7.7% Prevalence of neural axis abnormalities on routine magnetic resonance imaging in patients with presumed adolescent idiopathic scoliosis scheduled for spine surgery: a consecutive single surgeon retrospective cohort of 182 patients.

PURPOSE: The purpose of this study was to use a Delphi analysis to identify a clinically relevant threshold for the prevalence of neural axis abnormalities (NAAs) that would warrant routine preoperative screening. METHODS: A panel of experienced physicians specializing in pediatric spine surgery, pediatric neurosurgery, and pediatric neuroradiology was formed to establish consensus using a Delphi process to identify a minimum prevalence of NAAs that would initiate the implementation of preoperative MRIs as standard of care. Following the Delphi analysis, patients scheduled for PSF (Posterior Spinal Fusion) from 2010 to 2018 were retrospectively identified. Patients were included based on the following criteria: (1) 10-18 years old at time of MRI (inclusive), (2) AIS diagnosis prior to preoperative MRI (no concerning curve pattern, rate of progression, or neurologic signs/symptoms to suggest alternative diagnosis to AIS), and (3) standard preoperative MRI of the cervical, thoracic, and lumbar spine undergone. The prevalence of NAAs on preoperative MRI was recorded for all patients. RESULTS: There were 182 eligible patients. 14 had NAAs on MRI. The prevalence of NAAs was 7.7% [95% CI 4.27-12.57%]. This prevalence was significantly [p < 0.0001] higher than the clinically relevant threshold of 1.3% established by the Delphi panel. Of the 14 patients with NAAs noted on preoperative MRI, neurosurgical intervention was recommended for 4 patients, 2.2% [95% CI 0.6-5.5%] of the total cohort. CONCLUSIONS: Delphi panelists reported a low tolerance for NAAs among patients undergoing PSF for presumed AIS. Group consensus recommended routine screening should be implemented if the prevalence of NAAs is greater than 1.3%. The prevalence of NAAs in our cohort as well as related studies was significantly higher than this threshold. LEVEL OF EVIDENCE: Diagnostic-level III.

Adolescent athletes return to sports rapidly after posterior spine fusion for idiopathic scoliosis: a prospective cohort study.

PURPOSE: No consensus exists regarding the timing for return to sports after PSF for patients with AIS. Return-to-play protocols are based on expert opinion and vary widely. The purpose of this study was to determine how rapidly athletes return to baseline sports activity following posterior spinal fusion for adolescent idiopathic scoliosis. METHODS: Athletes were consecutively enrolled. Inclusion criteria included competition at a junior varsity level or greater for ≥ 3 months yearly, major Cobb angle of 40-75°, age 10-18 years, and one year of follow-up. Athletes completed preoperative sports performance and Patient Reported Outcomes Measurement Information System (PROMIS) physical activity, pain interference, and depressive symptoms questionnaires. Self-assessments were repeated monthly until one year after PSF. RESULTS: Twenty-six athletes were enrolled. The median time to return to sport was 2.7 months [range: 0.6-13 months]. At twelve months, 24 of 26 [90.1%; 95% CI 36.9-74.9%] athletes reported they had returned to the sport at their presurgical level of play. Participation in contact sports was associated with a longer return to sport relative to participation in non-contact/limited contact sports [Hazard Ratio: 0.37, 95% 95% CI 0.14-0.97, p = 0.0427]. Conditioning and flexibility were the most common barriers to return to sport. CONCLUSIONS: When released to unrestricted activity at 4-8 weeks, athletes rapidly return to baseline levels of sports performance, with over half achieving this metric by 3 months.

Bilateral Endogenous Bacterial Endophthalmitis Secondary to Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia.

Endogenous bacterial endophthalmitis (EBE) is a rare but vision-threatening complication of bacteria spreading contiguously through the blood-ocular border. The condition is frequently associated with a poor visual prognosis and has even resulted in death. We present a case of a 48-year-old female with bilateral endogenous methicillin-resistant Staphylococcus aureus (MRSA)endophthalmitis further complicated by septic emboli, endocarditis, osteomyelitis, and septic polyarthralgia. Her vision did not return despite aggressive antibiotic therapy and urgent bilateral vitrectomy. This case presents an interesting and rare clinical vignette resulting in infection and damage of multiple organ systems that required aggressive management and carefully orchestrated multidisciplinary care.

Ultrasonic Bone Scalpel (USBS) Does Not Reduce Blood Loss During Posterior Spinal Fusion (PSF) in Patients with Adolescent Idiopathic Scoliosis (AIS): Randomized Clinical Trial.

STUDY DESIGN: Randomized Clinical Trial. OBJECTIVE: The aim of this study was to compare the efficacy of USBS with standard-of-care surgical instruments during posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS) by evaluating the difference in estimated blood loss per level fused (EBL/level). SUMMARY OF BACKGROUND DATA: PSF surgery for AIS is often associated with high blood loss. Use of an ultrasonic bone scalpel (USBS) has been proposed to reduce blood loss during scoliosis surgery. METHODS: This was a single-blinded (patient-blinded), randomized, controlled superiority trial. We randomized 66 patients with AIS undergoing PSF to the control group (osteotome) or the experimental group (USBS). The primary outcome was intraoperative EBL/level obtained from red blood cell salvage reports. One-year follow-up was available for 57 of 62 (92%) of patients. RESULTS: EBL/level averaged 35 and 39 mL/level in the experimental and control groups, respectively [adjusted mean difference USBS - osteotome -8 mL/level, 95% CI: -16.4 to 0.3 mL/level, P = 0.0575]. There was no difference in curve correction [adjusted mean difference: -1.7%, 95% CI: -7.0 to 3.6%, P = 0.5321] or operative time [adjusted mean difference: -3.55 minutes, 95% CI: -22.45 to 15.46 min, P = 0.7089] between groups. Complications requiring change in routine postoperative care were noted in eight patients: two occurred in patients assigned to the experimental group and six occurred in patients assigned to the control group. CONCLUSION: There was no clinically significant difference in total blood loss, EBL/level, or complications between the two groups. In contrast to reports from other centers, at our high-volume spine center, USBS did not lead to reduced blood loss during PSF for AIS. These results may not be generalizable to centers with longer baseline operative times or higher baseline average blood loss during PSF for AIS.Level of Evidence: 1.