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Spine Deform 2021 May 10. Epub 2021 May 10.

Department of Orthopedics University of California, Davis, Sacramento, USA.

Background: Surgical site infection is a morbid, devastating complication after spinal procedures. Studies have investigated the effect of wound lavage with 3.5% Povidone-iodine solution or the use of intrawound Vancomycin powder. Read More

World Neurosurg 2021 Apr 30. Epub 2021 Apr 30.

Antalya Training And Research Hospital - Department of Orthopaedics and Traumatology.

Background: The choice of implants in neuromuscular scoliosis (NMS) surgery remains controversial. Sublaminar polyester bands (SPBs) seem to be a promising alternative implant. The purpose of current study was to compare clinical and radiological results of posterior instrumentation and fusion using hybrid constructs versus only pedicle screws for NMS treatment. Read More

J Neurosurg Pediatr 2021 Apr 30:1-8. Epub 2021 Apr 30.

Objective: Significant investigation in the adult population has generated a body of research regarding proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following long fusions to the sacrum and pelvis. However, much less is known regarding early complications, including PJK and PJF, in the ambulatory pediatric patient. As such, the objective of this study was to address the minimal literature on early complications after ambulatory pediatric patients underwent fusion to the sacrum with instrumentation to the pelvis in the era of sacral-alar-iliac (S2AI) instrumentation. Read More

J Clin Med 2021 Apr 15;10(8). Epub 2021 Apr 15.

Department of Medical Rehabilitation, "Carol Davila" University of Medicine and Pharmacy, 041914 Bucharest, Romania.

Background: This study aimed to compare the effectiveness of radial extracorporeal shockwave and ultrasound therapies in adult patients with idiopathic scoliosis in terms of pain, disability, and quality of life.

Methods: Forty-eight patients with idiopathic scoliosis were randomly divided into three groups of 16: shockwave, ultrasound, and control. The patients were evaluated at admission (day one) and at discharge (day 14) for pain, by using the visual analogue scale; for disability, by using the Oswestry disability index; and for the quality of life, with short form-36. Read More

Spine (Phila Pa 1976) 2021 Apr 23. Epub 2021 Apr 23.

Pediatrics Orthopedics Department, Necker Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 Bd. de l'Hôpital, 75013, Paris, France.

Study Design: A prospective study.

Objective: The aim was to report the results of an alternative technique to GR for neuromuscular scoliosis using a minimally invasive fusionless surgery with a minimum of 5 years follow-up.

Summary Of Background Data: Conservative treatment is not effective in progressive neuromuscular scoliosis. Read More

Int J Spine Surg 2021 Feb 12;15(1):26-36. Epub 2021 Feb 12.

The Ohio State University Wexner Medical Center, Columbus, Ohio.

Background: Adult cervical deformity (ACD) is a potentially debilitating condition resulting from kyphosis, scoliosis, or both, of the cervical spine. Conditions such as ankylosing spondylitis, rheumatoid arthritis, Parkinson's disease, and neuromuscular diseases are particularly known to cause severe deformities. We describe the 90-day cost and complications associated with spinal fusion for ACD using International Classification of Diseases (ICD) coding terminology and study if secondary diagnoses associated with potential for severe deformity affect the cost and complication profile of ACD surgery. Read More

Braz J Anesthesiol 2021 Apr 22. Epub 2021 Apr 22.

Centro Hospitalar Universitário Lisboa Central, Hospital Dona Estefânia, Anesthesiology Department, Lisbon, Portugal.

Merosin-deficient muscular dystrophy is caused by an autosomal recessive mutation on laminin-α2 gene characterized by severe progressive muscle weakness associated with neuromuscular scoliosis and restrictive lung disease. In this case report, we describe an alternative airway approach performed in a child with anticipated difficult airway and merosin-deficient muscular dystrophy. Significant anesthetic implications may increase the perioperative risk, requiring accurate knowledge to anticipate an adequate management and provide patient-safety strategies. Read More

Spine Deform 2021 Apr 16. Epub 2021 Apr 16.

Department of Orthopedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, 3400 Bainbridge Ave, 6th Floor, Bronx, NY, 10461, USA.

Study Design: Literature Review.

Objective: Review the etiology, clinical manifestations, diagnosis, and treatment of pelvic obliquity in cerebral palsy patients with neuromuscular scoliosis. Neuromuscular scoliosis (NMS) in cerebral palsy (CP) patients is rapidly progressive and often leads to an imbalance in musculoskeletal mechanics that extends to the pelvis. Read More

Spine Surg Relat Res 2021 31;5(2):109-113. Epub 2020 Aug 31.

Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan.

Introduction: Spinal muscular atrophy (SMA) is defined as a neuromuscular disorder induced by progressive weakness of the skeletal muscle and is usually accompanied by progressive spinal deformity including scoliosis. The newly developed Nusinersen, which is the first approved drug worldwide for SMA, requires accurate intrathecal injection, which is sometimes difficult in patients with severe spinal deformity.

Technical Note: For an accurate intrathecal approach in patients who have spinal fusion surgery to treat neuromuscular scoliosis, we have combined an L3 laminectomy with spinal correction and fusion surgery. Read More

Cureus 2021 Mar 4;13(3):e13690. Epub 2021 Mar 4.

Pediatric Orthopaedic Surgery, Children's Hospital of Mississippi, Jackson, USA.

Purpose Patients who have neuromuscular scoliosis, such as cerebral palsy (CP), often develop spinal deformities that negatively impact quality of life. The vertical expandable prosthetic titanium rib (VEPTR) was designed for thoracic insufficiency syndrome (TIS), but it has also been utilized in patients with CP with restrictive lung disease and spine deformity. Few studies report on VEPTRs in neuromuscular scoliosis; however, none reports on their utilization specifically in patients with CP. Read More

Spine (Phila Pa 1976) 2021 Apr 5. Epub 2021 Apr 5.

Department of Orthopaedic Surgery, Cedars-Sinai Medical Center Children's Orthopaedic Center, Children's Hospital Los Angeles.

Study Design: Retrospective cohort study.

Objective: The purpose of this study is to investigate the incidence of surgical site infection in neuromuscular scoliosis patients at a tertiary children's hospital before and after the implementation of strategies mentioned in the 2013 Best Practice Guideline.

Summary Of Background Data: Patients with neuromuscular scoliosis are at high risk for surgical site infection following spine surgery. Read More

J Perioper Pract 2021 Apr 7:1750458920962634. Epub 2021 Apr 7.

Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

Aim: To assess the relationship of preoperative hematology laboratory results with intraoperative estimated blood loss and transfusion volumes during posterior spinal fusion for pediatric neuromuscular scoliosis.

Methods: Retrospective chart review of 179 children with neuromuscular scoliosis undergoing spinal fusion at a tertiary children's hospital between 2012 and 2017. The main outcome measure was estimated blood loss. Read More

Spine Deform 2021 Apr 6. Epub 2021 Apr 6.

Sanggye Paik Hospital, College of Medicine, Inje University, Gimhae, South Korea.

Purpose: Analyzing and comparing past Scoliosis Research Society (SRS) poster and podium presentations would allow members to see trends in areas of interest and help authors guide future research efforts.

Methods: Abstract books from 2011 to 2017 were retrieved and titles were extracted. From each title and abstract body, keywords were identified and collected. Read More

Clin Pharmacol Ther 2021 Mar 31. Epub 2021 Mar 31.

Division of Child Neurology Reference Center for Neuromuscular Disease, Centre Hospitalier Régional de Références des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège & University of La Citadelle, Liège, Belgium.

Spinal muscular atrophy (SMA) is a rare, progressive neuromuscular disease characterized by loss of motor neurons and muscle atrophy. Untreated infants with Type 1 SMA do not achieve major motor milestones, and death from respiratory failure typically occurs before 2 years. Individuals with Types 2 and 3 SMA exhibit milder phenotypes and have better functional and survival outcomes. Read More

J Pediatr Orthop 2021 Mar 29. Epub 2021 Mar 29.

University of Miami Miller School of Medicine, Miami, FL Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Cleveland, OH.

Background: Recent focus on surgical site infections (SSIs) after posterior spine fusion (PSF) has lowered infection rates by standardizing perioperative antibiotic prophylaxis. However, efforts have neglected to detail antibiotic treatment of SSIs. Our aim was to document variability in antibiotic regimens prescribed for acute and latent SSIs following PSF in children with idiopathic, neuromuscular, and syndromic scoliosis. Read More

Musculoskelet Surg 2021 Mar 22. Epub 2021 Mar 22.

Department of Orthopedics and Trauma-Surgery, Krankenhaus Nord-Klinik Floridsdorf, Brünner Strasse 68, 1210, Vienna, Austria.

Background: Numerous studies proved that all pedicle screw constructs produce the best outcome in the surgical treatment of patients with scoliosis. However, the optimal amount and distribution of screws has not yet been defined. In recent studies on idiopathic scoliosis, the correlation between curve correction and implant density has been discussed with diversifying results. Read More

JB JS Open Access 2021 Jan-Mar;6(1). Epub 2021 Mar 10.

Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Pelvic obliquity (PO), or pelvic alignment in the coronal plane, is an important radiographic parameter to indicate fusion levels and judge success of scoliosis correction in patients with neuromuscular scoliosis. There are multiple commonly used techniques to measure PO that have good to excellent interrater and intrarater reliability, but these different methods yield inconsistent values when used on the same radiograph. This study evaluates the inconsistency in the magnitude of PO measurements for patients with neuromuscular scoliosis among 5 common measurement techniques. Read More

Eur J Paediatr Neurol 2021 Mar 4;31:92-101. Epub 2021 Mar 4.

Neuromuscular Unit, Neuropediatric Department, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Center for the Biomedical Research on Rare Diseases (CIBERER), ISCIII, Spain.

The approval of nusinersen for the treatment of spinal muscular atrophy (SMA) has significantly changed the natural history of the disease. Nevertheless, scoliosis secondary to axial muscle weakness occurs at some point in most of patients with SMA and a conventional posterior interlaminar approach for intrathecal administration of nusinersen can be particularly challenging to perform in patients with severe scoliosis and/or previous spine fusion surgeries. We developed a protocol for the administration of nusinersen in pediatric patients, which includes a decision-tree algorithm that categorizes patients according to the estimated technical difficulty for the intrathecal administration. Read More

Spine Deform 2021 Mar 11. Epub 2021 Mar 11.

Division of Pediatric Anesthesiology, Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA.

Purpose: Pre-incision intrathecal morphine (IM) is a popular adjunct in adolescent idiopathic spinal deformity surgery. This study represents our 25-year experience with IM in all diagnostic groups undergoing posterior spinal fusion (PSF) and segmental instrumentation (SI).

Methods: Our prospective Pediatric Orthopaedic Spine Database (1992-2018) identified all patients undergoing PSF and SI. Read More

Spine Deform 2021 Mar 10. Epub 2021 Mar 10.

Department of Orthopaedic Surgery and Musculoskeletal Medicine, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.

Purpose: To analyze the overall deformity correction for severe neuromuscular scoliosis using laterally placed intra-operative distraction and compare to those receiving standard surgical technique.

Methods: This was a retrospective, IRB-approved, cohort study of patients with GMFCS 4 or 5 spastic cerebral palsy with neuromuscular scoliosis, age greater than 10 years, who underwent posterior spinal fusion from 2007 to 2019. All patients had vectored cervical traction with Gardner-Wells tongs, with hips flexed in a relative sitting position. Read More

Respir Care 2021 Mar 9. Epub 2021 Mar 9.

Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, United Kingdom.

Background: Subjects with thoracic scoliosis were an important group in early studies of noninvasive ventilation (NIV). The aim of this study was to describe current rates of initiation of NIV and survival after initiation in this population.

Methods: This study included patients identified as having thoracic scoliosis and established between 1993 and 2018 on home NIV. Read More

BMJ Case Rep 2021 Mar 5;14(3). Epub 2021 Mar 5.

Neurology, Charing Cross Hospital, London, London, UK.

Axial myopathies with paraspinal predominance usually present with dropped head, abnormal posture or rigidity of the spine. Management of axial myopathy can be difficult and there is little data in the literature about surgical treatment. We discuss a case of axial myopathy with late-onset scoliosis and dropped head, focusing on the surgical management of the case. Read More

J Pediatr Orthop 2021 May-Jun 01;41(5):290-295

IWK Health Centre, Halifax, NS, Canada.

Background: It is unclear whether the type of proximal anchor affects the spine length achieved with distraction-based surgeries in patients with nonidiopathic early-onset scoliosis (EOS). Since distraction may produce kyphosis, spine length should be assessed in the sagittal plane using the sagittal spine length (SSL-curved arc length of the spine in the sagittal plane). Our purpose was to determine if the type of proximal anchor in distraction-based surgeries will affect final spine length. Read More

Childs Nerv Syst 2021 Feb 26. Epub 2021 Feb 26.

Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, 57, Av. Californie, 06200, Nice, France.

Purpose: To describe the potential issues in the methodology of surgical site infection (SSI) prevention and how it was investigated and corrected in a single institution.

Methods: A pediatric orthopedic unit experienced an increase of SSI, concerning up to 10% of scoliosis surgery cases from 2011 to 2013. An institutional procedure of multimodal and interdisciplinary risk evaluation was initiated, including a review of the literature, a morbi-mortality meeting, internal and external audits concerning the hygiene conditions in the operating room, the antibiotic prophylaxis, patients, and sterile material pathways. Read More

AJNR Am J Neuroradiol 2021 May 25;42(5):980-985. Epub 2021 Feb 25.

From the School of Medicine and Public Health, University of Wisconsin, Madison, WisconsinFrom the School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.

Background: Spinal muscular atrophy is a progressive neurodegenerative disorder that can be treated with intrathecal antisense oligonucleotide therapy (nusinersen). However, administration is often complicated by posterior spinal fusion and neuromuscular scoliosis, necessitating a transforaminal approach.

Purpose: To assess the safety profile of the transforaminal approach for intrathecal access. Read More

Spine Deform 2021 Feb 23. Epub 2021 Feb 23.

Department of Orthopedic Surgery, Pediatrics and Rehabilitation, SARAH Network of Rehabilitation Hospitals, SMHS Qd 301 Bloco A, Brasília, DF, 70335-901, Brazil.

Study Design: Retrospective review of a prospective database.

Purpose: To determine the rate of short-term surgical complications in the 3-month postoperative period in patients with myelomeningocele (MMC) who underwent surgical correction of spine deformities.

Methods: This study reviewed the medical records of MMC patients, aged ≤ 18 years, who underwent spine deformity correction between 2012 and 2018. Read More

BMC Musculoskelet Disord 2021 Feb 19;22(1):204. Epub 2021 Feb 19.

Department of Orthopedic Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA.

Background: Pediatric deformity surgery traditionally involves major blood loss. Patients refusing blood transfusion add extra clinical and medicolegal challenges; specifically the Jehovah's witnesses population. The objective of this study is to review the safety and effectiveness of blood conservation techniques in patients undergoing pediatric spine deformity surgery who refuse blood transfusion. Read More

Med Arch 2020 Dec;74(6):433-438

Royal Medical Services (RMS), Amman, Jordan.

Introduction: Scoliosis could develop at the childhood age and progress beyond skeletal maturity. An early spinal fusion arrests growth of the spine and thorax, risking the development of secondary thoracic insufficiency syndrome. Vertical expandable prosthetic titanium rib (VEPTR) is a fusionless technique aiming to correct the deformity with preservation of growth potential. Read More