Adolescent Idiopathic Scoliosis Treated by Posterior Spinal Segmental Instrumented Fusion : When Is Fusion to L3 Stable?

Objective: The purpose of this study was to identify risk factors for distal adding on (AO) or distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS) treated by posterior spinal fusion (PSF) to L3 with a minimum 2-year follow-up.

Methods: AIS patients undergoing PSF to L3 by two senior surgeons from 2000-2010 were analyzed. Distal AO and DJK were deemed poor radiographic results and defined as >3 cm of deviation from L3 to the center sacral vertical line (CSVL), or >10° angle at L3-4 on the posterior anterior- or lateral X-ray at ultimate follow-up.

The Incidence of Adding-On or Distal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Treated by Anterior Spinal Fusion to L3 Was Significantly Higher Than by Posterior Spinal Fusion to L3.

Objective: To compare and identify risk factors for distal adding-on (AO) or distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS) treated by anterior- (ASF) and posterior spinal fusion (PSF) to L3.

Methods: AIS patients undergoing ASF versus PSF to L3 from 2000-2010 were analyzed. Distal AO and DJK were deemed poor radiographic results.

Selecting the "Touched Vertebra" as the Lowest Instrumented Vertebra in Patients with Lenke Type-1 and 2 Curves: Radiographic Results After a Minimum 5-Year Follow-up.

Background: The selection of the lowest instrumented vertebra (LIV) in patients with adolescent idiopathic scoliosis (AIS) is still controversial. Although multiple radiographic methods have been proposed, there is no universally accepted guideline for appropriate selection of the LIV. We developed a simple and reproducible method for selection of the LIV in patients with Lenke type-1 (main thoracic) and 2 (double thoracic) curves and investigated its effectiveness in producing optimal positioning of the LIV at 5 years of follow-up.

Minimum five-year follow-up of posterior-only pedicle screw constructs for thoracic and thoracolumbar kyphosis.

Study Design: Retrospective cohort study.

Objective: To review/report 5-year follow-up data on patients diagnosed with thoracic and thoracolumbar kyphosis (TK/TLK) treated with posterior-only spinal fusion. TK/TLK was initially treated with combined anterior/posterior spinal fusion, evolving into widespread treatment with posterior-only spinal fusion.

Comparison of Single-Level Versus Multilevel Vertebral Column Resection Surgery for Pediatric Patients With Severe Spinal Deformities.

Study Design: Retrospective cohort of pediatric patients (younger than 21 years) with severe spinal deformities who underwent vertebral column resection (VCR) surgery.

Objective: To compare patients who underwent single- versus multilevel VCR surgery in terms of radiographic correction and perioperative complications.

Summary Of Background Data: There are few studies comparing single- to multilevel VCR surgery regarding the efficacy and safety of the procedures.

Key Role of Preoperative Recumbent Films in the Treatment of Severe Sagittal Malalignment.

Study Design: Retrospective cohort study.

Objective: To determine if severe sagittal malalignment (SM) patients without fixed deformities require a three-column osteotomy (3CO) to achieve favorable clinical and radiographic outcomes.

Summary Of Background Data: 3CO performed for severe SM has significantly increased in the last 15 years.

Clinical and Radiographic Outcomes After Posterior Vertebral Column Resection for Severe Spinal Deformity with Five-Year Follow-up.

Background: Short-term studies have shown improved outcomes and alignment after posterior vertebral column resection for severe spinal deformity. Our goal was to report long-term changes in radiographic and health-related quality-of-life measures in a consecutive series of pediatric and adult patients undergoing posterior vertebral column resection with a minimum follow-up of 5 years.

Methods: We reviewed all patients undergoing posterior vertebral column resection by a single surgeon prior to January 1, 2010, at a single institution.

Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database.

OBJECTIVE Postoperative complications are one of the most significant concerns in surgeries of the spine, especially in higher-risk cases such as neuromuscular scoliosis. Neuromuscular scoliosis is a classification of multiple diseases affecting the neuromotor system or musculature of patients leading to severe degrees of spinal deformation, disability, and comorbidity, all likely contributing to higher rates of postoperative complications. The objective of this study was to evaluate deformity correction of patients with neuromuscular scoliosis over a 12-year period (2004-2015) by looking at changes in postsurgical complications and management.

Results of the Scoliosis Research Society Morbidity and Mortality Database 2009-2012: A Report From the Morbidity and Mortality Committee.

Introduction: Members of the Scoliosis Research Society are required to annually submit complication data regarding deaths, visual acuity loss, neurological deficit and infection (2012-1st year for this measure) for all deformity operations performed. The purpose of this study is to report the 2012 results and the differences in these complications from the years 2009-2012.

Methods: The SRS M&M database is a self-reported complications registry of deformity operations performed by the members.

The cranial sagittal vertical axis (CrSVA) is a better radiographic measure to predict clinical outcomes in adult spinal deformity surgery than the C7 SVA: a monocentric study.

Purpose: Our study aimed to confirm the correlation between the Cranial Sagittal Vertical Axis (CrSVA) and patient-reported outcomes and to compare clinical correlation between CrSVA and C7 SVA in adult spinal deformity (ASD) patients.

Methods: 108 consecutive ASD patients were evaluated using the EOS 2D/3D radio-imaging device. A vertical plumb line from the cranial center was utilized to measure the distance to the posterior corner of S1 (CrSVA-S), and to the centers of the hip (CrSVA-H), the knee (CrSVA-K), and ankle (CrSVA-A), as well as measuring the standard C7 SVA.

Results of Revision Surgery for Proximal Junctional Kyphosis Following Posterior Segmental Instrumentation: Minimum 2-Year Postrevision Follow-Up.

Study Design: A retrospective cohort study.

Objectives: The aim of this study was to evaluate radiographic and patient-reported outcomes at minimum 2 years after revision surgery for proximal junctional kyphosis (PJK), correlating these results with PJK etiology.

Summary Of Background Data: There are no studies detailing the results of revision surgery for PJK following posterior segmental instrumentation.

Deformity Angular Ratio Describes the Severity of Spinal Deformity and Predicts the Risk of Neurologic Deficit in Posterior Vertebral Column Resection Surgery.

Study Design: Retrospective review of prospectively collected data.

Objective: To assess the value of the deformity angular ratio (DAR, maximum Cobb measurement divided by number of vertebrae involved) in evaluating the severity of spinal deformity, and predicting the risk of neurologic deficit in posterior vertebral column resection (PVCR).

Summary Of Background Data: Although the literature has demonstrated that PVCR in spinal deformity patients has achieved excellent outcomes, it is still high risk neurologically.

Long-term radiographic outcomes of a central hook-rod construct for osteotomy closure: minimum 5-year follow-up.

Study Design: Retrospective study.

Objective: To evaluate long-term effectiveness of central hook-rod constructs for posterior spinal osteotomy closure.

Summary Of Background Data: During osteotomy site closure various techniques are used, including patient positioning, rod cantilevering, extending fixation points, and compressing through pedicle fixation points.

Predicting Kyphosis Correction During Posterior-Only Vertebral Column Resection by the Amount of Spinal Column Shortening.

Study Design: Retrospective.

Objective: To investigate the relationship between the amount of correction achieved (K°) and extent of vertebral column shortening (mm) with posterior vertebral column resection (PVCR).

Summary Of Background Data: There is no scientific reference to the correlation between K° and column shortening (mm) with PVCR.

Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies.

Study Design: Retrospective matched-cohort comparative study.

Objective: Compare radiographical outcomes after the use of a standard 2-rod construct (2-RC) versus a multiple-rod construct (multi-RC) across 3-column osteotomy sites in a matched cohort with severe kyphosis and/or scoliosis with minimum 2-year follow-up.

Summary Of Background Data: Three-column osteotomies are used for treating severe spinal deformities, typically with a standard 2-RC across the highly unstable osteotomy site.

Results of revision surgery after pedicle subtraction osteotomy for fixed sagittal imbalance with pseudarthrosis at the prior osteotomy site or elsewhere: minimum 5 years post-revision.

Study Design: Retrospective review of pedicle subtraction osteotomy (PSO) cases.

Objective: To report our results, radiographic and clinical outcomes at a minimum 5 years following revision surgery for pseudarthrosis after a PSO.

Summary Of Background Data: To our knowledge, there is no report on the results of revision surgery for pseudarthrosis after a PSO.

Rapidly progressive Scheuermann's disease in an adolescent after pectus bar placement treated with posterior vertebral-column resection: case report and review of the literature.

Study Design: Case report and review of the literature.

Objective: This case illustrates the importance of the costosternal complex in maintaining the stability and alignment of the thoracic spine. The patient was iatrogenically destabilized by placement of a pectus bar leading to rapid symptomatic progression of his Scheuermann's kyphosis, ultimately requiring surgical correction.

Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis.

Study Design: Retrospective multicenter review.

Objective: Determine the definition, indications, results, and outcomes, focusing on complications of vertebral column resection (VCR) for severe pediatric spinal deformity.

Summary Of Background Data: The strict definition of the VCR procedure, indications, results, outcomes, and the numerous, potentially serious complications are unknown or controversial, and a large multicenter review has never been performed.

Reliability and accuracy analysis of a new semiautomatic radiographic measurement software in adult scoliosis.

Study Design: Radiographic software measurement analysis in adult scoliosis.

Objective: To assess the accuracy as well as the intra- and interobserver reliability of measuring different indices on preoperative adult scoliosis radiographs using a novel measurement software that includes a calibration procedure and semiautomatic features to facilitate the measurement process.

Summary Of Background Data: Scoliosis requires a careful radiographic evaluation to assess the deformity.

Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients.

Study Design: Retrospective review of a prospectively accrued patient cohort.

Objective: The ability to treat severe pediatric spinal deformity through an all-posterior vertebral column resection (VCR) has obviated the need for a circumferential approach in both primary and revision settings. We examined indications, correction rates, and complications of this challenging procedure in the pediatric population.

Vertebral column resection for the treatment of severe spinal deformity.

Unlabelled: The ability to treat severe pediatric and adult spinal deformities through an all-posterior vertebral column resection (VCR) has obviated the need for a circumferential approach in primary and revision surgery, but there is limited literature evaluating this new approach. Our purpose was therefore to provide further support of this technique. We reviewed 43 patients who underwent a posterior-only VCR using pedicle screws, anteriorly positioned cages, and intraoperative spinal cord monitoring between 2002 and 2006.

The morbidity of an anterior thoracolumbar approach: adult spinal deformity patients with greater than five-year follow-up.

Study Design: Retrospective study.

Objective: To analyze the complications and patient satisfaction related to an anterior thoracolumbar approach in the treatment of adult spinal deformity.

Summary Of Background Data: There is no long-term follow-up data on the effects of an anterior thoracolumbar approach on adult spinal deformity patients.

Comparison of Scheuermann kyphosis correction by posterior-only thoracic pedicle screw fixation versus combined anterior/posterior fusion.

Study Design: Retrospective comparison review.

Objective: Compare posterior-only treatment results with segmental thoracic pedicle screw constructs versus combined anterior/posterior fusion in patients with Scheuermann kyphosis.

Summary Of Background Data: Traditionally, operative Scheuermann kyphosis has been treated with combined anterior/posterior spinal fusion, with the anterior portion being performed via an open thoracotomy or a video-assisted thoracoscopic approach.

Perioperative changes in pulmonary function after anterior scoliosis instrumentation: thoracoscopic versus open approaches.

Study Design: A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis undergoing surgical correction.

Objective: To determine if a minimally invasive thoracoscopic approach had less postoperative pulmonary function impairment compared to open anterior instrumentation for idiopathic scoliosis.

Summary Of Background Data: Prior studies suggest that open anterior scoliosis surgery causes an initial decrease in pulmonary function that resolves by 2 years after surgery.

Analysis of the lowest instrumented vertebra following anterior spinal fusion of thoracolumbar/lumbar adolescent idiopathic scoliosis: can we predict postoperative disc wedging?

Study Design: A retrospective radiographic study.

Objectives: To investigate which radiographic parameters correlate best to ultimate lowest instrumented vertebra (LIV) position and subjacent disc wedging following anterior spinal fusion (ASF) for thoracolumbar/lumbar (TL/L) adolescent idiopathic scoliosis (AIS).

Summary Of Background Data: In an ASF of TL/L AIS, part of the operative goals are often to horizontalize and centralize the LIV, or potentially minimize subjacent disc wedging after surgery.