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Willingness to enroll in a surgical randomized controlled trial: patient and parent preferences regarding implant density for adolescent idiopathic scoliosis fusion

Larson, A. Noelle ; Floccari, Lorena V. ; Garg, Sumeet ; [et al.]

Springer Science and Business Media LLC ; 2020

In: Spine Deformity Vol. 8, No. 5 ( 2020-10), p. 957-963

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In: Spine Deformity, Springer Science and Business Media LLC, Vol. 8, No. 5 ( 2020-10), p. 957-963

Type of Medium: Online Resource

ISSN: 2212-134X , 2212-1358

URL: Article

DOI: 10.1007/s43390-020-00143-z

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2020

detail.hit.zdb_id: 2717704-X

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Best Practice Guidelines for Surgical Site Infection in High-risk Pediatric Spine Surgery: Definition, Prevention, Diagnosis, and Treatment

Badin, Daniel ; Leland, Christopher R. ; Matsumoto, Hiroko ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2022

In: Journal of Pediatric Orthopaedics Vol. 42, No. 10 ( 2022-11), p. e1008-e1017

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In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 10 ( 2022-11), p. e1008-e1017

Abstract: 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. Materials and Methods: 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. Results: 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. Conclusions: 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. Level of Evidence: Not applicable.

Type of Medium: Online Resource

ISSN: 0271-6798

URL: Article

DOI: 10.1097/BPO.0000000000002255

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2022

detail.hit.zdb_id: 2049057-4

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Growth-preserving instrumentation in early-onset scoliosis patients with multi-level congenital anomalies

Clement, R. Carter ; Yaszay, Burt ; McClung, Anna ; [et al.]

Springer Science and Business Media LLC ; 2021

In: Spine Deformity Vol. 9, No. 5 ( 2021-09), p. 1491-1491

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In: Spine Deformity, Springer Science and Business Media LLC, Vol. 9, No. 5 ( 2021-09), p. 1491-1491

Type of Medium: Online Resource

ISSN: 2212-134X , 2212-1358

URL: Article

DOI: 10.1007/s43390-021-00370-y

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2021

detail.hit.zdb_id: 2717704-X

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The Effect of Implant Density on Adolescent Idiopathic Scoliosis Fusion : Results of the Minimize Implants Maximize Outcomes Randomized Clinical Trial

Larson, A. Noelle ; Polly, David W. ; Sponseller, Paul D. ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2024

In: Journal of Bone and Joint Surgery Vol. 106, No. 3 ( 2024-2-7), p. 180-189

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In: Journal of Bone and Joint Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 106, No. 3 ( 2024-2-7), p. 180-189

Abstract: Severe adolescent idiopathic scoliosis (AIS) can be treated with instrumented fusion, but the number of anchors needed for optimal correction is controversial. Methods: We conducted a multicenter, randomized study that included patients undergoing spinal fusion for single thoracic curves between 45° and 65°, the most common form of operatively treated AIS. Of the 211 patients randomized, 108 were assigned to a high-density screw pattern and 103, to a low-density screw pattern. Surgeons were instructed to use ≥1.8 implants per spinal level fused for patients in the high-implant-density group or ≤1.4 implants per spinal level fused for patients in the low-implant-density group. The primary outcome measure was the percent correction of the coronal curve at the 2-year follow-up. The power analysis for this trial required 174 patients to show equivalence, defined as a 95% confidence interval (CI) within a ±10% correction margin with a probability of 90%. Results: In the intention-to-treat analysis, the mean percent correction of the coronal curve was equivalent between the high-density and low-density groups at the 2-year follow-up (67.6% versus 65.7%; difference, −1.9% [95% CI: −6.1%, 2.2%]). In the per-protocol cohorts, the mean percent correction of the coronal curv e was also equivalent between the 2 groups at the 2-year follow-up (65.0% versus 66.1%; difference, 1.1% [95% CI: −3.0%, 5.2%]). A total of 6 patients in the low-density group and 5 patients in the high-density group required reoperation (p = 1.0). Conclusions: In the setting of spinal fusion for primary thoracic AIS curves between 45° and 65°, the percent coronal curve correction obtained with use of a low-implant-density construct and that obtained with use of a high-implant-density construct were equivalent. Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Type of Medium: Online Resource

ISSN: 0021-9355 , 1535-1386

URL: Article

DOI: 10.2106/JBJS.23.00178

RVK:

XA 52200.A

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2024

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