High-dose Versus Low-dose Tranexamic Acid to Reduce Transfusion Requirements in Pediatric Scoliosis Surgery.

Background: Our objective was to quantify blood loss and transfusion requirements for high-dose and low-dose tranexamic acid (TXA) dosing regimens in pediatric patients undergoing spinal fusion for correction of idiopathic scoliosis. Previous investigators have established the efficacy of TXA in pediatric scoliosis surgery; however, the dosing regimens vary widely and the optimal dose has not been established.

Methods: We retrospectively analyzed electronic medical records for 116 patients who underwent spinal fusion surgery for idiopathic scoliosis by a single surgeon and were treated with TXA.

Paper #19: Utilization and Reliability of Intraoperative Neuromonitoring in Vertebral Column Resections for Severe Early-Onset Scoliosis.

Use of IOM in treating EOS with a VCR was found to be effective in 100% of the patients; despite 7/33 having a preop neuro deficit. 12/33 with an IOM change, with 42% having a post-op deficit.

Paper #20: Vertebral Column Resection for Early-Onset Scoliosis: Indications, Utilization and Outcomes.

EOS treated with VCR were predominantly congenital or myelomeningocele with 84% performed at index surgery and 70% definitive fusion. Correction of major curve was 69% and increases in spinal and thoracic height. Complication rate was 33% with 57% being IONM/neuro related.

Paper #34: Treatment of Severe Early Onset Scoliosis using Distraction Based Spinal Instrumentation : A matched comparative study.

Severe EOS can be treated as effectively with distraction instrumentation in comparison to less severe EOS.

Paper #36: Multi-level Congenital Deformities in Early Onset Scoliosis: Radiographic and Clinical Outcomes in Growth Friendly Graduates.

Treatment of complex congenital scoliosis with growth friendly instrumentation led to only modest correction of major curves, residual imbalance, minimal gain in spine and thoracic height and a high incidence of complications. It is unknown whether this treatment improves upon the natural history or early fusion.

Paper #40: Is There an Improvement in Quality of Life with Early Onset Scoliosis Managed with Traditional Growing Rods Converted to Magnetically Controlled Growing Rods?

Introduction of magnetically controlled growing rods (MCGR) for early onset scoliosis treatment was anticipated to improve quality of life for patients and their families. A cohort of patients converted from traditional growing rods to MCGR may be best suited to detect this improvement and have not previously been examined. Using the validated EOSQ-24, no HRQoL differences were detected between TGR, MCGR, or converted patient cohorts.

Paper #41: Two Year HRQOL Measures are Similar Between Magnetically-Controlled Growing Rod Patients and Traditional Growing Rod Patients.

Despite having lower HRQoL domain scores pre-operatively, EOS patients treated with magnetically-controlled growing (MCGR) had similar EOSQ-24 domain scores after two years of treatment compared to patients treated with traditional growing rods (TGR).

Paper #45: Development of a Risk Severity Score (RSS) Predicting Surgical Site Infection in Early Onset Scoliosis: Identifying High-Risk Patients.

The RSS was developed to quantify the risk of SSI when considering operative intervention in patients with early onset scoliosis undergoing spinal surgery. The tool includes neuromuscular etiology, myelomeningocele, spinal muscular atrophy, endocrine comorbidity, gastrointestinal comorbidity, pulmonary comorbidity, developmental delay, urinary incontinence, and ventriculoperitoneal shunt as predictive variables. The RSS can improve shared decision making with patients and families during preoperative counseling and aid policy makers and administrators in determining reliable and valid risk-adjusted outcome measures.

Timing of Changes in Three-Dimensional Spinal Parameters After Selective Thoracic Fusion in Lenke 1 Adolescent Idiopathic Scoliosis: Two-Year Follow-up.

Study Design: Retrospective analysis of the prospectively collected data.

Objective: To investigate the relationship between the axial rotation of the unfused lumbar spine and the parameters of the instrumented thoracic spine at varying time points after selective thoracic fusion (STF) in Lenke 1B and 1C adolescent idiopathic scoliosis (AIS).

Summary Of Background Data: The impact of STF on the spontaneous lumbar curve correction in AIS has been studied mainly in the frontal planes.

Risk factors associated with short-term complications and mortality after pediatric spinal arthrodesis.

OBJECTIVE Spinal arthrodesis is routinely performed in the pediatric population. However, there is limited information on the short-term outcomes of pediatric patients who have undergone spine fusion. Thus, the authors conducted a retrospective review of the Pediatric National Surgical Quality Improvement Program (NSQIP) database to determine the short-term mortality, complication, reoperation, and readmission rates of pediatric patients who underwent spinal arthrodesis for all indications.

Sacral-Alar-Iliac Fixation in Children with Neuromuscular Scoliosis: Minimum 5-Year Follow-Up.

Objective: To investigate the 5-year outcomes of children with neuromuscular scoliosis treated with sacral-alar-iliac screws.

Methods: We reviewed clinical and radiographic records of patients aged ≤18 years treated by 1 pediatric orthopedic surgeon for neuromuscular scoliosis with spinal fusion using sacral-alar-iliac pelvic anchors. Thirty-eight patients with a minimum 5-year radiographic follow-up (mean, 6.

Marfan Syndrome: A Clinical Update.

Marfan syndrome is a connective tissue disorder that can affect many organ systems. Affected patients present with orthopaedic manifestations of the syndrome during all phases of life. Pain caused by musculoskeletal abnormalities often requires definitive orthopaedic treatment.

Initial Cast Correction as a Predictor of Treatment Outcome Success for Infantile Idiopathic Scoliosis.

Background: Cast treatment for infantile idiopathic scoliosis patients ultimately corrects deformity in varying amounts. As the reasons for these differential outcomes are not fully elucidated, the aim of this study was to identify clinical and radiographic variables correlated with better cast correction.

Methods: Patients in the Children's Spine Study Group and Growing Spine Study Group registries who underwent cast treatment for idiopathic scoliosis between 2005 and 2013 with 1-year minimum follow-up were included.

Treatment of a Pediatric T-type Intercondylar Humerus Fracture With Hybrid Percutaneous Pinning and External Fixation.

T-type intercondylar fractures of the distal humerus are rare injuries in skeletally immature patients. Few studies are available to guide the treatment of these injuries. Small case series and expert recommendations suggest superiority of the open approach for direct reduction of the articular surface.

Retrieval and clinical analysis of distraction-based dual growing rod constructs for early-onset scoliosis.

Background Context: Growing rod constructs are an important contribution for treating patients with early-onset scoliosis. These devices experience high failure rates, including rod fractures.

Purpose: The objective of this study was to identify the failure mechanism of retrieved growing rods, and to identify differences between patients with failed and intact constructs.

Recurrence of Deep Surgical Site Infection in Cerebral Palsy After Spinal Fusion Is Rare.

Study Design: Retrospective review of prospective registry.

Objectives: To assess the following in children with cerebral palsy (CP) who develop deep surgical site infection (DSSI) after spinal fusion: (1) rate of infection recurrence after treatment; (2) treatments used; (3) radiographic outcomes; and (4) differences in Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) scores versus those of children with no infection (NI).

Summary Of Background Data: Studies show high rates of surgical site infection in patients with CP but do not address late recurrence or quality-of-life effects.

Risk Factors of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis-The Pelvis and Other Considerations.

Study Design: Prospective multicenter database study.

Objectives: To assess the incidence of proximal junctional kyphosis (PJK) in operative adolescent idiopathic scoliosis (AIS) using contemporary surgical techniques and to identify risk factors for PJK.

Summary Of Background Data: The incidence of PJK has been reported as high as 46% in AIS.

Mechanosignaling activation of TGFβ maintains intervertebral disc homeostasis.

Intervertebral disc (IVD) degeneration is the leading cause of disability with no disease-modifying treatment. IVD degeneration is associated with instable mechanical loading in the spine, but little is known about how mechanical stress regulates nucleus notochordal (NC) cells to maintain IVD homeostasis. Here we report that mechanical stress can result in excessive integrin αβ-mediated activation of transforming growth factor beta (TGFβ), decreased NC cell vacuoles, and increased matrix proteoglycan production, and results in degenerative disc disease (DDD).

Effectiveness of the Rigo Chêneau versus Boston-style orthoses for adolescent idiopathic scoliosis: a retrospective study.

Background: Bracing can effectively treat adolescent idiopathic scoliosis (AIS), but patient outcomes have not been compared by brace type. We compared outcomes of AIS patients treated with Rigo Chêneau orthoses (RCOs) or custom-molded Boston-style thoracolumbosacral orthoses (TLSOs).

Methods: We retrospectively reviewed patient records from one scoliosis center from 1999 through 2014.

State of dose prescription and compliance to international standard (ICRU-83) in intensity modulated radiation therapy among academic institutions.

Purpose: The purpose of this study was to evaluate dose prescription and recording compliance to international standard (International Commission on Radiation Units & Measurements [ICRU]-83) in patients treated with intensity modulated radiation therapy (IMRT) among academic institutions.

Methods And Materials: Ten institutions participated in this study to collect IMRT data to evaluate compliance to ICRU-83. Under institutional review board clearance, data from 5094 patients-including treatment site, technique, planner, physician, prescribed dose, target volume, monitor units, planning system, and dose calculation algorithm-were collected anonymously.

MRI Screening in Operative Scheuermann Kyphosis: Is it Necessary?

Study Design: Patients with preoperative spine magnetic resonance imaging (MRI) studies from a prospective multicenter study of operative adolescent Scheuermann kyphosis (SK).

Objectives: To investigate the usefulness of MRI screening in operative planning for SK surgeries.

Summary Of Background Data: Neural axis abnormalities in operative SK have not been previously studied with MRI screening, despite its use.

Growing Rods Are an Effective Fusionless Method of Controlling Early-Onset Scoliosis Associated With Neurofibromatosis Type 1 (NF1): A Multicenter Retrospective Case Series.

Background: Spinal deformities associated with neurofibromatosis type 1 (NF1) often have an early onset. These curves frequently develop dysplastic features. Rapid progression is common, and is often difficult to control with casting or bracing.

Submuscular Plate for Pediatric Femoral Fractures.

Management of pediatric femoral fractures is dependent on patient age and injury pattern. For length-stable femoral shaft fractures in school-age children (5 to 11 years of age), flexible intramedullary nailing (IMN) is a popular treatment method. However, for fracture patterns that are length-unstable or involve the proximal or distal third of the femur, flexible IMN has a higher rate of postoperative complications.

Complications of bladder closure in cloacal exstrophy: Do osteotomy and reoperative closure factor in?

Background/purpose: The aims of surgical management in cloacal exstrophy (CE) have shifted to optimizing outcomes and quality of life while minimizing morbidity. This report reviews the single-institution experience of complications of bladder closure in CE.

Methods: Patients with CE were identified from a prospectively-maintained bladder exstrophy-epispadias complex database.

Sacral-Alar-Iliac Fixation in Pediatric Deformity: Radiographic Outcomes and Complications.

Study Design: Retrospective case series.

Objectives: To assess the radiographic outcomes and complications of sacral-alar-iliac (SAI) fixation in children.

Summary Of Background Data: Pelvic fixation in children undergoing spinal deformity surgery can be challenging because of complex anatomy, compound biomechanical forces at the lumbosacral junction, and poor bone quality.