Incidence of complete spinal instrumentation removal following surgery for spinal deformity: a 22-year single institution study

The aim of this study was to define the incidence of complete implant removal following surgical correction of spinal deformity in pediatric patients over a 22-year period and identify possible risk factors. A retrospective review of our Pediatric Orthopedic Spine Database between 1992 and 2016 was performed. We included patients undergoing complete implant removal following scoliosis correction surgery with a minimum of 2-year follow-up. Medical charts were reviewed to determine initial patient diagnosis and the indication for implant removal. Statistical analysis was carried out to determine the associations between sex and factors such as primary diagnosis and indication for removal. A review of 1117 procedures in 1114 patients identified complete instrument removal in 52 (4.7%) patients (34 females and 18 males). Mean time to removal following surgery was 2.3 years (range: 0–5.9 years). Removal occurred in 24 of 548 (4.4%) patients with adolescent idiopathic scoliosis, four of 117 (3.4%) patients with juvenile idiopathic scoliosis, 11 of 287 (3.8%) patients with neuromuscular scoliosis, and three of 79 (3.8%) patients with syndromic scoliosis. Infection was the most common indication for complete implant removal [24 (46%) patients], followed by persistent pain [8 (15%) patients], and metal intolerance [8 (15%) patients]. There were two cases of early infection (
Source: Journal of Pediatric Orthopaedics B - Category: Orthopaedics Tags: SPINE Source Type: research

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Conclusion. Anxiety and mood are potentially modifiable risk factors that have the greatest impact on pre- and postoperative pain. These results can be used to identify higher-risk patients and develop preoperative therapeutic protocols to improve postoperative outcomes. Level of Evidence: 3
Source: Spine - Category: Orthopaedics Tags: DEFORMITY Source Type: research
ConclusionThe surgical treatment of postirradiation kyphotic spinal deformity is challenging, with common postoperative complications such as infection, instrumentation failure, and pseudarthrosis. However, with modern surgical techniques and spinal instrumentation, excellent deformity correction can be achieved and maintained. We recommend performing a two-stage procedure for cervicothoracic deformity, with anterior release followed by posterior fusion and instrumentation. In thoracolumbar deformities, correction can be achieved through single-stage posterior fusion. Rigid spinopelvic fixation with sacral-alar-iliac screw...
Source: Spine Deformity - Category: Orthopaedics Source Type: research
Publication date: November 2019Source: Spine Deformity, Volume 7, Issue 6Author(s): Jussi P. Repo, Ville T. Ponkilainen, Arja H. Häkkinen, Jari Ylinen, Paula Bergman, Kati KyröläAbstractStudy DesignObservational cohort study.ObjectivesTo measure and compare the structural validity of the Oswestry Disability Index (ODI) and the Scoliosis Research Society–30 (SRS-30) questionnaire in an adult population with prolonged degenerative thoracolumbar disease.Summary of Background DataThe ODI and the SRS-30 are commonly used patient-reported outcome instruments to assess back-specific disability and symptoms re...
Source: Spine Deformity - Category: Orthopaedics Source Type: research
Publication date: November 2019Source: Spine Deformity, Volume 7, Issue 6Author(s): Tracey P. Bastrom, Carrie E. Bartley, Peter O. Newton, Harms Study GroupAbstractStudy DesignObservational.ObjectiveTo examine changes in patient-reported two-year postoperative outcomes via the Scoliosis Research Society (SRS)-24 Outcomes Instrument from 2001 through 2015.Summary of Background DataTechniques for correction of adolescent idiopathic scoliosis (AIS) have evolved over the years, but it is unclear how these changes have impacted patient-reported outcomes.MethodsAIS patients with two-year postoperative follow-up from a prosp...
Source: Spine Deformity - Category: Orthopaedics Source Type: research
ConclusionThe case reported, herein, demonstrates the feasibility of SA in elderly patients undergoing lengthy complex lumbar surgeries who have been designated “high-risk” patients (ASA > II) and provides support for future investigation into surgical and anesthesia treatment options for geriatric high-risk patients presenting with complex lumbar spine pathologies.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
ConclusionsSpinal LGG is a rare entity with significant long-term effects. Although surgery is the most common initial treatment option, more in-depth analysis of molecular biomarkers may improve stratification and prognostication.
Source: Journal of Neuro-Oncology - Category: Cancer & Oncology Source Type: research
ConclusionOur meta-analysis suggested that long fusion terminating at L5 or the sacrum was similar in scoliosis correction, overall complication rate, revision rate, and improvement in pain and disability. However, fusion to L5 had advantages in lower rate of pseudarthrosis, implant-related complications, and proximal adjacent segment disease, while fusion to the sacrum had advantages in the restoration of lumbar lordosis, maintenance of sagittal balance, and absence of distal adjacent segment disease.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.
Source: European Spine Journal - Category: Orthopaedics Source Type: research
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 5th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Ano...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: opioid pain rosielle The profession Source Type: blogs
This study sought to define the range of PROMIS mobility, pain interference, and peer relationships scores for adolescents treated for AIS. Furthermore, correlations between these domains and equivalent domains in the legacy PRO, SRS-22, were determined. Methods. Pediatric PROMIS and SRS-22 were obtained at routine clinical visits for AIS at a tertiary care children's hospital from January 2017 to October 2017. Spearman correlations were performed to examine the associations between three pediatric PROMIS domains and the SRS-22 domains. Only patients who completed both PRO measures were included in the analyses. Radiogr...
Source: Spine - Category: Orthopaedics Tags: DEFORMITY Source Type: research
This study aims to characterize the anesthetic management and perioperative outcomes of AVT and traditional posterior spinal fusion (PSF) after establishing the technique at our institution. Scoliosis correction procedures performed in patients aged 10 to 21 years between January 2014 and August 2017 were identified in the electronic medical record. Patient characteristics and perioperative data about anesthetic use and pain management were extracted. Descriptive statistics were generated. Thirty-five patients undergoing AVT and 40 patients undergoing PSF met inclusion criteria. Preoperative fluoroscopy-guided epidural pla...
Source: AANA Journal - Category: Anesthesiology Authors: Tags: AANA J Source Type: research
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