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Study Design: Retrospective cohort study.Objective: To investigate the relationship between body mass index (BMI), spine flexibility index (FI), and their combined effects on adolescent idiopathic scoliosis (AIS) surgical outcomes.Background: BMI and FI are two factors considered during presurgical planning for AIS correction, but there is sparse research about their relationship. We hypothesize that AIS patients with increased BMI may be associated with decreased FI-a combination which could lead to worsened surgical outcomes.Materials and Methods: AIS patients ages 11 to 19 at surgery, who underwent posterior fusion at a single center from 2011 to 2017, were reviewed. Patients without proper radiographs to assess FI, or a previous spine surgical history, were excluded. FI was categorized as stiff (FI<50) or flexible (FI≥50), and patients were separated by major curve region. BMI was categorized as underweight (less than fifth percentile), healthy weight (fifth-85th percentile), overweight (85th-95th percentile), or obese (>95th percentile). Regression analysis was conducted to test BMI and FI's effects on intraoperative, immediate postoperative, and two-year postoperative outcomes.Results: A total of 543 patients (82% female), with an average age of 14.9 years, were included. In all, 346 patients had available two-year data. A 10% increase in BMI was associated with a 1.3% decrease in FI for patients with major thoracolumbar/lumbar curves ( P =0.01). Obese patients were most likely to have a postoperative complication ( P =0.003) or a two-year complication ( P =0.04). Revision surgery occurred after 58% of postoperative complications (15/26) and 80% of two-year complications (4/5). FI was negatively associated with initial curve magnitude ( P <0.001), operative time ( P =0.02), and blood loss ( P =0.02). Overweight patients with flexible curves were 10.0 times more likely to sustain a postoperative complication than healthy weight patients with stiff curves ( P =0.001).Conclusions: Elevated BMI was associated with decreased FI in patients with major thoracolumbar/lumbar curves. Patients with a high BMI and high FI were associated with the greatest risk of postoperative complication. [ABSTRACT FROM AUTHOR]

Background: This study investigated the frequency and potential risk factors associated with the development of distal femoral valgus deformity following plate fixation of diaphyseal femoral fractures in children. Methods: Records of eighty-five skeletally immature patients who underwent plate fixation of a diaphyseal femoral fracture at a tertiary-care pediatric center from January 2003 to December 2010 were reviewed. Demographic data and clinical information were analyzed. Radiographic measurement of the distance from the distal plate edge to the distal femoral physis and of the anatomic lateral distal femoral angle was performed. Development of distal femoral valgus deformity was defined as a change in the anatomic lateral distal femoral angle of ≥5° in the valgus direction. Logistic regression analysis and contingency tables were used to relate the development of distal femoral valgus deformity with retention of hardware, patient age, fracture site, plate-to-physis distance, and the location of a bend in the plate at fixation. Results: Midshaft fractures (45%) were more common than proximal or distal diaphyseal fractures. lntraoperatively,, the plate was bent proximally or distally, or both, in 80% of the patients. Distal femoral valgus deformity of ≥5° was seen in ten patients, eight of whom had distal diaphyseal fractures. Three of the ten patients developed symptoms as a result of the distal femoral valgus deformity that required at least one unplanned additional surgical procedure. On the basis of the statistical analysis, patients with a plate-to-physis distance of ⩽20 mm (relative risk= 12.77, p = 0.005) and a distal fracture (relative risk = 11.0, p < 0.001) were at a significantly higher risk of developing distal femoral valgus deformity. Although not clearly an independent factor, a distal bend was also found to be associated with distal femoral valgus deformity (p = 0.004) but was not predictive of the pathology. Conclusions: Distal femoral valgus deformity occurred in 30% of patients with distal diaphyseal fractures and in 12% overall. We advocate long-term monitoring of patients with femoral plate fixation, particularly those in whom the plate is placed ⩽20 mm from the distal femoral physis. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

The article analyzes the sagittal spinopelvic alignment in high-grade spondylolisthesis patients based on pelvic version and spine balance. Digitized sagittal radiographs of 133 patients were measured to determine sagittal alignment. Based on the results, the authors concluded that there were distinct groups termed balanced and unbalanced pelvis. These unbalanced pelvis patients had a sagittal spinal alignment the differed from the balanced pelvis.

Almost half of growing rod (GR) patients that undergo final fusion (FF) have an extension of instrumented levels. The purpose of this study was to review sagittal plane radiographic parameters of patients with distal extension of instrumented levels at FF to those whose levels remained the same. Radiographs were assessed preoperatively, after GR insertion/first lengthening, following GR treatment before FFs, and after FF. Measurements included sagittal balance, lumbar lordosis, thoracic kyphosis, and distal junction angle (DJA). Twenty-one patients were included. There was no change in sagittal balance. There was a significant decrease in lordosis and kyphosis following initial GR implantation. Kyphosis and lordosis increased during the GR period, but remained unchanged at time of FF. DJA increased 8° on average. Seven patients had distal extension of instrumented levels at time of FF (average 2 levels, range: 1-4). Indication for distal extension was sagittal plane decompensation in four cases. When comparing patients who had distal extension at the time of FF to those whose levels remained the same, there was no difference in the change in sagittal balance, lordosis, or kyphosis. Final DJA was significantly smaller in those patients with distal extension. Most GR patients that undergo FF demonstrate acceptable correction of sagittal plane radiographic parameters. A small cohort of patients requires distal extension at FF due to sagittal plane decompensation., Level of Evidence: Level IV, Therapeutic.