Effect of the Ultrasonic Bone Scalpel on Blood Loss During Pediatric Spinal Deformity Correction Surgery

Abstract Background: To date, there is a paucity of reports clarifying the change of spinopelvic parameters in patients with adult spinal deformity (ASD) who underwent long segment spinal fusion using iliac screw (IS) and S2-alar-iliac screw (S2AI) fixation.Methods: A retrospective review of consecutive patients underwent deformity correction surgery for ASD between 2013 and 2017 was performed. Patients were divided into two groups based on whether IS or S2AI fixation was performed. All radiographic parameters were measured preoperatively, immediately postoperatively, and the last follow-up. Demographics, intraoperative and clinical data were analyzed between the two groups. Additionally, the cohort was subdivided according to the postoperative change in pelvic incidence (PI): subgroup (C) was defined as change in PI ≥5° and subgroup (NC) with change <5°. In subgroup analyses, the 2 different types of postoperative change of PI were directly compared.Results: A total of 142 patients met inclusion criteria: 111 who received IS and 31 received S2AI fixation. The IS group (65.6 ± 26, 39.8 ± 13.8) showed a significantly higher change in lumbar lordosis (LL) and upper lumbar lordosis (ULL) than the S2AI group (54.4 ± 17.9, 30.3 ± 9.9) (p<0.05). In subgroup (C), PI significantly increased from 53° preoperatively to 59° postoperatively at least 50% of IS cohort, with a mean change of 5.8° (p<0.05). The clinical outcomes at the last follow-up were significantly better in IS group than in S2AI group in terms of VAS scores for back and leg. The occurrence of sacroiliac joint pain and pelvic screw fracture were significantly greater in S2AI group than in IS group (25.8% vs 9%, p<0.05) and (16.1% vs 3.6%, p<0.05).Conclusions: IS fixation showed a greater change in LL and ULL than S2AI fixation in ASD surgery. PI may be changed under certain circumstances.

Download Full-text

Survivals of the Intraoperative Motor-evoked Potentials Response in Pediatric Patients Undergoing Spinal Deformity Correction Surgery

Spine ◽

10.1097/brs.0000000000003030 ◽

2019 ◽

Vol 44 (16) ◽

pp. E950-E956

Author(s):

Shujie Wang ◽

Chaoxiong Li ◽

Lanjun Guo ◽

Haimei Hu ◽

Yang Jiao ◽

...

Keyword(s):

Evoked Potentials ◽

Spinal Deformity ◽

Pediatric Patients ◽

Motor Evoked Potentials ◽

Deformity Correction ◽

Correction Surgery

Download Full-text

Patient Expectations of Adult Spinal Deformity Correction Surgery

World Neurosurgery ◽

10.1016/j.wneu.2020.11.035 ◽

2020 ◽

Author(s):

Won Hyung A. Ryu ◽

Andrew Platt ◽

John E. O'Toole ◽

Ricardo Fontes ◽

Richard G. Fessler

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Patient Expectations ◽

Correction Surgery

Download Full-text

Improved accuracy of screw implantation could decrease the incidence of post-operative hydrothorax? O-arm navigation vs. free-hand in thoracic spinal deformity correction surgery

International Orthopaedics ◽

10.1007/s00264-018-3889-8 ◽

2018 ◽

Vol 42 (9) ◽

pp. 2141-2146 ◽

Cited By ~ 2

Author(s):

Zhihui Zhao ◽

Zhen Liu ◽

Zongshan Hu ◽

Changchun Tseng ◽

Jie Li ◽

...

Keyword(s):

Spinal Deformity ◽

Deformity Correction ◽

Thoracic Spinal ◽

Correction Surgery ◽

Improved Accuracy

Download Full-text

Case-matched comparative analysis of spinal deformity correction in arthrogryposis multiplex congenita versus adolescent idiopathic scoliosis

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.7.peds18347 ◽

2019 ◽

Vol 23 (1) ◽

pp. 22-29 ◽

Cited By ~ 1

Author(s):

Liang Xu ◽

Zhonghui Chen ◽

Yong Qiu ◽

Xi Chen ◽

Song Li ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Blood Loss ◽

Idiopathic Scoliosis ◽

Spinal Deformity ◽

Operating Time ◽

Deformity Correction ◽

Operation Time ◽

Pelvic Obliquity ◽

Arthrogryposis Multiplex Congenita ◽

Sagittal Vertical Axis

OBJECTIVEAs scoliosis in arthrogryposis multiplex congenita (AMC) is unusual and the number of cases reviewed in previous studies is also relatively small, no previous study exists that has directly compared the results of spinal deformity correction between AMC and adolescent idiopathic scoliosis (AIS) patients. The aim of this study was to compare the radiographic and clinical outcomes of surgical correction of spinal deformity associated with AMC versus AIS.METHODSTwenty-four adolescents with AMC were matched with 48 AIS patients in terms of Cobb angle of main curve, curve pattern, sex, age at surgery, Risser grade, and length of follow-up. Patients in both groups underwent posterior-only spinal correction and fusion procedures. The surgical outcomes and complications were analyzed and compared between the 2 groups.RESULTSIn comparison to the AIS group, the AMC group had a significantly longer mean operation time (5.6 vs 4.4 hours, p = 0.002), more blood loss (1620 ± 250 ml vs 840 ± 260 ml, p < 0.001), and more fusion levels (14.1 ± 2.3 levels vs 12.4 ± 2.5 levels, p = 0.007) as well as a lower correction rate (44.3% ± 11.1% vs 70.8% ± 12.4%, p < 0.001) and a higher rate of loss of correction (5.0% ± 3.1% vs 2.1% ± 1.9%, p < 0.001). Nine patients in the AMC group had preoperative pelvic obliquity, which was corrected from a mean of 14.2° ± 8.4° to a mean of 4.3° ± 3.2° (p < 0.001) after the surgery. The thoracic lordosis and sagittal vertical axis were significantly improved in the AMC group. Notably, however, the AMC group was found to have higher rates of screw malpositioning (15.9% vs 9.5%, p = 0.002) and complications (8/24 [33.3%] vs 4/48 [8.3%], p = 0.016) as compared to the AIS group.CONCLUSIONSCorrection of AMC-associated scoliosis tends to require a longer operating time and involve more fusion levels but results in less correction, more blood loss, and more complications, in comparison with AIS. In addition, more attention should be paid to pelvic obliquity and sagittal hyperlordosis in AMC patients.

Download Full-text

Bilateral dual iliac screws in spinal deformity correction surgery

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-018-0969-9 ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 6

Author(s):

Shigeto Ebata ◽

Tetsuro Ohba ◽

Hiroki Oba ◽

Hirotaka Haro

Keyword(s):

Spinal Deformity ◽

Deformity Correction ◽

Iliac Screws ◽

Correction Surgery

Download Full-text

Sequential correction using satellite rod for severe thoracic idiopathic scoliosis: an effective method to optimize deformity correction

Journal of Neurosurgery Spine ◽

10.3171/2020.9.spine201168 ◽

2021 ◽

pp. 1-7

Author(s):

Yang Li ◽

Benlong Shi ◽

Dun Liu ◽

Zhen Liu ◽

Xu Sun ◽

...

Keyword(s):

Blood Loss ◽

Idiopathic Scoliosis ◽

Deformity Correction ◽

Operation Time ◽

Consecutive Series ◽

Radiographic Parameters ◽

Significant Difference ◽

Correction Surgery ◽

Thoracic Idiopathic Scoliosis

OBJECTIVE The aim of this paper was to compare the radiographic and clinical outcomes between the sequential correction (SC) technique and the traditional 2-rod correction (TC) technique in patients with severe thoracic idiopathic scoliosis (STIS) undergoing posterior-only correction surgery. METHODS Records of a consecutive series of STIS patients undergoing posterior-only correction surgery between October 2013 and October 2017 with more than 2 years of follow-up were reviewed. The radiographic parameters were assessed preoperatively, postoperatively, and at the last follow-up. Radiographic parameters, operative time, blood loss, and complications were compared between the two groups. RESULTS A total of 33 patients were included in the SC group, and 21 patients were included in the TC group. There was no significant difference in age, sex, or deformity magnitude (93.6° ± 7.8° vs 89.8° ± 6.6°, p = 0.070) preoperatively between groups. The operation time was shorter in the SC group than in the TC group (251.5 ± 42.8 minutes vs 275.4 ± 39.8 minutes, p = 0.020), while both blood loss (1284.6 ± 483.3 vs 1398.0 ± 558.4 ml, p = 0.432) and number of fused levels (13.1 ± 2.8 vs 13.6 ± 2.4, p = 0.503) were similar between the groups. Compared with the TC group, patients in the SC group had a higher correction rate (55.8% ± 9.2% vs 45.7% ± 8.8%, p < 0.001), less coronal (1.1° ± 0.81° vs 2.9° ± 0.93°, p < 0.001) and sagittal (1.5° ± 0.96° vs 2.1° ± 0.64°, p = 0.015) correction loss at the 2-year follow-up, and a lower incidence of intraoperative pedicle screw pullout (14.3% vs 23.8%, p = 0.026). CONCLUSIONS The SC technique could significantly and practically reduce the difficulty of rod installation with better deformity correction outcomes than the traditional TC technique. The SC technique was an effective alternative for patients with STIS.

Download Full-text