Journal of pediatric orthopedics. Part B
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Proximal fusion level selection in adolescent idiopathic scoliosis (AIS) with a double thoracic curve (Lenke-2) remains debatable. The aim of this study was to compare the radiological outcomes of corrective surgery for Lenke-2 AIS according to the upper instrumented vertebra (UIV). This study included 74 patients who underwent corrective surgery for Lenke-2 AIS with the right main thoracic and left proximal thoracic (PT) curve at a single center. ⋯ If T3 or T4 is chosen as the UIV, then right shoulder depression can be a problem postoperatively. Greater skeletal maturity and higher flexibility of the main thoracic curve might be preoperative risk factors for PSI. Thus, extension of the proximal fusion to T2 can be considered if the patient shows greater skeletal maturation and more flexible main thoracic curve to prevent PSI in Lenke-2 AIS with the right main thoracic and left PT curve.
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Accelerated discharge protocols for scoliosis surgery have recently been described in the literature. There are limited data describing the association of length of stay (LOS) during the index admission with postoperative outcomes. We sought to define the economic and clinical implications of an additional 1 day in the hospital for scoliosis surgery. ⋯ Increased LOS during the index admission scoliosis surgery is associated with higher costs and an increased risk of 90-day postoperative complications. Protocols to decrease LOS for this surgery have potential benefits to patients, hospitals, and insurers. Level of Evidence: Level III, retrospective comparative study.
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The relationship between curve correction and spinal length gain in adolescent idiopathic scoliosis was examined. A total of 102 patients who underwent posterior spinal correction and fusion alone or in combination with anterior spinal correction and fusion (ASF) were studied. ⋯ The length gain/Cobb angle correction value was not significantly associated with sex, fusion approach, and the number of fused levels. Surgical T1-L5 spinal length gain (mm) equaled (70.20)-(3.51)×(degrees of Cobb angle correction)+(0.08)×(degrees of Cobb angle correction).