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There were a lot of fairly interesting papers presented at the meeting this year. I've selected a few that I thought would be meaningful to note here:
#25-Clinical Improvement through Surgery for Adult Spinal Deformity: What can be Expected and Who is Likely to Benefit Most? - 29% of patients did not experience improvement following surgery. Patients with severe disability were more likely to perceive improvement than patients with less disability. (This is something I've been commenting on for years.)
#69-Ideiopathic Scoliosis Mutations in VANGL1, an Axial Development Gene - Carol Wise and her group have discovered the first causal mutation that implicates a specific developmental pathway in idiopathic scoliosis pathogenesis.
#73-The Natural History of Scheuermann's Kyphosis - a Comparative Study after 37-Year Follow-up - I mention this because of the significance of having 37 year follow-up of 49 patients. Conclusion: Patients with untreated Scheuermann's kyphosis have a significantly higher risk of having back pain than the general population. Symptoms, however, do not restrict their working ability or employment status.
#76-Rates and Causes of Mortality Associated with Spine Surgery Based on the SRS M&M Database
Results:
197 mortalities among 108,419 patients (1.9 deaths per 1,000 patients; 2.0/1000 for adults 1.3/1000 for pediatric) Note: Most of these deaths were in patients with high co-morbidities
#85-The Clinical Value of an Intermediate Risk Score with AIS Prognostic Test (ScoliScore)
Results: Data were available on 340 patients with intermediate risk AIS-PT scores. Clinical outcomes were compared by score decile. For the 34 patients with scores between 51-58, 1 patient progressed to a severe curve and only 3 patients progressed beyond 30 degrees. For the 34 patients in the highest decile (scores between 160-180), 25 patients progressed to a severe curve and 33 progress >30 degrees.
Conclusion: Within the intermediate score range, individual risks vary tremendously (>20 fold) based on the actual score observed.
#92-Recurrence of Rib Prominence (RRP) Following AIS Surgery with Pedicle Screws and Direct Vertebral Body Derotation
Conclusion: Recurrence of rib prominence after posterior fusion with all pedicle screw constructs and DVR occurred in 16% of patients. Those with open triradiate cartilage had a significantly higher rate of RRP , although most with RRP were skeletally mature. There was a trend towards loss of correction and increased AVR at 2 years in patients with RRP.
I think there have been several threads about the return of one's rib hump at some point after surgery.
#94-The Prevalence of Postoperative Pain in Adolescent Idiopathic Scoliosis and the Association with Preoperative Pain
Results: 11% of patients reported pain at or prior to their 2 year follow-up; 13 patients within 6 months postop; 48 patients between 6-24 months. 7% had no obvious cause for their pain.
#126-The Prevalence of Endocrine Abnormalities in Patients with Pseudarthorosis after Spinal Fusion
Conclusion: Patients with pseudarthrosis after spinal fusion surgery were noted to have a high prevalence of metabolic/endocrine abnormalities. Vitamin D inadequacy/deficiency and osteoporosis/osteopenia were the most common, but other abnormalities were seen in half of the patients.
#25-Clinical Improvement through Surgery for Adult Spinal Deformity: What can be Expected and Who is Likely to Benefit Most? - 29% of patients did not experience improvement following surgery. Patients with severe disability were more likely to perceive improvement than patients with less disability. (This is something I've been commenting on for years.)
#69-Ideiopathic Scoliosis Mutations in VANGL1, an Axial Development Gene - Carol Wise and her group have discovered the first causal mutation that implicates a specific developmental pathway in idiopathic scoliosis pathogenesis.
#73-The Natural History of Scheuermann's Kyphosis - a Comparative Study after 37-Year Follow-up - I mention this because of the significance of having 37 year follow-up of 49 patients. Conclusion: Patients with untreated Scheuermann's kyphosis have a significantly higher risk of having back pain than the general population. Symptoms, however, do not restrict their working ability or employment status.
#76-Rates and Causes of Mortality Associated with Spine Surgery Based on the SRS M&M Database
Results:
197 mortalities among 108,419 patients (1.9 deaths per 1,000 patients; 2.0/1000 for adults 1.3/1000 for pediatric) Note: Most of these deaths were in patients with high co-morbidities
#85-The Clinical Value of an Intermediate Risk Score with AIS Prognostic Test (ScoliScore)
Results: Data were available on 340 patients with intermediate risk AIS-PT scores. Clinical outcomes were compared by score decile. For the 34 patients with scores between 51-58, 1 patient progressed to a severe curve and only 3 patients progressed beyond 30 degrees. For the 34 patients in the highest decile (scores between 160-180), 25 patients progressed to a severe curve and 33 progress >30 degrees.
Conclusion: Within the intermediate score range, individual risks vary tremendously (>20 fold) based on the actual score observed.
#92-Recurrence of Rib Prominence (RRP) Following AIS Surgery with Pedicle Screws and Direct Vertebral Body Derotation
Conclusion: Recurrence of rib prominence after posterior fusion with all pedicle screw constructs and DVR occurred in 16% of patients. Those with open triradiate cartilage had a significantly higher rate of RRP , although most with RRP were skeletally mature. There was a trend towards loss of correction and increased AVR at 2 years in patients with RRP.
I think there have been several threads about the return of one's rib hump at some point after surgery.
#94-The Prevalence of Postoperative Pain in Adolescent Idiopathic Scoliosis and the Association with Preoperative Pain
Results: 11% of patients reported pain at or prior to their 2 year follow-up; 13 patients within 6 months postop; 48 patients between 6-24 months. 7% had no obvious cause for their pain.
#126-The Prevalence of Endocrine Abnormalities in Patients with Pseudarthorosis after Spinal Fusion
Conclusion: Patients with pseudarthrosis after spinal fusion surgery were noted to have a high prevalence of metabolic/endocrine abnormalities. Vitamin D inadequacy/deficiency and osteoporosis/osteopenia were the most common, but other abnormalities were seen in half of the patients.
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