Methods: Spine surgeons of the Asia–Pacific Spine Society were asked to respond to a web-based survey on IONM. The questionnaire covered various aspects of IONM, including its common modality, Tc-MEP details, necessities for consistent use, and recommended modalities in major spine surgeries and representative surgical procedures. Results: Responses were received from 193 of 626 spine surgeons. Among these respondents, 177 used IONM routinely. Among these 177 respondents, 17 mainly used SEP, whereas the majority favored Tc-MEPs. Although a >50% decrease is the commonly used alarm point in Tc-MEP, half of the Tc-MEP users had no protocols planned for such scenarios. Moreover, half of the Tc-MEP users experienced complications, with bite injuries being the most common. Most respondents strongly recommended IONM in deformity surgery for pediatric and adult populations and tumor resection surgery for intramedullary spinal cord tumors. Conversely, IONM was the least recommended in lumbar spinal canal stenosis surgery. Conclusions Spine surgeons in Asia–Pacific countries favored IONM use, indicating widespread routine utilization. Tc-MEP was the predominant modality for IONM, followed by SEPs.

Methods: Spine surgeons of the Asia–Pacific Spine Society were asked to respond to a web-based survey on IONM. The questionnaire covered various aspects of IONM, including its common modality, Tc-MEP details, necessities for consistent use, and recommended modalities in major spine surgeries and representative surgical procedures. Results: Responses were received from 193 of 626 spine surgeons. Among these respondents, 177 used IONM routinely. Among these 177 respondents, 17 mainly used SEP, whereas the majority favored Tc-MEPs. Although a >50% decrease is the commonly used alarm point in Tc-MEP, half of the Tc-MEP users had no protocols planned for such scenarios. Moreover, half of the Tc-MEP users experienced complications, with bite injuries being the most common. Most respondents strongly recommended IONM in deformity surgery for pediatric and adult populations and tumor resection surgery for intramedullary spinal cord tumors. Conversely, IONM was the least recommended in lumbar spinal canal stenosis surgery. Conclusions Spine surgeons in Asia–Pacific countries favored IONM use, indicating widespread routine utilization. Tc-MEP was the predominant modality for IONM, followed by SEPs.

Methods: Spine surgeons of the Asia–Pacific Spine Society were asked to respond to a web-based survey on IONM. The questionnaire covered various aspects of IONM, including its common modality, Tc-MEP details, necessities for consistent use, and recommended modalities in major spine surgeries and representative surgical procedures. Results: Responses were received from 193 of 626 spine surgeons. Among these respondents, 177 used IONM routinely. Among these 177 respondents, 17 mainly used SEP, whereas the majority favored Tc-MEPs. Although a >50% decrease is the commonly used alarm point in Tc-MEP, half of the Tc-MEP users had no protocols planned for such scenarios. Moreover, half of the Tc-MEP users experienced complications, with bite injuries being the most common. Most respondents strongly recommended IONM in deformity surgery for pediatric and adult populations and tumor resection surgery for intramedullary spinal cord tumors. Conversely, IONM was the least recommended in lumbar spinal canal stenosis surgery. Conclusions Spine surgeons in Asia–Pacific countries favored IONM use, indicating widespread routine utilization. Tc-MEP was the predominant modality for IONM, followed by SEPs.

Methods: Patients with congenital scoliosis who underwent SSPPCF using a pedicle screw system were reviewed. We identified the following three surgical indications: (1) hemivertebra or wedge vertebra over the thoracic or thoracolumbar region with structural lumbar curves, (2) hemivertebra or wedge vertebra at the lumbar region with significant pelvic obliquity or sacral slanting, and (3) mixed or complex congenital scoliosis. The demographic, perioperative, and radiographic data of these patients were collected. Results: Thirty-four patients were reviewed. The mean patient age was 14.6±3.4 years. There were 13 hemivertebrae, three wedged vertebrae, two butterfly vertebrae, three hemivertebrae with butterfly vertebra, eight unsegmented bars, and five multiple complex lesions. The average surgical duration was 219.4±68.8 minutes. The average blood loss was 1,208.4±763.5 mL. Seven patients required allogeneic blood transfusion. The mean hospital stay duration was 6.1±2.5 days. The complication rate was 11.8% (4/34): one patient had severe blood loss, one had rod breakage, and two had distal adding-on. The Cobb angle reduced from 65.9°±17.4° to 36.3°±15.3° (p<0.001) with a correction rate (CR) of 44.8%±17.4%. The regional kyphotic angle decreased from 39.9°±20.5° to 27.5°±13.9° (p=0.001) with a CR of 19.3%±49.6%. Radiographic parameters (radiographic shoulder height, clavicle angle, T1 tilt, cervical axis, pelvic obliquity, coronal balance, and apical vertebral translation) showed significant improvement postoperatively. Conclusions SSPPCF was a feasible option for adolescent patients with congenital scoliosis who were skeletally matured.

Methods: Forty AIS patients were recruited. Demographic, preoperative, and postoperative data were recorded. The magnitude and characteristics of postoperative pain were assessed using the painDETECT questionnaire through telephone enquiries at intervals of 2, 6, 12, and 24 weeks. Statistical analyses were followed by Pearson correlation test to determine the relationship between pain scores at 6, 12, and 24 weeks with the risk factors. Results: Based on the painDETECT questionnaire, 90% of the patients had nociceptive pain, and 10% had a possible neuropathic pain component at 2 weeks postoperatively as per a mean painDETECT score of 7.1±4.5. Assessments at 6, 12, and 24 weeks showed that no patients had neuropathic pain with painDETECT scores of 4.4±3.2, 2.9±2.9, and 1.5±2.0, respectively. There was a significant correlation between total postoperative morphine use during 48 hours after the surgery and a tendency to develop neuropathic pain (p=0.022). Conclusions Chronic neuropathic pain was uncommon in AIS patients who had undergone PSF surgery. Higher opioid consumption will increase the possibility of developing chronic neuropathic pain.

Introduction: This study looked into the different anatomical locations of pain and their trajectories within the first two weeks after Posterior Spinal Fusion (PSF) surgery for Adolescent Idiopathic Scoliosis (AIS). Methods: We prospectively recruited patients with Adolescent Idiopathic Scoliosis (AIS) scheduled for PSF surgery. The anatomical locations of pain were divided into four: (1) surgical wound pain; (2) shoulder pain; (3) neck pain; and (4) low back pain. The anatomical locations of pain were charted using the visual analogue pain score at intervals of 12, 24, 36, 48 hours; and from day-3 to -14. Patient-controlled analgesia (morphine), use of celecoxib capsules, acetaminophen tablets and oxycodone hydrochloride capsule consumption were recorded. Results: A total of 40 patients were recruited. Patients complained of surgical wound pain score of 6.2±2.1 after surgery. This subsequently reduced to 4.2±2.0 by day-4, and to 2.4±1.3 by day-7. Shoulder pain scores of symptomatic patients peaked to 4.2±2.7 at 24 hours and 36 hours which then reduced to 1.8±1.1 by day-8. Neck pain scores of symptomatic patients reduced from 4.2±1.9 at 12 hours to 1.8±1.1 by day-4. Low back pain scores of symptomatic patients reduced from 5.3±2.3 at 12 hours to 1.8±1.1 by day12. Conclusions: Despite the presence of different anatomical locations of pain after surgery, surgical wound was the most significant pain and other anatomical locations of pain were generally mild. Surgical wound pain reduced to a tolerable level by day-4 when patients can then be comfortably discharged. This finding provides useful information for clinicians, patients and their caregivers.

Methods: A total of 30 sets of images, including plain radiographs, computed tomography scans, and magnetic resonance imaging scans, were randomly selected from our hospital patient database. All patients had undergone deformity correction surgery for kyphosis. Twelve spine surgeons from the Asia-Pacific region (six different countries) independently evaluated and classified the deformity types and proposed their surgical recommendations. This information was then compared with standard deformity classification and surgical recommendations. Results: The kappa coefficients for the classification were as follows: 0.88 for type 1A, 0.78 for type 1B, 0.50 for type 2B, 0.40 for type 3A, 0.63 for type 3B, and 0.86 for type 3C deformities. The overall kappa coefficient for the classification was 0.68. Regarding the repeatability of osteotomy recommendations, kappa values were the highest for Ponte’s (Schwab type 2) osteotomy (kappa 0.8). Kappa values for other osteotomy recommendations were 0.52 for pedicle subtraction/disc-bone osteotomy (Schwab type 3/4), 0.42 for vertebral column resection (VCR, type 5), and 0.30 for multilevel VCRs (type 6). Conclusions Excellent accuracy was found for types 1A, 1B, and 3C deformities (ends of spectrum). There was more variation among surgeons in differentiating between one-column (types 2A and 2B) and two-column (types 3A and 3B) deficiencies, as surgeons often failed to recognize the radiological signs of posterior column failure. This failure to identify column deficiencies can potentially alter kyphosis management. There was excellent consensus among surgeons in the recommendation of type 2 osteotomy; however, some variation was observed in their choice for other osteotomies.

STUDY DESIGN: Prospective study. PURPOSE: To compare Patients' and parents’ perceptions of physical attributes (PAs) of adolescent idiopathic scoliosis (AIS) patients and to report any correlations between their perceptions and Scoliosis Research Society-22r (SRS-22r) scores. OVERVIEW OF LITERATURE: Few studies have looked into the differences between Patients' and parents’ perceptions of their appearance. METHODS: AIS patient–parent pairs (n=170) were recruited. The Patients' and parents’ perceptions of six PAs were evaluated: waist asymmetry (WA), rib hump (RH), shoulder asymmetry (SA), neck tilt, breast asymmetry (BrA), and chest prominence. These PAs were ranked, and an aggregate PA (Agg-PA) score was derived from a score assigned to the attribute (6 for the most important PA and 1 for the least important). The patients also completed the SRS-22r questionnaire. RESULTS: Ninety-nine patients (58.2%) and 71 patients (41.8%) had thoracic and lumbar major curves, respectively. WA was ranked first by 54 patients (31.8%) and 50 parents (29.4%), whereas RH was ranked first by 50 patients (29.4%) and 38 parents (22.4%). The overall Agg-PA scores were similar for patients and parents (p>0.05). However, for thoracic major curves (TMCs) >40°, a significant difference was noted between the Agg-PA scores of patients and parents for SA (3.5±1.6 vs. 4.2±1.6, p=0.041) and BrA (3.0±1.6 vs. 2.2±1.3, p=0.006). For TMCs <40°, a significant difference was found between the Agg-PA scores of patients and parents for WA (3.7±1.6 vs. 4.4±1.5, p=0.050). BrA was negatively correlated with total SRS-22r score. CONCLUSIONS: There were no significant differences between patients and parents in their ranking of the most important PAs. For TMCs >40°, there were significant differences in the Agg-PA for SA and BrA. Pa¬tients were more concerned about BrA and parents were more concerned about SA. Patients' perception of the six PAs had weak correlation with SRS-22r scores.
Adolescent ; Awards and Prizes ; Body, Physical Appearance ; Breast ; Humans ; Neck ; Parents ; Prospective Studies ; Ribs ; Scoliosis ; Shoulder ; Thorax

To review existing publications on the safety of pedicle screw insertions in adolescent idiopathic scoliosis (AIS). Despite having increased risk for neurological and visceral injuries, the use of pedicle screws have led to increased correction rates in scoliosis surgery. A review was performed on topics pertinent to pedicle screw insertion in AIS, which included pedicle morphometry in AIS, structures at risk during pedicle screw insertion, and accuracy and safety of various pedicle screw insertion techniques. The importance of computer navigation and future research regarding pedicle screw placement in AIS were also briefly reviewed. Many authors have reported abnormal pedicle anatomy in AIS. Injury to the neural structures was highest over the apical region, whereas aortic injury was the highest at T5 and T10. In the proximal thoracic spine, the esophagus could be injured even with screws as short as 25 mm. Overall pedicle perforation rates for perforations >0 and >2 mm (assessed by computed tomography) ranged from 6.4% to 65.0% and 3.7% to 29.9%, respectively. The critical pedicle perforation (>2 mm excluding lateral thoracic) and anterior perforation (>0 mm) rates was reported to range from 1.5% to 14.5% and 0.0% to 16.1%, respectively. Pedicle perforation rates were lower with the use of computer navigation. The incidence of neurological adverse events after scoliosis surgery was 0.06%–1.9%. Aortic injury has only been observed in case reports. According to the available literature, pedicle screw insertion in AIS is considered safe with low rates of clinical adverse events. Moreover, the use of navigation technology has been shown to reduce pedicle perforation rates.
Adolescent* ; Esophagus ; Humans ; Incidence ; Pedicle Screws* ; Scoliosis* ; Spine

STUDY DESIGN: Clinical imaging study. PURPOSE: To study the surgical morphometry of C1 and C2 vertebrae in Chinese, Indian, and Malay patients. OVERVIEW OF LITERATURE: C1 lateral mass and C2 pedicle screw fixation is gaining popularity. However, there is a lack of C1–C2 morphometric data for the Asian population. METHODS: Computed tomography analysis of 180 subjects (60 subjects each belonging to Chinese, Indian, and Malay populations) using simulation software was performed. Length and angulations of C1 lateral mass (C1LM) and C2 pedicle (C2P) screws were assessed. RESULTS: The predicted C1LM screw length was between 23.2 and 30.2 mm. The safe zone of trajectories was within 11.0°±7.7° laterally to 29.1°±6.2° medially in the axial plane and 37.0°±10.2° caudally to 20.9°±7.8° cephalically in the sagittal plane. The shortest and longest predicted C2P screw lengths were 22.1±2.8 mm and 28.5±3.2 mm, respectively. The safe trajectories were from 25.1° to 39.3° medially in the axial plane and 32.3° to 45.9° cephalically in the sagittal plane. CONCLUSIONS: C1LM screw length was 23–30 mm with the axial safe zone from 11° laterally to 29° medially and sagittal safe zone at 21° cephalically. C2P screw length was 22–28 mm with axial safe zone from 26° to 40° medially and sagittal safe zone from 32° to 46° cephalically. These data serve as an important reference for Chinese, Indian, and Malay populations during C1–C2 instrumentation.
Asian Continental Ancestry Group* ; Humans ; Pedicle Screws ; Spine*