Erratum to Incidence and Risk Factors for Major Surgical Complications in Patients With Complex Spinal Deformity: A Report From an SRS GOP Site [Spine Deformity 3 (2015) 57-64].

The corresponding author regret that co-author name was incorrectly published as "Elias C. Papadopoulus" in the article. The correct name of the author should be displayed as "Elias C. Papadopoulos".

Incidence and Risk Factors for Major Surgical Complications in Patients With Complex Spinal Deformity: A Report From an SRS GOP Site.

STUDY DESIGN: Retrospective analysis of a prospectively collected single-center database. OBJECTIVES: To report the incidence of and identify risk factors for perioperative complications in surgically treated pediatric and adult patients with complex spine deformities in an underserved region and Scoliosis Research Society Global Outreach Program site. SUMMARY OF BACKGROUND DATA: Surgical treatment for complex spinal deformity is challenging and requires a multidisciplinary approach for optimal management. The incidence and risk factors for major perioperative complications in outreach sites with limited resources are unknown. METHODS: A total of 427 consecutive patients who underwent instrumented spinal fusion for complex spinal deformities were reviewed. Clinical, radiographic, and demographic data were reviewed at preoperative and postoperative time points, and potential risk factors for perioperative complications were assessed. The authors performed multivariate logistic regression analysis (LRA) to determine independent risk factors for postoperative complications and neurological deficits. RESULTS: Major complications were seen in 85 cases, which consisted of neurologic deficits (n = 27; 17 transient and 10 permanent), wound infections (n = 17), implant-related problems (n = 35), progressive deformity (n = 13), and death (n = 6). Among the possible risk factors, univariate LRA indicated 3-column osteotomies as a risk factor for postoperative major complications and multivariate LRA indicated 3-column osteotomies as an independent risk factor for neurological deficit. Curves 100° and above were at higher risk for complications. CONCLUSIONS: Postoperative complications were seen in 20% of surgically treated patients with complex spine deformities at a Scoliosis Research Society SRS Global Outreach Program site. Three-column osteotomies were identified as an independent risk factor of both postoperative complications and neurological deficits. The significant observed correlation of 3-column osteotomies and postoperative neurological deficits should serve as a guide for surgeons in the preoperative planning and management of severe spinal deformities, especially in locations with limited resources. Patients undergoing correction of large curves may also have a higher complication rate.

Early onset scoliosis: modern treatment and results.

BACKGROUND: Early onset scoliosis (EOS) is a potentially fatal, challenging group of diseases the management of which has markedly changed in the last decade. The purpose of this review is to provide the reader with a brief description of each of these new therapeutic modalities, their indications for use, and early clinical results. METHODS: A systematic review of peer-reviewed publications and abstracts related to the treatment of EOS in the last decade was carried out and synthesized into a review of modern treatment methods. RESULTS: Recent advances in techniques and understanding of preserving the thoracic space have improved the morbidity and mortality of children with progressive EOS. Derotational casting may be used in younger patients with curves between 25 and 60 degrees. The vertical expandable prosthetic titanium rib is best suited for patients with thoracic insufficiency syndrome. Single or dual growing rods may be used alone or in combination with vertical expandable prosthetic titanium rib to treat patients with progressive EOS who are not candidates for casting. Shilla technique is an alternative to growing rods that avoids the morbidity of repeated lengthenings but is not as well proven as the techniques described above. Other methods such as automatic growing rods and growth modulation techniques are still investigational, and their role needs to be defined after further study. CONCLUSIONS: Recent advances have improved the treatment of children with EOS. Treatment continues to be challenging with complication rates higher than treatment of idiopathic scoliosis. LEVEL OF EVIDENCE: Level V.

An analysis of the functional health of obese children and adolescents utilizing the PODC instrument.

Childhood and adolescent obesity is increasing in prevalence and is known to have long-term medical and musculoskeletal consequences. The baseline Pediatric Outcomes Data Collection Instrument (PODCI) was administered to 50 obese patients (>95th percentile BMI for age) or their parent (for those <11 years) presenting to a pediatric orthopaedic clinic to assess overall function. There were no differences between sexes (31 boys, 19 girls) or age group (>11 years, n = 36; <11 years, n = 14) in any demographic or PODCI category. Compared with normative data, there was significant impairment in sports and pain identified in both genders, African-Americans, and those older than 11 years. These findings were consistent when comparing genders, ethnicities, and ages. There was no difference in happiness between any gender, age, or ethnic group. All groups reported essentially neutral satisfaction. There appears to be a lack of self-recognition of or reluctance to admit functional impairment secondary to obesity. Being obese, African-American ethnicity, and age older than 11 years appear to be risk factors for limited, yet significant, functional impairment.

Comparison of Pavlik harness application and immediate spica casting for femur fractures in infants.

This retrospective study compares Pavlik harness application versus spica casting for the treatment of children under 1 year of age with a femoral shaft fracture. The clinical and radiographic outcomes of 24 patients treated in a Pavlik harness were compared with 16 patients treated in a spica cast. The average age and weight of the two groups were significantly different, but there were no differences in radiographic outcomes between the Pavlik and spica cast groups. Approximately one third of all spica patients had a skin complication that added an additional risk to the patient. There were no similar complications in the Pavlik group. There were no differences in the outcome of the fractures in the two groups. The authors believe that all children under 1 year of age with a femoral shaft fracture are candidates for treatment with a Pavlik harness.

Inter- and intraobserver variance of Cobb angle measurements with digital radiographs.

This study compares the intra- and interobserver variance of Cobb angle measurements of primary and secondary curves on digital radiographs versus traditional radiographs. Four orthopaedic surgeons of varying experience measured the Cobb angles from a standard posteroanterior thoracolumbar scoliosis radiograph (25 digital, 25 traditional) on two occasions 2 weeks apart. The intra- and interobserver variances were calculated and compared for major versus minor curves and the digital versus traditional radiographs. There was no statistical difference in the mean error index, the variability in choosing the end vertebra on successive measurements, between the digital and traditional groups. Similarly, there was no significant difference in the intraobserver or interobserver variance between the digital and traditional groups. Digital radiographs are comparable to the use of traditional radiographs for following patients with adolescent idiopathic scoliosis. Furthermore, increasing years of experience appears to result in fewer errors and more consistency using the Cobb method.