Plasma Technology Reduces Blood Loss in Adolescent Idiopathic Scoliosis Surgery: A Prospective Randomized Clinical Trial.

STUDY DESIGN: Prospective randomized clinical trial. OBJECTIVES: To assess the effectiveness of PEAK Plasmablade (PPB), compared with bipolar sealer and standard electrocautery, in the posterior spinal instrumentation and fusion (PSF) surgery performed for adolescent idiopathic scoliosis (AIS). METHODS: Ninety-three patients undergoing PSF surgery for AIS were randomized in 2 groups: group-A patients (n = 45) underwent PSF surgery using PPB; group-B patients (n = 48) were treated with bipolar sealer and standard electrocautery. Demographic and surgical data was recorded. All the patients underwent serial blood tests on the day before surgery (T0) and at 24 (T1), 48 (T2), 72 (T3), and 96 (T4) hours postoperatively. Visual analogue scale for pain (VAS) score, the percentage of paracetamol assumption, and the blood transfusion rate were recorded in the time-lapse T1 to T4. Intergroup variability was assessed. Pearson correlation test was performed. A P value <.05 was considered significant. RESULTS: In group A, a significantly shorter total operative time (P = .0087), a significantly lower total intraoperative blood loss (TBL) (P = .001), and a higher postoperative hemoglobin (Hb) (P = .01) were recorded. A significant higher mean Hb concentration and mean albumin value was recorded in group A at 24 and 48 hours postoperatively. A significant correlation between TBL and hospital stay was recorded in both groups (group A, P = .00 001; group B, P = .00 006); moreover, in both groups, a significant correlation was observed between TBL and mean VAS at 72 hours postoperatively (group A, P = .0009; group B, P = .0001) and at 96 hours postoperatively (group A, P = .000 044; group B, P = .00 001). CONCLUSIONS: PPB reduces the intraoperative blood loss in PSF performed for AIS, thus allowing a patient's faster recovery.

Accuracy of plain radiographs to identify wrong positioned free hand pedicle screw in the deformed spine.

BACKGROUND: The accuracy rate of pedicle screws placement in the deformed spine can be easily assessed on computed tomography (CT), while it is difficult to be evaluated in conventional radiography in the posterior-anterior (PA) and lateral projections, even if they are an essential step to identify wrong positioned screws after surgery. Aim of the study is to evaluate the accuracy of plain radiographs compared with CT in identifying wrong positioned pedicle-screws in the deformed spine. METHODS: A total of 1125, pedicle screws implanted with free hand technique in 79 patients surgically treated for scoliosis with intraoperative/postoperative. Plain radiographs and CT of the spine were investigated. The pedicle screws location was evaluated by three independent spine surgeon with more than 10 years' experience, using the method described by Kim in plain radiographs. Other three independent spine surgeon with more than 10 years' experience, unknowing the previous results, evaluate the same pedicle screws using the Rongming Xu criteria in CT scans. When there is a disagreement among the readers is chosen the most common classification. Data were finally compared and analyzed using SPSS® 11.0 software. RESULTS: Comparative analysis of pedicle screws using postoperative CT and plain radiographs showed: 22 true positives, i.e. pedicle-screws considered as out both in plain radiographs and CT scans; 1048 true negatives, i.e. pedicle-screws evaluated as in both in X-ray and CT scans; 9 false positives, i.e. pedicle-screws considered as out in plain radiographs but defined in in CT scans, and 52 false negatives, i.e. pedicle-screws considered as in in plain-radiographs, but defined out in CT. The accuracy of standard radiographs in detecting the placement of pedicle-screws amounts to 94.6%, with a sensitivity of 71% and a specificity of 95.3%. CONCLUSIONS: Even if only 61 pedicle-screws out (5.4%) were not correctly identified in plain radiographs, none dangerous placement (3 cases) is unrecognized, underling that the CT accuracy is higher only to detect screws with a "safe" wrong placement that, according to literature data, not require revision surgery. Intraoperative X-ray, allowing a possible revision of misplaced screws during surgery, must be considered as the gold standard for pedicle screw evaluation. Even if postoperative CT scanning should not be performed as a routine control measure, it still useful in case of clinically suspected screw wrong positioning.

The pedicle instrumentation and percutaneous elevation (Pi.Pe): a new cementless surgical technique in type A post-traumatic vertebral fractures.

PURPOSE: To investigate if bone substitutes are strictly necessary to restore the vertebral body height and improve the clinical outcome, in patients with thoracolumbar or lumbar AO type A post-traumatic vertebral fractures, managed with balloon kyphoplasty combined with posterior screw and rod system. METHODS: 105 patients with post-traumatic thoracolumbar spine fracture were recruited. At baseline, the patients underwent a CT and an MRI of the spine. Clinical evaluation was performed, using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), at baseline, 48 h after surgery, at 3-month follow-up (FU), 6-month FU, 48 h after the instrumentation removal and at 24-month FU. At each FU, VK, regional kyphosis (RK), central wall (MH/PH) and anterior wall (AH/PH) heights were assessed on lateral spine X-rays. At 6-month FU, a CT scan of the spine was performed to investigate the fracture healing. The posterior instrumentation was removed 7 months after surgery (range 6-10 months). RESULTS: A significant reduction of mean VAS (p < 0.05) and ODI (p < 0.05) was observed after surgery; no impairment of these scores was observed after the instrumentation removal. A significant correction of VK, RK, AH/PH and MH/PH was recorded after surgery; no significant changes of these values were noticed at subsequent FU. After the instrumentation removal, only an RK impairment was recorded, but it was not significant. CONCLUSIONS: PMMA or bone substitutes are not necessary to keep the reduction of the endplate obtained with the balloon tamp, when BK is performed in the association with posterior percutaneous pedicle screws instrumentation. These slides can be retrieved under Electronic Supplementary Material.