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Study design: A retrospective single center study.Objective：To identify risk factors for multiple implant-related complications with growing-rod for early-onset scoliosis.Background: High incidence of implant-related complications in the treatment of early-onset scoliosis with traditional growing rod. The risk factors for multiple implant-related complications (MIRC) have not been adequately studied.Methods: Data of 59 early-onset scoliosis patients who had been underwent growing rod surgery at Beijing Chao-yang Hospital from September 2007 to December 2017 were reviewed. All patients had complete clinical and radiographic data. Patients were divided into groups with or without MIRC. The univariate and multivariate logistic regression analysis were performed to identify the risk factors associated MIRC.Results: The average age of insertion was 8.9 years and mean follow-up was 51.91 months. 234 implantation or expansion surgeries were performed and the average operation interval was 11.4 months. A total of 60 implant-related complications occurred. Ultimately, MIRC developed in 20 (33.9%) of 59 patients. Number of surgery procedure > 3 times , follow-up time ³50 months , preoperative thoracic kyphosis > 50°, postoperative thoracic kyphosis >50°, postoperative lumbar lordosis >50°, postoperative sagittal vertical axial >40mm are potential risk factors for MIRC (P 3 times, postoperative thoracic kyphosis >50°, postoperative lumbar lordosis >50°are independent risk factors for MIFRC (P50°had an 18.647 times higher risk of MIFRC than postoperative thoracic kyphosis angle Conclusions: Traditional growing rod in the setting of EOS has excellent clinical and radiographic outcomes but a high multiple implant-related complications. Number of surgery procedure > 3 times, postoperative thoracic kyphosis >50°, postoperative lumbar lordosis >50° are independent risk factors for MIRC.

Background：Children with early-onset scoliosis living in high-altitude areas have severe deformities and poor nutritional status.However, no reports on early-onset scoliosis treatment using traditional growing rods in such children exist. Thus, we analyzed the outcomes of traditional growing rods treatment in such patients and the effect of altitude on therapy.Methods：Between September 2007 and December 2017, 59 consecutive patients with EOS underwent systematic surgical correction using traditional growing rods.They were divided into the high-altitude and low-altitude groups, and differences in surgical efficacy and complications between the groups were analyzed pre- and postoperatively.Radiographic measurements,including the Cobb angle,thoracic kyphosis, lumbar lordosis, T1–S1and T1–T12 heights,sagittal and coronal balance, distance between C7PL and sagittal vertical axis,pelvic incidence,sacral slope, and pelvic tilt were assessed preoperatively, postoperatively, and at the last follow-up. Continuous data were analyzed using paired or independent Student’s t-tests, and they were compared preoperatively, postoperatively, and at the last follow-up using a repeated measures analysis of variance. Enumerated data were analyzed using the χ2 test.Results：The mean patient ageat the initial surgery and mean follow-up duration were 8.9±2.4(5–14) years and 51.91±25.23 months, respectively.Altogether, 234 operations were conducted for all patients with an average interval between operations of 11.4±3.0months.The average Cobb angle was similar in both groups preoperatively and at the last follow-up,it was significantly different postoperatively. TK was significantly different in all three periods.T1–S1 and T1–T12 heights were significantly different only during the preoperative period. The overall rates of complications and implant-related complications did not differ significantly between the groups.Conclutions：Deformity in patients with EOS in high-altitude areas was more severe, and treatment using TGRs yielded a satisfactory therapeutic effect.

Background Whether to preserve L5-S1 with no pre-existing pathology in the fusion for patients with adult degenerative scoliosis (ADS) remains controversial. This study is to determine the predictors of L5-S1 diseases for the distal fusion to L5 in the long instrumented fusion for ADS. Methods A total of 159 patients with ADS who had undergone long floating fusion were evaluated with a minimum 2 year follow-up between 2014 to 2018. The patient- and surgical-related risk factors for each individual were identified by using univariate testing. All patients were divided into groups with and without L5-S1 diseases. Univariate testing was used to identify the potential risk factors. Independent risk factors of L5-S1 diseases were identified using multivariate logistic regression. Results BMD of the patients with L5-S1 diseases were much higher than that without L5-S1 diseases (P = 0.003). Postoperative sacral slope in L5-S1 diseases group was much higher than that without L5-S1 diseases group (P = 0.000). Patient-related independent risk factors for the development of L5-S1 diseases included gender (OR = 0.41, P = 0.016) and BMD (OR = 0.42, P = 0.000). Surgical-related independent risk factors for the development of L5-S1 diseases included fusion level (OR = 2.64, P = 0.033) and postoperative sacral slope (OR = 1.43, P = 0.000).ConclusionsGender and BMD were the most common patient-related independent risk factors, Fusion levels and postoperative sacral slope were the most common surgical-related independent risk factors. Prevention of these risk factors can reduce the incidence of L5-S1 diseases in patients with long floating fusion.

Background: Children with early-onset scoliosis (EOS) living in high-altitude areas have serious deformities and poor nutritional status. There are no reports on the treatment of EOS with traditional growing rods (TGRs)in children in high-altitude areas. This study aimed to analyze the outcomes of patients in high-altitude areas treated with TGRs and compare their results according to whether altitude had an effect on therapy.Methods: Between September 2007 and December 2017, 59 consecutive patients with EOS underwent systematic surgical correction using TGRs. Patients were divided into the high-altitude group(H-A group) and low-altitude group(L-A group), and differences in surgical efficacy and complications between the groups were analyzed pre- and postoperatively. Radiographic measurements included the Cobb angle, thoracic kyphosis (TK), lumbar lordosis, T1–S1range,T1–T12 range, sagittal balance, coronal balance, distance between the C7PL and sagittal vertical axis, pelvic incidence, sacral slope, and pelvic tilt, assessed preoperatively, postoperatively, and at the last follow-up. Paired or independent Student’s t-tests were used to analyze continuous data. The χ2 test was used to analyze enumeration data. Repeated measurement analysis of variance was used to compare continuous data preoperatively, postoperatively, and at the last follow-up.Results: Mean age of all patients at the initial surgery was 8.9±2.4(5–14) years; mean duration of follow-up was 51.91±25.23months.The number of surgical procedures for all patients was 234.The average interval between operations was 11.4±3.0months.The average Cobb angle was similar in both groups preoperatively and at the last follow-up(P>0.05),although it was significantly different postoperatively (P0.05). The overall rates of complications and implant-related complications did not differ significantly between the groups(P>0.05).Conclusion: Deformity in patients with EOS in high-altitude areas was more serious, and treatment using TGRs yielded a satisfactory therapeutic effect.

Objective. We aimed to evaluate the value of 3-dimensional printing (3DP) spine model in the surgical treatment of severe spinal deformity since the prosperous development of 3DP technology.Materials and Methods. Severe scoliosis or hyper-kyphosis patients underwent posterior fixation and fusion surgery using the 3DP spine models were reviewed (3DP group). Spinal deformity surgeries operated by free-hand screw implantation during the same period were selected as the control group after propensity score matching (PSM). The correction rate, pedicle screw accuracy, and complications were analyzed. Class A and B screws were defined as accurate according to Gertzbein and Robbins criteria.Results. 35 patients were enrolled in the 3DP group and 35 matched cases were included in the control group. The perioperative baseline data and deformity correction rate were similar between both groups (P>0.05). However, the operation time and blood loss were significantly less in the 3DP group (296.14±66.18 min vs. 329.43±67.16 min, 711.43±552.28 mL vs. 1322.29±828.23 mL, PConclusion. The study provided solid evidence that 3DP spine models can enhance surgeons' confidence in performing higher grade osteotomies and improve the safety and efficiency in severe spine deformity correction surgery. 3D printing technology has a good prospect in spinal deformity surgery.