Placement of ilio-sacral screws in fusionless technique for pediatric neuromuscular scoliosis utilizing planning software, in conjunction with intraoperative navigation, results in a safer optimal screw: a CT-based study.

Purpose: The insertion of ilio-sacral (IS) screws for distal anchoring in the instrumentation of pediatric neuromuscular scoliosis (NS) presents a significant challenge, often leading to elevated rates of complications. Utilizing computed tomography (CT) navigation and preoperative planning technology is proposed as a potential solution to mitigate these challenges. This study aims to assess the precision of IS screw placement through CT-graphic measurements, both with and without preoperative planning, followed by navigated IS screw insertion, in pediatric neuromuscular scoliosis.

Qualitative study exploring the views of patients and healthcare providers on current rehabilitation practices after lumbar fusion surgery.

Objectives: To explore the views of patients and healthcare providers on current rehabilitation after lumbar fusion surgery (LFS) to fuel the development of a novel rehabilitation care pathway.

Design: A cross-sectional, qualitative study with an interpretive descriptive design.

Setting: Academic and non-academic hospital setting in Belgium.

Three- instead of two-dimensional evaluation of key parameters alters the choice of the lowest instrumented vertebra in Lenke 1 and 2 AIS patients.

Purpose: Treatment of AIS, a three-dimensional spinal (3D) deformity, is guided by a two-dimensional (2D) evaluation. Novel 3D approaches that address the 2D limitations have not been adopted in AIS care due to their lengthy and complex 3D reconstruction procedures. This study aims to introduce a simple 3D method that translates the 2D key parameters (Stable vertebra (SV), Lenke lumbar modifier, Neutral vertebra (NV)) into 3D and to quantitively compare these 3D corrected parameters to the 2D assessment.

Partial Femoral Diaphysectomy With Vastus Lateralis Interposition in a Paraplegic Patient With Severely Debilitating Hip Ankylosis: Low Risks and High Gains?

We present the case of a 56-year-old male unable to sit because of an ankylosed right hip. This ankylosis originated from combined neurogenic heterotopic ossifications (NHO) and traumatic heterotopic ossifications (THO) as a result of a road traffic accident. Because of multiple ossifications, the proximity of neurovascular structures, and chronic pressure ulcers, a resection was deemed unsafe.

Best practice rehabilitation pathway for the management of single and double-level lumbar fusion surgery: a modified Delphi Study.

Background: There is limited evidence to guide the rehabilitation of patients following single or double-level lumbar fusion surgery (LFS). This is reflected in extensive variability in current rehabilitation regimes and subsequent low clinical success rates, which urges a call for a consensus rehabilitation pathway.

Aim: To establish consensus on the optimal pre-, peri- and postoperative rehabilitation of LFS.

Applying a knowledge translation framework for triaging low back pain and radicular pain at an emergency department: an iterative process within an uncontrolled before-and-after design.

Background: Diagnostic imaging for low back pain (LBP) without any indication of a serious underlying cause does not improve patient outcomes. However, there is still overuse of imaging, especially at emergency departments (EDs). Although evidence-based guidelines for LBP and radicular pain management exist, a protocol for use at the ED in the Belgian University Hospitals Leuven was not available, resulting in high practice variation.

Applying the ICF model in adult spinal deformity: disability in terms of participation should be incorporated in the care pathway.

Purpose: To investigate the participation restriction of adult spinal deformity (ASD) patients, and its relation with the impairments in body structure and function, and activity limitation, as this important information regarding the individual's perspective on the social impact of the disease on their life is presently not captured.

Methods: Forty-three ASD patients participated in the study and completed the impact on participation and autonomy (IPA) questionnaire to assess the level of participation. Activity limitations and impairments were measured with the Balance Evaluation Systems Test (BESTest) and Scoliosis Research Society-22r (SRS-22).

Rehabilitation to improve outcomes of lumbar fusion surgery: a systematic review with meta-analysis.

Purpose: To evaluate the effectiveness of rehabilitation strategies on disability, pain, pain-related fear, and return-to-work in patients undergoing lumbar fusion surgery for degenerative conditions or adult isthmic spondylolisthesis.

Methods: Six electronic databases were systematically searched for randomized controlled trials (RCTs) evaluating the effect of rehabilitation (unimodal or multimodal). The estimated effect size was calculated for interventions with homogeneous content using a random-effects model.

Variability drivers of treatment costs in hospitals: A systematic review.

Objectives: Studies on variability drivers of treatment costs in hospitals can provide the necessary information for policymakers and healthcare providers seeking to redesign reimbursement schemes and improve the outcomes-over-cost ratio, respectively. This systematic literature review, focusing on the hospital perspective, provides an overview of studies focusing on variability in treatment cost, an outline of their study characteristics and cost drivers, and suggestions on future research methodology.

Methods: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Handbook for Systematic Reviews of Interventions.

Spinopelvic movement strategies during sit-to-stand and stand-to-sit in adult spinal deformity.

Background: Research interest on the impact of adult spinal deformity (ASD) on spinopelvic and whole body motion has increased over the past years. Studies focusing on overground walking, showed that patients with ASD indeed present with functional impairments. Functional tasks challenging the spinopelvic complex, such as sit-to-stand-to-sit, might identify clinically relevant biomechanical parameters and could further increase our insights on how ASD impacts functioning and disability.

The Function Assessment Scale for Spinal Deformity: Validity and Reliability of a New Clinical Scale.

Study Design: Cross-sectional study.

Objective: The aim of this study was to develop and validate the Function Assessment scale for Spinal Deformity (FASD).

Summary Of Background Data: Spinal malalignment impacts daily functioning.

Subject-Specific Spino-Pelvic Models Reliably Measure Spinal Kinematics During Seated Forward Bending in Adult Spinal Deformity.

Image-based subject-specific models and simulations are recently being introduced to complement current state-of-the-art mostly static insights of the adult spinal deformity (ASD) pathology and improve the often poor surgical outcomes. Although the accuracy of a recently developed subject-specific modeling and simulation framework has already been quantified, its reliability to perform marker-driven kinematic analyses has not yet been investigated. The aim of this work was to evaluate the reliability of this subject-specific framework to measure spine kinematics in ASD patients, in terms of 1) the overall test-retest repeatability; 2) the inter-operator agreement of spine kinematic estimates; and, 3) the uncertainty of those spine kinematics to operator-dependent parameters of the framework.

Spinal Palpation Error and Its Impact on Skin Marker-Based Spinal Alignment Measurement in Adult Spinal Deformity.

Spinal alignment measurement in spinal deformity research has recently shifted from using mainly two-dimensional static radiography toward skin marker-based motion capture approaches, allowing three-dimensional (3D) assessments during dynamic conditions. The validity and accuracy of such skin marker-based methods is highly depending on correct marker placement. In this study we quantified, for the first time, the 3D spinal palpation error in adult spinal deformity (ASD) and compared it to the error in healthy spines.

A Dynamic Optimization Approach for Solving Spine Kinematics While Calibrating Subject-Specific Mechanical Properties.

This study aims to propose a new optimization framework for solving spine kinematics based on skin-mounted markers and estimate subject-specific mechanical properties of the intervertebral joints. The approach enforces dynamic consistency in the entire skeletal system over the entire time-trajectory while personalizing spinal stiffness. 3D reflective markers mounted on ten vertebrae during spine motions were measured in ten healthy volunteers.

Dynamic sagittal alignment and compensation strategies in adult spinal deformity during walking.

Background Context: Radiographic evaluation in adult spinal deformity (ASD) offers no information on spinopelvic alignment and compensation during dynamic conditions. Motion analysis offers the potential to bridge the gap between static radiographic and dynamic alignment measurement, increasing our understanding on how ASD impacts function.

Purpose: This study aimed to explore the changes in sagittal alignment and compensation strategies in ASD between upright standing and walking, compared to control subjects and within different sagittal alignment groups.

Returning to Elective Orthopedic Surgery During the COVID-19 Pandemic: A Multidisciplinary and Pragmatic Strategy for Initial Patient Selection.

Objective: The aim of the study was to design an objective, transparent, pragmatic, and flexible workflow to assist with patient selection during the initial phase of return to elective orthopedic surgery during the COVID-19 pandemic with the main purpose of enhancing patient safety.

Methods: A multidisciplinary working group was formed consisting of representatives for orthopedics, epidemiology, ethics, infectious diseases, cardiovascular diseases, and intensive care medicine. Preparation for upcoming meetings consisted of reading up on literature and testing of proposed methodologies on our own waiting lists.

Development and validation of a modeling workflow for the generation of image-based, subject-specific thoracolumbar models of spinal deformity.

Quantitative dynamic evaluation of spino-pelvic motion in subjects with spinal deformity using optical motion analysis is currently lacking. The aim of this study was to develop and validate subject-specific, thoracolumbar spine multi-body skeletal models for evaluating spino-pelvic kinematics in a spinal deformity population. A new workflow for creating subject-specific spino-pelvic models in a weight-bearing position through computed tomography (CT) and biplanar radiography is described.

Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS-COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management.

Background: The worldwide spread of a novel coronavirus disease (COVID-19) has led to a near total stop of non-urgent, elective surgeries across all specialties in most affected countries. In the field of aesthetic surgery, the self-imposed moratorium for all aesthetic surgery procedures recommended by most international scientific societies has been adopted by many surgeons worldwide and resulted in a huge socioeconomic impact for most private practices and clinics. An important question still unanswered in most countries is when and how should elective/aesthetic procedures be scheduled again and what kind of organizational changes are necessary to protect patients and healthcare workers when clinics and practices reopen.

Variability in Hospital Costs of Adult Spinal Deformity Care.

Study Design: Retrospective, single-center analysis.

Objective: To calculate the total clinical hospital cost of the Adult Spinal Deformity (ASD) care trajectory, to explain cost variability by patient and surgery characteristics, and to identify areas of process improvement opportunities.

Summary Of Background Data: ASD is associated with a high financial and clinical burden on society.

A subject-specific method to measure dynamic spinal alignment in adult spinal deformity.

Background Context: Two-dimensional static radiography currently forms the golden standard in spinal alignment measurement in adult spinal deformity (ASD). However, these static measurements offer no information on dynamic spinal behavior. To fully understand the functionality and compensation strategies of ASD patients, tools to assess dynamic spinal alignment are needed.

The Transverse Gravitational Deviation Index, a Novel Gravity Line-Related Spinal Parameter, Relates to Balance Control and Health-Related Quality of Life in Adults With Spinal Deformity.

Study Design: Prospective cross-sectional case-control study design.

Objective: This study aims to analyze the relation between balance control as well as health-related quality of life (HRQOL) in patients with adult spinal deformity (ASD), with a novel gravity line (GL)-related 3D spinal alignment parameter, the transverse gravitational deviation index (TGDI), defined to quantify the transverse plane position of any vertebra with respect to the GL.

Summary Of Background Data: Demographic data and balance control have both been identified as important determinants of HRQOL in ASD patients during a preoperative setting.

Reliability of the balance evaluation systems test and trunk control measurement scale in adult spinal deformity.

Objective: To test the reliability of the Balance Evaluation Systems Test (BESTest) and Trunk Control Measurement Scale (TCMS) between sessions and raters in the adult spinal deformity (ASD) population.

Summary Of Background Data: Up to now evaluation in ASD was mainly based on static radiographic parameters. Recently literature showed that dynamic balance was a better predictor of health-related quality of life than radiographic parameters, stressing the importance of balance assessment.

An Acute Paraspinal Compartment Syndrome: Anatomic Description of the Compartment and Surgical Technique.

An acute paraspinal compartment syndrome (CS) is a rare condition and is only described in a few case reports. In our spine surgery department, a 16-year-old boy with severe low back pain due to a lumbar paraspinal CS. was treated with a paraspinal fasciotomy.

Postoperative bracing after lumbar surgery: a survey amongst spinal surgeons in Belgium.

Purpose: Bracing is frequently prescribed following lumbar surgery for degenerative conditions. However, previous studies failed to demonstrate the advantage of postoperative lumbar bracing in both short- and long-term outcome in terms of pain, quality of life and fusion rate. The purpose of this study was to assess the prescription patterns and rationale for postoperative bracing amongst spinal surgeons in Belgium.