1
|
Fields MW, Rymond CC, Malka MS, Givens RR, Simhon ME, Matsumoto H, Marciano GF, Boby AZ, Roye BD, Vitale MG. Improvement in axial rotation with bracing reduces the risk of curve progression in patients with adolescent idiopathic scoliosis. Spine Deform 2024:10.1007/s43390-024-00888-x. [PMID: 38698106 DOI: 10.1007/s43390-024-00888-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/23/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE New evidence highlights the significance of 3D in-brace correction for Adolescent Idiopathic Scoliosis (AIS) patients. This study explores how axial parameters relate to treatment failure in braced AIS patients. METHODS AIS patients (Sanders 1-5) undergoing Rigo-Chêneau bracing at a single institution were included. Axial vertebral rotation (AVR) was determined by utilizing pre-brace and in-brace 3D reconstructions from EOS® radiographs. The primary outcome was treatment failure: surgery or coronal curve progression > 5°. Minimum follow-up was two years. RESULTS 75 patients (81% female) were included. Mean age at bracing initiation was 12.8 ± 1.3 years and patients had a pre-brace major curve of 31.0° ± 6.5°. 25 patients (76% female) experienced curve progression > 5°, and 18/25 required surgical intervention. The treatment failure group had larger in-brace AVR than the success group (5.8° ± 4.1° vs. 9.9° ± 7.6°, p = 0.003), but also larger initial coronal curve measures. In-brace AVR did not appear to be associated with treatment failure after adjusting for the pre-brace major curve (Hazard Ratio (HR):0.99, 95% Confidence Interval (CI):0.94-1.05, p = 0.833). Adjusting for pre-brace major curve, patients with AVR improvement with bracing had an 85% risk reduction in treatment failure versus those without (HR:0.15, 95% CI:0.02-1.13, p = 0.066). At the final follow-up, 42/50 (84%) patients without progression had Sanders ≥ 7. CONCLUSIONS While in-brace rotation was not an independent predictor of curve progression (due to its correlation with curve magnitude), improved AVR with bracing was a significant predictor of curve progression. This study is the first step toward investigating the interplay between 3D parameters, skeletal maturity, compliance, and brace efficacy, allowing a future prospective multicenter study. LEVEL OF EVIDENCE Retrospective study; Level III.
Collapse
Affiliation(s)
- Michael W Fields
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Christina C Rymond
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Matan S Malka
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
- Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, Chony 8-N, New York, NY, 10032-3784, USA
| | - Ritt R Givens
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
- Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, Chony 8-N, New York, NY, 10032-3784, USA.
| | - Matthew E Simhon
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Gerard F Marciano
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Afrain Z Boby
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Benjamin D Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
- Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, Chony 8-N, New York, NY, 10032-3784, USA
| | - Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
- Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, Chony 8-N, New York, NY, 10032-3784, USA
| |
Collapse
|
2
|
Marciano GF, Simhon ME, Lehman RA, Lenke LG. Strategies to Avoid Distal Junctional Pathology. Neurosurg Clin N Am 2023; 34:585-597. [PMID: 37718105 DOI: 10.1016/j.nec.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Distal junctional pathology remains an unsolved issue in spine surgery. Distal junctional pathology can occur on a spectrum from asymptomatic radiographic finding to catastrophic distal construct failure. It is significant to address as postoperative sagittal balance has been shown to be correlated with patient-reported outcomes. Current literature and clinical experience suggest there are techniques that can be implemented regardless of setting to avoid distal junctional pathology. Much of the avoidant strategy relies on understanding the deformity pathology, selection of the lowest instrumented vertebra (LIV), health of the segments caudal to the LIV, and methods of fixation.
Collapse
Affiliation(s)
- Gerard F Marciano
- Department of Orthopedics, Columbia University Medical Center, 622 West 168th Street, PH 11- Center, New York, NY 10032, USA.
| | - Matthew E Simhon
- Department of Orthopedics, Columbia University Medical Center, 622 West 168th Street, PH 11- Center, New York, NY 10032, USA
| | - Ronald A Lehman
- The Daniel and Jane Och Spine Hospital at New York-Presbyterian/Allen, 5141 Broadway, New York, NY 10034, USA
| | - Lawrence G Lenke
- The Daniel and Jane Och Spine Hospital at New York-Presbyterian/Allen, Och Spine/Allen NYP Hospital, 5141 Broadway, New York, NY 10034, USA
| |
Collapse
|
3
|
Marciano GF, Ferlauto HR, Confino J, Kelly M, Surace MF, Vulcano E. Clinical Outcomes Following Percutaneous Ankle Fusion With Bone Graft Substitute. Foot Ankle Orthop 2023; 8:24730114231178781. [PMID: 37332629 PMCID: PMC10272655 DOI: 10.1177/24730114231178781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Background Percutaneous ankle fusion is an emerging technique with minimal published outcome data. The goal of the present study is to retrospectively review clinical and radiographic outcomes following percutaneous ankle fusion and provide technique tips to perform percutaneous ankle fusion. Methods Patients >18 years of age, treated by a single surgeon, from February 2018 to June 2021, who underwent primary isolated percutaneous ankle fusion supplemented with platelet-derived growth factor B (rhPDGF-BB) and beta-tricalcium phosphate, with at least 1-year follow-up were included. Surgical technique consisted of percutaneous ankle preparation followed by fixation with 3 headless compression screws. Pre- and postoperative visual analog scale (VAS) and Foot Function Index (FFI) were compared using paired t tests. Fusion was assessed radiographically by the surgeon on postoperative radiographs and computed tomography (CT) at 3 months postoperatively. Results Twenty-seven consecutive adult patients were included in the study. Mean follow-up was 21 months. Mean age was 59.8 years. Mean preoperative and postoperative VAS scores were 7.4 and 0.2, respectively (P < .01). Mean preoperative FFI pain domain, disability domain, activity restriction domain, and total score were 20.9, 16.7, 18.5, and 56.4, respectively. Mean postoperative FFI pain domain, disability domain, activity restriction domain, and total score were 4.3, 4.7, 6.7, and 15.8, respectively (P < .01). Fusion was achieved in 26 of 27 patients (96.3%) at 3 months. Four patients (14.8%) had complications. Conclusion We found in this cohort with surgery performed by a surgeon highly experienced in minimally invasive surgery that percutaneous ankle fusion augmented with a bone graft supplement achieved a high rate of fusion (96.3%) and a significant improvement in pain and function postoperatively while associated with minimal complications. Level of Evidence Level IV, case series.
Collapse
Affiliation(s)
- Gerard F. Marciano
- Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Harrison R. Ferlauto
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jamie Confino
- Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Meghan Kelly
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ettore Vulcano
- Department of Orthopedics, Mount Sinai Medical Center, Miami, FL, USA
| |
Collapse
|
4
|
Matsumoto H, Boby AZ, Sinha R, Campbell ML, Hung CW, Gbolo FC, Marciano GF, Levine S, Fano AN, Simhon ME, Quan T, Bainton NM, George A, Mizerik AS, Roye BD, Roye DP, Vitale MG. Development and Validation of a Health-Related Quality-of-Life Measure in Older Children and Adolescents with Early-Onset Scoliosis: Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF). J Bone Joint Surg Am 2022; 104:1393-1405. [PMID: 35726883 DOI: 10.2106/jbjs.21.01508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The 24-question Early-Onset Scoliosis Questionnaire (EOSQ-24) is a proxy measure assessing health-related quality of life (HRQoL) among patients with early-onset scoliosis (EOS). There exists an increasing need to assess HRQoL through a child's own perspective, particularly for older children and adolescents with EOS. The purpose of this study was to develop and validate a self-reported questionnaire, the Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF), to assess HRQoL in older children and adolescents with EOS. METHODS A literature review, an expert focus group, and patient interviews were used to generate a preliminary survey of appropriate domains and question items. This survey was provided to English-speaking patients with EOS who were 8 to 18 years of age and capable of answering survey questions. Content validity was assessed for clarity and relevance of questions. Confirmatory factors analysis was performed to reduce the number of items and determine domains that fit items. Reliability was evaluated by measuring the internal consistency of items and test-retest reliability. Construct validity was evaluated by convergent, discriminant, and known-group validity. RESULTS The literature review, expert focus group, and patient interviews identified 59 questions in 14 domains. Psychometric analysis reduced these to 30 questions across 12 domains: General Health, Pain/Discomfort, Pulmonary Function, Transfer, Physical Function/Daily Living, Participation, Fatigue/Energy Level, Sleep, Appearance, Relationships, Emotion, and Satisfaction. The final questionnaire was found to have good content and construct validity and adequate reliability. CONCLUSIONS The EOSQ-SELF is a valid and reliable instrument for measuring self-reported HRQoL among older children and adolescents with EOS (ages 8 to 18 years). This will serve as an important research outcome measure and enhance clinical care by providing a better understanding of HRQoL for these patients. LEVEL OF EVIDENCE Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Afrain Z Boby
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Rishi Sinha
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Megan L Campbell
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Chun Wai Hung
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Fay C Gbolo
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Gerard F Marciano
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Sonya Levine
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Adam N Fano
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Matthew E Simhon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Theodore Quan
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Nicole M Bainton
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Ameeka George
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Amber S Mizerik
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Benjamin D Roye
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - David P Roye
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Michael G Vitale
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| |
Collapse
|
5
|
Coury JR, Skaggs KF, Marciano GF, Pinyavat T, Naseef M, Roye BD, Vitale MG. Intraoperative Anaphylaxis to the Bovine Flowable Gelatin Matrix: A Report of 2 Cases. JBJS Case Connect 2022; 12:01709767-202203000-00063. [PMID: 35239550 DOI: 10.2106/jbjs.cc.21.00753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE We present 2 cases of life-threatening intraoperative anaphylaxis to the bovine flowable gelatin matrix during pediatric spinal deformity surgery for kyphoscoliosis. Both patients had no known bovine or gelatin allergies. Anaphylaxis occurred shortly after pressurized injection into the first cannulated pedicle tract and was successfully treated with epinephrine, diphenhydramine, and methylprednisolone infusion. The allergic reaction was confirmed with tryptase levels and serum-specific immunoglobulin E for beef, pork, bovine collagen, and porcine collagen. CONCLUSION In patients with beef, pork, or gelatin intolerance, a significant atopic history or childhood vaccine reaction, preoperative allergy consultation, and testing should be performed to prevent this life-threatening complication.
Collapse
Affiliation(s)
- Josephine R Coury
- Department of Pediatric Orthopedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Kira F Skaggs
- Department of Pediatric Orthopedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Gerard F Marciano
- Department of Pediatric Orthopedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Teeda Pinyavat
- Department of Pediatric Anesthesiology, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Mervat Naseef
- Department of Pediatric Allergy and Immunology, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Benjamin D Roye
- Department of Pediatric Orthopedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Michael G Vitale
- Department of Pediatric Orthopedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
6
|
Bixby EC, Skaggs K, Marciano GF, Simhon ME, Menger RP, Anderson RCE, Vitale MG. Resection of congenital hemivertebra in pediatric scoliosis: the experience of a two-specialty surgical team. J Neurosurg Pediatr 2021:1-10. [PMID: 34214975 DOI: 10.3171/2020.12.peds20783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Institutions investigating value and quality emphasize utilization of two attending surgeons with different areas of technical expertise to treat complex surgical cases and to minimize complications. Here, the authors chronicle the 12-year experience of using a two-attending surgeon, two-specialty model to perform hemivertebra resection in the pediatric population. METHODS Retrospective cohort data from 2008 to 2019 were obtained from the NewYork-Presbyterian Morgan Stanley Children's Hospital operative database. This database included all consecutive pediatric patients < 21 years old who underwent hemivertebra resection performed with the two-attending surgeon (neurosurgeon and orthopedic surgeon) model. Demographic information was extracted. Intraoperative complications, including durotomy and direct neurological injury, were queried from the clinical records. Intraoperative neuromonitoring data were evaluated. Postoperative complications were queried, and length of follow-up was determined from the clinical records. RESULTS From 2008 to 2019, 22 patients with a median (range) age of 9.1 (2.0-19.3) years underwent hemivertebra resection with the two-attending surgeon, two-specialty model. The median (range) number of levels fused was 2 (0-16). The mean (range) operative time was 5 hours and 14 minutes (2 hours and 59 minutes to 8 hours and 30 minutes), and the median (range) estimated blood loss was 325 (80-2700) ml. Navigation was used in 14% (n = 3) of patients. Neither Gardner-Wells tongs nor halo traction was used in any operation. Neuromonitoring signals significantly decreased or were lost in 14% (n = 3) of patients. At a mean ± SD (range) follow-up of 4.6 ± 3.4 (1.0-11.6) years, 31% (n = 7) of patients had a postoperative complication, including 2 instances of proximal junctional kyphosis, 2 instances of distal junctional kyphosis, 2 wound complications, 1 instance of pseudoarthrosis with hardware failure, and 1 instance of screw pullout. The return to the operating room (OR) rate was 27% (n = 6), which included patients with the abovementioned wound complications, distal junctional kyphosis, pseudoarthrosis, and screw pullout, as well as a patient who required spinal fusion after loss of motor evoked potentials during index surgery. CONCLUSIONS Twenty-two patients underwent hemivertebra resection with a two-attending surgeon, two-specialty model over a 12-year period at a specialized children's hospital, with a 14% rate of change in neuromonitoring, 32% rate of nonneurological complications, and a 27% rate of unplanned return to the OR.
Collapse
Affiliation(s)
- Elise C Bixby
- 1Department of Orthopedics, Columbia University Irving Medical Center, New York, New York
| | - Kira Skaggs
- 1Department of Orthopedics, Columbia University Irving Medical Center, New York, New York
| | - Gerard F Marciano
- 1Department of Orthopedics, Columbia University Irving Medical Center, New York, New York
| | - Matthew E Simhon
- 1Department of Orthopedics, Columbia University Irving Medical Center, New York, New York
| | | | | | - Michael G Vitale
- 1Department of Orthopedics, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|