RESUMEN
Background Since posterior cervical fixation with lateral mass screws was introduced in 1979, multiple techniques have been described in the literature. However, no study to date has determined whether pre-drilling all lateral masses prior to screw insertion has a benefit over the traditional sequential drilling and screw insertion on the alignment of the screw-rod construct. This study sought to determine the efficacy and efficiency in achieving alignment with a novel pre-drilling technique compared to the traditional sequential drilling technique. The authors hypothesized that the novel pre-drilling technique could be applied more quickly and precisely than the traditional sequential drilling technique. Methods Eight cervical spine sawbones models were utilized to place 64 lateral mass screws by two surgeons. The pre-drilling technique was utilized to place 32 screws in four models, and the sequential drilling technique was utilized to place the 32 screws in the remaining four models. In the traditional sequential drilling technique, each lateral mass underwent screw tract preparation and insertion before proceeding to the subsequent vertebra. In the pre-drilling technique, all lateral masses were marked and drilled sequentially before screw placement. CT imaging with 3D reconstructions was generated for all models. Variability in screw placement and time taken to fully instrument the models were compared. Results The mean time to completion of the pre-drilling technique was 337 ± 22 seconds compared to 490 ± 22 seconds with the traditional technique (p<0.01). There was a significantly higher variability in the coronal plane within the traditional group between C5 and C6 compared to other adjacent vertebrae (p<0.05). There was no significant difference in the start point variability and the overall tightness of line fit between the techniques. Conclusions Our study suggests that a novel pre-drilling technique for lateral mass screw insertion may be more efficient and reliable than the traditional sequential drilling technique. In addition, this technique may reduce the need for rod contouring or additional implants to optimize the alignment of cervical instrumentation. However, further clinical studies are necessary to validate the potential clinical and radiologic benefits of this described technique.
RESUMEN
STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate outcomes and complications following operative and nonoperative management of hyperostotic spine fractures. METHODS: Patients presenting between 2008 and 2017 to a single level 1 trauma center with hyperostotic spine fractures had their information and fracture characteristics reviewed. Bivariate analyses were conducted to compare patients across a number of characteristics and outcomes. Multivariate logistic regression models for complication and mortality were done in a stepwise fashion. RESULTS: Sixty-five ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH) patients with a spine fracture met our inclusion criteria. DISH was slightly more prevalent (55% vs 45%). Overall delayed diagnosis, reoperation, mortality (at 1 year), and complication rates were high at 32%, 13%, 23%, and 57%, respectively. In multivariate logistic regression models, patients undergoing operative management had significantly increased odds of having a complication (odds ratio [OR] = 23.03, 95% confidence interval [CI] = 2.24-236.45, P = .008), while increasing age was associated with increased odds of death (OR = 1.18, 95% CI = 1.06-1.31, P = .003). CONCLUSIONS: Patients with AS or DISH who fracture their spine are at high risk of complication and death. However, neither operative nor nonoperative treatment increases the odds of mortality. This study helps add to a growing, but still limited, body of literature on the characteristics of patients with spine fractures in the setting of AS or DISH.
RESUMEN
BACKGROUND: Early-onset scoliosis is a heterogeneous condition, with highly variable manifestations and natural history. No standardized classification system exists to describe and group patients, to guide optimal care, or to prognosticate outcomes within this population. A classification system for early-onset scoliosis is thus a necessary prerequisite to the timely evolution of care of these patients. METHODS: Fifteen experienced surgeons participated in a nominal group technique designed to achieve a consensus-based classification system for early-onset scoliosis. A comprehensive list of factors important in managing early-onset scoliosis was generated using a standardized literature review, semi-structured interviews, and open forum discussion. Three group meetings and two rounds of surveying guided the selection of classification components, subgroupings, and cut-points. Initial validation of the system was conducted using an interobserver reliability assessment based on the classification of a series of thirty cases. RESULTS: Nominal group technique was used to identify three core variables (major curve angle, etiology, and kyphosis) with high group content validity scores. Age and curve progression ranked slightly lower. Participants evaluated the cases of thirty patients with early-onset scoliosis for reliability testing. The mean kappa value for etiology (0.64) was substantial, while the mean kappa values for major curve angle (0.95) and kyphosis (0.93) indicated almost perfect agreement. The final classification consisted of a continuous age prefix, etiology (congenital or structural, neuromuscular, syndromic, and idiopathic), major curve angle (1, 2, 3, or 4), and kyphosis (-, N, or +) variables, and an optional progression modifier (P0, P1, or P2). CONCLUSIONS: Utilizing formal consensus-building methods in a large group of surgeons experienced in treating early-onset scoliosis, a novel classification system for early-onset scoliosis was developed with all core components demonstrating substantial to excellent interobserver reliability. This classification system will serve as a foundation to guide ongoing research efforts and standardize communication in the clinical setting.