Relative lumbar lordosis and lordosis distribution index: individualized pelvic incidence–based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis

OBJECTIVEThe subtraction of lumbar lordosis (LL) from the pelvic incidence (PI) offers an estimate of the LL required for a given PI value. Relative LL (RLL) and the lordosis distribution index (LDI) are PI-based individualized measures. RLL quantifies the magnitude of lordosis relative to the ideal lordosis as defined by the magnitude of PI. LDI defines the magnitude of lower arc lordosis in proportion to total lordosis. The aim of this study was to compare RLL and PI − LL for their ability to predict postoperative complications and their correlations with health-related quality of life (HRQOL) scores.METHODSInclusion criteria were ≥ 4 levels of fusion and ≥ 2 years of follow-up. Mechanical complications were proximal junctional kyphosis/proximal junctional failure, distal junctional kyphosis/distal junctional failure, rod breakage, and implant-related complications. Correlations between PI − LL, RLL, PI, and HRQOL were analyzed using the Pearson correlation coefficient. Mechanical complication rates in PI − LL, RLL, LDI, RLL, and LDI interpreted together, and RLL subgroups for each PI − LL category were compared using chi-square tests and the exact test. Predictive models for mechanical complications with RLL and PI − LL were analyzed using binomial logistic regressions.RESULTSTwo hundred twenty-two patients (168 women, 54 men) were included. The mean age was 52.2 ± 19.3 years (range 18–84 years). The mean follow-up was 28.8 ± 8.2 months (range 24–62 months). There was a significant correlation between PI − LL and PI (r = 0.441, p < 0.001), threatening the use of PI − LL to quantify spinopelvic mismatch for different PI values. RLL was not correlated with PI (r = −0.093, p > 0.05); therefore, it was able to quantify divergence from ideal lordosis for all PI values. Compared with PI − LL, RLL had stronger correlations with HRQOL scores (p < 0.05). Discrimination performance was better for the model with RLL than for PI − LL. The agreement between RLL and PI − LL was high (κ = 0.943, p < 0.001), moderate (κ = 0.455, p < 0.001), and poor (κ = −0.154, p = 0.343), respectively, for large, average, and small PI sizes. When analyzed by RLL, each PI − LL category was further divided into distinct groups of patients who had different mechanical complication rates (p < 0.001).CONCLUSIONSUsing the formula of PI − LL may be insufficient to quantify normolordosis for the whole spectrum of PI values when applied as an absolute numeric value in conjunction with previously reported population-based average thresholds of 10° and 20°. Schwab PI − LL groups were found to constitute an inhomogeneous group of patients. RLL offers an individualized quantification of LL for all PI sizes. Compared with PI − LL, RLL showed a greater association with both mechanical complications and HRQOL. The use of RLL and LDI together, instead of PI − LL, for surgical planning may result in lower mechanical complication rates and better long-term HRQOL.

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Proximal Junctional Kyphosis in Lenke 5 AIS Patients: The Important Factor of Pelvic Incidence

10.21203/rs.3.rs-73074/v1 ◽

2020 ◽

Author(s):

Quan Zhou ◽

Bowen Hu ◽

Xi Yang ◽

Yueming Song ◽

Limin Liu ◽

...

Keyword(s):

Cobb Angle ◽

Pelvic Incidence ◽

Potential Mechanism ◽

Significant Difference ◽

Correction Surgery ◽

The Mean ◽

Radiographic Data ◽

Junctional Kyphosis ◽

Selection Of

Abstract BackgroundThe purpose of the study was to investigate whether pelvic incidence (PI) will affect the occurrence of PJK in Lenke 5 AIS patients after correction surgery and try to explore a better surgical scheme based on PI.MethodsLenke 5C AIS patients that underwent correction surgery for thoracolumbar/lumbar (TL/L) curves with a minimum of a 2-year follow-up were identified. Demographic and radiographic data were collected preoperatively, postoperatively, and at the final follow-up. The comparison between the PJK and the Non-PJK group was conducted and the subgroup analysis was performed based on the preoperative value of PI to investigate the potential mechanism of PJK. ResultsThe mean preoperative Cobb angle of the TL/L curve was 53.4°±8.6. At the final follow-up, the mean TL/L Cobb angle was drastically decreased to 7.3°±6.8 (P <0.001). The incidence of PJK was 21.9% (7/32) in the low PI group (PI<45°) and 15.8% (6/38) in the high PI group (PI≥45°), and there was no statistical difference between the two groups (2=0.425, P > 0.05). The UIV of the PJK subgroup was much closer to the cranial level than the Non-PJK subgroup for the high PI group (PJK vs. Non-PJK: 6.0±1.3 vs. 8.6±1.6, P = 0.003). There was no significant difference in the selection of LIV between the two groups.ConclusionsThe incidence of PJK in Lenke 5 AIS was 18.6%. Our results found no difference in the incidence of PJK according to PI, but the mechanisms of PJK may be different for different PI values. The design of surgical plans for Lenke 5 AIS patients should take individual PI into account to decrease the incidence of PJK.

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Clinical Outcomes of S2 Alar-Iliac (S2AI) Screw Technique in The Treatment of Severe Spinal Sagittal Imbalance: A Retrospective 2-Year Follow-Up Study

10.21203/rs.3.rs-1033808/v1 ◽

2021 ◽

Author(s):

Yao Zhao ◽

Beiyu Xu ◽

Longtao Qi ◽

Chunde Li ◽

Zhengrong Yu ◽

...

Keyword(s):

Lumbar Lordosis ◽

Adult Spinal Deformity ◽

Pearson Correlation ◽

Sacral Slope ◽

Sagittal Imbalance ◽

Global Alignment ◽

Mechanical Complications ◽

Group A ◽

Group B

Abstract Background The treatment of adult spinal deformity (ASD) remains a significant challenge, especially in elderly patients. This study aimed to evaluate the outcomes of the S2AI screw technique in the treatment of severe spinal sagittal imbalance with a minimum 2-year follow-up. Methods From January 2015 to December 2018, 23 patients with severe degenerative thoracolumbar kyphosis who underwent placement of S2AI screws for long segment fusion were retrospectively reviewed. Patients were divided into group A (no mechanical complications, 13 cases) and group B (with mechanical complications, 10 cases) according to the occurrence of mechanical complications at the last follow-up. Radiographic parameters were compared between groups preoperatively, 1 month postoperatively, and at the last follow-up. Risk factors for mechanical complications were analyzed. Results The incidence of mechanical complications was 43.5%, and the revision rate was 17.4%. At 1 month postoperatively, sagittal correction was better in group A than in group B (P<0.05). The lumbar lordosis (LL), pelvic incidence minus lumbar lordosis (PI-LL), T1 pelvic angle (TPA), and sagittal vertical axis (SVA) of both groups at the last follow-up were significantly different from corresponding values at 1 month postoperatively (P<0.05), and the sagittal correction was partially lost. Pearson correlation analysis revealed that the occurrence of mechanical complications was associated with sacral slope (SS), LL, PI-LL, and global alignment and proportion (GAP) score at 1 month postoperatively. Conclusion A high incidence of mechanical complications was observed in long-segment corrective surgery with the S2AI screw technique for severe spinal sagittal imbalance. Inadequate sagittal correction is a risk factor for the development of mechanical complications.

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Does the Global Alignment and Proportion score overestimate mechanical complications after adult spinal deformity correction?

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20538 ◽

2021 ◽

Vol 34 (1) ◽

pp. 96-102

Author(s):

Griffin R. Baum ◽

Alex S. Ha ◽

Meghan Cerpa ◽

Scott L. Zuckerman ◽

James D. Lin ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

External Validation ◽

Global Alignment ◽

Mechanical Complication ◽

Complication Rates ◽

Mechanical Complications ◽

Significant Difference ◽

Chi Square Analysis

OBJECTIVEThe goal of this study was to validate the Global Alignment and Proportion (GAP) score in a cohort of patients undergoing adult spinal deformity (ASD) surgery. The GAP score is a novel measure that uses sagittal parameters relative to each patient’s lumbosacral anatomy to predict mechanical complications after ASD surgery. External validation is required.METHODSAdult ASD patients undergoing > 4 levels of posterior fusion with a minimum 2-year follow-up were included. Six-week postoperative standing radiographs were used to calculate the GAP score, classified into a spinopelvic state as proportioned (P), moderately disproportioned (MD), or severely disproportioned (SD). A chi-square analysis, receiver operating characteristic curve, and Cochran-Armitage analysis were performed to assess the relationship between the GAP score and mechanical complications.RESULTSSixty-seven patients with a mean age of 52.5 years (range 18–75 years) and a mean follow-up of 2.04 years were included. Patients with < 2 years of follow-up were included only if they had an early mechanical complication. Twenty of 67 patients (29.8%) had a mechanical complication. The spinopelvic state breakdown was as follows: P group, 21/67 (31.3%); MD group, 23/67 (34.3%); and SD group, 23/67 (34.3%). Mechanical complication rates were not significantly different among all groups: P group, 19.0%; MD group, 30.3%; and SD group, 39.1% (χ2 = 1.70, p = 0.19). The rates of mechanical complications between the MD and SD groups (30.4% and 39.1%) were less than those observed in the original GAP study (MD group 36.4%–57.1% and SD group 72.7%–100%). Within the P group, the rates in this study were higher than in the original study (19.0% vs 4.0%, respectively).CONCLUSIONSThe authors found no statistically significant difference in the rate of mechanical complications between the P, MD, and SD groups. The current validation study revealed poor generalizability toward the authors’ patient population.

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Preliminary results of anterior lumbar interbody fusion, anterior column realignment for the treatment of sagittal malalignment

Neurosurgical FOCUS ◽

10.3171/2017.8.focus17423 ◽

2017 ◽

Vol 43 (6) ◽

pp. E6 ◽

Cited By ~ 17

Author(s):

Pooria Hosseini ◽

Gregory M. Mundis ◽

Robert K. Eastlack ◽

Ramin Bagheri ◽

Enrique Vargas ◽

...

Keyword(s):

Lumbar Lordosis ◽

Interbody Fusion ◽

Pelvic Incidence ◽

Anterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Proximal Junctional Kyphosis ◽

Common Complication ◽

Sagittal Malalignment ◽

Junctional Kyphosis

OBJECTIVESagittal malalignment decreases patients’ quality of life and may require surgical correction to achieve realignment goals. High-risk posterior-based osteotomy techniques are the current standard treatment for addressing sagittal malalignment. More recently, anterior lumbar interbody fusion, anterior column realignment (ALIF ACR) has been introduced as an alternative for correction of sagittal deformity. The objective of this paper was to report clinical and radiographic results for patients treated using the ALIF-ACR technique.METHODSA retrospective study of 39 patients treated with ALIF ACR was performed. Patient demographics, operative details, radiographic parameters, neurological assessments, outcome measures, and preoperative, postoperative, and mean 1-year follow-up complications were studied.RESULTSThe patient population comprised 39 patients (27 females and 12 males) with a mean follow-up of 13.3 ± 4.7 months, mean age of 66.1 ± 11.6 years, and mean body mass index of 27.3 ± 6.2 kg/m2. The mean number of ALIF levels treated was 1.5 ± 0.5. Thirty-three (84.6%) of 39 patients underwent posterior spinal fixation and 33 (84.6%) of 39 underwent posterior column osteotomy, of which 20 (60.6%) of 33 procedures were performed at the level of the ALIF ACR. Pelvic tilt, sacral slope, and pelvic incidence were not statistically significantly different between the preoperative and postoperative periods and between the preoperative and 1-year follow-up periods (except for PT between the preoperative and 1-year follow-up, p = 0.018). Sagittal vertical axis, T-1 spinopelvic inclination, lumbar lordosis, pelvic incidence–lumbar lordosis mismatch, intradiscal angle, and motion segment angle all improved from the preoperative to postoperative period and the preoperative to 1-year follow-up (p < 0.05). The changes in motion segment angle and intradiscal angle achieved in the ALIF-ACR group without osteotomy compared with the ALIF-ACR group with osteotomy at the level of ACR were not statistically significant. Total visual analog score, Oswestry Disability Index, and Scoliosis Research Society–22 scores all improved from preoperative to postoperative and preoperative to 1-year follow-up. Fourteen patients (35.9%) experienced 26 complications (15 major and 11 minor). Eleven patients required reoperation. The most common complication was proximal junctional kyphosis (6/26 complications, 23%) followed by vertebral body/endplate fracture (3/26, 12%).CONCLUSIONSThis study showed satisfactory radiographic and clinical outcomes at the 1-year follow-up. Proximal junctional kyphosis was the most common complication followed by fracture, complications that are commonly associated with sagittal realignment surgery and may not be mitigated by the anterior approach.

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The impact of increasing interbody fusion levels at the fractional curve on lordosis, curve correction, and complications in adult patients with scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20256 ◽

2020 ◽

pp. 1-10

Author(s):

Dominic Amara ◽

Praveen V. Mummaneni ◽

Shane Burch ◽

Vedat Deviren ◽

Christopher P. Ames ◽

...

Keyword(s):

Postoperative Complications ◽

Revision Surgery ◽

Lumbar Lordosis ◽

Interbody Fusion ◽

Pelvic Incidence ◽

Secondary Analysis ◽

Lumbar Interbody Fusion ◽

Curve Correction ◽

Surgery Rates

OBJECTIVERadiculopathy from the fractional curve, usually from L3 to S1, can create severe disability. However, treatment methods of the curve vary. The authors evaluated the effect of adding more levels of interbody fusion during treatment of the fractional curve.METHODSA single-institution retrospective review of adult patients treated for scoliosis between 2006 and 2016 was performed. Inclusion criteria were as follows: fractional curves from L3 to S1 > 10°, ipsilateral radicular symptoms concordant on the fractional curve concavity side, patients who underwent at least 1 interbody fusion at the level of the fractional curve, and a minimum 1-year follow-up. Primary outcomes included changes in fractional curve correction, lumbar lordosis change, pelvic incidence − lumbar lordosis mismatch change, scoliosis major curve correction, and rates of revision surgery and postoperative complications. Secondary analysis compared the same outcomes among patients undergoing posterior, anterior, and lateral approaches for their interbody fusion.RESULTSA total of 78 patients were included. There were no significant differences in age, sex, BMI, prior surgery, fractional curve degree, pelvic tilt, pelvic incidence, pelvic incidence − lumbar lordosis mismatch, sagittal vertical axis, coronal balance, scoliotic curve magnitude, proportion of patients undergoing an osteotomy, or average number of levels fused among the groups. The mean follow-up was 35.8 months (range 12–150 months). Patients undergoing more levels of interbody fusion had more fractional curve correction (7.4° vs 12.3° vs 12.1° for 1, 2, and 3 levels; p = 0.009); greater increase in lumbar lordosis (−1.8° vs 6.2° vs 13.7°, p = 0.003); and more scoliosis major curve correction (13.0° vs 13.7° vs 24.4°, p = 0.01). There were no statistically significant differences among the groups with regard to postoperative complications (overall rate 47.4%, p = 0.85) or need for revision surgery (overall rate 30.7%, p = 0.25). In the secondary analysis, patients undergoing anterior lumbar interbody fusion (ALIF) had a greater increase in lumbar lordosis (9.1° vs −0.87° for ALIF vs transforaminal lumbar interbody fusion [TLIF], p = 0.028), but also higher revision surgery rates unrelated to adjacent-segment pathology (25% vs 4.3%, p = 0.046). Higher ALIF revision surgery rates were driven by rod fracture in the majority (55%) of cases.CONCLUSIONSMore levels of interbody fusion resulted in increased lordosis, scoliosis curve correction, and fractional curve correction. However, additional levels of interbody fusion up to 3 levels did not result in more postoperative complications or morbidity. ALIF resulted in a greater lumbar lordosis increase than TLIF, but ALIF had higher revision surgery rates.

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Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

Urologia Internationalis ◽

10.1159/000371726 ◽

2015 ◽

Vol 95 (1) ◽

pp. 44-49 ◽

Cited By ~ 1

Author(s):

Maria Angela Cerruto ◽

Carolina D'Elia ◽

Francesca Maria Cavicchioli ◽

Stefano Cavalleri ◽

Matteo Balzarro ◽

...

Keyword(s):

Uterine Prolapse ◽

Pelvic Organ ◽

Consecutive Series ◽

Complication Rates ◽

Early Complications ◽

Robot Assisted ◽

Female Patients ◽

The Mean ◽

Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

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The utility of supine radiographs in the assessment of thoracic flexibility and risk of proximal junctional kyphosis

Journal of Neurosurgery Spine ◽

10.3171/2020.11.spine201565 ◽

2021 ◽

pp. 1-7

Author(s):

Francis Lovecchio ◽

Renaud Lafage ◽

Jonathan Charles Elysee ◽

Alex Huang ◽

Bryan Ang ◽

...

Keyword(s):

Thoracic Spine ◽

Lumbar Lordosis ◽

Pelvic Tilt ◽

Pelvic Incidence ◽

Vertical Axis ◽

Control Analysis ◽

Proximal Junctional Kyphosis ◽

Sagittal Vertical Axis ◽

Significant Difference ◽

Junctional Kyphosis

OBJECTIVE Supine radiographs have successfully been used for preoperative planning of lumbar deformity corrections. However, they have not been used to assess thoracic flexibility, which has recently garnered attention as a potential contributor to proximal junctional kyphosis (PJK). The purpose of this study was to compare supine to standing radiographs to assess thoracic flexibility and to determine whether thoracic flexibility is associated with PJK. METHODS A retrospective study was conducted of a single-institution database of patients with adult spinal deformity (ASD). Sagittal alignment parameters were compared between standing and supine and between pre- and postoperative radiographs. Thoracic flexibility was determined as the change between preoperative standing thoracic kyphosis (TK) and preoperative supine TK, and these changes were measured over the overall thoracic spine and the fused portion of the thoracic spine (i.e., TK fused). A case-control analysis was performed to compare thoracic flexibility between patients with PJK and those without (no PJK). The cohort was also stratified into three groups based on thoracic flexibility: kyphotic change (increased TK), lordotic change (decreased TK), and no change. The PJK rate was compared between the cohorts. RESULTS A total of 101 patients (mean 63 years old, 82.2% female, mean BMI 27.4 kg/m2) were included. Preoperative Scoliosis Research Society–Schwab ASD classification showed moderate preoperative deformity (pelvic tilt 27.7% [score ++]; pelvic incidence–lumbar lordosis mismatch 44.6% [score ++]; sagittal vertical axis 42.6% [score ++]). Postoperatively, the average offset from age-adjusted alignment goals demonstrated slight overcorrection in the study sample (−8.5° ± 15.6° pelvic incidence–lumbar lordosis mismatch, −29.2 ± 53.1 mm sagittal vertical axis, −5.4 ± 10.8 pelvic tilt, and −7.6 ± 11.7 T1 pelvic angle). TK decreased between standing and supine radiographs and increased postoperatively (TK fused: −25.3° vs −19.6° vs −29.9°; all p < 0.001). The overall rate of radiographic PJK was 23.8%. Comparisons between PJK and no PJK demonstrated that offsets from age-adjusted alignment goals were similar (p > 0.05 for all). There was a significant difference in the PJK rate when stratified by thoracic flexibility cohorts (kyphotic: 0.0% vs no change: 18.4% vs lordotic: 35.0%; p = 0.049). Logistic regression revealed thoracic flexibility (p = 0.045) as the only independent correlate of PJK. CONCLUSIONS Half of patients with ASD experienced significant changes in TK during supine positioning, a quality that may influence surgical strategy. Increased thoracic flexibility is associated with PJK, possibly secondary to fusing the patient’s spine in a flattened position intraoperatively.

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Lateral Antebrachial Cutaneous Nerve as a Donor Source for Digital Nerve Grafting: A Concept Revisited

The Open Orthopaedics Journal ◽

10.2174/1874325001711011041 ◽

2017 ◽

Vol 11 (1) ◽

pp. 1041-1048 ◽

Cited By ~ 4

Author(s):

Mehmet Bekir Unal ◽

Kemal Gokkus ◽

Evrim Sirin ◽

Eren Cansü

Keyword(s):

Pearson Correlation ◽

Mean Value ◽

Cutaneous Nerve ◽

Digital Nerve ◽

Mean Values ◽

Nerve Grafts ◽

The Mean ◽

The Difference ◽

Mean Time

Objective: The main objective of this study is to evaluate the availability of lateral antebrachial cutaneous nerve (LACN) autograft for acute or delayed repair of segmented digital nerve injuries. Patients and Methods: 13 digital nerve defects of 11 patients; treated with interposition of LACN graft that harvested from ipsilateral extremity were included in the study. Mean follow up period was 35, 7 months. The mean time from injury to grafting is 53, 3 days. The results of the mean 2PDT and SWMT values of injured /uninjured finger at the end of follow up period were evaluated with Paired T test. The correlation between the defect length and the difference of 2PDT, SWMT values between the uninjured and injured finger at the end of follow up period; were evaluated with Pearson - correlation analysis. Results: The mean value of our 2PDT and SWMT results are ~5,923, ~3, 52, respectively in which can be interpreted between the normal and diminished light touch. The defect length and difference percentage of SWMT values is positively and significantly correlated statistically. Mean length of interposed nerve grafts was 18.5 mm. The age of the patient and the mean values of 2PDT and SWMT with the difference % of 2PDT and % of SWMT are not statistically correlated. Conclusion: Based on results regarding sensory regaining at recipient side and negligible sensory deficit at harvesting side, we suggest that lateral antebrachial cutaneous nerve might be a valuable graft option for digital nerve defects.

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Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120959141 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095914

Author(s):

Justin C. Kennon ◽

Erick M. Marigi ◽

Chad E. Songy ◽

Chris Bernard ◽

Shawn W. O’Driscoll ◽

...

Keyword(s):

Clinical Outcomes ◽

Case Series ◽

Ulnar Collateral Ligament ◽

Ulnar Neuropathy ◽

Complication Rates ◽

Collateral Ligament ◽

Level Of Evidence ◽

Functional Scores ◽

The Mean

Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.

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Revision Strategies for Harrington Rod Instrumentation: Radiographic Outcomes and Complications

Global Spine Journal ◽

10.1177/2192568220960759 ◽

2020 ◽

pp. 219256822096075

Author(s):

Philip K. Louie ◽

Sravisht Iyer ◽

Krishn Khanna ◽

Garrett K. Harada ◽

Alina Khalid ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Revision Surgery ◽

Lumbar Lordosis ◽

Pelvic Incidence ◽

Vertical Axis ◽

Sagittal Vertical Axis ◽

Radiographic Outcomes ◽

Harrington Rod

Study Design: Retrospective case series. Objective: The purpose of this study is to evaluate the clinical and radiographic outcomes following revision surgery following Harrington rod instrumentation. Methods: Patients who underwent revision surgery with a minimum of 1-year follow-up for flatback syndrome following Harrington rod instrumentation for adolescent idiopathic scoliosis were identified from a multicenter dataset. Baseline demographics and intraoperative information were obtained. Preoperative, initial postoperative, and most recent spinopelvic parameters were compared. Postoperative complications and reoperations were subsequently evaluated. Results: A total of 41 patients met the inclusion criteria with an average follow-up of 27.7 months. Overall, 14 patients (34.1%) underwent a combined anterior-posterior fusion, and 27 (65.9%) underwent an osteotomy for correction. Preoperatively, the most common lower instrumented vertebra (LIV) was at L3 and L4 (61%), whereas 85% had a LIV to the pelvis after revision. The mean preoperative pelvic incidence–lumbar lordosis mismatch and C7 sagittal vertical axis were 23.7° and 89.6 mm. This was corrected to 8.1° and 28.9 mm and maintained to 9.04° and 34.4 mm at latest follow-up. Complications included deep wound infection (12.2%), durotomy (14.6%), implant related failures (14.6%), and temporary neurologic deficits (22.0%). Eight patients underwent further revision surgery at an average of 7.4 months after initial revision. Conclusions: There are multiple surgical techniques to address symptomatic flatback syndrome in patients with previous Harrington rod instrumentation for adolescent idiopathic scoliosis. At an average of 27.7 months follow-up, pelvic incidence–lumbar lordosis mismatch and C7 sagittal vertical axis can be successfully corrected and maintained. However, complication and reoperation rates remain high.

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