Three-dimensional deformity correction in adolescent idiopathic scoliosis patients: what are the benefits of hybrid apical sublaminar bands versus all-pedicle screws?

The amount of three-dimensional (3D) correction with apical sublaminar band (hybrid-SLB) technique has not been compared to all-pedicle screw instrumentation for adolescent idiopathic scoliosis (AIS) using detailed axial correction metrics or comparable rod types. Our purpose is to compare 3D improvement in AIS deformities following posterior spinal instrumentation and fusion (PSIF) with hybrid-SLB and segmental correction to all-pedicle screw correction. Patients ages 10-18 years with AIS who underwent PSIF between 2015 and 2022 and had preoperative and postoperative EOS imaging were included.

Implementing a Halo Gravity Traction Program: A Multidisciplinary Endeavor.

Halo gravity traction (HGT) is a preoperative modality for children with severe spinal deformity used to optimize spine flexibility and balance while decreasing the likelihood of neurologic injury. HGT is a dependable solution for these challenging spinal deformities. Aligning treatment guidelines and providing resources, education, and training for staff are key components for a successful HGT program.

Two AIS Cases, 2 Surgeons, 1 Operating Room, 1 Day: Faster and Safer Than 1 Case in a Day.

Background: To lessen surgical times for patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where 2 AIS cases were completed in 1 day by the same 2 surgeons operating together in 1 operating room (OR). We describe the results of this initiative, comparing operative times and outcomes to cases of these surgeons operating individually.

Methods: From 2017 to 2023, patients aged 10 to 18 years with AIS undergoing PSIF were prospectively enrolled for "Two Spine Tuesday.

Transiliac-Shortening Osteotomy to Treat Ischial Pressure Injury due to Fixed Pelvic Obliquity: A Case Report.

Case: A 17-year-old adolescent boy with Gross Motor Function Classification System 5 cerebral palsy and neuromuscular scoliosis underwent posterior spinal fusion and segmental spinal instrumentation from T3 to the pelvis. He developed a right ischial pressure injury a few months postoperatively, which persisted despite nonoperative measures. He subsequently underwent an ipsilateral transiliac-shortening osteotomy 16 months after spinal surgery to treat his residual pelvic obliquity and the ischial pressure injury, which healed completely.

Time-Dependent Bacterial Contamination of a Surgical Suction Tip.

No in vitro surgical study has evaluated the time-dependent contamination of surgical suction tips compared with controls. Our purpose was to determine the difference in suction tip bacterial contamination rates between suction-positive and suction-negative tips. A matched-pair analysis of the contamination of surgical suction tips over a six-hour period was performed in two clean operating rooms.

Surgical technique: proximal extension of instrumentation using sublaminar bands for salvage of postoperative proximal junctional failure in pediatric patients.

Purpose: Proximal junctional failure is a complication that can occur following posterior spine surgery with instrumentation. The ability to surgically revise this complication is important for the spine surgeon, yet there is little literature on the topic, especially for pediatric patients.

Methods: The technique we describe involves proximal extension of the existing instrumentation using paired levels of sublaminar bands that allows for a smooth transition of forces at the junction of instrumented and non-instrumented regions of the spine.

The effect of surgical time on perioperative complications in adolescent idiopathic scoliosis cases. A propensity score analysis.

Background: Posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS) can be lengthy and complication-ridden. The aim of this study was to evaluate the effect of surgical time on perioperative complications in this procedure when controlling for confounding variables with propensity score analysis.

Methods: This was an IRB-approved review of electronic health records from 2010 to 2019 at a single tertiary care children's hospital.

2015-2021 Industry Payments to Pediatric Orthopaedic Surgeons: Analysis of Trends and Characteristics of Top-earning Surgeons.

Background: Analysis of industry payments to pediatric orthopaedic surgeons last occurred in 2017. We investigated payments to pediatric orthopaedic surgeons from 2015 to 2021 to understand surgeon characteristics associated with increased industry payments.

Methods: Open Payments Database datasets from 2015 to 2021 were queried for nonresearch payments to pediatric orthopaedic surgeons.

BrAIST-Calc: Prediction of Individualized Benefit From Bracing for Adolescent Idiopathic Scoliosis.

Study Design: Prospective multicenter study data were used for model derivation and externally validated using retrospective cohort data.

Objective: Derive and validate a prognostic model of benefit from bracing for adolescent idiopathic scoliosis (AIS).

Summary Of Background Data: The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) demonstrated the superiority of bracing over observation to prevent curve progression to the surgical threshold; 42% of untreated subjects had a good outcome, and 28% progressed to the surgical threshold despite bracing, likely due to poor adherence.

Concave rod first vs. convex rod first in AIS instrumentation with differential rod contouring: computer modeling and simulations based on ten AIS surgical cases.

Purpose: To assess biomechanical differences between AIS instrumentations using concave vs. convex rod first.

Methods: Instrumentations of ten AIS patients were simulated first with major correction maneuvers using the concave rod then with convex rod.

Biomechanical analysis of rod contouring in posterior spinal instrumentation and fusion for 3D correction of adolescent idiopathic scoliosis.

Purpose: To biomechanically evaluate 3D corrective forces and deformity correction attributable to key parameters of rod contouring in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Methods: Computerised patient-specific biomechanical models of six AIS cases were used to simulate PSF and evaluate the effects of 5.5-mm cobalt-chrome rod contouring angle (concave-convex angles: 30°-15°, 45°-15° and 60°-15°), length (spanning 4 and 7 vertebrae), and apex location (T7, T9).

Diagnosis and Treatment of Idiopathic Congenital Clubfoot.

Idiopathic congenital clubfoot is the most common serious musculoskeletal birth defect in the United States and the world. The natural history of the deformity is to persist into adult life with a significant decrease in function and quality of life. The Ponseti method (serial casting, Achilles tenotomy, and bracing of the clubfoot) has become the most effective and accepted treatment of children born with clubfoot worldwide.

Outcomes and Complications in Management of Congenital Myopathy Early-Onset Scoliosis.

Background: Congenital myopathies (CMs) are complex conditions often associated with early-onset scoliosis (EOS). The purpose of this study was to investigate radiographic outcomes in CM patients undergoing EOS instrumentation as well as complications. Secondarily, we sought to compare these patients to a population with higher prevalence, cerebral palsy (CP) EOS patients.

Concave or convex rod translation first in adolescent idiopathic scoliosis instrumentation with differential rod contouring?

The objective was to assess deformity correction and bone-screw force associated respectively with concave manipulation first, convex manipulation first, and different differential rod contouring configurations. Instrumentation scenarios were computationally simulated for 10 AIS cases with mean thoracic Cobb angle (MT) of 54±8°, apical vertebral rotation (AVR) of 19±2° and thoracic kyphosis of 21±9°. Instrumentations with major correction maneuvers using the concave side rod were first simulated; instrumentations with major correction maneuvers using the convex side rod were then simulated.

Musculoskeletal Education: An Assessment of the Value of the American Academy of Pediatrics Musculoskeletal Boot Camp Course in Improving Clinical Confidence of Pediatricians Managing Common Musculoskeletal Conditions.

In 2016, the American Academy of Pediatrics Section on Orthopaedics established an annual Musculoskeletal (MSK) Boot Camp course to fill the gaps in MSK knowledge, performance, and outcomes for pediatricians and primary care doctors. A standardized one-day curriculum of key MSK topics was developed including short lectures, hands-on workshops, debates, live webinars, and Q&A sessions. A survey was created to evaluate attendee confidence related to diagnosing 20 common MSK conditions in children and adolescents at the beginning and end of the course.

An intraoperative laterally placed distractor for gradual load sharing correction of severe spastic neuromuscular spinal deformity.

Purpose: To analyze the overall deformity correction for severe neuromuscular scoliosis using laterally placed intra-operative distraction and compare to those receiving standard surgical technique.

Methods: This was a retrospective, IRB-approved, cohort study of patients with GMFCS 4 or 5 spastic cerebral palsy with neuromuscular scoliosis, age greater than 10 years, who underwent posterior spinal fusion from 2007 to 2019. All patients had vectored cervical traction with Gardner-Wells tongs, with hips flexed in a relative sitting position.

Anaphylaxis after injecting a hemostatic agent containing gelatin into vertebral bone under pressure-a warning.

Study Design: Case series.

Purpose: The use of topical hemostatic agents is common in spinal deformity surgery. While beneficial, emerging case data shows gelatin-containing agents causing intra-operative complications.

Twenty-two Years of Pediatric Musculoskeletal Firearm Injuries: Adverse Outcomes for the Very Young.

Background: Firearm injuries are a significant cause of morbidity and mortality for children in the United States. The purpose of this study is to investigate the 22-year experience of pediatric firearm-related musculoskeletal injuries at a major pediatric level 1 hospital and to analyze the risk of adverse outcomes in children under 10 years of age.

Methods: An institutional review board-approved, retrospective cohort analysis was conducted on pediatric firearm-related musculoskeletal injuries at our institution from 1995 to 2017.

Why Irrigate for the Same Contamination Rate: Wound Contamination in Pediatric Spinal Surgery Using Betadine Versus Saline.

Background: The risk of surgical site infection in pediatric posterior spine fusion (PSF) is up to 4.3% in idiopathic populations and 24% in patients with neuromuscular disease. Twenty-three percent of pediatric PSF tissue cultures are positive before closure, with a higher rate in neuromuscular patients.

Treatment of type III supracondylar humerus fractures: adherence and limitations of American Academy of Orthopedic Surgeons Appropriate Use Criteria App.

The American Academy of Orthopedic Surgeons (AAOS) published Appropriate Use Criteria (AUC) in 2014 to aid physicians in the management of pediatric supracondylar humerus fractures. AUC should be evaluated in real practice, and if necessary modified based on identified problems. This study compares AAOS AUC recommendations with actual treatment performed in a cohort of patients treated for type III supracondylar humerus fractures.

Operative time in adolescent idiopathic scoliosis surgery: a need for a standard definition.

Our objective is to report and define 'operative time' in adolescent idiopathic scoliosis (AIS) posterior spinal fusion surgeries. Documenting key times during surgery are important to compare operative risks, assess learning curves, and evaluate team efficiency in AIS surgery. 'Operative time' in literature has not been standardized.

Pediatric Orthopaedists Are Not Immune: Characterizing Self-reported Burnout Rates Among POSNA Members.

Background: There are no published data characterizing burnout rates for pediatric orthopaedic surgeons. The primary purpose of this study was to identify the rates of self-reported personal and team burnout among members of the Pediatric Orthopaedic Society of North America (POSNA). A secondary aim was to determine whether specific demographic variables were more likely to be associated with self-reported burnout.