The global impact of the COVID-19 pandemic on pediatric spinal care: A multi-centric study.

Background: The COVID-19 pandemic has affected healthcare worldwide since December 2019. We aimed to identify the effect of the COVID-19 pandemic on outpatient clinic and surgical volumes and peri-operative complications for pediatric spinal deformities patients. Methods: In this multi-center retrospective study, outpatient visits (in-person and virtual care) and pediatric spine surgeries volumes in four high-volume pediatric spine centers were compared between March and December 2019 and the same period in 2020. Peri-operative complications were collected and compared in the same periods. Descriptive statistics were calculated, and comparative analyses were performed. Results: During the 2020 study period, the outpatient visit (in-person and virtual care) volume decreased during local lockdown periods by 71% for new patients (p < 0.001) and 53% for returning patients (p = 0.03). Overall, for 2020, there was a 20% reduction in new patients (p = 0.001) and 21% decrease in returning patients (p < 0.001). During the pandemic, there was also 20% less overall surgical volume of adolescent idiopathic scoliosis (AIS) patients undergoing primary posterior spinal fusion, with a 70% reduction during lockdown times (p < 0.001). Complication rate and profile were similar between periods. Conclusion: There was a significant decrease in outpatient pediatric spine outpatient visits, particularly new patients, which may increase the proportion of pediatric patients with spinal deformities that present late, meeting surgical indication. This, in combination with the reduction in surgical volume of AIS over the first year of the pandemic, could result in an extended waitlist for surgeries during years to come. Complication rate was similar for both periods, suggesting it is safe to continue elective pediatric spine surgery even in a time of a pandemic. Level of evidence: level IV.

Magnetically Controlled Growing Rods Graduation: Lessons From a Single-center Series of 48 Patients.

BACKGROUND: Magnetically controlled growing rod (MCGR) treatment for early-onset scoliosis (EOS) has become a widely utilized method of deformity control, but long-term follow-up reports are sparse. We evaluated the outcomes of a large group of consecutive pediatric patients diagnosed with EOS who were treated by MCGR to the endpoint of definitive spinal fusion in a single center. We hypothesized that lessons learned from treating a large volume of MCGR patients would lower the complication rate in comparison to what was previously reported by other studies. METHODS: The records of 48 EOS patients with varied etiologies who were treated by MCGR between 2012 and 2022 and reached the end of treatment were analyzed retrospectively for baseline and final radiographic measurements and surgery-related complications. RESULTS: The mean percent of improvement in the major coronal deformity was 51.7±25.0% and the mean T1 to T12 total growth was 52.9±21.9 mm. The total complication rate was 22.9% of which 12.5% required a single unplanned surgery, 6.3% required multiple unplanned surgeries, and 4% did not require any unplanned surgery. CONCLUSION: MCGR treatment provides adequate control of EOS, enabling satisfactory growth of the thoracic spine. The complication rate in a single large volume center is moderate. LEVEL OF EVIDENCE: IV.

Cementless posterior spinal fusion for the treatment of OI patients with severe spine deformity-a case series.

PURPOSE: The purpose of this study is to present the outcomes all patients with osteogenesis imperfecta (OI) who underwent cementless posterior spinal fusion for the treatment of severe spine deformity in our institution. METHODS: All patients with OI who underwent surgical correction of their spine deformity in our institution between 2003 and 2020 were enrolled. The collected data included demographics, operative and follow-up findings, medical history, bisphosphonate therapy, HGT protocol, pre- and post-HGT and postoperative scoliosis and kyphosis curve measurements, hospitalization length, complications, and revision surgeries. General treatment strategies included cessation of bisphosphonate therapy around the surgery, 30-day HGT protocol, titanium rods, cementless screw technique, and a high implant density policy. RESULTS: Eleven consecutive patients with OI who underwent surgery for spine deformity in our institution were identified. The mean age at surgery was 15.6 ± 2.3. Mean follow-up period was 6.6 ± 5.8 years. The mean pre- and postoperative scoliosis curves were 85.4 ± 19.3° and 43.1 ± 12.5°, respectively, representing a 49.5% correction rate. Five patients underwent HGT and achieved a mean correction of 27.6 ± 7.1° (31.6%) preoperatively. Implant density ratio was 1.5 (screw or hook/level). Mean postoperative hospitalization length was 5.9 ± 1.6 days. One patient had deep wound infection which resolved following treatment according to our protocol for surgical site infection, and one patient had skull penetration by one of the halo pins. CONCLUSION: Surgical treatment of severe spine deformity in OI patients with cementless posterior spinal fusion is safe and effective after applying a specific preoperative strategy.

Magnetically Controlled Growing Rods Graduation: Deformity Control with High Complication Rate.

STUDY DESIGN: A multicenter retrospective review of consecutive series of patients. OBJECTIVE: Long-term experience with using the magnetically controlled growing rods (MCGR) to treat patients with deformity in the growing spine to the conclusion of treatment with posterior spine fusion. SUMMARY OF BACKGROUND DATA: MCGR treatment for growing spine gained popularity with paucity of long-term follow up data. We hypothesized that final fusion might be more effective in bringing additional correction of the spine deformity after treatment with MCGR than that reported after traditional growing rods (TGR) due to less scarring and auto-fusion. METHODS: Retrospective review of 47 patients with varied etiology, treated between 2011 and 2017 which graduated treatment were followed in five academic medical centers for average of 50 months (range, 10-88). RESULTS: The initial mean coronal deformity of 69.6° (95% CI 65-74) was corrected to 40° (95% CI 36-40) immediately after the MCGR implantation but progressed to 52.8° (95% CI 46-59) prior to the final surgery (P < 0.01). Nevertheless, thoracic spine growth (T1-T12 height) improved from 187.3 mm (95% CI 179-195) following index surgery to 208.9 mm (95% CI 199-218) prior to final fusion (P < 0.01). Significant correction and spinal length were obtained at final fusion, but metallosis was a frequent observation (47%, 22/47). The average growth rate was 0.5 mm/month (95% CI 0.3-0.6). The overall complication rate within our cohort was 66% (31/47) with 45% (21/47) of unplanned returns to the operating theater. 32% (15/47) of the patients had an implant related complication. Unplanned surgery was highly correlated with thoracic kyphosis greater than 40° (OR 5.42 95% CI 1.3-23). CONCLUSION: Treatment of growing spine deformities with MCGR provides adequate control of spine deformity it is comparable to previously published data about TGR. The overall high complications rate over time and specifically implant related complications.Level of Evidence: 4.

The use of three rods in correcting severe scoliosis.

PURPOSE: The three-rod technique, utilising a short apical concavity rod is an option to achieve controlled correction in severe scoliosis. We describe this technique, the complications encountered, and the long-term outcomes. METHOD: All paediatric patients who had at least 2 years follow-up after undergoing corrective surgery for scoliosis ≥ 100° using 3 parallel rods were included. Radiographs were assessed to evaluate the correction and clinical records examined for any loss of correction, complications, revision procedures or neuromonitoring events. RESULTS: Twenty-five patients met the inclusion criteria. Four underwent prior anterior fusion to prevent crankshaft phenomenon. The mean angle of the deformity was 112.0° (range 100.3-137.1). Mean maximal kyphosis was 48.8° (range 11.4-78.8°) and mean curve flexibility 4.4% (range 0-37.0%). Intraoperative traction achieved an average of 70.4% (95% CI 56.6-84.1%). Nine patients (39%) showed a reduction in MEPs during definitive surgery. All returned to within 75% of baseline by the end of surgery. All patients had normal postoperative neurology. One patient underwent removal of hardware for late infection. The mean overall Cobb correction was 55.7° (95% CI 50.2-61.2°), equating to 50.2% (95% CI 44.9-55.4%) of the mean initial deformity. Thoracic kyphosis reduced by a mean of 18.2° (95% CI 12.8-23.6°). CONCLUSION: Our series suggests that three-rod constructs are able to safely and effectively achieve 50% correction of severe scoliosis.

Frontal plane biomechanics of the operated and non-operated knees before and after unilateral total knee arthroplasty.

BACKGROUND: After unilateral total knee arthroplasty, frontal plane loading patterns on the operated knee remain pathological in the long term, but it is unclear how they change in the early postoperative period. Additionally, researchers have suggested that the non-operated knee bears greater frontal plane loads postoperatively, but this effect is unclear. The objective of the present study was to compare the preoperative and early postoperative frontal plane loading patterns of both knees after unilateral total knee arthroplasty. METHODS: Fifty patients with end-stage knee osteoarthritis were examined prior to and six weeks after surgery. Patients underwent a three-dimensional gait analysis that determined the frontal plane loading patterns of knee varus angle and knee adduction moment during gait, and completed self-evaluative questionnaires and functional tests. FINDINGS: There were no significant loading differences between limbs preoperatively. The operated knee showed large reductions in varus angle and adduction moment after surgery (all p<0.001). The non-operated knee showed no increases in varus angle or adduction moment, but did show a small reduction in the adduction moment (p<0.001). Both knees showed reduction in pain after surgery (p<0.001) and the operated Knee Society Score improved after surgery (p=0.01). INTERPRETATION: Total knee arthroplasty reduces frontal plane loading in the operated knee and does not worsen frontal plane loading in the non-operated knee. Therapy after surgery should focus on retaining the reduction in knee adduction moment in the operated knee and preventing further worsening loading patterns in the non-operated knee.