Timing of intraoperative neurophysiological monitoring (IONM) recovery and clinical recovery after termination of pediatric spinal deformity surgery due to loss of IONM signals.

Background Context: Intraoperative neurophysiological monitoring (IONM) is used to reduce the risk of spinal cord injury during pediatric spinal deformity surgery. Significant reduction and/or loss of IONM signals without immediate recovery may lead the surgeon to acutely abort the case. The timing of when monitorable signals return remains largely unknown.

The Effect of Implant Density on Adolescent Idiopathic Scoliosis Fusion: Results of the Minimize Implants Maximize Outcomes Randomized Clinical Trial.

Background: Severe adolescent idiopathic scoliosis (AIS) can be treated with instrumented fusion, but the number of anchors needed for optimal correction is controversial.

Methods: We conducted a multicenter, randomized study that included patients undergoing spinal fusion for single thoracic curves between 45° and 65°, the most common form of operatively treated AIS. Of the 211 patients randomized, 108 were assigned to a high-density screw pattern and 103, to a low-density screw pattern.

Intraoperative neuromonitoring predicts postoperative deficits in severe pediatric spinal deformity patients.

Purpose: To evaluate intraoperative monitoring (IOM) alerts and neurologic deficits during severe pediatric spinal deformity surgery.

Methods: Patients with a minimum Cobb angle of 100° in any plane or a scheduled vertebral column resection (VCR) with minimum 2-year follow-up were prospectively evaluated (n = 243). Preoperative, immediate postoperative, and 2-year postoperative neurologic status were reported.

Perioperative Complications and Health-related Quality of Life Outcomes in Severe Pediatric Spinal Deformity.

Study Design: Prospective multicenter cohort study.

Objective: To evaluate perioperative complications and mid-term outcomes for severe pediatric spinal deformity.

Summary Of Background Data: Few studies have evaluated the impact of complications on health-related quality of life (HRQoL) outcomes in severe pediatric spinal deformity.

Medical complications and health-related quality of life in complex pediatric spine deformities exceeding 100 degrees or treated by 3CO.

Study Design: Retrospective review of prospectively collected data.

Objective: To determine the incidence of medical complications in the pediatric population aged 10-20 years with baseline deformities exceeding 100 degrees or who had 3CO at surgery. Severe pediatric spine deformity poses a great challenge to the treating physician and carries a high complication rate.

Ten-year follow-up of Lenke 5 curves treated with spinal fusion.

Introduction: Patients with surgically treated Lenke 5 curves require at least partial fusion of the lumbar spine. The implications of lumbar fusion remain unknown as long-term follow-up is sparse.

Methods: A retrospective review of a prospectively collected registry of patients with Lenke 5 curves treated with spinal fusion was performed.

Baclofen Pump Use: Complications After Growth-friendly Instrumentation for Early-onset Scoliosis.

Background: Patients with early-onset scoliosis (EOS) and spasticity may receive treatment with an intrathecal baclofen pump. We assessed how baclofen pumps are associated with the odds of complications and secondary interventions after growth-friendly (GF) spine surgery for EOS and analyzed infectious complications within the pump cohort.

Methods: Using a prospectively maintained, international multicenter database, we studied patients with neuromuscular EOS with baclofen pumps who underwent GF spine surgery from 2002 through 2019 (n=25).

Modified Clavien-Dindo-sink classification system for adolescent idiopathic scoliosis.

Purpose: The Clavien-Dindosink (CDS) classification system provides more treatment-focused granularity than subjective methods of describing surgical complications; however, it has not been validated in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The purpose of this study was to modify the CDS system for application in patients with AIS undergoing PSF to assess its inter- and intra-rater reliability for describing complications faced by this population.

Methods: A review of all complications specific to patients with AIS captured in a large multicenter international database was performed.

New neurologic deficit and recovery rates in the treatment of complex pediatric spine deformities exceeding 100 degrees or treated by vertebral column resection (VCR).

Study Design: Prospective multicenter international observational study.

Objective: To investigate incidence of new neurologic deficit (NND) and the long-term recovery patterns following complex pediatric spine deformity surgery. The SRS M&M reports identify pediatric patients as having higher rate of new neurologic deficit compared with adults, while congenital and neuromuscular deformities are associated with higher new neurologic risks.

Does thoracoplasty adversely affect lung function in complex pediatric spine deformity? A 2-year follow-up review.

Study Design: Retrospective review of prospective multi-center cohort.

Objective: To investigate the impact of thoracoplasty on pulmonary function at 2-year follow-up among complex pediatric spine deformity patients. Complex pediatric spine deformities may be associated with significant rib prominence causing body image concerns.

Willingness to enroll in a surgical randomized controlled trial: patient and parent preferences regarding implant density for adolescent idiopathic scoliosis fusion.

Study Design: Prospective survey of adolescent idiopathic scoliosis (AIS) patients/parents with surgical magnitude curves.

Objective: We hypothesized that patients and families considering fusion surgery would be willing to enroll in a randomized controlled trial (RCT) evaluating the effect of number of implants on curve correction. Surgical RCTs are infrequently performed, particularly in a pediatric population.

What Are the Indications for Spinal Fusion Surgery in Scheuermann Kyphosis?

Background: Surgical indications for Scheuermann kyphosis are variable. We sought to evaluate the characteristics of patients undergoing operative versus nonoperative treatment of Scheuermann kyphosis to better understand current practices and the factors which contribute to the decision for surgical management.

Methods: Multicenter prospective cohort study.

Use of Activity Trackers in Orthopaedics.

Activity trackers are relatively inexpensive, easily available, and widely used by consumers. There has been increased interest in healthcare practice and research to use activity tracker data. Continuous collection of health variables including step count, heart rate, and calorimetry provides researchers and clinicians data to monitor patients after an intervention and/or encourage physical activity.

Risk Factors for Coronal Decompensation After Posterior Spinal Instrumentation and Fusion in Adolescent Idiopathic Scoliosis.

Study Design: Retrospective review of multicenter data set with adolescent idiopathic scoliosis (AIS) patients with at least 2 years of follow-up after posterior spinal instrumentation and fusion (PSIF).

Objectives: The purpose of this study is to investigate risk factors for coronal decompensation 2 years after PSIF for AIS.

Summary Of Background Data: Coronal decompensation is a potential complication of spinal instrumentation for AIS.

Best Practices in Intraoperative Neuromonitoring in Spine Deformity Surgery: Development of an Intraoperative Checklist to Optimize Response.

Study Design: Consensus-based creation of a checklist and guideline.

Objective: To develop a consensus-based checklist to guide surgeon responses to intraoperative neuromonitoring (IONM) changes in patients with a stable spine and to develop a consensus-based best practice guideline for IONM practice in the United States.

Summary Of Background Data: Studies show that checklists enhance surgical team responses to crisis situations and improve patient outcomes.

Are More Screws Better? A Systematic Review of Anchor Density and Curve Correction in Adolescent Idiopathic Scoliosis.

Study Design: Systematic review of clinical studies.

Objectives: To critically evaluate existing literature to determine whether increased anchor or implant density (screws, wires, and hooks per level fused) results in improved curve correction for adolescent idiopathic scoliosis (AIS) surgery.

Summary Of Background Data: Wide variability exists in the number of screws used for AIS surgery.

Paediatric spinal fusion surgery and the transition to home-based care: provider expectations and carer experiences.

There are more than 12 million children with special healthcare needs (CSHCNs) in the United States, many of whom require specialised health-care to treat chronic physical and developmental conditions. This study is a qualitative investigation of programme, surgical and at-home recovery experiences among CSHCNs and their family carers who participated in a spine surgical care programme at a paediatric hospital in the Western United States. The programme is designed to manage increased surgical risk and the transition of care from hospital to home for children with severe scoliosis undergoing spinal fusion surgery.

Selective thoracic fusion in Lenke 1C curves: prevalence and criteria.

Study Design: Multicenter retrospective analysis of prospectively collected data.

Objective: Evaluate radiographical and clinical characteristics of patients undergoing a selective thoracic fusion (STF) for Lenke 1C curves.

Summary Of Background Data: STF of adolescent idiopathic scoliosis has been advocated for the so-called "false double major" curve (Lenke 1C/King type II).

The safety of spinal pedicle screws in children ages 1 to 12.

Background Context: Pedicle screws have shown to be a safe and effective method of spinal fixation, offering superior multiplanar correction compared with hooks or sublaminar wires in selected situations. Though only food and drug administration (FDA) approved in the adolescent population, they are commonly used in an off-label manner in the preadolescent population.

Purpose: To determine if the complication rate of the off-label use of pedicle screws for spinal fixation in the preadolescent 0- to 12-year-old population is comparable with the complication rate in the FDA-approved 13- to 18-year-old population.

Variability in spinal surgery outcomes among children's hospitals in the United States.

Background: We performed a retrospective cohort study of 7637 spinal fusion surgical cases from 2004 to 2006 at 38 children's hospitals participating in the Pediatric Health Information System database to evaluate the variability of in-hospital outcomes by patient factors and between facilities in children who underwent spinal surgery.

Methods: Outcomes were stratified by whether children did or did not have neurological impairment. Multilevel multivariate logistic regression models were used to determine patient and hospital factors associated with in-hospital infections, surgical complications, and length of stay (LOS)≥10 days.

The role of serial casting in early-onset scoliosis (EOS).

Background: Serial casting has demonstrated efficacy for idiopathic early-onset scoliosis (EOS). Results of casting in nonidiopathic (syndromic and congenital) EOS patients have not previously been well described.

Methods: A total of 53 patients underwent serial casting for EOS from 2005 to 2010 at a single institution.

A multidisciplinary approach improves infection rates in pediatric spine surgery.

Background: Surgical site infections (SSI) associated with elective pediatric spinal surgery are a commonly reported complication, increasing hospital length of stay, readmissions, operations, and financial costs. In July 2007, a multidisciplinary task force, designated Target Zero, was created to address this issue and establish prevention protocols at our institution.

Methods: A consecutive series of 394 patient charts from April 2006 to September 2008 were retrospectively reviewed to identify patients who developed an SSI secondary to elective spinal surgery.

Use and outcomes of wound drain in spinal fusion for adolescent idiopathic scoliosis.

Study Design: A multicenter retrospective analysis.

Objective: To evaluate outcomes of closed-suction wound drainage after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis and to identify surgeon patterns of drain use in this cohort.

Summary Of Background Data: There is little evidence on the use of drains in spinal surgery, particularly for repair of adolescent idiopathic scoliosis.

Fixation points within the main thoracic curve: does more instrumentation produce greater curve correction and improved results?

Study Design: Prospective consecutive multicenter case series.

Objective: To compare fixation type and amount to curve correction controlled for curve flexibility.

Summary Of Background Data: The enhanced spinal purchase from segmental fixation should increase the force implants can exert without failure.

Pathways that distinguish simple from complex scoliosis repair and their outcomes.

Purpose Of Review: Surgical management of spinal deformities in patients with neuromuscular diseases or other underlying comorbidities is often challenging, as this population is at an increased risk of experiencing complications. Identifying these patients early on in the preoperative planning process is imperative in order to improve patient outcomes.

Recent Findings: Many recent studies have identified risk factors associated with perioperative and postoperative complications, including neuromuscular diseases, genetic syndromes, traumatic nerve/muscle injuries, seizure disorders, decreased cognitive ability, poor pulmonary status, restrictive lung disease, history of frequent pneumonias, sleep apnea, malnutrition, cardiac disease, immune-compromised patients, social status, ambulatory status, and the complexity of the procedure itself.