Time to surgery for adolescent idiopathic scoliosis: How long does it take? A multicenter study.

Study design: Retrospective review of multicentric data. Objectives: To estimate the time from initial visit to surgery in adolescent idiopathic scoliosis (AIS) patients and the main reasons for the time to surgery in a multicenter study. Methods: This retrospective study evaluated 509 patients with AIS from 16 hospitals across six Latin American countries. From each hospital's deformity registry, the following patient data were extracted: demographics, main curve Cobb angle, Lenke Classification at the initial visit and time of surgery, time from indication-for-surgery to surgery, curve progression, Risser skeletal-maturity score and causes for surgical cancelation or delay. Surgeons were asked if they needed to change the original surgical plan due to curve progression. Data also were collected on each hospital's waiting list numbers and mean delay to AIS surgery. Results: 66.8% of the patients waited over six months and 33.9% over a year. Waiting time was not impacted by the patient's age when surgery first became indicated (p = 0.22) but waiting time did differ between countries (p < 0.001) and hospitals (p < 0.001). Longer time to surgery was significantly associated with increasing magnitude of the Cobb angle through the second year of waiting (p < 0.001). Reported causes for delay were hospital-related (48.4%), economic (47.3%), and logistic (4.2%). Oddly, waiting time for surgery did not correlate with the hospital's reported waiting-list lengths (p = 0.57). Conclusion: Prolonged waits for AIS surgery are common in Latin America, with rare exceptions. At most centers, patients wait over six months, most commonly for economic and hospital-related reasons. Whether this directly impacts surgical outcomes in Latin America still must be studied.

Unplanned Readmission Following Early Postoperative Complications After Fusion Surgery in Adult Spine Deformity: A Multicentric Study.

STUDY DESIGN: Multicentric retrospective study, Level of evidence III. OBJECTIVE: The objective of this multicentric study was to analyze the prevalence and risk factors of early postoperative complications in adult spinal deformity patients treated with fusion. Additionally, we studied the impact of complications on unplanned readmission and hospital length of stay. METHODS: Eight spine centers from 6 countries in Latin America were involved in this study. Patients with adult spinal deformity treated with fusion surgery from 2017 to 2019 were included. Baseline and surgical characteristics such as age, sex, comorbidities, smoking, number of levels fused, number of surgical approaches were analyzed. Postoperative complications at 30 days were recorded according to Clavien-Dindo and Glassman classifications. RESULTS: 172 patients (120 females/52 males, mean age 59.4 ± 17.6) were included in our study. 78 patients suffered complications (45%) at 30 days, 43% of these complications were considered major. Unplanned readmission was observed in 35 patients (20,3%). Risk factors for complications were: Smoking, previous comorbidities, number of levels fused, two or more surgical approaches and excessive bleeding. Hospital length of stay in patients without and with complications was of 7.8 ± 13.7 and 17 ± 31.1 days, respectively (P 0.0001). CONCLUSION: The prevalence of early postoperative complications in adult spinal deformity patients treated with fusion was of 45% in our study with 20% of unplanned readmissions at 30 days. Presence of complications significantly increased hospital length of stay.

Clostridium perfringens in the spine: A rare cause of post-surgical infection.

BACKGROUND: Post-surgical infections of the spine occur in from 0% to 18% of cases. Postoperative spine infections due to Clostridium Perfringens (CP) resulting in necrotizing fasciitis are extremely rare. However, since they may be fatal, early and definitive treatment is critical. CASE DESCRIPTION A: 62-year-old male with a T8-T9 Type C fracture, in ASIA Grade "E" (neurologically intact) underwent a posterior T6-T10 arthrodesis. However, 2 weeks postoperatively, he developed a postoperative thoracic wound infection; the cultures were positive for CP. As the patient developed necrotizing fasciitis, emergent debridement, negative pressure continued drainage, and initiation of appropriate antibiotic therapy were critical. CONCLUSION: Postoperative spinal infections due to CP with accompanying necrotizing fasciitis are extremely rare. As these infections may be fatal, they must be rapidly diagnosed and treated.

Experiencia en la implementación de un protocolo para el tamizaje de escoliosis idiopática del adolescente en instituciones educativas de Bogotá / Implementation of a Protocol for Idiopathic Adolescent Scoliosis Screening. A Successful experience / Implementação de um protocolo para rastreamento de escoliose idiopática do adolescente. Uma experiência de sucess

Introducción: La escoliosis idiopática del adolescente es una deformidad tridimensional de la columna vertebral con un ángulo >10° en el plano coronal, medido por el método de Cobb, y que afecta a la población entre 10 y 18 años. Aunque se desconocen los mecanismos precisos que llevan a la presentación de esta deformidad, se sugiere que presenta un patrón de herencia autosómico dominante con penetrancia incompleta. Las curvas <20° reciben manejo expectante, las curvas entre 21° y 39° reciben manejo ortésico y el resto de curvas tendrían indicación quirúrgica. Debido a la complejidad y el costo de la cirugía, el beneficio del tratamiento ortésico y el impacto negativo en la calidad de vida de los pacientes que un diagnóstico tardío puede traer, se ha sugerido la implementación de programas para la detección temprana de esta patología. Objetivos: Narrar de forma breve la experiencia en la aplicación, así como las incidencias y los resultados preliminares, de un protocolo de investigación para el tamizaje de escoliosis. Desarrollo de la experiencia: Durante 2016 se tamizó a 387 estudiantes de dos instituciones educativas de la ciudad de Bogotá. La prevalencia de sospecha de escoliosis fue del 41,3 %. No hubo correlación entre la evaluación de los profesores con los médicos. Solo el 15 % de los participantes asistió a la cita para diagnóstico con especialista en columna; sin embargo, el 76 % de estos presentaron un diagnóstico asociado a deformidad de la columna vertebral. Se añadió una nueva institución para aumentar el impacto social del estudio. Discusión: El alto porcentaje de estudiantes que se beneficiaron de un diagnóstico temprano y la instauración de tratamiento aboga a favor y permite sugerir la utilidad de estos programas de tamizaje; sin embargo, se requiere mayor reconocimiento del problema y más sensibilización por parte de las instituciones educativas para participar en los programas.

Introduction: Idiopathic Adolescent Scoliosis is a tridimensional deformity of the vertebral spine with an angle greater than 10° measured in the plain view; it is presented in children between 10 and 18 years. Although exact mechanisms by which scoliosis is produced are unknown, it has been suggested that it follows an autosomal dominant pattern of inheritance with incomplete penetrance. Curves less than 20° receive expectant treatment, between 21 and 39° orthotic management and the rest have surgical indication. Given the complexity and the cost of surgical procedure, the possible benefits of orthotic treatment and the negative impact in life quality of a delayed diagnosis, screening programs had been implemented for early diagnosis worldwide. Objetive: To briefly narrate the experience, incidences and preliminary results in the application of a protocol to screen for idiopathic scoliosis. Develop: in 2016, 387 students were screened in two institutions. Prevalence of a positive screening were 41, 3 %. There was no correlation between teacher and doctors' assessments. Only 15 % of participants assist to control appointment at the hospital; however, 76 % of those who assist were found with a spinal deformity. A new institution was recruited in order to enhance the social impact of our work. Discussion: The great amount of students who benefited from an early diagnosis and treatment, allows us to suggest that screening programs like this one are useful; however it requires increase awareness of the problem by schools and parents in order to achieve full involvement.

Introdução: A escoliose idiopática do adolescente é uma deformidade tridimensional da coluna vertebral com um ângulo superior a 10° medido na vista plana; é apresentado em crianças entre 10 e 18 anos. Embora os mecanismos exatos pelos quais a escoliose é produzida sejam desconhecidos, foi sugerido que ela segue um padrão de herança autossômica dominante com penetrância incompleta. Curvas inferiores a 20° recebem tratamento expectante, entre 21 e 39° de tratamento ortopédico e o restante tem indicação cirúrgica. Dada a complexidade e o custo do procedimento cirúrgico, os possíveis benefícios do tratamento ortótico e o impacto negativo na qualidade de vida de um diagnóstico tardio, foram implementados programas de triagem para o diagnóstico precoce em todo o mundo. Objetivo: narrar brevemente a experiência, incidências e resultados preliminares na aplicação de um protocolo para a triagem de escoliose idiopática. Desenvolver: em 2016, 387 alunos foram selecionados em duas instituições. A prevalência de uma triagem positiva foi de 41, 3%. Não houve correlação entre as avaliações de professores e médicos. Apenas 15% dos participantes auxiliam no controle da consulta no hospital; no entanto, 76% dos que assistiram foram encontrados com uma deformidade da coluna vertebral. Uma nova instituição foi recrutada para aumentar o impacto social do nosso trabalho. Discussão: A grande quantidade de estudantes que se beneficiaram de um diagnóstico e tratamento precoces permite sugerir que programas de triagem como este são úteis; no entanto, exige maior conscientização do problema por parte das escolas e dos pais, a fim de alcançar o envolvimento total.

Spinal cord issues in adult patients with MPS: transition of care survey.

PURPOSE: This study aims to raise awareness of the need for research and appropriate guidelines for managing spinal cord issues in adult patients with mucopolysaccharidosis (MPS) and transition of these patients from pediatric to adult care. METHODS: Pediatric/adult neurosurgeons, orthopedic spine surgeons, and treating physicians with expertise in metabolic disorders and spinal cord issues were invited to complete a survey to assess their experience with spinal cord problems in MPS and their opinion on transitioning routes from pediatric to adult care. RESULTS: Twenty specialists completed the survey; 16 had treated spinal cord issues in patients with MPS. Foramen magnum and cervical stenosis (87%), atlanto-axial instability (67%), and lumbar spine instability (33%) were the main spinal cord issues encountered; 28% had treated adult patients for one or more spinal cord issues. In 40% of cases, this concerned an intervention or procedures performed during childhood. The main specialist responsible for the care of adult patients with MPS differed considerably between institutions and included both pediatric and adult specialists (30% pediatric neurosurgeons, 10% pediatric spine orthopedic surgeons, 30% adult spine neurosurgeons, 20% general adult surgeons). The preferred option (> 50%) for the transition of care was an interdisciplinary team of pediatric and adult specialists. CONCLUSIONS: Further work needs to be done to address problems of managing spinal cord issues in adult patients with MPS. Currently, the responsibility for the care of patients with MPS with spinal cord issues is inconsistent. The best strategy for transitioning these patients from pediatric to adult care is likely an interdisciplinary approach.

A Simple Bone Cyst in Cervical Vertebrae of an Adolescent Patient.

INTRODUCTION: Spinal simple bone cysts, also known as solitary cysts, are extremely unusual benign primary bone tumors with few cases reported in the literature. CASE PRESENTATION: Incidental Magnetic Resonance Imaging (MRI) finding of a C2 Simple bone cyst in a 13-year-old female patient is reported. Complementary studies suggested the benign nature of the lesion. Patient underwent cervical curettage followed by tumor excision. A lateral submandibular approach to the upper cervical spine was used and careful bone resection was possible with a radiofrequency assisted burr and no instrumentation or fixation was required. The stability of the defect was ensured by filling it with bone allograft and by prescribing a postsurgical plastic cervical collar to maintain neck immobilization. Histological examination supported the diagnosis of simple bone cyst. At 6-12-month follow-up the patient presented no recurrence or symptomatology. CONCLUSIONS: Solitary bone cysts are infrequent entities in the cervical vertebrae and preservation of spine stability without instrumentation to avoid neurological complications is often challenging. In this case, the proximity of the cyst to the right vertebral artery and the risk of injury were high; however the surgical approach used was successful and no recurrence or instability was evidenced on postoperative MRI.

Dystrophic thoracic spine dislocation associated with type-1 neurofibromatosis: Case report and rationale for treatment.

The authors report a rare case of spontaneous dystrophic thoracic spine dislocation in a 14-year-old boy with neurofibromatosis type 1 (NF-1). Anteroposterior and lateral standing radiographs showed a dysplastic kyphoscoliotic deformity, with the thoracic kyphosis and scoliosis measuring 75° and 69°, respectively. Three-dimensional reconstruction after computed tomography demonstrated spondyloptosis at T5-T6 with overlapping of T5 over T6 and T7. The patient underwent circumferential fusion with anterior fibular strut grafting mechanically secured between the inferior and superior endplates of T5 and T7 followed by an instrumented posterior fusion from T2 to L1 and thoracoplasty. There was satisfactory resolution of the deformity with stabilization at the last follow-up evaluation.

Factores de riesgo para transfusión sanguínea perioperatoria en reemplazo total de cadera: estudio de casos y controles / Risk factors for blood transfussion in hip arthroplasty

Introducción: actualmente, y a pesar de múltiples esfuerzos, las tasas de transfusión sanguínea perioperatoria en el reemplazo total de cadera siguen siendo altas en la mayoría de las instituciones. Como un primer paso para tratar de disminuir esa frecuencia de transfusión deben establecerse las condiciones que aumentan el riesgo de dicho desenlace. Este es el objetivo del presente estudio. Materiales y métodos: 230 reemplazos totales de cadera fueron evaluados retrospectivamente en un estudio tipo casos y controles. La frecuencia de los posibles factores de riesgo fue medida tanto en el grupo de pacientes que requirieron transfusión como en el grupo que no la requirió. Los datos fueron sometidos tanto a análisis uni como multivariado. Resultados: 106 pacientes requirieron transfusión, lo cual representa una proporción de 46,1%. Se identificaron el sexo femenino, un bajo nivel de hemoglobina preoperatoria y unas cifras tensionales elevadas, como factores de riesgo para transfusión sanguínea; estas variables fueron significativas tanto en el análisis univariado como en el multivariado. Al analizar otros factores como el peso, el índice de masa corporal, las comorbilidades, o el tipo de anestesia, se encontraron algunas diferencias que no fueron estadísticamente significativas. Discusión: los resultados del presente estudio sugieren que es necesario concentrar esfuerzos en las condiciones preoperatorias del paciente con el propósito de disminuir el riesgo de transfusión. Debe ponerse especial atención en la corrección de los niveles preoperatorios de hemoglobina y las cifras tensionales.