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Purpose: The purpose of the study was to evaluate the clinical efficacy and safety of using Ponte osteotomy combined with posterior lumbar interbody fusion in the treatment of patients with degenerative scoliosis. Method: The medical records and imaging data of degenerative scoliosis patients in our department from 2013 to 2022 were retrospectively collected. A total of 47 patients were included, including 16 male patients and 31 female patients. The mean follow-up was 47.8 months. Whole spine X-rays in the standing position were performed on all patients preoperatively, postoperatively, and at the latest follow-up. The length of hospital stay, complications, operative duration, estimated blood loss, instrumented segment, fused segment, clinical scores, and various radiological indicators were recorded. Results: The coronal vertical axis improved from 3.1 ± 1.9 cm preoperatively to 1.2 ± 1.0 cm postoperatively with an average reduction of 1.9 ± 1.7 cm. The preoperative coronal Cobb angle was 18.1 ± 10.6°, the immediate postoperative Cobb angle was 6.6 ± 3.9°, and the Cobb angle at the last follow-up was 5.8 ± 3.7°. The sagittal vertical axis decreased from 5.6 ± 3.7 cm preoperatively to 2.7 ± 1.9 cm immediately after the operation and was well maintained at the last follow-up (3.1 ± 2.5 cm). Lumbar lordosis increased from 22.2 ± 10.2° preoperatively to 40.4 ± 8.3° postoperatively and 36.0 ± 8.8° at the last follow-up. The ODI score, VAS low back pain score, and VAS leg pain score were also improved to varying degrees. Conclusion: Ponte osteotomy combined with posterior lumbar interbody fusion can significantly improve coronal and sagittal plane deformities and postoperative functional scores in patients with adult degenerative scoliosis. [ABSTRACT FROM AUTHOR]

Background: Contradictory opinions about whether early correction and fusion surgeries should be performed for congenital scoliosis (CS) patients at a young age exist. The objectives of this study were to analyze the association between patient characteristics and fusion-surgery outcomes in CS patients treated with spinal correction and fusion surgeries and to report risk factors for extended length of stay (LOS), more estimated blood loss (EBL), longer fused segments and higher medical costs.Methods: We analyzed data of 1,207 CS inpatients treated with fusion surgeries in our institute from January 2010 - December 2019. All patients underwent spinal X-ray, CT, MRI, echocardiogram and urogenital ultrasound. We analyzed demographic and clinical information and outcome measures, including LOS, EBL, fused segments and medical costs.Results: Age at fusion (OR = 1.053; p < 0.001), musculoskeletal defects (OR = 1.670; p = 0.004) and thoracic deformity (OR = 1.519; p = 0.03) were risk factors for extended LOS. Age at fusion (OR = 1.117; p < 0.001), male sex (OR = 1.813; p < 0.001), mixed defects (OR = 1.662; p = 0.027) and failure of formation (OR = 1.718; p = 0.021) were risk factors for more EBL. Age at fusion (OR = 1.213; p < 0.001) was a risk factor for longer fused segments. Age at fusion (OR = 1.091; p < 0.001) and thoracic deformity (OR = 1.853; p = 0.004) were risk factors for higher medical costs.Conclusions: We found that older age at fusion in CS patients is a risk factor for extended LOS, more EBL, longer fused segments and higher medical costs with the risk increasing by 5-21 % for each year of age. Other identified risk factors include thoracic deformity for extended LOS; longer fused segments, higher medical costs, and musculoskeletal defects for extended LOS; and CS type (FF and MD) and sex (male) for more EBL. [ABSTRACT FROM AUTHOR]

Background: Previous reports confirmed early spinal fusion may compromise pulmonary function and thoracic development in skeletal immature patients with scoliosis. However, the different effects in patients with various Risser signs remain unknown. This study aimed to compare the influence of early thoracic fusion on pulmonary function and thoracic growth in patients with idiopathic scoliosis (IS) with closed triangular cartilage (TRC) and different Risser signs. Methods: Thirty-six patients with IS and a closed TRC were retrospectively selected and divided into the low Risser (LR, Risser sign ≤2, 22 patients) and high Risser (HR, 280% before and after surgery. The T1-T12 and anteroposterior thoracic diameter significantly increased after surgery in both groups, while the maximum inner chest diameter only increased in the LR group at the final follow-up. However, there were no significant differences in respiratory function and thoracic data between both groups. Conclusion: For patients with IS, early fusion did not deteriorate pulmonary function or thoracic development in TRC-closed patients whose Risser sign was ≤2 compared with those with a Risser sign >2. [ABSTRACT FROM AUTHOR]

Background: There have been many reports on the treatment of congenital kyphoscoliosis. However, congenital deformities in the cervicothoracic spine (C7-T1) have not been well described because of the rarity of these conditions.Methods: The medical records and imaging studies of 25 children who were treated with 360° osteotomy for congenital deformities in the cervicothoracic spine (C7-T1) at a mean age of 11.4 years were reviewed.Results: All 25 children presented with torticollis; 4 presented with neck pain; 10, with facial asymmetry; and 3, with preoperative neurological deficits. Twenty-three patients had congenital deformities in other regions of the spine. Six patients had a total of 8 intraspinal deformities. On average, the cervicothoracic curve was corrected from 53° preoperatively to 14° at the latest follow-up, the segmental kyphosis was corrected from 25° to 12°, and the head tilt improved from 25° to 5°. Nineteen patients had a total of 28 complications, including 1 transient cord injury together with a permanent C8 nerve root injury, 11 transient nerve root injuries, 1 transient Horner syndrome, 9 cases of decompensation of a compensatory curve, 2 implant failures, 2 cases of hemothorax, 1 dural tear, and 1 case of delayed wound-healing.Conclusions: Most congenital cervicothoracic deformities are fixed, and early surgical intervention may be needed. A 360° osteotomy is indicated for this type of rigid deformity and may provide satisfactory correction. However, 360° osteotomy in the cervicothoracic spine (C7-T1) is technically demanding with a higher risk of nerve root injuries, although most injuries tend to be transient. If the compensatory thoracic curve is severe and rigid, 1-stage or staged surgery in this region may be required.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: To assess the risk factors for blood transfusion in a great number of adolescent cases with different types of scoliosis who received scoliosis surgery.Methods: Data of patients who were diagnosed as scoliosis and received one-stage posterior correction and spinal fusion from January 2014 to December 2017 were prospectively collected and retrospectively analyzed. Patients' demographic characteristics, segments of spinal fusion, Cobb angle of the major curve,osteotomy pattern, preoperative and postoperative levels of hemoglobin, and allogeneic blood transfusion (ABT) were recorded and analyzed.Results: In this study, 722 cases with adolescent scoliosis were included, of whom 32.8% (237/722) received ABT. Risk factors included diagnosis: neurofibromatosis (OR = 5.592), syndromic (OR = 3.029),osteotomy: Ponte osteotomy (OR = 5.997), hemivertebrae resection (OR = 29.171), pedicle subtraction osteotomy (PSO)(OR = 8.712), vertebral column resection (VCR)(OR = 32.265);fusion segments (OR = 1.224) and intraoperative blood loss (OR = 1.004). In the subgroup analysis of cases with idiopathic scoliosis, Ponte osteotomy (OR = 6.086), length of segments of spinal fusion (OR = 1.293), and intraoperative blood loss (OR = 1.001) were found as risk factors for ABT. Results of receiver operating characteristic (ROC) curve analysis revealed that length of segments of spinal fusion equal to 11.5 vertebrae was the best cutoff value for cases with idiopathic scoliosis who did not receive osteotomy in both ABT group and non-ABT group. In the subgroup analysis of congenital scoliosis, Ponte osteotomy (OR = 5.087), hemivertebra resection (OR = 5.457), PSO (OR = 4.055), VCR (OR = 6.940), and intraoperative blood loss (OR = 1.004) were risk factors for ABT.Conclusions: Method of diagnosis, osteotomy pattern, segments of spinal fusion, and intraoperative blood loss were risk factors for ABT in cases with adolescent scoliosis. In cases with idiopathic scoliosis, Ponte osteotomy and segments of spinal fusion longer than 11.5 vertebrae were risk factors for ABT. In cases with congenital scoliosis, osteotomy pattern was the main risk factor for ABT.Level Of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this retrospective study is to evaluate the efficacy and safety of posterior-only vertebral column resection (PVCR) for the treatment of angular and isolated congenital kyphosis.Methods: 24 patients with isolated angular congenital kyphosis treated by PVCR in our hospital were retrospectively studied. The patients' radiographs and hospital records were reviewed. Deformity in sagittal planes and global sagittal alignment were analyzed for correction and maintenance of the correction in preoperative, postoperative, and follow-up radiographs. The complications and related risk factors were analyzed.Results: The average age was 13.9 (4-40) years. Three of them were revision surgeries. Two patients have intraspinal anomalies. The mean follow-up is 56.9 (26-129) months. The mean operation time was 293.1 (170-480) min. The averaged blood loss was 993.8 (250-3000) ml. The segmental kyphosis was 87.3° before surgery, 17.6° post surgery and 20.4° at the latest the follow-up. And the sagittal vertical axis was improved from 43.1 mm to 9.2 mm. Mean total score of SRS-22 was 89.3. Complications occurred in 4 patients, including 1 screw pullout due to pseudarthrosis, 1 proximal junctional kyphosis, 1 incomplete spinal cord injury and 1 root injuries.Conclusion: Posterior-only vertebral column resection is an ideal procedure for severe rigid congenital kyphosis. However, it is still a highly technical demanding procedure. Neurological compromises still remain the biggest challenges. Sufficient height of anterior reconstruction, avoidance sacrifice of bilateral roots in the same level in the thoracic spine, avoidance of the sagittal translation of the upper and lower vertebras, intra-operative neuromonitoring, and preoperative surgical release of diastematomyelia and tethered cord may help to improve the safety. [ABSTRACT FROM AUTHOR]

Introduction: Posterior selective thoracolumbar or lumbar (TL/L) fusion with pedicle screw constructs for adolescent idiopathic scoliosis (AIS) has been studied in a few researches. However, few studies have discussed the indication for selective TL/L fusion and the behaviors of its adjacent disc angle. The present study aims to discuss the indication for posterior selective TL/L fusion and the behavior of the adjacent disc angle.Methods: 45 consecutive cases of AIS undergoing posterior selective TL/L fusion were retrospectively evaluated, with an average follow-up of 36 months. Radiographs were reviewed to determine the coronal curve magnitude and the sagittal alignment preoperatively, postoperatively and at final follow-up. Thoracic curves in groups A had a correction loss of more than 5°, while thoracic curves in group B had a correction loss of not more than 5°.Results: The coronal curve magnitude of the TL/L curve averaged 44° preoperatively and it was corrected to 6° immediately with a correction rate of 84.8 %. At final follow-up it was 9° with a correction loss of 3°. The minor thoracic curve was 26° preoperatively, and the convex side bending curve magnitude averaged 8° with a flexibility of 72.7 %. It was corrected to 13° immediately with a spontaneous correction of 48.5 %. At final follow-up it was 14° with a correction loss of 1°. UIVA decreased from 4° to 2° after surgery, and it was 2° at final follow-up. LIVA decreased from 7° to 4° after surgery, and it was 5° at final follow-up. Maximal correction of TL/L curves in group A is significantly less than that in group B. 1 patient received revision surgery to fuse the progressive thoracic curve.Conclusion: Posterior selective TL/L fusion with pedicle screw constructs allows for spontaneous thoracic correction and maintains coronal and sagittal balance during the follow-up. Maximal correction instead of undercorrection was recommended for moderate Lenke 5C curves. Disc wedging could be improved after surgery and well maintained during the follow-up. [ABSTRACT FROM AUTHOR]

Background: Posterior hemivertebra resection has become a safe and effective procedure for congenital scoliosis due to hemivertebra. However, there are still complications following primary posterior hemivertebra resection in recent reports. No risk factors associated with construct/implant related complications were identified so far. The purpose of this study is to analyze complications following primary posterior hemivertebra resection and to investigate the possible risk factors associated with construct/implant related complications in congenital scoliosis cases due to hemivertebra.Methods: One hundred and sixteen congenital scoliosis cases with hemivertebra (male: female = 62:54), who underwent primary posterior hemivertebra resection from January 2003 to January 2012 in our medical center, were retrospectively evaluated in this study. Medical records were reviewed and long cassette standing spinal radiographs were measured before surgery, after surgery and at the final follow-up. Complications, including construct/implant related complications and non-construct/implant related ones, were recorded by chart review. Potential risk factors, including sex, age, segmental and main scoliosis and their correction rates, usage of cage (yes or not), fusion levels (bisegmental fusion or not), location of hemivertebra and contralateral bar/rib synostosis (with or without), were also collected.Results: The mean age of initial surgery was 9.8 years old (range, 2-19 years), and the average follow-up was 67 months (range, 24-133 months). The segmental scoliosis was corrected from 34.7° ± 11.9° to 7.1° ± 5.6° post-operatively, and 9.5° ± 7.0° at the latest follow-up, with a correction rate of 79.5 %. The total main scoliosis was corrected from 43.0° ±15.6° to post-operative 11.4° ± 6.8°, and 13.9° ± 7.5° at the latest follow-up, with a mean correction rate of 73.5 %. Complications occurred in 11 out of 116 cases (9.5 %), including 7 (63.6 %) construct/implant related complications (two pedicle misplacement, one rod breakage and four implant removals due to screw dislodgement with the growth) and 4 (36.4 %) non-construct/implant related ones (one proximal adjacent kyphosis, one progressive kyphosis, and two wound non-union). Younger age (≤5 years old), lumbar hemivertebra resection, or bisegmental fusion may contribute to a higher prevalence of construct/implant related complications than other cases, although the number of cases was too small to perform statistical analysis.Conclusions: The occurrence of construct/implant related complications in patients with hemivertebra resection is most likely multifactorial. Cases with younger age, bisegmental fusion, or lumbar hemivertebra may increase the risk of construct/implant related complications. Measures, such as careful preoperative evaluation and surgical plan with CT scan, sophisticated operation during surgery, usage of cage or cross-links to improve postoperative instant stability, protection in brace and regular follow-up postoperatively, should be taken to reduce construct/implant related complication rate. [ABSTRACT FROM AUTHOR]

Introduction: Lumbosacral hemivertebra poses a unique problem because it can cause gross imbalance and progressive compensatory thoracolumbar deformity. Previous studies have reported lumbosacral hemivertebra resection through a combined anterior and posterior approach, but there have been no reports on the results and complications of hemivertebra resection via a posterior-only procedure and short fusion with large series of patients.Materials and Methods: This retrospective study of a prospective collected database comprises a consecutive series of 14 congenital scoliosis due to lumbosacral hemivertebra treated by 1-stage posterior hemivertebra resection with short segmental fusion, with at least a 2-year follow-up period (24-144 months). Surgical reports and patient charts were reviewed. Radiographic evaluation included measured changes in segmental scoliosis and lordosis, compensatory scoliosis, thoracic kyphosis, lumbar lordosis, and trunk shift. Quality of life data from Scoliosis Research Society (SRS)-22 questionnaires were also collected.Results: Our results showed that the mean follow-up period was 38.4 months. The mean fusion level was 3.2 segments. Mean operation time was 207.8 min with the average blood loss of 235.7 ml. The mean segmental scoliosis was 30° preoperatively, 5° postoperatively (83 % correction rate), and 4° (87 %) at the latest follow-up. The compensatory coronal curve of 30° was spontaneously corrected to 13° at most recent follow-up. Trunk shift was significantly improved on both coronal (63 %) and sagittal plane (58 %) after the surgery, and kept stable during the follow-up. The total SRS-22 score, the self-image domain score and the satisfaction domain score demonstrated significant improvement compared with preoperative status. Only one intra-operative complication was observed, a pedicle fracture.Conclusions: In summary, our results showed that one-stage HV resection and short segment fusion by a posterior approach can offer excellent scoliosis correction and trunk shift improvement without neurological complications, while saving motion segments as much as possible. This strategy is not only corrective of the deformity but also preventive of compensatory curve progression, thus avoiding long lumbar fusion. [ABSTRACT FROM AUTHOR]

Purpose: Until now there have been many reports on hemivertebra resection. But there were no large series on the posterior hemivertebra resection with bisegmental fusion. This is a retrospective study to evaluate the surgical outcomes of posterior hemivertebra resection only with bisegmental fusion for congenital scoliosis caused by fully segmented non-incarcerated hemivertebra. Methods: In our study, 36 consecutive cases (19 males, 17 females) diagnosed with congenital scoliosis, resulting from fully segmented non-incarcerated hemivertebra, treated by posterior hemivertebra resection with bisegmental fusion were investigated retrospectively, with at least a 3 year follow-up period (36-106 months). Results: The total number of resected hemivertebra was 36. Mean operation time was 188.6 min with average blood loss of 364.2 ml. The segmental scoliosis was corrected from 36.6° to 5.1° with a correction rate of 86.1 %, and segmental kyphosis(difference to normal segmental alignment) from 21.2° to 5.8° at the latest follow-up. The correction rate of the compensatory cranial and caudal curve is 76.4 and 75.1 %. Unanticipated surgeries were performed on eight patients, including one delayed wound healing, two pedicle fractures, one progressive deformity and four implants removals. Conclusions: Posterior hemivertebra resection with bisegmental fusion allows for early intervention in very young children. Excellent correction can be obtained while the growth potential of the unaffected spine could be preserved well. However, it is not indicated for the hemivertebra between L5 and S1. The most common complication of this procedure is implant failure. Furthermore, in the very young children we noted that although solid fusion could be observed in the fusion level, implants migration may still happen during the time of adolescence, when the height of the body developed rapidly. So a close follow-up is necessary. [ABSTRACT FROM AUTHOR]

Background Context: The lowest instrumented vertebra (LIV) determination in Lenke type 5 Adolescent Idiopathic Scoliosis (AIS) requires a thorough understanding and prediction of the correction force on the LIV from coronal, sagittal, and axial plane. Although many LIV selection criteria have been reported, none of them comprehensively evaluated the multidimensional characteristics of the LIV till now.Purpose: To develop and evaluate our LIV selection criteria in Lenke type 5 AIS patients using pedicle screw system via posterior approach.Study Design: A retrospective study.Patient Sample: All consecutive patients with Lenke 5 curves who were treated with one-stage selective lumbar fusion using complete pedicle screw system in our center from January 2006 to December 2017, with minimum 2-year follow-up.Outcome Measures: Age, gender and Risser grade, fused levels, operating time, intraoperative blood loss, complications, and Scoliosis Research Society (SRS)-22 questionnaires outcome were recorded. Coronal, sagittal, and axial parameters were measured from plain radiographs.Methods: A total of 138 consecutive patients with Lenke 5 curves treated with selective lumbar fusion were retrospectively analyzed, with minimum 2-year follow-up. Our LIV selection criteria include: (1) the most cephalad vertebrae touched by central sacrum vertical line (CSVL); (2) Nash-Moe rotation being equal or less than grade I on the standing AP radiograph; (3) CSVL cross between the two pedicles of LIV on concave bending film; (4) not at the apex of kyphosis. Radiographic data, operative data, perioperative complications and SRS-22 outcomes were collected and analyzed.Results: The mean follow-up period was 50.9±24.7 months. The thoracolumbar/lumbar curve was corrected from 46.9°±8.9° before surgery to 5.5°±2.6° at the final follow-up. The C7-CSVL was 19.7±6.2 mm before surgery and 5.2±3.4 mm at the final follow-up. The LIV translation was corrected from 22.3 ±5.4 mm before surgery to 4.8 ± 2.6 mm at the final follow-up, with the correction rate of 78.4%. The LIV tilt was corrected from 21.6 ± 4.4° before surgery to 2.6 ± 2.3° at the final follow up, with the correction rate of 87.9%. Our LIV saved 0.3 level than SRS-last barely touching vertebra, 0.6 level than SRS-last substantially touching vertebra, 0.9 level than neutral vertebra, and 1.4 level than stable vertebra.Conclusion: The present study indicates using our LIV criteria, our study achieved the correction rate of thoracolumbar/lumbar curve as 88.9%, with the rate of adding on or coronal imbalance as 8.7% (12/138). The criteria may provide important guidance for preoperative decision-making in Lenke 5 AIS patients, and more multicenter prospective studies with larger samples are needed to further validate the findings of this study. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study of instrumentation failure after posterior vertebral column resection (pVCR) in adult spinal deformity (ASD) patients.Objective: The morbidity and related risk factors of the instrumentation failure.Summary Of Background Data: Instrumentation failure is another common complication after pVCR. But no report about it has been published before. The safety of titanium mesh cages (TMCs) for this failure is still unknown so far.Methods: A total of 35 consecutive ASD patients (18 females and 17 males), who underwent pVCR between May 2005 and December 2014 in our hospital, were retrospectively reviewed. The mean age and follow-up period were 37.8 ± 12.8 years and 45.5 ± 27.3 months. Proportion was used to describe the morbidity of instrumentation failure. Potential risk factors were compared between patients with and without instrumentation failures by using Student t test or χ tests (Fisher exact tests). Risk factors related to TMCs were analyzed in TMC group.Results: There were 70 vertebra resected in total, with the mean of 10.3 segments instrumented. The mean correction rates of main curve (n = 25) and segmental kyphosis (n = 35) were 68.8% and 67.9%, respectively. Five patients (14.3%) suffered rod breakage. The failure was noted an average of 6.8 months after surgery. The risk factors included BMI (>27, P = 0.026), comorbidity (Achondroplasia, P = 0.047), and anterior column defect (ACD>20 mm, P = 0.045). TMC subsidence of ≥5 mm was the risk factor related to TMC in TMC group (P = 0.041).Conclusion: It is safe to reconstruct with a TMC after pVCR in ASD, but the height should be as low as possible to reduce ACD. For those patients with risk factors, autologous bone graft and a satellite rod should be considered. If TMC subsidence ≥5 mm, a frequent follow-up should be performed.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background Context: Intraoperative monitoring (IOM) is an essential method for preventing postoperative spinal deficits during posterior vertebral column resection (VCR) surgery for treatment of severe spine deformities, but the IOM features directing at VCR procedures are rarely reported and need to be further clarified.Purpose: To evaluate an important surgical point that will lead to the IOM loss frequently, and then remind the surgeons to pay close attention to impending monitoring changes during posterior VCR surgery.Study Design/setting: Retrospective study.Patient Sample: A total of 77 patients with severe spine deformities who underwent posterior VCR and deformity correction surgeries from January 2012 to May 2015 are retrospectively analyzed in our spine center.Outcome Measures: IOM (motor-evoked potentials [MEP] and somatosensory-evoked potentials) was used for intraoperative spinal function assessment.Methods: Patients were divided into 2 groups according to their preoperative spinal function, including 27 patients with preoperative spinal deficits and 50 patients with spinal normal. And the IOM data during surgery, especially among VCR procedures, were mainly analyzed in the present study.Results: With the VCR procedure almost complete, most patients showed varying degrees of IOM loss that included 37 cases showing obvious IOM degenerations and 21 cases showing significant IOM loss with alerts immediately. Moreover, the patients with preoperative spinal deficits have more significant decreasing percentage in MEP amplitude (81% vs. 68%, p<.05) than those patients without.Conclusions: With the VCR procedure almost complete, surgeons must pay closely attention to the IOM signals and should be ready to take corresponding surgical measures to deal with the impeding monitoring loss. [ABSTRACT FROM AUTHOR]