Vertebral Body Stapling versus Bracing for Patients with High-Risk Moderate Idiopathic Scoliosis.

Purpose. We report a comparison study of vertebral body stapling (VBS) versus a matched bracing cohort for immature patients with moderate (25 to 44°) idiopathic scoliosis (IS). Methods. 42 of 49 consecutive patients (86%) with IS were treated with VBS and followed for a minimum of 2 years. They were compared to 121 braced patients meeting identical inclusion criteria. 52 patients (66 curves) were matched according to age at start of treatment (10.6 years versus 11.1 years, resp. [P = 0.07]) and gender. Results. For thoracic curves 25-34°, VBS had a success rate (defined as curve progressio

Predicting radiographic outcomes of vertebral body tethering in adolescent idiopathic scoliosis patients using machine learning.

Anterior Vertebral Body Tethering (AVBT) is a growing alternative treatment for adolescent idiopathic scoliosis (AIS), offering an option besides spinal fusion. While AVBT aims to correct spinal deformity through growth correction, its outcomes have been mixed. To improve surgical outcomes, this study aimed to develop a machine learning-based tool to predict short- and midterm spinal curve correction in AIS patients who underwent AVBT surgery, using the most predictive clinical, radiographic, and surgical parameters. After institutional review board approval and based on inclusion criteria, 91 AIS patients who underwent AVBT surgery were selected from the Shriners Hospitals for Children, Philadelphia. For all patients, longitudinal standing (PA or AP, and lateral) and side bending spinal Radiographs were retrospectively obtained at six visits: preop and first standing, one year, two years, five years postop, and at the most recent follow-up. Demographic, radiographic, and surgical features associated with curve correction were collected. The sequential backward feature selection method was used to eliminate correlated features and to provide a rank-ordered list of the most predictive features of the AVBT correction. A Gradient Boosting Regressor (GBR) model was trained and tested using the selected features to predict the final correction of the curve in AIS patients. Eleven most predictive features were identified. The GBR model predicted the final Cobb angle with an average error of 6.3 ± 5.6 degrees. The model also provided a prediction interval, where 84% of the actual values were within the 90% prediction interval. A list of the most predictive features for AVBT curve correction was provided. The GBR model, trained on these features, predicted the final curve magnitude with a clinically acceptable margin of error. This model can be used as a clinical tool to plan AVBT surgical parameters and improve outcomes

Intraspinal pathology

The term "spinal dysraphism" covers two types of spinal congenital malformations, traditionally grouped as "open" and "closed" forms. These two groups have almost no features in common, including their embryological origin, presentation, natural history, and treatment algorithm. Open spinal dysraphism or myelomeningocele is primarily a neural tube closure defect, resulting with a more or less very stereotypic lesion and clinical presentation. The aim of treatment is to preserve the neurological and clinical status of the newborn. Closed spinal dysraphism is far more complicated and is represented by various forms of different combinations of mesodermal structures. While the neurological impairment in myelomeningocele is straightforward related to the incomplete differentiation of the neural tissue, the mechanisms of neurological impairment in closed dysraphisms are far more complex and controversial. This complexity, in turn, generates an ongoing controversy in establishing universal algorithms for treatment

Neuromuscular spine deformity/ [edited by] Amer F. Samdani, Peter O. Newton, Paul D. Sponseller, Harry L. Shufflebarger, Randal R. Betz

Includes bibliographical references and index"About 85% of spine deformities (scoliosis, kyphosis, lordosis) are idiopathic, but some forms are caused by severe neuromuscular disorder such as muscular dystrophy, cerebral palsy, Friedreich's ataxia, and spinal cord tumors and lesions. These are more difficult conditions, since curve progression is much greater than in idiopathic conditions and bracing does not usually prevent progression of the spinal curvature. Smaller curvatures in nonambulatory patients can sometimes be treated by wheelchair modifications, but most patients will undergo surgery. These surgeries are complex because of the severity of the condition itself and because of the various other medical conditions affecting these patients. There is currently no book on the topic, and chapters in spine deformity books give the topic scant coverage. Samdani et al are the world's leader in this field, and they will present the definitive book on the topic, featuring foundational chapters, coverage of the specific neuromuscular disorders, surgical techniques, and postop considerations and complications, and the will be accompanied by surgical videos. The Authors are members of the prestigious Harms Study Group, a worldwide association of spine surgeons performing multi-center research studies on scoliosis"--Provided by publisherNeuromuscular Spine Deformity; Title Page; Copyright; Dedication; Contents; Foreword; Preface; Acknowledgments; Contributors; Part I. Surgical and Medical Considerations; 1. Preoperative Evaluation and Optimization; 2. Nonoperative Management; 3. Surgical Indications in Neuromuscular Scoliosis; 4. Intraoperative Issues: Anesthesia, Neuromonitoring, Estimated Blood Loss; 5. Unique Challenges with Scoliosis and Dislocated Hips; 6. Predicting Complications: When to Operate or Not; Part II. Diagnosis Specific; 7. Scoliosis in Cerebral Palsy8. Surgical Treatment of Spinal Deformity in Myelomeningocele 9. The Patient with Spinal Cord Injury: Surgical Considerations; 10. The Spine in Duchenne Muscular Dystrophy; 11. Spinal Muscular Atrophy; 12. Other Neuromuscular Conditions: Rett Syndrome, Charcot-Marie-Tooth Disease, and Friedreich's Ataxia; 13. Neurosurgical Causes of Scoliosis; 14. Sagittal Plane Spinal Deformity in Patients with Neuromuscular Disease; 15. Spinal Deformity Associated with Neurodegenerative Disease in Adults; Part III. Surgical Techniques; 16. Sacropelvic Fixation Techniques17. Comparison of Unit Rods with Modular Constructs in Cerebral Palsy18. Halo-Gravity Traction: An Adjunctive Treatment for Severe Spinal Deformity; 19. Osteotomies: Ponte and Vertebral Column Resection; 20. Growing Spine Options for Neuromuscular Scoliosis; 21. Anterior Approaches to the Spine for Neuromuscular Spinal Deformity; Part IV. Postoperative Management and Complications; 22. Incidence of Major Complications in Surgery for Neuromuscular Spine Deformity; 23. Management of Early and Late Infection; 24. Postoperative Intensive Care Unit Management25. Reoperations: Instrumentation Failure, Junctional Kyphosis, and Cervical Extension26. Health-Related Quality of Life in Neuromuscular Scoliosis; 27. Baclofen Pump: Preoperative, Intraoperative, and Postoperative Management; Index1 online resource (xvi, 186 pages)

The Impact of Anterior Vertebral Body Tethering on Pulmonary Function.

STUDY DESIGN: Retrospective, single-center study. OBJECTIVE: To examine pulmonary function tests (PFTs) in patients undergoing anterior vertebral body tethering (AVBT). SUMMARY OF BACKGROUND DATA: The effect of AVBT on pulmonary status remains unclear. METHODS: We examined preoperative and postoperative PFTs following AVBT in a retrospective, single-center cohort of patients. Outcomes were compared using percent predicted values as continuous and categorical variables (using 10% change as significant) and divided into categorical values based on the American Thoracic Society (ATS) standards. RESULTS: 58 patients with adolescent idiopathic scoliosis were included with a mean age of 12.5±1.4 years and follow-up of 4.2±1.1 years. The mean thoracic curve was 47°±9°, which improved to 21°±12°. At baseline, the mean FEV1% and FVC% values were 79% and 82%, respectively. Four patients had normal FEV1% (≥100%), 67% had mild restrictive disease (70-99%), and the rest had worse FEV1%. Mean FEV1 improved from 2.2 to 2.6 L (P0.05) with mean postoperative PFTs at 37±12 months postoperative. The use of mini-open thoracotomy was not associated with worsening PFTs, but extension of the lowest instrumented vertebra below T12 was correlated with decreasing FEV1% in the bivariate analysis (P CONCLUSION: Pulmonary function in most patients undergoing AVBT remained stable (76%) or improved (14%); however, a subset may worsen (10%). Further studies are needed to identify the risk factors for this group, but worse preoperative PFTs and extension below T12 may be risk factors for worsening pulmonary function

Reduction in radiation (fluoroscopy) while maintaining safe placement of pedicle screws during lumbar spine fusion

OBJECTIVE: The purpose of this study is to report the results using PediGuard (electrical conductivity device) to reduce radiation exposure while drilling the pilot hole for pedicle screw placement. METHOD: Eighteen patients diagnosed with a degenerative lumbar spine, that required a posterior spinal fusion. Average age of the patients were 55 ± 12 years. Patients received postoperative CT scans of all screws. Scans were reviewed by an independent reviewer grading 'in' 2 mm of breach. In a randomized fashion, the surgeon created pilot holes with either his standard technique or by using the PediGuard. Fluoroscopy was used for each drilling as necessary. Once the pilot hole was created, the surgeon inserted titanium screws into the pedicle pilot holes. A total of 78 screws (39 standard probe and 39 PediGuard ) were analyzed. RESULTS: 78 screws (39 standard probe and 39 PediGuard were analyzed. No significant difference in breach rate > 2mm by either method (p=1.000), with one screw out in each group. Fluoroscopy shots averaged 5.2 (range, 0 to 15), average decrease of 2.3 (30%) per screw in the PediGuard group vs. 7.5 (range, 2 to 17) in the standard group (p< .001). CONCLUSION: This trial to assess pedicle probe location within the pedicle and vertebral body showed the number of fluoroscopy shots were reduced by 30%, compared to a standard probe while maintaining a 97.5% screw placement accuracy