Are We Underestimating the Significance of Pedicle Screw Misplacement?

Study Design: A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed.

Objective: To evaluate the accuracy of pedicle screw placement using a novel classification system to determine potentially significant screw misplacement.

Summary Of Background Data: The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature.

Complications associated with surgical repair of syndromic scoliosis.

Background: There are a number of syndromes that have historically been associated with scoliosis e.g.: Marfan, Down, and Neurofibromatosis.

Increased Risk of Infection in Obese Adolescents After Pedicle Screw Instrumentation for Idiopathic Scoliosis.

Study Design: Original research.

Objective: To evaluate perioperative risk factors associated with obesity in children undergoing posterior spinal fusion for adolescent idiopathic scoliosis. The authors hypothesized that patients with a high body mass index (BMI) percentile would be associated with increased morbidity as measured by various intraoperative parameters.

Prevalence, Distribution, and Surgical Relevance of Abnormal Pedicles in Spines with Adolescent Idiopathic Scoliosis vs. No Deformity: A CT-Based Study.

Background: A thorough understanding of pedicle morphology is necessary for pedicle screw placement. Previous studies classifying pedicle morphology, to our knowledge, have neither discussed the range of abnormal morphology nor correlated patient or curve characteristics with abnormal morphology to identify at-risk pedicles.

Methods: With the use of computed tomography (CT) images, we analyzed a total of 6116 pedicles from ninety-five patients without spinal deformity (forty-two females and fifty-three males) and ninety-one patients with adolescent idiopathic scoliosis (AIS) (sixty-eight females and twenty-three males).

Minimally Invasive Surgery in Patients With Adolescent Idiopathic Scoliosis: Is it Better than the Standard Approach? A 2-Year Follow-up Study.

Study Design: This is a retrospective controlled study.

Objective: To compare the safety and efficacy of minimally invasive surgery (MIS) for the surgical management of adolescent idiopathic scoliosis (AIS) to the standard open posterior approach (PSF).

Summary Of Background Data: MIS approaches offer the potential to reduce soft-tissue trauma, intraoperative blood loss, and surgical-site infection.

Pedicle screws adjacent to the great vessels or viscera: a study of 2132 pedicle screws in pediatric spine deformity.

Study Design: A retrospective study.

Objective: To determine the incidence of pedicle screws close to vital structures and to identify patient or curve characteristics that increase the risk of screw misplacement.

Summary And Background: Most pedicle screw misplacements are asymptomatic, thus they are frequently undetected.

Scoliosis surgery in patients with adolescent idiopathic scoliosis does not alter lung volume: a 3-dimensional computed tomography-based study.

Study Design: Retrospective study of surgically treated patients with adolescent idiopathic scoliosis.

Objective: To determine the change in lung volume after the surgical correction of scoliosis using a volumetric reconstruction of lung volume from computed tomographic (CT) scans.

Summary Of Background Data: Previously published studies have shown that pulmonary function tests improve after scoliosis correction; however, these results are not consistent.

Timing of surgical staging in adult spinal deformity surgery: is later better?

Hassanzadeh H, Gjolaj JP, El Dafrawy MH, et al. The timing of surgical staging has a significant impact on the complications and functional outcomes of adult spinal deformity surgery. Spine J 2013;13:1717-22 (in this issue).

Anterior release generates more thoracic rotation than posterior osteotomy: a biomechanical study of human cadaver spines.

Study Design: Biomechanical testing of human cadaveric spines.

Objective: To determine the effect of anterior and posterior anatomic structures on the rotational stability of the thoracic spine.

Summary Of Background Data: Historically, large and/or stiff spinal deformities were treated with anterior release to facilitate correction.

Comparative analysis of perioperative differences between hybrid versus pedicle screw instrumentation in adolescent idiopathic scoliosis.

Study Design: Retrospective review of patients with adolescent idiopathic scoliosis (AIS).

Objective: The objective of the study was to compare perioperative parameters and outcomes between pedicle screw and hybrid instrumentation for the treatment of AIS.

Summary Of Background Data: Pedicle screws have been shown to allow for better correction and fewer revisions than hybrid systems.

Pedicle subtraction osteotomy in the cervical spine.

Study Design: Description of surgical technique with review of literature.

Objective: To describe the surgical management of cervical spine deformity, using pedicle subtraction osteotomy.

Summary Of Background Data: Previous articles have primarily described Smith-Petersen osteotomies and Simmons' modifications to correct fixed cervical deformity.

Pediatric spinal deformity: what every orthopaedic surgeon needs to know.

Pediatric spinal deformity is an integral part of orthopaedic surgical practice. In a general or specialized practice, the well-versed orthopaedic surgeon should be aware of the diagnostic methods and the natural history from which practice standards are derived. It is important to be aware of the spectrum of spinal deformity in children (from early-onset scoliosis to adolescent idiopathic scoliosis, kyphosis, and spondylolisthesis) and current principles of growth and maturation as applied to the spine and the thorax.

Patient evaluation and clinical assessment of adult spinal deformity.

The clinical evaluation of adults with spinal deformity can be challenging for both general orthopaedic surgeons and spinal specialists. To properly treat these patients, the physician must be aware of the various types of adult spinal deformity and the basic principles of spinal misalignment. A complete patient assessment must include a thorough history and physical examination.

Minimally invasive scoliosis surgery: an innovative technique in patients with adolescent idiopathic scoliosis.

Minimally invasive spine surgery is becoming more common in the treatment of adult lumbar degenerative disorders. Minimally invasive techniques have been utilized for multilevel pathology, including adult lumbar degenerative scoliosis. The next logical step is to apply minimally invasive surgical techniques to the treatment of adolescent idiopathic scoliosis (AIS).

Nerve injury during the transpsoas approach for lumbar fusion.

A lateral transpsoas approach to achieve interbody fusion in the lumbar spine using either the extreme lateral interbody fusion or direct lateral interbody fusion technique is an increasingly popular method to treat spinal disease. Dissection and dilation through the iliopsoas muscle places the lumbosacral plexus at risk for injury, but there is very limited information in the published literature about adverse clinical events resulting in postoperative motor deficits or reports of failure of electrophysiological monitoring to detect nerve injury. The authors present 2 cases of postoperative motor deficits following the transpsoas approach not detected by intraoperative monitoring, review the medical literature, and discuss strategies for complication avoidance.