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Growth modulation through anterior vertebral body tethering (AVBT) has emerged as a fusionless option for the treatment of progressive scoliosis. When tethering the main thoracic curve, the compensatory thoracolumbar/lumbar curve must correct indirectly as a result. The present study evaluated the response of these lumbar curves following AVBT of the main thoracic curves.Patients who underwent thoracic AVBT and who had a minimum follow-up of 2 years were included. Magnitudes of the thoracic and lumbar curves were recorded preoperatively and at the first-erect and 2-year postoperative visits. Lumbar curves were further stratified according to their lumbar modifier (A, B, or C). Analysis of variance (ANOVA) and repeated-measures ANOVA were performed to compare correction rates, and the Pearson coefficient was utilized to determine the correlation between the tethered thoracic curve and uninstrumented lumbar curve magnitudes.A total of 218 patients were included. Thoracic curve correction was 40% at the first-erect visit and 43% at 2 years (p = 0.012). Lumbar correction was 30%, 26%, and 18% at the first-erect visit (p0.001 for all compared with preoperatively) and minimally changed at 31%, 26%, and 24% at 2 years for lumbar modifiers A, B, and C, respectively. A total of 118 patients (54%) showed thoracic curve improvement between the first-erect and 2-year visits. In a subgroup analysis, these patients had a correction in lumbar curve magnitude from preoperatively to the first-erect visit of 30%, 22%, and 16% for lumbar modifiers A, B, C, respectively, that increased to 42%, 34%, and 31% at 2 years, with strong correlation to thoracic correction at 2-year follow-up (r = 0.557, p0.001).Although there was immediate lumbar correction following AVBT of a main thoracic curve, further improvement following initial correction was only observed among patients with growth modulation of the thoracic curve. Considering all patients, the uninstrumented lumbar curve corrected 30% at 2 years and the instrumented thoracic curve corrected 40%. As indications for AVBT are refined, these data will provide insight into the response of the uninstrumented lumbar curve.Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Elastic intramedullary nails (EINs) are the treatment of choice for school-age children (5 to 12) with diaphyseal femur fractures. Previous literature suggests that EINs are an effective treatment for stable fracture patterns, but may be inadequate for unstable fracture patterns. The purpose of this study was to evaluate whether patients with length unstable fractures had a higher complication rate than those with length stable fractures when treated with EINs.All patients with diaphyseal femur fractures treated with EINs over a 22-year period at a single institution were reviewed. Patients were excluded if they had a pathologic fracture, neuromuscular disorder, spinal cord injury with subsequent involvement of affected limb, metabolic bone disease, or if they did not have at least 6-month follow-up.A total of 85 patients with 87 diaphyseal femur fractures treated with EINs were included in the study. In all, 57.5% of the fractures were categorized as length stable and 42.5% were length unstable. Fourteen percent of length stable patients had a residual angular deformity compared with 5.4% of the length unstable group (P=0.24). The length unstable group experienced more shortening at the fracture site than the patients in the length stable group (P=0.003), but no patient required further intervention for their shortening. Two patients in the length stable group experienced overgrowth2 cm and required subsequent surgery. No relationship was observed between fracture pattern and frequency of complications (length stable 8% vs. length unstable 10.8%, P=0.69). Finally, the knee immobilizer group (10.7%) and the long leg cast group (18.2%) had significantly higher complication rates than the single leg spica cast group (0%, P0.05).There was no significant difference in complication rate between length stable and unstable fractures treated with EINs. Adjunctive spica casting may be protective against postoperative complications. While fracture shortening was more likely in the length unstable group, it did not result in increased rate of limb length discrepancy at final follow-up.Level IV, Case Series.

Purpose The purpose of this study was to investigate associations between the various definitions of adding-on identified in the literature and HRQoL at 10 years following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) to identify a clinically relevant definition. Methods In this retrospective cohort study, patients with Lenke type 1 or 2 AIS with 10-year follow-up after PSF were identified in a multicenter registry. Adding-on was identified independently using 5 published definitions and expert spine surgeons' visual confirmation. Worsening of HRQoL was defined as a preoperative to 10-year postoperative decrease in SRS-22 domain score ≥ the minimal clinically important difference (MCID). Results One hundred fifty patients were included, and 118 had HRQoL data available for the main analysis. Worsening pain was noted in 49 (41.5%) patients, appearance in 1 (0.8%), and activity in 70 (59.3%) from preoperative to postoperative. 4 of the 5 definitions of adding-on demonstrated no evidence of association with worsening HRQoL. By Cho's definition (either 1. ≥ 5° increase in Cobb angle AND increase in number of vertebrae in curve distally, or 2. ≥ 5° increase in angulation of 1st disc below LIV), adding-on (27 patients, 22.9%) was associated with an increased risk of worsening pain (59.3% vs. 36.3%, p = 0.033) and activity (77.8% vs. 53.8%, p = 0.026). There was no evidence of association with changes in appearance. Risk of worsening pain and activity was increased by 1.75 and 1.51 times (p = 0.023 and p = 0.002), respectively. Conclusion Cho's definition of adding-on was associated with worsening HRQoL at 10 years following PSF for Lenke type 1 and 2 AIS. Consistent use of this definition will allow us to compare studies and obtain meaningful information in this population. Level of evidence Level II.

In contrast to infection and curve progression, return to OR for implant malposition is potentially within the surgeon’s control. With increasing surgeon familiarity with freehand/fluoroscopic pedicle screw placement, rates of return to OR due to malposition may have decreased over time. We sought to document the incidence and risk factors for return to OR due to screw malposition in a large cohort of patients with idiopathic scoliosis. AIS patients enrolled in a multicenter prospective registry with minimum 2-year follow-up undergoing PSF between 2003 and 2017 were included. Surgeries with the use of intraoperative CT-guided navigation were excluded. Return to OR due to screw malposition over time was tabulated. Lenke class, age at surgery, year of surgery, height, weight, surgeon and site were evaluated. 2435 patients underwent PSF with non-navigated open pedicle screw instrumentation. Mean age was 14.6 years, mean thoracic curve magnitude was 53°, and mean lumbar was 40°. Patients did not routinely undergo intraoperative or postoperative CT evaluation. There were 10 returns to OR for screw malposition at a mean of 0.83 years postoperatively (range 0.1–3.4 years), for an overall incidence of 0.4%. Of the 14 screws, 10 were thoracic, 7 were left-sided. No association was found between screw malposition and curve size, enrolling site, surgeon, BMI, Lenke class, or age. Five patients had radiculopathy which improved after screw revision. Return to OR for screw malposition changed from 2003 to 2017 (1–0.2%) but this did not reach statistical significance. Although the incidence of asymptomatic malpositioned screws is unknown, the rate of return to the OR for implant malposition overall in this registry was 1 in 250 patients. Recent data suggest the rate has decreased to 1 in 500 patients. Further work may determine whether enabling technologies can reduce the rate, ideally to a “never event”.

The Clavien–Dindosink (CDS) classification system provides more treatment-focused granularity than subjective methods of describing surgical complications; however, it has not been validated in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The purpose of this study was to modify the CDS system for application in patients with AIS undergoing PSF to assess its inter- and intra-rater reliability for describing complications faced by this population. A review of all complications specific to patients with AIS captured in a large multicenter international database was performed. All complications were classified according to CDS, modified by addition of “prolonged initial hospital stay” as a criterion for Grade II. A survey of this complication list and an additional 20 clinical vignettes (sent out on two occasions) was sent to nine spinal deformity surgeons. Weighted kappa values were used to determine inter- and intra-rater reliability. The Fleiss κ value for interrater reliability among 5 respondents grading all AIS complications was 0.8 (very good). For each grade, interrater reliability was very good, with an overall range of 0.8–1. The overall kappa value for intrarater reliability among eight respondents grading 20 vignettes was between 0.6 (good) and 0.9 (very good). The modified CDS classification system has very good interrater and intrarater reliability in describing complications following PSF in patients with AIS. This system may be of greater utility for reporting outcomes than a “major” versus “minor” complication system and can serve as a valuable tool for improving surgical practices and patient outcomes in this population. IV case series.

Pediatric orthopedic surgeons must accurately assess the skeletal stage of adolescent idiopathic scoliosis (AIS) patients for selection and timing of optimal treatment. Successful treatment using vertebral growth modulation is highly dependent on skeletal growth remaining. We sought to evaluate the current-state use of the Sanders Skeletal Maturity System (SSMS) in regard to precision and accuracy. We hypothesized that pediatric orthopedic surgeons currently use SSMS with moderate precision and accuracy. Eight practicing pediatric orthopedic surgeons who perform vertebral body tethering surgery without specific training in SSMS were asked to assign the SSMS stage for 34 de-identified hand radiographs from AIS patients. Precision was evaluated as inter-rater reliability, using both Krippendorff’s α and Weighted Cohen’s kappa statistics, and as intra-rater reliability, using only Weighted Cohen’s kappa statistics. Surgeon accuracy was evaluated using Weighted Cohen’s kappa statistics with comparison of surveyed surgeons’ responses to the gold standard rating. Inter-rater reliability across the surveyed surgeons indicated moderate to substantial agreement using both statistical methods (α = 0.766, κ = 0.627) with the majority of discord occurring when assigning SSMS stages 2 through 4. The surveyed surgeons displayed substantial accuracy when compared to the gold standard (κ = 0.627) with the majority of inaccuracy involving the identification of stage 3B. When re-surveyed, the surgeons showed substantial intra-rater reliability (κ = 0.71) with increased inconsistencies when deciding between SSMS stage 3A and stage 3B. The current-state use of SSMS across pediatric orthopedic surgeons for evaluation of AIS patients displays adequate but imperfect precision and accuracy with difficulties delineating SSMS stages 2 through 4, which correlate with adolescent growth periods germane to scoliosis growth modulation surgery. Centralized assessment of hand-bone age may help ensure standardized reporting for non-fusion scoliosis research.

To identify the prevalence and predictors of nonspecific back pain in primary thoracic adolescent idiopathic scoliosis (AIS) patients at 10 years after surgery. This was a case–control multi-center study. A query of patients who underwent surgical correction of major thoracic AIS between 1997 and 2007 with 10-year follow-up was reviewed. SRS-22 pain scores at 10 years were classified as below normal (≤ 2 standard deviations below average for controls of similar age/sex from published literature) or within/above the control range. One hundred and seventy-one patients with an average of 10.5 ± 0.8-years follow-up were included. Average age at surgery was 14 ± 2 years. The rate of pain was 23% for males and 11% for females (p = 0.08). Differences in age, 10-year SRS mental health score, and radiographic measures were noted. Of 12 patients who underwent revision surgery, 42% reported below normal pain scores versus 11% in cases without revision (p = 0.012). Classification and regression tree (CART) analysis identified 10-year thoracic curve magnitude and 10-year mental health scores as significant predictors. Thoracic Cobb of ≤ 26° at 10 years was associated with a 7% rate of below normal pain scores compared to 27.5% when the curve was > 26° (OR = 4.8, p 4.2 and 15% had more pain than normal if mental health score was ≤ 4.2 (OR 23, p 26°) at 10 years was the primary predictor of increased pain. For patients with less coronal deformity (

BACKGROUND The purpose of the present study was to evaluate associations between changes in segmental vertebral coronal angulation (screw angulation) and overall height after anterior spinal growth tethering for the treatment of idiopathic scoliosis and to compare the rates of coronal angulation change using the preoperative Sanders stage. METHODS Patients with idiopathic scoliosis who underwent anterior spinal growth tethering between 2012 and 2016 and had ≥2 years of follow-up were retrospectively studied. We calculated each segment's screw angulation rate of change (degrees/month) and each patient's height velocity (cm/month) between each of the visits (3 to 12 visits/patient) and divided the visits into 4 groups by postoperative duration ( 2 to 3 years, >3 years). Patients were divided into 2 groups according to the preoperative Sanders stage. Generalized estimating equations and repeated-measures correlation were utilized for analyses with non-independent samples. RESULTS We analyzed 23 patients (16 female, 7 male) with a mean age (and standard deviation) of 12.2 ± 1.6 years who had right thoracic idiopathic scoliosis (mean, 53° ± 8°). All patients were immature at the time of surgery (Risser stage 0 or 1, Sanders stage 2 or 3). The mean duration of follow-up was 3.4 ± 1.1 years (range, 2 to 5 years). The rate of change for each segment's screw angulation after anterior spinal growth tethering was -0.16°, -0.14°, -0.05°, and 0.03° per month (with negative values indicating a reduction in scoliosis) for 2 to 3 years, and >3 years, respectively (p ≤ 0.001), and the mean height velocity was 0.65, 0.57, 0.30, and 0.19 cm per month for 2 to 3 years, and >3 years, respectively (p < 0.001). Changes in screw angulation correlated with height increases after anterior spinal growth tethering (r = -0.46, p < 0.001). Scoliosis correction for patients in the Sanders stage-2 group continued for 3 years (0.23°, 0.23°, and 0.09° per level per month for the first 3 years, respectively) and occurred at more than twice the rate for patients in the Sanders stage-3 group, for whom scoliosis correction ceased 2 years postoperatively (0.11° and 0.09° per level per month for the first 2 years, respectively). CONCLUSIONS Scoliosis correction was associated with overall height changes and occurred primarily within 2 to 3 years after surgery in this cohort of largely Risser stage-0 patients. The correction rate was 2.8° per segment per year for the first 2 years in the Sanders stage-2 group, compared with 1.2° per segment per year for the Sanders stage-3 group. Surgical timing that considers the patient's skeletal maturity is an important factor in generating proper postoperative correction after anterior spinal growth tethering. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

To identify curve/correction characteristics associated with adding-on at 2 years after posterior spinal fusion (PSF) in Lenke 1/2 AR curves. A prospective multicenter registry was queried to identify patients with adolescent idiopathic scoliosis (AIS), Lenke 1/2 AR curves, who underwent PSF with a minimum of 2-year follow-up. Patient characteristics as well as pre- and post- operative radiographic variables were evaluated using Classification and Regression Tree (CART) analysis to determine which factors contribute to adding-on. 253 patients treated with PSF were assessed for adding-on, of which 50 met our adding-on criteria. Univariate analysis revealed adding-on was associated several factors including: post-operative thoracic and lumbar curve magnitude (p > 0.001), first erect (FE) end instrumented vertebra (EIV) angulation (p = 0.009) and EIV translation (p = 0.001), younger age (p = 0.027), Risser stage (p = 0.024), and a more proximal lowest instrumented vertebra (LIV) (p 0.5°). In Lenke 1 and 2 AR curves, pre-operative LIV translation appears to be an independent risk factor for adding-on; and in those with

Prior "best practice guidelines" (BPG) have identified strategies to reduce the risk of acute deep surgical site infection (SSI), but there still exists large variability in practice. Further, there is still no consensus on which patients are "high risk" for SSI and how SSI should be diagnosed or treated in pediatric spine surgery. We sought to develop an updated, consensus-based BPG informed by available literature and expert opinion on defining high-SSI risk in pediatric spine surgery and on prevention, diagnosis, and treatment of SSI in this high-risk population.After a systematic review of the literature, an expert panel of 21 pediatric spine surgeons was selected from the Harms Study Group based on extensive experience in the field of pediatric spine surgery. Using the Delphi process and iterative survey rounds, the expert panel was surveyed for current practices, presented with the systematic review, given the opportunity to voice opinions through a live discussion session and asked to vote regarding preferences privately. Two survey rounds were conducted electronically, after which a live conference was held to present and discuss results. A final electronic survey was then conducted for final voting. Agreement ≥70% was considered consensus. Items near consensus were revised if feasible to achieve consensus in subsequent surveys.Consensus was reached for 17 items for defining high-SSI risk, 17 items for preventing, 6 for diagnosing, and 9 for treating SSI in this high-risk population. After final voting, all 21 experts agreed to the publication and implementation of these items in their practice.We present a set of updated consensus-based BPGs for defining high-risk and preventing, diagnosing, and treating SSI in high-risk pediatric spine surgery. We believe that this BPG can limit variability in practice and decrease the incidence of SSI in pediatric spine surgery.Not applicable.

Determine the efficacy of intraoperative traction (IOT) on curve correction in AIS. A prospective, multicenter, longitudinal database identified patients with major thoracic AIS (Lenke 1–4) treated with surgery using IOT and follow-up of 2 years. These cases were matched to comparable cases treated without traction (non-IOT). All patients were treated with single-stage posterior only surgery with pedicle screw constructs. Perioperative, radiographic and clinical outcome data at 2 years post-op were compared between the groups. 104 cases treated with IOT were matched to 104 treated without IOT. Operating room time was significantly greater in the IOT group (339 vs. 306 min, p = 70° (IOT 72% vs. non-IOT 64%, p = 0.04). IOT was associated with a significant reduction in 2D T5–T12 kyphosis measurements (IOT − 6.5° vs non-IOT + 0.48°, p

Retrospective review of a prospectively collected multicenter database. To identify risk factors for early and late readmission of surgically treated patients with adolescent idiopathic scoliosis (AIS). Specific risk factors associated with readmission in patients with AIS remain poorly understood. Patients with AIS who were operatively treated from 19 centers specializing in the treatment of pediatric spinal deformity were studied. Data from a minimum 2 years of clinical follow-up and any readmission were available for analysis. Characteristics of patients with no readmission, early readmission ( 90 days) were evaluated. Both univariate and multivariate analyses of risk factors for readmission were performed. 2049 patients were included in our cohort, with 1.6% requiring early readmission and 3.3% late readmission. In the multivariate analysis, greater preoperative coronal imbalance was associated with early readmission. Longer operative time was associated with late readmission. Finally, greater preoperative pain (SRS-22 pain scale) was associated with both early and late readmission. GI complications accounted for a higher proportion of early readmissions than previously reported in the literature. Preoperative counseling of patients with higher levels of pain and coronal imbalance and the implementation of a thorough postoperative bowel regimen may help optimize patient outcomes. 3.

In a sex-inclusive cohort of patients with adolescent idiopathic scoliosis (AIS): (1) assess the relationship between 3D curve severity, curve flexibility, and paraspinal muscle fatty infiltration, and (2) describe three-dimensional (3D) fatty infiltration of the paraspinal muscles. Fat signal fraction of the paravertebral muscles was measured in pre-operative magnetic resonance images (MRIs) of males and females with AIS at the apex, ± 1, and ± 2 levels from the apex of the curve (n = 62). In a subset of patients with biplanar erect radiographic imaging (n = 35), 3D measures of deformity (axial rotation of the apical vertebrae, thoracic kyphosis, and coronal Cobb angle) were measured. Contrary to previous studies, no relationship between coronal Cobb angle and fatty infiltration was found. However, axial apical rotation and sagittal Cobb angle were found to be significant predictors of paravertebral fatty infiltration (R2 = 0.196–0.222). Curve concavity, female sex, and proximity to the curve apex were found to be the strongest predictors of fatty infiltration. Greater fatty infiltration of the paravertebral muscles was found on the concave side of the curve (15–24% vs. 11–13%), with increasing fatty infiltration toward the apex of the curve. Fatty infiltration was protected on the convex side of the curve, with no differences in the amount of fatty infiltration across levels. These findings highlight that coronal curve severity and flexibility are not the primary influencing factors for the degree of paraspinal fatty infiltration in patients with AIS. This may have implications for nonsurgical rehabilitation strategies such as bracing and physical therapy. II.

Energy healing (EH) is a part of the diverse group of Complementary and Alternative Medicines (CAM). The purpose of this study was to evaluate the effects of EH therapy prior to and following posterior surgical correction for adolescent idiopathic scoliosis (AIS) compared to controls. Patients were prospectively randomized to one of two groups: standard operative care for surgery (controls) vs. standard care with the addition of three EH sessions. The outcomes included visual analog scales (VAS) for pain and anxiety (0–10), days until conversion to oral pain medication, and length of hospital stay. For the experimental group, VAS was assessed pre- and post-EH session. Fifty patients were enrolled—28 controls and 22 EH patients. The controls had a median of 12 levels fused vs. 11 in the EH group (p = 0.04). Pre-operative thoracic and lumbar curve magnitudes were similar (p > 0.05). Overall VAS pain scores increased from pre- to post-operative (p

To evaluate associations between vertebrae and disc shape asymmetry and adolescent idiopathic scoliosis (AIS) curve severity. Analysis included normal screening referrals and patients with right, main thoracic AIS who underwent upright, biplanar radiographs with 3D reconstruction at a single institution from 2010 to 2015. Peri-apical anterior, posterior, right, and left vertebral body heights (aVBH, pVBH, rVBH, lVBH) and intervertebral disc heights (DH) were measured, and ratios of these measurements were calculated in sagittal and coronal planes. Correlations were performed between curve severity and height measurements. Sagittal and coronal plane components of these measurements were compared between normal controls with coronal curve measurements

The advantage of considering the three-dimensional curve patterns, including the patterns of the vertebral position and alignment, in classification of adolescent idiopathic scoliosis (AIS) patients and whether such classification system relates to the surgical outcomes are not fully determined. A total of 371 AIS patients who received posterior spinal fusion surgery with 2-year follow-up were included retrospectively and consecutively. The 3D positions and orientations of the T1–L5 vertebrae were calculated from the 3D reconstructions of the spines at pre-operative and 2-year follow-up, a total of 102 variables per patient. A probabilistic clustering method was used to cluster the pre-operative and 2-year follow-up 3D spinal curve patterns separately. The distributions of the Lenke types and 3D pre-operative clusters in the post-operative clusters were determined. A total of nine pre-operative clusters including, four right thoracic types, three left thoracolumbar/lumbar types, one low apex right thoracic/thoracolumbar, and one left thoracic/right lumbar were determined. Three post-operative 3D curve patterns were Type 1 with higher residual proximal Cobb angle, Type 2 with lower T5–T12 kyphosis and highest pelvic incidence-lordosis mismatch, and Type 3 with larger lumbar curve magnitude and rotation compared to the other two groups. More than 50% of patients in each of the 3D pre-operative clusters had the same post-operative group. We developed a 3D classification of the AIS patients before and two-year after spinal fusion surgery. The link between the pre- and post-operative clusters lends itself to application of this classification system in developing predictive models of the AIS surgical outcomes.

The selection of lowest instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) is determined by coronal and sagittal plane indicators. Failure to properly select the LIV can lead to suboptimal outcomes and the need for revision surgery. A subset of patients have discordant coronal last touched vertebra (cLTV) and stable sagittal vertebra (SSV) which complicates the choice of LIV. The purpose of this study is to report the incidence of discordant cLTV and SSV when choosing LIV and investigate the association between length of fusion and patient-reported outcomes (PROs) and distal junctional kyphosis (DJK). This retrospective multicenter cohort study included AIS patients with discordant pre-operative cLTV and SSV. Patients fused only to include the proximal cLTV were compared to patients fused to include the distal SSV. Primary outcomes included DJK and PROs measured by SRS-22. Eight hundred and fifty-six patients were identified of which 114 (13.3%) had discordant SSV and cLTV. The DJK incidence was 7.7% and 45.5% in patients fused to include the SSV versus short of the SSV, respectively. Lenke Modifier type B and C patients with fusions short of the SSV had a 9.2 times increased risk of developing DJK at 2 years compared to patients with fusions including the SSV (95% CI 2.8, 29.7; p

Item does not contain fulltext PURPOSE: Although multimodal IONM has reached a widespread use, several unresolved issues have remained in clinical practice. The aim was to determine differences in approaches to form a basis for taking actions to improve patient safety globally. METHODS: A survey comprising 19 questions in four sections (demographics, setup, routine practices and reaction to alerts) was distributed to the membership of the SRS. RESULTS: Of the estimated 1300 members, 205 (~ 15%) completed the survey. Respondent demographics reflected SRS member distribution. Most of the respondents had > 10 years of experience. TcMEP and SSEP were available to > 95%. Less than 5% reported that a MD/PhD with neurophysiology background routinely examines patients preoperatively, while 19% would consult if requested. After an uneventful case, 36% reported that they would decrease sedation and check motor function if the patient was to be transferred to ICU intubated. Reactions to dropped signals that recovered or did not fully recover varied between attempting the same correction to aborting the surgery with no rods and returning another day, with or without implant removal. After a decrease of signals, 85.7% use steroids of varied doses. Of the respondents, 53.7% reported using the consensus-created checklist by Vitale et al. Approximately, 14% reported never using the wake-up test while others use it for various conditions. CONCLUSION: The responses of 205 experienced SRS members from different regions of the world showed that surgeons had different approaches in their routine IONM practices and in the handling of alerts. This survey indicates the need for additional studies to identify best practices.

Prospective cerebral palsy (CP) registry review. (1) Evaluate the incidence/risk factors of gastrointestinal (GI) complications in CP patients after spinal fusion (SF); and (2) investigate the validity of the modified Clavien–Dindo–Sink classification. Perioperative GI complications result in increased length of stay (LOS) and patient morbidity/mortality. However, none have analyzed the outcomes of GI complications using an objective classification system. A prospective/multicenter CP database identified 425 children (mean, 14.4 ± 2.9 years; range, 7.9–21 years) who underwent SF. GI complications were categorized using the modified Clavien–Dindo–Sink classification. Grades I–II were minor complications and grades III–V major. Patients with and without GI complications were compared. 87 GI complications developed in 69 patients (16.2%): 39 minor (57%) and 30 major (43%). Most common were pancreatitis (n = 45) and ileus (n = 22). Patients with preoperative G-tubes had 2.2 × odds of developing a GI complication compared to oral-only feeders (OR 2.2; 95% CI 0.98–4.78; p = 0.006). Similarly, combined G-tube/oral feeders had 6.7 × odds compared to oral-only (OR 6.7; 95% CI 3.10–14.66; p

To evaluate how 3D parameters of the instrumented thoracic spine relate to the uninstrumented lumbar spine following thoracic-only fusion (TOF) for adolescent idiopathic scoliosis (AIS) and determine the factors predictive of lumbar correction. A multi-center retrospective review was conducted of AIS patients with Lenke 1–4 B or C curves undergoing fusion of their thoracic spine only with minimum 2-year follow-up and 3D spine reconstructions from biplanar radiography. Pre-operative to 2-year post-operative differences were evaluated. Pearson’s correlations were used to identify 3D coronal, sagittal and axial relationships at 2 years post-operative. Multivariate linear regression was used to identify variables most predictive of lumbar curve correction. Eighty-four AIS patients met inclusion (54 B modifiers, 30 C modifiers). Average pre-operative thoracic and lumbar curves were 54 ± 9° and 41 ± 7° and corrected to 19 ± 7° and 21 ± 7°, respectively. 3D T5-T12 thoracic kyphosis increased from 6 ± 13° to 26 ± 8°. Thoracic and lumbar apical rotation decreased from − 14 ± 6° to -5 ± 6° and 13 ± 5° to 11 ± 6°, respectively. Thoracic curve correction correlated with lumbar curve correction (r = 0.67, p = 0.001) and decreased LIV tilt correlated with smaller residual lumbar curve magnitude (r = 0.63, p

Prospective multicenter international observational study. To investigate incidence of new neurologic deficit (NND) and the long-term recovery patterns following complex pediatric spine deformity surgery. The SRS MM idiopathic kyphoscoliosis(5 patients); congenital scoliosis (7 patients); congenital kyphoscoliosis (4 patients); congenital kyphosis (6 patients), other kyphosis (1 patient) and syndromic (1 patient). 1 patient was lost to follow-up (f/u) after discharge; 1 had chronic deficits at the first post-operative erect visit (from discharge to 9 months f/u) and was subsequently lost to follow-up; 2 patients were improving at 1-year f/u but lost to subsequent f/u. 16 patients had normal neurologic function by the time of the first post-operative erect visit, 21 patients at 1-year f/u and 21 patients at the 2-year f/u. 2 patients (0.69%) had improved NND at 2-year mark. A significant proportion of patients with complex spine deformity experience NND. However, significant improvement in neurologic function can be expected over time as seen in this study without additional surgical intervention in most cases. Congenital deformities accounted for 63% of the patients experiencing NND.

To compare 3D postoperative deformity correction using two distinct commonly utilized techniques for the treatment of adolescent idiopathic scoliosis (AIS). AIS patients with major thoracic (Lenke 1–2) curves at two sites who underwent deformity correction via posterior spinal instrumented fusion using one of two distinct techniques were retrospectively reviewed. Patients were matched 1:1 between sites for Lenke type (95% Lenke 1) and follow-up time. The “band site” performed posteromedial translation using thoracic sublaminar bands and 5.5-mm rods. The “screw site” performed spine derotation using differential rod contouring with pedicle screws and 5.5-mm rods. 3D measures of deformity from spinal reconstructions were compared between sites. Preoperatively, the groups had similar thoracic curve magnitudes (band, 55 ± 12° vs. screw, 52 ± 10°; p > 0.05); the “screw site” had less T5–T12 kyphosis (2 ± 14° vs. 7 ± 12°, p = 0.05) and greater thoracic apical rotation (− 19 ± 7° vs. − 14 ± 8°, p = 0.007). Postoperatively, the “screw site” had greater percent correction (61% vs. 76%, p

Retrospective review of prospective multi-center cohort. To investigate the impact of thoracoplasty on pulmonary function at 2-year follow-up among complex pediatric spine deformity patients. Complex pediatric spine deformities may be associated with significant rib prominence causing body image concerns. Surgical correction of spine deformity may include thoracoplasty to correct the rotational prominence. Some surgeons refrain from performing thoracoplasty due to its purported negative effect on pulmonary function. There is paucity of literature on the effect of thoracoplasty on pulmonary function at 2-year follow-up in pediatric patients with complex spine deformity. We reviewed data of 312 patients (> 100°, with or without vertebral column resection (VCR)) or ( 0.05). Group 1 had significantly lower body mass index (BMI) compared to Group 2 (18.4 kg m−2 ± 2.8 vs. 19.9 kg m−2 ± 4.8, p = 0.0351). The average baseline coronal and sagittal Cobbs were larger for Group 1 relative to Group 2 (p 0.05). The rate of pre-op utilization of halo gravity traction (HGT) was 52.5% vs. 26.7% (p = 0.008), at an average duration of 103 days vs. 47 days, p = 0.0001. The rate of surgical osteotomies was similar in both groups. Estimated blood volume (EBV) loss was greater in Group 1 (63.1% vs. 43.1%, p = 0.0012). Post-op coronal and sagittal Cobb correction was similar in both groups. The incidence of post-op pulmonary complication was similar in both groups (8.2% vs. 8.9%, p = 0.899). Baseline and 2-year follow-up PFT did not differ significantly between and within the groups. Vertebral column resection (VCR) did not negatively affect PFT in both groups. Despite higher curve magnitudes in patients undergoing surgical correction and thoracoplasty for complex pediatric spine deformity, our findings revealed that thoracoplasty does not negatively affect pulmonary function at 2-year follow-up.

Background The selection of the lowest instrumented vertebra (LIV) in patients with adolescent idiopathic scoliosis (AIS) is still controversial. Although multiple radiographic methods have been proposed, there is no universally accepted guideline for appropriate selection of the LIV. We developed a simple and reproducible method for selection of the LIV in patients with Lenke type-1 (main thoracic) and 2 (double thoracic) curves and investigated its effectiveness in producing optimal positioning of the LIV at 5 years of follow-up. Methods The radiographs for 299 patients with Lenke type-1 or 2 AIS curves that were included in a multicenter database were evaluated after a minimum duration of follow-up of 5 years. The "touched vertebra" (TV) was selected on preoperative radiographs by 2 independent examiners. The LIV on postoperative radiographs was compared with the preoperative TV. The final LIV position in relation to the center sacral vertical line (CSVL) was assessed. The CSVL-LIV distance and coronal balance in patients who had fusion to the TV were compared with those in patients who had fusion cephalad and caudad to the TV. The sagittal plane was also reviewed. Results In 86.6% of patients, the LIV was selected at or immediately adjacent to the TV. Among patients with an "A" lumbar modifier, those who had fusion cephalad to the TV had a significantly greater CSVL-LIV distance than those who had fusion to the TV (p = 0.006) or caudad to the TV (p = 0.002). In the groups with "B" (p = 0.424) and "C" (p = 0.326) lumbar modifiers, there were no differences among the TV groups. Conclusions We recommend the TV rule as a third modifier in the Lenke AIS classification system. Selecting the TV as the LIV in patients with Lenke type-1 and 2 curves provides acceptable positioning of the LIV at long-term follow-up. The position of the LIV was not different when fusion was performed caudad to the TV but came at the expense of fewer motion segments. Patients with lumbar modifier "A" who had fusion cephalad to the TV had greater translation of the LIV, putting these patients at risk for poor long-term outcomes. Level of evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Study design Observational. Objectives To report on the rate of major complications following spinal fusion and instrumentation to treat spinal deformity in patients with cerebral palsy (CP). Summary of background data Understanding the risk of major complications following the surgical treatment of spine deformities in patients with CP is critical. Methods A prospectively collected, multicenter database of patients with CP who had surgical correction of their spinal deformity (scoliosis or kyphosis) was reviewed for all major complications. Patients with ≥ 2 year follow-up or who died ≤ 2 years of surgery were included. A complication was defined as major if it resulted in reoperation, re-admission to the hospital, prolongation of the hospital stay, was considered life-threatening, or resulted in residual disability. Overall complication and revision rates were calculated for the perioperative (Peri-op; occurring ≤ 90 days postoperative) and delayed postoperative (Delayed; > 90 days) time periods. Results Two hundred and fifty-seven patients met inclusion. Seventy-eight (30%) patients had a major complication, 18 (7%) had > 1. There were 92 (36%) major complications; 64 (24.9%) occurred Peri-op. The most common Peri-op complications were wound (n = 16, 6.2%) and pulmonary issues (n = 28, 10.9%), specifically deep infections (n = 12, 4.7%) and prolonged ventilator support (n = 21, 8.2%). Delayed complications (n = 28, 10.9%) were primarily deep infections (n = 8, 3.1%) and instrumentation-related (n = 6, 2.3%). There were 42 additional surgeries for an overall unplanned return to the operating room rate of 16% (Peri-op: 8.6%, Delayed: 7.8%). Thirty-six (14.0%) reoperations were spine related surgeries (wound or instrumentation-related). Eleven (4.3%) patients died between 3 months to 5.6 years postoperatively; 4 occurred ≤ 1 year of surgery. Two deaths were directly related to the spinal deformity surgery. Conclusion Spinal deformity surgery in CP patients with greater than 2 years of follow-up have a postoperative major complication rate of 36% with a spine-related reoperation rate of 14.0%. Level of evidence Therapeutic-IV.

Prospective cohort review. To compare two AIS databases to determine if a performance improvement-based surgeon group has different outcomes compared to a national database. The American College of Surgeon’s National Quality Improvement Program (ACS-NSQIP) and a surgeon study group (SG) collect prospective data on AIS surgery outcomes. NSQIP offers open enrollment to all institutions, and SG membership is limited to 15 high-volume institutions, with a major initiative to improve surgeon performance. While both provide important outcome benchmarks, they may reflect outcomes that are not relatable nationwide. The ASC-NSQIP Pediatric Spine Fusion and SG database were queried for AIS 30- and 90-day complication data for 2014 and 2015. Prospective enrollment and a dedicated site coordinator with rigorous data quality assurance protocols existed for both registries. Outcomes were compared between groups with respect to superficial and deep surgical site infections (SSI), neurologic injury, readmission, and reoperation. There were a total of 2927 AIS patients included in the ASC-NSQIP data and 721 in the SG database. Total complication rate was 9.4% NSQIP and 3.6% SG. At 90 days, there were fewer surgical site infections reported by SG than ASC-NSQIP (0.6% vs. 1.6%, p = 0.03). Similarly, there were less spinal cord injuries (0.8% vs 1.5%, p = 0.006), 30-day readmissions (0.8% vs. 2.6%, p = 0.002), and 30-day reoperations (0.6% vs. 1.7%, p = 0.02) in the SG cohort. Comparison of these two data sets suggests a range of complications and readmission rates, with the SG demonstrating lower values. These results are likely multi-factorial with the performance improvement initiative of the SG playing a role. Understanding the rate and ultimate risk factors for readmission and complications from big data sources has the potential to further drive quality improvement. III.

Retrospective. To determine how the pre- and postoperative three-dimensional (3D) sagittal profiles of Lenke 5 curves in idiopathic scoliosis patients compare to unaffected controls. Prior research evaluating the sagittal plane of Lenke 5 (thoracolumbar/lumbar) curves in 2D suggests that the major curve is hypolordotic. Patients with Lenke 5 curves treated with thoracolumbar/lumbar posterior fusion who had biplanar radiography (with 3D reconstruction) preoperatively (Pre) and 2+ years postoperatively (PO2Y) were included. A cohort of similarly aged controls (C) without spinal pathology was identified. The following 3D sagittal measurements were compared both pre- and postoperatively to controls: T1–T10, T10–L3, L3–S1, and pelvic incidence (PI). Kyphosis is designated by positive values, and lordosis by negative values. Nineteen Lenke 5 patients and 125 controls were included. Preoperatively, Lenke 5 patients were hypokyphotic relative to controls from T1 to T10 (30° ± 13° vs. 42° ± 9°, p

Retrospective study. To analyze the relationships between three-dimensional (3D) measurements of spinal deformity and Scoliosis Research Society-22 (SRS-22) scores in preoperative patients with major thoracic adolescent idiopathic scoliosis (AIS). Previous studies reported 2D measurements were not or only weakly correlated with preoperative SRS-22 scores. However, 2D measures do not always accurately represent the 3D deformity. A multicenter prospective registry of surgically treated AIS patients was reviewed for patients with right major thoracic AIS (Lenke type 1–4) who underwent biplanar radiography and completed the SRS-22 questionnaire preoperatively. For the 3D measurements, two reference frames were utilized: global (gravity/patient-based) and local (vertebra/disc-based). To obtain regional measurements, the individual segments in the appropriate reference plane were summed between the levels of interest. Patients were divided into two groups for each SRS-22 domain according to their scores: low (

Retrospective. Utilize three-dimensional (3D) measurements to assess the relationship between thoracic scoliosis severity and thoracic kyphosis in a large, multicenter cohort, and determine impact of 3D measurements on adolescent idiopathic scoliosis (AIS) curve classification. Research has demonstrated differences in two-dimensional (2D) and 3D assessment of the sagittal plane deformity in AIS. A prior smaller, single-institution study demonstrated an association between scoliosis severity and loss of 3D thoracic kyphosis. Data included retrospective compilation of prospectively enrolled bracing candidates and prospectively enrolled surgical candidates with thoracic AIS. Analysis included two groups based on thoracic curve magnitude: moderate (20–45°) and severe (> 45°). Imaging was performed using 2D radiographs. 3D thoracic kyphosis was calculated using a 2D to 3D conversion formula. Kyphosis was categorized according to the Lenke classification sagittal plane modifier. Analysis included 3032 patients. 2D kyphosis was significantly less in the moderate group (21 ± 12 vs 23 ± 14, p = 0.028). However, estimated 3D kyphosis was significantly greater in the moderate group (13 ± 10 vs 5 ± 12, p

STUDY DESIGN Retrospective. OBJECTIVE To evaluate the effect of preoperative rod shape on 3D spinal deformity correction. SUMMARY OF BACKGROUND DATA Differential rod contouring is a surgeon-dependent process based on an estimate of 3D deformity correction sought and the flexibility of the spine. An objective measure to this otherwise subjective scoliosis correction technique is lacking. METHODS A series of adolescent idiopathic scoliosis (AIS) patients with right, thoracic major curves, preoperative rod contour tracings, and EOS imaging was evaluated. All patients underwent posterior spinal fusion with 5.5 mm steel rods contoured prior to insertion. 3D reconstructions were generated pre- and postoperatively using sterEOS software (EOS Imaging) and imported into MATLAB (Mathworks) for analysis. A new measurement of the maximum perpendicular distance from the preinsertion concave rod contour to the preoperative 3D sagittal spinal reconstruction was defined as rod to 3D spine distance (RSD). Linear regressions were used to identify relationships between pre and postoperative parameters, including RSD and 3D thoracic kyphosis. RESULTS Ninety-nine patients were included. Average preoperative concave rod angle decreased from (48 ± 10°) preoperatively to 26 ± 6° postoperatively (P

Retrospective review of a prospectively collected multicenter registry of pediatric patients with cerebral palsy (CP) and neuromuscular scoliosis (NMS) undergoing spinal fusion. To define risk factors for unplanned readmission after elective spinal deformity surgery. Patients with CP and NMS have high rates of hospital readmission; however, risk factors for readmission are not well established. Univariate and multivariate analyses were used to compare the demographics, operative and postoperative course, radiographic characteristics, and preoperative Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaires of patients who did not require readmission to those who required either early readmission (within 90 days of the index surgery) or late readmission (readmission after 90 days). Of the 218 patients identified, 19 (8.7%) required early readmission, while 16 (7.3%) required late readmission. Baseline characteristics were similar between the three cohorts. On univariate analysis, early readmission was associated with longer duration of surgery (p

Multiple studies have reported on the risks and preventative measures associated with acute surgical site infection (SSI) in patients with adolescent idiopathic scoliosis (AIS). Few studies have evaluated treatment and results. The purpose of this study was to evaluate the need for development of best practice guidelines based on the management of an acute SSI across 9 different centers. A prospectively collected, multicenter database of patients undergoing surgical correction of AIS was reviewed for all acute SSI. Infection characteristics, treatment methods, and outcomes were summarized. Twenty-three (0.6%) from a total of 3926 AIS patients were treated for an acute SSI, all of which resolved. Twenty patients had documentation of the infection treatment (10 deep infections, 10 superficial). All ten patients with deep infections underwent operative incision and drainage. Six patients ultimately found to have a superficial infection underwent I&D and another 3 had dressing changes in the office. In the deep group, one patient had instrumentation exchanged and seven patients had bone graft removed. All 16 patients who underwent operative I&D had cultures obtained with 11 positive cultures. All deep infection patients were started on IV antibiotics for 2 days to 6 weeks prior to conversion to oral antibiotics. Five of six operative superficial infections were begun on IV antibiotics with conversion to oral antibiotics. Total antibiotic administration ranged from 5 days to 7 months in the deep infection group and 1 to 6 weeks in the superficial group. While deep infections are consistently treated with I&D, there is significant variability in the surgical and medical management of acute SSI. Considering the universal resolution of the infection, there is opportunity for the development of BPG to minimize treatment morbidity and cost, while optimizing outcomes for this major complication. Therapeutic-IV.

Retrospective analysis of consecutive cases. To identify clinically relevant three-dimensional (3D) sub-groups for adolescent idiopathic scoliosis (AIS). Classifications for AIS are developed to assist surgeons in surgical planning and therapeutic management. However, current systems are based on two-dimensional (2D) parameters that do not completely describe the 3D deformity. Hence, variations in surgical results based on pre-operative 2D classifications may be attributed to the lack of 3D description. Subjects from a multicenter database of AIS patients were included in this study. All patients had bi-planar radiographs and 3D reconstruction of the entire spine. A clustering algorithm based on fuzzy c-means was utilized to identify sub-groups based on the following ten parameters measured on 3D reconstructions of the spine: Cobb angle, orientation of the plane of maximum curvature of the proximal thoracic, mid-thoracic (MT) and thoracolumbar (TLL) levels, axial rotation of the apical vertebra of the MT and TLL segments, T4–T12 thoracic kyphosis, and L1–S1 lumbar lordosis. Da Vinci views were also generated and analyzed for each patient in the study. A panel of four experienced spine surgeons from the SRS 3D Scoliosis Committee reviewed and evaluated each group to determine if cluster groups were clinically distinct from each other. The clustering algorithm was able to detect 11 sub-groups. The population size for each cluster varied from 11 to 290. Statistically significant differences were seen between the parameters for each group. Four spine surgeons reviewed the three most representative cases of each group and unanimously agreed that each cluster group represents a sub-group that was not defined in current classifications. This study presents a new method of classifying AIS based on a fuzzy clustering algorithm using parameters describing the 3D characteristics of the deformity. Further clinical validation is needed to confirm the usefulness of this classification system. IV.

Traditionally, adolescent idiopathic scoliosis (AIS) has not been associated with back pain, but the increasing literature has linked varying factors between pain and AIS and suggested that it is likely underreported. Our objective was to investigate factors associated with post-op pain in AIS. A prospectively collected multicenter registry was retrospectively queried. Pediatric patients with AIS having undergone a fusion with at least 2 years of follow-up were divided into two groups: (1) patients with a postoperative SRS pain score ≤ 3 or patients having a reported complication specifically of pain, and (2) patients with no pain. Patients with other complications associated with pain were excluded. Of 1744 patients, 215 (12%) experienced back pain after postoperative recovery. A total of 1529 patients (88%) had no complaints of pain, and 171 patients (10%) had pain as a complication, with 44 (2%) having an SRS pain score ≤ 3. The mean time from date of surgery to the first complaint of back pain was 25.6 ± 21.6 months. In multivariate analysis, curve type (16% of Lenke 1 and 2 curves vs. 10% of Lenke 5 and 6, p = 0.002) and a low preoperative SRS pain score (no pain 4.15 ± 0.67 vs. pain 3.75 ± 0.79, p

Prospective, quality-improvement. To evaluate pain management following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and Scheuermann’s Kyphosis (SK) determine the optimal opioid and benzodiazepine prescription amounts, and implement a multimodal post-operative pain regimen. The incidence of prescription opioid abuse is increasing in the United States. Orthopedic spine surgeons often prescribe large quantities of opioids post-operatively for pain control. Previous efforts on pain control have focused on in-patient post-operative regimens after PSF. Between 2/1/17 and 5/30/18 patients with AIS or SK were sent home with pain diaries after discharge to document daily narcotic, benzodiazepine, non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen and gabapentin use following PSF. Diaries were collected at the 4 week post-operative visit. Data from two cohorts were reviewed: pre-intervention and post-intervention. Our prescription intervention went into effect 9/1/17. Twenty-four (30%) patients returned pain diaries. The pre-intervention cohort consisted of 12 patients (7 female; 5 males; 14.9 years (range 12–19)). Patients were prescribed on average 80 × 5 mg tabs (26–140) of oxycodone but used on average 45 tabs (12–129) over an average of 17.5 days (9–33). They were prescribed an average of 30 × 2 mg tabs (0–150) of diazepam, used on average 4.8 (0–105) tabs over 12.5 (5–25) days. The post-intervention cohort consists of 12 patients (9 female; 3 male; 14.8 years (12–19)). They were prescribed on average 50 × 5 mg tabs (35–80) of oxycodone, used 20.5 (0–39.5) tabs over 8.5 days (3–16). They were prescribed on average 18 × 2 mg tabs of diazepam (0–43), used 5.4 tabs (0–19) over 10 days (5–14). This analysis has directly impacted clinical practice. Prescribed opioid and benzodiazepine doses have been decreased by over 50%, and more resources are being directed towards determining the disparity between the amount of medications prescribed and consumed in our post-operative patients.

Traditionally, 2-year follow-up data have been the established standard for reporting clinical outcomes following spinal deformity surgery. However, previous studies indicate that 2-year follow-up does not represent long-term outcomes. Currently, there is no clear data that demonstrate a difference in outcomes between the 1 and 2 years postoperative time-periods following posterior spinal fusions (PSF) for adolescent idiopathic scoliosis (AIS).A multi-center, prospective database was queried for AIS patients treated with PSF. Clinical outcome scores, assessed by SRS-22, coronal and sagittal radiographic parameters were assessed at time periods: 6 months, 1 year, and 2 years post operatively. Complications and reoperation rates were also assessed. Statistical analysis compared outcomes variables across time-points to assess for significant differences.694 patients (82.6% female, mean age at surgery 14.9 ± 2.13 years) were identified. Between post-operative year 1 and 2, significant difference in SRS-22 domain scores were present for function domain (4.5 vs. 4.6; p 0.001), mental health domain (4.3 vs. 4.2; p 0.001), and total domain score (4.4 vs. 4.4; p = 0.03) but were below the minimal clinically important difference threshold. New complication development was significantly higher within the first year following surgery than the 1-2 year follow-up period (p 0.001) with greater complication severity within the 0-1 year follow-up period (P = 0.03).There are no clinically important changes in SRS-22 domain scores between 1 and 2 years following PSF for AIS, with higher complications in the first year following PSF. Two-year follow-up data provide little added clinical information while under-estimating the cumulative complication and reoperation rates at long-term follow-up.

As 2-year follow-up may not be sufficient to assess the risk of curve progression following fusion in immature patients with adolescent idiopathic scoliosis (AIS), this study reports on 5-year outcomes of AIS patients, factoring in maturity and surgical approach, to determine whether immature patients are at risk of continued curve progression beyond 2 years.A multicenter database was reviewed for AIS patients who underwent spinal fusion with pedicle screw fixation and who had both 2 and 5-year follow-up. Radiographic and SRS-22 scores were compared between three groups: open triradiate cartilage-posterior fusion (OTRC-P), OTRC-combined anterior/posterior fusion (OTRC-APSF), and closed TRC (CTRC, matched to OTRC-P group).142 subjects were included (67 OTRC-P, 8 OTRC-APSF, 67 CTRC). Main curve type (p = 0.592) and size (p = 0.117) were not different between groups at all timepoints. Compensatory curve size was similar at all timepoints for OTRC-P and CTRC, with a slight increase for OTRC-APSF from immediate postoperative to 5 years. At 5 years, OTRC-P had 10° loss of correction in 25% of patients, which was greater than in the CTRC (6%) and OTRC-APSF (0%) groups (p = 0.002). No significant differences were found in loss of correction of the compensatory curve or in SRS-22 scores between groups.Compared to those with CTRC and those treated with anterior/posterior fusion, patients with OTRC treated with posterior fusion had an increased risk of main curve progression greater than 10°, with some continued loss of correction after 2 years. This did not appear to affect patient-reported outcomes.