scholarly journals Concurrent and overlapping surgery: perspectives from surgeons on spinal posterior instrumented fusion for adolescent idiopathic scoliosis

2021 ◽  
pp. 1-7
Author(s):  
Sachin Allahabadi ◽  
Hao-Hua Wu ◽  
Sameer Allahabadi ◽  
Tiana Woolridge ◽  
Michael A. Kohn ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Level Of Evidence ◽  
Instrumented Fusion ◽  
The Public ◽  
Spine Instrumentation ◽  
Simultaneous Surgery ◽  
Posterior Spine ◽  
Strongly Agree ◽  
Posterior Instrumented Fusion

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

scholarly journals Adolescent idiopathic scoliosis: surgical treatment and quality of life

2017 ◽  
Vol 25 (3) ◽  
pp. 85-89 ◽  
Author(s):  
Luciano Miller Reis Rodrigues ◽  
Alberto Ofenhejm Gotfryd ◽  
André Nunes Machado ◽  
Matheus Defino ◽  
Leonardo Yukio Jorge Asano
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Perioperative Complications ◽  
Case Series ◽  
Clinical Results ◽  
Spine Fusion ◽  
Level Of Evidence ◽  
Posterior Spine ◽  
A Prospective Study

ABSTRACT OBJECTIVES: The purpose of this study was to determine the influence of perioperative factors and their impact on clinical and functional outcomes in Brazilian patients with adolescent idiopathic scoliosis (AIS). METHODS: We performed a prospective study with 49 consecutive AIS patients who underwent spine fusion and had a minimum 2 year follow-up. Clinical and radiographic data were correlated to SRS-30 scores in order to predict postoperative results. RESULTS: There was a negative association between patient age at the time of surgery and back pain. We also observed higher scores in the "satisfaction" domain in patients who underwent surgery after 15 years of age (p < 0.05). The average SRS-30 "mental health" score was significantly higher in males than in females (p= 0.035). Patients treated with braces had worse results than those who did not use them (p= 0.005). CONCLUSIONS: Posterior spine fusion led to improvement of all domains of the SRS-30 questionnaire. Clinical results were influenced by age, sex and the use of braces prior to surgery. There was no correlation between curve correction and presence of perioperative complications. Level of Evidence IV, Case Series.

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

Folia Medica ◽  
2018 ◽  
Vol 60 (2) ◽  
pp. 200-207 ◽  
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.

scholarly journals Adolescent idiopathic scoliosis detection and referral trends: impact treatment options

2020 ◽  
Vol 9 (1) ◽  
pp. 75-84
Author(s):  
Alison Anthony ◽  
Reinhard Zeller ◽  
Cathy Evans ◽  
Jennifer A. Dermott
Keyword(s):  
Family History ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Geographic Location ◽  
Initial Assessment ◽  
Brace Treatment ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Curve Magnitude

Abstract Study design Retrospective cross-sectional study. Objective To analyze the patient demographic referred for scoliosis to the Hospital for Sick Children to determine the proportion of patients suitable for brace treatment, as per the Scoliosis Research Society guidelines. Summary of background data There is level 1 evidence that bracing in adolescent idiopathic scoliosis (AIS) decreases the risk of curve progression and need for surgery, but optimal brace treatment requires early curve detection. Methods We performed a retrospective review of 618 consecutive patients who underwent initial assessment in our Spine Clinic between Jan. 1 and Dec. 31, 2014. We included children 10–18 years, with scoliosis greater than 10°, excluding those diagnosed with non-idiopathic curves. Primary outcomes were Cobb angle, menarchal status, and Risser score. We analyzed the effect of specific referral variables (family history, the person who first noticed the curve, and geographic location of residence) on presenting curve magnitude. Results During the study period, 335 children met the inclusion criteria, with an average age of 14.1 ± 1.8 years and a mean Cobb angle of 36.8 ± 14.5°. Brace treatment was indicated in 17% of patients; 18% had curves beyond optimal curve range for bracing (> 40°), and 55% were skeletally mature, therefore not brace candidates. The majority of curves (54%) were first detected by the patient or family member and averaged 7° more than curves first detected by a physician. A family history of scoliosis made no difference to curve magnitude, nor did geographic location of residence. Conclusion The majority of AIS patients present too late for effective management with bracing. Level of evidence III.

scholarly journals T1-weighted MR imaging of bone marrow pattern in children with adolescent idiopathic scoliosis: a preliminary study

2018 ◽  
Vol 12 (2) ◽  
pp. 181-186 ◽  
Author(s):  
S. I. Shiran ◽  
L. Shabtai ◽  
L. Ben-Sira ◽  
D. Ovadia ◽  
S. Wientroub
Keyword(s):  
Bone Marrow ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Lenke Classification ◽  
Adjacent Disc ◽  
Vertebral Bodies ◽  
Preliminary Study ◽  
Mri Study

Purpose Distinct normal physiological patterns of fat conversion in vertebrae were described both for children and adults. Our aim was to evaluate the T1-weighted bone marrow pattern of the vertebral bodies in various sites along the scoliotic spine of children with adolescent idiopathic scoliosis (AIS). Methods We retrospectively evaluated spine MRI studies of children with AIS. Scoliosis radiographs were assessed for type of curvature according to the Lenke classification. A paediatric neuroradiologist assessed the T1-weighted signal of vertebral bodies in comparison with the adjacent disc and distinct patterns of fatty conversion within the apical and stable vertebral bodies. Statistical assessment was performed. Results MRI study of the spines of 75 children with AIS were assessed, 59 (79%) of whom were female, with an age range of nine to 19 years. The relative overall T1-weighted signal intensity of the vertebral body bone marrow relative to the intervertebral disc was hyperintense in 76% and isointense in 24%. Fatty conversion grade of the stable vertebra was higher than the apex vertebra (p = 0.0001). A significant tendency to have more advanced fat conversion patterns in the apex vertebra up to age 13.5 years old compared with adolescents above that (p = 0.015) was seen. Conclusion This preliminary study suggests a different pattern of bone marrow conversion in AIS from the normal physiologic pattern described in the literature. Whether these changes are secondary to the biomechanics of the curved spine or may suggest that bone marrow maturation rate and content have a role in the pathogenesis of AIS remains to be further researched. Level of Evidence Level III (Diagnostic Study)

scholarly journals Does Thoracic Kyphosis Have Any Importance in Selective Versus Nonselective Fusion Preference in Patients With Lenke Type 5C Adolescent Idiopathic Scoliosis? A Contribution to the Guidance of the Lenke Classification

2021 ◽  
Author(s):  
Gökhan Karademir ◽  
Kerim Sarıyılmaz ◽  
Okan Özkunt ◽  
Mehmet Demirel ◽  
Fatih Dikici ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Thoracic Kyphosis ◽  
Sagittal Plane ◽  
Treatment Preference ◽  
Level Of Evidence ◽  
Lenke Classification ◽  
Selective Fusion ◽  
The Mean ◽  
Age Range

Abstract BackgroundAlthough Lenke classification analyses the sagittal plane as (+), N, and (-), it does not consider it in the choice of treatment, and it has limitations with overall thoracic kyphosis (TK). To investigate the importance of TK for treatment preference in patients with Lenke 5C adolescent idiopathic scoliosis (AIS) by comparing radiological outcomes of the patients who underwent selective fusion (SF) or nonselective fusion (NSF). MethodsThirty-two patients with Lenke type 5C AIS were included and then divided into two groups as per the fusion procedure used in the surgical treatment. SF group including 17 patients (15 females; mean age = 16 years, age range, 14–21) with normal TK and NSF group including 15 patients (11 females; mean age = 17 years, age range, 13–26) with thoracic hyper-kyphosis. Thorocolumbar/lumbar (TL/L) Cobb, thoracic (T) Cobb, TK and lumbar lordosis (LL) were measured on standing spine radiographs preoperatively and at the final follow-up. The correction rates (CR) of each radiographic parameter were calculated.ResultsNo significant differences were observed in the mean CR of all radiographic parameters, except TK and LL correction rates. The mean CR of TK was significantly higher in NSF group (-17% [range, -100–69]) than in SF group (67% [range, 9–100]) (p = 0.000). Likewise, the mean CR of LL was found significantly higher in NSF group (12.47% [range, -100–51]) than in SF group (-2.41% [range, -75–47]) (p = 0.036).ConclusionIn patients in whom Lenke's sagittal modifier is N, SF can be performed efficiently. NSF should be preferred in those with Lenke's sagittal modifiers (+) as TK can be better controlled with NSF.Level of Evidence: 3

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