Purpose Since the state of alarm was decreed in Spain on 14 March 2020, the coronavirus disease 2019 (COVID-19) pandemic has had an extraordinary impact in paediatric hospitals. This study shows the effect of the pandemic on our practice in paediatric orthopaedics in a referral third level paediatric hospital. Methods We performed a single-centre retrospective review of the official census from a third level paediatric hospital from 14 March to 14 April for the years 2018, 2019 and 2020. Results The patients seen in our clinic during this period in 2020 decreased in by 82% (p < 0.001) compared with 2018 and 2019, however, the number of telemedicine consultations increased by 90.21% (p < 0.001). The total number of patients attending the clinic (including onsite and virtual) was reduced by 54.25% (p < 0.001). The total surgeries performed plummeted by 81% in this period in 2020 (p < 0.001) due to a reduction in elective cases of 94.6% (p < 0.001). No significant decrease was found in the number of urgent surgical cases per day in 2020 (p = 0.34). Finally, the number of orthopaedic patients admitted to our emergency department dropped by 78.6% during the state of alarm (p < 0.001). Conclusion According to our results, the pandemic has significantly affected our daily practice by decreasing elective surgeries and onsite clinics, but other activities have increased. As we have implemented telemedicine and new technologies to adapt to this setback, we should take advantage of the situation to change our practice in the future to better allocate our health resources and to anticipate outbreaks. Published without peer review. Level of Evidence IV

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5.

Objectives: The aim of this study is to examine whether surgical treatment of early onset scoliosis (EOS) with magnetically controlled growing rods (MCGRs) or a vertical expandable prosthetic titanium rib (VEPTR) resulted in fewer short-term (24 months) complications and reoperations.Background: EOS is a challenging problem for spine surgeons that has been managed with different growthfriendly instrumentation systems. Although rib-based devices encourage spinal growth via regular lengthening, the high rate of complications and reoperations leads us to use spine-based devices such as MCGRs to mitigate this concern.Methods: A total of 35 EOS patients were included in the study. Twenty patients were included in the VEPTR group, and 15 patients were included in the MCGR group. Demographic data and 2 years of postoperative complications and reoperations were reviewed retrospectively. As secondary outcomes, radiographic outcomes were reported preoperatively and 1 year after surgery. Indications for this technique and complications were collected from the charts.Results: Demographic data showed no significant differences between the 2 groups. Significant differences were found in the complications rate at 2 years, with 65% complications in the VEPTR group and 13.3% complications in the MCGR group (P , .001). The reoperation rate at 2 years was also significantly higher in the VEPTR group, with 50% versus 13.3% in the MCGR group (P ¼ .0009). As secondary outcomes, radiological parameters such as main curve Cobb angle correction (P ¼ .001) and apical vertebral translation (P ¼ .002) were significantly higher in the MCGR group. Significant differences were also found in sagittal profile parameters; T1-T12 and T1-S1 were significantly higher in the MCGR group (P , .001).Conclusions: According to our results, VEPTR has significantly higher complication and reoperation rates at 2 years postsurgery compared with MCGR.

Study Design. Prospective experimental study with on-site simulation. Objective. To compare the accuracy and efficiency of different techniques for pedicle screw instrumentation (PSI). Summary of Background Data. Improving the safety and efficiency of PSI is a critical step to reduce the complication rates and the cost of scoliosis surgery. Innovative operative techniques for PSI have shown to safely improve efficiency, thereby reducing cost. Surgical simulation is a valuable tool to study different operative techniques. Methods. Five spine fellows instrumented 20 simulation models of a scoliotic spine with 10 pedicle screws per model. Four techniques were studied, including the conventional pedicle probe and the innovative sequential drilling technique, with or without computed tomography (CT)-based navigation. Our primary outcome measures were efficiency and accuracy of PSI. We analyzed the data with bivariate analyses using the Chi-square test for categorical variables and the Student t test or ANalysis Of VAriance with Bonferroni post-hoc tests for continuous variables. Results. The drilling techniques (free hand and navigated) were more efficient as compared with the pedicle probe techniques (P < 0.01). The navigated techniques resulted in better accuracy as compared with the free hand techniques (P = 0.036). Most pedicle breaches were medial (n = 32/52). The concave apical pedicle (T4 right side) had the highest incidence of breaches. There was no significant difference in efficiency comparing the free hand and the navigated pedicle probe techniques (P = 0.261) or comparing the free hand drilling and the navigated drilling techniques (P = 1.00). Conclusion. On site surgical simulation is a promising concept for teaching advanced procedural skills. Our findings suggest that navigation improves the accuracy of PSI while sequential drilling safely improves efficiency. Combining navigation with sequential drilling can significantly improve the accuracy and the efficiency of PSI in scoliosis surgery, as previously suggested with our published clinical data. Level of Evidence: 4

Background: In osteoporotic vertebral fractures (OVF) involving neurological symptoms and severe kyphosis, vertebral osteotomies are necessary but are associated with a high risk of complications.Methods: We performed a retrospective study. In 14 patients (mean age, 69.3 years old) with unstable thoracolumbar fractures associated with severe kyphosis, a posterior instrumentation with polymethylmethacrylateaugmented screws and a modified pedicle subtraction osteotomy (PSO) at the fracture level were performed to stabilize the spine and correct the kyphosis. The underlying principle behind the osteotomy's technique was to exaggerate the defect caused by the fracture and shorten the spine: (1) completion of a wide laminoforaminotomy, (2) use of successive reamers rotated in the pedicle at a 258 angle in the axial plane to obtain its complete decancellation, (3) insertion of the reamers in a more medial orientation (558) to collapse the posterior wall, and (4) breakage of the lateral wall. Radiographic and clinical outcomes were analyzed pre-and postoperatively. Complications were reported.Results: Functional scores improved after surgery. Oswestry disability index and visual analog scale scores decreased significantly (33 and 4 points, respectively). Patient satisfaction rate reached 93%. Average postoperative regional vertebral kyphosis was decreased to 3.798. No dural tear or neurological injuries were observed. Blood loss of 920 mL (6350 mL) and two mechanical complications were reported.Conclusions: OVF can lead to severe deformities. In osteoporotic bones, the use of sequential reamers can simplify the PSO technique, allowing for the shortening and stabilization of the spine without manipulating the dural sac. The risk of neurological injuries and blood loss is decreased.Level of Evidence: 4.

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