The Association of Organizational Readiness With Lung Cancer Screening Utilization.

INTRODUCTION: Lung cancer screening is widely underutilized. Organizational factors, such as readiness for change and belief in the value of change (change valence), may contribute to underutilization. The aim of this study was to evaluate the association between healthcare organizations' preparedness and lung cancer screening utilization. METHODS: Investigators cross-sectionally surveyed clinicians, staff, and leaders at10 Veterans Affairs from November 2018 to February 2021 to assess organizational readiness to implement change. In 2022, investigators used simple and multivariable linear regression to evaluate the associations between facility-level organizational readiness to implement change and change valence with lung cancer screening utilization. Organizational readiness to implement change and change valence were calculated from individual surveys. The primary outcome was the proportion of eligible Veterans screened using low-dose computed tomography. Secondary analyses assessed scores by healthcare role. RESULTS: The overall response rate was 27.4% (n=1,049), with 956 complete surveys analyzed: median age of 49 years, 70.3% female, 67.6% White, 34.6% clinicians, 61.1% staff, and 4.3% leaders. For each 1-point increase in median organizational readiness to implement change and change valence, there was an associated 8.4-percentage point (95% CI=0.2, 16.6) and a 6.3-percentage point increase in utilization (95% CI= -3.9, 16.5), respectively. Higher clinician and staff median scores were associated with increased utilization, whereas leader scores were associated with decreased utilization after adjusting for other roles. CONCLUSIONS: Healthcare organizations with higher readiness and change valence utilized more lung cancer screening. These results are hypothesis generating. Future interventions to increase organizations' preparedness, especially among clinicians and staff, may increase lung cancer screening utilization.

Microwave Imaging of Breast Tumor Using Time-Domain UWB Circular-SAR Technique.

This paper explores the competency of the time domain ultra-wideband (UWB)-circular synthetic aperture radar (CSAR) to image the breast and detect tumors. The image reconstruction is performed using a time domain global back projection technique adapted to the circular trajectory data acquisition. This paper also proposes a sectional image reconstruction method to compensate for the group velocity changes in different layers of a multilayer medium. Experiments on an advanced breast phantom examines the suitability of this technique for breast tumor imaging. The advanced breast phantom is designed based on a MRI of a real patient, fabricated using 3D printing technology, and filled with liquids that emulate normal and cancerous tissues. The measurement results, compared with MRI imaging of the phantom, demonstrate the suitability of the UWB-CSAR method for breast tumor imaging. This method can be a tool for early diagnosis as well as for treatment monitoring during chemotherapy or radiotherapy.

Proposed Therapeutic Range of Treosulfan in Reduced Toxicity Pediatric Allogeneic Hematopoietic Stem Cell Transplant Conditioning: Results From a Prospective Trial.

Treosulfan is given off-label in pediatric allogeneic hematopoietic stem cell transplant. This study investigated treosulfan's pharmacokinetics (PKs), efficacy, and safety in a prospective trial. Pediatric patients (n = 87) receiving treosulfan-fludarabine conditioning were followed for at least 1 year posttransplant. PKs were described with a two-compartment model. During follow-up, 11 of 87 patients died and 12 of 87 patients had low engraftment (≤ 20% myeloid chimerism). For each increase in treosulfan area under the curve from zero to infinity (AUC(0-∞) ) of 1,000 mg hour/L the hazard ratio (95% confidence interval) for mortality increase was 1.46 (1.23-1.74), and the hazard ratio for low engraftment was 0.61 (0.36-1.04). A cumulative AUC(0-∞) of 4,800 mg hour/L maximized the probability of success (> 20% engraftment and no mortality) at 82%. Probability of success with AUC(0-∞) between 80% and 125% of this target were 78% and 79%. Measuring PK at the first dose and individualizing the third dose may be required in nonmalignant disease.

Intrabone hematopoietic stem cell gene therapy for adult and pediatric patients affected by transfusion-dependent ß-thalassemia.

ß-thalassemia is caused by ß-globin gene mutations resulting in reduced (ß+) or absent (ß0) hemoglobin production. Patient life expectancy has recently increased, but the need for chronic transfusions in transfusion-dependent thalassemia (TDT) and iron chelation impairs quality of life1. Allogeneic hematopoietic stem cell (HSC) transplantation represents the curative treatment, with thalassemia-free survival exceeding 80%. However, it is available to a minority of patients and is associated with morbidity, rejection and graft-versus-host disease2. Gene therapy with autologous HSCs modified to express ß-globin represents a potential therapeutic option. We treated three adults and six children with ß0 or severe ß+ mutations in a phase 1/2 trial ( NCT02453477 ) with an intrabone administration of HSCs transduced with the lentiviral vector GLOBE. Rapid hematopoietic recovery with polyclonal multilineage engraftment of vector-marked cells was achieved, with a median of 37.5% (range 12.6-76.4%) in hematopoietic progenitors and a vector copy number per cell (VCN) of 0.58 (range 0.10-1.97) in erythroid precursors at 1 year, in absence of clonal dominance. Transfusion requirement was reduced in the adults. Three out of four evaluable pediatric participants discontinued transfusions after gene therapy and were transfusion independent at the last follow-up. Younger age and persistence of higher VCN in the repopulating hematopoietic cells are associated with better outcome.

Hybrid coronary revascularization versus coronary artery bypass surgery with bilateral or single internal mammary artery grafts.

OBJECTIVE: Hybrid coronary revascularization (HCR) combines minimally invasive left internal mammary artery (LIMA)-left anterior descending artery (LAD) bypass with percutaneous intervention of non-LAD vessels. The purpose of this study was to compare outcomes of HCR to conventional coronary artery bypass graft (CABG) surgery with single internal mammary artery (SIMA) or bilateral internal mammary artery (BIMA) grafting. METHODS: Between October 2003 and September 2013, 306 consecutive patients who underwent HCR were compared with 8254 patients who underwent CABG with SIMA (7381; 89.4%) or BIMA (873; 10.6%) at a US academic center. The primary outcome was a composite of 30-day death, myocardial infarction, and stroke (major cerebrovascular and cardiac event [MACCE]). In addition to multiple logistic and linear regression analysis, a propensity score-matched analysis was used to compare HCR with SIMA and with BIMA. RESULTS: The Society of Thoracic Surgeons-predicted risk of mortality was 1.6% for HCR, 2.1% for SIMA, and 1.1% for BIMA (P < .001). Factors associated with HCR use were older age, lower body mass index, history of percutaneous coronary intervention, and 2-vessel disease. In propensity-matched groups, 30-day MACCE rates were comparable (3.3% for HCR vs 1.3% for BIMA [odds ratio (OR), 2.50; P = .12] and vs 3.6% for SIMA [OR, 1.00; P = 1.00]). In-hospital complications were lower after HCR versus SIMA or BIMA (OR, 0.59; P = .033 and OR, 0.55; P = .015, respectively), as was the need for blood transfusion (OR, 0.44; P < .001 and OR, 0.57; P < .001). HCR was associated with shorter hospital stay compared with SIMA (OR, 1.28; P = .038) or BIMA (OR, 1.40; P = .006). No survival difference between matched groups was found at midterm follow-up (HCR vs SIMA: hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.32-1.38; P = .66; HCR vs BIMA: HR, 1.05; 95% CI, 0.48-2.29; P = .91). CONCLUSIONS: HCR may represent a safe, less invasive alternative to conventional CABG in carefully selected patients, with similar short-term and midterm outcomes as CABG performed with either SIMA or BIMA grafting.

Congenital thoracic scoliosis with unilateral unsegmented bar, convex hemivertebrae, and fused concave ribs with severe progression after posterior fusion at age 2: 40-year follow-up after revision anterior and posterior surgery at age 8.

STUDY DESIGN: Case report with 40-year follow-up after definitive surgery. OBJECTIVE: To show that extensive spine fusion in a young child can control the curve and does not necessarily lead to early death. SUMMARY OF BACKGROUND DATA: Recent efforts to avoid early spine fusion by using either progressive lengthening of spinal or rib cage implants are based on the theory that early spine fusion is deleterious and results in early death due to pulmonary compromise. Unfortunately, there is little to no documentation to support this theory. METHODS: This is a single case report of a child who at the age of 3 months had a 32° congenital thoracic congenital scoliosis with a unilateral unsegmented bar, concave fused ribs, and convex hemivertebrae. By age 2 years, the curve had progressed to 64°, so a posterior fusion was done from T5 to T12. By age 8 years, the curve had dramatically increased, and she was referred to the author. She underwent a double-wedge osteotomy, both anteriorly and posteriorly, plus anterior fusion T4-L3 and posterior fusion from T1 to L3. A halo cast was used for correction. RESULTS: At a 40-year follow-up after her definitive surgery at the age of 8 years, she is still alive and functioning well, although her vital capacity is poor. CONCLUSION: Extensive thoracic spine fusion at an early age did not result in early death, but the patient is far from ideal.

L5 hemivertebra resection and T12-S1 fusion in a 14-year-old female with a 36-year follow-up.

STUDY DESIGN: Case report. OBJECTIVE: To demonstrate a 36-year follow-up of a rare operation. SUMMARY OF BACKGROUND DATA: There have been no reports of follow-up of pediatric hemivertebra excision and fusion into midadult life. METHODS: A chart and radiological review at 36 years after surgery. RESULTS: The patient is alive and well and leading a normal life. Her Oswestry Disability Index is 0. Mild degenerative radiological signs are evident at the adjacent level above (T10-T12) and below (sacroiliac joints). CONCLUSION: Early excision of the L5 hemivertebra would have been preferable, but the long-term results are good.

Severe neurofibromatosis kyphoscoliosis, posterior wedge osteotomy, halo-traction, and anterior autograft strut fusion, with 28-year follow-up.

STUDY DESIGN: Case report with very long-term follow-up. OBJECTIVE: To demonstrate the lasting value of correction and stabilization with multiple anterior autogenous strut grafting. SUMMARY OF BACKGROUND DATA: Although anterior strut grafting has been shown to be ideal for neurofibromatosis kyphosis, there have been no reports as to whether the benefit is maintained or lost over many years. METHODS: This is a single case report with very long-term follow-up. RESULTS: This adult patient, operated in February 1982, has been followed for 28 years, and is doing very well in life, although her pulmonary capacity is compromised. CONCLUSION: Although patients with severe spine deformity because of neurofibromatosis tend to deteriorate with time, this patient demonstrates that with aggressive correction and fusion management, a long-term good quality of life can be achieved.

Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy.

STUDY DESIGN: A retrospective clinical cohort study at a single spine center of patients with degenerative scoliosis and radiculopathy severe enough to require surgery. OBJECTIVE: To evaluate the functional outcomes of 3 surgeries for degenerative scoliosis with radiculopathy; decompression alone, decompression and limited fusion, and decompression and full curve fusion. SUMMARY OF BACKGROUND DATA: Although these 3 surgical treatments have all been described for this problem, there exists little information as to what outcomes to expect. METHODS: The study cohort consisted of 85 patients who met the inclusion criteria of degenerative scoliosis and radiculopathy, who had undergone 1 of the above 3 surgeries, who had not had any previous lumbar spine surgery, who had a minimum follow-up of at least 2 years, and who had filled out preoperative and postoperative functional evaluation forms including SF-36, Oswestry Disability Index, Roland Morris Scores, and a satisfaction questionnaire. Logistic regression analysis was conducted to predict the likelihood of success as related to decompression alone of rotatory olisthetic segments, extent of fusion, and postoperative sagittal balance. Patient demographics including curve magnitude, operative blood loss, length of hospital stay, complications, and need for revision surgeries were analyzed. The patients having decompression alone had the highest mean age (76.4 years) compared to decompression and limited fusion (70.4), and decompression and full curve fusion (62.5). RESULTS: Cobb scoliosis angles remained unchanged in the 2 groups not having full curve fusion, while the full curve fusion group changed from a mean 39° before surgery to 19° at follow-up. The complication rate was highest (56%) in the full fusion group, was 40% in the limited fusion group, and 10% in the decompression alone group. The overall SF-36 analysis showed significant improvement in bodily pain, social function, role emotional, mental health, and mental composite domains. Oswestry Disability Indexes improved significantly in the decompression alone and limited fusion groups, but not in the full fusion group. In contrast, the satisfaction questionnaire showed the highest success to be in the full-curve fusion group and the lowest in the decompression-only group.Regression analysis revealed that sacrum to curve apex fusions and positive postoperative sagittal imbalance were associated with poor outcomes. CONCLUSION: Both good and poor results were seen with each of the 3 procedures.

Development and growth of anterior spine surgery in Minnesota.

Until the 1960s, it was not possible to directly access the thoracic vertebrae in order to correct conditions such as congenital kyphosis. Attempts to treat problems using traditional posterior spine surgeries often failed, leaving patients paraplegic. Using a procedure initially done in Hong Kong, surgeons from the University of Minnesota in 1966 became some of the first in the United States to access the thoracic spine from the anterior position, allowing for correction of deformities. This article highlights Minnesota surgeons' contributions to the development of anterior spine surgery.

The Moe Maximal Correction Test to determine true curve flexibility: a historical note with current application.

This is not a prospective randomized clinical trial or a consecutive case series, but rather the description of a technique developed years ago, but still applicable. As spine surgeons, we wish to know the true correctability of a curvature before determining the best method of treatment. Do we need to do a posterior surgery only? Do we need to do a combined anterior and posterior surgery? Do we need to place the patient in preoperative skeletal traction? Although many different techniques have been described for the determination of true curve flexibility, the Moe Maximal Correction Test has never before been described.

Scoliosis secondary to a hemivertebra: seven patients with gradual improvement without treatment.

STUDY DESIGN: Retrospective case series. OBJECTIVE: To make clinicians aware of this unusual natural history. SUMMARY OF BACKGROUND DATA: Nonprogressive and progressive scolioses due to hemivertebrae have been abundantly documented in the literature. There has been no article describing spontaneous improvement. Two case reports have been described elsewhere in a general article on natural history. METHODS: From a previous review of 1250 patients with congenital spine deformity of all types, 7 patients were identified with spontaneous improvement of their scoliosis due to a hemivertebra during growth. RESULTS: The mean curve at start of observation was 31 degrees (range: 24 degrees -43 degrees), and at the end of observation was 19 degrees (range: 10 degrees -30 degrees). Six of the curves were at the thoracolumbar region (T11-L2), and the other at T1. The average duration of follow-up was 9 years. CONCLUSION: Spontaneous curve improvement is rare, but possible. In view of the difficulty of prediction for curves due to a hemivertebra, careful observation with careful curve measurement is recommended. Inappropriate early, aggressive surgery should be avoided.

Long-term follow-up of adolescent idiopathic scoliosis patients who had Harrington instrumentation and fusion to the lower lumbar vertebrae: is low back pain a problem?

STUDY DESIGN: Retrospective functional and radiographic analysis. OBJECTIVE: To analyze the back pain and disability in patients who had instrumentation and fusion to L2, L3, L4, or L5, at least 10 years previously, and to compare them with a control group of the same age, sex, weight, and height. SUMMARY OF BACKGROUND DATA: Considerable confusion exists as to the incidence and severity of low back problems in patients with adolescent idiopathic scoliosis fused to the lower lumbar spine. MATERIALS AND METHODS: A total of 171 patients met the inclusion criteria of adolescent idiopathic scoliosis, Harrington instrumentation, and fusion to L2, L3, L4, or L5, a minimum follow-up of 10 years following surgery, and a detailed questionnaire at follow-up. These were compared to a control group of 209 persons of equal sex, age, weight, and height. Eighty-eight patients were personally evaluated, including radiographs at follow-up. The mean follow-up was 19 years. RESULTS: Back pain, no matter how trivial or infrequent, was noted in 75% of the patients and 65% of the controls, statistically different at P=0.039. Pain intensity was equal to controls in fusions to L2 or L3, but increased in those fused to L4. Comparing all fused patients to the controls, there was no difference in narcotic use, use of back supports, visits to physicians, or hospitalizations for back problems. There was no difference in the short form-36 in the patients according to whether fused to L2, L3, or L4. CONCLUSION: When compared to a control group of equal sex, age, weight, and height, adolescent idiopathic scoliosis patients had a slightly higher incidence of back pain. When compared to the control group using short form-36 evaluation, the patients had statistically equal scores in all 8 domains. Most patients were able to perform most activities of daily living.

A concomitant posterior approach improves fusion rates but not overall reoperation rates in multilevel cervical fusion for spondylosis.

STUDY DESIGN: Retrospective comparative study of 2 approaches to multilevel fusion for cervical spondylosis in consecutive patients at a single institution. OBJECTIVE: To provide justification for a concomitant posterior approach in multilevel cervical fusion for spondylosis by demonstrating decreased pseudarthrosis and reoperation rates. SUMMARY OF BACKGROUND DATA: Among the factors that affect cervical rates is the number of levels, such that increasing the number of levels leads to lower fusion rates. Because of this, modifications have been sought to improve union in multilevel procedures. One option is an antero-posterior (AP) approach or circumferential arthrodesis. METHODS: Seventy-eight consecutive patients who underwent multilevel cervical fusion at a single institution and with minimum 2-year follow-up data were divided into an anterior-only group (anterior: n=55), and an AP group (AP: n=23). Union was assessed by surgical exploration, computerized tomography scan, and flexion-extension radiographs. The groups were compared in terms of pseudarthrosis rates and reoperation rates. RESULTS: Using chi(2) analysis, there was a significant difference in pseudarthrosis rates (anterior 38% vs. AP 0%; P<0.001), and reoperation rate for pseudarthrosis (anterior 22% vs. AP 0%; P=0.01). There were no differences in overall (anterior 36% vs. AP 30%; P=0.62) and early (anterior 15% vs. AP 26%; P=0.13) reoperation rates, but late reoperations were increased in the anterior group (24% vs. AP 4%; P=0.043). CONCLUSIONS: A concomitant posterior fusion significantly reduced the incidence of pseudarthrosis (0% vs. 38%) and pseudarthrosis-related reoperations (0% vs. 22%) compared with traditional anterior-only fusion. However, this did not translate to a difference in overall reoperation rates. The majority of reoperations in the AP group (86%) were performed within 6 months, whereas those in the anterior-only group (65%) were performed later, which was generally when a pseudarthrosis became evident.

Functional and radiological outcomes of 360 degrees fusion of three or more motion levels in the lumbar spine for degenerative disc disease.

STUDY DESIGN: This is a single-center, multisurgeon, retrospective study of radiologic and functional outcome measures at a minimum 2-year follow-up. OBJECTIVE: We studied the radiologic and functional outcomes following 3 or more motion segment fusions of the lumbar spine for low back pain due to multilevel degenerative disc disease. SUMMARY OF BACKGROUND DATA: Good functional outcomes have been reported for 1 or 2-level fusions, but there are no reports dealing specifically with 3 or more level fusions. METHODS: A total of 80 adult patients met the inclusion/exclusion criteria of multilevel (3 or more motion segments) 360 degrees fusion for lumbar degenerative disc disease, failed nonoperative treatment for at least 1 year, no previous lumbar fusion, no fracture, tumor or infection of the spine, completed preoperative and postoperative functional questionnaires including SF-36 (n = 80), Oswestry (n = 69), Roland Morris (n = 68), and radiologic evaluation of fusion solidity with a minimum follow-up of 2 years. RESULTS: The average patient age was 57 years (range, 27-81). The mean follow-up was 4 years (2-7). On average, patients had fusion of 4 motion segments (range, 3-8 levels). Solid arthrodesis at the first surgery was achieved in 65/80 (81%). Adjacent segment degeneration was noted in 11 patients. Of these, 5 had undergone an extension of their fusion within the study period. There were no deaths or neurologic complications. Deep wound infection occurred in 2 patients, neither requiring implant removal. The Oswestry Disability Index scores improved from 49.8 to 35.1 (29.5%) (P < 0.001). The Roland Morris scores improved from 17.6 to 12.2 (30.7%) (P < 0.001). For the SF-36 scales, significant (P < 0.001) improvement was seen in all scales except Role Emotional scores and Mental Composite Scales. CONCLUSION: The surgical treatment of lumbar degenerative disc disease by 360 degrees fusion should be considered for properly selected patients. The goal of surgery is reduction, not elimination of disability.

Cervical degenerative changes in idiopathic scoliosis patients who underwent long fusion to the sacrum as adults: incidence, severity, and evolution.

BACKGROUND: To date, there have been no published studies of the degenerative changes in the cervical spine in adult idiopathic scoliosis patients with thoracic and lumbar curves severe enough to require major reconstructive surgery. MATERIALS AND METHODS: The primary study group was 48 adult patients who had previously undergone a fusion from T10 or higher to the sacrum as an adult for idiopathic scoliosis. These were compared to 38 adults with unfused idiopathic scoliosis of 30 degrees -50 degrees and to 42 symptomatic adults presenting with cervical pain. Cervical degeneration was assessed using a new cervical degenerative index (CDI). RESULTS: The amount of degenerative change seen in the cervical spine in the long-fusion group was significantly higher at baseline (just prior to the fusion) than the two control populations and became much higher at a mean follow-up of 8.5 years. CONCLUSIONS: This unique subgroup of patients, those having fusion from the thoracic spine to the sacrum as adults for adolescent idiopathic scoliosis, had a high incidence and severity of degenerative changes in their cervical spine. Due to the presence of advanced cervical degenerative changes prior to the fusion, it is not possible to blame the fusion as the main cause for these findings. These changes are either related to the thoracic and lumbar deformities or are more likely due to this subgroup having a higher natural propensity for degenerative changes.

Ultra-long-term follow-up of pediatric spinal deformity problems: 23 patients with a mean follow-up of 51 years.

BACKGROUND: The aim of this study was to analyze the true outcomes of a unique cohort of patients with spinal deformities who were treated as children and followed for 40 or more years. METHODS: Altogether, 23 patients were reviewed who had been originally treated in our community, whose original charts and radiographs were still available, and who had undergone recent evaluation. RESULTS: The diagnoses were congenital deformity in eight, adolescent idiopathic scoliosis in four, poliomyelitis in three, infantile idiopathic scoliosis in two, spondylolisthesis in two, and one each of tuberculosis and dwarfism. Sixteen had undergone fusion surgery. CONCLUSIONS: Early spine fusion for deformity produced far better results than delayed fusion. A solid fusion at the end of growth remained unchanged. Degenerative changes outside the fusion area were rare and seldom required further surgery. In summary, 23 patients with a mean follow-up of 51 years after treatment are presented. Early fusion was far superior to delayed or nonsurgical treatment.

Perioperative complications in revision anterior lumbar spine surgery: incidence and risk factors.

STUDY DESIGN: This is a retrospective review of 129 consecutive anterior lumbar revision surgeries in 108 patients. It is a single-center, multi-surgeon study. OBJECTIVE: To determine occurrence rates and risk factors for perioperative complications in revision anterior lumbar fusion surgery. SUMMARY OF BACKGROUND DATA: Although complication rates from large series of primary anterior fusion procedures have been reported, reports of complication rates for revision anterior fusion procedures are relatively rare. Concern exists chiefly about the risk to vascular and visceral structures because of scar tissue formation from the original anterior exposure. METHODS: This was a retrospective review of 129 consecutive anterior revision lumbar surgeries in 108 patients operated between 1998 and 2003. There were 40 men and 68 women. The age of patients ranged from 25 to 83 (average 50.6 years). Patients were excluded if surgery was for tumor or infection. Patients were divided into 2 groups; those with revision surgery at the same level and those with revision surgery at an adjacent level. Outcome measures included all perioperative complications. Statistical analysis included Student t test and nonparametric sign-rank. RESULTS: The number of surgical levels treated for revision was similar between the 2 groups (1 level 69%; 2 levels 19%; 3 or more levels 12%). Revision cases at the same operative level had a higher overall complication rate (42%) compared with extensions (20%; P = 0.007). This difference was primarily because of vein lacerations (23.7% vs. 3.6%, P = 0.002). There were 2 ureteral problems, both successfully salvaged. There were no arterial injuries or deaths. CONCLUSION: Complication rates for revision lumbar surgery in this series were 3 to 5 times higher than reported for primary lumbar exposures. Complication rates were significantly higher for revision anterior lumbar fusions at the same segment, which were typically in the lower lumbar spine, compared with cases involving extensions, which were typically in the upper lumbar spine.

Complications in long fusions to the sacrum for adult scoliosis: minimum five-year analysis of fifty patients.

STUDY DESIGN: A retrospective study of complications with minimal 5-year follow-up of 50 adults with scoliosis with fusion from T10 or higher to S1. OBJECTIVES: To document the perioperative and long-term complications and instrumentation problems, and to attempt to determine variables which may influence these problems. It is not a study of curve correction, balance, or functional outcome. SUMMARY OF BACKGROUND DATA: Several previous studies from this and other centers have shown a relatively high complication rate for this select group of patients. Various fusion techniques (anterior, posterior, autograft, allograft), various instrumentation techniques, and various immobilization techniques have created confusion as to the best methodology to employ. Minimal 2-year follow-ups have been standard, but longer follow-ups have shown additional problems. METHODS: The study cohort consisted of 50 adult patients from a single center who had undergone corrective scoliosis surgery from T10 or higher to the sacrum and who had at least a 5-year minimum follow-up. The mean age was 54 years (range, 18-72), and the mean follow-up was 9.7 years (range, 5-26). All radiographs, office charts, and hospital charts were combed by an independent investigator for complications, which were divided into major and minor, as well as early, intermediate and late. The curvature values and corrections were the subject of a different article, and were not included in this study. RESULTS: There were no deaths or spinal cord injuries. Six patients had nerve root complications, 4 of which totally recovered. Pseudarthrosis was seen in 24% of the patients, only 25% of which were detected within the 2-year follow-up period. Pseudarthrosis was most common at the lumbosacral level. There was no statistical difference in the pseudarthrosis rate between patients with sacral-only fixation versus iliac fixation. Painful implants requiring removal were noted in 11 of the 50 patients. CONCLUSION: Long fusions to the sacrum in adults with scoliosis continue to have a high complication rate. As compared to the original publications in the 1980s (Kostuik and Hall, Spine 1983;8:489-500; Balderston et al, Spine 1986;11:824-9) the more recent articles have shown a reduction, but not elimination of the pseudarthrosis problem using segmental instrumentation and anterior fusion of the lumbar spine coupled with structural interbody grafting at L4-L5 and L5-S1. Two-year follow-up is inadequate as pseudarthrosis and painful implants often are detected later. Only 3 of the 12 patients with pseudarthrosis were detected within the first 2 years after surgery.