lumbar surgeries, history of significant trauma, or significant coronal or sagittal deformity. Treatment strategies consisted of segmental interbody fusion at the level of spondylolisthesis combined with percutaneous short-segment pedicle screw fixation without posterior decompression. Data Collection The clinical data consisted of visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, estimated periprocedural blood loss, length of surgery, and length of stay. Radiographic measurements of the degrees of anterolisthesis, segmental lordosis, and overall
Minimally invasive anterior and lateral transpsoas approaches for closed reduction of grade II spondylolisthesis: initial clinical and radiographic experience
David S. Xu, Konrad Bach, and Juan S. Uribe
The case for T2 pedicle subtraction osteotomy in the surgical treatment of rigid cervicothoracic deformity
Frank J. Yuk, Jonathan J. Rasouli, Marc S. Arginteanu, Alfred A. Steinberger, Frank M. Moore, Kevin C. Yao, John M. Caridi, and Yakov Gologorsky
measured in the sagittal plane through many different indexes. Measurement of cervical lordosis is less appropriate in these patients, as cervical lordosis may be maintained, with the kyphotic deformity occurring more caudally. Cobb angle measurements spanning the cervicothoracic junction have commonly been described. These radiographic measurements are also useful in determining the level of correction achieved after corrective surgery. The most common index currently used, however, is the C2–7 SVA. 6 In an ideally balanced spine, the C2–S1 SVA should be less than 5 cm
Cervical radiographic parameters in 1- and 2-level anterior cervical discectomy and fusion
Christopher C. Gillis, Megan C. Kaszuba, and Vincent C. Traynelis
after 1- to 4-level ACDF with nonlordotic allografts failed to show any statistically significant difference between the preoperative and 2-year postoperative radiographic measurements of segmental lordosis or overall cervical lordosis in 101 patients. 3 Despite widespread use, the impact of lordotic allografts on radiographic alignment after 1-level ACDF (ACDF1) and 2-level ACDF (ACDF2) has not been fully examined. The current understanding of cervical lordosis and the correction of cervical deformity continues to evolve. Kyphosis is the most common cervical
Clinical outcomes of the traditional dual growing rod technique combined with apical pedicle screws in the treatment of early-onset scoliosis: preliminary results from a single center
Yang Yang, Zhe Su, Shengru Wang, You Du, Yiwei Zhao, Guanfeng Lin, Xiaohan Ye, Nan Wu, Qianyu Zhuang, and Terry Jianguo Zhang
. Radiographic measurements included the Cobb angle of the main curve, apical vertebral translation (AVT), apical vertebral rotation (AVR), T1–12 height, T1–S1 height, space available for the lung (SAL) (i.e., concave hemithorax height/convex hemithorax height ratio), 18 upper thoracic kyphosis (T2–5), thoracic kyphosis (TK, T5–12), thoracolumbar kyphosis (T10–L2), lumbar lordosis (L1–S1), proximal junctional angle, trunk shift, and sagittal vertical axis. Proximal junctional kyphosis (PJK) was defined as a proximal junctional angle ≥ 10° and ≥ 10° greater than the preindex
Evaluation of coronal alignment from the skull using the novel orbital–coronal vertical axis line
Scott L. Zuckerman, Hani Chanbour, Fthimnir M. Hassan, Christopher S. Lai, Yong Shen, Nathan J. Lee, Mena G. Kerolus, Alex S. Ha, Ian A. Buchanan, Eric Leung, Meghan Cerpa, Ronald A. Lehman Jr., and Lawrence G. Lenke
– 10 and even 5 cm, 11 yet most prior studies use a threshold value of 3 cm. 8 , 12 , 13 Postoperative CM has also been associated with decreased patient-reported outcomes (PROs) and increased rates of revision surgery. 2 – 4 , 8 An empirical vacuum exists regarding the optimal method to evaluate coronal alignment, how coronal alignment affects outcomes, and surgical goals to correct CM. 2 , 5 , 6 , 14 The C7-CVA has been the standard to measure alignment in the coronal plane, and radiographic measurements evaluating coronal alignment above C7 are lacking. The
Does relocation of the apex after osteotomy affect surgical and clinical outcomes in patients with ankylosing spondylitis and thoracolumbar kyphosis?
Zhuo-jie Liu, Bang-ping Qian, Yong Qiu, Sai-hu Mao, Jun Jiang, and Bin Wang
laminectomy, maintaining the already obtained kyphosis correction. However, when neurological complications were confirmed, reducing the kyphosis correction even after extensive decompression was considered for a better chance of recovery. Radiographic Measurements and Clinical Assessment The radiographic evaluation was performed using full-length freestanding lateral spine radiographs obtained prior to surgery, immediately after surgery, and at the last follow-up. The following spinopelvic parameters were measured: 1) global kyphosis (GK, the Cobb angle between the
Longitudinal assessment of segmental motion of the cervical spine following total disc arthroplasty: a comparative analysis of devices
Matthew W. Colman, Athan G. Zavras, Vincent P. Federico, Michael T. Nolte, Alexander J. Butler, Kern Singh, and Frank M. Phillips
. Exclusion criteria were patients younger than 18 years; those treated for trauma, tumor, or infection; and patients undergoing nontraditional TDA including hybrid configurations. The medical records of all patients were reviewed for baseline demographics and procedural characteristics. Patients were grouped based on the TDA device with which they were implanted. Radiographic Outcomes Radiographic measurements were performed using the preoperative, 2 months postoperative, and final postoperative lateral cervical radiographs (static, flexion, and extension). On
Surgical correction of severe adult lumbar scoliosis (major curves ≥ 75°): retrospective analysis with minimum 2-year follow-up
Thomas J. Buell, Ching-Jen Chen, James H. Nguyen, Peter A. Christiansen, Saikiran G. Murthy, Avery L. Buchholz, Chun-Po Yen, Mark E. Shaffrey, Christopher I. Shaffrey, and Justin S. Smith
categorical variables. The normality of data was assessed using the Shapiro-Wilk test. Univariate radiographic measurement analyses included the paired samples t-test or Wilcoxon signed-rank test, when appropriate. For comparing curve flexibility between independent groups, the nonparametric Mann-Whitney U-test was utilized. HRQL measurements were analyzed with the nonparametric Wilcoxon signed-rank test. All tests were two-tailed, and p values < 0.05 were considered statistically significant. Statistical analyses were performed using Statistical Package for Social Science
A telescopic ventriculoatrial shunt that elongates with growth
Burton L. Wise
✓ A ventriculoatrial (VA) shunt catheter has been developed, based on a double telescopic principle, that elongates during longitudinal growth of the child. It is implanted in patients by a technique similar to that used for other VA shunts, with minor modifications. Radiopaque markers on the expandable portion of the shunt allow radiographic measurement of the “growth” of the shunt. These shunts have been implanted in 18 children with hydrocephalus; in 15 they continue to function, a duration of from 1 to 4 years. In eight this was the initial shunt, while in 10 others the telescopic shunt was implanted at the time of revision of a standard shunt. One additional special model was implanted directly in the auricle by thoracotomy and is functioning over 5 months later. This type of shunt may largely eliminate the need for prophylactic lengthening of VA shunts during growth and prevent the problem of distal shunt obstruction due to growth.
Need for standard outcome reporting systems in craniosynostosis
Caroline Szpalski, Katie Weichman, Fabio Sagebin, and Stephen M. Warren
Craniosynostosis is the premature fusion of one or more cranial sutures. When a cranial suture fuses prematurely, skull growth is altered and the head takes on a characteristic pathological shape determined by the suture(s) that fuses. Numerous treatment options have been proposed, but until recently there were no parameters or guidelines of care. Establishing such parameters was an important step forward in the treatment of patients with craniosynostosis, but results are still assessed using radiographic measurements, complication rates, and ad hoc reporting scales. Therefore, clinical outcome reporting in the treatment of craniosynostosis is inconsistent and lacks methodological rigor.
Today, most reported evidence in the treatment of craniosynostosis is level 5 (expert opinion) or level 4 (case series) data. Challenges in obtaining higher quality level 1 or level 2 data include randomizing patients in a clinical trial as well as selecting the appropriate outcome measure for the trial. Therefore, determining core outcome sets that are important to both patients and health care professionals is an essential step in the evolution of caring for patients with craniosynostosis.
Traditional clinical outcomes will remain important, but patient-reported outcomes, such as satisfaction, body image, functional results, and aesthetic outcomes, must also be incorporated if the selected outcomes are to be valuable to patients and families making decisions about treatment. In this article, the authors review the most commonly used tools to assess craniosynostosis outcomes and propose a list of longitudinal parameters of care that should be considered in the evaluation, diagnosis, and treatment evaluation of a patient with craniosynostosis.