Reinstrumentation for rapid curve progression after implant removal following posterior instrumented fusion in adolescent idiopathic scoliosis: a case report

Purpose The purpose of this study was to determine perspectives of surgeons regarding simultaneous surgery in patients undergoing posterior spine instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS). Methods A survey was administered to orthopaedic trainees and faculty regarding simultaneous surgery for primary PSIF for AIS. A five-point Likert scale (1: ‘Strongly Disagree’ to 5: ‘Strongly Agree’) was used to assess agreement with statements about simultaneous surgery. We divided simultaneous surgery into concurrent, when critical portions of operations occur at the same time, and overlapping, when noncritical portions occur at the same time. Results The 72 respondents (78.3% of 92 surveyed) disagreed with concurrent surgery for ‘one of my patients’ (response mean 1.76 (sd 1.03)) but were more accepting of overlapping surgery (mean 3.94 (sd 0.99); p < 0.0001). The rating difference between concurrent and overlapping surgery was smaller for paediatric and spine surgeons (-1.25) than for residents or those who did not identify a subspecialty (-2.17; p = 0.0246) or other subspecialty surgeons (-2.57; p = 0.0026). Respondents were more likely to agree with explicit informed consent for concurrent surgery compared with overlapping (mean 4.32 (sd 0.91) versus 3.44 (sd 1.14); p < 0.001). Conclusion Orthopaedic surgeons disagreed with concurrent but were more accepting of overlapping surgery and anaesthesia for PSIF for AIS. Respondents were in greater agreement that patients should be explicitly informed of concurrence than of overlap. The surgical community’s evidence and position regarding simultaneous surgery, in particular overlapping, must be more effectively presented to the public in order to bridge the gap in perspectives. Level of Evidence IV

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Results of Thoracoscopic Instrumented Fusion versus Conventional Posterior Instrumented Fusion in Adolescent Idiopathic Scoliosis Undergoing Selective Thoracic Fusion

Spine ◽

10.1097/01.brs.0000138304.77946.ea ◽

2004 ◽

Vol 29 (18) ◽

pp. 2031-2038 ◽

Cited By ~ 55

Author(s):

Hee-Kit Wong ◽

Hwan-Tak Hee ◽

Zhirong Yu ◽

David Wong

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Instrumented Fusion ◽

Selective Thoracic Fusion ◽

Posterior Instrumented Fusion

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Perioperative Blood Management in Posterior Instrumented Fusion for Adolescent Idiopathic Scoliosis: Original Study and Short Review of the Literature

Folia Medica ◽

10.1515/folmed-2017-0100 ◽

2018 ◽

Vol 60 (2) ◽

pp. 200-207 ◽

Cited By ~ 1

Author(s):

Lamprini Katranitsa ◽

Nikolaos Gkantsinikoudis ◽

Stylianos Kapetanakis ◽

Georgios Charitoudis ◽

Anastasios Christodoulou ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Blood Transfusion ◽

Idiopathic Scoliosis ◽

Autologous Blood ◽

Allogeneic Blood Transfusion ◽

Allogeneic Blood ◽

Instrumented Fusion ◽

Group A ◽

Group B ◽

Posterior Instrumented Fusion

Abstract Background: The potential hazards of allogeneic blood transfusion are well established in literature. Few things are known, however, about the results of combining different blood saving techniques and their results in avoiding allogeneic blood transfusion (ABT) in scoliosis surgery. Aim: To report specific results about utilization of preoperative autologous blood donation (PABD) and intraoperative blood-saver (BLDS) in conjunction, aiming to minimize the need for ABT. Materials and methods: Between 1989 and 2012, 107 patients underwent posterior instrumented fusion (PIF) for adolescent idiopathic scoliosis (AIS) correction. Retrospective evaluation was conducted. Patients were classified into two groups, according to the method utilized: group A with only allogeneic blood transfusion (ABT) and group B where PABD with BLDS intraoperatively was applied. Hematocrit and hemoglobin values were evaluated preoperatively, postoperatively, and at discharge. The variables we examined included also gender, age, levels fused and number of predeposited blood units, required transfused blood units (TBU), as well as ABT rates between the two groups. Results: More than 70% of the transfusions in both groups were needed intraoperatively. In group A, an average of 2.4 units per patient was transfused and ABT reached 76%. In contrast, in group B an average of 4.5 units per patient was transfused but ABT rate was only 7.3%, while the rest 92.7% was autologous blood. However, the wasted autologous blood reached 24.9%. Conclusions: Our results demonstrated that PABD with intraoperative cell salvage (CS) is associated with statistically significant ABT rates decrement but the combination of these methods cannot assure ABT avoidance.

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Should L3 be selected as the lowest instrumented vertebra in patients with Lenke type 5C adolescent idiopathic scoliosis whose lowest end vertebra is L4?

Journal of Neurosurgery Spine ◽

10.3171/2020.11.spine201807 ◽

2021 ◽

pp. 1-10

Author(s):

Tomohiro Banno ◽

Yu Yamato ◽

Hiroki Oba ◽

Tetsuro Ohba ◽

Tomohiko Hasegawa ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Curve Progression ◽

Global Alignment ◽

Fusion Surgery ◽

Radiographic Outcomes ◽

Lowest Instrumented Vertebra ◽

Upper Instrumented Vertebra ◽

Coronal Decompensation

OBJECTIVE L3 is most often selected as the lowest instrumented vertebra (LIV) to conserve mobile segments in fusion surgery; however, in cases with the lowest end vertebra (LEV) at L4, LIV selection as L3 could have a potential risk of correction loss and coronal decompensation. This study aimed to compare the clinical and radiographic outcomes depending on the LEV in adolescent idiopathic scoliosis (AIS) patients with Lenke type 5C curves. METHODS Data from 49 AIS patients with Lenke type 5C curves who underwent selective thoracolumbar/lumbar (TL/L) fusion to L3 as the LIV were retrospectively analyzed. The patients were classified according to their LEVs into L3 and L4 groups. In the L4 group, subanalysis was performed according to the upper instrumented vertebra (UIV) level toward the upper end vertebra (UEV and 1 level above the UEV [UEV+1] subgroups). Radiographic parameters and clinical outcomes were compared between these groups. RESULTS Among 49 patients, 32 and 17 were in the L3 and L4 groups, respectively. The L4 group showed a lower TL/L curve correction rate and a higher subjacent disc angle postoperatively than the L3 group. Although no intergroup difference was observed in coronal balance (CB), the L4 group showed a significantly higher main thoracic (MT) and TL/L curve progression during the postoperative follow-up period than the L3 group. In the L4 group, the UEV+1 subgroup showed a higher absolute value of CB at 2 years than the UEV subgroup. CONCLUSIONS In Lenke type 5C AIS patients with posterior selective TL/L fusion to L3 as the LIV, patients with their LEVs at L4 showed postoperative MT and TL/L curve progression; however, no significant differences were observed in global alignment and clinical outcome.

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