Spine
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Multicenter Study
Which Lenke 1A curves are at the greatest risk for adding-on... and why?
Multicenter review of prospectively collected data. ⋯ Understanding the difference between Lenke 1A-L and 1A-R curve types may be helpful in preventing the adding-on phenomena postoperatively. To prevent adding-on in 1A-R curves, we recommend fusing distally to 1 level above the neutral vertebra or 1 to 2 levels above the stable vertebra. In 1A-L curves, adding-on may simply be a need to balance some lumbar curve progression in a young, skeletally immature patient.
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Multicenter Study
Multivariate analysis of factors associated with kyphosis maintenance in adolescent idiopathic scoliosis.
Multicenter retrospective cohort study of 269 patients. ⋯ Our multivariate analysis demonstrates that in patients with AIS who have thoracic hypokyphosis as part of their deformity, certain factors must be taken into account in the preoperative planning to prevent hypokyphosis after surgical correction.
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Retrospective review of a multicenter series. ⋯ Patients with thoracic hyperkyphosis present even more of a challenge with respect to complications, specifically implant-related complications. Our study shows that growing rod surgery in patients with kyphosis more than 40° has significantly more general and implant complications than that in patients with normal thoracic kyphosis. Implant complications were more common in hyperkyphotic (>40°) patients and increased linearly with increasing kyphosis. The most common implant complication was rod breakage. Patients with hyperkyphotic thoracic spines, particularly syndromic patients, must be monitored closely and parents should be counseled regarding the likelihood of future adverse events.