Behavior of the un-instrumented lumbar curve following exclusive tethering of the thoracic region.

Introduction: Anterior vertebral body tethering (AVBT) has recently been utilized as a surgical alternative to posterior spinal fusion for a subset of pediatric scoliosis patients. Indications for AVBT are evolving and, while early results have been promising, there is a paucity of literature examining the behavior of the lumbar curve after exclusive tether of the thoracic region. It was hypothesized that thoracic tether leads to a spontaneous decrease in the un-instrumented lumbar curve.

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.

"Distanced Traveled" Program Increases Interest in Orthopedics in Title I High School Students.

Objectives: The Distance Traveled program aims to increase access to orthopedic education by increasing early exposure, knowledge, and interest in musculoskeletal (MSK) medicine among title 1 high school students. Title 1 high schools are a federal designation for schools serving a high percentage of students from low-income families. The program focuses on addressing barriers such as limited field exposure, lack of role models, misconceptions about physical demands, and negative stereotypes.

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).

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.

Fosaprepitant Use as an Antiemetic to Prevent Postoperative Nausea and Vomiting in Pediatric Spinal Fusion Patients May Be Associated With More Rapid Transition to Oral Pain Medication and Reduced Length of Stay.

Background: Significant postoperative nausea and vomiting (PONV) in pediatric patients undergoing posterior spinal fusion is common and limits recovery, prolonging hospital stay. Fosaprepitant is a long-acting antiemetic and works by blocking substance P binding to the neurokinin-1 (NK) receptor. There is evidence that its perioperative use substantially reduces PONV in adults, but there is a dearth of literature on its use in pediatric PONV.

Development of a classification system for potential sources of error in robotic-assisted spine surgery.

Purpose: Robotic-assisted spine surgery (RASS) has increased in prevalence over recent years, and while much work has been done to analyze differences in outcomes when compared to the freehand technique, little has been done to characterize the potential pitfalls associated with using robotics. This study's goal was to leverage expert opinion to develop a classification system of potential sources of error that may be encountered when using robotics in spine surgery. This not only provides practitioners, particularly those in the early stages of robotic adoption, with insight into possible sources of error but also provides the community at large with a more standardized language through which to communicate.

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.

Building consensus: development of a best practice guideline (BPG) for avoiding errors in robotic-assisted spine surgery (RASS).

Introduction: With the rapid increase in the use of robotic-assisted spine surgery (RASS), reports describing complications have inevitably emerged. This study builds on previous work done to identify, characterize, and classify potential sources of error in spine surgery performed with enabling technology in the operating room. The goal of this study is to leverage expert opinion to develop a set of best practice guidelines that can be employed to minimize complications and optimize patient safety, specifically as it relates to RASS.

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".

The Variability of the Cervicothoracic Inflection Point: A Cohort Analysis of the Multi-Ethnic Asymptomatic Normative Study (MEANS).

Study DesignCross-sectional Cohort Study.ObjectiveTo determine the cervicothoracic inflection point in an asymptomatic, adult population.IntroductionThe cervicothoracic inflection point (CTIP) is an important sagittal marker to understand for patients with cervical deformities.

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.

What Is the Risk of Irrigation and Debridement Following Foot and Ankle Surgery? Development of a Risk Severity Scoring System.

Background: Surgical site infection (SSI) after foot and ankle surgery has serious negative effects on patient health and quality of life. While previous studies have looked at predisposing factors for SSI, to our knowledge, no study has proposed a risk severity score.

Questions/purposes: Can a risk severity score, based on patient demographic characteristics and surgical variables, be developed for preoperative use in patients undergoing foot and ankle surgery that will calculate the risk of an irrigation and debridement (I&D) procedure within 90 days of surgery utilizing data from previous surgeries?

Methods: A retrospective chart study was performed on patients undergoing foot and ankle surgery.

Orthopedic Surgery Residents: How Much Do They Know About Occupational Therapy?

Background Orthopedic hand surgeons rely on occupational therapy (OT) as a crucial part of rehabilitation following injury or surgery. Therefore, orthopedic surgeons should understand the full range of OT services. There is limited prior research on orthopedic residents' understanding of OT in the United States.

A Prolonged Case of Severe Mpox as an Opportunistic Infection in Advanced AIDS.

The case report discusses a 29-year-old male with advanced HIV who experienced one of the longest, confirmed cases of monkeypox (mpox) infection. Despite treatment with antivirals and supportive care, including intravenous tecovirimat and vaccinia immune globulin, the patient's condition worsened over a six-and-a-half-month period. He suffered from widespread ulcerative, necrotic lesions and multiple complications, including acute kidney injury, multi-drug resistant bacterial infections, and respiratory failure.

Innovative technologies in thoracolumbar and lumbar spine surgery failing to reach standard of care: state-of-art review.

Purpose: To evaluate previously popular technologies in the field of spine surgery, and to better understand their advantages and limitations to the current standards of care. Spine surgery is an ever-evolving field that serves to resolve various spinal pathologies in patients of all ages. While there are established treatments for various conditions, such as lumbar spinal stenosis, idiopathic scoliosis, and degenerative lumbar disease, there is always further research and development in these areas to produce innovative technologies that can lead to better outcomes.

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.

Characteristics of Spinal Morphology According to the "Current" and "Theoretical" Roussouly Classification Systems in a Diverse, Asymptomatic Cohort: Multi-Ethnic Alignment Normative Study (MEANS).

Study Design: Cross-sectional cohort study.

Objective: To classify spinal morphology using the "current" and "theoretical" Roussouly systems and assess sagittal alignment in an asymptomatic cohort.

Methods: 467 asymptomatic volunteers were recruited from 5 countries.

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.

Practical Methods of Assessing Coronal Alignment and Outcomes in Adult Spinal Deformity Surgery: A Comparative Analysis.

Study Design: Asymptomatic cohort: prospective, cross-sectional, multicenter. Symptomatic: retrospective, multisurgeon, single-center.

Objective: To assess the association between cranial coronal alignment and adult spinal deformity (ASD) surgical risk and outcomes.