Showing papers by "Behrooz A. Akbarnia published in 2019"
TL;DR: Surgical and quality-of-life outcomes at the end of growing rod treatment in patients with severe versus moderate early-onset scoliosis (EOS) were similar and delaying surgery until the major curve has progressed beyond 90° is associated with larger residual deformity and more complications than treating at a lesser curve magnitude.
Abstract: STUDY DESIGN A retrospective review of a prospective, multicenter database. OBJECTIVE The aim of this study was to compare surgical and quality-of-life outcomes at the end of growing rod treatment in patients with severe versus moderate early-onset scoliosis (EOS). SUMMARY OF BACKGROUND DATA Knowledge of the outcomes of severe EOS after growth-friendly treatment is limited because this condition is uncommon. METHODS We identified 40 children with severe EOS (major curve ≥90°) treated with growing rods before age 10 with minimum 2-year follow-up after last lengthening or final fusion. From the same registry, we matched 40 patients with moderate EOS (major curve < 90°). Twenty-seven patients in the severe group and 12 in the moderate group underwent final fusion (P < 0.001). RESULTS Mean preoperative curves were 102° (range, 90°-139°) in the severe group and 63° (range, 33°-88°) in the moderate group (P < 0.001). At final follow-up, mean curves were 56° (range, 10°-91°) and 36° (range, 12°-89°), respectively (P < 0.001). Fourteen (35%) children in the severe group and 32 (80%) in the moderate group had scoliosis of < 45° at final follow-up [risk ratio (RR), 0.44; 95% confidence interval (95% CI), 0.20-0.57]. At final follow-up, 30 (75%) children in the severe group and 35 (88%) in the moderate group had achieved T1-T12 length of ≥18 cm (RR, 0.86; 95% CI, 0.70-1.09). Thirty-five children in the severe group and 26 in the moderate group had at least one complication (RR, 1.35; 95% CI, 1.05-1.73). Mean 24-Item Early-Onset Scoliosis Questionnaire scores were similar between groups at final follow-up. CONCLUSION Delaying surgery until the major curve has progressed beyond 90° is associated with larger residual deformity and more complications than treating at a lesser curve magnitude. Quality-of-life outcomes were similar between those with severe and moderate EOS. LEVEL OF EVIDENCE 3.
23 citations
TL;DR: Early reoperations were less common than later returns to the operating room in both groups, but cMIS demonstrated less risk of infection and early reoperation when compared with the HYB group.
Abstract: Study Design:A multicenter retrospective review of an adult spinal deformity database.Objective:We aimed to characterize reoperation rates and etiologies of adult spinal deformity surgery with circ...
14 citations
TL;DR: Children with skeletal dysplasia gained significantly less spinal growth during growth-friendly management of their EOS and their health-related quality of life was significantly lower both preoperatively and at final follow-up than in children with idiopathic EOS.
Abstract: Aims The aim of this study was to compare the surgical and quality-of-life outcomes of children with skeletal dysplasia to those in children with idiopathic early-onset scoliosis (EOS) undergoing g...
8 citations
TL;DR: Preoperative assessment of rest pain level in the supine position has a significant association with reduction in NRS leg and back scores in patients undergoing indirect decompression for lumbar spinal stenosis, and may successfully indicate which patients will be candidates for direct decompression with interbody fusion from an anterior or lateral approach.
Abstract: Study Design:Retrospective review of a single institution.Objective:To determine if resting leg pain level is a predictor of success for indirect decompression in the setting of lumbar spinal steno...
4 citations
2 citations
TL;DR: Despite large areas of congenital fusion, growth-friendly constructs facilitate spinal growth and improve curve correction in Escobar syndrome and these results are comparable to those in idiopathic EOS.
Abstract: BACKGROUND The aims of this study were to characterize the spinal deformity of patients with Escobar syndrome, describe results of growth-friendly treatments, and compare these results with those of an idiopathic early-onset scoliosis (EOS) cohort to determine whether the axial stiffness in Escobar syndrome limited correction. METHODS We used 2 multicenter databases to review the records of 8 patients with EOS associated with Escobar syndrome who had at least 2-year follow-up after initiation of growth-friendly treatment from 1990 to 2016. An idiopathic EOS cohort of 16 patients matched for age at surgery (±1 y), postoperative follow-up (±1 y), and initial curve magnitude (±10 degrees) was identified. A randomized 1:2 matching algorithm was applied (α=0.05). RESULTS In the Escobar group, spinal deformity involved 7 to 13 vertebrae and ranged from no vertebral anomalies in 3 patients to multiple segmentation defects in 6 patients. Mean age at first surgery was 5 years (range, 1.4 to 7.8 y) with a mean follow-up of 7.5 years (range, 4.0 to 10 y). Mean major curve improved from 76 degrees at initial presentation, to 43 degrees at first instrumentation, to 37 degrees at final follow-up (both P<0.001). Mean pelvic obliquity improved from 16 degrees (range, 5 to 31 degrees) preoperatively to 4 degrees (range, 0 to 8 degrees) at final follow-up (P=0.005). There were no differences in the mean percentage of major curve correction between the idiopathic EOS and Escobar groups at the immediate postoperative visit (P=0.743) or final follow-up (P=0.511). There were no differences between the cohorts in T1-S1 height at initial presentation (P=0.129) or in growth per month (P=0.211). CONCLUSIONS Multiple congenital fusions and spinal curve deformity are common in Escobar syndrome. Despite large areas of congenital fusion, growth-friendly constructs facilitate spinal growth and improve curve correction. These results are comparable to those in idiopathic EOS. LEVEL OF EVIDENCE Level III-case-control study.
2 citations
TL;DR: In this article, a new slot-scanning imaging system, EOS imaging, has been shown, in patients with adolescent idiopathic scoliosis, to emit significantly lower levels of ionizing radiation.
Abstract: Background: Long-term ionizing radiation exposure is a risk to young scoliosis patients. A new slot-scanning imaging system, “EOS imaging” has been shown, in patients with adolescent idiopathic scoliosis, to emit significantly lower levels of ionizing radiation. This is a single-center, preliminary report of radiographic assessment by a new system. Methods: Thirty-eight patients with early onset scoliosis (EOS) who had spine radiographs (antero-posterior, lateral or bending) were included. Patients were divided into two groups: (1) conventional radiography (CR) and (2) EOS-imaging. Patients’s demographics and total annual radiation (TAR) doses were calculated. The mean TAR dose per patient was compared to annual background radiation estimated by Radiological Society of North America (2.4 mSv). The mean radiation dose for anteroposterior and lateral spine film with the EOS imaging system was reported as 0.12 and 0.19 mSv per the manufacturer. Results: There were 25 patients in the CR and 18 patients in the EOS-imaging group. Five patients had films from both CR and EOSimaging on different occasions. Mean follow-up of the entire cohort from the first spine x-ray was 1.3 years (0.3 2 years). The mean TAR dose per patient was 10.2 mSv (3.3 20.3) and 1.3 (0.6 2.2) for CR and EOS-imaging groups, respectively. The mean TAR was 4.25× (CR) and 0.54× (EOS-imaging) that of annual background radiation. The mean age of patients at the first spine X-ray within the study period was 4.1 years (0.11 9.2) in CR and 7.6 year (3.3 10.5) in the EOS-imaging group. Conclusions: Our study shows the TAR dose per patient from EOS imaging systems are lower than conventional systems and can be utilized for patients as young as 3 years old. This study suggests that the use of this new system can reduce TAR dose in EOS patients; however, a larger cohort with longer follow-up is needed to critically examine this statement.
1 citations