Single Long-Incision Minimally Invasive Surgery

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

The objective of this study is to determine differences in outcomes in patients with adolescent idiopathic scoliosis undergoing spinal deformity correction surgery using a posterior spinal fusion (PSF) approach versus single and triple-incision minimally invasive surgery (MIS).

SUMMARY OF BACKGROUND DATA

MIS increased in popularity as surgeons' focus moved towards soft tissue preservation, but it carries technical demands and increased surgical time compared with PSF.

PATIENTS AND METHODS

Surgeries performed from 2016 to 2020 were included. Cohorts were formed based on surgical approach: PSF versus single long-incision MIS (SLIM) versus traditional MIS [3-incision MIS (3MIS)]. There were a total of 7 subanalyses. Demographic, radiographic, and perioperative data were collected for the 3 groups. Kruskal-Wallis and χ 2 tests were used for continuous and categorical variables, respectively.

RESULTS

Five hundred thirty-two patients met our inclusion criteria, 294 PSF, 179 3MIS, and 59 SLIM.Estimated blood loss (mL) ( P < 0.00001) and length of stay (LOS) ( P < 0.00001) was significantly higher in PSF than in SLIM and 3MIS. Surgical time was significantly higher in 3MIS than in PSF and SLIM ( P = 0.0012).Patients who underwent PSF had significantly lower postoperative T5 to T12 kyphosis ( P < 0.00001) and percentage kyphosis change ( P < 0.00001). Morphine equivalence was significantly higher in the PSF group during total hospital stay ( P = 0.0042).Patients who underwent SLIM and 3MIS were more likely to return to noncontact ( P = 0.0096) and contact sports ( P = 0.0095) within 6 months and reported lower pain scores ( P < 0.001) at 6 months postoperation.

CONCLUSION

SLIM has a similar operative time to PSF and is technically similar to PSF while maintaining the surgical and postoperative outcome advantages of 3MIS.

Does a dedicated "Scoliosis Team" and surgical standardization improve outcomes in adolescent idiopathic scoliosis surgery and is it reproducible?

PURPOSE

The objective of this study was to determine if standardization improves adolescent idiopathic scoliosis (AIS) surgery outcomes and whether it is transferrable between institutions.

METHODS

A retrospective review was conducted of AIS patients operated between 2009 and 2021 at two institutions (IA and IB). Each institution consisted of a non-standardized (NST) and standardized group (ST). In 2015, surgeons changed institutions (IA- > IB). Reproducibility was determined between institutions. Median and interquartile ranges (IQR), Kruskal-Wallis, and χ2 tests were used.

RESULTS

500 consecutive AIS patients were included. Age (p = 0.06), body mass index (p = 0.74), preoperative Cobb angle (p = 0.53), and levels fused (p = 0.94) were similar between institutions. IA-ST and IB-ST had lower blood loss (p < 0.001) and shorter surgical time (p < 0.001). IB-ST had significantly shorter hospital stay (p < 0.001) and transfusion rate (p = 0.007) than IB-NST. Standardized protocols in IB-ST reduced costs by 18.7%, significantly lowering hospital costs from $74,794.05 in IB-NST to $60,778.60 for IB-ST (p < 0.001). Annual analysis of surgical time revealed while implementation of standardized protocols decreased operative time within IA, when surgeons transitioned to IB, and upon standardization, IB operative time values decreased once again, and continued to decrease annually. Additions to standardized protocol in IB temporarily affected the operative time, before stabilizing.

CONCLUSION

Surgeon-led standardized AIS approach and streamlined surgical steps improve outcomes and efficiency, is transferrable between institutions, and adjusts to additional protocol changes.

Effect of Pedicle Screw Size on Surgical Outcomes Following Surgery for 412 Adolescent Idiopathic Scoliosis Patients

STUDY DESIGN

Retrospective Review.

OBJECTIVE

The objective of this study was to determine differences in surgical and post-operative outcomes in AIS patients undergoing spinal deformity correction surgery using standard or large pedicle screw size.

SUMMARY OF BACKGROUND

Use of pedicle screw fixation in spinal deformity correction surgery is considered safe and effective. Still, the small size of the pedicle and the complex 3D anatomy of the thoracic spine makes screw placement challenging, with improper pedicle screw fixation leading to catastrophic complications including injuries to nerve roots, spinal cord, and major vessels. Thus, insertion of larger diameter screw sizes has raised concerns amongst surgeons, especially in the pediatric population.

MATERIALS AND METHODS

AIS patients undergoing PSF between 2013 and 2019 were included. Demographic, radiographic, and operative outcomes collected. Patients in the large screw size group (GpI) received 6.5 mm diameter screw sizes at all levels while standard screw size group (GpII) received 5.0 to 5.5 mm diameter screw sizes at all levels. Kruskall-Wallis and Fisher's exact test performed for continuous and categorical variables respectively.Subanalyses included (1) screw accuracy in patients with available CT scans, (2) stratified analysis of large- and standard-screw patients with ≥60% flexibility rate, (3) stratified analysis of large- and standard-screw patients with <60% flexibility rate, and (4) matched analysis of large- and standard-screw patients by surgeon and year of surgery.

RESULTS

GpI patients experienced significantly higher overall curve correction ( P <0.001), with 87.6% experiencing at least one grade reduction of apical vertebral rotation from preoperative to postoperative visit( P =0.008).Patients with larger screws displayed higher postoperative kyphosis. No patient experienced medial breaching.

CONCLUSION

Large screw sizes have similar safety profiles to standard screws without negatively impacting surgical and perioperative outcomes in AIS patients undergoing PSF. Additionally, coronal, sagittal, and rotational correction is superior for larger-diameter screws in AIS patients.

The Social Media Presence of Professional Sports Team Physicians Is High Among Major League Soccer, Major League Lacrosse, Major League Rugby, Winter Olympics, and Women's National Basketball Association, But Highest Among MLS Team Physicians

Purpose

To quantify the social media utilization of professional sports team physicians on popular platforms and analyze differences between physician users and physician non-users for smaller major professional sports: Major League Soccer (MLS), Major League Lacrosse (MLL), Major League Rugby (MLR), Winter Olympics (WO) and Women's National Basketball Association (WNBA).

Methods

Physicians for the MLS, MLL, MLR, WO, and WNBA were identified and characterized based on training background, practice setting, years of experience, and geographic location. Social media presence on Facebook, Twitter, LinkedIn, Instagram, and ResearchGate were determined. Differences between social media users and non-users were analyzed via chi-squared tests for nonparametric variables. Secondary analysis consisted of univariate logistic regression to identify associated factors.

Results

86 team physicians were identified. 73.3% of physicians had at least one social media profile. 80.2% of physicians were orthopedic surgeons. Specifically, 22.1% had a professional Facebook page, 24.4% had a professional Twitter page, 58.1% had a LinkedIn profile, 25.6% a ResearchGate profile, and 9.3% an Instagram account. All physicians with a social media presence were fellowship-trained.

Conclusions

Seventy-three percent of team physicians in the MLS, MLL, MLR, WO, or WNBA have social media presence, with over half using LinkedIn. Fellowship-trained physicians were significantly more likely to use social media, and 100% of physicians with social media presence were fellowship trained. MLS and WO team physicians were significantly more likely to use LinkedIn (P = .02). MLS team physicians were significantly more likely to use social media overall (P = .004). No other metric significantly impacted social media presence.

Clinical Relevance

The influence of social media is vast. It is important to explore the extent that sports team physicians utilize social media and how this use may influence patient care.