Actuator Size of Magnetic Controlled Growth Rod (7 cm vs. 9 cm) is Not Predictive of Unplanned Return to the Operating Room: A Retrospective Multicenter Comparative Cohort Study.

Background: Magnetic controlled growth rods (MCGR) are the most common type of implant used for operative treatment of patients with early-onset scoliosis (EOS). Rods can have either a 7-cm actuator, allowing 2.8 cm of potential expansion, or a 9-cm actuator which allows 4.

Rib-on-Pelvis Deformity and Reported Pain in Neuromuscular Early-Onset Scoliosis.

Background: Neuromuscular early-onset scoliosis (N-EOS) often presents with a long sweeping thoracolumbar scoliosis and pelvic obliquity. With severe pelvic obliquity, the ribs come into contact with the high side of the pelvis, termed rib-on-pelvis deformity (ROP). The goal of this study is to evaluate whether ROP is associated with reported pain and other health-related quality of life (HRQOL) measures.

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.

Clinical Relevance of Painful Congenital Early-onset Scoliosis: A Magnetic Resonance Image-based Study.

Background: Back pain, as a clinical marker in scoliosis, has been associated with underlying pathology for many years, warranting further magnetic resonance imaging (MRI). Failures of segmentation, mixed defects, female gender, rib anomalies, congenital thoracic anomalies, and neurocutaneous markers are known risk factors for abnormal MRI pathology findings in patients with congenital early-onset scoliosis (Congenital-EOS). Yet, back pain has not been evaluated as a risk factor for underlying MRI pathology in patients with Congenital-EOS.

Who gets staged surgery in severe pediatric and adolescent spine deformity?

Background: There is significant debate regarding the indications of staged surgery for severe adolescent spinal deformity, and the factors associated with the decision to perform staged compared to same-day surgery have not been previously investigated. Thus, the purpose of this study was to determine which factors were most strongly associated with this decision.

Methods: A prospective multicenter registry of adolescent patients with severe spinal deformity was reviewed.

Delayed Diagnosis of Cervical Epidural Hematoma in a 3-Year-Old Boy: A Case Report.

Case: A 3-year-old boy presented to the emergency department with torticollis after a fall. With normal cervical radiographs and neurologic exam, he was diagnosed with cervical strain and discharged. After 2-week progressive symptoms, he was referred to a pediatric spine surgeon.

Return to play following spine surgery.

Return to physical activity is a primary concern for adolescents with idiopathic scoliosis who are indicated for spinal fusion surgery. Preoperative counseling often addresses questions regarding ability to return to sport, postoperative restrictions, time away from play, and the safety of returning to activities. Previous works have shown that flexibility can noticeably decrease after surgery, and that the ability to return to the same level of play may be impacted by the levels of the spine included in the fusion.

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.

The Reliability of the AO Spine Upper Cervical Classification System in Children: Results of a Multi-Center Study.

Background: There is no uniform classification system for traumatic upper cervical spine injuries in children. This study assesses the reliability and reproducibility of the AO Upper Cervical Spine Classification System (UCCS), which was developed and validated in adults, to children.

Methods: Twenty-six patients under 18 years old with operative and nonoperative upper cervical injuries, defined as from the occipital condyle to the C2-C3 joint, were identified from 2000 to 2018.

Adolescent athletes return to sports rapidly after posterior spine fusion for idiopathic scoliosis: a prospective cohort study.

Purpose: No consensus exists regarding the timing for return to sports after PSF for patients with AIS. Return-to-play protocols are based on expert opinion and vary widely. The purpose of this study was to determine how rapidly athletes return to baseline sports activity following posterior spinal fusion for adolescent idiopathic scoliosis.

Modified Clavien-Dindo-Sink system is reliable for classifying complications following surgical treatment of early-onset scoliosis.

Purpose: Appropriately measuring and classifying surgical complications is a critical component of research in vulnerable populations, including children with early-onset scoliosis (EOS). The purpose of this study was to assess the inter- and intra-rater reliability of a modified Clavien-Dindo-Sink system (CDS) classification system for EOS patients among a group of pediatric spinal deformity surgeons.

Methods: Thirty case scenarios were developed and presented to experienced surgeons in an international spine study group.

7.7% Prevalence of neural axis abnormalities on routine magnetic resonance imaging in patients with presumed adolescent idiopathic scoliosis scheduled for spine surgery: a consecutive single surgeon retrospective cohort of 182 patients.

Purpose: The purpose of this study was to use a Delphi analysis to identify a clinically relevant threshold for the prevalence of neural axis abnormalities (NAAs) that would warrant routine preoperative screening.

Methods: A panel of experienced physicians specializing in pediatric spine surgery, pediatric neurosurgery, and pediatric neuroradiology was formed to establish consensus using a Delphi process to identify a minimum prevalence of NAAs that would initiate the implementation of preoperative MRIs as standard of care. Following the Delphi analysis, patients scheduled for PSF (Posterior Spinal Fusion) from 2010 to 2018 were retrospectively identified.

Posterior-only Resection of Single Hemivertebrae With 2-Level Versus >2-Level Fusion: Can We Improve Outcomes?

Background: The outcomes of congenital scoliosis (CS) patients undergoing hemivertebra (HV) resection surgery with a 2-level fusion versus a >2-level fusion are unclear. We hypothesized that CS patients undergoing HV resection and a >2-level fusion have decreased curve progression and reoperation rates compared with 2-level fusions.

Methods: Retrospective review of prospectively collected data from a multicenter scoliosis database.

Optimizing Expansion Clinic for Patients With Magnetic Controlled Growth Rods.

In 2017, members of the Pediatric Spine Study Group reported that 80% of new growth-friendly implants inserted were magnetically controlled growing rods (MCGRs). MCGRs are usually expanded more often than every 6 months, as was general practice with traditional growth rods. The growing volume of expansion visits is managed variably at different centers.

Navigation Options for Spinal Surgeons: State of the Art 2021.

The use of navigation in spinal surgery has been increasing over the past decade. There are three primary types of navigation in spinal surgery: three-dimensional image-based computer-assisted navigation, robot-assisted navigation, and three-dimensional printed patient-specific drill guides for navigation. All three have demonstrated increased accuracy in placement of spinal instrumentation versus freehand or fluoroscopic-assisted techniques.

Uncorrected Pelvic Obliquity Is Associated With Worse Health-related Quality of Life (HRQoL) in Children and Their Caregivers at the End of Surgical Treatment for Early Onset Scoliosis (EOS).

Background: While largely of concern in nonambulatory patients, pelvic obliquity (PO) can be found in many patients with early onset scoliosis (EOS) and may remain following surgery. However, its association with health-related quality of life (HRQoL) in children and their caregivers at the end of treatment is not well understood. The purpose of this study was to investigate the association between residual PO and HRQoL in children and their caregivers at the end of surgical treatment in ambulatory patients with EOS.

Mortality in Early-Onset Scoliosis During the Growth-friendly Surgery Era.

Introduction: Early-onset scoliosis (EOS) is a spinal deformity that occurs in patients 9 years of age or younger. Severe deformity may result in thoracic insufficiency, respiratory failure, and premature death. The purpose of this study is to describe the modern-day natural history of mortality in patients with EOS.

Does ventilator use status correlate with quality of life in patients with early-onset scoliosis treated with rib-based growing system implantation?

Purpose: Pulmonary function and quality of life (QOL) are important outcome measures for patients with early-onset scoliosis (EOS) undergoing rib-based growing system (RBGS) implantation. The Assisted Ventilation Rating (AVR) measures ventilator requirements in this population. A higher, more severe, score implies negative changes in QOL.

The Effect of Surgeon Experience on Outcomes Following Growth Friendly Instrumentation for Early Onset Scoliosis.

Background: The purpose of this study was to utilize a multicenter, multisurgeon cohort to assess the effect of surgeon experience on outcomes of growth friendly instrumentation (GFI) in early onset scoliosis (EOS). We hypothesized that unplanned return to the operating room (UPROR), estimated blood loss (EBL), and surgical time would be greater amongst early career surgeons (ECSs) when compared with advanced career surgeons (ACSs).

Methods: An international pediatric spine database was queried for patients ages 2 to 10 years treated by posterior distraction-based GFI with at least of 2-year follow up.

0.4% incidence of return to OR due to screw malposition in a large prospective adolescent idiopathic scoliosis database.

Purpose: In contrast to infection and curve progression, return to OR for implant malposition is potentially within the surgeon's control. With increasing surgeon familiarity with freehand/fluoroscopic pedicle screw placement, rates of return to OR due to malposition may have decreased over time. We sought to document the incidence and risk factors for return to OR due to screw malposition in a large cohort of patients with idiopathic scoliosis.

Myelopathic Patients Undergoing Severe Pediatric Spinal Deformity Surgery Can Improve Neurologic Function to That of Non-Myelopathic Patients by 1-Year Postoperative.

Study Design: Multi-center, prospective, observational cohort.

Objective: To compare myelopathic vs. non-myelopathic ambulatory patients in short- and long-term neurologic function, operative treatment, and patient-reported outcomes.