Can titanium surface technology reduce cost for biologics in anterior lumbar interbody fusion?

Objective: Advances in surface architecture and technology have made interbody fusion devices more bioactive, with the hope of facilitating the fusion process more successfully. The advent of these increasingly bioactive implants may reduce reliance on more expensive biologics that have previously been used to achieve high fusion rates.

Methods: A retrospective review of prospectively collected data (August 2018-December 2019) was conducted of consecutively performed anterior lumbar interbody fusions in which an acid-etched, nanosurface-modulated, titanium interbody device packed only with corticocancellous allograft chips and local blood was used.

Radiographic outcomes and complications of anterior column realignment (ACR): a systematic review.

Background: Anterior Column Realignment (ACR) was introduced to serve as a powerful segmental kyphosis correction technique in minimally invasive Adult Spinal Deformity (ASD) surgery. Releasing the Anterior Longitudinal Ligament (ALL) and annulus allows opening of the disc space to accommodate hyperlordotic cages. The overall safety and efficacy of ACR has been difficult to determine due to the heterogenicity of surgical techniques, complications reporting, and a paucity of published studies leading to preliminary and controversial conclusions.

Proximal foundation anchor variations and their correlation with unplanned return to the operating room (UPROR) in children with EOS treated with magnetically controlled growing rods (MCGR).

Introduction: The evolution of MCGR technique has led to modifications in the configuration of the proximal construct to decrease the incidence of implant-related complications (IRC) and revision surgeries. However, there is no data characterizing the performance of the most used configurations reducing the risk of complications.

Methods: 487 patients were identified from an international multicenter EOS database.

Incidence of postoperative neurological deficit with the use of an intraoperative neuromonitoring protocol for lateral lumbar interbody fusion.

Objective: Intraoperative neuromonitoring (IONM) has become commonplace in assessing neurological integrity during lateral approaches to lumbar interbody fusion surgeries. Neuromonitoring is designed to aid surgeons in identifying the potential for intraoperative nerve injury and reducing associated postoperative complications. However, standardized protocols for neuromonitoring have not been provided, and outcomes are not well described.

Establishing a Standardized Clinical Consensus for Reporting Complications Following Lateral Lumbar Interbody Fusion.

Mitigating post-operative complications is a key metric of success following interbody fusion. LLIF is associated with a unique complication profile when compared to other approaches, and while numerous studies have attempted to report the incidence of post-operative complications, there is currently no consensus regarding their definitions or reporting structure. The aim of this study was to standardize the classification of complications specific to lateral lumbar interbody fusion (LLIF).

Outcomes of Growth-friendly Instrumentation in Osteogenesis Imperfecta: A Preliminary Report.

Background: There is limited literature on the outcomes in patients with osteogenesis imperfecta (OI) undergoing growth-friendly instrumentation (GFI). The purpose of this study was to report the outcomes of GFI in patients with early-onset scoliosis (EOS) and OI. We hypothesized that similar trunk elongation could be obtained in OI patients, but with higher complication rates.

Definition of Tweener: Consensus Among Experts in Treating Early-onset Scoliosis.

Background: The term "Tweener" is colloquially used to refer to early-onset scoliosis (EOS) patients whose age and development make them candidates for multiple surgical options. The purpose of this study was to establish expert consensus on a definition to formally characterize the Tweener population.

Methods: A 3-round survey of surgeons in an international EOS study group was conducted.

Can a bioactive interbody device reduce the cost burden of achieving lateral lumbar fusion?

Objective: Intervertebral devices are increasingly utilized for fusion in the lumbar spine, along with a variety of bone graft materials. These various grafting materials often have substantial cost burdens for the surgical procedure, although they are necessary to overcome the limitations in healing capacity for many traditional interbody devices. The use of bioactive interbody fusion devices, which have demonstrable stimulatory capacity for the surrounding osteoblasts and osteoprogenitor cells and allow for osseointegration, may reduce this heavy reliance on osteobiologics for achieving interbody fusion.

Surgical treatment of young adults with idiopathic scoliosis.

Objective: In this study, the authors report on their experience with the surgical treatment of young adults with idiopathic scoliosis (YAdISs) who did not have surgical treatment in adolescence but did require intervention after skeletal maturity.

Methods: The medical records of YAdISs between 18 and 40 years of age who had been surgically treated at two institutions between 2009 and 2018 were retrospectively evaluated. Pre- and postoperative clinical and radiographic information was gathered and compared at 2 years after treatment.

Re-evaluating consensus and uncertainty among treatment options for early onset scoliosis: a 10-year update.

Purpose: Consensus and uncertainty in early onset scoliosis (EOS) treatment were evaluated in 2010. It is currently unknown how treatment preferences have evolved over the past decade. The purpose of this study was to re-evaluate consensus and uncertainty among treatment options for EOS patients to understand how they compare to 10 years ago.

Contraindications to magnetically controlled growing rods: consensus among experts in treating early onset scoliosis.

Purpose: The purpose of this study was to describe contraindications to the magnetically controlled growing rod (MCGR) in patients with early onset scoliosis (EOS) by establishing consensus amongst expert surgeons who treat these patients frequently.

Methods: Nine pediatric spine surgeons from an international EOS study group participated in semi-structured interviews via email to identify factors that influence decision making in the use of MCGR. A 39-question survey was then developed to specify these factors as contraindications for MCGR-these included patient age and size, etiology, medical comorbidities, coronal and sagittal curve profiles, and skin and soft tissue characteristics.

Ilizarov kyphectomy technique in the management of the gibbus deformity with an open wound in meningomyelocele patients: a case report with five years of follow-up.

Purpose: To propose an alternative method of surgical technique to address gibbus deformity in meningomyelocele with open wound simultaneously.

Methods: We report a rare case of an 8-year-old girl with a refractory skin breakdown on her gibbus deformity, which underwent an Ilizarov kyphectomy technique to address her skin breakdown, and spinal deformity at the same time, while planning a definitive fusion in the future.

Results: The patient was followed up for about 5 years.

Treatment of Early-onset Scoliosis: Similar Outcomes Despite Different Etiologic Subtypes in Traditional Growing Rod Graduates.

Background: It is unclear whether traditional growing rod (TGR) treatment outcomes vary by early-onset scoliosis (EOS) subtype. The goal of this study was to compare radiographic outcomes and complications of TGR treatment by EOS subtype.

Methods: We queried an international database of EOS patients from 20 centers to identify "graduates" who had (1) undergone primary TGR treatment from 1993 to 2014; (2) completed TGR treatment; and (3) had an uneventful clinical examination within 6 months after completion of TGR treatment with no anticipated further intervention.

The role of traditional growing rods in the era of magnetically controlled growing rods for the treatment of early-onset scoliosis.

Purpose: To describe the clinical and radiographic profile of early-onset scoliosis (EOS) patients treated with traditional growing rods (TGR) during the magnetically-controlled growing rod (MCGR) era.

Methods: A US multicenter EOS database was reviewed to identify (1) patients who underwent TGR after MCGR surgery was introduced at their institution, (2) patients who underwent MCGR during the same time period. Of 19 centers, 8 met criteria with all EOS etiologies represented.

An initial effort to define an early onset scoliosis "graduate"-The Pediatric Spine Study Group experience.

Purpose: Increasingly, patients with early onset scoliosis (EOS) are completing a growth friendly surgical program followed by observation, removal of implants or a definitive spinal fusion. These patients are colloquially referred to as "graduates". A standardized definition of a graduate is needed for research and comparing the outcomes, family counseling, and a better understanding of the population.

Effect of race, age, and gender on lumbar muscle volume and fat infiltration in the degenerative spine.

Background: The quantity and quality of spinal muscles in patients with degenerative spinal diseases and various backgrounds such as age, gender, or race is unclear. We quantitatively evaluated the cross-sectional area (CSA) and fatty degeneration of the muscles around the spine, using magnetic resonance imaging (MRI) in patients with degenerative spinal disease, and studied the effects of age, gender, and race in multicenter retrospective study.

Methods: The subjects were Caucasian and Asian patients with degenerative lumbar disease who underwent L4-5 single level spinal fusion surgery at centers in the United States and Japan.

Complications in the treatment of EOS: Is there a difference between rib vs. spine-based proximal anchors?

Introduction: Currently, there is significant equipoise regarding the selection and placement of growing spinal instrumentation when treating patients with early-onset scoliosis (EOS). The primary purpose of this study was to compare complications following surgery in patients receiving rib-based versus spine-based proximal anchors as a part of posterior growing instrumentation in the management of EOS.

Methods: Retrospective cohort study.

Comparing health-related quality of life and burden of care between early-onset scoliosis patients treated with magnetically controlled growing rods and traditional growing rods: a multicenter study.

Study Design: Multicenter retrospective cohort study.

Objectives: To compare pre-operative and post-operative EOSQ-24 scores in magnetically controlled growing rods (MCGR) and traditional growing rod (TGR) patients. Since the introduction of MCGR, early-onset scoliosis patients have been afforded a reduction in the number of surgeries compared to the TGR technique.

Minimum 5-Year Follow-up on Graduates of Growing Spine Surgery for Early Onset Scoliosis.

Introduction: After discontinuation of growth friendly (GF) surgery for early onset scoliosis, patients undergo spinal fusion or continued observation. This last planned treatment is colloquially called "definitive" treatment, conferring these patients as "graduates" of a growing program. The 5-year radiographic and clinical outcomes of this cohort are unknown.