Showing papers in "Spine in 2018"
TL;DR: Online information on kyphosis is low quality and its contents are of unknown source and accuracy, and clinicians should possess knowledge about the online information related to their field and contribute to the development of optimal medical videos.
Abstract: Study design A quality-control YouTube-based study using the recognized quality scoring systems. Objective In this study, our aim was to confirm the accuracy and quality of the information in kyphosis videos shared on YouTube. Summary of background data The Internet is a widely and increasingly used source for obtaining medical information both by patients and clinicians. YouTube, in particular, manifests itself as a leading source with its ease of access to information and visual advantage for Internet users. Methods The first 50 videos returned by the YouTube search engine in response to "kyphosis" keyword query were included in the study and categorized under seven and six groups, based on their source and content. The popularity of the videos was evaluated with a new index called the video power index (VPI). The quality, educational quality, and accuracy of the source of information were measured using the Journal of American Medical Association (JAMA) score, Global Quality Score (GQS), and Kyphosis-Specific Score (KSS). Results Videos had a mean duration of 397 seconds and a mean number of 131,644 views, with a total viewing number of 6,582,221. The source (uploader) in 36% of the videos was a trainer and the content in 46% of the videos was exercise training. Seventy-two percent of the videos were about postural kyphosis. Videos had a mean JAMA score of 1.36 (range: 1-4), GQS of 1.68 (range: 1-5), and KSS of 3.02 (range: 0-32). The academic group had the highest scores and the lowest VPIs. Conclusion Online information on kyphosis is low quality and its contents are of unknown source and accuracy. In order to keep the balance in sharing the right information with the patient, clinicians should possess knowledge about the online information related to their field and should contribute to the development of optimal medical videos. Level of evidence 3.
227 citations
TL;DR: Evidence supporting that total operative time is prolonged in robot-assisted surgery compared to conventional free-hand and the effective consequence of robot-assistance on radiation exposure, length of stay, and operative time remains unclear and requires meticulous examination in future studies.
Abstract: Study Design.Systematic review.Objective.The authors aim to review comparative outcome measures between robotic and free-hand spine surgical procedures including: accuracy of spinal instrumentation, radiation exposure, operative time, hospital stay, and complication rates.Summary of Background Data.
139 citations
TL;DR: In this paper, the authors studied patient profile associated with preoperative chronic opioid therapy (COT), and study COT as a risk factor for 90-day complications, emergency department (ED) visits, and readmission after primary one-to two-level posterior lumbar fusi.
Abstract: Study Design.Retrospective, economic analysis.Objective.To study patient profile associated with preoperative chronic opioid therapy (COT), and study COT as a risk factor for 90-day complications, emergency department (ED) visits, and readmission after primary one- to two-level posterior lumbar fusi
130 citations
TL;DR: In this article, the authors assess the long-term, >10-year clinical outcomes of anterior cervical discectomy and fusion and compare outcomes based on primary diagnosis of disc herniation, stenosis or advanced degenerative disc disease (DDD).
Abstract: Study Design.Prospective cohort study with >10-year follow-up.Objective.To assess the long-term, >10-year clinical outcomes of anterior cervical discectomy and fusion (ACDF) and to compare outcomes based on primary diagnosis of disc herniation, stenosis or advanced degenerative disc disease (DDD), n
123 citations
TL;DR: MIS screw placement directed by AR with intraoperative 3D imaging in a hybrid OR is accurate and efficient, without any fluoroscopy or x-ray imaging during the procedure.
Abstract: Study design Cadaveric laboratory study. Objective To assess the feasibility and accuracy of minimally invasive thoracolumbar pedicle screw placement using augmented reality (AR) surgical navigation. Summary of background data Minimally invasive spine (MIS) surgery has increasingly become the method of choice for a wide variety of spine pathologies. Navigation technology based on AR has been shown to be feasible, accurate, and safe in open procedures. AR technology may also be used for MIS surgery. Methods The AR surgical navigation was installed in a hybrid operating room (OR). The hybrid OR includes a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D imaging capabilities, integrated optical cameras for AR navigation, and patient motion tracking using optical markers on the skin. Navigation and screw placement was without any x-ray guidance. Two neurosurgeons placed 66 Jamshidi needles (two cadavers) and 18 cannulated pedicle screws (one cadaver) in the thoracolumbar spine. Technical accuracy was evaluated by measuring the distance between the tip of the actual needle position and the corresponding planned path as well as the angles between the needle and the desired path. Time needed for navigation along the virtual planned path was measured. An independent reviewer assessed the postoperative scans for the pedicle screws' clinical accuracy. Results Navigation time per insertion was 90 ± 53 seconds with an accuracy of 2.2 ± 1.3 mm. Accuracy was not dependent on operator. There was no correlation between navigation time and accuracy. The mean error angle between the Jamshidi needles and planned paths was 0.9° ± 0.8°. No screw was misplaced outside the pedicle. Two screws breached 2 to 4 mm yielding an overall accuracy of 89% (16/18). Conclusion MIS screw placement directed by AR with intraoperative 3D imaging in a hybrid OR is accurate and efficient, without any fluoroscopy or x-ray imaging during the procedure. Level of evidence N/A.
94 citations
TL;DR: In this paper, a retrospective review of the first 72 consecutive patients treated with single-position one- or two-level lateral interbody fusion with bilateral percutaneous pedicle screw and rod fixation was performed.
Abstract: Study Design.Retrospective review of prospectively collected data of the first 72 consecutive patients treated with single-position one- or two-level lateral (LLIF) or oblique lateral interbody fusion (OLLIF) with bilateral percutaneous pedicle screw and rod fixation by a single spine surgeon.Object
91 citations
TL;DR: Supplemental perioperative ketamine reduces postoperative opioid consumption up to 24 hours following spine surgery and none of the adverse events studied attained statistical significance.
Abstract: Study design A meta-analysis of randomized controlled trials (RCTs). Objective The aim of this study was to evaluate the effectiveness of perioperative supplemental ketamine to reduce postoperative opioid analgesic consumption following spine surgery. Summary of background data Although low-dose supplemental ketamine has been known to reduce pain after surgery, there is conflicting evidence regarding whether ketamine can be effective to reduce opioid consumption following spine surgery. Methods Comprehensive search of PubMed, the Cochrane Central Register of Controlled Trials for prospective RCTs, Web of Science, and Scopus. Patients who received supplemental ketamine were compared with the control group in terms of postoperative morphine equivalent consumption, pain scores, and adverse events. Mean differences (MDs) and 95% confidence intervals (CIs) were used to describe continuous outcomes. Odds ratios (ORs) and 95% CIs were applied to dichotomous outcomes. Results A total of 14 RCTs comprising 649 patients were selected for inclusion into the meta-analysis. Patients who were administered adjunctive ketamine exhibited less cumulative morphine equivalent consumption at 4, 8, 12, and 24 hours following spine surgery (all Ps 0.05). Conclusion Supplemental perioperative ketamine reduces postoperative opioid consumption up to 24 hours following spine surgery. Level of evidence 1.
84 citations
TL;DR: The efficacy and safety of full-endoscopic decompression via the interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine is delineated using a meta-analysis of five retrospective cohort studies.
Abstract: Study Design.A meta-analysis of five retrospective cohort studies.Objective.The aim of the study was to delineate the efficacy and safety of full-endoscopic decompression via the interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine using a meta-analysis.Summary of
73 citations
TL;DR: For patients with symptomatic DS, patients who received surgery had significantly greater improvements in pain and function compared with nonoperative treatment through 8 years of follow-up.
Abstract: Study Design.Randomized trial with a concurrent observational cohort study.Objective.To compare 8-year outcomes between surgery and nonoperative care and among different fusion techniques for symptomatic lumbar degenerative spondylolisthesis (DS).Summary of Background Data.Surgical treatment of DS h
73 citations
TL;DR: Depression is more common in patients with LBP among Koreans, especially in severely depressed individuals, and the presence of depression was significantly associated with L BP.
Abstract: STUDY DESIGN A cross-sectional study. OBJECTIVE This study was designed to analyze the relationship between the presence and severity of depression and low back pain (LBP) in a representative sample of the general population using a self-report screening questionnaire for depression. SUMMARY OF BACKGROUND DATA There is increasing evidence supporting an association between depression and LBP. However, the degree of the association between these two conditions in the general population is poorly understood. METHODS Health surveys and examinations were conducted on a nationally representative sample (n = 7550) of Koreans. LBP status was determined by a simple survey response concerning LBP >30 days during the past 3 months. Depression was defined as individuals with a total score >10 on the Patient Health Questionnaire (PHQ)-9 survey. The severity of depression was categorized as none (0-4), mild (5-9), moderate (10-14), moderately severe (15-19), and severe (20-27) according to PHQ-9 score. Data regarding demographics, socioeconomic history, and comorbid health conditions were used to analyze adjusted, weighted logistic regression models. RESULTS In the Korean population, the prevalence of depression was significantly greater in individuals with LBP (20.3%) than in those without LBP (4.5%). On multivariate logistic regression analysis, the presence of depression was significantly associated with LBP (adjusted odd ratio [aOR]: 3.93, P < 0.001). The risk of LBP increased with increasing severity of depression as follows: severe depression (aOR: 9.28, P < 0.001), moderately severe depression (aOR: 3.24, P = 0.001), moderate depression (aOR: 4.97, P < 0.001), and mild depression (aOR: 2.48, P < 0.001). CONCLUSION Depression is more common in patients with LBP among Koreans. The presence of depression was significantly associated with LBP, especially in severely depressed individuals. LEVEL OF EVIDENCE 3.
73 citations
TL;DR: These findings serve as a baseline in identifying patients at risk for chronic use and alter surgeons to work toward discontinuation of opioids before lumbar spinal surgery and identify modifiable risk factors associated with prolonged consumption.
Abstract: STUDY DESIGN A retrospective, observational cohort study. OBJECTIVE In patients undergoing lumbar spine arthrodesis, we sought to establish perioperative trends in chronic versus naive opioid users (OUs) and identify modifiable risk factors associated with prolonged consumption. SUMMARY OF BACKGROUND DATA The morbidity associated with excessive opioid use for chronic conditions continues to climb and has been identified as a national epidemic. Limiting excessive perioperative opioid use after procedures such as lumbar fusion remains a national health strategy. METHODS A national commercial claims dataset (2007-2015) was queried for all patients undergoing anterior lumbar interbody fusion (ALIF) and/or lumbar [posterior/transforaminal lumbar interbody fusion (P/TLIF) or posterolateral fusion (PLF)] spinal fusion procedures. Patients were labeled as either an OU (prescription within 3 months pre-surgery) or opioid naive (ON, no prescription). Rates of opioid use were evaluated preoperatively for OU, and longitudinally tracked up to 1-year postoperatively for both OU and ON. Multivariable regression techniques investigated factors associated with opioid use at 1-year following surgery. In addition, a clinical calculator (app) was created to predict 1-year narcotic use. RESULTS Overall, 26,553 patients (OU: 58.3%) underwent lumbar surgery (ALIF: 8.5%; P/TLIF: 43.8%; PLF: 41.5%; ALIF+PLF: 6.2%). At 1-month postop, 60.2% ON and 82.9% OUs had a filled opioid prescription. At 3 months, prescription rates declined significantly to 13.9% in ON versus 53.8% in OUs, while plateauing at 6 to 12-month postoperative period (ON: 8.4-9.6%; OU: 42.1-45.3%). At 1 year, significantly higher narcotic prescription filling rates were observed in OUs than in ON (42.4% vs. 8.6%; P < 0.001). Preoperative opioid use was the strongest driver of 1-year narcotic use following ALIF [odds ratio (OR): 7.86; P < 0.001], P/TLIFs (OR: 4.62; P < 0.001), or PLF (OR: 7.18; P < 0.001). CONCLUSION Approximately one-third patients chronically use opioids before lumbar arthrodesis and nearly half of the pre-op OUs will continue to use at 1 year. Our findings serve as a baseline in identifying patients at risk for chronic use and alter surgeons to work toward discontinuation of opioids before lumbar spinal surgery. LEVEL OF EVIDENCE 3.
TL;DR: Investigation of the incidence of adjacent segment disease (ASD) at 2, 5, and 10 years after primary posterior lumbar interbody fusion (PLIF) and clinical features of ASD found degenerative spondylolisthesis at the cranial segment was the most frequent.
Abstract: Study Design.A retrospective study.Objective.The aim of this study was to investigate the incidence of adjacent segment disease (ASD) at 2, 5, and 10 years after primary posterior lumbar interbody fusion (PLIF), and clinical features of ASD.Summary of Background Data.Few reports have examined ASD af
TL;DR: The history of lumbar inter body fusion surgery is focused on, starting from the foundation which was laid in the 19th and 20th century until today, when the development of material and techniques evolved from simple wiring to the combination of transforaminal interbody fusion with polyether ether ketone cages.
Abstract: In this historical study we present an overview of lumbar interbody fusion surgery, which is one of the most commonly performed instrumented spinal fusion surgeries. The present article focuses on the history of lumbar interbody fusion surgery, starting from the foundation which was laid in the 19th
TL;DR: PROMIS CATs demonstrate convergent validity, known groups validity, and responsiveness for surgically treated patients with lumbar stenosis to detect change over time and are more efficient than legacy instruments.
Abstract: Study Design.Prospective, cohort study.Objective.Demonstrate validity of Patient reported outcomes measurement information system (PROMIS) physical function, pain interference, and pain behavior computer adaptive tests (CATs) in surgically treated lumbar stenosis patients.Summary of Background Data.
TL;DR: In ASD, postsurgical outcomes and complication rates deteriorated as frailty and CCI increased, whereas surgery produced favorable outcomes and acceptable complication rates in DS and LSCS regardless of frailtyand CCI.
Abstract: STUDY DESIGN Retrospective review of surgically treated 481 adult patients with spinal disorders. OBJECTIVE The aim of this study was to elucidate the effect of frailty and comorbidities on postoperative health-related quality of life (HRQoL) and complication rates. SUMMARY OF BACKGROUND DATA Elective surgeries for spinal disorders not only improve clinical outcomes but also have high complication rates. METHODS We retrospectively reviewed the results of consecutive elective spine surgeries for 156 adult spinal deformities (ASDs: 65 ± 9 years), 152 degenerative spondylolisthesis (DS: 64 ± 10 years), or 173 lumbar spinal canal stenosis (LSCS: 71 ± 9 years) with follow-up of at least 2 years. Modified Frailty Index (mFI) and Charlson Comorbidity Index (CCI) were determined from baseline demographics. We compared the prevalence and the influence of mFI and CCI on postoperative outcomes and complication rates. RESULTS The mFI and CCI were significantly worse in ASD than in others (mFI: ASD 0.09 ± 0.12, DS 0.06 ± 0.06, LSCS 0.04 ± 0.05, P < 0.01. CCI: ASD 2.1 ± 1.6, DS 1.4 ± 0.7, LSCS 1.6 ± 0.9, P < 0.01). Postoperative HRQoL deteriorated as mFI worsened in ASD (nofrail: Oswestry Disability Index [ODI] 26 ± 11, Scoliosis Research Society Questionnaire [SRS] 3.7 ± 0.7; prefrail: ODI 32 ± 12, SRS 3.6 ± 0.6; frail: ODI 42 ± 15, SRS 3.2 ± 0.7). In DS and LSCS, however, SF-36 physical component score and mental component score improved regardless of mFI and CCI. The 2-year major complications rate increased with frailty (36%, 58%, and 81%) in ASD, but not in others. CONCLUSION ASDs were more frail and had more comorbidities than the other populations. In ASD, postsurgical outcomes and complication rates deteriorated as frailty and CCI increased, whereas surgery produced favorable outcomes and acceptable complication rates in DS and LSCS regardless of frailty and CCI. Careful patient selection and treatment of comorbidities before surgery may decrease complications and improve outcomes for the surgical treatment of ASD. LEVEL OF EVIDENCE 4.
TL;DR: Investigating the ability of Patient-Reported Outcomes Measurement Information System (PROMIS) health domains to discriminate between levels of disease severity and to determine the concurrent validity and responsiveness of PROMIS relative to “legacy” measures found it to be responsive to changes after lumbar spine surgery.
Abstract: Study design A prospective cohort study. Objective The aim of this study was to investigate the ability of Patient-Reported Outcomes Measurement Information System (PROMIS) health domains to discriminate between levels of disease severity and to determine the concurrent validity and responsiveness of PROMIS relative to "legacy" measures. Summary of background data PROMIS may measure recovery after lumbar spine surgery. Concurrent validity and responsiveness have not been compared with legacy measures in this population. Methods We included 231 adults undergoing surgery for lumbar degenerative disease. Discriminant ability of PROMIS was estimated for adjacent categories of disease severity using the Oswestry Disability Index (ODI). Concurrent validity was determined through correlation between preoperative legacy measures and PROMIS. Responsiveness was estimated using distribution-based and anchor-based criteria (change from preoperatively to within 3 months postoperatively) anchored to treatment expectations (North American Spine Society Patient Satisfaction Index) to determine minimal important differences (MIDs). Significance was accepted at P Results PROMIS discriminated between disease severity levels, with mean differences between adjacent categories of 3 to 8 points. There were strong to very strong correlations between Patient Health Questionnaire-8, Generalized Anxiety Disorder-7, and PROMIS anxiety, depression, fatigue, and sleep disturbance; between ODI and PROMIS fatigue, pain, and physical function; between the 12-Item Short-Form Health Survey physical component and PROMIS pain and physical function; and between the Brief Pain Inventory (BPI) pain interference and PROMIS depression and pain. BPI back pain and leg pain intensity showed weak or no correlation with PROMIS. Distribution-based MIDs ranged from 3.0 to 3.5 points. After incorporating longitudinal anchor-based estimates, final PROMIS MID estimates were anxiety, -4.4; depression, -6.0; fatigue, -5.3; pain, -5.4; physical function, 5.2; satisfaction with participation in social roles, 6.0; and sleep disturbance, -6.5. Conclusion PROMIS discriminated between disease severity levels, demonstrated good concurrent validity, and was responsive to changes after lumbar spine surgery. Level of evidence 2.
TL;DR: Low BMD was a significant risk factor for PJF in this propensity-matched cohort and surgeons should consider prophylactic treatments when correcting ASD in patients with low BMD, according to a selection bias in surgical strategy.
Abstract: Study Design.A propensity-matched comparison of risk factors for proximal junctional failure (PJF), which is a symptomatic proximal junctional kyphosis developing after corrective surgery for adult spinal deformity (ASD).Objective.To elucidate the role of bone strength for developing PJF.Summary of
TL;DR: Both, upper and lower C7 slope correlated strongly with T1 slope and showed similar relationship with cervical balance parameters as T 1 slope, therefore, C 7 slope could potentially substitute T1 slopes, especially upper C7 slopes due to the good visibility.
Abstract: Study Design.Retrospective analysis of consecutive 45 radiographs and 120 kinematic magnetic resonance images (kMRI)Objective.The aim was to assess the visibility of C7 and T1 endplates on radiographs, and to verify the correlation between C7 or T1 slope and cervical balance parameters using kMRI.Su
TL;DR: Health related quality of life data reveal superior outcomes in overall satisfaction and financial burden domains in theMCGR group, however, the positive effects of MCGR decrease when controlled for length of follow up, indicating that the MCGR is not yet a magic fix-all, and that the TGR remains an option in the treatment of EOS.
Abstract: Study Design.Cross-sectional study.Objective.To compare quality of life and caregiver burden in traditional growing rod (TGR) and magnetic controlled growing rods (MCGR) patients.Summary of Background Data.MCGR decrease surgical sessions associated with treatment of early onset scoliosis (EOS), hopi
TL;DR: The minimum clinically important difference (MCID) in SF-36v2 Physical Component Summary (PCS) and Mental component Summary (MCS) scores in patients undergoing surgery for degenerative cervical myelopathy (DCM) was found to be 4 points.
Abstract: Study Design.Post-hoc analysis of 606 patients enrolled in the AOSpine CSM-NA or CSM-I prospective, multicenter cohort studies.Objective.The aim of this study was to determine the minimum clinically important difference (MCID) in SF-36v2 Physical Component Summary (PCS) and Mental Component Summary
TL;DR: The intrawound application of vancomycin after posterior approach spine surgery was associated with a reduced risk of SSI and return to OR associated with SSI.
Abstract: Study Design.Secondary analysis of data from a prospective multicenter observational study.Objective.The aim of this study was to evaluate the occurrence of surgical site infection (SSI) in patients with and without intrawound vancomycin application controlling for confounding factors associated wit
TL;DR: This large, population-based study has shown that endplate defect was strongly and independently associated with DD at every lumbar disc level, providing a mechanism by which increasing age and BMI predispose to DD.
Abstract: Study Design.Cross-sectional study of spine magnetic resonance in a population, predominantly female, sample.Objective.To determine the relationship between vertebral endplate defect and intervertebral disc degeneration (DD) in general population.Summary of Background Data.Precise understanding of t
Nagoya University1, Kanazawa University2, Tohoku University3, Tohoku Pharmaceutical University4, Hamamatsu University School of Medicine5, University of Tsukuba6, Gunma University7, Wakayama Medical University8, Jichi Medical University9, Hirosaki University10, Tokai University11, Kurume University12, Chiba University13, Fujita Health University14, Kyoto University15, Shiga University of Medical Science16, University of Toyama17, Tokyo Medical and Dental University18, Keio University19
TL;DR: Perioperative complications or postoperative motor palsy were significantly related to a higher number of T-OPLL levels, comorbid ossification of ligamentum flavum rate, lower preoperative JOA score, higher preoperative positive PST rate, more surgical invasiveness, a lower rate of intraoperative spinal cord floating in ultrasonography, and higher rate of deterioration of IONM.
Abstract: Study Design.Prospective, multicenter, nationwide study.Objective.To investigate perioperative complications and risk factors in surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) using data from the registry of the Japanese Multicenter Research Organization for Ossifi
TL;DR: IONM seems to have presumable positive effects in identifying neurological deficits, however, the role of IONM in the decrease of new neurological deficits remains unclear.
Abstract: Study Design.Systematic literature review and meta-analysis.Objective.The objective of this systematic literature review was to evaluate if intraoperative neurophysiological monitoring (IONM) can prevent neurological injury during spinal operative surgical procedures.Summary of Background Data.IONM
TL;DR: A failure mechanism in MAGEC rods due to the natural off axis loading in the spine was proposed and the largest data set reporting a complete analysis of explantedMAGEC rods to date was proposed.
Abstract: Study Design.Analysis of explanted MAGnetic Expansion Control (MAGEC) growing rods.Objective.To analyze explanted MAGEC rods used in management of early onset scoliosis and identify the mode of failure in such cases.Summary of Background Data.Magnetically controlled growing rods are increasingly use
TL;DR: The improvements in visual analogue scale for neck pain and Neck Disability Index scores in the persistent nonunion group were significantly lower than those in the final union group at 2 years, and early revision could be considered if the pseudarthrosis is associated with considerable neck pain after multilevel ACDF.
Abstract: Study Design.Retrospective comparative study.Objective.To investigate the consequences and appropriate management of pseudarthrosis after anterior cervical discectomy and fusion (ACDF).Summary of Background Data.Pseudarthrosis is a frequent complication of ACDF and causes unsatisfactory results. Lit
TL;DR: It is suggested that depressed patients experience a greater magnitude of improvement in PROMIS physical function and depression scores than nondepressed patients, and despite this, depressed patients have worse postoperative outcomes for PROMis physical function, depression, pain, and ODI.
Abstract: Study Design.A retrospective cohort study.Objective.The aim of this study was to investigate the effect depression has on the improvement of patient-reported outcome measures (PROMs) following lumbar decompression.Summary of Background Data.Decompression without fusion is a viable treatment option f
TL;DR: It is identified that obesity, advanced American Society of Anesthesiologists classification, and longer operative time were predictive of postoperative SSI, and increased age, female sex, serum creatinine more than 1.5 mg/dL, and prolonged operative duration are associated with non-SSI infectious complications after SLLF.
Abstract: Study Design.Retrospective multivariate analysis of a prospectively collected, multicenter database.Objective.To identify patient characteristics and perioperative risk factors associated with postoperative infectious complications after single-level lumbar fusion (SLLF) surgery.Summary of Backgroun
TL;DR: Both iCT and 3D C-arm–based spinal navigation provides high pedicle screw accuracy rates, and Immediate screw assessability and placement accuracy in the cervical-thoracic spine, however, appear to be limited with intraoperative 3DC-arm imaging alone.
Abstract: Study Design.A prospective case-series study and a retrospective analysis of historical patients for comparison of data.Objective.To compare accuracy and limitations of intraoperative computed tomography (iCT)- versus 3D C-arm–based spinal navigation for posterior pedicle screw implantation.Summary
TL;DR: Evolution of surgical technique in AIS over the past 20 years has resulted in a cessation of anterior only surgery, increasing use of all screw constructs, less blood loss, greater use of AF, shorter operative times and LOS, lower major complications rates, and greater improvements in SRS scores.
Abstract: STUDY DESIGN Retrospective review of a prospective adolescent idiopathic scoliosis (AIS) registry. OBJECTIVE To study the evolution of the operative approach, outcomes, and complication rates in AIS surgery over the past 20 years. SUMMARY OF BACKGROUND DATA Surgical techniques in AIS surgery have evolved considerably over the past 20 years. We study the trends in the operative management of AIS over this period and their impact on perioperative outcomes. METHODS A total of 1819 AIS patients (1995-2013) with 2-year F/U were studied. Operative approach, perioperative parameters, major complication rates, and SRS outcomes were assessed. Linear regression was used to assess the trend of changes over 5-year quartiles. RESULTS Mean age at surgery was 14.6 ± 2.1 years, 80.2% were females, and this remained consistent throughout. Operative time, EBL/level, and LOS decreased over the 20 years (P < 0.0001). The use of antifibrinolytic (AF) increased from 6.7% to 68.8% in the past 10 years (P < 0.0001). Number of levels fused increased and LIV was more distal (in relation to stable vertebrae) over time in Lenke 1 and 2 curves (levels fused 7.97-9.94, P < 0.0001 and 9.8-11.0, P=0.0134, respectively). Anterior spinal fusion (ASF) in Lenke 1 curves decreased from 81% in the first quartile to 0% in the last (P = 0.0429). ASF for Lenke 5 curves evolved from 78% in the second quartile to 0 in the last. Thoracoplasty performance decreased from 76% to 20.3% (P = 0.1632). All screw constructs in PSF cases increased from 0% to 98.4% (P = 0.0095). Two-year major complication rates decreased over time (18.7%-5.1%; P = 0.0173). Increased improvement in SRS scores were observed in pain, image, function, and total domains. CONCLUSION Evolution of surgical technique in AIS over the past 20 years has resulted in a cessation of anterior only surgery, increasing use of all screw constructs, less blood loss, greater use of AF, shorter operative times and LOS, lower major complications rates, and greater improvements in SRS scores. LEVEL OF EVIDENCE 2.