Roussouly classification of adult spinal deformity.

With an estimated prevalence of 68% among healthy adults without a previous diagnosis of scoliosis, adult spinal deformities are a growing concern as the population ages. Our understanding of this growing concern has been historically guided by previous studies performed on the pediatric population. Over time, different classifications have been developed with their own respective limitations. The Roussouly classification was the first classification to describe the shapes of an asymptomatic spine. It considers lumbar lordosis, pelvic incidence, and the inflection point from lumbar lordosis to thoracic kyphosis to attempt to stratify the shapes of an asymptomatic spine. This classification aims to guide treatment, provide information regarding prognosis, allow stratification for research, and be highly reproducible. Overall, the Roussouly classification is a novel way to think about sagittal malalignment, considering the patient's individual anatomy, while allowing for communication between surgeons. Additionally, it has proven to be a reliable system that provides prognostic value for clinicians and may minimize complications when a patient's sagittal alignment is optimized using this classification system.

Osteoporosis: An Update on Screening, Diagnosis, Evaluation, and Treatment.

Osteoporosis screening, diagnosis, and treatment have gained much attention in the health care community over the past 2 decades. During this time, creation of multispecialty awareness programs (eg, "Own the Bone," American Orthopedic Association; "Capture the Fracture," International Osteoporosis Foundation) and improvements in diagnostic protocols have been evident. Significant advances in technology have elucidated elements of genetic predisposition for decreased bone mineral density in the aging population. Additionally, several novel drug therapies have entered the market and provide more options for primary care and osteoporosis specialists to medically manage patients at risk for fragility fractures. Despite this, adherence to osteoporosis screening and treatment protocols has been surprisingly low by health care practitioners, including orthopedic surgeons. Continued awareness and education of this skeletal disorder is crucial to effectively care for our aging population. [Orthopedics. 2023;46(1):e20-e26.].

Efficacy of Cefazolin Versus Vancomycin Antibiotic Cement Spacers.

OBJECTIVE: Cefazolin is a heat-labile antibiotic that is not usually added to polymethylmethacrylate (PMMA) cement spacers because it is believed to be inactivated by the high polymerization temperatures. The purpose of this study was to compare cefazolin versus vancomycin high-dose antibiotic cement spacers. METHODS: High-dose antibiotic PMMA spacers with either cefazolin or vancomycin were fabricated. Setting time, compressive strength, and compression modulus of spacers were measured. Spacers were emerged in saline, and the eluent was tested on days 1, 2, 3, 7, 14, and 30 to determine the zone of inhibition of methicillin-sensitive Staphylococcus aureus and estimate the cumulative antibiotic released. RESULTS: Cefazolin, compared with vancomycin-loaded spacers, had significantly shorter setting time [mean difference (MD) -1.8 minutes, 95% confidence interval (CI), -0.6 to -3.0], greater compressive strength (MD 20.1 megapascal, CI, 15.8 to 24.5), and compression modulus (MD 0.15 megapascal, CI, 0.06 to 0.23). The zone of inhibition of eluent from PMMA-C spacers was significantly greater than PMMA-V spacers at all time points, an average of 11.7 ± 0.8 mm greater across time points. The estimated cumulative antibiotic released from cefazolin spacers was significantly greater at all time points ( P < 0.0001). CONCLUSIONS: Cefazolin was not inactivated by PMMA polymerization and resulted in spacers with superior antimicrobial and biomechanical properties than those made with vancomycin, suggesting that cefazolin could play a role in the treatment of infected bone defects with high-dose antibiotic PMMA spacers.

The Hip-Spine Challenge.

➤: The proper diagnosis and treatment of patients with concurrent hip and spine pathological processes can be challenging because of the substantial overlap in symptomatology. ➤: There is no consensus on which pathological condition should be addressed first. ➤: Factors such as advanced spinal degeneration, deformity, and prior fusion alter the biomechanics of the spinopelvic unit. Attention should be paid to recognizing these issues during the work-up for a total hip arthroplasty as they can result in an increased risk of dislocation. ➤: In patients with concurrent spine and hip degeneration, the surgeon must pay close attention to appropriate implant positioning and have consideration for implants with enhanced stability to minimize the risk of dislocation. ➤: A proper understanding of sagittal balance and restoration of this balance is integral to improving patient outcomes following spinal surgery. ➤: The advent of new imaging modalities, increased awareness of spinopelvic mobility, as well as a better understanding of sagittal alignment will hopefully improve our treatment of patients with hip-spine syndrome.