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Objective: Although the advantages of postoperative braces have been verified in many fields, it is not clear whether postoperative braces can help reduce patients' adverse psychological emotions such as kinesiophobia, anxiety, and depression. This study aims to analyze whether the use of a postoperative brace helps reduce adverse psychological emotions in adolescent idiopathic scoliosis (AIS) patients undergoing spinal deformity surgeries. Methods: All consecutive patients who underwent spinal corrective surgeries at our institution between April 2023 and July 2023 formed the prospective cohort. Outcome measures were collected in the preoperative period, 3 months after surgery, and 6 months after surgery. All patients were assessed using the Tampa scale for kinesiophobia (TSK), the hospital anxiety and depression scale (HADS), and the numerical rating scale (NRS). A statistical model of propensity score matching was used to eliminate potential selection bias and maintain comparability. Multivariate linear regression models were used to determine the relationship between postoperative brace and adverse psychological emotions. Results: After propensity score matching, this study ultimately enrolled 150 patients. There were no significant differences between the two groups in terms of demographic and perioperative variables. The fully adjusted model showed that the TSK scores of the non‐brace group at the 3‐month (ꞵ = 2.50, 95% CI 0.80–4.20, p = 0.005) and 6‐month follow‐up (ꞵ = 2.75, 95% CI 0.75–4.74, p = 0.007) were significantly higher than those of the brace group. The HADS score of the non‐brace group at the 3‐month follow‐up was significantly higher than that of the brace group (ꞵ = 1.75, 95% CI 0.28–3.22, p = 0.019). The NRS score of the non‐brace group at the 3‐month follow‐up was significantly higher than that of the brace group (ꞵ = 0.69, 95% CI 0.05–1.33, p = 0.034). At the 6‐month follow‐up, there were no significant difference for HADS score or NRS score between the two groups. Conclusion: In the early postoperative period, the postoperative brace could provide AIS patients with psychological supports and help them reduce the frequency of adverse psychological emotions. The postoperative brace could continuously improve the fear of movement within 6 months after surgery, and help reduce anxiety, depression, and pain within 3 months after surgery. [ABSTRACT FROM AUTHOR]

Objective Although the advantages of postoperative braces have been verified in many fields, it is not clear whether postoperative braces can help reduce patients' adverse psychological emotions such as kinesiophobia, anxiety, and depression. This study aims to analyze whether the use of a postoperative brace helps reduce adverse psychological emotions in adolescent idiopathic scoliosis (AIS) patients undergoing spinal deformity surgeries. Methods All consecutive patients who underwent spinal corrective surgeries at our institution between April 2023 and July 2023 formed the prospective cohort. Outcome measures were collected in the preoperative period, 3 months after surgery, and 6 months after surgery. All patients were assessed using the Tampa scale for kinesiophobia (TSK), the hospital anxiety and depression scale (HADS), and the numerical rating scale (NRS). A statistical model of propensity score matching was used to eliminate potential selection bias and maintain comparability. Multivariate linear regression models were used to determine the relationship between postoperative brace and adverse psychological emotions. Results After propensity score matching, this study ultimately enrolled 150 patients. There were no significant differences between the two groups in terms of demographic and perioperative variables. The fully adjusted model showed that the TSK scores of the non‐brace group at the 3‐month (ꞵ = 2.50, 95% CI 0.80–4.20, p = 0.005) and 6‐month follow‐up (ꞵ = 2.75, 95% CI 0.75–4.74, p = 0.007) were significantly higher than those of the brace group. The HADS score of the non‐brace group at the 3‐month follow‐up was significantly higher than that of the brace group (ꞵ = 1.75, 95% CI 0.28–3.22, p = 0.019). The NRS score of the non‐brace group at the 3‐month follow‐up was significantly higher than that of the brace group (ꞵ = 0.69, 95% CI 0.05–1.33, p = 0.034). At the 6‐month follow‐up, there were no significant difference for HADS score or NRS score between the two groups. Conclusion In the early postoperative period, the postoperative brace could provide AIS patients with psychological supports and help them reduce the frequency of adverse psychological emotions. The postoperative brace could continuously improve the fear of movement within 6 months after surgery, and help reduce anxiety, depression, and pain within 3 months after surgery.

Efficacy of dexmedetomidine (DEX) as a cardioprotective agent in Indonesian children undergoing classic tetralogy of Fallot (TOF) repair with cardiopulmonary bypass (CPB). A prospective, parallel trial using block randomization along with double-blinded preparation of treatment agents by other parties. National Cardiovascular Center Harapan Kita, Indonesia. Sixty-six children with classic TOF scheduled for corrective surgery. No children were excluded. All patients had fulfilled the criteria for analysis. A total of 0.5 µg/kg bolus of DEX was added to the CPB priming solution, followed by 0.25 µg/kg/h maintenance during bypass. The placebo group used normal saline. Follow-ups were up to 30 days. Troponin I was lower in the DEX group at 6 hours (30.48 ± 19.33 v 42.73 ± 27.16, p = 0.039) and 24 hours after CPB (8.89 ± 5.42 v 14.04 ± 11.17, p = 0.02). Within a similar timeframe, DEX successfully lowered interleukin-6 (p = 0.03; p = 0.035, respectively). Lactate was lower in the Dex group at 1, 6, and 24 hours after CPB (p < 0.01; p = 0.048; p = 0.035; respectively). Dexmedetomidine increased cardiac output and index from 6 hours after bypass, but vice versa in systemic vascular resistance. Reduction of vasoactive inotropic score was seen during intensive care unit monitoring in the Dex group (p = 0.049). Nevertheless, DEX did not significantly affect the length of ventilation (p = 0.313), intensive care unit stay (p = 0.087), and mortality (p > 0.99). Dexmedetomidine during CPB is an effective cardioprotective agent in TOF children having surgery. Postoperative mortality was comparable across groups. [ABSTRACT FROM AUTHOR]

Thoracolumbar junctional kyphosis (TLJK) due to osteoporotic vertebral fracture (OVF) negatively impacts patients' quality of life. The necessity of pelvic fixation in corrective surgery for TLJK due to OVF remains controversial. This study aimed to: 1) evaluate the surgical outcomes of major corrective surgery for thoracolumbar junctional kyphosis due to osteoporotic vertebral fracture, and 2) identify the risk factors for distal junctional failure to identify potential candidates for pelvic fixation. Patients who underwent surgical correction (fixed TLJK>40°, OVF located at T11–L2, the lowermost instrumented vertebra at or above L5) were included. Sagittal vertical axis, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis (L1-S1), local kyphosis, and lower lumbar lordosis (L4-S1) were assessed. Proximal and distal junctional kyphosis (P/DJK) and failures (P/DJF) were evaluated. Pre/postoperative spinopelvic parameters were compared between DJF and non-DJF patients. Thirty-one patients (mean age: 72.3 ± 7.9 years) were included. PJK was observed in five patients (16.1%), while DJK in 11 (35.5%). Twelve cases (38.7%) were categorized as failure. Among the patients with PJK, there was only one patient (20%) categorized as PJF and required an additional surgery. Contrary, all of eleven patients with DJK were categorized as DJF, among whom six (54.5%) required additional surgery for pelvic fixation. In comparisons between DJF and non-DJF patients, there was no significant difference in pre/postoperative LK (pre/post, p = 0.725, p = 0.950). However, statistically significant differences were observed in the following preoperative alignment parameters: SVA (p = 0.014), LL (p = 0.001), LLL (p = 0.006), PT (p = 0.003), and PI-LL (p < 0.001). Spinopelvic parameters, which represent the compensatory function of lumbar hyperlordosis and pelvic retroversion, have notable impacts on surgical outcomes in correction surgery for TLJK due to OVF. Surgeons should consider each patient's compensatory function when choosing a surgical approach. [ABSTRACT FROM AUTHOR]

Study designComparative cohort study.ObjectiveFactors that influence the lower instrumented vertebra (LIV) selection in adult cervical deformity (ACD) are less reported, and outcomes in the cervicothoracic junction (CTJ) and proximal thoracic (PT) spine are unclear.MethodsA prospective ACD database was analyzed using the following inclusion criteria: LIV between C7 and T5, upper instrumented vertebra at C2, and at least a 1-year follow-up. Patients were divided into CTJ (LIV C7-T2) and PT groups (LIV T3-T5) based on LIV levels. Demographics, operative details, radiographic parameters, and the health-related quality of life (HRQOL) scores were compared.ResultsForty-six patients were included (mean age, 62 years), with 22 and 24 patients in the CTJ and PT groups, respectively. Demographics and surgical parameters were comparable between the groups. The PT group had a significantly higher preoperative C2-C7 sagittal vertical axis (cSVA) (46.9 mm vs 32.6 mm, P = 0.002) and T1 slope minus cervical lordosis (45.9° vs 36.0°, P = 0.042) than the CTJ group and was more likely treated with pedicle-subtraction osteotomy (33.3% vs 0%, P = 0.004). The PT group had a larger correction of cSVA (-7.7 vs 0.7 mm, P = 0.037) and reciprocal change of increased T4-T12 kyphosis (8.6° vs 0.0°, P = 0.001). Complications and reoperations were comparable. The HRQOL scores were not different preoperatively and at 1-year follow-up.ConclusionsThe selection of PT LIV in cervical deformities was more common in patients with larger baseline deformities, who were more likely to undergo pedicle-subtraction osteotomy. Despite this, the complications and HRQOL outcomes were comparable at 1-year follow-up.

Objective To explore the method of self-made adjustable nipple retraction corrector for the treatment of different degrees of nipple retraction. Methods From May 2020 to May 2022, Department of Aesthetic Surgery of Aesthetic Hospital, Affiliated Hospital of Zunyi Medical University used a self-made adjustable nipple retraction corrector to treat 27 patients (37 sides) with different degrees of nipple retraction. Among them, 18 cases (27 sides) of mild nipple retraction were treated with self-made adjustable nipple retraction corrector. Nine patients (10 sides) with moderate or severe congenital nipple retraction were treated by rotating-embedding valve technique combined with self-made adjustable nipple retraction corrector. Results The incision healed in stage Ⅰ, the blood flow of the nipple was normal, and the sensation was not abnormal. The 27 patients were followed up for 6 to 24 months (average 12 months). The convex degree of the affected lateral papilla was satisfactory and the shape was basically symmetrical. No recurrence was reported during the follow-up. Conclusion Self-made adjustable nipple retraction corrector has good therapeutic effect in the treatment of different degrees of nipple retraction and is worth popularizing. [ABSTRACT FROM AUTHOR]

Abstract Brachycephalic obstructive airway syndrome (BOAS) comprises a group of anatomical upper respiratory tract abnormalities that collectively result in various degrees of upper respiratory tract obstruction. Stenotic nares is a common feature of BOAS, and in dogs, the main cause is axial deviation of the alar cartilage. In contrast, narrowing of the nares in cats is predominantly the result of a redundant skin fold at the junction of the ventral floor of the nostrils and the haired skin of the lip. Three brachycephalic cats with inspiratory obstruction were referred to the surgery department of the Veterinary Teaching Hospital of Ferdowsi University of Mashhad, Iran. The predominant cause of obstruction was nostril stenosis due to the presence of redundant skin on the ventral floor of the nares. All three cats underwent surgical correction using a single pedicle advancement flap technique, which was first described by Berns et al. (2020). All three cats had positive outcomes, with no surgical complications and no episodes of respiratory distress reported within a 9‐month follow‐up. Appropriate surgical treatment of feline patients with stenotic nares can result in good long‐term outcomes.

Brachycephalic obstructive airway syndrome (BOAS) comprises a group of anatomical upper respiratory tract abnormalities that collectively result in various degrees of upper respiratory tract obstruction. Stenotic nares is a common feature of BOAS, and in dogs, the main cause is axial deviation of the alar cartilage. In contrast, narrowing of the nares in cats is predominantly the result of a redundant skin fold at the junction of the ventral floor of the nostrils and the haired skin of the lip. Three brachycephalic cats with inspiratory obstruction were referred to the surgery department of the Veterinary Teaching Hospital of Ferdowsi University of Mashhad, Iran. The predominant cause of obstruction was nostril stenosis due to the presence of redundant skin on the ventral floor of the nares. All three cats underwent surgical correction using a single pedicle advancement flap technique, which was first described by Berns et al. (2020). All three cats had positive outcomes, with no surgical complications and no episodes of respiratory distress reported within a 9‐month follow‐up. Appropriate surgical treatment of feline patients with stenotic nares can result in good long‐term outcomes. [ABSTRACT FROM AUTHOR]

Abstract Objective The literature currently available on the characteristics of patients who require intensive care unit (ICU) admission after correction surgery for adult spinal deformity is lacking; this study aimed to identify risk factors for postoperative ICU admission following correction surgery for adult spinal deformity. Methods A retrospective review of patients who underwent primary posterior-based spinal fusion from 2015 to 2023 was performed. According to the ward they returned to, patients were further divided into an ICU group and a non-ICU group. Univariate and multivariate analyses were performed to evaluate preoperative and perioperative parameters to identify independent risk factors for postoperative ICU admission in adult spinal deformity patients. Results A total of 274 patients were included, including 115 males (41.97%) and 159 females (58.03%). The mean age of the patients was 32.00 ± 11.16 years (19–77 years). Following adjusted analysis, the preoperative and perioperative factors that were independently associated with ICU admission were age, body mass index ≥ 28 kg/m2, neuromuscular spinal deformity, respiratory disease, grade III-IV American Society of Anesthesiologists (ASA) classification, a scoliosis Cobb angle ≥ 90°, a kyphosis Cobb angle ≥ 90°, and ≥ 12 fused segments. Compared with the non-ICU group, the ICU group had a higher incidence of complications, a longer hospital stay, and higher medical costs (P

Objectives: The purpose of this study was to investigate postoperative pelvic incidence minus lumbar lordosis mismatch (PI–LL) and health-related quality of life (HRQOL) outcomes to determine age-adjusted PI–LL targets. Method: The dataset encompassed a range of variables, including age, sex, body mass index, Charlson comorbidity index, presence of osteopenia, hospital stay, operative duration, blood loss, American Society of Anesthesiologists score, number of fusion levels, lumbar lordosis, sagittal vertical axis, pelvic incidence, and PI–LL. The non-linear relationship between PI–LL and clinical outcomes was examined using a curve analysis, with adjustments made for potential confounding variables. Upon identification of a non-linear relationship, a two-piecewise regression model was employed to determine the threshold effect. Results: A total of 280 patients were enrolled. In the fully adjusted model, the optimal PI–LL target for patients aged 45–54 years old was PI–LL < 10°, the optimal target for patients aged 55–74 was 10–20°, and the optimal target for patients older than 75 years was more suitable for PI–LL > 20°. In the curve-fitting graph, it could be seen that the relationship between PI–LL and HRQOL outcomes was not linear in each age group. The peaks of the curves within each group occurred at different locations. Higher and lower thresholds for optimal surgical goals were determined using the two-piecewise regression model from the SRS-22 score and the ODI score. Conclusions: This study showed that the optimal PI–LL after corrective surgery in adult degenerative scoliosis patients should be adjusted according to age.

ABSTRACT The black swan (Cygnus atratus, LATHAM, 1790) is a bird kept as an ornamental in zoos. Because of their long beaks they tend to have a reserved prognosis in musculoskeletal disorders such as beak trauma, secondary to skull bone fractures, presenting irreversible lesions. The aim of this report is present a clinical surgical innovation in the repair of a black swan’s gnathotheca fissure with the application of non-conventional materials used. It was observed that one of the swans kept in a zoo display area had difficulty feeding, with associated weight loss. It was observed tissue loss and a lacerative lesion in the caudal sublingual region of its beak. The lesion was corrected by a separate simple suture in the cranial region of the beak and with a x-clamping using steel surgical wire and the application of dental resin in the distal region to perform a sustentation bridge in the beak end-gap. After 12 days, the animal was able to feed again and remained perfectly adapted to the restoration, reestablishing the anatomical and physiological function of its beak.

Objective There has been increasing concern about the importance of sagittal alignment in the evaluation and treatment of spinal scoliosis. However, recent studies have only focused on patients with mild to moderate scoliosis. To date, little is known about the sagittal alignment in patients with severe and rigid scoliosis (SRS). This study was performed to evaluate the sagittal alignment in patients with SRS, and to analyze how it was altered after corrective surgery. Methods In this retrospective cohort study, we included 58 patients with SRS who underwent surgery from January 2015 to April 2020. Preoperative and postoperative radiographs were reviewed, and the sagittal parameters mainly included thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacrum slope (SS), and sagittal vertical axis (SVA). The sagittal balance state was evaluated according to whether the PI minus the LL (PI‐LL) was less than 9°, and the patients were divided into thoracic hyperkyphosis and normal groups based on whether the TK exceeded 40°. The Student's t test, Pearson's test, and Receiver operating characteristic (ROC) curve analysis were used to compare related parameters between the different groups. Results The mean follow‐up duration was 2.8 years. Preoperatively, the mean PI was 43.6 ± 9.4°, and the mean LL was 65.2 ± 13.9°. Sixty‐nine percent of patients showed sagittal imbalance, and they showed larger TK and LL values and smaller PI and SVA values than those with sagittal balance. Additionally, most patients (44/58) presented with thoracic hyperkyphosis; this group had smaller PI and SVA values than the normal patients. Patients with syringomyelia‐associated scoliosis were more likely to present with thoracic hyperkyphosis. The TK and LL values were significantly decreased, and 45% of patients with preoperative sagittal imbalance recovered after surgery. These patients had a larger PI (46.4 ± 9.0° vs 38.3 ± 8.8°, P = 0.003) and a smaller TK (25.5 ± 5.2° vs 36.3 ± 8.0°, P = 0.000) at the final follow‐up. Conclusion Preoperative sagittal imbalance appears in the majority of SRS patients, accounting for approximately 69% of our cohort. Patients with small PI values or syringomyelia‐associated scoliosis were more likely to present with thoracic hyperkyphosis. Sagittal imbalance can generally be corrected by surgery, except in patients with a PI less than 39°. To achieve good postoperative sagittal alignment, we recommend controlling the TK to within 31°.

Objective: The literature currently available on the characteristics of patients who require intensive care unit (ICU) admission after correction surgery for adult spinal deformity is lacking; this study aimed to identify risk factors for postoperative ICU admission following correction surgery for adult spinal deformity. Methods: A retrospective review of patients who underwent primary posterior-based spinal fusion from 2015 to 2023 was performed. According to the ward they returned to, patients were further divided into an ICU group and a non-ICU group. Univariate and multivariate analyses were performed to evaluate preoperative and perioperative parameters to identify independent risk factors for postoperative ICU admission in adult spinal deformity patients. Results: A total of 274 patients were included, including 115 males (41.97%) and 159 females (58.03%). The mean age of the patients was 32.00 ± 11.16 years (19–77 years). Following adjusted analysis, the preoperative and perioperative factors that were independently associated with ICU admission were age, body mass index ≥ 28 kg/m2, neuromuscular spinal deformity, respiratory disease, grade III-IV American Society of Anesthesiologists (ASA) classification, a scoliosis Cobb angle ≥ 90°, a kyphosis Cobb angle ≥ 90°, and ≥ 12 fused segments. Compared with the non-ICU group, the ICU group had a higher incidence of complications, a longer hospital stay, and higher medical costs (P < 0.05). Conclusion: This study identified independent risk factors associated with postoperative ICU admission in adult spinal deformity patients; and explored relative measures to decrease or avoid the risk of postoperative ICU admission. Surgeons could use these data to develop and plan appropriate perioperative care processes in advance and provide consultation for family members before surgery. [ABSTRACT FROM AUTHOR]

Objective: The aim was to provide epidemiological and clinical data on patients with orofacial clefts in Lower Saxony in Germany. Materials and methods: The records of 404 patients with orofacial clefts treated surgically at the University Medical Center Goettingen from 2001 to 2019 were analyzed in this retrospective study. Prevalence of orofacial clefts in general, orofacial clefts as manifestation of a syndrome, sex distribution, and prevalence of different cleft types was evaluated and associated with the need for corrective surgery, family history, pregnancy complications, and comorbidities. Results: The prevalence of orofacial clefts for Goettingen in Lower Saxony was 1:890. 231 patients were male and 173 were female. CLP was most common (39.1%) followed by CP (34.7%), CL (14.4%), CLA (9.9%), and facial clefts (2%). The left side was more frequently affected and unilateral cleft forms occurred more often than bilateral ones. Almost 10% of the population displayed syndromic CL/P. 10.9% of all patients had a positive family history regarding CL/P, predominantly from the maternal side. Pregnancy abnormalities were found in 11.4%, most often in the form of preterm birth. Comorbidities, especially of the cardiovascular system, were found in 30.2% of the sample. 2.2% of patients treated according to the University Medical Center Goettingen protocol corrective surgery was performed in form of a velopharyngoplasty or residual hole closure. Conclusions: The epidemiological and clinical profile of the study population resembled the expected distributions in Western populations. The large number of syndromic CL/P and associated comorbidities supports the need for specialized cleft centers and interdisciplinary cleft care. [ABSTRACT FROM AUTHOR]

Ankylosing spondylitis is a chronic systemic rheumatic disease that mainly affects the sacroiliac joints and the skeleton. When advanced, it results in cervical and thoracolumbar kyphosis and ankylosis. In ankylosing spondylitis, the main purpose of deformity correction surgery is to deter the progressive spasticity of the spine and to restore the alignment in the coronal and sagittal planes. Successful corrective surgery enables patients with ankylosing spondylitis to improve disability, pain, quality of life, as well as lung function. For successful deformity correction surgery in ankylosing spondylitis patients, a detailed preoperative evaluation of underlying medical diseases and complications related to anesthesia is essential. Also, the use of computer-assisted simulation programs to calculate the level of osteotomy correction and the operator's experience for precise planning of the level of correction can be beneficial. A computer simulation program for preoperative preparation for successful surgery of kyphosis due to ankylosing spondylitis, analysis of spinal sagittal alignment factors and compensation mechanisms, and determination of correction angles are introduced, and representative open and closed wedge osteotomy techniques are described. [ABSTRACT FROM AUTHOR]

Study design: Retrospective study. Objective: To evaluate the predictive effect of the 3 global sagittal parameters (Sagittal Vertical Axis [SVA], T1 Pelvic Angle [TPA], and relative TPA [rTPA]) in the surgical outcome of patients with adult degenerative scoliosis (ADS), then to define the optimum corrective goal based on the best of them. Methods: 117 ADS patients were included in this study and followed-up for an average of 3 years. Functional evaluation and radiographs were assessed preoperatively and postoperatively. The predictive accuracy of SVA, TPA, and relative TPA was analyzed through receiver operating characteristic (ROC) curve. The cutoff value of TPA was obtained at the maximal Youden index from ROC curve. Results: TPA most highly correlated with postoperative oswestry disability index (ODI). The best cutoff value of TPA was set at 19.3° (area under curve =0.701). TPA >19.3° was the highest risk factor in multivariate logistic regression analysis (OR = 7.124, P = 0.022). Patients with TPA <19.3° at 3 months after operation showed a better ODI than those with TPA >19.3°. Correcting TPA less than 19.3° for patients with preoperative TPA >19.3° attributed to a better health related quality of life (HRQOL) and sagittal balance at last follow-up. The formula "Postoperative TPA = 0.923 × PI - 0.241 × postoperative LL - 0.593 × postoperative SS - 2.471 (r = 0.914, r 2 = 0.836, P <.001)" described the relation between SS, LL, PI, and TPA. Conclusion: TPA was a useful global parameter for the prediction of postoperative HRQOL for patients with ADS. Keeping TPA <19.3° could improve the postoperative HRQOL for ADS patients with preoperative TPA >19.3°, and TPA <19.3° could be an optimum correction target for patients with ADS. [ABSTRACT FROM AUTHOR]

Objective: There has been increasing concern about the importance of sagittal alignment in the evaluation and treatment of spinal scoliosis. However, recent studies have only focused on patients with mild to moderate scoliosis. To date, little is known about the sagittal alignment in patients with severe and rigid scoliosis (SRS). This study was performed to evaluate the sagittal alignment in patients with SRS, and to analyze how it was altered after corrective surgery. Methods: In this retrospective cohort study, we included 58 patients with SRS who underwent surgery from January 2015 to April 2020. Preoperative and postoperative radiographs were reviewed, and the sagittal parameters mainly included thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacrum slope (SS), and sagittal vertical axis (SVA). The sagittal balance state was evaluated according to whether the PI minus the LL (PI‐LL) was less than 9°, and the patients were divided into thoracic hyperkyphosis and normal groups based on whether the TK exceeded 40°. The Student's t test, Pearson's test, and Receiver operating characteristic (ROC) curve analysis were used to compare related parameters between the different groups. Results: The mean follow‐up duration was 2.8 years. Preoperatively, the mean PI was 43.6 ± 9.4°, and the mean LL was 65.2 ± 13.9°. Sixty‐nine percent of patients showed sagittal imbalance, and they showed larger TK and LL values and smaller PI and SVA values than those with sagittal balance. Additionally, most patients (44/58) presented with thoracic hyperkyphosis; this group had smaller PI and SVA values than the normal patients. Patients with syringomyelia‐associated scoliosis were more likely to present with thoracic hyperkyphosis. The TK and LL values were significantly decreased, and 45% of patients with preoperative sagittal imbalance recovered after surgery. These patients had a larger PI (46.4 ± 9.0° vs 38.3 ± 8.8°, P = 0.003) and a smaller TK (25.5 ± 5.2° vs 36.3 ± 8.0°, P = 0.000) at the final follow‐up. Conclusion: Preoperative sagittal imbalance appears in the majority of SRS patients, accounting for approximately 69% of our cohort. Patients with small PI values or syringomyelia‐associated scoliosis were more likely to present with thoracic hyperkyphosis. Sagittal imbalance can generally be corrected by surgery, except in patients with a PI less than 39°. To achieve good postoperative sagittal alignment, we recommend controlling the TK to within 31°. [ABSTRACT FROM AUTHOR]

Purpose: Spinal osteotomies performed to treat fixed spinal deformities are technically demanding and associated with a high complications rate. The main purpose of this study was to analyze complications and their risk factors in spinal osteotomies performed for fixed sagittal imbalance from multiple etiologies. Methods: The study consisted of a blinded retrospective analysis of prospectively collected data from a large multicenter cohort of patients who underwent 3-columns (3C) spinal osteotomy, between January 2010 and January 2017. Clinical and radiological data were compared pre- and post-operatively. Complications and their risk factors were analyzed. Results: Two hundred eighty-six 3C osteotomies were performed in 273 patients. At 1 year follow-up, both clinical (VAS pain, ODI and SRS-22 scores) and radiological (SVA, SSA, loss of lordosis and pelvic version) parameters were significantly improved (p < 0.001). A total of 164 patients (59.2%) experienced at least 1 complication (277 complications). Complications-free survival rates were only 30% at 5 years. Most of those were mechanical (35.2%), followed by general (17.6%), surgical site infection (17.2%) and neurological (10.9%). Pre-operative neurological status [RR = 2.3 (1.32–4.00)], operative time (+ 19% of risk each additional hour) and combined surgery [RR = 1.76 (1.08–2.04)] were assessed as risk factors for overall complication (p < 0.05). The use of patient-specific rods appeared to be significantly associated with less overall complications [RR = 0.5 (0.29–0.89)] (p = 0.02). Conclusion: Spinal 3C osteotomies were efficient to improve both clinical and radiological parameters despite high rates of complication. Efforts should be made to reduce operative time which appears to be the strongest predictive risk factor for complication. [ABSTRACT FROM AUTHOR]

Iatrogenic hallux varus is formed due to an imbalance between the bone, tendon, and ligamentous-articular structures in the first metatarsophalangeal joint (MJ), with the progression of the medial deviation of the big toe. A secondary factor is an imbalance between excessive medial tension and weakness or excessive soft tissue release of lateral capsular-ligamentous structures. The article is devoted to a rare but no less complex postoperative complication of hallux valgus deformity, acquired hallux varus. Based on the literature data on this topic, in the work, the clinical anatomy of the first metatarsophalangeal joint, the pathogenesis of the development of tendon-muscle imbalance in the above joint, and the leading causes of hallux varus are described. Also, the issues of the clinic, X-ray diagnostics, and classification of this type of foot pathology are considered with a description of the appropriate surgical tactics for different types of deformity. [ABSTRACT FROM AUTHOR]

As the number of fusion levels increases, the complexity of spinal correction surgery also increases. Thus, we conducted this study to determine the safety and efficacy of tranexamic acid (TXA) involving eight or more spinal fusion levels. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, a search of the PubMed, Embase, CENTRAL, Web of Science, and ClinicalTrials.gov databases was conducted for relevant studies published prior to May 30, 2019. The primary outcomes, including blood loss and transfusion requirement, and the secondary outcomes, including general indices, postoperative hemoglobin, and coagulation function, were analyzed using Rev Man 5.3.5 software and STATA version 12.0. Eight randomized controlled trials (473 participants) were included in the study. Compared to the control treatments, TXA reduced intraoperative blood loss, total blood loss, transfusion volume, and prothrombin time. There were no significant differences between the TXA and non-TXA groups in transfusion rate, operative time, hospital stay, complications, hemoglobin level, and other coagulation function parameters. In the pediatric subgroup analysis, TXA additionally improved hemoglobin levels, platelet count, and prothrombin time international normalized ratio. The present meta-analysis showed that TXA reduced blood loss and transfusion volume in both adults and children. In pediatric patients, TXA led to a greater benefit in postoperative hemoglobin levels and coagulation function. Intravenous TXA is safe and effective in children with eight or more spinal corrective levels.

• Less invasive procedures have been introduced into adult spinal deformity surgery. • Some older patients experience complications and long recovery time. • Around half of patients showed unwillingness to undergo the same surgery again. • Incidence of major complications was an independently-associated factor. Despite less invasive surgical procedures in adult spinal deformity (ASD) surgery, some older patients have complications and long recovery time. We investigated patients' willingness to undergo the same surgery again and sought to elucidate the factors related to their perception of surgical outcomes. Enrolled were 60 of our patients (≥65 years old) that underwent long corrective fusion using lateral interbody fusion and who had a minimum of 2 years of follow-up. Patients were asked whether they would theoretically undergo the same surgery again: 28 answered yes (46.7 %; Group-Y), and 32 answered no (53.3 %; Group-N). There was no difference between the groups in age, sex, body mass index, frailty, preoperative patient-reported outcomes (PROs; Oswestry disability index [ODI] and Scoliosis Research Society 22r [SRS-22r]), surgical time, estimated blood loss, or pre-operative and 2-year post-operative radiographic parameters. Major complications had occurred more frequently in Group-N (P = 0.048). Although at 2-year follow-up there was significant improvement of spinal deformity and PROs (P < 0.001) in both groups, PROs in Group-N were inferior (Visual analogue scale [VAS] for low back pain, P = 0.043; VAS for satisfaction, P = 0.001; ODI: P = 0.005; SRS-22r: pain, P = 0.032; self-image, P = 0.014; subtotal, P = 0.005; satisfaction, P < 0.001). After multivariate logistic regression analysis with the willingness to undergo the same surgery again as an objective factor, incidence of major complication was found to be an independently-associated factor in unwillingness to undergo the same surgery again for older patients with ASD if they had the same condition in the future. Avoiding major perioperative complications is important in obtaining satisfactory perception of outcomes in ASD surgery. [ABSTRACT FROM AUTHOR]

Objective: Pelvic incidence minus lumbar lordosis mismatch (PI-LL) is directly related to poor quality of life in adult degenerative scoliosis (ADS) patients. The purpose of the study was to determine the most appropriate postoperative PI-LL value for patients with ADS., Methods: The medical records of patients with ADS in our department were retrospectively collected. The data included age, sex, body mass index, age-adjusted Charlson comorbidity index, osteopenia, length of hospital stay, operative duration, estimated blood loss, American Society of Anesthesiologists score, number of fusion levels, lumbar lordosis, sagittal vertical axis, pelvic incidence, PI-LL, Scoliosis Research Society-22 score, Oswestry Disability Index score, and mechanical complications., Results: A total of 316 patients were enrolled. PI-LL, lumbar lordosis, sagittal vertical axis, Scoliosis Research Society-22 score, Oswestry Disability Index score at the time of last follow-up were 20.7 ± 8.5°, 23.4 ± 14.1°, 4.0 ± 2.1 cm, 3.7 ± 0.9, and 18.1 ± 5.5, respectively. In terms of mechanical complications, 88 patients (27.8%), 34 patients (10.8%), and 19 patients (6.0%) had proximal junctional kyphosis, distal junctional kyphosis, and implant-related complications, respectively. In the fully adjusted model, compared with 0 grade PI-LL group and ++ grade PI-LL group, + grade PI-LL group had the best clinical outcomes and the fewest mechanical complications. The stability of these conclusions was verified in sensitivity analyses., Conclusions: Optimal PI-LL value should be 10°-20° after corrective surgery in patients with ADS, which is associated with excellent clinical outcomes and lower complication rates. Previous criteria may be at risk of overcorrection, which may lead to proximal junctional kyphosis., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Abstract Background Recently, Oblique lumbar interbody fusion (OLIF) is commonly indicated to correct the sagittal and coronal alignment in adult spinal deformity (ASD). Endplate fracture during surgery is a major complication of OLIF, but the detailed location of fracture in vertebral endplate in ASD has not yet been determined. We sought to determine the incidence and location of endplate fracture and subsidence of the OLIF cage in ASD surgery, and its association with fusion status and alignment. Methods We analyzed 75 levels in 27 patients were analyzed using multiplanar CT to detect the endplate fracture immediately after surgery and subsidence at 1 year postoperatively. The prevalence was compared between anterior and posterior, approach and non-approach sides, and concave and convex side. Their association with fusion status, local and global alignment, and complication was also investigated. Results Endplate fracture was observed in 64 levels (85.3%) in all 27 patients, and the incidence was significantly higher in the posterior area compared with the anterior area (85.3 vs. 68.0%, p=0.02) of affected vertebra in the sagittal plane. In the coronal plane, there was no significant difference in incidence between left (approach) and right (non-approach) sides (77.3 and 81.3%, respectively), or concave and convex sides (69.4 and 79.6%) of wedged vertebra. By contrast, cage subsidence at 1 year postoperatively was noted in 14/75 levels (18.7%), but was not associated with endplate fracture. Fusion status, local and global alignment, and complications were not associated with endplate fracture or subsidence. Conclusion Endplate fracture during OLIF procedure in ASD cases is barely avoidable, possibly induced by the corrective maneuver with ideal rod counter and cantilever force, but is less associated with subsequent cage subsidence, fusion status, and sustainment of corrected alignment in long fusion surgery performed even for elderly patients.

Background: Early biventricular dysfunction in repaired tetralogy of Fallot (TOF) children may lead to poor clinical outcomes. We aimed to assess biventricular function in TOF children before and after surgery by speckle tracking echocardiography (STE) and compare them with the controls. Methods: Twenty repaired TOF children and 20 normal children as controls were assessed by STE. Tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF), biventricular strain, and strain rate were compared before and after surgery and between TOF children and controls. Results: Postoperative LVEF (p = 0.001), strain (p = 0.001), and strain rate (p = 0.001) for left ventricle improved significantly compared to preoperative phase. However, postoperative left ventricular strain (p = 0.05) and strain rate (p = 0.01) in TOF children were significantly impaired compared to controls. Postoperative LVEF was correlated inversely with postoperative strain rate (r = −0.40, p = 0.04). Postoperative TAPSE (p = 0.001), strain (p = 0.001), and strain rate (p = 0.001) for right ventricle significantly worsened when compared with the preoperative phase. Moreover, postoperative TAPSE (p = 0.001), strain (p = 0.001), and strain rate (p = 0.01) were significantly impaired compared to controls. Postoperative right ventricular strain rate was correlated significantly with the weight of children (r = 0.48, p = 0.02), and postoperative left ventricular strain showed significant correlations with aortic clamp time (r = 0.44, p = 0.04) and with ICU stay (r = −0.46, p = 0.04). Conclusion: Despite normal LVEF, TOF children exhibit impaired left ventricular strain and strain rate after surgery. TAPSE, strain, and strain rate for the right ventricle worsen after surgical repair. STE‐driven strain can be used to detect early ventricular dysfunction and the associated prognostic implications. [ABSTRACT FROM AUTHOR]

AIM: To analyze the influence of total femtosecond laser small incision lenticule extraction(SMILE)on corneal surface regularity index(SRI).METHODS:Totally 210(401 eyes)myopic patients treated in Qinhuangdao Optometry Ophthalmology Hospital between January 2017 and December 2019 were enrolled in the study. Among them, patients treated with total femtosecond laser SMILE were included in the observation group(n=110, 205 eyes), while those treated with femtosecond laser-assisted in situ keratomileusis(FS-LASIK)were includded in the control group(n=100, 196 eyes). The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), anterior corneal surface asphericity index(Q-value)at a diameter of 6mm and SRI were compared between the two groups before and after operation.RESULTS: The UCVA and BCVA of both groups were improved at 3mo and 6mo after operation(P0.05). The observation group had higher SRI than the control group at 3mo, 6mo and 1a(P

As the number of fusion levels increases, the complexity of spinal correction surgery also increases. Thus, we conducted this study to determine the safety and efficacy of tranexamic acid (TXA) involving eight or more spinal fusion levels. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines , a search of the PubMed, Embase, CENTRAL, Web of Science, and ClinicalTrials.gov databases was conducted for relevant studies published prior to May 30, 2019. The primary outcomes, including blood loss and transfusion requirement, and the secondary outcomes, including general indices, postoperative hemoglobin, and coagulation function, were analyzed using Rev Man 5.3.5 software and STATA version 12.0. Eight randomized controlled trials (473 participants) were included in the study. Compared to the control treatments, TXA reduced intraoperative blood loss, total blood loss, transfusion volume, and prothrombin time. There were no significant differences between the TXA and non-TXA groups in transfusion rate, operative time, hospital stay, complications, hemoglobin level, and other coagulation function parameters. In the pediatric subgroup analysis, TXA additionally improved hemoglobin levels, platelet count, and prothrombin time international normalized ratio. The present meta-analysis showed that TXA reduced blood loss and transfusion volume in both adults and children. In pediatric patients, TXA led to a greater benefit in postoperative hemoglobin levels and coagulation function. Intravenous TXA is safe and effective in children with eight or more spinal corrective levels. [ABSTRACT FROM AUTHOR]

Introduction: Obesity remains a major public chronic disease, and the multifactorial components of its relapse in many patients remain inevitable. Methods: This article provides a panoramic view of the most commonly performed revisional bariatric surgery (RBS). RBS is a complex procedure; thus, primary procedures should be well chosen and performed to avoid the increasing number of RBS cases. Results: Bariatric surgery is the only successful long-term treatment for obesity. However, a proportion of primary bariatric surgeries has failed during the follow-up period. In recent decades, the solution for these complications is by performing RBS. It is mandatory to understand obesity as a chronic disease to appropriately treat patients. Treatment strategies are needed to determine the indications for revision. RBS requires a meticulous evaluation to facilitate good long-term results. Conclusions: Treatment strategies will be a fundamental pillar to wisely determine the indications for revision and identify the factors influencing failure by prudently and rationally evaluating the revisional procedure that the patient will benefit from and acquiring a high level of surgical skills. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to investigate postoperative pelvic incidence minus lumbar lordosis mismatch (PI-LL) and health-related quality of life (HRQOL) outcomes to determine age-adjusted PI-LL targets. Method: The dataset encompassed a range of variables, including age, sex, body mass index, Charlson comorbidity index, presence of osteopenia, hospital stay, operative duration, blood loss, American Society of Anesthesiologists score, number of fusion levels, lumbar lordosis, sagittal vertical axis, pelvic incidence, and PI-LL. The non-linear relationship between PI-LL and clinical outcomes was examined using a curve analysis, with adjustments made for potential confounding variables. Upon identification of a non-linear relationship, a two-piecewise regression model was employed to determine the threshold effect. Results: A total of 280 patients were enrolled. In the fully adjusted model, the optimal PI-LL target for patients aged 45-54 years old was PI-LL < 10°, the optimal target for patients aged 55-74 was 10-20°, and the optimal target for patients older than 75 years was more suitable for PI-LL > 20°. In the curve-fitting graph, it could be seen that the relationship between PI-LL and HRQOL outcomes was not linear in each age group. The peaks of the curves within each group occurred at different locations. Higher and lower thresholds for optimal surgical goals were determined using the two-piecewise regression model from the SRS-22 score and the ODI score. Conclusions: This study showed that the optimal PI-LL after corrective surgery in adult degenerative scoliosis patients should be adjusted according to age.

Background: Recently, Oblique lumbar interbody fusion (OLIF) is commonly indicated to correct the sagittal and coronal alignment in adult spinal deformity (ASD). Endplate fracture during surgery is a major complication of OLIF, but the detailed location of fracture in vertebral endplate in ASD has not yet been determined. We sought to determine the incidence and location of endplate fracture and subsidence of the OLIF cage in ASD surgery, and its association with fusion status and alignment.Methods: We analyzed 75 levels in 27 patients were analyzed using multiplanar CT to detect the endplate fracture immediately after surgery and subsidence at 1 year postoperatively. The prevalence was compared between anterior and posterior, approach and non-approach sides, and concave and convex side. Their association with fusion status, local and global alignment, and complication was also investigated.Results: Endplate fracture was observed in 64 levels (85.3%) in all 27 patients, and the incidence was significantly higher in the posterior area compared with the anterior area (85.3 vs. 68.0%, p=0.02) of affected vertebra in the sagittal plane. In the coronal plane, there was no significant difference in incidence between left (approach) and right (non-approach) sides (77.3 and 81.3%, respectively), or concave and convex sides (69.4 and 79.6%) of wedged vertebra. By contrast, cage subsidence at 1 year postoperatively was noted in 14/75 levels (18.7%), but was not associated with endplate fracture. Fusion status, local and global alignment, and complications were not associated with endplate fracture or subsidence.Conclusion: Endplate fracture during OLIF procedure in ASD cases is barely avoidable, possibly induced by the corrective maneuver with ideal rod counter and cantilever force, but is less associated with subsequent cage subsidence, fusion status, and sustainment of corrected alignment in long fusion surgery performed even for elderly patients. [ABSTRACT FROM AUTHOR]

Background: Conventional posterior lumbar spinal fusion (PLSF) surgical treatment in severe adolescent idiopathic scoliosis (AIS) patients involved transpleural technique. AIS patients undergoing anterior spinal fusion (ASF) together with extrapleural treatments in the treatment of thoracolumbar scoliosis are well known for its effect in curve correction. Health-related quality of life (HRQOL) of patients after ASF and PLSF has yet to be explored. Subjects and Methods: Severe AIS patients underwent ASF with extrapleural or PLSF with transpleural treatments filled out Scoliosis Research Society-22 (SRS-22) questionnaire before and after surgery. HRQOL before and after surgery was compared. HRQOL between ASF and PLSF was also compared. Results: Twenty-eight patients (10 ASF extrapleural and 18 PLSF transpleural) filled out the SRS-22 questionnaire before and after surgery. No significant difference in function, pain, self-image, mental, satisfaction, and mean scores between ASF and PLSF. All mentioned domains and mean scores were significantly improved after surgery in both ASF and PLSF. Conclusions: Significant improvements in all HRQOL domains after either treatment after surgery were observed, while there was no difference when compared with each other postoperatively. ASF with extrapleural treatment provided same HRQOL as of PLSF.

Abstract Purpose To evaluate the predictive effect of lumbar lordosis minus thoracic kyphosis (LL-TK) in the surgical outcome of adult degenerative scoliosis (ADS) patients and explore the optimum target base on it. Methods The preoperative and postoperative data including radiographic image and functional evaluation (Visual Analog Scale, VAS; Oswestry Disability Index, ODI; Japanese Orthopaedic Association, JOA) of 130 patients with ADS who underwent corrective surgery was retrospectively reviewed. The relationship between sagittal parameters and surgical outcome was assessed by using the Pearson correlation analysis. Receiver operating characteristic (ROC) curve was used to define the optimum cutoff value of LL-TK. Patients were divided into two groups based on LL-TK to compare the preoperative and postoperative status. Results LL-TK assessed soon after surgery strongly correlated with health-related quality of life (HRQOL) and sagittal vertical axis (SVA) at last follow-up. The cutoff value of LL-TK was set at 10° to determine a good clinical outcome (ODI 10° presented significantly better postoperative VAS, ODI, JOA, and SVA than patients with LL-TK 10° showed a better clinical outcome and sagittal balance, so LL-TK > 10° could be the optimum corrective target for these patients.

Introduction: Approximately 3% of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC. Methods: This study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for 2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis. Results: Sixty-three patients (15.6%) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm2 (sensitivity, 76.5%; specificity, 58.3%), but that of the hip was not (p=0.228). Conclusions: PJFr was found in 16% cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm2 may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.

Severe kyphotic deformity in patients with ankylosing spondylitis can be corrected surgically to achieve a better spinal alignment and an improved visual axis. Different surgical techniques are used today depending on the extent of ossification and the degree of kyphosis. It is well known that the underlying disease leads to distinct biomechanical changes of the spinal column causing an increased fracture risk especially in case of minor trauma. This includes manipulations during surgical procedures as well as during the required perioperative measures. We present the case of a 45-year-old patient with severe global kyphotic deformity due to ankylosing spondylitis. During the elective corrective surgery (pedicle subtraction osteotomy at the level of L3) the patient sustained a spontaneous fracture at L2/3. This fortunately nondisplaced wedge-shaped fracture in the sense of a Smith-Peterson osteotomy led to a spontaneous correction of the kyphosis. The described unexpected event required a change in the surgical strategy. Correction could be achieved using a two-stage surgical procedure without further drawbacks for the patient.This case report stresses the need of particular attention regarding the increased susceptibility of the spinal column in case of ankylosing spondylitis.

Study Design: A retrospective study.Objective: The aim of this study is to investigate the changes in sleep quality in patients surgically treated for kyphosis due to ankylosing spondylitis (AS) and the correlation between these changes and spinal sagittal realignment.Summary Of Background Data: Sleep problems are prevalent in AS patients. However, little attention has been paid to the sleep quality in patients with AS kyphosis and the effect of surgical intervention on sleep quality.Methods: We have retrospectively reviewed 62 patients with AS-induced thoracolumbar kyphosis who underwent surgically treatment from October 2012 to November 2016. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Preoperative and postoperative radiological characteristics and supine function were documented. We compared the above-mentioned parameters pre- and 24 months postoperatively and analyzed the correlation of the changes in the PSQI with the changes in radiological characteristics.Results: Fifity-one patients (82%) classified as poor sleepers preoperatively. In addition to use of sleeping medication, each domain of the PSQI and the total PSQI were increased postoperatively. Improved sleep quality was correlated with changes in spinal sagittal characteristics, among which the lumbar lordosis (LL) and the chin-brow vertical angle (CBVA) were the independent correlation factors. The number of patients with supine dysfunction decreased from 89% to 15% after surgery. Significant differences were identified in the PSQI scores between the patients with and without supine dysfunction either pre- or postoperatively.Conclusion: Surgical correction of spinal deformity may improve sleep quality and supine function in patients with AS. Spinal sagittal realignment may be correlated with the improvement of sleep quality.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

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AIM: To investigate the ocular surface and refractive change after the surgery of levator resection and frontalis suspension. METHODS: One hundred and twenty-one patients(146 eyes)for corrective surgery of congenital ptosis were selected in our department from July 2014 to June 2016. According to the severity of congenital ptosis, all the children divided into mild group(47 eyes), moderate group(68 eyes)and severe group(31 eyes). All the children were divided into group of less than 5 years old(104 eyes)and group of more than or equal to 5 years old(42 eyes)according to the age. According to the surgical approach, all the children divided into group of levator resection(62 eyes)and group of frontalis suspension(84 eyes). The effects of the two surgeries on the ocular surface and refractive were compared. The relationship between age, severity of postoperative ptosis and postoperative ocular surface, refractive of children were analyzed. RESULTS: There were no significant differences in break-up time(BUT), keratometry(Km)and corneal astigmatism(Ast)in the levator resection group and frontalis suspension group(P>0.05). There was significant difference between the mild, moderate and severe group on the proportion of excellent corrected to uncorrected(Z=-2.936, P=0.003). The proportion of excellent correction in mild group was higher than that of moderate and severe group(93.6%, 83.8%and 67.7%). The indexes of BUT(F=9.793, P=0.041)and Km(F=11.657, P=0.037)in the three groups decreased with the increase of severity. While the Ast(F=28.417, Pχ2=4.082, P=0.043). The index of Km(t=2.813, P=0.006)was higher and Ast(t=-7.741, PP>0.05). CONCLUSION: The corneal refractive power and astigmatism can be improved similarly after treated with levator resection and frontalis suspension surgery. And there is some damage of corneal epithelial in the initial postoperation, but the function of ocular surface can return to normal after a period of time. The less severity of ptosis before surgery, the better improvement of ocular surface and refractive after sugery. There is no correlation between the age and postoperative ocular surface, but earlier surgical treatment may improve the children's refractive power and astigmatism and achieve greater benefits.

Purpose: To assess cardiothoracic structure and function in patients with pectus excavatum compared with control subjects using cardiovascular magnetic resonance imaging (CMR). Method: Thirty patients with pectus excavatum deformity (23 men, 7 women, age range: 14-67 years) underwent CMR using 1.5-Tesla scanner (Siemens) and were compared to 25 healthy controls (18 men, 7 women, age range 18-50 years). The CMR protocol included cardiac cine images, pulmonary artery flow quantification, time resolved 3D contrast enhanced MR angiography (CEMRA) and high spatial resolution CEMRA. Chest wall indices including maximum transverse diameter, pectus index (PI), and chest-flatness were measured in all subjects. Left and right ventricular ejection fractions (LVEF, RVEF), ventricular long and short dimensions (LD, SD), mid-ventricle myocardial shortening, pulmonary-systemic circulation time, and pulmonary artery flow were quantified. Results: In patients with pectus excavatum, the pectus index was 9.3 +/- 5.0 versus 2.8 +/- 0.4 in controls (P < 0.001). No significant differences between pectus excavatum patients and controls were found in LV ejection fraction, LV myocardial shortening, pulmonary-systemic circulation time or pulmonary flow indices. In pectus excavatum, resting RV ejection fraction was reduced (53.9 +/- 9.6 versus 60.5 +/- 9.5; P = 0.013), RVSD was reduced (P < 0.05) both at end diastole and systole, RVLD was increased at end diastole (P < 0.05) reflecting geometric distortion of the RV due to sternal compression. Conclusion: Depression of the sternum in pectus excavatum patients distorts RV geometry. Resting RVEF was reduced by 6% of the control value, suggesting that these geometrical changes may influence myocardial performance. Resting LV function, pulmonary circulation times and pulmonary vascular anatomy and perfusion indices were no different to controls.

Study Design: Case-control study.Objective: To examine factors influencing cervical alignment after corrective surgery for adult patients with adolescent idiopathic scoliosis (AdIS) SUMMARY OF BACKGROUND DATA.: Corrective surgery for spinal deformity influences postoperative cervical spinal alignment, but changes in the cervical alignment in adults with AdIS are scarcely reported.Methods: We retrospectively examined 85 patients with AdIS who underwent posterior corrective surgery for thoracic or lumbar major curve and were followed up for 2 years. Clinical characteristics, radiographic parameters, and health-related quality of life (HRQOL) were evaluated. Cervical deformity (CD) was defined as one of the following cases: (1) T1 tilt minus C2-C7 angle more than 20°, (2) C2-C7 SVA more than 40 mm, (3) and C2-C7 angle less than -10°. Patients were divided into those with and without CD based on the defined criteria; statistically relevant factors were analyzed.Results: There were 19 patients in the postoperative CD group. The average age at the time of surgery was lower in the CD group (26.5 vs. 31.4). In the CD group, the average preoperative T1 tilt was smaller (1.1° vs. 12.5°), and the C2-C7 angle was kyphotic (-16.1° vs. 3.0°). The average kyphotic angle at thoracic spine (T5-T12) was lower in the CD group preoperatively (12.5° vs. 19.5°) and postoperatively (15.2° vs. 20.8°). HRQOL outcomes were comparable between the groups. Of the patients with preoperative CD, 51.5% (n = 17) maintained their deformity at the final follow-up, and baseline C2-C7 angle was lower than those who converted to non-CD following surgery (n = 16) (-17.0° vs. -10.3°).Conclusion: More than half of the patients with baseline CD maintained their cervical malalignment postoperatively. Patients with postoperative CD presented cervical kyphotic and thoracic hypokyphotic alignments before surgery. Because CD has the potential to lead to cervical degeneration, careful follow-up observation is necessary for these young patients.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to quantify limitations in sagittal ankle range of motion (ROM) at least two years after lateral column lengthening osteotomy of the calcaneus (LLC) and their implications regarding quality of life.Methods: Fifteen patients with a mean follow-up of 80 ± 27 months after LLC and 15 age-matched healthy persons participated in this study. Ankle joint complex ROM in plantarflexion and dorsiflexion was measured bilaterally using a goniometer and fluoroscopy (patients only). Quality of life was assessed using the short-form health questionnaire (SF36). Differences in ROM parameters (for the tibiotalar and subtalar joint) between sides (affected vs. unaffected) and between groups (patient vs. controls) and the relationship between ROM parameters and quality of life scores were assessed.Results: ROM of the ankle joint complex on the affected side in patients was smaller than on the contralateral side (goniometer and fluoroscopy) and in healthy persons (goniometer; all P < .05). Among patients, SF36 total and pain scores, respectively, correlated with ROM of the subtalar joint (fluoroscopy; R = 0.379, P = 0.039 and R = 0.537, P = 0.001). Among patients and healthy persons, those with smaller dorsiflexion (goniometer) had lower quality of life scores.Conclusions: The smaller sagittal ROM of the affected ankle joint complex compared with the contralateral foot and healthy controls was mainly explained by limitations in the tibiotalar joint. Because of its association with quality of life, ROM should be considered in the treatment and rehabilitation planning in patients who are candidates for LLC. [ABSTRACT FROM AUTHOR]

Purpose: Gastroesophageal reflux disease (GERD) is reported as one of the symptoms of adult spinal deformity (ASD). Little is known about the mid- to long-term improvement in GERD symptoms after ASD surgery. Therefore, this retrospective study from prospectively collected database aimed to investigate GERD symptoms in patients for a minimum of 2 years after ASD corrective surgery.Methods: Records from 230 patients (mean age: 64 years) who underwent ASD surgery were examined using the frequency scale for the symptoms of GERD (FSSG) questionnaires for the diagnosis of GERD. FSSG scores and radiographic parameters were investigated preoperatively and postoperatively at 6 months and 1, 2, and 5 years.Results: In total, 90 (39%) patients were preoperatively diagnosed with GERD defined by FSSG score ≥ 8 points. Radiographic results showed that the corrective surgeries improved local and global alignments. In the GERD patients, preoperative FSSG scores (16.1 ± 7.3 points) significantly improved to 7.7 ± 7.4 points within 6 months postoperatively (p < 0.001), and postoperative FSSG scores maintained at 1 year (9.9 ± 8.2 points, p = 0.061), 2 years (9.7 ± 8.2 points, p = 0.086), and 5 years (9.4 ± 8.0 points, p = 0.177). Among the GERD group, 62 patients (69%; improvement cases) showed improvement in GERD symptoms defined by FSSG score < 8 points within 6 months postoperatively.Conclusions: Among ASD patients, 39% were diagnosed with GERD. In 69% of these patients, GERD symptoms improved within 6 months of corrective surgery and maintained up to 5 years postoperatively. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

Orthognathic or corrective surgeries are of great importance nowadays are esthetics is put forward for most of the patients. A very important factor in the success of a surgery is the mental attitude of the patient. There has been much interest recently in the effect of attitude on one's overall health and healing. The study aims at comparing the esthetic changes between pre op and post op orthognathic surgeries. The questionnaire was personally distributed to 50 patients who had reported with an orthodontic complaint and wanted to undergo orthognathic surgery. Pre and post operative pictures of patients who underwent orthodontic treatment were shown to the participants and they had been asked to answer the questions asked. Questions were set in such a way that they were self explanatory and could be interpreted in a clear manner by the person taking up the survey. 80% of the total were also found to expect more esthetical improvements in the surgery that was performed. 46% of them could find a lot of difference in the nose and 80% of them could spot clear and visible changes in the teeth whereas 34% of them stated that there were no major alterations that were seen in the face. Most of the patients who participated in the survey were females and of age 18-30 years. Chi square test shows p<0.000, significant. It is seen that most of the general population felt that the aesthetics has been improved in a patient who underwent orthognathic surgery. [ABSTRACT FROM AUTHOR]

Background: Apical surgery is considered a standard oral surgical procedure. It is often a last resort to surgically maintain a tooth with a periapical lesion that cannot be managed with conventional endodontic (re-)treatment. The main goal of apical surgery is to prevent bacterial leakage from the root-canal system into the periradicular tissues by placing a tight root-end filling following root-end resection. Hence, this study is done to assess the knowledge of dental students on various periapical surgical methods. Aim: The aim of the study is to assess the knowledge on various periapical surgical procedures among dental students. Materials and Methods: The questionnaire was self-formulated and was delivered by hand and collected on completion. The medium for answering the questionnaire was English. All the responses were kept anonymous. The questionnaire contained 15 questions which were framed to assess the knowledge, attitude, and practice on denture magnets among dental practitioners. The questions were related to types of periapical surgical procedures, indications, contraindications, etc. One hundred students were randomly selected to complete the questionnaire. The responses to each of the questions were entered into Microsoft Excel sheet and summarized through the pie chart. Results: Majority of the students, i.e., 56% of them were aware of periradicular surgery, but very few 21% and 23% of them were aware of corrective and fistulative surgery, respectively. About 7% of them were aware of cortical trephination under fistulative surgery. Under premedications administered during periapical surgery, 68% were aware of amoxicillin and many of them were unaware of valium and clindamycin. The majority of them were aware of the indications and contraindications of periapical surgery. Conclusion: This survey shows that the dental students have a fairly rough knowledge about various periapical surgical procedures. Yet some of them were unaware of cortical trephination and decompression procedures. Most of them had good knowledge regarding the flap designs used, but they did not have enough knowledge about various premedications used other than amoxicillin. Hence, it is important to educate them regarding all the indications, contraindications, types of procedures, thereby creating awareness among dental students, which will be useful for the students in their clinical practice. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy and safety of tranexamic acid (TXA) in patients with adolescent idiopathic scoliosis undergoing corrective surgery. A literature search of PubMed, Embase, and Cochrane Library was performed to identify studies published from inception to February 2019. After study selection and data extraction, statistical analysis was performed. Odds ratios and weighted mean differences (WMDs) with 95% confidence intervals (CIs) for all available clinical outcomes were analyzed using fixed-effects or random-effects models. Twelve studies comprising 2500 patients were included. Intravenous TXA use was associated with significantly fewer patients received blood transfusions (odds ratio, 0.12; 95% CI, 0.06 to 0.22; P < 0.001), less intraoperative estimated blood loss (WMD, −470.07; 95% CI, −645.23 to −294.90; P < 0.001), less intraoperative estimated blood loss per segment (WMD, −27.40; 95% CI, −32.80 to −22.00; P < 0.001), less cell salvage blood transfusion (WMD, −106.02; 95% CI, −170.84 to −41.20; P = 0.001), and shorter surgical time (WMD, −26.18; 95% CI, −46.91 to −5.46; P = 0.010). No significant difference was found in postoperative hemoglobin (WMD, 0.39; 95% CI, −0.07 to 0.86; P = 0.100) and hemoglobin change (WMD, −0.92; 95% CI, −2.90 to 1.07; P = 0.360) between TXA and control groups. No renal, thromboembolic, or other major complications associated with TXA were noted in included studies. TXA was effective in reducing surgical time, intraoperative estimated blood loss, and blood transfusion without increasing complications in patients undergoing corrective surgery for adolescent idiopathic scoliosis. TXA had no influence on postoperative hemoglobin and hemoglobin change. [ABSTRACT FROM AUTHOR]