Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation (UNILF): outcomes at 7 years.

PURPOSE: To assess clinical, functional and radiographical results of one-level minimally invasive transforaminal interbody fusion with unilateral pedicle screw fixation (UNILIF) in the treatment of stable lumbar degenerative diseases with a minimum of 5 years of follow-up. MATERIAL AND METHOD: From January 2012 to December 2016, clinical and radiological data of patients with degenerative lumbar disease managed by UNILIF were prospectively collected. Patients with a follow-up that ended before 5 years were excluded. SF-12, Oswestry disability index (ODI) and visual analog scale (VAS) were collected preoperatively, at 2 years and at the last follow-up. A full-spine standing radiograph was performed at each follow-up appointment. RESULTS: Mean operative time was 74.7 (± 19) minutes, mean blood loss was 131.1 (± 207) ml and mean follow-up was 7.5 (± 1.7) years. All functional scores and VAS were significantly improved between the preoperative and the 2 years postoperative. Between the 2 years postoperative and the last follow-up ODI and VAS continued to significantly improved. Fusion rate was 98.6% on radiographic analysis at follow-up. CONCLUSION: UNILIF method is a safe and effective surgical strategy. It provides a durable improvement in functional score over 7 years of follow-up with a stable radiological correction over time.

Validation of the French version of the Caregivers' Priorities and Child Health Index of Life with Disabilities questionnaire.

INTRODUCTION: The Caregivers' Priorities and Child Health Index of Life with Disabilities (CPCHILD) is a questionnaire that measures the health-related quality of life (HRQL) of children with cerebral palsy (CP). Though measuring HRQL is challenging in these children, it is a valuable help for medical decision-making. There is no questionnaire to assess HRQL in French-speaking children with severe CP. OBJECTIVE: To translate and adapt transculturally the CPCHILD questionnaire into French (CPCHILD-FV). MATERIAL AND METHODS: The CPCHILD was translated from English into French by forward and backward translation by independents translators. The questionnaire was then tested on 32 caregivers of patients with CP classified as GMFCS IV or V, remarks of caregivers were analyzed by an expert committee and, if necessary, modifications were performed. Internal consistency of the CPCHILD-FV was assessed using a sample of 32 parents or caregivers and test-retest reliability was assessed on a random sample of 10 patients. RESULTS: The translation and transcultural process resulted in a French version of the CPCHILD. Some items of the CPCHILD required careful discussion to ensure that items had the same meaning as in the original. Internal consistencies were over 0.70 for each domain except for health, and 0.97 for the total scores. The ICC for the test-retest reliability of the CHILD-FV total score was 0.98 (95% CI: 0.93-0.99) and ranged from 0.59 to 0.99 for the domains. CONCLUSION: The translation and cross-cultural adaptation of the CPCHILD questionnaire provides a French version than can measure the HRQL of children with severe CP. LEVEL OF EVIDENCE: IV; prospective study without control group.

Risk of repeated drainage in pediatric septic arthritis: patient or method?

How drainage of septic arthritis should be performed remains controversial. The aim of the present study was to compare arthrocentesis (Ac) using double intra-articular needle lavage to arthrotomy (At) as first-line drainage treatment for pediatric hip and knee septic arthritis. The secondary objective was to identify risk factors of second articular drainage. A retrospective review of medical records of children with knee and hip septic arthritis was conducted. Inclusion criteria were: children treated for septic arthritis between 2014 and 2020 with a positive culture of joint fluid. Clinical, biological, radiographical and ultrasound data were recorded at presentation and during follow-up. Patients were divided into 2 groups according to the type of drainage performed: Ac or At. 25 hips and 44 knees were included, 42 treated by Ac (15 hips, 27 knees) and 27 by At (10 hips, 17 knees). There is no significant difference between Ac and At regarding the need for repeated drainage and Ac nor At was reported as risk factor for repeated drainage. The presence of associated musculoskeletal infection (MSI) was a significant risk factor of repeated drainage [odds ratio = 11.8; 95% confidence interval = 1.2-114.2; P < 0.001]. Significantly more associated MSI (P < 0.001), level I virulence germs (P < 0.001) and positive blood culture (<0.001) were found in patients who underwent repeated drainage. There was no significant difference between Ac and At regarding rate of repeated drainage. The risk factors for repeated drainage were: associated with MSI, virulent germs and positive blood culture.

Translation and validation of the French version of the adolescent idiopathic scoliosis Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ).

PURPOSE: Scoliosis is an abnormality which causes anterior trunk asymmetry. The Truncal Anterior Asymmetry Scoliosis Questionnaire-adolescent idiopathic scoliosis (AIS) (TAASQ) measures the feeling about anterior trunk appearance in girls with AIS. It comprises 14 questions which evaluate frontal asymmetry of breasts, shoulders, and waist as well as behavioral attitude. There is currently no validated questionnaire in French to evaluate truncal asymmetry in AIS girls. The aim of this study was to translate and validate the French version of the TAASQ (TAASQ-VF). METHODS: The study reports the translation and transcultural adaptation of the TAASQ into French. The translation was tested on 20 patients to verify comprehension and modify if necessary. To assess the reliability of the translated version, each domain as well as the total measure were tested for internal consistency. Convergent validity was evaluated on 63 patients and test-retest on a sample of 15. RESULTS: The translation and content validation process resulted in a French version of the TAASQ. Internal consistency was over 0.80 for each item, over 0.70 for each domain, and 0.88 for the total scores. SAQ were used to perform convergent validity with TAASQ-VF. The TAASQ-FV correlated well with many of the SAQ domains (p < 0.05) and every TAASQ-FV domain correlated with at least one SAQ domain (p < 0.05). Test-retest reliability for the total score and for each domain was good. CONCLUSION: The translation and cross-cultural adaptation of the TAASQ questionnaire provides a French version that can measure the feeling about frontal appearance in girls with idiopathic scoliosis.

Intraoperative neurophysiological monitoring in scoliosis surgery: literature review of the last 10 years.

INTRODUCTION: Patients with spinal deformities undergoing corrective surgery are at risk for iatrogenic spinal cord injury (SCI) and subsequent neurological deficit. Intraoperative neurophysiological monitoring (IONM) allows early detection of SCI which enables early intervention resulting in a better prognosis. The primary aim of this literature review was to search if there are threshold values of TcMEP and SSEP in the literature that are widely accepted as alert during IONM. The secondary aim was to update knowledge concerning IONM during scoliosis surgery. METHOD: PubMed/MEDLINE and Cochrane library electronic databases were used to search publication from 2012 to 2022. The following keywords were used: evoked potential, scoliosis, surgery, intraoperative monitoring and neurophysiological. We included all studies dealing with SSEP and TcMEP monitoring during scoliosis surgery. Two authors reviewed all titles and abstracts to identify studies that met the inclusion criteria. RESULTS: We included 43 papers. Rates of IONM alert and neurological deficit varied from 0.56 to 64% and from 0.15 to 8.3%, respectively. Threshold values varied from a loss of 50 to 90% for TcMEP amplitude, whereas it seems that a loss of 50% in amplitude and/or an increase of 10% of latency is widely accepted for SSEP. Causes of IONM changes most frequently reported were surgical maneuver. CONCLUSION: Concerning SSEP, a loss of 50% in amplitude and/or an increase of 10% of latency is widely accepted as an alert. For TcMEP, it seems that the use of highest threshold values can avoid unnecessary surgical procedure for the patient without increasing risk of neurological deficit.

Successful closed reduction of a trans-scaphoid perilunate dislocation in a 11-year-old boy: a case report.

CASE: Perilunate dislocation is an uncommon injury in children. We report the case of an 11-year-old boy who presented a trans-scapho-perilunate fracture-dislocation of the carpus after falling from his bike. Treatment consisted of a closed reduction under general anesthesia followed by cast immobilization for 12 weeks. The injury healed with good wrist function on follow-up. CONCLUSION: Closed reduction should be attempted because it can be successful and allows for closed treatment with the cast. It provides good radiological healing and satisfying functional results.

Orthopaedic and trauma surgery in the time of COVID-19 in France: A nationwide survey.

INTRODUCTION: The year 2020 was marked by the COVID-19 pandemic. The entire French health system was mobilized. Surgical services were asked to reschedule all elective procedures. We wondered about the impact of this pandemic on French orthopaedic surgeons. The main objective of this survey was to assess the impact of COVID-19 on emergency and non-emergency orthopaedic surgical activities. The secondary objectives were: to report how orthopaedic surgeons had mobilized and reorganized, and to assess the physical and psychological consequences on their state of health. HYPOTHESIS: The COVID-19 epidemic has led to the suspension of all elective orthopaedic surgeries and has also led to changes in the management of urgent surgeries and traumatology. MATERIAL AND METHODS: This descriptive epidemiological study was conducted in France. A 40-question survey was sent to all French orthopaedic surgeons (senior surgeons and residents) via the mailing lists of the French Society of Orthopaedic and Traumatological Surgery (SoFCOT), the French Society of Pediatric Orthopaedics (SoFOP) and the College of Young Orthopedists (CJO). RESULTS: Over a period of one month, 1098 surgeons; 852 senior surgeons and 246 residents, answered the questionnaire. The complete cessation of all elective interventions was effective in 80% of cases. Urgent and semi-urgent interventions were maintained. Three hundred and twenty-six surgeons (30%) modified their trauma management, among them 55% came from the regions most affected by the pandemic. Sixty percent of surgeons did not receive training to take care of COVID+ patients and 40% took care of these patients. Among the orthopaedic surgeons surveyed, 28% were redeployed to medical services. Teleconsultation was used by 41% of surgeons. Twenty-six (2%) surgeons tested positive for COVID-19 and 54% showed at least one sign of psychological suffering. CONCLUSION: French orthopaedic surgeons reorganized and changed their practices quickly and efficiently to deal with the pandemic. However, progress remains to be seen with training of orthopaedic surgeons in the care of COVID+patients, as well as to democratize the use of telemedicine. LEVEL OF EVIDENCE: IV.

Side bending radiographs and lowest instrumented vertebra in adolescent idiopathic scoliosis: A French quality-of-care study.

BACKGROUND: Determining which spinal levels to instrument during surgical treatment of Lenke Type 1 adolescent idiopathic scoliosis (AIS) depends on the reducibility of the primary and secondary curve patterns. This reducibility can be evaluated in several ways, with the most popular being radiographs in bending for moderate thoracic and lumbar curvatures. Hypothesis Side-bending radiographs will alter the choice of the lowest instrumented vertebra (LIV) for the surgical treatment of AIS. METHODS: Thirteen experienced French spine surgeons were invited to perform surgical planning on 23 patients based on stereoradiographs with and without (standing) side-bending views. The surgical planning was repeated a second time to assess the intra- and inter-rater reliability. Variations in the choice of LIV were analyzed for each evaluation. RESULTS: The intra-rater reliability was moderate to substantial. The inter-rater reliability was low to moderate. The study compared 879 surgical plans. Selective fusion was chosen in 0.3% of the plans. The median LIV was L2. The availability of side bending views changed the plan in 39% of cases. However, 36% of the plans were changed in the control (test-retest) condition. No significant difference was found between the variations with side-bending radiographs and "control" variations (p>0.05). CONCLUSION: The use of radiographs in bending has no significant effect on the LIV choice in this study. This result is derived from statistically robust analysis made possible by one of the largest datasets available on this topic. Large inter-rater variability was observed and will be explored further in a future study. LEVEL OF EVIDENCE: II; non-randomized controlled comparative study.

Elbow dislocation with and without an associated fracture in children: A prospective study of functional outcomes following 3 weeks of immobilization.

INTRODUCTION: The initial management of elbow dislocations in children, emergency reduction and brachial-antebrachial-palmar (BABP) immobilization, remains the most widely used method. Osteosynthesis could be associated in case of fractures. On the other hand, there is no consensus on the duration of immobilization in the recent literature. The objective of this study was to describe the medium-term functional results of a prospective cohort of children presenting with an elbow dislocation immobilized for 3 weeks, with or without an associated fracture. The hypothesis of this study was that 3 weeks of immobilization was sufficient and made it possible to obtain a satisfactory, rapid functional recovery without residual instability. MATERIAL AND METHOD: All children with an elbow dislocation with or without an associated fracture were included. The dislocation was urgently reduced and subsequent surgery could be indicated in the event of associated injuries. All the children had 3 weeks of immobilization with a BABP cast. Radiological and clinical follow-up was carried out for 2 years. The parameters evaluated were: 3 functional scores and the range of motion (ROM) of the elbow. Clinical or radiological complications were sought. RESULTS: A total of 50 children were included, the mean age was 10.6 years (± 2.6). Functional score results were "good' or "excellent' at 3 months of follow-up, "excellent' at 6 months and thereafter. The mean limitation in ROM at the last follow-up was 4.7° (± 7.2°) with all ranges combined. Eighty-two percent of children had a mean limitation in ROM of less than 10°. None of the children presented with a recurrence of elbow dislocation and instability. CONCLUSION: Immobilization of elbow dislocations for 3 weeks in children confers good medium-term functional results without exposing them to the risk of instability, whether or not the dislocation is associated with a fracture. LEVEL OF EVIDENCE: II; Prospective cohort study.

Halo-gravity traction followed by definitive fusion in severe early onset scoliosis: results of a trunk analysis based on biplanar 3D reconstructions.

PURPOSE: Definitive fusion can be considered in early onset scoliosis (EOS) around triradiate cartilage closure. Halo-gravity traction (HGT) is an old strategy that can help lengthen and balance the spine before fusion. The postoperative changes of the trunk have never been investigated to date with modern imaging. The goal of this study was to analyze the 3D radiological outcomes, and the associated pulmonary function, of a cohort of severe EOS patients treated by definitive posterior fusion prepared by HGT. METHODS: All consecutive EOS patients with severe (> 85°) and stiff (flexibility < 25%) curves, treated by HGT followed by posterior fusion, were followed. 3D radiological measurements and pulmonary function were assessed. RESULTS: Forty-nine EOS patients underwent fusion, with a mean follow-up of 4 years (± 1). Age at surgery averaged 13.5 years old. HGT protocol reached on average 41% of body weight. Mean preoperative 3D Cobb angle was 95° (± 10) and final correction averaged 68.4% after surgery. 3D T4T12 kyphosis was reduced after surgery (11°, p < 0.01), while the apical vertebral rotation was improved by 27.8% (p = 0.06). 3D thoracic volume increased after surgery (p = 0.02), with a 3D T1T12 height gain averaging 3.7 cm (± 2). Both parameters were significantly correlated with total lung capacity improvement. Seven complications (14.2%) were reported, and 5 patients (10.6%) underwent unplanned revision. CONCLUSION: HGT is a safe and efficient strategy to prepare posterior fusion in severe EOS patients. The 3D trunk analysis demonstrated significant postoperative gains in thoracic and spinal lengths, as well as in thoracic volume. LEVEL OF EVIDENCE: IV.

Functional and radiological outcome after forearm plating in children and adolescent fracture.

The literature on forearm overgrowth after plating in traumatic conditions is relatively poor though this technique can be useful when intra-medullary nailing is not sufficient in pediatric cases. The goal of this study was to assess a potential overgrowth after plating and identify impact on function. We conducted a retrospective study of all pediatric patients who underwent open surgery of the radius and/or ulna diaphysis with internal fixation by plating, in our institution, between October 2013 and July 2019. At last follow-up, functional and radiological outcomes were compared between the operated and uninjured forearm. Range of motion (ROM) of the wrist and elbow, clinical scores, radial and ulnar length were measured. A positive bone length discrepancy of more than 2mm was considered as an overgrowth. Were also studied the radio-ulnar index, radial inclination and radiocarpal angle. Thirteen patients were included. The mean age was 12.1 years old (±3.0 years), they were plated on the radius (10 cases) or on the ulna (3 cases). Mean follow- up was 4.4 years (± 1.8). In two cases, the plated bone (radius) was significantly longer than the uninjured one. There was no significant difference regarding radio-ulnar index, radial inclination and radiocarpal angle. The only statistically significant difference between the operated and uninjured forearm was the pronation/supination range, which was greater in the uninjured forearm (mean 160 ±48° versus 175 ±49°, p=0.01). This study confirms the good functional and radiological outcomes after plating even in a skeletally immature forearm. Level of evidence : IV.

ACL reconstruction with lateral extra-articular tenodesis using a continuous graft: 10-year outcomes of 50 cases.

BACKGROUND: Persistence of pivot shift is the main problem after isolated intra-articular anterior cruciate ligament (ACL) reconstruction. Adding lateral extra-articular tenodesis (LET) to the ACL procedure increases the knee's stability by controlling rotational laxity. The aim of this study was to evaluate the long-term clinical and radiological outcomes of combined ACL reconstruction with LET using a continuous hamstring graft as a first-line procedure. MATERIAL AND METHODS: Fifty patients were reviewed at 10 years postoperative. Subjective outcome scores -IKDC, Lysholm, KOOS and Tegner- were collected. A clinical and radiological assessment was done. The knees' anteroposterior laxity was measured with a rollimeter. RESULTS: The mean IKDC subjective score was 85.5, the mean Lysholm score was 90.2 and 80% of patients had a score graded as good or very good. No pivot shift was present in 94% of patients and there was a firm endpoint in the Lachman test in 86% of patients. There was a flexion deficit>5° in 5 patients and an extension deficit of 10° in one patient. Most patients (56%) had resumed their physical activities at the same level as before the surgery. Signs of osteoarthritis were found in 26% of patients (16% were Ahlback stage 1 and 10% were stage 2). There was only one graft failure. These good outcomes are consistent with other published studies on combined ACL-LET. There was neither significant stiffness, nor a higher rate of secondary osteoarthritis relative to ACL reconstruction only, particularly in the lateral tibiofemoral compartment. CONCLUSION: Adding primary LET to ACL reconstruction improves control of rotational laxity over time without increasing the complication rate. LEVEL OF EVIDENCE: IV, retrospective study without control group.

Divergent Intramedullary Nailing (DIN): A Modified Intramedullary Nailing Technique to Treat Paediatric Distal Tibial Fractures.

INTRODUCTION: Elastic stable intramedullary nailing (ESIN) allows for efficient reduction and stabilization of fractures of the tibial shaft in children and adolescents. However, for fractures of the distal third of the tibia, traditional ESIN could be inappropriate, thus compromising the stability and the healing of the fracture. The aim of this study was to present and to assess a new technique of modified ESIN to treat fracture of the distal third of the tibia, called divergent intramedullary nailing (DIN). METHODS: We performed a retrospective monocentric study. All patients less than 16 years old, managed in our pediatric orthopaedics department, and operated upon according to the DIN technique for a displaced and/or unstable fracture of the distal third of the tibia were included. Demographic and surgical data were collected. X-rays were performed preoperatively, postoperatively, at 6 weeks, and every 6 months. The surgical technique starts as does the classic ESIN. However, nails are not curved, so that they cross only once at the proximal part of the tibia; they are divergent and supported by the medial and lateral distal part of the tibial shaft. This allows for reduction and stabilization of the fracture. RESULTS: A total of 13 patients were included, with a mean age of 10 years and a mean follow-up of 32 months. The size of the nail varied between 2.5 and 4 mm. The mean surgical time was 54 minutes. The DIN technique provided a satisfying reduction (coronal and sagittal angulation <3 degrees) for the 13 fractures. In addition, there was no secondary displacement at 6 weeks. All patients were healed at 6 months, with no clinical torsion or axis malalignment. CONCLUSIONS: The current study confirms the feasibility and the efficiency of the DIN method to treat fracture of the distal third of the tibia.

Efficacy, pain, and overall patient satisfaction with pediatric upper arm fracture reduction in the emergency department.

INTRODUCTION: Immediate closed reduction and cast immobilization performed under sedation in the emergency room is the mainstay management for most isolated displaced or angulated upper limb fractures in children. We aimed to determine if this approach is safe, effective and if patients, parents and staff are satisfied with this approach.Our working hypothesis was this management provides a high satisfaction rate. PATIENTS AND METHODS: Between January 2017 and October 2017 we included 118 children presenting with upper arm fractures amenable to closed reduction under our institutional analgesia protocol. Children received 0.4mg/kg of Oramorph oral solution, they were then evaluated 40minutes later, and if their Face Legs Activity Cry Consolability (for children under 16 years-old) and/or Visual Analog Scale (for children over 6 years-old) were under 4, they underwent closed reduction by an orthopaedic resident under Nitrous oxide. If their pain assessment scale was above 4, they received an extra 0.4mg/kg of Oramorph oral solution and underwent closed reduction 40minutes later under nitrous oxide. These children were managed without hospitalization, as outpatients. Children>6, families and nursing staff were also given a visual satisfaction scale (using a 1-10 score) just before being discharged from the ER in order to evaluate their experience. RESULTS: Closed reduction in the ER was judged satisfactory from an orthopedic point-of-view in 115 cases (97.6%). Parents, children and the nursing team gave the experience in the ER an average satisfaction score of 9 out of 10. CONCLUSION: ER reduction is not only safe and effective but is also associated with a high satisfaction rate amongst children, their families and the nursing staff.

Optimal postoperative immobilisation for supracondylar humeral fractures.

BACKGROUND: Supracondylar humeral fractures (SCHFs) are very common in paediatric patients. In France, percutaneous fixation with two lateral-entry pins is widely used after successful closed reduction. Postoperative immobilisation is typically with a long arm cast combined with a tubular-bandage sling that immobilises the shoulder and holds the arm in adduction and internal rotation to prevent external rotation of the shoulder, which might cause secondary displacement. The objective of this study was to compare this standard immobilisation technique to a posterior plaster splint with a simple sling. HYPOTHESIS: Secondary displacement is not more common with a posterior plaster splint and sling than with a long arm cast. MATERIAL AND METHODS: One hundred patients with extension Gartland type III SCHFs managed by closed reduction and percutaneous fixation with two lateral-entry pins between December 2011 and December 2015 were assessed retrospectively. Postoperative immobilisation was with a posterior plaster splint and a simple sling worn for 4 weeks. Radiographs were obtained on days 1, 45, and 90. RESULTS: Secondary displacement occurred in 8% of patients. No patient required revision surgery. DISCUSSION: The secondary displacement rate was comparable to earlier reports. Of the 8 secondary displacements, 5 were ascribable to technical errors. The remaining 3 were not caused by rotation of the arm and would probably not have been prevented by using the tubular-bandage sling. CONCLUSION: A posterior plaster splint combined with a simple sling is a simple and effective immobilisation method for SCHFs provided internal fixation is technically optimal. LEVEL OF EVIDENCE: IV retrospective observational study.

Conservative treatment of pediatric thoracic and lumbar spinal fractures: outcomes in the sagittal plane.

To assess sagittal plane spinopelvic balance and functional outcomes in a pediatric cohort of patients with a thoracic and/or a lumbar fracture treated conservatively. A multicentric study retrospectively reviewed radiological and functional outcomes (mean follow-up 49 months) of 48 patients (mean age 12 years) with thoracic and/or lumbar spinal fractures that occurred between 1996 and 2014. Demographic data and radiological spinopelvic parameters were analyzed. Functional outcome was evaluated by a telephone interview. First, a comparison between the initial and the last follow-up full-spine radiographs was performed for the assessment of bone remodeling and sagittal plane balance. Then, patients were classified into two groups (group 1: Risser≤2 and group 2, Risser>2) to assess the influence of skeletal maturity on the restoration of a correct sagittal balance. A total of 62% of the patients were at skeletal maturity at the final follow-up (Risser 4 and 5). Patients with a Risser grade of 2 or less had a higher remodeling potential. The mean residual local kyphosis in thoracic and lumbar fractures was, respectively, 8.2° and 8.7°. The mean thoracic global kyphosis remains stable at the last follow-up, in contrast to lumbar lordosis, which increased significantly. Sagittal plane global measurements on the basis of the C7-plumbline remained unchanged at the last follow-up. There was no change in the pelvic parameters, except for the sacral slope in the group 1 for patients with a lumbar fracture. The current study confirms a greater correction in younger patients (Risser≤2) in spinal fractures and reported that thoracic fractures have a higher remodeling potential than lumbar fracture. A local kyphosis of almost 10° remained at the last follow-up. However, no deterioration in the sagittal plane balance was found. This suggests compensatory mechanisms in adjacent structures for children and adolescents and excludes the only hypothesis of bone remodeling.

Do Sublaminar Polyester Bands Affect the Outcomes of Postoperative Infections After Adolescent Idiopathic Scoliosis Surgery?

BACKGROUND: The incidence of surgical site infections (SSI) after adolescent idiopathic scoliosis (AIS) surgery ranges from 0.5% to 7%. There is currently a regain of interest in hybrid constructs, combining lumbar pedicle screws and thoracic sublaminar bands, but some authors have raised concerns about the risk of SSI and the difficulty of bacterial eradication. The goal of this study was therefore to assess the outcomes of SSI after AIS surgery using sublaminar bands. METHODS: A total of 524 consecutive patients operated for AIS using sublaminar bands between June 2006 and June 2014 were included. SSI cases were identified and analyzed retrospectively. Radiologic and functional outcomes were evaluated at follow-up using EOS imaging and SRS 30 scores, and compared with a control group. RESULTS: The overall SSI rate was 5.3%, with a majority of monomicrobial (86%) infections occurring in the first 6 weeks postoperative (93%). The most frequent pathogens were skin germs (Staphylococcus aureus and Propionibacterium acnes) with a community profile. Patients were treated successfully with surgical debridement without implants removal, associated with 6 weeks of antibiotherapy. However, 25% of patients required >1 surgical debridement. Instrumentation removal was decided in the 2 cases with late SSI, and performed uneventfully. Radiologic and functional outcomes at follow-up were not affected by the occurrence of SSI. CONCLUSIONS: Sublaminar bands are not associated with a higher risk of infection. However, the SSI rate in the current study stands in the upper range of the literature, and other preventive strategies should be considered. In case of early infection, bands removal is not necessary to obtain pathogen eradication, but the sublaminar implants can be pulled out safely in case of late SSI. The occurrence of SSI does not alter the outcomes at follow-up. LEVEL OF EVIDENCE: Level III.

Titanium vs cobalt chromium: what is the best rod material to enhance adolescent idiopathic scoliosis correction with sublaminar bands?

PURPOSE: Cobalt chromium (CoCr) rods have recently gained popularity in adolescent idiopathic scoliosis (AIS) surgical treatment, replacing titanium (Ti) rods, with promising frontal correction rates in all-screw constructs. Posteromedial translation has been shown to emphasize thoracic sagittal correction, but the influence of rod material in this correction technique has never been investigated. The aim of this study was to compare the postoperative correction between Ti and CoCr rods for the treatment of thoracic AIS using posteromedial translation technique. METHODS: 70 patients operated for thoracic (Lenke 1 or 2) AIS, in 2 institutions, between 2010 and 2013, were included. All patients underwent posterior fusion with hybrid constructs using posteromedial translation technique. The only difference between groups in the surgical procedure was the rod material (Ti or CoCr rods). Radiological measurements were compared preoperatively, postoperatively and at last follow-up (minimum 2 years). RESULTS: Preoperatively, groups were similar in terms of coronal and sagittal parameters. Postoperatively, no significant difference was observed between Ti and CoCr regarding frontal corrections, even when the preoperative flexibility of the curves was taken into account (p = 0.13). CoCr rods allowed greater restoration of T4T12 thoracic kyphosis, which remained stable over time (p = 0.01). Most common postoperative complication was proximal junctional kyphosis (n = 4). However, no significant difference was found between groups regarding postoperative complications rate. CONCLUSION: CoCr and Ti rods both provide significant and stable frontal correction in AIS treated with posteromedial translation technique using hybrid constructs. However, CoCr might be considered to emphasize sagittal correction in hypokyphotic patients.