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Purpose: Halo-gravity traction has been reported to successfully assist in managing severe spinal deformity. This is a systematic review of all studies on halo-gravity traction in the treatment of spinal deformity to provide information for clinical practice.Methods: A comprehensive search was conducted for articles on halo-gravity traction in the treatment of spinal deformity according to the PRISMA guidelines. Appropriate studies would be included and analyzed. Preoperative correction rate of spinal deformity, change of pulmonary function and prevalence of complications were the main measurements.Results: Sixteen studies, a total of 351 patients, were included in this review. Generally, the initial Cobb angle was 101.1° in the coronal plane and 80.5° in the sagittal plane, and it was corrected to 49.4° and 56.0° after final spinal fusion. The preoperative correction due to traction alone was 24.1 and 19.3%, respectively. With traction, the flexibility improved 6.1% but postoperatively the patients did not have better correction. Less aggressive procedures and improved pulmonary function were observed in patients with traction. The prevalence of traction-related complications was 22% and three cases of neurologic complication related to traction were noted. The prevalence of total complications related to surgery was 32% and that of neurologic complications was 1%.Conclusion: Partial correction could be achieved preoperatively with halo-gravity traction, and it may help decrease aggressive procedures, improve preoperative pulmonary function, and reduce neurologic complications. However, traction could not increase preoperative flexibility or final correction. Traction-related complications, although usually not severe, were not rare. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the amount of correction and risk of complications of posterior vertebral column resection (PVCR) in the treatment of spinal deformity.Methods: A comprehensive research was conducted in MEDLINE, EMBASE and Cochrane Database of Systematic Reviews for published articles about PVCR in spinal deformity. Data from these included studies were pooled with the help of the Review Manager software from the Cochrane Collaboration and the R software. The amount of correction of PVCR was indicated with change of coronal and sagittal Cobb angle after operation. Risk of complications was demonstrated with prevalence.Results: 7 studies, a total of 390 patients, were included for analysis. The average operative time for PVCR was 430 min and the estimated blood loss was 2,639 ml. The mean amount of correction by PVCR was 64.1° in scoliosis and 58.9° in kyphosis, accounting a correction rate of 61.2 and 63.1 %, respectively. As to coronal and sagittal imbalance, data were limited. The overall prevalence of complications of PVCR was 32 % (95 % CI 12-54 %). The most common was neurologic complications, estimated to be 8 % (95 % CI 2-16 %). And risk of spinal cord injury was 2 % (95 % CI 0-3 %). The revision rate was 6 % (95 % CI 1-13 %). Incidence of infection was pooled to be 2 % (95 % CI 1-4 %). Complication rate related with implant was 2 % (95 % CI 0-6 %).Conclusion: PVCR is a powerful surgical procedure for severe spinal deformity. However, it has the risk of excessive blood loss and major complications. Decision of PVCR should be prudent and the procedure should be performed by an experienced surgical team. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate clinical and radiological outcomes of patients who underwent posterior vertebral column resection (PVCR) by a single neurosurgeon in a single institution. Methods: Thirty-four consecutive patients with severe spinal deformities who underwent PVCR between 2010 and 2016 were enrolled. The radiographic measurements included a kyphotic angle of PVCR levels (VCR angle), sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis (LL), and spinopelvic parameters. The data of surgical time, estimated blood loss, duration of hospital stay, complications, intraoperative neurophysiologic monitoring, and the Scoliosis Research Society (SRS)-22 questionnaire were collected using a retrospective review of medical records. Results: The VCR angle, LL, and SVA values were significantly corrected after surgery. The VCR and LL angle were changed from the average of 38.4±32.1° and −22.1±39.1° to −1.7±29.4° (p<0.001) and −46.3±23.8° (p=0.001), respectively. The SVA was significantly reduced from 103.6±88.5 mm to 22.0±46.3 mm (p=0.001). The clinical results using SRS-22 survey improved from 2.6±0.9 to 3.4±0.8 (p=0.033). There were no death and permanent neurological deficits after PVCR. However, complications occurred in 19 (55.9%) patients. Those patients experienced a total of 31 complications during- and after surgery. Sixteen reoperations were performed in twelve (35.3%) patients. The incidence of transient neurological deterioration was 5.9% (two out of 34 patients). Conclusion: Severe spinal deformities can be effectively corrected by PVCR. However, the PVCR technique should be utilized limitedly because surgery-related serious complications are relatively common. [ABSTRACT FROM AUTHOR]

Background: A conventional iliac bolt and the S2 alar iliac screw fixation technique (S2AI) are commonly used sacropelvic fixation techniques. However, conventional iliac bolt technique requires a lateral connector and commonly has prominent screw head problems. S2AI reportedly has a high instrument failure rate. We aim to introduce a modified iliac screw fixation technique and to investigate its clinical application in adult patients. Methods: The entrance site of the modified iliac screw fixation technique was 1 cm medial and 1 cm caudal from the posterosuperior iliac spine. From 2009 to 2015, ten adult patients underwent sacropelvic fixation with the modified iliac screw fixation technique in our spine clinic. A minimum 12-month clinical and radiographic follow-up was adopted. The mean follow-up period was 30.7 months (12-74 months). Mean number of fixation levels was 7.7 segments (5-10 segments). Results: Postoperatively, the C7 plumb line (SVA) was significantly decreased ( P = 0.04). Upon the last X-ray, SVA did not differ between postoperative and the last X-ray ( P = 0.1). There was no breakage during our follow-up period. There was no prominent screw head. There were no cases requiring implant removal. Conclusions: The modified iliac screw fixation technique does not cause prominence in the sacral region, and does not require a lateral connector, both of which are necessary when using the classical iliac bolt technique. This technique also avoids the acute angle between the screw head and the shaft of the screw commonly seen in S2AI. The modified iliac screw fixation technique can be an effective alternative for sacropelvic fixation. [ABSTRACT FROM AUTHOR]

Purpose: Proximal junctional kyphosis (PJK) is a common radiographic finding following long spinal fusions. Whether PJK leads to negative clinical outcome is currently debatable. A systematic review was performed to assess the prevalence, risk factors, and treatments of PJK. Methods: Literature search was conducted on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials using the terms 'proximal junctional kyphosis' and 'proximal junctional failure'. Excluding reviews, commentaries, and case reports, we analyzed 33 studies that reported the prevalence rate, risk factors, and discussions on PJK following spinal deformity surgery. Results: The prevalence rates varied widely from 6 to 61.7 %. Numerous studies reported that clinical outcomes for patients with PJK were not significantly different from those without, except in one recent study in which adult patients with PJK experienced more pain. Risk factors for PJK included age at operation, low bone mineral density, shorter fusion constructs, upper instrumented vertebrae below L2, and inadequate restoration of global sagittal balance. Conclusions: Prevalence of PJK following long spinal fusion for adult spinal deformity was high but not clinically significant. Careful and detailed preoperative planning and surgical execution may reduce PJK in adult spinal deformity patients. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study which analyzed time-dependent change of, prevalence of, and risk factors for proximal junctional kyphosis (PJK) in adult spinal deformity after long segmental posterior spinal instrumented fusion with a minimum five-year postoperative follow-up. It was found that the prevalence of PJK at 7.8 years post-operation was 39 percent.

The article cites a study which determines proximal junctional kyphosis (PJK) prevalence and analyzes risk factors associated with PJK in adolescent idiopathic scoliosis (AIS) patients after 3 different posterior segmental spinal instrumentation and fusion surgeries. Results show that a larger preoperative thoracic kyphosis angle, greater immediate postoperative thoracic kyphosis angle decrease, thoracoplasty, and male sex correlated significantly with PJK.

Background: There have been few detailed reports concerning pseudarthrosis following spinal instrumentation and arthrodesis in adults with spinal deformity since the introduction of modern segmental fixation techniques. The purposes of this study were to analyze the prevalence, risk factors, and outcome scores on the Scoliosis Research Society Instrument-24 associated with pseudarthrosis following instrumentation and arthrodesis for the treatment of spinal deformity in adults. Methods: A clinical and radiographic assessment of 232 adults with spinal deformity who were treated surgically at a single institution was conducted. The average age of the patients was 40.8 years, and the operation was a primary procedure in 150 patients and a revision procedure in eighty-two patients. All patients who underwent a long (four vertebrae or more) spinal instrumentation and arthrodesis with a minimum follow-up of two years were included in the analysis. Clinical outcomes were assessed with the Scoliosis Research Society questionnaire. Results: Forty patients had a pseudarthrosis. Factors that were found to be significantly associated with pseudarthrosis were preoperative thoracolumbar kyphosis of >20° (p < 0.0001), an age of more than fifty-five years (p = 0.001), arthrodesis to S1 compared with arthrodesis to L5 or a cephalad level (p = 0.002), and arthrodesis of more than twelve vertebrae (p = 0.037). Patients with a pseudarthrosis had lower total outcome scores on the Scoliosis Research Society questionnaire, on the average, than those without a pseudarthrosis (p = 0.001). Conclusions: The prevalence of pseudarthrosis following long arthrodesis with use of modern segmental spinal instrumentation for the treatment of spinal deformity in adults was 17%, and the clinical outcome in these patients can be negatively affected by the pseudarthrosis. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective review of a multicenter database. Objective. To evaluate whether surgeon experience is associated with complication rates in adult spinal deformity (ASD) surgery. Summary of Background Data. Multiple patient- and surgeryrelated factors have been shown to increase the risk of complications in ASD. No study exists evaluating surgeon experience as an associated factor with complications in ASD. Methods. The Scoliosis Research Society Morbidity and Mortality database was queried for patients older than 18 years who underwent ASD from 2004 to 2007. Patient demographics, surgical characteristics, complications, and surgeon membership status were analyzed. Two-tailed t test and χ 2 tests were performed, with P value of less than 0.05 considered significant. Results. A total of 5117 patients underwent ASD surgery. The average patient age was 51.8 years. Patients operated by candidate members were older than those operated by active members (53.1 vs. 51.4, P = 0.003). Active members performed 3836 (75%) cases whereas candidate members performed 1281 cases. There were 1110 (21.7%) revisions. A total of 681 (13.3%) complications were recorded, 498 (13.0%) for active and 183 (14.3%) for candidate members, respectively ( P = 0.24). Mortality rate was 0.29%. Spinal cord complications accounted for 0.68% of all cases. Active members had 21 (0.55%) spinal cord complications, whereas candidates had 14 (1.1%) ( P = 0.049). There were a total of 174 (3.4%) surgical site infections (SSI). Active members had 82 (2.1%) deep SSI, whereas candidate members had 36 (2.8%) deep SSI ( P = 0.164). Active members had 33 (0.9%) superficial SSI whereas candidate members had 23 (1.8%) superficial SSI ( P = 0.008). Conclusion. There was a statistically significant, 2-fold increase in the rate of spinal cord complications and superficial SSI among candidate compared with active members. Overall complication rates were similar between candidate and active members. [ABSTRACT FROM AUTHOR]

The article discusses a study on determining the number of thoracic scoliotic pedicles that have cancellous channels compared with cortical and absent channels. The study evaluated four pedicle types in 53 patients with consecutive scoliosis as well as in 21 cases of adolescent idiopathic scoliosis through computed tomography images before the operation. The study proposed a classification for pedicle channels that describe the osseous anatomy where 90% of thoracic pedicles had cancellous channels during surgery.

The article compares the efficacy and safety of several different anchors in the apical levels of scoliotic curves using radiographic outcomes and clinical complications. It shows that all four constructs were able to achieve and maintain acceptable correction safely without permanent neurologic deficit. The article also shows that all four constructs demonstrated acceptable impact failure rate.

The article presents a preliminary evaluation of the Scoliosis Research Society Outcomes Instrument (SRS-24) and determines whether differences in baseline scores exist between American and Japanese patients with idiopathic scoliosis. SRS-24 scores in the Japanese idiopathic scoliosis population differed from that of the American population. Japanese patients had less back pain, a negative self-image regarding back deformity, higher general physical function, and daily activity.

The article presents a retrospective review which evaluates the incremental accuracy of pedicle screws used in spinal deformity via a free-hand technique at a single institution over an 8-year period. Results show that overall accuracy of acceptable screws using the free-hand pedicle screw placement technique in the deformed spine was 89.5%, without any neurologic, vascular, or visceral complications over an 8-year period.

Objective To determine a neurosurgeon's learning curve of surgical treatment for adolescent idiopathic scoliosis (AIS) patients. Methods This study is a retrospective analysis. Forty-six patients were treated by a single neurosurgeon between 2011 and 2017 using posterior segmental instrumentation and fusion. According to the time period, the former and latter 23 patients were divided into group 1 and group 2, respectively. Patients' demographic data, curve magnitude, number of levels treated, amount of correction achieved, radiographic/clinical outcomes, and complications were compared between the groups. Results The majority were females (34 vs. 12) with average ages of 15.0 versus 15.6, respectively. The mean follow-up period was 24.6 months. The average number of fusion levels was similar with 10.3 and 11.5 vertebral bodies in groups 1 and 2, respectively. The average Cobb angle of major curvature was 59.8° and 58.5° in groups 1 and 2, respectively. There observed significant reductions of operative time (324.4 vs. 224.7 minutes, P = 0.007) and estimated blood loss (648.3 vs. 438.0 mL, P = 0.027) in group 2. The correction rate of the major structural curve was greater in group 2 (70.7% vs. 81.0%, P = 0.001). There was no case of neurologic deficit, infection, and revision for screw malposition. One patient of group 1 underwent fusion extension surgery for shoulder asymmetry. Conclusion Radiographic and clinical outcomes of AIS patients treated by a neurosurgeon were acceptable. AIS surgery may be performed with an acceptable rate of complications after about 20 surgeries. With acquisition of surgical experiences, neurosurgeons could perform deformity surgery for AIS effectively and safely. [ABSTRACT FROM AUTHOR]