Full-Endoscopic Technique for Posterior Fossa Decompression in Chiari Malformation.

Background And Importance: Full-endoscopic techniques are well-described for spinal procedures. Although endoscopic-assisted techniques are reported for posterior fossa decompression (PFD) in Chiari malformation (CM), a full-endoscopic technique is yet to be reported in these patients. The aim of this study was to present and describe a full-endoscopic technique for PFD in patients with CM.

Clinical experience and complications with limited pleural dissection combined with a novel, simplified technique for thoracic Redon-like drain in vertebral body tethering.

Purpose: To report on our experience with a simplified, suction-bottle-drain technique of thoracic drain (Redon-like) combined with fully thoracoscopic vertebral body tethering (VBT) and a limited pleural approach, with particular focus on the rate of pulmonary complications.

Methods: A retrospective study was performed on all consecutive patients who underwent VBT for adolescent idiopathic scoliosis. For all subjects, a 10G Redon drain, an active drain system consisting of a perforated tube and a suction bottle, was placed intrathoracically and tunneled under the skin.

Multi-Modal Data Correspondence for the 4D Analysis of the Spine with Adolescent Idiopathic Scoliosis.

Adolescent idiopathic scoliosis is a three-dimensional spinal deformity that evolves during adolescence. Combined with static 3D X-ray acquisitions, novel approaches using motion capture allow for the analysis of the patient dynamics. However, as of today, they cannot provide an internal analysis of the spine in motion.

Safety and Efficacy of Stand-Alone Bioactive Glass Injectable Putty or Granules in Posterior Vertebral Fusion for Adolescent Idiopathic and Non-Idiopathic Scoliosis.

Posterior spinal fusion (PSF) is the standard procedure for the treatment of severe scoliosis. PSF is a standard procedure that combines posterior instrumentation with bone grafting and/or bone substitutes to enhance fusion. The aim of this retrospective study was to evaluate and compare the post-operative safety and efficiency of stand-alone bioactive glass putty and granules in posterior spine fusion for scoliosis in a paediatric cohort.

Full-endoscopic technique for posterior fossa decompression in Chiari malformation type I: An anatomical feasibility study in human cadavers.

Although endoscope-assisted techniques have been described, a full-endoscopic approach is yet to be performed for posterior fossa decompression (PFD) in Chiari malformation type I (CM-I). This study aims to describe the full-endoscopic PFD technique and evaluate its feasibility. Five fresh-frozen anonymized adult human cadavers were operated on using an endoscope with an oval shaft cross-section with a diameter of 9.

Virtual Scoliosis Surgery Using a 3D-Printed Model Based on Biplanar Radiographs.

The aim of this paper is to describe a protocol that simulates the spinal surgery undergone by adolescents with idiopathic scoliosis (AIS) by using a 3D-printed spine model. Patients with AIS underwent pre- and postoperative bi-planar low-dose X-rays from which a numerical 3D model of their spine was generated. The preoperative numerical spine model was subsequently 3D printed to virtually reproduce the spine surgery.

Comparison of Trunk Motion between Moderate AIS and Healthy Children.

Analysis of kinematic and postural data of adolescent idiopathic scoliosis (AIS) patients seems relevant for a better understanding of biomechanical aspects involved in AIS and its etiopathogenesis. The present project aimed at investigating kinematic differences and asymmetries in early AIS in a static task and in uniplanar trunk movements (rotations, lateral bending, and forward bending). Trunk kinematics and posture were assessed using a 3D motion analysis system and a force plate.

Kickstand rods and correction of coronal malalignment in patients with adult spinal deformity.

Purpose: Coronal malalignment (CM) is a challenging spinal deformity to treat. The kickstand rod (KR) technique is powerful for correcting truncal shift. This study tested the hypothesis that the KR technique provides superior coronal alignment correction in adult deformity compared with traditional rod techniques.

Is frailty responsive to surgical correction of adult spinal deformity? An investigation of sagittal re-alignment and frailty component drivers of postoperative frailty status.

Purpose: Frailty has been associated with adverse postoperative outcomes. Recently, a novel frailty index for preoperative risk stratification in patients with adult spinal deformity was developed. Components of the ASD-FI utilize patient comorbidity, clinical symptoms, and patient-reported-outcome-measures (PROMS).

Are the Arbeitsgemeinschaft Für Osteosynthesefragen (AO) Principles for Long Bone Fractures Applicable to 3-Column Osteotomy to Reduce Rod Fracture Rates?

Objective: The aim was to determine whether applying Arbeitsgemeinschaft für Osteosynthesefragen (AO) principles for external fixation of long bone fracture to patients with a 3-column osteotomy (3CO) would be associated with reduced rod fracture (RF) rates.

Summary Of Background Data: AO dictate principles to follow when fixating long bone fractures: (1) decrease bone-rod distance; (2) increase the number of connecting rods; (3) increase the diameter of rods; (4) increase the working length of screws; (5) use multiaxial fixation. We hypothesized that applying these principles to patients undergoing a 3CO reduces the rate of RF.

Probability of severe frailty development among operative and nonoperative adult spinal deformity patients: an actuarial survivorship analysis over a 3-year period.

Background: Little is known of how frailty, a dynamic measure of physiological age, progresses relative to age or disability status. Operative treatment of adult spinal deformity (ASD) may play a role in frailty remediation and maintenance.

Purpose: Compare frailty status, severe frailty development, and factors influencing severe frailty development among ASD patients undergoing operative or nonoperative treatment.

Intraoperative alignment goals for distinctive sagittal morphotypes of severe cervical deformity to achieve optimal improvements in health-related quality of life measures.

Background Context: Patients with severe cervical deformity (CD) often have profound deficits in numerous activities of daily living. The association between health status and postoperative radiographic goals is difficult to quantify.

Purpose: We aimed to investigate the radiographic characteristics of patients who achieved optimal health related quality of life scores following surgery for CD.

The Influence of Surgical Intervention and Sagittal Alignment on Frailty in Adult Cervical Deformity.

Background: Frailty is a relatively new area of study for patients with cervical deformity (CD). As of yet, little is known of how operative intervention influences frailty status for patients with CD.

Objective: To investigate drivers of postoperative frailty score and variables within the cervical deformity frailty index (CD-FI) algorithm that have the greatest capacity for change following surgery.

Prediction of brace effect in scoliotic patients: blinded evaluation of a novel brace simulator-an observational cross-sectional study.

Purpose: Bracing is the most commonly used treatment for scoliosis. But braces remain predominantly "handcrafted." Our objective was to create a novel brace simulator using a high-fidelity 3D "avatar" of the patient's trunk.

The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation Following Multilevel Thoracic and Lumbar Spine Surgery: A Propensity Score Matched Analysis.

Background: Patients undergoing multilevel spine surgery are at risk for delayed extubation.

Objective: To evaluate the impact of type and volume of intraoperative fluids administered during multilevel thoracic and/or lumbar spine surgery on postoperative extubation status.

Methods: Retrospective evaluation of medical records of patients ≥ 18 yr undergoing ≥ 4 levels of thoracic and/or lumbar spine fusions was performed.

The SPOT GRADE: A New Method for Reproducibly Quantifying Surgical Wound Bleeding.

Study Design: Benchtop model with prospective surgeon video testing.

Objective: To create a surface bleeding severity scale, the SPOT GRADE (SG), for quantitative assessment of target bleeding site (TBS) blood loss. This is of particular interest for spinal surgery due to epidural bleeding and an inability to use diathermy and radiofrequency cautery close to nerve roots.

Recent and Emerging Advances in Spinal Deformity.

Background: Over the last several decades, significant advances have occurred in the assessment and management of spinal deformity.

Objective: The primary focus of this narrative review is on recent advances in adult thoracic, thoracolumbar, and lumbar deformities, with additional discussions of advances in cervical deformity and pediatric deformity.

Methods: A review of recent literature was conducted.

Ratio of lumbar 3-column osteotomy closure: patient-specific deformity characteristics and level of resection impact correction of truncal versus pelvic compensation.

Purpose: The resection point of a lumbar three-column osteotomy (3CO) creates separation of the spino-pelvic complex. This study investigates the impact of patients' baseline deformity and level of 3CO resection on the distribution of correction between the trunk and the pelvis following osteotomy closure.

Methods: Patients who underwent single lumbar 3CO, upper instrumented vertebra (UIV) T1-T10, and 6 month follow-up were included.

Defining Spino-Pelvic Alignment Thresholds: Should Operative Goals in Adult Spinal Deformity Surgery Account for Age?

Study Design: Retrospective review of prospective, multicenter database.

Objective: The aim of the study was to determine age-specific spino-pelvic parameters, to extrapolate age-specific Oswestry Disability Index (ODI) values from published Short Form (SF)-36 Physical Component Score (PCS) data, and to propose age-specific realignment thresholds for adult spinal deformity (ASD).

Summary Of Background Data: The Scoliosis Research Society-Schwab classification offers a framework for defining alignment in patients with ASD.

The benefit of nonoperative treatment for adult spinal deformity: identifying predictors for reaching a minimal clinically important difference.

Background Context: Adult spinal deformity (ASD) patients may gain minimal clinically important difference (MCID) in one or more of the health-related quality-of-life instruments without surgical intervention. The present study identifies the baseline characteristics of this subset of nonoperative patients and proposes predictors of those most likely to benefit.

Purpose: The study aims to determine the factors that affect likelihood of nonoperative patients to reach MCID.

Five-Year Follow-Up of a Prospective, Randomized Trial Comparing Two Lumbar Total Disc Replacements.

Study Design: This was a prospective, randomized, controlled, multicenter study.

Objective: The purpose of this study was to compare outcomes of two lumbar total disc replacements (TDRs) at 5-year follow-up and report results of serum ion level analysis in a subgroup of patients receiving a metal-on-metal implant.

Summary Of Background Data: Lumbar TDR has been compared with fusion in several randomized studies, finding TDR noninferior to fusion and superior on some measures.

The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery.

Background: Positive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion.

Objective: To evaluate the relationship between regional cervical sagittal alignment and postoperative outcomes for patients receiving multilevel cervical posterior fusion.

Methods: From 2006 to 2010, 113 patients received multilevel posterior cervical fusion for cervical stenosis, myelopathy, and kyphosis.

Link N is cleaved by human annulus fibrosus cells generating a fragment with retained biological activity.

Presently, there are no established treatments to prevent, stop or even retard back pain arising from disc degeneration. Previous studies have shown that Link N can act as a growth factor and stimulate the synthesis of proteoglycans and collagens, in IVD. However, the sequences in Link N involved in modulating cellular activity are not well understood.

Comparison of 2 lumbar total disc replacements: results of a prospective, randomized, controlled, multicenter Food and Drug Administration trial with 24-month follow-up.

Study Design: This was a prospective, randomized, controlled multicenter study with 24-month follow-up.

Objective: The purpose of this study was to evaluate the safety and efficacy in a Food and Drug Administration Investigation Device Exemption of a new lumbar total disc replacement (TDR) by comparing it to an earlier TDR approved for sale.

Summary Of Background Data: Randomized trials have reported TDR to produce results similar or superior to lumbar fusion.