953 Role of Routine Preoperative Echocardiograms in Adolescent Idiopathic Scoliosis Patients undergoing Deformity Correction Surgery

Introduction Patients with Adolescent Idiopathic Scoliosis (AIS) are often noted to have routine preoperative Echocardiograms (ECHO). The prevalence of ECHO abnormalities and their impact on perioperative outcome is not clear, especially balancing against its costs. The study aims at identifying the significance of routine preoperative ECHO for AIS patients. Methodology Clinical records of 295 adolescent AIS patients, >10years age (mean 15.64years), who underwent primary posterior corrective surgery in a tertiary spinal centre, between 2015-2020, were reviewed. Patients with revision surgery, anterior correction, syndromic/neuromuscular scoliosis and/or pre-existent known cardiac comorbidities were excluded. Results 139(47%) patients had preoperative ECHO. 21(15%) patients showed echocardiographic abnormalities (11 trivial valvular abnormalities, 5 mild root dilatation, 3 mild pericardial effusion and 2 septal defects). None of these patients showed any clinical symptoms/signs or required Cardiology assessment; and none had perioperative cardiovascular complications. Conversely, four(1.36%) patients demonstrated auscultatory murmurs on preoperative clinical assessment. None reported any perioperative complication. The average known cost of an echocardiogram was noted to be £363. Conclusions Routine preoperative Echocardiogram for all AIS patients is not recommended or deemed cost-effective. Positive clinical assessment finding could be used as a screening tool for performing ECHO in AIS patients.

Prone Transpsoas Technique for Simultaneous Single-Position Access to the Anterior and Posterior Lumbar Spine

BACKGROUND Effective decompression, arthrodesis, and correction of spinal conditions frequently utilize operative approaches that expose both the anterior and posterior spinal column. Until now, circumferential spinal column access often requires the surgeon to reposition and drape the patient multiple times or utilize a posterior only approach that has limited anterior correction capability or to utilize a lateral-only approach that complicates otherwise traditional posterior surgical maneuvers. OBJECTIVE To describe a technique utilizing a single surgical position that enables minimally disruptive anterior column correction with simultaneous access to the posterior spinal column. METHODS The operative technique for accessing the lateral lumbar interbody space from a prone transpsoas (PTP) approach is described. The rationale for this approach and a representative case example are reviewed. RESULTS The PTP approach was used to perform an L3-4 and L4-5 interbody fusion in a 71-yr-old female with spondylolisthesis, severe stenosis, and locked facets. The PTP approach enabled efficient completion of an anterior column correction, direct posterior decompression, multi-segment pedicle fixation, and maintenance of alignment, all while in a single prone position. There were no intraoperative or postoperative complications. CONCLUSION The authors’ early experience with the described PTP technique suggests it is not only feasible but offers some advantages, as it allows for single-position surgery maximizing both anterior and posterior column access and corrective techniques. Further follow-up studies of this technique are ongoing.