Does the addition of convex uniplanar screws in hybrid constructs improve 3D surgical correction in thoracic adolescent idiopathic scoliosis posterior fusion?

Purpose: Hybrid techniques using thoracic sublaminar bands have proved their efficacy in adolescent idiopathic scoliosis posterior fusion, but clinical axial correction sometimes remained disappointing. One solution found was "the frame technique" and the second alternative was the replacement of the convex sublaminar bands by periapical uniplanar screws. The goal of this study was to compare clinical and radiological outcomes of both techniques in a consecutive cohort of adolescent idiopathic scoliosis patients. Methods: All patients undergoing primary posterior fusion for thoracic adolescent idiopathic scoliosis between January 2017 and March 2020 were included. Two groups were compared: Group 1 with thoracic sublaminar bands only and Group 2 with periapical uniplanar screws. All patients underwent standing stereoradiographs. The main frontal, sagittal, and axial (apical vertebra rotation) radiological parameters of interest were analyzed. Functional outcomes were assessed using the Scoliosis Research Society 30 score. Results: A total of 147 adolescents were included (Group 1, n = 73 and Group 2, n = 74 patients). In the frontal plane, a greater reduction index was observed in Group 2 (68% versus 62%, p < 0.001) as well as a better apical axial correction (67.8% versus 46.6%, p = 0.03). The number of thoracoplasty performed was reduced (6.7% versus 20.5%, p = 0.02) in Group 2, with a significant decrease in the rate of mechanical complication. No significant loss of correction was observed during follow-up in any of the group. Conclusion: The adjunction of convex uniplanar screws at the periapical levels improved the three-dimensional surgical correction of thoracic adolescent idiopathic scoliosis treated with hybrid constructs. Level of evidence: level III, retrospective comparative study.

Influence of pelvic tilt correction on PJK occurrence after adult spinal deformity surgery.

INTRODUCTION: Many risk factors for proximal junctional kyphosis (PJK) have been reported in the literature, especially sagittal alignment modifications, but studies on pelvic tilt (PT) variations and its influence on PJK are missing. Aim of this study was to analyze the influence of pelvic tilt correction, after long fusion surgery for ASD patients, on PJK occurrence. METHODS: A monocentric retrospective study was conducted on prospectively collected data, including 76 patients, operated with fusion extending from the thoraco-lumbar junction to the ilium. Radiologic parameters were measured on fullspine standing radiographs preoperatively, postoperatively (<6 months) and at latest follow-up (before revision surgery or >2 years). All parameters were analyzed comparing patients with PJK (group "PJK") and without PJK (group "no PJK"). A further analysis compared patients with low (PT/PI<25th percentile, LowPT group) and high (PT/PI>75th percentile, HighPT group) preoperative pelvic tilt. RESULTS: « PJK ¼ patients had a greater lumbar lordosis and thoracic kyphosis correction (p=0,03 et <0,001 respectively) compared to the "no PJK" patients. Pelvic tilt was significantly lower postoperatively in the "PJK" group (p=0,03). Patients from the HighPT PJK group were significantly more corrected than patients from the HighPT noPJK group (p=0,003). CONCLUSION: Through the analysis of 76 patients, we showed that pelvic tilt did not seem to play a role in the setting of PJK after ASD surgery. Decreasing PT after surgery could be an element to watch out for in patients with PJK risk factors.

Social media use among French spine surgeons: an underrated tool?

PURPOSE: The goal of this study was to determine the use of social media (SM) among the French spine surgeons. METHODS: In 2022, an online questionnaire has been sent to the community of French spine surgeons. All surgeons were asked to answer a 21-question survey about their use of SM in their daily practice. RESULTS: Eighty-five surgeons were included, with 80% claiming to use SM. Mean age was 45 ± 10.7. Usage rate significantly differed among experience categories: 85% of younger surgeons and 69% after ten years of experience (p = 0.01). LinkedIn was the most commonly used (78% among SM users), then Facebook (46%). Instagram was less used by most experienced surgeons (p = 0.01). Time spent on SM was more important at home (p < 0.01). About 31% of participants' patients were able to contact their surgeon through SM, mainly through LinkedIn, professional websites and Facebook (respectively 15%, 13% and 12%). Pictural data were shared on SM by 29% of SM users, mainly on LinkedIn (19%), then professional websites (12%). Google reviews were significantly less valued by most experienced surgeons (p = 0.01) but more valued by private practice surgeons (p = 0.009). CONCLUSION: 80% of French spine surgeons use social media for professional purposes. However, SM may not be used to its full potential as only 25% of SM-using broadcast pictures and contact their patients through SM. The most popular network is LinkedIn, followed by Facebook. Most experienced surgeons use less SM, particularly Instagram, and value less Google reviews.

Sagittal correction after short percutaneous fixation for thoracolumbar compression fractures: comparison of the combination of SpineJack® kyphoplasty and fractured vertebra screw fixation.

PURPOSE: The aim of this study was to compare two percutaneous pedicle fixations for the treatment of thoracolumbar fractures: one associating a jack kyphoplasty (SpineCut) and the other using intermediate screws (Trident). METHODS: All adult patients treated for single-level Magerl/AO type A thoracolumbar traumatic fractures in four orthopaedic departments, with SpineCut or Trident, with a one year minimum follow-up, were retrospectively included. Neurological disorders and osteoporotic fractures were not included. The following data were collected: age, sex, Magerl/AO type, type of surgery, and complications. Radiological parameters were analyzed on pre-operative CT scan, and on standing X-rays before discharge, at three months and one year post-operative: vertebral wedge angle (VWA), regional kyphosis angle (RKA), and traumatic regional angulation (TRA: difference between RKA and physiological values for each vertebra). RESULTS: Eighty patients were included, with 42 patients in SpineCut group and 38 in Trident group. Mean age was 41 ± 15.7 years. TRA correction did not differ between the groups: respectively 11.2 ± 8.1° in SpineCut versus 10.2 ± 9.1° in Trident group (p = 0.52). TRA loss of correction between early post-operative and three months was statistically higher in Trident group: -4 ± 5.1° versus -1.5 ± 3.8° (p = 0.03). After 3 months, TRA correction loss was comparable between the groups. Multivariate analysis demonstrated that pre-operative VWA was the only factor significantly associated with early TRA correction loss (p = 0.01). VWA correction and loss of correction did not differ significantly between the groups. No complications were observed. CONCLUSION: Percutaneous pedicle fixations of traumatic thoracolumbar fractures associating jack kyphoplasty and intermediate screws are both safe and efficient techniques.

Implant removal after short percutaneous pedicle fixation associated with SpineJack® kyphoplasty: is correction sustained?

PURPOSE: This study objective was to evaluate sagittal correction loss after instrumentation removal in patients treated for thoracic or lumbar compression fractures treated with SpineJack® kyphoplasty associated with short percutaneous pedicle screw fixation. METHODS: This retrospective multicenter study was carried out in three major French trauma centers. All patients with a single type A thoracic or lumbar fracture, treated by the studied technique between 2017 and 2020, have been included. Demographic data, fracture type, removal procedure achievement and term were collected. Radiological parameters were measured at five timepoints: pre-operative, intra-operative, immediate post-operative, early post-operative (< 3 months) and at follow-up (1 year). Vertebral wedge angle (angle between the two endplates of the fractured vertebra) and traumatic regional angulation (TRA-calculated by subtracting regional kyphosis from the physiological reference values). RESULTS: 150 patients were included. Mean age was 48.6 ± 17.8 years. Average follow-up was 14.4 ± 3 months. 82 patients had secondary instrumentation removal. Mean time to removal was 6.4 ± 2.4 months. TRA correction loss between immediate post-operative and last follow-up was greater in removal group: 5.1 ± 5.6° versus 2.7 ± 4.7° (p = 0.01). Material was removed earlier in younger patients (p = 0.002). TRA correction loss was similar in the early and late removal groups (p = 0.83). Multivariate analysis identified only Magerl/AO A3 fractures as risk factor for loss of TRA correction (p = 0.007). CONCLUSION: Instrumentation removal was associated with good radiological outcomes with a non-significant loss of vertebral wedge angle and tolerable loss of traumatic regional angulation (+ 2.4° compared to the no-removal group), even if performed early.