Brace yourself (Part-time): part-time bracing leads to curve improvement in juvenile idiopathic scoliosis.

Purpose: The efficacy of bracing for juvenile idiopathic scoliosis (JIS) remains controversial. Although full-time bracing is standard for curves > 25°, part-time bracing for smaller curves (< 25°) may prevent progression. This study evaluates the effectiveness of part-time bracing compared to observation in JIS patients with 15-24° curves, hypothesizing that part-time bracing reduces curve progression and the need for full-time bracing.

Three-dimensional Rigo Cheneau-style brace for adolescent idiopathic scoliosis: higher in-brace correction and lower rates of curve progression.

Purpose: Bracing has long been the mainstay of conservative management for adolescent idiopathic scoliosis (AIS) yet there is little data comparing treatment outcomes among different brace types. The purpose of this study is to compare curve progression and need for surgery between patients treated with Rigo Cheneau-style orthoses (RCSO) that focus on three-dimensional correction and traditional thoracolumbar-sacral orthoses (TLSO).

Methods: Patients who began treatment at a single institution with an initial major coronal curve between 20° and 45° and no previous scoliosis treatment were included.

Determination of Normative Values for the Early Onset Scoliosis Self-Reported Questionnaire (EOSQ-SELF).

Background: The early-onset scoliosis (EOS) self-questionnaire (EOSQ-SELF) is a recently validated patient-reported outcome (PRO) instrument created to allow patients with EOS to report their perspectives on their own health (Appendix 1, Supplemental Digital Content 1, http://links.lww.com/BPO/A936).

Provider Perspectives on Use of Nighttime and Full-time Bracing to Treat Adolescent Idiopathic Scoliosis.

Background: For patients with adolescent idiopathic scoliosis (AIS), full-time scoliosis braces are effective in preventing curve progression but are a source of stress for patients and families. Nighttime hypercorrective braces have minimal impact on daily life, but there is little evidence to guide prescription. It is not known how providers with expertise in scoliosis incorporate nighttime bracing into their routine clinical practice.

Failure to replace removed growth friendly implants results in deteriorating radiographic outcomes.

Introduction: Management of early onset scoliosis (EOS) patients can require growth-friendly surgery to manage spinal deformity in children too immature for a definitive fusion. There is limited literature on outcomes for patients with failed growing constructs requiring removal of implants (ROI).

Methods: We studied EOS patients from an international registry undergoing removal of growth-friendly implants, comparing early re-implantation (within 12 months of ROI) to observation-only.

Risk of proximal junctional kyphosis after revision of growing rod constructs.

Introduction: For early-onset scoliosis (EOS) patients with growth-friendly implants, posterior distraction is a known contributor to proximal junctional kyphosis (PJK). Rib-based proximal fixation is thought to potentially reduce the risk of PJK compared to spine-based anchors. However, the effect of revising proximal rib-based implants to rib vs.

Indications for and outcomes of muscle flap reconstruction after pediatric posterior spinal fusion: An ACS-NSQIP analysis of 32,466 surgeries.

Background: Muscle flap reconstruction immediately after pediatric spinal fusion surgeries has been associated with favorable post-operative outcomes. This study employed a database with large geographic coverage to further characterize indications for and outcomes of such reconstructions.

Methods: Overall, 32,466 posterior spinal fusion cases from 2016 to 2022 were identified within the ACS-NSQIP Pediatric (NSQIP-P) database.

Maintenance of construct integrity with subaxial cervical pedicle screws when crossing the cervicothoracic junction in complex pediatric deformity: an international multicenter study.

Objective: In cases of complex pediatric spinal deformity, posterior spinal instrumentation crossing the cervicothoracic junction (CTJ) may be required. This is most frequently encountered for revision surgery to address proximal junctional kyphosis (PJK). In the cervical spine, lateral mass screws are most commonly used, although they may result in biomechanically weak proximal constructs and predispose to instrumentation failure.

Magnetically controlled rod fracture is related to rod diameter but lower than TGR.

Purpose: To quantify the risk of rod fracture after growth-friendly early-onset scoliosis (EOS) surgery, compare the risk of fracture between magnetically controlled growing rods (MCGR) and traditional growing rods (TGR), and compare the risk of fracture based on rod diameter.

Methods: EOS patients undergoing TGR or MCGR instrumentation were identified from a large, multi-national registry (Pediatric Spine Study Group). Subgroup analyses (chi-squared and Mann-Whitney U tests) were performed between rods with diameters ≤ 5 mm and > 5 mm and between MCGR and TGR.

A Novel Preoperative Scoring System to Accurately Predict Cord-Level Intraoperative Neuromonitoring Data Loss During Spinal Deformity Surgery: A Machine-Learning Approach.

Background: An accurate knowledge of a patient's risk of cord-level intraoperative neuromonitoring (IONM) data loss is important for an informed decision-making process prior to deformity correction, but no prediction tool currently exists.

Methods: A total of 1,106 patients with spinal deformity and 205 perioperative variables were included. A stepwise machine-learning (ML) approach using random forest (RF) analysis and multivariable logistic regression was performed.

Making wrong site surgery a "never event" in spinal deformity surgery by use of a "landmark vertebra" to eliminate variability in identifying a target vertebral level.

Purpose: Despite the introduction of "standardized counting" methods, errors in counting spinal levels and subsequent wrong-level surgery (WLS) remain critically important patient safety concerns. Previous work by our group has documented inconsistency in the identification of T12 despite the use of these systems including the Spinal Deformity Study Group (SDSG) conventions. To assist with consistent and repeatable identification of proposed preoperative surgical levels, the current study investigates a new strategy: utilization of a "landmark vertebra".

Do teams of strangers create health care dangers? The effect of OR team consistency on operative times in adolescent idiopathic scoliosis.

Purpose: Teamwork and communication are important components of any surgical team. This study uses a simple, reproducible, and quantitative "team consistency score" and a nodal-based model for examining prior interactions amongst team members to represent and quantify the regularity of an OR team for a specific surgical case.

Methods: The electronic medical record (EMR) at our institution was queried for pediatric patients undergoing spinal surgery from January 2021 through December 2023.

Spontaneous Resolution of Kyphoscoliosis Secondary to Guillain-Barre Syndrome: A Case Report.

Case: Spinal deformity associated with Guillain-Barre syndrome (GBS) is not commonly reported. We present a 6-year-old girl who developed kyphoscoliosis after being diagnosed GBS. She had extensive motor deficits requiring 2 hospitalizations and treatment with IV immunoglobulin therapy.

Sagittal spinopelvic alignment in ambulatory persons with cerebral palsy.

Purpose: This study aimed to describe the spinopelvic alignment of a cohort of young ambulatory individuals with cerebral palsy (CP) and compare it to published spinopelvic alignment data for the typically developing adolescents.

Methods: Thirty-seven adolescents (18 females) with CP at GMFCS I-III were included in this retrospective case series. Lumbar lordosis and pelvic incidence were measured, and their mismatch was calculated.

Timing of intraoperative neurophysiological monitoring (IONM) recovery and clinical recovery after termination of pediatric spinal deformity surgery due to loss of IONM signals.

Background Context: Intraoperative neurophysiological monitoring (IONM) is used to reduce the risk of spinal cord injury during pediatric spinal deformity surgery. Significant reduction and/or loss of IONM signals without immediate recovery may lead the surgeon to acutely abort the case. The timing of when monitorable signals return remains largely unknown.

Preoperative Echocardiogram Does Not Contribute to Surgical Risk Assessment in Patients With Large Curve Scoliosis and No Cardiac Risk Factors.

Objective: Severe scoliosis can affect thoracic organs, potentially leading to cardiovascular abnormalities. Thus, echocardiograms have been suggested for use in preoperative screening in patients with significant scoliosis. However, the utility of preoperative heart screenings in patients without known or suspected heart problems is not well understood.

Lowest instrumented vertebrae in early onset scoliosis: is there a role for a more selective approach?

Purpose: This purpose of this study was to assess the impact of patient and implant characteristics on LIV selection in ambulatory children with EOS and to assess the relationship between the touched vertebrae (TV), the last substantially touched vertebrae (LSTV), the stable vertebrae (SV), the sagittal stable vertebrae (SSV), and the LIV.

Methods: A multicenter pediatric spine database was queried for patients ages 2-10 years treated by growth friendly instrumentation with at least 2-year follow up. The relationship between the LIV and preoperative spinal height, curve magnitude, and implant type were assessed.

Evaluating compliance with the best practice guidelines for wrong-level surgery prevention in high-risk pediatric spine surgery.

Purpose: In 2018, Best Practice Guidelines (BPGs) were published for preventing wrong-level surgery in pediatric spinal deformity, but successful implementation has not been established. The purpose of this study was to evaluate BPG compliance 5 years after publication. We hypothesized higher compliance among BPG authors and among surgeons with more experience, higher caseload, and awareness of the BPGs.

A New Look at Vertebral Body Tethering (VBT): Through the Modified Clavien-Dindo-Sink (mCDS) Classification.

Introduction: Anterior vertebral body tethering (AVBT) is increasingly popular as an option for surgical treatment of idiopathic scoliosis (IS). While the technology remains new, it is important for families and patients to be able to compare it to the current standard of care, posterior spinal fusion (PSF). The purpose of this study is to describe the complication rate of AVBT in IS using the mCDS and to compare it to the recently reported complication rate of PSF in IS.

Institutional Variability in Anesthesia Time for Mehta Casting in Early-Onset Scoliosis (EOS).

Purpose: Mehta casting is a potentially curative intervention for early-onset scoliosis (EOS) that typically requires multiple anesthetics. The Food and Drug Administration (FDA) reported that >3 hours of anesthesia under the age of 3 years old may alter brain development; however, no standard exists for the duration of anesthesia during casting. The purpose of this study is to quantify the variability in anesthesia during Mehta casting.

Scoliosis Bracing: Details Make the Difference.

Effective bracing for idiopathic scoliosis is influenced by factors such as age, skeletal maturity, and curve attributes, with success reliant on patient adherence and engagement. The purpose of this paper is to highlight strategies for successful treatment. Using standardized, effective communication detailing patient data, including radiographic measurements, supports clear communication between orthopaedic surgeon, orthotist, and patient.

Failure to lengthen consensus for the magnetically controlled growing rod (MCGR).

Introduction: MCGR lengthening has become an important innovation in treating patients with EOS. An alternative to traditional growing instrumentation, a single surgical procedure is necessary for insertion of the construct, followed by non-invasive lengthening in the outpatient setting. With every new technology emanates a new complication to troubleshoot.