Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique.

Background: Fixed sagittal imbalance (a syndrome in which the patient is only able to stand with the weight-bearing line in front of the sacrum) has many etiologies. The most commonly reported technique for correction is the Smith-Petersen osteotomy. Few reports on pedicle subtraction procedures (resection of the posterior elements, pedicles, and vertebral body through a posterior approach) are available in the peer-reviewed literature.

Free hand pedicle screw placement in the thoracic spine: is it safe?

Study Design: A retrospective study.

Objective: To evaluate the safety of a free hand technique of pedicle screw placement in the thoracic spine at a single institution over a 10-year experience.

Summary Of Background Data: Thoracic pedicle screw fixation techniques are still controversial for thoracic deformities because of possible complications including neurologic.

Late complications of adult idiopathic scoliosis primary fusions to L4 and above: the effect of age and distal fusion level.

Unlabelled: STUDY DESIGN A retrospective analysis of primary cases of adult idiopathic scoliosis treated with long instrumented fusions from the thoracic spine proximally to segments that range from T11 to L4 distally.

Objective: To analyze whether patients requiring revision surgery had lower postoperative SRS-24 scores; age >or=40 years correlated with higher rates of revision surgery; disc degeneration below the fusion occurred more commonly with a more distal lowest instrumented vertebra or older patient age (>or=40 years); and whether smokers had higher rates of major complications or revision surgery.

Summary Of Background Data: Few reports describe complications related to primary long fusions using modern 2+ rods, hook/pedicle screw instrumentation methods in the treatment of adult idiopathic scoliosis.

Comparison of SRS questionnaire results submitted by both parents and patients in the operative treatment of idiopathic scoliosis.

Study Design: A prospective, cross-sectional analysis of patients with operative idiopathic scoliosis comparing Scoliosis Research Society's Outcomes Instrument (SRS-24) scores from both parents and patients obtained separately on the same day along with pertinent radiographic data.

Objective: To determine the correlation of parents' and patients' perspectives of the patients' preoperative and postoperative experience using the SRS-24 questionnaire emphasizing parent-patient disparities.

Summary Of Background Data: No report to our knowledge has addressed the association between parent assessments of their child's presurgical and postsurgical outcome as verified by SRS-24 questionnaire data.

Can we predict the ultimate lumbar curve in adolescent idiopathic scoliosis patients undergoing a selective fusion with undercorrection of the thoracic curve?

Study Design: Retrospective review of anterior and posterior fusions for treatment of adolescent idiopathic thoracic scoliosis.

Objectives: To delineate the best factors determining final lumbar curve magnitude in patients with adolescent idiopathic scoliosis undergoing a selective thoracic anterior or posterior spinal fusion at or proximal to the first lumbar vertebra.

Summary Of Background Data: Although spontaneous lumbar curve correction occurs consistently following a selective thoracic anterior or posterior spinal fusion, the degree of correction is somewhat unpredictable.

Aprotinin reduces blood loss during spinal surgery in children.

Study Design: A prospective blinded, randomized controlled study compared the effect of a perioperative infusion of aprotinin versus placebo during long segment spinal fusions in children.

Objectives: To determine whether aprotinin decreases blood loss and transfusion requirements in pediatric patients with spinal deformities undergoing posterior spinal fusions of seven or greater segments.

Summary Of Background Data: Blood loss is a major cause of morbidity during long segment spinal fusion.

The pros and cons to saving the L5-S1 motion segment in a long scoliosis fusion construct.

Study Design: This is a review of the literature and personal experience as it pertains to whether a long fusion should be stopped at L5 or S1 in a patient with adult lumbar scoliosis and degenerative changes.

Objectives: To summarize the problems with decision-making and to point out the strengths and limitations of past studies.

Summary Of Background Data: There is a paucity of data on this subject.

The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine.

Study Design: Retrospective radiographic review.

Objectives: To analyze how the Lenke classification of adolescent idiopathic scoliosis provides a template of specific curve patterns that may be appropriate to perform selective fusion of the spine.

Methods: A new triad classification system of adolescent idiopathic scoliosis has been developed.

Thoracolumbar deformity arthrodesis to L5 in adults: the fate of the L5-S1 disc.

Study Design: A retrospective clinical and radiographic analysis of long adult deformity fusions terminating at L5.

Objectives: To define the results of thoracolumbar fusions to L5 in adult deformity patients with critical evaluation for potential subsequent L5-S1 disc degeneration and L5 implant loosening.

Summary Of Background Data: Few studies have reported the results of long adult fusions to L5 and the potential for subsequent advanced L5-S1 disc degeneration is unknown.

Staged posterior surgery for severe adult spinal deformity.

Study Design: Retrospective analysis with prospective outcomes.

Objective: To analyze the strategy of dividing one prolonged, complex, posterior surgery into two smaller posterior procedures staged during one hospitalization.

Summary Of Background Data: When operating on complex revision adult deformity, the posterior surgery alone can be unduly prolonged, placing patients at risk for hemodynamic complications associated with protracted same-day surgery.

Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance.

Study Design: Radiographic analysis, outcomes analysis (pain scale, Oswestry, SRS-24), and accumulation of complications. Outcomes and complications collected prospectively. Radiographic analysis performed retrospectively.

Prospective comparison of gait and trunk range of motion in adolescents with idiopathic thoracic scoliosis undergoing anterior or posterior spinal fusion.

Study Design: Prospective evaluation of gait and spinal range of motion (ROM) in adolescent idiopathic scoliosis (AIS) patients undergoing either an anterior or a posterior spinal fusion.

Objective: Compare changes in gait and spine ROM between AIS patients undergoing either an anterior or posterior spinal fusion.

Summary And Background Data: Problems with AIS posterior spinal fusion and attempts to minimize the number of spinal segments fused have led to the promotion of anterior spinal fusion.

Gait changes as the result of deformity reconstruction surgery in a group of adults with lumbar scoliosis.

Study Design: This was a prospective analysis of adult spinal deformity patients having fusions from the thoracic spine down to L5 or the sacrum. Gait analysis was performed before surgery and 1 and 2 years postoperatively, as was questionnaire analysis.

Objectives: To compare the preoperative and postoperative gait of revision and primary patients having long fusions to the distal lumbar spine or sacrum with that of a group of able-bodied adults.

Evaluation and surgical treatment of high-grade isthmic dysplastic spondylolisthesis.

In children and young adults who seek medical treatment for high-grade isthmic dysplastic spondylolisthesis, common clinical symptoms are referable to the lumbosacral spine and/or the lower extremities. Pain in the lumbosacral spine may be secondary to altered lumbosacral alignment and biomechanics. It also may be caused by malalignment of the entire spinal-pelvic axis as a result of anterior sagittal imbalance.

Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance.

Background: Fixed sagittal imbalance (a syndrome in which the patient is only able to stand with the weight-bearing line in front of the sacrum) has many etiologies. The most commonly reported technique for correction is the Smith-Petersen osteotomy. Few reports on pedicle subtraction procedures (resection of the posterior elements, pedicles, and vertebral body through a posterior approach) are available in the peer-reviewed literature.

Correction of thoracic adolescent idiopathic scoliosis with segmental hooks, rods, and Wisconsin wires posteriorly: it's bad and obsolete, correct?

Study Design: Forty-four consecutive thoracic idiopathic adolescent curves surgically treated between 1995 and 1999 at one institution were analyzed. All were thoracic curves; there were no lumbar curves, double major curves, or triple major curves.

Objectives: To study the clinical and radiographic results for these 44 patients.

Evaluation of ventilatory efficiency during exercise in patients with idiopathic scoliosis undergoing spinal fusion.

Study Design: A prospective evaluation of ventilatory function following spinal fusion in adolescent idiopathic scoliosis.

Objectives: To prospectively evaluate pulmonary function, maximal oxygen uptake, and ventilatory efficiency during exercise in patients with adolescent idiopathic scoliosis before surgery and a minimum of 2 years postoperation.

Summary Of Background Data: For reasons that are unclear, patients with untreated adolescent idiopathic scoliosis tend to avoid aerobic exercise.

Can triggered electromyograph thresholds predict safe thoracic pedicle screw placement?

Study Design: A prospective clinical study of thoracic pedicle screws monitored with triggered electromyographic testing.

Objective: To evaluate the sensitivity of recording rectus abdominis triggered electromyographs to assess thoracic screw placement.

Summary Of Background Data: Triggered electromyographic testing from lower extremity myotomes has identified medially placed lumbar pedicle screws.

Correlation of pelvic incidence with low- and high-grade isthmic spondylolisthesis.

Purpose: The development of isthmic spondylolisthesis is influenced by forces across the lumbosacral region of the spine. Pelvic incidence is a radiographic parameter that has been shown to be an independent parameter that influences both sagittal spinal balance and pelvic orientation. Our hypothesis then is that there is a positive correlation between pelvic incidence and spondylolisthesis.

Correlation of radiographic, clinical, and patient assessment of shoulder balance following fusion versus nonfusion of the proximal thoracic curve in adolescent idiopathic scoliosis.

Study Design: Retrospective clinical, radiographic, and patient outcome review of surgically treated adolescent idiopathic scoliosis.

Objectives: To correlate radiographic and clinical features of shoulder balance and the proximal thoracic curve with patient satisfaction outcomes at a minimum 2-year follow-up.

Summary Of Background Data: Traditionally, radiographic features of a structural proximal thoracic curve have been T1 tilt, proximal thoracic Cobb angle, and proximal thoracic side-bending Cobb; however, these do not always correlate with clinical shoulder balance.

Dowel fibular strut grafts for high-grade dysplastic isthmic spondylolisthesis.

Study Design: This is a clinical study that examines the results of partial reduction and fibular dowel graft placement for high-grade isthmic spondylolisthesis.

Objectives: To demonstrate the efficacy of partial reduction and fibular dowel graft placement in the treatment of high-grade isthmic spondylolisthesis.

Summary Of Background Data: Previous literature has demonstrated difficulty in treating high-grade isthmic spondylolisthesis both with high rates of pseudarthrosis as well as neurologic complications if a complete reduction is attempted.