长期随访。这些患者中约有22%的人在指数手术10年后需要再次手术,主要原因是植入物失败/假关节、SSI和植入物突出/无症状。并发症和再次手术在指数手术后的10年中持续存在,这就加强了在这些患者进入成年期后对其进行长期随访的必要性:证据等级:III。
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引用次数: 0
Incidental dural tears during pediatric posterior spinal fusions. 小儿脊柱后路融合术中偶然出现的硬脑膜撕裂。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI: 10.1007/s43390-024-00873-4
Paal K Nilssen, Edward Compton, Stephen Stephan, Lindsay M Andras, Jason K Chu, David L Skaggs, Kenneth D Illingworth

Purpose: To characterize the frequency of incidental dural tears in pediatric spine surgery, their treatment, complications, and results of long-term follow-up.

Methods: A retrospective review of all pediatric patients who underwent a posterior spinal fusion (PSF) between 2004-2019 at a tertiary children's hospital was conducted. Electronic medical records were reviewed for patient demographics, intra-operative data, presence of an incidental dural tear, repair method, and patient outcomes.

Results: 3043 PSFs were reviewed, with 99 dural tears identified in 94 patients (3.3% overall incidence). Mean follow-up was 35.7 months (range 0.1-142.5). When the cause of the dural tear was specified, 69% occurred during exposure, 5% during pedicle screw placement, 4% during osteotomy, 2% during removal of implants, and 2% during intra-thecal injection of morphine. The rate of dural tears during primary PSF was significantly lower than during revision PSF procedures (2.6% vs. 6.2%, p < 0.05). 86.9% of dural tears were repaired and/or sealed intraoperatively, while 13.1% had spontaneous resolution. Postoperative headaches developed in 13.1% of patients and resolved at a mean of 7.6 days. There was no difference in the incidence of headaches in patients that were ordered bedrest vs. no bedrest (p > 0.99). Postoperative infections occurred in 9.5% of patients and 24.1% patients were identified to have undergone a revision surgery.

Conclusions: Incidence of intra-operative dural tears in pediatric spine surgery is 3.3%. Although complications associated with the dural tear occur, most resolve over time and there were no long-term sequelae in patients with 2 years of follow up.

Level of evidence: Level IV.

目的:了解小儿脊柱手术中意外硬膜撕裂的发生频率、治疗方法、并发症及长期随访结果:方法:对一家三级儿童医院 2004-2019 年间接受脊柱后路融合术(PSF)的所有儿科患者进行回顾性研究。研究人员查阅了电子病历,以了解患者的人口统计学特征、术中数据、是否存在意外硬脊膜撕裂、修复方法和患者预后:共审查了 3043 例 PSF,在 94 名患者中发现了 99 例硬膜撕裂(总发生率为 3.3%)。平均随访时间为 35.7 个月(0.1-142.5 个月)。当硬膜撕裂的原因明确时,69%发生在暴露过程中,5%发生在椎弓根螺钉置入过程中,4%发生在截骨过程中,2%发生在移除植入物过程中,2%发生在椎管内注射吗啡过程中。初次 PSF 手术的硬膜撕裂率明显低于翻修 PSF 手术(2.6% 对 6.2%,P 0.99)。9.5%的患者发生了术后感染,24.1%的患者被确认接受了翻修手术:结论:小儿脊柱手术中术中硬膜撕裂的发生率为3.3%。结论:小儿脊柱手术中术中硬脊膜撕裂的发生率为3.3%,虽然会出现硬脊膜撕裂相关并发症,但大多数并发症会随着时间的推移而消失,在2年的随访中,患者没有出现长期后遗症:证据等级:IV 级。
{"title":"Incidental dural tears during pediatric posterior spinal fusions.","authors":"Paal K Nilssen, Edward Compton, Stephen Stephan, Lindsay M Andras, Jason K Chu, David L Skaggs, Kenneth D Illingworth","doi":"10.1007/s43390-024-00873-4","DOIUrl":"10.1007/s43390-024-00873-4","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the frequency of incidental dural tears in pediatric spine surgery, their treatment, complications, and results of long-term follow-up.</p><p><strong>Methods: </strong>A retrospective review of all pediatric patients who underwent a posterior spinal fusion (PSF) between 2004-2019 at a tertiary children's hospital was conducted. Electronic medical records were reviewed for patient demographics, intra-operative data, presence of an incidental dural tear, repair method, and patient outcomes.</p><p><strong>Results: </strong>3043 PSFs were reviewed, with 99 dural tears identified in 94 patients (3.3% overall incidence). Mean follow-up was 35.7 months (range 0.1-142.5). When the cause of the dural tear was specified, 69% occurred during exposure, 5% during pedicle screw placement, 4% during osteotomy, 2% during removal of implants, and 2% during intra-thecal injection of morphine. The rate of dural tears during primary PSF was significantly lower than during revision PSF procedures (2.6% vs. 6.2%, p < 0.05). 86.9% of dural tears were repaired and/or sealed intraoperatively, while 13.1% had spontaneous resolution. Postoperative headaches developed in 13.1% of patients and resolved at a mean of 7.6 days. There was no difference in the incidence of headaches in patients that were ordered bedrest vs. no bedrest (p > 0.99). Postoperative infections occurred in 9.5% of patients and 24.1% patients were identified to have undergone a revision surgery.</p><p><strong>Conclusions: </strong>Incidence of intra-operative dural tears in pediatric spine surgery is 3.3%. Although complications associated with the dural tear occur, most resolve over time and there were no long-term sequelae in patients with 2 years of follow up.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11343891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Utilizing a comprehensive machine learning approach to identify patients at high risk for extended length of stay following spinal deformity surgery in pediatric patients with early onset scoliosis. 利用综合机器学习方法,识别早期脊柱侧凸儿科患者脊柱畸形手术后延长住院时间的高风险患者。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-03 DOI: 10.1007/s43390-024-00889-w
Michael W Fields, Jay Zaifman, Matan S Malka, Nathan J Lee, Christina C Rymond, Matthew E Simhon, Theodore Quan, Benjamin D Roye, Michael G Vitale

Purpose: Early onset scoliosis (EOS) patient diversity makes outcome prediction challenging. Machine learning offers an innovative approach to analyze patient data and predict results, including LOS in pediatric spinal deformity surgery.

Methods: Children under 10 with EOS were chosen from the American College of Surgeon's NSQIP database. Extended LOS, defined as over 5 days, was predicted using feature selection and machine learning in Python. The best model, determined by the area under the curve (AUC), was optimized and used to create a risk calculator for prolonged LOS.

Results: The study included 1587 patients, mostly young (average age: 6.94 ± 2.58 years), with 33.1% experiencing prolonged LOS (n = 526). Most patients were female (59.2%, n = 940), with an average BMI of 17.0 ± 8.7. Factors influencing LOS were operative time, age, BMI, ASA class, levels operated on, etiology, nutritional support, pulmonary and neurologic comorbidities. The gradient boosting model performed best with a test accuracy of 0.723, AUC of 0.630, and a Brier score of 0.189, leading to a patient-specific risk calculator for prolonged LOS.

Conclusions: Machine learning algorithms accurately predict extended LOS across a national patient cohort and characterize key preoperative drivers of increased LOS after PSIF in pediatric patients with EOS.

目的:早发脊柱侧凸(EOS)患者的多样性使得结果预测具有挑战性。机器学习提供了一种创新方法来分析患者数据并预测结果,包括小儿脊柱畸形手术的LOS:从美国外科医生学会的 NSQIP 数据库中选取了 10 岁以下的 EOS 儿童。使用 Python 中的特征选择和机器学习功能对超过 5 天的延长 LOS 进行预测。根据曲线下面积(AUC)确定的最佳模型得到优化,并用于创建延长 LOS 的风险计算器:该研究共纳入 1587 名患者,其中大部分是年轻人(平均年龄:6.94 ± 2.58 岁),33.1% 的患者经历过长期住院治疗(n = 526)。大多数患者为女性(59.2%,n = 940),平均体重指数为(17.0 ± 8.7)。影响住院时间的因素包括手术时间、年龄、体重指数、ASA分级、手术级别、病因、营养支持、肺部和神经系统合并症。梯度提升模型的测试准确率为0.723,AUC为0.630,Brier评分为0.189,表现最佳,从而产生了一个患者特异性LOS延长风险计算器:结论:机器学习算法能准确预测全国患者队列中的长期住院时间,并描述了导致儿科 EOS 患者 PSIF 术后长期住院时间延长的主要术前因素。
{"title":"Utilizing a comprehensive machine learning approach to identify patients at high risk for extended length of stay following spinal deformity surgery in pediatric patients with early onset scoliosis.","authors":"Michael W Fields, Jay Zaifman, Matan S Malka, Nathan J Lee, Christina C Rymond, Matthew E Simhon, Theodore Quan, Benjamin D Roye, Michael G Vitale","doi":"10.1007/s43390-024-00889-w","DOIUrl":"10.1007/s43390-024-00889-w","url":null,"abstract":"<p><strong>Purpose: </strong>Early onset scoliosis (EOS) patient diversity makes outcome prediction challenging. Machine learning offers an innovative approach to analyze patient data and predict results, including LOS in pediatric spinal deformity surgery.</p><p><strong>Methods: </strong>Children under 10 with EOS were chosen from the American College of Surgeon's NSQIP database. Extended LOS, defined as over 5 days, was predicted using feature selection and machine learning in Python. The best model, determined by the area under the curve (AUC), was optimized and used to create a risk calculator for prolonged LOS.</p><p><strong>Results: </strong>The study included 1587 patients, mostly young (average age: 6.94 ± 2.58 years), with 33.1% experiencing prolonged LOS (n = 526). Most patients were female (59.2%, n = 940), with an average BMI of 17.0 ± 8.7. Factors influencing LOS were operative time, age, BMI, ASA class, levels operated on, etiology, nutritional support, pulmonary and neurologic comorbidities. The gradient boosting model performed best with a test accuracy of 0.723, AUC of 0.630, and a Brier score of 0.189, leading to a patient-specific risk calculator for prolonged LOS.</p><p><strong>Conclusions: </strong>Machine learning algorithms accurately predict extended LOS across a national patient cohort and characterize key preoperative drivers of increased LOS after PSIF in pediatric patients with EOS.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864861","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
Preoperative rehabilitation optimization for spinal surgery: a narrative review of assessment, interventions, and feasibility. 脊柱手术的术前康复优化:对评估、干预措施和可行性的叙述性回顾。
IF 1.6 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-24 DOI: 10.1007/s43390-024-00893-0
Justin L Reyes, Josephine R Coury, Alexandra Dionne, Roy Miller, Prerana Katiyar, Abigail Smul, Prachi Bakarania, Joseph M Lombardi, Zeeshan M Sardar

Purpose: Postoperative physical therapy (PT) is a cornerstone of orthopedic and musculoskeletal rehabilitation, proven to provide various positive clinical benefits. However, there is a paucity of literature evaluating the utility of preoperative rehabilitation specific to spine surgery. Thus, this review article aims to provide an overview of previously published studies discussing the efficacy of preoperative rehabilitation programs and its role in spinal surgery. Special emphasis was given to preoperative frailty assessments, physical performance tests, interventional strategies, feasibility, and future directions.

Methods: We performed a literature review using PubMed, Google Scholar, EMBASE, and PubMed Central (PMC) using directed search terms. Articles that examined preoperative rehabilitation in adult spine surgery were compiled for this review. Prehabilitation programs focused on exercise, flexibility, and behavioral modifications have been shown to significantly improve pain levels and functional strength assessments in patients undergoing elective spine surgery. In addition, studies suggest that these programs may also decrease hospital stays, return to work time, and overall direct health care expenditure costs. Screening tools such as the FRAIL scale can be used to assess frailty while physical function tests like the timed-up-and go (TUGT), 5 repetition sit-to-stand test (5R-STST), and hand grip strength (HGS) can help identify patients who would most benefit from prehabilitation.

Conclusions: This review illustrates that prehabilitation programs have the potential to increase quality of life, improve physical function and activity levels, and decrease pain, hospital stays, return to work time, and overall direct costs. However, there is a paucity of literature in this field that requires further study and investigation.

目的:术后物理治疗(PT)是骨科和肌肉骨骼康复的基石,已被证实可提供各种积极的临床益处。然而,评估脊柱手术术前康复的文献却很少。因此,这篇综述文章旨在概述之前发表的关于术前康复计划的疗效及其在脊柱手术中的作用的研究。文章特别强调了术前虚弱评估、体能测试、干预策略、可行性和未来发展方向:我们利用 PubMed、Google Scholar、EMBASE 和 PubMed Central (PMC) 进行了文献综述,并使用了定向检索词。本综述汇编了研究成人脊柱手术术前康复的文章。研究表明,以运动、柔韧性和行为矫正为重点的术前康复计划可显著改善脊柱外科择期手术患者的疼痛程度和功能强度评估。此外,研究还表明,这些计划还可以缩短住院时间、重返工作岗位时间和整体直接医疗支出费用。FRAIL量表等筛查工具可用于评估虚弱程度,而定时起立行走(TUGT)、5次重复坐立测试(5R-STST)和手握力(HGS)等身体功能测试可帮助确定哪些患者最能从康复前训练中获益:本综述表明,康复训练计划有可能提高生活质量、改善身体功能和活动水平,并减少疼痛、住院时间、重返工作岗位时间和整体直接成本。然而,该领域的文献还很少,需要进一步研究和调查。
{"title":"Preoperative rehabilitation optimization for spinal surgery: a narrative review of assessment, interventions, and feasibility.","authors":"Justin L Reyes, Josephine R Coury, Alexandra Dionne, Roy Miller, Prerana Katiyar, Abigail Smul, Prachi Bakarania, Joseph M Lombardi, Zeeshan M Sardar","doi":"10.1007/s43390-024-00893-0","DOIUrl":"10.1007/s43390-024-00893-0","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative physical therapy (PT) is a cornerstone of orthopedic and musculoskeletal rehabilitation, proven to provide various positive clinical benefits. However, there is a paucity of literature evaluating the utility of preoperative rehabilitation specific to spine surgery. Thus, this review article aims to provide an overview of previously published studies discussing the efficacy of preoperative rehabilitation programs and its role in spinal surgery. Special emphasis was given to preoperative frailty assessments, physical performance tests, interventional strategies, feasibility, and future directions.</p><p><strong>Methods: </strong>We performed a literature review using PubMed, Google Scholar, EMBASE, and PubMed Central (PMC) using directed search terms. Articles that examined preoperative rehabilitation in adult spine surgery were compiled for this review. Prehabilitation programs focused on exercise, flexibility, and behavioral modifications have been shown to significantly improve pain levels and functional strength assessments in patients undergoing elective spine surgery. In addition, studies suggest that these programs may also decrease hospital stays, return to work time, and overall direct health care expenditure costs. Screening tools such as the FRAIL scale can be used to assess frailty while physical function tests like the timed-up-and go (TUGT), 5 repetition sit-to-stand test (5R-STST), and hand grip strength (HGS) can help identify patients who would most benefit from prehabilitation.</p><p><strong>Conclusions: </strong>This review illustrates that prehabilitation programs have the potential to increase quality of life, improve physical function and activity levels, and decrease pain, hospital stays, return to work time, and overall direct costs. However, there is a paucity of literature in this field that requires further study and investigation.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093353","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
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Spine deformity
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