Notes

Continuing Education associated with Animal Physicians within Uganda: A dog training Wants Review.
Prospective case series.

Determine the efficacy of anterior vertebral body tethering (AVBT) in skeletally immature patients.

The value of AVBT is currently unclear given the paucity of available data.

Consecutive skeletally immature patients with idiopathic scoliosis were treated with AVBT between 2012 and 2018 by one of two surgeons working at two independent centres and followed up for >2 years. Data was collected prospectively and supplemented retrospectively where necessary. Outcomes were measured preoperatively, at first erect radiograph (FE), 1-year postoperatively and at most recent follow up (FU).

112 patients underwent 116 primary tethering procedures (108 thoracic & 8 lumbar tethers). Four patients had primary tethering of both lumbar and thoracic curves. At surgery mean age was 12.7 ± 1.4 years (8.2-16.7) and Risser 0.5 ± 0.9 (0 to 3). Follow up was mean 37 ± 9 months (15-64). Preoperative mean coronal Cobb angle of the 130 tethered curves was 50.8° ± 10.2 (31 to 81) and corrected ure cases is associated with satisfactory deformity correction in the majority of cases. However, complication and revision rates suggest the need for improved implants and patient selection. Long-term follow-up remains crucial to establish the true efficacy of this procedure.Level of Evidence 3.
Retrospective observational study.

To investigate the spinal cord safety margins for C2 instrumentation.

Intraoperative spinal cord injury during C2 spine surgery is a rare, but potentially life-threatening complication. Pre-operative planning for C2 instrumentation mainly focuses on C2 pedicle bony dimensions on CT and the vertebral artery location and few studies have evaluated C2 spinal cord safety margins.

We measured two distances in C2 bilaterally 1) C2 pedicle to dura distance (P-D), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and the dural sac, 2) C2 pedicle to spinal cord (P-SC), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and spinal cord. We defined the distances above 4 mm as safe for instrumentation.

A total of 146 patients (mean age 71.2, 50.7% female) were included. The average distances were 5.5 mm for C2 left P-D, 5.9 mm for C2 right P-D, 10.1 mm for C2 left P-SC and 10.6 mm for C2 right P-SC. Twenty eight (21.4%) patients had C2 P-D distances under 4 mm and out of those 2 (7%) patients had distances under 2 mm. There were more female patients with C2 P-D distances under 4 mm compared to males. No patient had C2 P-SC distances under 4 mm.

We demonstrated that around 20% of patients had C2 P-D distance below 4 mm, but no patient had C2 P-SC distance less than 4 mm. Since a lateral misplacement can lead to a potentially fatal vertebral artery injury, medial screw trajectory is recommended for C2 pedicle instrumentation with consideration of these safety margins.Level of Evidence 3.
We demonstrated that around 20% of patients had C2 P-D distance below 4 mm, but no patient had C2 P-SC distance less than 4 mm. Since a lateral misplacement can lead to a potentially fatal vertebral artery injury, medial screw trajectory is recommended for C2 pedicle instrumentation with consideration of these safety margins.Level of Evidence 3.
Retrospective-comparative; LOE-3.

The purpose of this study was to investigate what effect, if any, an institutional opioid reduction prescribing policy following 1-or-2-level lumbar fusion has on Hospital-Consumer-Assessment-of-Healthcare-Providers-and-Systems-(HCAHPS)-survey results.

Prior research has demonstrated that high levels of opioid-prescribing may be related, in part, to a desire to produce superior patient satisfaction.

A retrospective review of prospectively-collected data was conducted on patients who underwent 1-or-2-level lumbar fusions L3-S1 between October 2014-October 2019 at a single institution. Patients with complete survey information were included in the analysis. Patients with a history of trauma, fracture, spinal deformity, fusions > 2 levels, or prior lumbar fusion surgery L3-S1 were excluded. Cohorts were based on date of surgery relative to implementation of an institutional opioid reduction policy, which commenced in October 1, 2018. To better compare groups, opioid pduction in opioids prescribed at discharge after 1-or-2-level lumbar fusion is not associated with any statistically significant change in patient satisfaction with pain management, as measured by the HCAHPS survey.Level of Evidence 3.
A reduction in opioids prescribed at discharge after 1-or-2-level lumbar fusion is not associated with any statistically significant change in patient satisfaction with pain management, as measured by the HCAHPS survey.Level of Evidence 3.
Several options for grafting exist; iliac crest bone grafting, allografts, and bone substitutes. Local bone graft (LBG) offers high-quality bone graft and no commercial cost. The aim of this study was to assess the clinical and radiologic results of adolescent idiopathic scoliosis (AIS) surgery with posterior instrumentation and fusion (PIF) in patients using only LBG and to measure the quantities harvested.

A total of 218 AIS patients who underwent pedicle screw PIF surgery using only LBG with a minimum 1-year follow-up were reviewed. Bone was harvested during surgery from the excised facet joints, spinous processes (not from the end instrumented vertebrae) and decortication of laminae and transverse processes in the operative field. The harvested bone graft weight of 127 patients was recorded prospectively and then computed to graft weight per kilogram body weight (GWPK) and graft weight per motion segment (GWPMS).

The median follow-up time was 24.7 months (12.1 to 133 mo) with 128 of the 218 patients having over 2 years follow-up. A total of 280 curves were fused. One hundred fifty-six of the patients had single curve instrumentation and 62 had double curve surgery. The median preoperative primary Cobb angle was 57.0 (31 to 100) degrees and postoperatively was 20.0 (0 to 66) degrees, indicating a median correction of 65.3% (17.5% to 100%). selleck kinase inhibitor The median graft weight was 30 g (14 to 62 g), GWPK was 0.54 g/kg (0.24 to 1.29 g/kg) and GWPMS was 3.3 g/motion segments (2.3 to 10.0 g/kg). Twelve of 218 patients (5.5%) required subsequent surgery. Only 2 patients developed pseudarthrosis (0.91%), noting that modern segmental instrumentation warrants longer follow-up for increased confidence of complete fusion.

LBG achieved successful fusion in over 99% of patients undergoing PIF for AIS. The described terms GWPK and GWPMS can be insightful for future studies. LBG offers a safe and low-cost solution for bone grafting in AIS surgery.

Level IV.
Level IV.
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