Study Design. Retrospective cohort study. Objective. To assess if initial adherence to prescribed brace wear for adolescent idiopathic scoliosis (AIS) predicts future adherence and curve improvement. Summary of Background Data. AIS bracing can be effective if patients adhere to prescribed brace wear. Previous research has associated age, sex, and brace prescription length with future adherence. We hypothesize that a patient's initial adherence to brace wear may be associated with future adherence and outcomes. Materials and Methods. Consecutive AIS patients who met the Scoliosis Research Society (SRS) criteria for bracing from 2015 to 2019 at a single center were reviewed. Patients were stratified into groups based on their adherence during the initial one-month brace wean-in period-adherent patients were defined as wearing the brace > 80% of the daily prescribed amount. Brace wear was recorded by a thermosensor and assessed during the wean-in period, six-, 12-, and 24-month postbracing appointments. Statistical testing was conducted to analyze if initial adherence was associated with future adherence, curve change, and bracing success-defined as reaching Risser stage 4 with a Cobb angle <40°.Results. Sixty patients (mean age = 12.5 yr) were included, of which the majority were females (83%) with thoracic curves (70%). Thirty-two patients were considered adherent, and this cohort demonstrated improved adherence relative to the nonadherent group at the six-, 12-, and 24-month appointments (P < 0.001). Adherent patients also showed a significant reduction in their scoliosis at the 12-month appointment, unlike nonadherent patients (P < 0.001). Ninety-seven percent of adherent patients achieved bracing success compared with 71% of nonadherent (P = 0.016). Females were more likely to be adherent than males. Conclusions. Initial adherence to prescribed AIS brace wear was associated with future adherence, bracing success, and curve improvement. Early recognition of nonadherence may offer an opportunity for supportive intervention to improve brace wear behavior.
Background: Accurate pedicle screw placement is critical to surgically correct pediatric high-grade spondylolisthesis (HGS). The recent advent of robotics coupled with computer-assisted navigation (RAN) may represent a novel option to improve surgical outcomes of HGS, secondary to enhanced pedicle screw placement safety. This series presents the HGS-RAN technique adopted by our site, describing its surgical outcomes and feasibility. Methods: Consecutive patients with a diagnosis of HGS (Meyerding grade III to V), operated on using RAN from 2019 to 2020 at a single-center were reviewed. Demographics, screw accuracy, sagittal L5-S1 parameters, complications, and perioperative outcomes were described. All patients were treated with instrumentation, decompression, posterior lumbar interbody fusion, and reduction. Robotic time included anatomic registration to end of screw placement. Screw accuracy-defined as a screw placed safely within the planned intrapedicular trajectory-was characterized by the Gertzbein-Robbins system for patients with additional 3-dimensional imaging. Results: Ten HGS patients, with an average age of 13.7 years old, were included in the series. All 62 screws were placed without neurological deficit or complication. Seven patients had additional 3-dimensional imaging to assess screw accuracy (42 of 62 screws). One hundred percent of screws were placed safely with no pedicle breaches (Gertzbein-Robbins-grade A). Thirty screws (48%) were placed through separate incisions that were percutaneous/transmuscular and 32 screws (52%) were inserted through the main incision. There were statistically significant improvements in L5 slippage (P = 0.002) and lumbosacral angle (P = 0.002), reflecting successful HGS correction. The total median operative time was 324 minutes with the robotic usage time consuming a median of 72 minutes. Median estimated blood loss was 150 mL, and length-of-stay was a median 3 days. Conclusions: This case-series demonstrates that RAN represents a viable option for HGS repair, indicated by high screw placement accuracy, safety, and L5-S1 slippage correction. Surgeons looking to adopt an emerging technique to enhance safety and correction of pediatric HGS should consider the RAN platform. Level of Evidence: Level IV-therapeutic study.
(1) Background: Robotics coupled with navigation (RAN) is a modern surgical platform shown to increase screw placement accuracy during pediatric scoliosis surgery. Our institution uses a technique which combines the RAN platform for apical pedicle screw placement and the freehand (FH) technique for terminal pedicle screw placement during scoliosis surgery (termed hybrid technique). We question if the complementary use of the RAN technology affects intraoperative outcomes, relative to the FH-only approach. (2) Methods: 60 adolescent idiopathic scoliosis (AIS) patients, ages 11–19 at surgery, who were operated on from 2019 through 2020 by a single surgeon, were retrospectively reviewed. Patients were separated by surgery type (hybrid RAN or FH), matched on demographic and surgical factors, and their intraoperative outcomes were compared statistically. (3) Results: Hybrid RAN patients had more screws placed (p = 0.01) and were of a higher BMI percentile (p = 0.005). Controlling for the number of screws placed, BMI%, and initial curve magnitude, there were no statistical differences in estimated blood loss per screw (p = 0.51), curve correction (p = 0.69), complications (p = 0.52), or fluoroscopy time (p = 0.88), between groups. However, operative time was two minutes longer per screw for hybrid RAN patients (p < 0.001). (4) Conclusions: Hybrid RAN surgeries took longer than FH, but yielded comparable effectiveness and safety as the FH technique during the initial RAN adoption phase.
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.
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