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Background: Thoracic anterior vertebral body tethering (TAVBT) is an emerging treatment for adolescent idiopathic scoliosis. Tether breakage is a known complication of TAVBT with incompletely known incidence. We aim to define the incidence of tether breakage in patients with adolescent idiopathic scoliosis who undergo TAVBT. The incidence of tether breakage in TAVBT is hypothesized to be high and increase with time postoperatively., Methods: All patients with right-sided, thoracic curves who underwent TAVBT with at least 2 and up to 3 years of radiographic follow-up were included. Tether breakage between 2 vertebrae was defined a priori as any increase in adjacent screw angle >5 degrees from the minimum over the follow-up period. The presence and timing of tether breakage were noted for each patient. A Kaplan-Meier survival analysis was performed to calculate expected tether breakage up to 36 months. χ 2 analysis was performed to examine the relationship between tether breakage and reoperations. Independent t test was used to compare the average final Cobb angle between cohorts., Results: In total, 208 patients from 10 centers were included in our review. Radiographically identified tether breakage occurred in 75 patients (36%). The initial break occurred at or beyond 24 months in 66 patients (88%). Kaplan-Meier survival analysis estimated the cumulative rate of expected tether breakage to be 19% at 24 months, increasing to 50% at 36 months. Twenty-one patients (28%) with a radiographically identified tether breakage went on to require reoperation, with 9 patients (12%) requiring conversion to posterior spinal fusion. Patients with a radiographically identified tether breakage went on to require conversion to posterior spinal fusion more often than those patients without identified tether breakage (12% vs. 2%; P =0.004). The average major coronal curve angle at final follow-up was significantly larger for patients with radiographically identified tether breakage than for those without tether breakage (31 deg±12 deg vs. 26 deg±12 deg; P =0.002)., Conclusions: The incidence of tether breakage in TAVBT is high, and it is expected to occur in 50% of patients by 36 months postoperatively., Level of Evidence: Level IV., Competing Interests: Compliance with Ethical Standards: (i) This study was given Ethical Approval by the Institutional Review Board prior to the conduct of this study. (ii) Informed consent was obtained from all participants. (iii) The authors received no funding for the preparation of this manuscript. (iv) The authors of this work have no disclosures or potential conflicts of interest related to this study. B.S.L.: Consultant and speaker’s bureau for Zim Vie Tether and receives royalties. J.M.P.: Consultant for ZimVie. A.A.: Consultant for Zimvie and receives royalties. L.C.B.: PATENTS (1) Kunes; Brian; (Washington, DC); Hollins; Stacy; (New Castle, VA); Blakemore; Laurel; (Falls Church, VA); Hsu; Brian; (Greenwich, AU); Ferguson; John; (Auckland, NZ). Anterior tether tensioner. US Patent Application 17/091773, filed November 6, 2020. (2) Blakemore, Laurel (Williston, FL) Ross, Catherine(Arlington, VA). Tethering Screw System. US Patent 10,548,639. Filed April 25, 2016, issued February 4, 2020. P.O.N.: ZimVie through Setting Scoliosis Straight Foundation—Research support. A.F.S.: Zim Vie—IP royalties and paid consultant. L.L.H.: Zimmer: Paid presenter or speaker. S.A.S.: Globus Medical Royalties. The remaining authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Accurate reporting of long-term complications of surgical treatment of adolescent idiopathic scoliosis (AIS) is critical, but incomplete. This study aimed to report on the rate of complications following surgical treatment of AIS among patients with at least 10 years of follow-up., Methods: This was a retrospective review of prospectively collected data from a multicenter registry of patients who underwent surgical treatment for AIS with minimum 10-year follow-up. Previously published complications were defined as major if they resulted in reoperation, prolonged hospital stay/readmission, neurological deficits, or were considered life-threatening. Rates and causes of reoperations were also reviewed., Results: Two hundred and eighty-two patients were identified with mean age at surgery of 14.6 ± 2.1 years. Mean follow-up was 10.6 (range 9.5-14) years. Eighty-seven patients had anterior spinal fusion (ASF); 195 had posterior spinal fusion (PSF). The overall major complication rate was 9.9% (n = 28) in 27 patients. Among PSF patients, the complication rate was 9.7% (n = 19) in 18 patients. The complications were surgical site infection (37%), adding-on (26%), pulmonary (16%), neurologic (11%), instrumentation (5%), and gastrointestinal (5%). In ASF patients, the complication rate was 10.3% (n = 9) among nine patients. The complications were pulmonary (44%), pseudoarthrosis (22%), neurologic (11%), adding-on (11%), and gastrointestinal (11%). The reoperation rate was 6.0% (n = 17) among 17 patients. Although most of the complications presented within the first 2 years (60.7%), surgical site infection and adding-on were also seen late into the 10-year period., Conclusion: This is the largest prospective study with at least a 10-year follow-up of complications following spinal fusion for AIS, the overall major complication rate was 9.9% with a reoperation rate of 6.0%. Complications presented throughout the 10-year period, making long-term follow-up very important for surveillance., Level of Evidence: Therapeutic II., (© 2022. The Author(s), under exclusive licence to Scoliosis Research Society.)

Study Design: Multicenter retrospective review., Objective: To calculate overall incidence of pedicle screw "plowing" in adolescent idiopathic scoliosis (AIS) patients who underwent posterior spinal fusion (PSF). To identify risk factors for pedicle screw plowing and associated postoperative outcomes, including loss of correction and revision rate., Summary of Background Data: Curve correction of AIS generates perpendicular stresses that can cause pedicle screws to lose alignment and "plow" through pedicles craniocaudally., Methods: We reviewed records of 1057 patients who underwent PSF for AIS from 2002 to 2015. Preoperative and first postoperative erect radiographs were evaluated by two observers to determine (1) presence of plowing and (2) subsequent loss of correction (LOC). Plowing was defined as more than 25° sagittal angulation compared with pedicle axis or entry of the most dorsal part of the screw outside the pedicle projection. LOC was defined as postoperative change in focal angulation of an instrumented spinal level, when in consensus of both reviewers. Bivariate analyses were performed (alpha = 0.05)., Results: Nineteen thousand five hundred sixty nine screws were assessed across our cohort of 1057 patients. Both observers agreed that 48 patients (4.5%) demonstrated plowing of more than or equal to one pedicle screw. For 72 screws (0.4%), both observers noted plowing, most commonly through the cranial cortex of the pedicle (65/72 screws) and at the lowest instrument vertebra (LIV) (17/72 screws). Factors associated with plowing included larger curves (P = 0.02); lower mean pedicle screw density (P = 0.0003); skeletal immaturity as measured by open triradiate cartilage (P = 0.04); and younger chronological age at time of surgery (P = 0.04). LOC occurred in 13 patients, most commonly at LIV (P < 0.0001). Revision rate for loss of screw fixation was higher in the plowing group (P = 0.003)., Conclusion: Pedicle screw plowing occurred in 4.5% of AIS patients, especially in those skeletally immature and with decreased implant density. Plowing commonly occurred in the cranial direction and was associated with LOC, particularly at the LIV.Level of Evidence: 3., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: A multicenter, prospectively collected database of 20 years of operatively treated adolescent idiopathic scoliosis (AIS) was utilized to retrospectively examine pre- and postoperative thoracic kyphosis at 2-year follow-up., Objective: To determine if the adoption of advanced three-dimensional correction techniques has led to improved thoracic kyphosis correction in AIS., Summary of Background Data: Over the past 20 years, there has been an evolution of operative treatment for AIS, with more emphasis on sagittal and axial planes. Thoracic hypokyphosis was well treated with an anterior approach, but this was not addressed sufficiently in early posterior approaches. We hypothesized that patients with preoperative thoracic hypokyphosis prior to 2000 would have superior thoracic kyphosis restoration, but the learning curve with pedicle screws would reflect initially inferior restoration and eventual improvement., Methods: From 1995 to 2015, 1063 patients with preoperative thoracic hypokyphosis (<10°) were identified. A validated formula for assessing three-dimensional sagittal alignment using two-dimensional kyphosis and thoracic Cobb angle was applied. Patients were divided into 1995-2000 (Period 1, primarily anterior), 2001-2009 (Period 2, early thoracic pedicle screws), and 2010-2015 (Period 3, modern posterior) cohorts. Two-way repeated measures analysis of variance and post-hoc Bonferroni corrections were utilized with P < 0.05 considered significant., Results: Significant differences were demonstrated. Period 1 had excellent restoration of thoracic kyphosis, which worsened in Period 2 and improved to near Period 1 levels during Period 3. Period 3 had superior thoracic kyphosis restoration compared with Period 2., Conclusion: Although the shift from anterior to posterior approaches in AIS was initially associated with worse thoracic kyphosis restoration, this improved with time. The proportion of patients restored to >20° kyphosis with a contemporary posterior approach has steadily improved to that of the era when anterior approaches were more common., Level of Evidence: 3.

Study Design: A retrospective analysis of a prospectively collected database was performed., Objective: The purpose of this study is to compare 3-dimensional correction associated with the anterior release (AR) and contemporary posterior instrumentation versus posterior-only surgery., Summary of Background Data: The role of AR as a tool in the treatment of adolescent idiopathic scoliosis (AIS) has seen a decline with the popularization of thoracic pedicle screw instrumentation., Methods: Five surgeons were queried for all surgical thoracic AIS cases from 2003 to 2010 treated with thoracoscopic AR/fusion and contemporary posterior instrumentation and fusion and thoracic pedicle screw instrumentation (>80% screws) with 2-year follow-up. These cases were then matched with posterior spinal fusion only cases from a multicenter prospective database. The 2 groups were matched on the basis of major curve magnitude within 5 degrees, T5-T12 kyphosis within 9 degrees, and angle of trunk rotation within 9 degrees. Radiographic and clinical parameters were compared for the 2 groups. Continuous variables were analyzed with analysis of variance and categorical dependent variables with the χ test., Results: A total of 47 cases of AR were matched to 47 (1:1 match) posterior spinal fusion cases. Preoperative parameters were similar between groups (P>0.05). Postoperatively, AR cases had a lower major curve (20 vs. 25 degrees, P=0.034; 72% vs. 66% correction, P=0.037). T5-T12 kyphosis was greater in the AR cases (26 vs. 20 degrees; P=0.005). The angle of trunk rotation was similar for the groups. Anchor density was lower in the AR group (1.6 vs. 1.9; P<0.0001). There were 3 complications associated with the AR: 1 pneumothorax and 2 conversions to minithoracotomies for failure to maintain single lung ventilation., Conclusions: AR improves coronal and sagittal plane correction in contemporary AIS surgery with a satisfactory complication profile with less pedicle screw density required for clinically similar corrections. A further prospective study on the benefits of AR may help define specific indications.

Background: Intraoperative blood loss during posterior spinal fusion for adolescent idiopathic scoliosis (AIS) has been reportedly associated with multiple factors. This study aims to investigate the effect of thoracic kyphosis on blood loss in AIS spinal fusion., Methods: Patients with AIS who underwent posterior-only procedures for Lenke I and II type curves were identified. All included patients had intraoperative tranexamic acid. Difference in estimated blood loss per blood volume (EBL/BV) was identified between hypokyphotic curves (-), normal curves (N), and hyperkyphotic curves (+) classified based on Lenke sagittal modifier. Regression analysis was then performed with EBL/BV as dependent variable. Independent variables included radiographically measured T5-T12 kyphosis and calculated 3D T5-T12 kyphosis in addition to sex, body mass index (BMI), operative time, number of fused vertebrae, number of Ponte osteotomy levels, and main thoracic coronal curve., Results: In total, 837 patients were included. For female patients: EBL/BV was significantly higher for (-) (18%) compared with (N) (16%) and (+) (14%). A total of 29 female patients had T5-T12≤0 (-15 to 0 degree). EBL/BV was not significantly higher than patients with T5-T12>0 degree (18%±9% vs. 16%±11%; P=0.212). For male patients: EBL/BV was significantly higher in (-) (23%) compared with (+) (16%). In total, 14 male patients had T5-T12≤0 (-13 to 0) degree. EBL/BV was significantly higher than patients with T5-T12>0 degree (32%±18% vs. 18%±13%; P=0.015). Significant factors in predicting EBL/BV were sex, BMI, number of fused levels, and both 2D and 3D T5-T12 kyphosis. Male sex as well as every fused-level predicted an increase in EBL/BV~2%. Every 10-unit decrease in BMI predicted an increase in EBL/BV of 7%. Every 10-degree decrease in 2D or 3D T5-T12 kyphosis predicted an increase in EBL/BV~1%. The impact of the number of Ponte osteotomy levels was not significant., Conclusions: This study supports the role of sagittal thoracic alignment in affecting EBL/BV in AIS surgery. Male patients with severe thoracic lordosis (T5-T12≤0 degree) are the highest risk group for intraoperative bleeding. These findings are helpful in predicting the intraoperative blood loss for patients with AIS undergoing posterior spinal fusion. In addition to sex and number of fused levels, decreased thoracic kyphosis is associated with increased blood loss., Level of Evidence: Level III-prognostic study.

Study Design: Retrospective analysis of a prospectively collected, national inpatient hospital database., Objective: We aimed to investigate comorbid psychiatric disorders in the adult spinal deformity (ASD) population. We hypothesized that a high incidence of comorbid psychiatric disorders in ASD would negatively impact perioperative outcomes., Summary of Background Data: Patients with adult spinal fusion (ASF) suffer from severe back pain and often depression. Psychiatric comorbidities in the ASD population are not well understood, despite the apparent psychological effects of spinal deformity-related self-image., Methods: The Nationwide Inpatient Sample databases from 2001 to 2009 were queried for patients ages 18 years or older with in-hospital stays including a spine arthrodesis. Patients were divided into two groups: ASD (diagnosis of scoliosis, excluding neuromuscular and congenital) and all other ASF. Subjects were further stratified by presence of a comorbid psychiatric diagnosis. Differences between each surgical group in psychiatric frequency and complications were calculated using analysis of variance, adjusted for operative complexity. A binary logistic regression analyzed the association between psychiatric diagnoses and likelihood of complications., Results: A total of 3,366,352 ASF and 219,975 ASD patients were identified. The rate of comorbid psychiatric diagnoses in ASD was significantly higher (23.5%) compared to ASF patients (19.4%, P < 0.001). Complication rates were higher for ASD compared to ASF; patients without a psychiatric diagnosis had lower (or comparable) complication rates than psychiatric patients, across all disorder categories. Patients with psychotic disorders and dementia showed more complications than controls; patients with mood, anxiety and alcohol disorders showed fewer., Conclusion: Psychiatric comorbidities are more common in the ASD population than in adult fusion patients. ASD and ASF patients with the most common psychiatric disorders (mood, anxiety, and alcohol abuse) are not at increased risk for complications compared to controls. Those patients with psychotic disorders and dementia are at a significant risk for increased complications and surgeons should be aware of these specific risks., Level of Evidence: 2.

Study Design: Prospective multicenter database study., Objectives: To assess the incidence of proximal junctional kyphosis (PJK) in operative adolescent idiopathic scoliosis (AIS) using contemporary surgical techniques and to identify risk factors for PJK., Summary of Background Data: The incidence of PJK has been reported as high as 46% in AIS. Factors associated with PJK have been incompletely explored., Methods: Prospectively enrolled 851 AIS patients (2000-2011, 78.5% female, average 14.4 years) were evaluated 2 years postoperatively. Radiographic and sagittal spinopelvic parameters and rod contour angle (RCA), a new measure that reflects the proximal contouring of the rod, were independently evaluated for association with PJK based on Lenke type. Multivariate logistic regression with backward elimination was performed to identify risk factors for PJK., Results: Overall PJK incidence was 7.05% and varies based on Lenke type (Lenke 1, 6.35%; Lenke 2 and 4, 4.39%; Lenke 3 and 6, 11.64%; and Lenke 5, 8.49%; p = .06). Among patients with Lenke 1 curves, risk factors for PJK were loss of kyphosis after surgery, and stopping caudal to the upper end vertebra (UEV). The risk of developing PJK increases by 7.1% with each lost degree of kyphosis compared with preoperation that occurs after the instrumentation is placed. For Lenke 2 and 4 curves, loss of kyphosis and more lordotic (negative) RCA were risk factors for PJK. For Lenke 3 and 6 curves, larger preoperative T5-T12 kyphosis was the only significant risk factor for PJK. Upper instrumented vertebra (UIV) at or cephalad to the UEV was associated with increased risk of PJK in Lenke 5 curves, which was contrary to the finding for Lenke 1 curves. No significant correlation was found between sagittal pelvic parameters and developing PJK., Conclusion: The incidence of PJK in patients after surgery for AIS is 7.05% and varies based on Lenke type. Loss of kyphosis, larger preoperative kyphosis, UIV caudal to the proximal UEV (Lenke 1), UIV at or cephalad to the UEV (Lenke 5), and decreased RCA were the major risk factors for PJK in AIS., Level of Evidence: Level II., (Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.)

Study Design: A prospective multicenter database of operative patients with Scheuermann kyphosis (SK) with minimum 1-year follow-up was studied for major complications compared with contemporaneous operative patients with adolescent idiopathic scoliosis (AIS) from the database., Objective: To evaluate complications associated with current surgical techniques in SK and AIS., Summary of Background Data: There is a paucity of literature regarding complications associated with SK surgical treatment, but prior data suggest an elevated neurological risk., Methods: Complication rates were compared using analysis of variance and Fisher exact test analyses. Major complications were those that were life-threatening, caused spinal cord, nerve root, or ocular injury or required reoperation including surgical site infections. A binary logistic regression determined the likelihood of complications based on diagnosis, levels fused, blood loss, operative time, and length of stay., Results: Ninety-seven patients with SK (57 males; mean age, 16.5 yr; 75.3° mean kyphosis) and 800 patients with AIS (622 females; mean age, 14.9 yr; 55.6° mean curvature) met inclusion criteria. Patients with SK had significantly more major complications than those with AIS (16.3% vs. 2.3%; P < 0.001). The SK group had more infections (10.3% vs. 0.75%) and reoperations (14.4% vs. 1.4%) (P < 0.001). Operative time was longer and more levels were fused in the SK group (P < 0.001). Surgical site infection was the most common complication. There were no significant differences in length of stay or blood loss. Patients with SK were 3.9× more likely to have a major complication than those with AIS (odds ratio: 0.26, P = 0.003). The number of levels fused was an independent predictor of major complications: each additional level fused increased the odds of a complication by 36% in both groups (odds ratio: 1.36, P = 0.034)., Conclusion: Major complications are 3.9× more likely to occur in operative SK than in AIS. The number of levels fused is an independent risk factor for major complications. Patients with SK are at higher risk for infections and reoperation than those with AIS., Level of Evidence: 2.

Study Design: A retrospective review., Objective: To compare the radiographical and clinical profiles between 2 surgical approaches for the correction of sagittal plane spinal deformity., Summary of Background Data: Sagittal plane decompensation is the radiographical parameter that carries the greatest impact on adverse outcomes. Surgical correction methods are heterogeneous, and opposing views pervade the spine community in consideration of the most effective approach and techniques to achieve correction., Methods: A total of 33 cases with sagittal spinal deformity were assessed according to their surgical approach, posterior only versus combined anteroposterior group. Comparison was based on the demographic data, and radiographical parameters included pelvic tilt, pelvic incidence, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis., Results: Twenty two subjects were identified for the posterior-only and 11 subjects for the anteroposterior group. Average age was 58.7 years in the posterior-only and 55.7 years for the combined approach. Preoperative mean sagittal vertical axis was 186.6 and 147.7 mm, for the posterior-only and combined approaches, respectively (P = 0.1). Preoperative mean pelvic tilt was 34.2° for the posterior-only and 36.9° for the combined approach group (P = 0.5). A greater operative time for the combined approach was significant, 535 versus 333 minutes for the posterior-only approach (P < 0.001). In the posterior-only group, 8 of 22 patients and 7 of 11 patients in the combined-approach cohort experienced a postoperative complication (P = 0.16). The average follow-up was 41.8 and 47.7 months for the posterior-only and combined approaches, respectively (P = 0.4)., Conclusion: A posterior-only or combined surgical approach had comparable radiographical outcomes. Higher morbidity was significant in regard to operative time in the combined-approach group. Deciding on the approach best suited for achieving correction in the sagittal plane likely resides on the surgeon's experience and expertise.

Study Design: Multicenter retrospective cohort study of 269 patients., Objective: The purpose of this study is to evaluate the surgical and radiographical factors in adolescent idiopathic scoliosis (AIS) surgery that significantly affect kyphosis maintenance., Summary of Background Data: Decreased kyphosis in the thoracic spine is a component of the 3-dimensional deformity in AIS. Suboptimal sagittal alignment after spinal fusion has been identified as a possible cause of lumbar and cervical spinal degeneration and junctional malalignment. Segmental spinal instrumentation continues to evolve, and although excellent coronal plane correction is readily achieved, sagittal plane thoracic hypokyphosis may be seen postoperatively., Methods: A retrospective analysis of prospectively collected data from a multicenter AIS database was performed to evaluate factors associated with kyphosis maintenance. A total of 526 patients were enrolled in the database and had a mean thoracic kyphosis (T5-T12) of 22°. In total, 269 patients were identified who had kyphosis of less than 22° and thus comprised the group to be included in this analysis. A complete radiographical series was obtained for each patient preoperatively, immediately postoperatively, and at 2 years postoperatively. All operative data, including the number of levels fused and implant type and density, were also recorded. Multivariate and regression analysis were performed., Results: Eight variables were found to be significantly correlated with kyphosis maintenance at 2 years postoperatively. Anterior approach (r = 0.37, P < 0.001), increased thoracic coronal curve (r = 0.20, P = 0.001), and a greater percentage of hooks in the construct (r = 0.18, P = 0.034) were associated with increased kyphosis at follow-up. A greater number of levels fused (r = -0.33, P < 0.001), preoperative kyphosis (r = -0.39, P < 0.001), percentage of screws in the construct (r = -0.18, P = 0.03), using standard stainless steel rods (r = -0.47, P = 0.011), and percent decrease in thoracic curve (r = -0.23, P < 0.001) all were correlated with hypokyphosis at follow-up., Conclusion: Our multivariate analysis demonstrates that in patients with AIS who have thoracic hypokyphosis as part of their deformity, certain factors must be taken into account in the preoperative planning to prevent hypokyphosis after surgical correction.

Study Design: A retrospective multicenter review of 78 patients with Scheuermann's kyphosis treated operatively was conducted., Objective: The purpose of this study was to evaluate correction of sagittal alignment, maintenance of correction, and occurrence of, and etiologic factors associated with, junctional kyphosis in patients managed operatively for Scheuermann's kyphosis., Summary of Background Data: There is a paucity of literature regarding the surgical treatment of Scheuermann's kyphosis using current implant systems and operative techniques. Junctional kyphosis has been shown to occur in up to one third of patients. Factors causing junctional kyphosis have not been clearly elucidated. Loss of correction has been variable based on the technique used. No clear-cut advantages or disadvantages have been shown for the use of anterior release., Methods: Kyphosis, lordosis, C7 sagittal plumbline, apical translation, junctional sagittal alignment, and pelvic incidence were assessed among other radiographic parameters from a centralized database. The incidence of junctional kyphosis and its association to the above parameters and to fusion levels were assessed. Complication rates and differences between patients undergoing combined anteroposterior surgery and those having posterior surgery alone were evaluated., Results: Of the 78 patients, 42 underwent combined anteroposterior procedures (Group 1) and 36 had posterior surgery only (Group 2). Mean age was 16.7 years. Overall, the greatest Cobb kyphosis of 78.8 degrees was corrected to 51.4 degrees at follow-up. Preoperative kyphosis was 82.6 degrees and 74.4 degrees for Groups 1 and 2, respectively (P < 0.001) and 55.8 degrees and 46.2 degrees at follow-up (P = 0.000). Loss of correction was 3.2 degrees (not significant) and 6.4 degrees (P = 0.000), respectively. Lordosis corrected from -65.5 degrees to -51.7 degrees . Proximal and distal junctional kyphosis of >or=10 degrees occurred in 25 (32.1%) and 4 (5.1%), respectively. The development of a proximal junctional kyphosis correlated directly with kyphosis at follow-up and indirectly with percent correction. Among patients with proximal junctional kyphosis, the magnitude of junctional kyphosis correlated directly with the degree of pelvic incidence. Pelvic incidence correlated directly with lumbar lordosis but not kyphosis. Twelve complications occurred in 12 patients, including posterior wound infection (1), distal (2), and proximal (1) junctional kyphosis, and pseudarthrosis (1), those requiring reoperation., Conclusion: This is one of the largest reported series of Scheuermann's kyphosis treated operatively to our knowledge. A high rate of junctional kyphosis, especially at the proximal end, is associated with surgery for Scheuermann's kyphosis using current techniques. Proximal junctional kyphosis is associated with higher magnitude of kyphosis at follow-up, less percent correction; its magnitude correlated directly with pelvic incidence. Loss of correction is less in patients undergoing combined anteroposterior surgery. Pelvic incidence correlates directly with lordosis but not kyphosis, suggesting that these parameters are not causative of Scheuermann's kyphosis.

Abstract: Background context: Anterior fusion through an open thoracotomy restores kyphosis more reliably than posterior techniques in patients with thoracic adolescent idiopathic scoliosis (AIS). Video-assisted thoracoscopic spinal fusion and instrumentation (VATS) minimizes the morbidity, from soft tissue and muscle dissection that accompanies traditional open thoracotomy. To our knowledge, there has not been a comprehensive analysis of VATS with respect to radiographic and clinical outcomes in the sagittal plane. Purpose: To measure the radiographic and clinical outcomes after VATS with emphasis on the sagittal plane. Study design/setting: A retrospective, radiographic review of 26 consecutive patients with Lenke type-I AIS who underwent VATS. Methods: Radiographs of 26 consecutive patients with Lenke type-I AIS curves operated by a single surgeon were retrospectively reviewed after VATS. Sagittal and coronal parameters were compared with reported data for open anterior and posterior procedures. Results: There was an increase in kyphosis from baseline to final follow-up by 6.6° (25%) from T2 to T12 (p<.0001), 8.7° (50%) from T5 to T12 (p<.0001), and 8° (54%) in the instrumented segment (p<.0001). Junctional kyphosis did not occur. No differences were detected in sagittal measurements between the first postoperative erect and the final radiographs. Patients experienced significant improvements from baseline to 2 years in Scoliosis Research Society-22 Health-Related Quality-of-Life Outcome Questionnaire scores (p<.0001). Conclusions: Video-assisted thoracoscopic spinal fusion and instrumentation, in agreement with results reported for open anterior instrumentation, reliably restores or increases thoracic kyphosis while preserving junctional alignment in thoracic AIS. [Copyright &y& Elsevier]

Study Design: A cross-sectional survey of surgeon members of the Scoliosis Research Society (SRS).Objective: This study sought to characterize the incidence, clinical presentation, diagnostic workup, treatment, and neurologic prognosis following delayed postoperative neurologic deficit (DPND) in patients undergoing spinal deformity surgery.Summary Of Background Data: DPND is a potentially devastating condition following spinal surgery, characterized by the development of a neurological deficit within hours or days of the surgical procedure. To date, only case reports and small case series have been published on the topic.Methods: We developed a survey to characterize DPND following spinal deformity surgery. This survey was distributed to surgeon members of the SRS through email and standard mail. The overall response rate was 38% (352/929).Results: Our results suggest an estimated DPND incidence of 1 of 9910 cases (0.01%). Eighty-one surgeons (23%) experienced at least 1 DPND in the past 10 years (92 total cases). Most common diagnoses were scoliosis (69%), kyphosis (23%), and spondylolisthesis (14%); 20% were revision surgeries. The number of hours to deficit onset was as follows: 1 to 12 (36%), 13 to 24 (27%), 25 to 48 (27%), more than 48 (10%). The most commonly cited sources of injury included ischemic injury (38%) and cord compression (15%). Forty-one percent experienced complete neurologic recovery, 26% partial, and 33% no recovery. Twenty-one percent of patients achieved final neurologic status within 1 week, 38% by 1 month, and 73% by 6 months. Patients with compression-related DPND had a significantly greater likelihood of experiencing some neurologic recovery (≥1 ASIA Grade) than ischemia-related DPND (86% versus 51%, P = 0.049).Conclusions: DPND occurs at an estimated incidence of 0.01%. Sixty-three percent of DPND cases occurred within the first 24 hours and 90% within 48 hours. Complete (41%) or partial (26%) neurologic recovery may be expected, especially in compression-related DPND, emphasizing the need for perioperative vigilance, prompt recognition, and early intervention.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluates the effects on device-level lordosis, cranial and caudal adjacent level lordosis, and overall cervical sagittal alignment. Result shows that total cervical lordosis increased in both cervical total disc replacement (TDR-C) and anterior cervical discectomy and fusion (ACDF). They concluded that lordosis increased at the device-level, cranial adjacent level and in total cervical lordosis.