[Posterior instrumented correction and fusion of adolescent idiopathic scoliosis]. / Dorsale Korrekturspondylodese der idiopathischen Adoleszentenskoliose.

OBJECTIVE: Balanced frontal curve correction with horizontal shoulder levels, restoration of sagittal plane and vertebral derotation with a fusion length as short as possible. INDICATIONS: Curves larger than 40-50° Cobb angle; furthermore age, location, degree of rotation, and sagittal plane deviation have to be considered. SURGICAL TECHNIQUE: Posteriorly, segmental pedicle screw instrumentation with a high screw density (80%) and both titanium alloy and cobalt chrome rods. Freehand screw placement under consideration of both natural and deformity-induced pedicle morphology. Correction via reduction screws or instruments. Combined correction technique with rod rotation, segmental screw approximation to the generally concave rod and segmental correction of vertebral translation. Moderate concave distraction and convex compression. If needed, final in situ bending of the rods. Schwab type I osteotomies; in rigid curves type II osteotomies. Fusion with local bone, allogenic bone and/or bone substitutes (i.e., tricalcium phosphate). Intraoperative placement of a thoracic epidural catheter for postoperative pain control. Neurological monitoring throughout the procedure. POSTOPERATIVE MANAGEMENT: Mobilization on postoperative day 1 with focus on pain management and nutrition. Return to school after 4 weeks. Physiotherapy after 3 months, cycling after 3-6 months, and full sport activities after 1 year. RESULTS: Frontal curve correction of 60-80%, sufficient sagittal plane correction. Correction of rib hump 40%. Patient satisfaction is high at 95% and long-term revision rates of < 10%.

[Evidence-based implant choice in infections of the spine : Is it a gut thing, after all?] / Evidenzbasierte Implantatwahl bei Infektionen der Wirbelsäule : Ist es doch eine Bauchsache?

The choice of implant in an infection of the spine depends on what type of infection it is: discitis, spondylodiscitis, early infection after spinal surgery, or a late infection. The appropriate treatment strategies vary. In spondylodiscitis, a titanium implant may be necessary. In implant-associated early infections, surgical sanitization is often sufficient without changing the implant. In late infections, implant exchange is necessary because of biofilm.

[Characterisation of the impact and features of trampoline park-related injuries]. / Die spezifischen Auswirkungen und Merkmale von Trampolinpark-assoziierten Verletzungen.

INTRODUCTION: Numerous studies have described indoor trampoline park (ITP)-related injury patterns, but they have shown heterogeneous results. No such study has been performed in Germany to date. The aim of this study was to analyse the specific trampoline-related injury patterns found in our population. METHODS: This retrospective study included patients suffering from ITP-related injuries between 1 October 2016 and 30 April 2018. 258 patients were included in the analysis. Patients were categorised depending on different variables including age, sex, site of injury, diagnosis, length of admission and treatment using SPSS. RESULTS: In the 19-month study period, 258 patients with ITP-related injuries were recruited. Single ITP-related injuries were diagnosed in 250 (96.9 %) patients. The median age of this group was 22 years (IQR 15-28). 126 (50.4 %) injuries were suffered by men and 124 (49.6 %) by women. 168 (67.2 %) injuries occurred in the lower extremity. Sprains (n = 114, 45.6 %) and fractures without joint dislocation (n = 59, 23.6 %) were the most common diagnoses. Males suffered significantly more often from injuries of the upper extremity (26.2 vs. 9.7 %; p = 0.010), while females most commonly suffered from injuries of the lower extremity (79.8 vs. 54.8 %; p < 0.001). 45 (18 %) patients required hospital admission and twenty-five (10.0 %) patients required surgery. Eight (3.1 %) patients suffered from injuries in more than one anatomic location. CONCLUSIONS: ITP-related injuries were more prevalent in adults compared with children. The lower limb was the most affected anatomic location in all ages. The pattern of the injuries was heterogeneous, and their respective treatment represents a major challenge for traumatology surgeons.

Predictors of shoulder level after spinal fusion in adolescent idiopathic scoliosis.

BACKGROUND: For patients with adolescent idiopathic scoliosis, shoulder balance influences their treatment satisfaction and psychological well-being. Several parameters are known to affect postoperative shoulder balance, but few prognostic models are as yet available. PURPOSE: This study aimed to identify independent predictive factors that can be used to assess preoperatively which patients are at risk of postoperative shoulder elevation, and to build a linear prediction model. METHODS: N = 102 patients with all Lenke types were reviewed radiographically before surgery and 1 year afterward. The outcome measures were coracoid height difference (CHD), clavicular angle (CA), and clavicle-first rib intersection difference (CiRID). Predictive factors commonly used in the literature were investigated using correlation analysis and statistical testing. Significant contributing factors were included in three multiple linear regression models (for CHD, CA, and CiRID). RESULTS: The mean shoulder level (CHD) significantly changed from a lower left shoulder value of -8.5 mm before surgery to 3.3 mm at the follow-up examination. A high preoperative left shoulder level by CiRID, a large amount of Cobb angle correction of the distal thoracic curve, a low preoperative Cobb angle in the lumbar curve, and a structural proximal thoracic curve proved to be determinants and thus risk factors for left-sided shoulder elevation after surgery. The three models predicting CHD, CA, and CiRID at the follow-up examination included these four risk factors and were significant. CONCLUSIONS: Preoperative variables have the strongest influence on shoulder level after spinal instrumentation. Additionally, extensive correction of the distal thoracic curve can cause elevation of the left shoulder.

The influence of isolated thoracoplasty on the evolution of pulmonary function after treatment of severe thoracic scoliosis.

INTRODUCTION AND PURPOSE: Isolated thoracoplasty (iTP) on the convex side is performed long time after scoliosis surgery has been performed. ITP is thought to cause a further decline in pulmonary function (PF); however, the amount of decline is ill defined. The objectives of this study were to examine the influence of iTP on the postoperative evolution of PF and rib hump reduction in patients that previously undergone scoliosis surgery. METHODS: Over an 11-year period, 75 patients underwent iTP. The authors performed a retrospective case series review. Patients with data from PF tests performed preoperatively and at the last follow-up were included. Minimum follow-up was 12 months. The PF value reported was predicted FVC (FVC%). According to the American Thoracic Society, pulmonary impairment was classified as no impairment (FVC: >80-100%), mild (FVC: >65 ≤80%), moderate (FVC: >50 ≤65), and severe (FVC ≤50%). The outcome was studied using validated measures (SRS-24 score, COMI, and the COPD Assessment Test (CAT)). The CAT is stratified into mild impairment (<10 pts), moderate impairment (10-20 pts), severe impairment (>20-30 pts), and disabled (>30 pts). RESULTS: Twenty-six patients fulfilled the inclusion criteria. The patients' average age was 28 years at surgery with iTP, and 22 were females; the average BMI was 23, and the average follow-up was 76 months. Twenty of the patients had AIS, and six had congenital scoliosis. The time between scoliosis correction and iTP averaged 39 months. The mean number of resected rib segments was 7, and the mean blood loss was 834 ml. FVC% was 66% preoperatively and 57% at follow-up, with a significant change of 9% (p < .02). Fourteen patients had a FVC% change between preoperation and follow-up that was ≥5%; this change was not dependent on the preoperative FVC%. PF showed a slight but non-significant improvement with longer follow-up. At the time of iTP, the thoracic curve averaged 67°, and thoracic kyphosis averaged 46°. Rib hump height was 34 mm before iTP and 15 mm at follow-up (p < .03). At follow-up, the SRS-24 score was 81, the COMI score was 4 points, and the CAT score was 8 points. Eight patients had a CAT >10. Two patients had a major complication. A comparison of patients with pulmonary impairment preoperation vs. follow-up found 4 vs. 1 patients had no PF impairment, 8 vs. 4 patients had mild impairment, 10 vs. 13 patients had moderate impairment, and 4 vs. 8 patients had severe impairment. CONCLUSIONS: Isolated TP was shown an effective technique for rib hump resection. Six years after iTP, the FVC% declined by an average of 9%. Several patients had long-lasting effects in terms of %FVC decline. iTP should be reserved for patients with significant rib hump deformity.

Surgical correction of scoliosis in patients with severe cerebral palsy.

INTRODUCTION: There is a lack of data in the literature on surgical correction of severe neuromuscular scoliosis in patients with serious extent of cerebral palsy. The purpose of this retrospective cohort study was to analyze the radiological and clinical results after posterior-only instrumentation (group P) and combined anterior-posterior instrumentation (group AP) in severe scoliosis in patients with Gross Motor Function Classification System grades IV and V. MATERIALS AND METHODS: All eligible patients who underwent surgery in one institution between 1997 and 2012 were analyzed, and charts, surgical reports, and radiographs were evaluated with a minimum follow-up period of 2 years. RESULTS: Fifty-seven patients were included (35 in group P, 22 in group AP), with a median follow-up period of 4.1 years. The preoperative mean Cobb angles were 84° (34 % flexibility) in group P and 109° (27 % flexibility) in group AP. In group P, the Cobb angle was 39° (54 % correction) at discharge and 43° at the final follow-up, while in group AP the figures were 54° (50 % correction) at discharge and 56° at the final follow-up. Major complications occurred in 23 vs. 46 % of the patients, respectively. Preoperative curve flexibility was an important predictor for relative curve correction, independently of the type of surgery. CONCLUSION: Posterior-only surgery appears to lead to comparable radiological results, with shorter operating times and shorter intensive-care unit and hospital stays than combined surgery. The duration of surgery was a relevant predictor for complications.

Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients.

INTRODUCTION/PURPOSE: In adult scoliosis surgery (AS) delineation of risk factors contributing to failure is important to improve patient care. Treatment goals include deformity correction resulting in a balanced spine and horizontal lowest instrumented vertebra (LIV) in fusions not ending at S1. Therefore, the study objectives were to determine predictors for deformity correction, complications, revision surgery, and outcomes as well as to determine predictors of postoperative evolution of the LIV-take-off angle (LIV-TO) and symptomatic adjacent segment disease (ASD). METHODS: The authors performed a retrospective analysis of 448 patients who had AS surgery. Patients' age averaged 51 years, BMI 26, and follow-up of 40 months. According to the SRS adult scoliosis classification, 51 % of patients had major lumbar curves, 24 % each with single thoracic or double major curves. 54 % of patients had stable vertebra at L5 and 34 % of patients had fusion to S1. The mean number of posterior fusion levels was eight and implant density 73 %. Among standard radiographic measures of deformity the LIV-TO was assessed on neutral and bending/traction-films (bLIV-TO). Clinical outcomes were assessed in 145 patients with degenerative-type AS using validated measures (ODI, COMI and SF-36). Prediction analysis was conducted with stepwise multiple regression analyses. RESULTS: Preoperative thoracic curve (TC) was 53° and 33° at follow-up. Preoperative lumbar curve (LC) was 43° and 24° at follow-up. Curve flexibility was low (TC 34 %/LC 38 %). TC-correction (38 %) was predicted by preoperative TC (r = 0.9) and TC-flexibility (r = 0.8). LC-correction (50 %) was predicted by preoperative LC (r = 0.8), LC-flexibility (r = 0.8) and screw density (r = 0.7). Preoperative LIV-TO was 18.2° and at follow-up 9.4° (p < 0.01). 20 % of patients had a non-union (18 % at L5-S1). The risk for non-union at L5-S1 increased with age (p = 0.04), low screw density (p = 0.03), and postoperative sagittal imbalance [(T9-tilt (p = 0.01), C7-SVA (p = 0.01), LL (p = 0.01) and PI-LL mismatch (p = 0.01)]. 32 % of patients had revision surgery. Risk for revision was increased in fusions to S1 (p < 0.01), increased BMI (p < 0.01), sagittal imbalance (C7-SVA, p < 0.01), age (p = 0.02), and disc wedging distal to the LIV (p < 0.01). To a varying extent, clinical outcomes negatively correlated (p < 0.05) with revision, ASD, perioperative complications, age, low postoperative TC- and LC-correction, and sagittal and coronal imbalance at follow-up (C7-SVA, PT, and C7-CSVL). 59 patients had ASD, which correlated with preoperative and postoperative sagittal and coronal parameters of deformity. In a multivariate model, preoperative bLIV-TO (p < 0.01) and preoperative LIV-TO (p < 0.01) demonstrated the highest predictive strength for follow-up LIV-TO. CONCLUSION: In the current study, the magnitude of deformity correction in the sagittal and coronal planes was shown to have significant impact on radiographic and clinical outcomes as well as revision rates. Findings indicate that risks for complications might be reduced by restoration of sagittal balance, appropriate deformity correction and advanced lumbosacral fixation. The use of preoperative LIV-TO and LIV-TO on bending/traction-films were shown to be useful for surgical planning, selection of the LIV and prediction of follow-up-TO, respectively. Parameters of sagittal balance rather than coronal deformity predicted ASD.

Sagittal balance of the cervical spine: an analysis of occipitocervical and spinopelvic interdependence, with C-7 slope as a marker of cervical and spinopelvic alignment.

OBJECT: Sagittal malalignment of the cervical spine has been associated with worsened postsurgical outcomes. For better operative planning of fusion and alignment restoration, improved knowledge of ideal fusion angles and interdependences between upper and lower cervical spine alignment is needed. Because spinal and spinopelvic parameters might play a role in cervical sagittal alignment, their associations should be studied in depth. METHODS: The authors retrospectively analyzed digital lateral standing cervical radiographs of 145 patients (34 asymptomatic, 74 symptomatic; 37 surgically treated), including full-standing radiographs obtained in 45 of these patients. Sagittal measurements were as follows: C2-7, occiput (Oc)-C2, C1-2 Cobb angles, and C-7 slope (the angle between the horizontal line and the superior endplate of C-7), as well as T4-12 and L1-S1 Cobb angles, sacral slope, pelvic incidence, and C-7 sagittal vertical axis (SVA). A correlation analysis was performed, and linear regression models were developed. RESULTS: Statistical analyses revealed significant correlations between C2-7 and Oc-C2 (r = -0.4, p < 0.01), Oc-C2 (r = -0.3, p < 0.01), and C1-2 angle (r = -0.3, p < 0.01). C-7 slope was significantly correlated with C2-7 (r = -0.5, p < 0.01) and with Oc-C2 angle (r = 0.2, p = 0.02). Total cervical (Oc-C7) lordosis was 30.2° and did not differ significantly among asymptomatic, symptomatic, and surgically treated patients. Correlations between C2-7 and Oc-C2 alignment were stronger in asymptomatic patients (r = -0.5, p < 0.01) and surgically treated patients (r = -0.5, p < 0.01) than in symptomatic patients (r = -0.3, p = 0.01), but the between-group difference was not significant (p > 0.1). Comparing cervical and spinopelvic alignment revealed a significant correlation between sacral slope and C-7 slope (r = -0.3, p = 0.04) and C2-7 (r = 0.4, p < 0.01). The C-7 SVA correlated significantly with the C-7 slope (r = -0.4, p < 0.01). The interdependences were stronger within the occipitocervical parameters than between the cervical and remaining spinal parameters. CONCLUSIONS: Significant correlations between the upper and lower cervical spine exist, confirming the existence of inherent compensatory mechanisms to maintain overall balance; no significant differences were found among asymptomatic, symptomatic, and surgically treated patients. The C-7 slope is a useful marker of overall sagittal alignment, acting as a link between the occipitocervical and thoracolumbar spine.

Effects of liberal vs. conventional volume regimen on pulmonary function in posterior scoliosis surgery.

BACKGROUND: We observed an increased rate of pulmonary complications (hypoxemia, pulmonary edema, re-intubation) in some patients after posterior spinal fusion, though standardized intraoperative volume regimens for major surgery were used. Therefore, we focused on the effects of two different standardized fluid regimens (liberal vs. conventional) as well as on two different types of postoperative pain management (thoracic epidural catheter vs. intravenous analgesia) concerning pulmonary function in patients undergoing posterior spinal fusion. METHODS: 23 patients received a conventional intraoperative fluid management (crystalloids 5.5 ml/kg/h), whereas 22 patients obtained a liberal regimen (crystalloids approximately 11 ml/kg/h) during surgery. After surgery a thoracic epidural catheter was used in 29 patients, whereas 16 patients got a conventional intravenous analgesia. Regarding pulmonary outcome, the re-intubation rate, the postoperative oxygen saturations as well as delivery volumes and retention times of pleural drainages were evaluated. RESULTS: Patients with conventional intraoperative fluid management had a less frequent reintubation rate (p = 0.015), better postoperative oxygen saturations (p = 0.043) and lower delivery volumes of pleural drainages (p = 0.027) compared to those patients with liberal volume regimen. Patients with thoracic epidural catheter had improved oxygen saturations on pulse oximetry at the first day after surgery (p < 0.001) and lower delivery volumes of pleural drainages than patients with intravenous analgesia (p = 0.008). CONCLUSIONS: The combination of a more restrictive fluid management (better pulmonary oxygen uptake and ventilation, less pulmonary edema) and a thoracic epidural catheter (sympatholysis, pain management) in posterior spinal fusion may be advantageous as both factors can improve pulmonary outcome.

Pulmonary function after anterior double thoracotomy approach versus posterior surgery with costectomies in idiopathic thoracic scoliosis.

INTRODUCTION: The surgical approach in the treatment of idiopathic thoracic scoliosis depends on the type of curve involved. In anterior correction, the rib hump is corrected by derotating the thoracic spine. In posterior scoliosis surgery, additional rib hump resection is sometimes necessary to achieve an optimal cosmetic result. The aim of this study was to compare pulmonary function in these two patient groups. MATERIALS AND METHODS: Forty patients in the anterior group (A) were treated with standard double thoracotomy, with an anterior derotation spondylodesis and a primary stable dual-rod system. The posterior group (P) included 29 patients who were treated with a pedicle screw-based posterior instrumentation spondylodesis, with additional rib hump resection. Pulmonary function was evaluated preoperatively, on the 12th postoperative day, and at 3, 6, 12 and 24 months during the follow-up. RESULTS: The patients' mean age was 15 years in group A and 19 in group P with a standard deviation 8.7 years and a significant difference. With regard to body height or weight there were no significant differences between the two groups. In group A, the deterioration in pulmonary function immediately after the operation (from [Formula: see text] 75.3 %/71.3 % preoperatively to 38.5 %/36.1 % postoperatively) was clearer than in group P ([Formula: see text] 71.6 %/65.7 % preoperatively to 47.7 %/48.4 % postoperatively). During a follow-up period of 3 months, the values improved in both groups in comparison with the values immediately after the operation. Up to the 2 year follow-up, pulmonary function in the posterior and anterior groups corresponded to the preoperative values, with no significant differences. There was a trend toward moderately increased values in the posterior group and moderately decreased values in the anterior group at the 2-year follow-up examination, in comparison with the preoperative baseline, but without a statistically significant difference. Two major complications occurred in the anterior group, with reintubation and several bronchoscopy examinations due to atelectasis. CONCLUSION: The severe deterioration in group A is caused by the substantial trauma with double thoracotomy in contrast to rib hump resection. For patients with severe restrictive pulmonary distress, posterior instrumentation in combination with rib hump resection would be preferable to an anterior procedure involving double thoracotomy. Respiratory physiotherapy exercise should be administered in order to minimise postoperative pulmonary distress. In conclusion opening of the chest wall leads to deterioration of pulmonary function with improvement to the preoperative values after 6 months in the posterior and after 24 months in the anterior group.

Spontaneous lumbar curve correction in selective anterior instrumentation and fusion of idiopathic thoracic scoliosis of Lenke type C.

BACKGROUND: Posterior pedicle screw instrumented correction and fusion have become the gold standard in the surgical treatment of thoracic scoliosis. However, in thoracic Lenke type C curves selective posterior fusion of the thoracic curve may lead to spinal imbalance. The aim of the study was to analyse the radiological results of selective anterior thoracic fusion using a standard open dual rod technique with special respect to spontaneous lumbar curve correction (SLCC). METHODS: Twenty-eight patients (26 patients with Lenke 1C and 2 patients with Lenke 2C curves) with an average age of 15 years were surgically treated with an anterior dual rod system through a standard open double thoracotomy approach. Average clinical and radiological follow-up was 4 years (24-84 months). RESULTS: Fusion was carried out mostly from end-to-end vertebra. The primary curve was corrected from 61.6° (average correction on reverse bending films 42.9 %) to 27.1° (56.0 % correction) with an average loss of correction of 2.2°. The secondary lumbar curve measured 47.7° preoperatively (40-56°, average correction on reverse bending films 66.2 %) and corrected spontaneously to 30.1° (36 % SLCC) and remained stable without any cases of deterioration or decompensation during follow-up. Lumbar apical vertebral translation increased minimally by an average of 4 mm directly, postoperatively, and returned to an average of preoperative values during follow-up. All but two curves remained as type C lumbar modifier at follow-up. Preoperatively, three patients showed a marked coronal imbalance of more than 3 cm (all left, average 4.0 cm); at follow-up, two patients were still out of balance by more than 3 cm (all to the left, average 3.4 cm). Preoperatively, a marked shoulder imbalance of more than 1.0 cm was found in 11 patients; this was corrected in all patients to <1.0 cm at follow-up. The apical vertebral rotation measured according to Perdriolle was corrected from 23.5° to 15.0° in the thoracic spine (36.2 % correction) with an average clinical reduction of the rib hump of 63.2 %. In the lumbar spine, there was no relevant radiological derotation; however, clinically, the lumbar hump corrected spontaneously by 44.3 %. Thoracic kyphosis measured 28.5° preoperatively and 32.3° at follow-up. All six patients with a preoperative hypokyphosis (<20°) of an average of 9.5° were successfully corrected to an average thoracic kyphosis of 23.8° at follow-up. There were no cases of junctional thoracolumbar kyphosis. There were neither reoperations nor implant failures with pseudarthrosis. CONCLUSION: Selective anterior correction and fusion in primary thoracic curves with lumbar modifier type Lenke C resulted in a reliable and satisfactory SLCC. Advantages of anterior versus posterior techniques are the true segmental derotation with excellent rib hump correction and a superior restoration of thoracic kyphosis.

Validation of the pain sensitivity questionnaire in chronic pain patients.

Recently, a self-rating measure for pain perception based on imagined painful daily life situations, the Pain Sensitivity Questionnaire (PSQ), has been developed and shown to correlate with experimentally obtained pain intensity ratings in healthy subjects. Here, we assessed the validity of the PSQ for investigation of general pain perception (ie, pain perception outside the site of clinical pain) in chronic pain patients. PSQ scores were obtained in 134 chronic pain patients and compared to those of 185 healthy control subjects. In a subgroup of 46 chronic pain patients, we performed experimental pain testing outside the clinical pain site, including different modalities (heat, cold, pressure, and pinprick) and different measures (pain thresholds, pain intensity ratings). Results show that PSQ scores were significantly correlated with both experimental pain intensity ratings (Pearson's r=0.71, P<.001) and experimental pain thresholds (r=-0.52, P<.001). In addition, chronic pain patients exhibited significantly elevated PSQ scores as compared to healthy controls, consistent with the generalized increase of experimentally determined pain perception that has repeatedly been reported in chronic pain patients. These results demonstrate that the PSQ constitutes a valid self-rating measure of pain perception outside the clinical pain site in chronic pain patients and might serve as an alternative to experimental assessment of pain perception outside the clinical pain site in situations where experimental pain testing is not feasible.

Giant cell tumors of the axial skeleton.

Background. We report on 19 cases of giant cell tumor of bone (GCT) affecting the spine or sacrum and evaluate the outcome of different treatment modalities. Methods. Nineteen patients with GCT of the spine (n = 6) or sacrum (n = 13) have been included in this study. The mean followup was 51.6 months. Ten sacral GCT were treated by intralesional procedures of which 4 also received embolization, and 3 with irradiation only. All spinal GCT were surgically treated. Results. Two (15.4%) patients with sacral and 4 (66.7%) with spinal tumors had a local recurrence, two of the letter developed pulmonary metastases. One local recurrence of the spine was successfully treated by serial arterial embolization, a procedure previously described only for sacral tumors. At last followup, 9 patients had no evidence of disease, 8 had stable disease, 1 had progressive disease, 1 died due to disease. Six patients had neurological deficits. Conclusions. GCT of the axial skeleton have a high local recurrence rate. Neurological deficits are common. En-bloc spondylectomy combined with embolization is the treatment of choice. In case of inoperability, serial arterial embolization seems to be an alternative not only for sacral but also for spinal tumors.

Publication rate of abstracts presented at the Annual Congress of the Spine Society of Europe (years 2000-2003).

INTRODUCTION: The quality of presentations at medical conferences is of major importance. The publication rate (PR) following congress presentation is an indicator of the extent and quality of a scientific society's activity. The purpose of this study was to investigate publication rates in the Spine Society of Europe (SSE), compare them with the results for American spine societies, and determine factors affecting publication. MATERIALS AND METHODS: All 839 abstracts of podium and poster presentations at SSE congresses held in 2000-2003 were investigated. PRs in peer-reviewed journals within a period of 5 years were assessed. Subgroup analyses were performed for different study types. The consistency of abstracts with publications was also analyzed. RESULTS: The overall PR was 37.8%, with a mean of 17.7 ± 15.7 months between congress and publication and a mean impact factor of 1.8 ± 1.0 at the time of publication. Comparatively high PRs were found for podium presentations versus posters, studies with higher versus lower levels of evidence, experimental versus clinical studies, prospective versus retrospective studies, randomized versus nonrandomized studies, studies reporting significant main results versus those without, and multicenter studies versus single-center studies. Biomechanical studies also achieved high PRs. CONCLUSION: The PR was similar to that of NASS (40%) and only slightly inferior to that of SRS (47%) and ISSLS (45%). This shows the high quality of presentations at SSE congresses. The fate of unpublished abstracts is worth further consideration. It is questionable whether it is acceptable to cite abstracts that have not passed a journal's peer-review process and to implement their results in clinical practice.

Publication rate of abstracts presented at the Annual Congress of the German Society of Orthopaedics and Trauma Surgery.

INTRODUCTION: The quality of abstracts presented at medical conferences reflects the scientific activity in the organisations involved. The aims of this study were to evaluate the publication rate of studies presented at the annual congress of the German Society of Orthopaedics and Trauma Surgery and to investigate predictive factors for publication. The results were to be compared with other international meetings. METHOD: All 1,100 abstracts presented at the Congress of the German Society of Orthopaedics and Trauma Surgery in 2003 were assessed. The publication rate for the corresponding articles in peer-reviewed journals within 5 years was examined using a PubMed search. The consistency of the congress abstracts with the publications was studied. Factors influencing publication rates were investigated, including level of evidence (LoE) and type of study. RESULTS: The publication rate was 36%, with a mean of 15 months between conference and publication (mean impact factor 1.50). No significant differences were observed between publication rates for oral presentations and posters. Experimental studies and those with LoE I and II had higher publication rates (47.1%; 55.2%; 39.8%) than clinical studies and those with LoE III and IV (30.8%; 29.2%; 28.0%). Abstracts of randomised studies and prospective studies showed publication rates of 43.2 and 35.6% and were published more often than abstracts of non-randomised studies and retrospective studies, with publication rates of 35.3 and 27.1%. CONCLUSION: The publication rate was in the lower range of rates available for comparable conferences--e.g., the American Academy of Orthopaedic Surgeons, with rates between 34 and 55%--but lower than those of the Orthopaedic Trauma Association, at 52-67%. However, 64% of the abstracts remained unpublished, calling into question the acceptability of citing conference abstracts in the scientific literature and implementing them in clinical practice.

Prospective evaluation of physical activity in patients with idiopathic scoliosis or kyphosis receiving brace treatment.

Bracing is an established method of conservative treatment for adolescent idiopathic scoliosis and kyphosis. Compliance among adolescents is frequently inadequate due to the discomfort of wearing a brace, cosmetic issues, and fear on the part of patients and parents that bracing may reduce everyday physical activities. The aim of this prospective, controlled study was to objectify the impact of spinal bracing on daily step activity in patients receiving conservative treatment for adolescent idiopathic scoliosis (AIS) or adolescent kyphosis (AK). Forty-eight consecutive patients (mean age 13.4 ± 2.3 years), consisting of 38 AIS patients (33 girls, 5 boys) and 10 AK patients (6 girls, 4 boys) were included. Once the decision to carry out bracing had been taken and while the patients were waiting for the individual brace to be built, step activity was assessed without braces by means of step activity monitoring (SAM) for seven consecutive days. After 8 weeks of brace wearing, step activity was assessed during regular brace treatment, again for seven consecutive days. In addition, brace-wearing times were simultaneously recorded using temperature probes implanted in the braces to measure compliance. Before and during brace treatment, patients completed the Scoliosis Research Society (SRS-22) questionnaire. The SAM was worn for an average of 12.7 ± 1.5 h/day during the first measurement and 12.3 ± 1.9 h on average during the second measurement. The mean gait cycles (GCs) per day and per hour before treatment were 5,036 ± 1,465 and 395 ± 105, respectively. No significant reduction in step activity was found at the follow-up measurement during bracing, at 4,880 ± 1,529 GCs/day and 403 ± 144 GCs/h. Taking the 23-h recommended time for brace wearing as a basis (100%), patients wore the brace for 72.7 ± 27.6% of the prescribed time, indicating an acceptable level of compliance. Girls showed a higher compliance level (75.6 ± 25.6%) in comparison with boys (56.7 ± 31.9%), although the difference was not significant (P = 0.093). The SRS-22 total score showed no differences between the two measurements (2.57 ± 0.23 vs. 2.56 ± 0.28). Implementing a simultaneous and objective method of assessing step activity and brace-wearing times in everyday life proved to be feasible, and it expands the information available regarding the impact of bracing on patients' quality of life. The results clearly show that brace treatment does not negatively interfere with daily step activity in AIS and AK patients. This is an important finding that should help reduce patients' and parents' worries concerning bracing.

Sagittal balance of thoracic lordoscoliosis: anterior dual rod instrumentation versus posterior pedicle screw fixation.

Posterior pedicle screw fixation is now the standard treatment for surgical correction of idiopathic scoliosis and has largely replaced anterior techniques, but there have been reports describing a lordogenic effect of segmental pedicle screw instrumentation in the thoracic spine. This clinical study compared anterior dual rod instrumentation with posterior pedicle screw fixation for idiopathic thoracic lordoscoliosis, including 42 patients (7 male, 35 female; average age 16 years, range 12-34) who underwent posterior pedicle screw fixation (n = 20) or anterior dual rod instrumentation (n = 22) at two centers. The average follow-up period was 33 months (24-108 months). Inclusion criteria were a diagnosis of adolescent idiopathic scoliosis with a structural thoracic curve (Lenke 1-3) and thoracic hypokyphosis (T4-T12 < 20°). The main thoracic curve magnitude and sagittal profile on standing radiographs were evaluated. Thoracic kyphosis was significantly restored from preoperatively 10.2° to 23.4° postoperatively in the anterior group and from 7.6° to 12.9° in the posterior group (P < 0.005). Kyphosis improved significantly better in the anterior group than in the posterior group (P < 0.005). The preoperative and postoperative main thoracic curve values were 63° (48-80°) and 25.2° in the anterior group and 60.6° (50-88°) and 23.6° in the posterior group, with no significant differences between the groups. No neurological or other severe complications were observed. Anterior dual rod instrumentation in patients with thoracic lordoscoliosis allows significantly better restoration of thoracic kyphosis than posterior pedicle screw instrumentation.

Left convex thoracic scoliosis: retrospective analysis of 25 patients after surgical treatment / Escoliose torácica sinistro-convexa: análise retrospectiva de 25 pacientes após o tratamento cirúrgico / Escoliosis torácica convexa izquierda: análisis retrospectivo de 25 pacientes después de tratamiento quirúrgico

OBJECTIVE: A retrospective analysis of clinical and radiological data was conducted, with an emphasis on perioperative complications and risk factors and a minimum follow-up period of two years. The postoperative quality of life was assessed using the SRS-22 questionnaire. METHODS: Between 1999 and 2009, 25 patients (nine male, 16 female) with LCTS, with a mean age of 13.7 years (2.3-29.8 years), were treated with correction and instrumented fusion at a single institution. Seven patients had congenital scoliosis and 18 patients had noncongenital scoliosis (idiopathic, n = 5; neuropathic, n = 4; neoplasm-associated/iatrogenic, n = 3; secondary to other conditions, n = 6). The average preoperative Cobb angle was 74° (49-102°). RESULTS: A mean correction of 51 percent was achieved postoperatively. The mean Cobb angle at the final follow-up examination was 45° (19-85°), with a significant loss of correction of 8.8° on average. Major complications affected five patients (20 percent): respiratory insufficiency requiring prolonged intubation, intraoperative cardiac arrest with resuscitation being necessary twice in one patient, persistent clonus, low-grade infection, implant-based complications requiring revision surgery, and adding-on. Minor complications were observed in 22 patients (88 percent), mainly gastrointestinal and pulmonary. No cases of paraplegia or death occurred. A noncongenital etiology had been diagnosed before the age of 10 years in all of the patients who had major complications. The best score on the SRS-22 questionnaire was achieved in the domain of pain (87 percent), while the poorest was in the domain of self-image (68 percent). CONCLUSIONS: The results of this study emphasize an increased complication rate in patients with LCTS scheduled for scoliosis surgery. Additional preoperative examinations (MRI, paediatric consultation, cardiologic consultation, pulmonary function test) are mandatory in patients with LCTS. Preoperatively, patients should be informed about the increased cardiopulmonary and neurological risk which may be associated with scoliosis surgery.

OBJETIVO: Foi realizado estudo retrospectivo baseado em parâmetros clínicos e radiológicos, com ênfase nas complicações, fatores de risco e seguimento mínimo de dois anos. A qualidade de vida pós-operatória foi avaliada por meio do questionário SRS-22. MÉTODOS: No período de 1999 a 2009, 25 pacientes (nove do sexo masculino e 16 do sexo feminino) com idade variando de 2,3 a 29,8 anos (média de idade de 13,7 anos) foram submetidos a tratamento cirúrgico por meio de instrumentação e artrodese. Sete pacientes apresentavam escoliose congenital, cinco apresentavam escoliose idiopática, quatro neuropática, três associada à neoplasia ou iatrogenia, e seis associada a outras doenças. A média dos valores pré-operatórios do ângulo de Cobb foi 74° (49-102°). RESULTADOS: A média de correção no pós-operatório foi de 51 por cento. Na avaliação de seguimento final, o valor médio do ângulo de Cobb foi 45° com variação de 19 a 85°, tendo ocorrido significante perda da correção com o valor médio de 8.8°. Complicações maiores ocorreram em cinco pacientes (20 por cento): insuficiência respiratória requerendo entubação prolongada, parada cardíaca intraoperatória com ressuscitação, clônus persistente, infecção de baixo grau, complicações com implantes requerendo revisão cirúrgica, e descompensação do tronco. Complicações menores foram observadas em 22 pacientes (88 por cento), sendo principalmente gastrointestinais e pulmonares. Nenhum caso de paraplegia ou morte ocorreu na série de pacientes estudados. As curvas de etiologia não congênita foram diagnosticadas antes dos 10 anos de idade em todos os pacientes que apresentaram complicações maiores. O melhor escore do questionário SRS-22 foi observado no domínio da dor (87 por cento), e o pior no domínio da autoimagem (68 por cento). CONCLUSÕES: O resultado do estudo enfatiza as altas taxas de complicação nos pacientes portadores de escoliose torácica sinistro-convexa que são submetidos ao tratamento cirúrgico. Avaliações pré-operatórias adicionais (RNM, avaliação pediátrica, avaliação cardiológica, teste de função pulmonar) devem ser realizadas nesse grupo de pacientes. Antes do procedimento, os pacientes devem ser informados acerca do alto risco de complicações cardiopulmonares e neurológicas associadas ao tratamento cirúrgico da deformidade.

OBJETIVO: Fue realizado un análisis retrospectivo de datos clínicos y radiológicos, con énfasis en complicaciones perioperatorias y factores de riesgos, y un período mínimo de seguimiento de 2 años. La calidad de vida posoperatoria fue evaluada usándose el cuestionario SRS-22. MÉTODOS: entre 1999 y 2009, 25 pacientes (nueve del sexo masculino, 16 del sexo femenino) con ETCI, con edad promedio de 13,7 años (2,3 - 29,8 años) fueron tratados con corrección y fusión instrumentada, en una única institución. Siete pacientes tenían escoliosis congénita y 18 pacientes tenían escoliosis no congénita (idiopática, n = 5; neuropática, n = 4; asociada a neoplasma/iatrogénica, n = 3; secundaria de otras condiciones, n = 6). El ángulo de Cobb preoperativo promedio fue 74º (49-102º). RESULTADOS: una corrección promedio de 51 por ciento fue alcanzada después de la operación. El ángulo de Cobb promedio, en el examen final de seguimiento, fue 45º (19-85º), con una pérdida significativa de corrección de 8,8º en promedio. Complicaciones graves afectaron a cinco pacientes (20 por ciento): insuficiencia respiratoria que requirió intubación prolongada, paro cardíaco intraoperativo con resucitación siendo necesaria dos veces para un paciente, clonus persistente, infección leve, complicaciones con implantes que precisaron de otra cirugía, y accesorios. Complicaciones de menor importancia fueron observadas en 22 pacientes (88 por ciento), principalmente gastrointestinales y pulmonares. No ocurrieron casos de paraplejía ni de muerte. Una etiología no congénita fue diagnosticada, antes de la edad de 10 años, en todos los pacientes que tuvieron complicaciones graves. La mejor puntuación en el cuestionario SRS-22 fue obtenida en el dominio de dolor (87 por ciento), mientras que la peor se registró en el dominio de la autoimagen (68 por ciento). CONCLUSIONES: Los resultados de este estudio enfatizan una tasa de complicación aumentada en pacientes portadores de ETCI con programación de cirugía de escoliosis. Exámenes preoperatorios adicionales (IRM, consulta pediátrica, consulta cardiológica, prueba de función pulmonar) son obligatorios en pacientes con ETCI. Antes de la operación, los pacientes deben ser informados sobre los mayores riesgos cardiopulmonar y neurológico que pueden estar vinculados a la cirugía de escoliosis.

Two recurrences of adjacent spondylodiscitis after initial surgical intervention with posterior stabilization, debridement, and reconstruction of the anterior column in a patient with spondylodiscitis: a case report.

STUDY DESIGN: Case report. SUMMARY OF BACKGROUND DATA: This report describes a patient who had 2 episodes of destructive spondylodiscitis occurring adjacent to levels at which surgery had previously been carried out due to an initial spondylodiscitis. A review of the literature did not reveal any equivalent cases. A comprehensive description of the management of this unusual course of spondylodiscitis is therefore presented here. METHODS: Initially, the patient was suffering from L1-L2 spondylodiscitis caused by previous staphylococcal sepsis. After ineffective conservative antibiotic treatment, surgery was carried out, with posterior instrumentation and fusion at T11-L4 and removal and replacement of the L1 and L2 vertebral bodies. RESULTS: After 2 months, the patient presented with paraparesis due to adjacent spondylodiscitis at T10-T11. The posterior instrumentation was therefore extended up to T9, and removal of the vertebral body of T11 was carried out. After 14 months, the patient was readmitted with pain and increased inflammatory parameters due to spondylodiscitis at T8/T9. Removal of the vertebral bodies was again carried out at T8 and T9, and posterior fusion up to T5 was performed. The patient received antibiotic treatment from 2 months before the first operation up to 3 months after surgery. CONCLUSION: Newly developing spondylodiscitis adjacent to a level at which a previous spondylodiscitis has been treated surgically is a rare condition, and aggressive treatment is necessary.