Selective Thoracic Fusion for Idiopathic Scoliosis: A Comparison of Three Surgical Techniques with Minimum 5-year Follow-up.

STUDY DESIGN: Single-center retrospective review of outcomes among three surgical techniques in the treatment of thoracic idiopathic scoliosis (T-AIS) with a follow-up of at least 5 years. OBJECTIVE: To investigate how outcomes compare in video-assisted anterior thoracic instrumentation (VATS), all hooks/hook-pedicle screw hybrid instrumentation (HHF), and all pedicle screw instrumentation (PSF) techniques for T-AIS. SUMMARY OF BACKGROUND DATA: Studies comparing outcomes for anterior versus posterior fusion for T-AIS are few and with short follow-up. METHODS: Three groups of patients with T-AIS who underwent thoracic fusion were included in this study: 98 patients with mean curve of 49.0°â€Š±â€Š9.5° underwent VATS (Group 1); 44 patients with mean curve of 51.1°â€Š±â€Š7.4° underwent HHF (Group 2); and 47 patients with mean curve of 47.6°â€Š±â€Š9.9° underwent PSF (Group 3). Radiological outcomes were compared at preoperative, and up to 5 years. Surgical outcomes were noted until latest follow-up. RESULTS: Group 1 had less blood loss, less fusion levels, longer surgical time, and longer hospital stay compared with the other groups (P < 0.01). Groups 1 and 3 were comparable in all time periods with 78.8% and 78.2% immediate curve correction, and 72.9% and 72.1% at 5 years, respectively. Group 2 had lower correction in all time periods (P < 0.0001). Thoracic kyphosis and lumbar lordosis decreased in Group 3, but improved in both Groups 1 and 2 (P < 0.0001). Group 1 had more respiratory complications. The posterior groups had more deep wound infections. Two patients in Group 1 and one patient in Group 2 required revision surgery for implant-related complications. Reoperations for deep wound infections were noted only in the posterior groups. CONCLUSION: This is the first report comparing 5 year outcomes between anterior and posterior surgery for T-AIS. All three surgical methods resulted in significant and durable scoliosis correction; however, curve correction using HHF was inferior to both VATS and PSF with the latter two groups achieving similar coronal correction. However, VATS involved fewer segments, kyphosis improvement, and no deep wound infection, whereas PSF has less surgical time, shorter hospital stays, and no revision surgery from implant-related complications.Level of Evidence: 3.

Risk factors for surgical complications in the management of ossification of the posterior longitudinal ligament.

BACKGROUND CONTEXT: Ossification of the posterior longitudinal ligament (OPLL) is a progressive, debilitating disease most commonly affecting the cervical spine. When compared to other degenerative pathologies, OPLL procedures carry a significantly higher risk of complications owing to increased case complexity and technical difficulties. Most previous studies have focused on functional outcomes and few have reported on risk factors for postoperative complications in OPLL patients. PURPOSE: To identify clinical and radiological risk factors of surgical complications following treatment for cervical OPLL STUDY DESIGN: Retrospective review PATIENT SAMPLE: One hundred thirty-one patients with cervical myelopathy secondary to OPLL who underwent surgical decompression with complete 2-year follow-up. OUTCOME MEASURES: Surgical and medical postoperative complications were analyzed. Revision surgery rates and mortality rates were recorded. METHODS: Clinical, surgical, and radiological characteristics were collected for each patient. Complications within 30 days were identified. Univariate and multivariate analysis were performed to identify risk factors for surgical complications. RESULTS: There were 39 (29.8%) surgical complications in the cohort, which included C5 palsy (7.6%), dural tear (3.1%), surgical site infection (3.1%), and epidural hematoma (1.5%). 2-year revision and mortality rates were 4.6% and 2.3%, respectively. Univariate analysis revealed that blood loss ≥750mL (OR 3.42, p=0.028), operative duration ≥5.5 hours (OR 3.16, p=0.008), hill-type OPLL (OR 3.08, p=0.011), K-line (-) OPLL (OR 5.39, p<0.001), and presence of a double-layer sign (OR 3.79, p=0.002) were significant risk factors. In multivariate analysis, only hill-type OPLL (OR 2.61, p=0.048) and K-line (-) OPLL (OR 2.98, p=0.031) were found to be significant. Patients with both hill-type and K-line (-) OPLL had a 3.5 times risk of developing surgical complications (p=0.009). CONCLUSIONS: Patients with OPLL have a higher risk of perioperative surgical complications if they had a hill-shaped OPLL and K-line (-) OPLL on preoperative imaging studies. To the best of the authors' knowledge, this study is the first to link hill-type and K-line (-) OPLL morphology as risk factors for perioperative surgical complications.

Detection and Genome Analysis of a Lineage III Peste Des Petits Ruminants Virus in Kenya in 2011.

In May 2011 in Turkana County, north-western Kenya, tissue samples were collected from goats suspected of having died of peste des petits ruminant (PPR) disease, an acute viral disease of small ruminants. The samples were processed and tested by reverse transcriptase PCR for the presence of PPR viral RNA. The positive samples were sequenced and identified as belonging to peste des petits ruminants virus (PPRV) lineage III. Full-genome analysis of one of the positive samples revealed that the virus causing disease in Kenya in 2011 was 95.7% identical to the full genome of a virus isolated in Uganda in 2012 and that a segment of the viral fusion gene was 100% identical to that of a virus circulating in Tanzania in 2013. These data strongly indicate transboundary movement of lineage III viruses between Eastern Africa countries and have significant implications for surveillance and control of this important disease as it moves southwards in Africa.

Identification of carbohydrates on Eimeria stiedai sporozoites and their role in the invasion of cultured cells in vitro.

The carbohydrates present on Eimeria stiedai sporozoites and their functional role in the process of invasion of host cells were examined. Lectin-binding sites on the surface of sporozoites were detected by means of peroxidase-conjugated lectins. Sporozoites showed specific binding with UEA-I and PNA lectins, which bind L-fucose and D-galactose, respectively. Exposure of sporozoites to 100 microg/ml UEA-I significantly reduced their ability to invade primary rabbit liver biliary epithelial cells, but similar treatment with PNA had no such effect. Pre-incubation of these cells in Dulbecco's minimum essential medium containing 10% fetal bovine serum and 1% L-fucose suppressed the invasion activity of the sporozoites, but pre-incubation of the sporozoites in the same medium without L-fucose had no effect on cell penetration. D-galactose added to the medium had no effect on the invasion activity of sporozoites. These results indicate that L-fucose residues on E. stiedai sporozoites and L-fucose-binding sites on host cells both are associated with the recognition and/or invasion process.

Identification of carbohydrates on Eimeria stiedai sporozoites and their role in invasion of cultured cells in vitro.

Invasion specificity of Eimeria stiedai sporozoites in cultured cells was examined. Intracellular sporozoites were observed in hepatobiliary epithelial cells, as early as 3 hours post inoculation (p.i.) but the infection rate was monitored for 6 hours. No intracellular parasites were found in rabbit parenchymal hepatocytes and rabbit kidney cells, even on prolonged culturing. In the hepatobiliary epithelial cells inoculated with fixed sporozoites, no intracellular parasite were found. Sporozoites attached on the cell surface of the hepatobiliary epithelial cells fixed with paraformaldehyde but did not penetrate. The carbohydrates present on Eimeria stiedai sporozoites and their functional role in the process of invasion of host cells were also examined. Lectin binding sites on the surface of sporozoites were detected by means of peroxidase-conjugated lectins. Sporozoites showed specific binding with UEA-I and PNA lectins, which bind L-fucose and D-galactose, respectively. Exposure of sporozoites to 100 microg/ml UEA-I significantly reduced their ability to invade primary rabbit hepatobiliary epithelial cells, but similar treatment with PNA had no such effect. Preincubation of these cells in Dulbecco's minimum essential medium containing 10% fetal bovine serum and 1% L-fucose suppressed the invasion activity of the sporozoites, but preincubation of the sporozoites in the same medium without L-fucose had no effect on cell penetration. D-galactose added to the medium had no effect on the invasion activity of sporozoites. These results indicate that L-fucose residues on E. stiedai sporozoites and L-fucose binding sites on host cells both are associated with recognition and/or invasion process.