A Preoperative Spinal Education intervention for spinal fusion surgery designed using the Rehabilitation Treatment Specification System is safe and could reduce hospital length of stay, normalize expectations, and reduce anxiety : a prospective cohort study.

AIMS: Psychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal Education (POSE) programme, specified using the Rehabilitation Treatment Specification System (RTSS) and designed to normalize expectations and reduce anxieties, was safe and reduced LOS. METHODS: POSE was offered to 150 prospective patients over ten months (December 2018 to November 2019) Some chose to attend (Attend-POSE) and some did not attend (DNA-POSE). A third independent retrospective group of 150 patients (mean age 57.9 years (SD 14.8), 50.6% female) received surgery prior to POSE (pre-POSE). POSE consisted of an in-person 60-minute education with accompanying literature, specified using the RTSS as psychoeducative treatment components designed to optimize cognitive/affective representations of thoughts/feelings, and normalize anxieties about surgery and its aftermath. Across-group age, sex, median LOS, perioperative complications, and readmission rates were assessed using appropriate statistical tests. RESULTS: In all, 65 (43%) patients (mean age 57.4 years (SD 18.2), 58.8% female) comprised the Attend-POSE, and 85 (57%) DNA-POSE (mean age 54.9 years (SD 15.8), 65.8% female). There were no significant between-group differences in age, sex, surgery type, complications, or readmission rates. Median LOS was statistically different across Pre-POSE (5 days ((interquartile range (IQR) 3 to 7)), Attend-POSE (3 (2 to 5)), and DNA-POSE (4 (3 to 7)), (p = 0.014). Pairwise comparisons showed statistically significant differences between Pre-POSE and Attend-POSE LOS (p = 0.011), but not between any other group comparison. In the Attend-POSE group, there was significant change toward greater surgical preparation, procedural familiarity, and less anxiety. CONCLUSION: POSE was associated with a significant reduction in LOS for patients undergoing spinal fusion surgery. Patients reported being better prepared for, more familiar, and less anxious about their surgery. POSE did not affect complication or readmission rates, meaning its inclusion was safe. However, uptake (43%) was disappointing and future work should explore potential barriers and challenges to attending POSE. Cite this article: Bone Jt Open 2022;3(2):135-144.

Halo Femoral Traction for 1 Week Between Staged Anterior and Posterior Fusion Surgeries for Severe Adolescent Scoliosis Is Effective and Safe.

OBJECTIVE: To report the outcomes of halo femoral traction (HFT) used for 1 week between anterior release and definitive posterior fusion in adolescents with severe rigid scoliosis. METHODS: A retrospective single-center review of 22 consecutive patients (mean age at surgery, 14.1 years; range, 10.5-18.2 years; 17 girls) with severe, rigid scoliosis treated with anterior release, followed by HFT for 7 days prior to posterior instrumented fusion. Cobb angles were measured preoperatively, 1 week after anterior release and traction, after posterior fusion, and at a minimum 2-year follow-up. Complications were recorded. RESULTS: Mean preoperative Cobb angle was 97° (range, 80°-118°), correcting to 52° with anterior release and HFT and 31° after posterior fusion. This equated to a 68% deformity correction and was maintained at final follow-up. Three traction-related complications were experienced, including 1 case of neck pain and 2 cases of brachial plexopathy that resolved with traction weight reduction. CONCLUSIONS: Three-staged deformity correction using HFT for 1 week only offers gradual correction of the spine over sufficient time to optimize deformity correction yet minimizes neurologic dysfunction.

Fifteen-minute consultation: neuromuscular spinal deformity in disabled children.

Spinal deformity is common and occasionally inevitable in children with disabilities. This article concentrates on non-ambulant children with a spinal deformity, and aims to help the paediatrician understand the challenges families and spinal surgeons face.

Neuromuscular scoliosis as a sequelae of Guillain-Barré syndrome.

The neuromuscular sequaelae of Guillain-Barré syndrome are well documented in the literature. Persistent distal muscular weakness and loss of peripheral limb reflexes are common in those affected. We report a case of a 14-year-old boy who developed the Miller-Fisher variant of Guillain-Barré syndrome at the age of 8 years. Six years after the acute episode, he had persistent lower limb areflexia and mild weakness. He had also developed a neuromuscular scoliosis. The scoliosis was successfully treated with posterior instrumentation and fusion surgery. Neuromuscular scoliosis is rare following Guillain-Barré syndrome, with no previous reports associated with the Miller-Fisher variant that we are aware of. When evaluating patients post Guillain-Barré syndrome, structural spinal examination is essential to identify rare deformity that may need surgical correction.

Spinal cord compression by a solitary metastasis from a low grade leydig cell tumour: a case report and review of the literature.

BACKGROUND: Leydig tumour is rare and there are only three cases with metastatic disease reported. CASE PRESENTATION: A 52 year-old Caucasian male was admitted, on emergency basis to the Orthopaedic Department with six weeks history of increasing midthoracic back pain, change in gait, poor balance, subjective weakness and numbness of the lower trunk and legs. MRI scan showed change in the signal intensity of T4 and T5 vertebral body but their height were maintained. Urgent T4 and T5 corpectomies, decompression of the spinal cord and reconstruction of the vertebral bodies were performed followed by radiotherapy. Neurological status significantly improved with a mild residual numbness over the dorsum of the right foot. The histology of the excised tumour was identical to the primary. At 2 years follow-up visit the patient is neurologically stable and disease free without other organs metastases. CONCLUSION: This is the first case in English literature, which shows that spinal metastases could occur even in the early stage of Leydig cell tumour, without other organs involvement. Aggressive surgical management of spinal metastases combined with post operative radiotherapy can give a better chance for long survivorship.

Hematogenous methicillin-resistant Staphylococcus aureus spondylodiscitis.

STUDY DESIGN: Retrospective case series. OBJECTIVE: To determine relevant demographics, clinical presentations, and outcomes of this condition. SUMMARY OF BACKGROUND DATA: This is the first study looking specifically at methicillin-resistant Staphylococcus Aureus (MRSA) spondylodiscitis. METHODS: We performed a retrospective review of patients presenting between 2000 and 2005. RESULTS: Thirteen cases were identified. The mean age was 65 years; 85% were male. All cases presented with back pain, spinal tenderness, and systemic upset. Neurologic deficit was present initially in 39%, and 8% developed neurologic deterioration during treatment. The thoracic spine (53%) was most commonly affected, followed by the lumbar (33%), thoracolumbar junction (7%), and cervical spine (7%); 16% of cases were multilevel. The white cell count, erythrocyte sedimentation rate and C-reactive protein were elevated in all cases with means of 17.3 x 10(-9)/L, 102 mm/h, and 236 mg/L, respectively. Radiologic diagnosis was established with MRI in all cases. The most common risk factors were diabetes mellitus (62%), malnourishment (54%), cirrhosis (31%), end-stage renal failure (15%), and intravenous drug use (15%). Multiple risk factors were present in 76% of cases, and only 15% had no identifiable risk factors. The main sources of sepsis were intravenous catheters (23%), urinary tract (15%), and intravenous drug use (15%). Treatment consisted of intravenous vancomycin monotherapy for a mean period of 4 weeks followed by oral combination or monotherapy antimicrobials for a mean period of 8 weeks. Operative intervention was required in 38% of cases. At 6 months, 54% of cases were clinically free of infection, 38% had died, and 8% required ongoing treatment. Neurologic deficit was present in 50% of survivors. At 1 year, 29% of survivors had MRSA bacteremia and spondylodiscitis recurrence. CONCLUSION: This is a devastating condition with high mortality and morbidity.