Background: To evaluate the clinical impact of intraoperative tranexamic acid administration in minimizing intraoperative blood loss and transfusion requirements during minimally invasive scoliosis surgery (MISS). Methods: Consecutive data were collected from 97 patients with adolescent idiopathic scoliosis who underwent MISS between 2021 and 2023. Tranexamic acid was first introduced in June 2022. Surgical outcomes, complications, and blood parameters were compared between group A (no tranexamic acid) and group B (tranexamic acid). Results: Forty-three patients underwent surgery without intraoperative tranexamic acid (group A), and 54 underwent surgery with tranexamic acid (group B). Variables including age, height, weight, body mass index, hospital stay duration, Cobb angle, correction rate, curve type, fusion extent, and pre- and postoperative hemoglobin levels were not significantly different between the 2 groups (all p > 0.50). On average, 2.03 red blood cell (RBC) transfusions were administered. Group A required 2.6 units, whereas group B required 1.7 units, representing a significant reduction (p = 0.005). Postoperatively, an average of 0.5 RBC units were administered.Group A required 0.9 units, and group B required 0.3 units, with a significant difference (p = 0.001). No significant difference was found in the hemoglobin level between the day before surgery and postoperative days 1 and 4 (all p > 0.05). Significant differences were observed between the 2 groups in the estimated blood loss change (1,358 vs. 1,118 mL, p = 0.035) and Hemovac volume (1,063.26 vs. 910.65 mL, p = 0.002). Eleven patients in group A required thoracentesis or chest tube insertion after MISS, whereas those in Group B did not require invasive procedures. Conclusions In MISS, tranexamic acid reduced blood transfusion needs, Hemovac volume, incidence and severity of hemothorax, and pleural effusion were associated with thoracoplasty.

Background: To evaluate the clinical impact of intraoperative tranexamic acid administration in minimizing intraoperative blood loss and transfusion requirements during minimally invasive scoliosis surgery (MISS). Methods: Consecutive data were collected from 97 patients with adolescent idiopathic scoliosis who underwent MISS between 2021 and 2023. Tranexamic acid was first introduced in June 2022. Surgical outcomes, complications, and blood parameters were compared between group A (no tranexamic acid) and group B (tranexamic acid). Results: Forty-three patients underwent surgery without intraoperative tranexamic acid (group A), and 54 underwent surgery with tranexamic acid (group B). Variables including age, height, weight, body mass index, hospital stay duration, Cobb angle, correction rate, curve type, fusion extent, and pre- and postoperative hemoglobin levels were not significantly different between the 2 groups (all p > 0.50). On average, 2.03 red blood cell (RBC) transfusions were administered. Group A required 2.6 units, whereas group B required 1.7 units, representing a significant reduction (p = 0.005). Postoperatively, an average of 0.5 RBC units were administered.Group A required 0.9 units, and group B required 0.3 units, with a significant difference (p = 0.001). No significant difference was found in the hemoglobin level between the day before surgery and postoperative days 1 and 4 (all p > 0.05). Significant differences were observed between the 2 groups in the estimated blood loss change (1,358 vs. 1,118 mL, p = 0.035) and Hemovac volume (1,063.26 vs. 910.65 mL, p = 0.002). Eleven patients in group A required thoracentesis or chest tube insertion after MISS, whereas those in Group B did not require invasive procedures. Conclusions In MISS, tranexamic acid reduced blood transfusion needs, Hemovac volume, incidence and severity of hemothorax, and pleural effusion were associated with thoracoplasty.

Background: To evaluate the clinical impact of intraoperative tranexamic acid administration in minimizing intraoperative blood loss and transfusion requirements during minimally invasive scoliosis surgery (MISS). Methods: Consecutive data were collected from 97 patients with adolescent idiopathic scoliosis who underwent MISS between 2021 and 2023. Tranexamic acid was first introduced in June 2022. Surgical outcomes, complications, and blood parameters were compared between group A (no tranexamic acid) and group B (tranexamic acid). Results: Forty-three patients underwent surgery without intraoperative tranexamic acid (group A), and 54 underwent surgery with tranexamic acid (group B). Variables including age, height, weight, body mass index, hospital stay duration, Cobb angle, correction rate, curve type, fusion extent, and pre- and postoperative hemoglobin levels were not significantly different between the 2 groups (all p > 0.50). On average, 2.03 red blood cell (RBC) transfusions were administered. Group A required 2.6 units, whereas group B required 1.7 units, representing a significant reduction (p = 0.005). Postoperatively, an average of 0.5 RBC units were administered.Group A required 0.9 units, and group B required 0.3 units, with a significant difference (p = 0.001). No significant difference was found in the hemoglobin level between the day before surgery and postoperative days 1 and 4 (all p > 0.05). Significant differences were observed between the 2 groups in the estimated blood loss change (1,358 vs. 1,118 mL, p = 0.035) and Hemovac volume (1,063.26 vs. 910.65 mL, p = 0.002). Eleven patients in group A required thoracentesis or chest tube insertion after MISS, whereas those in Group B did not require invasive procedures. Conclusions In MISS, tranexamic acid reduced blood transfusion needs, Hemovac volume, incidence and severity of hemothorax, and pleural effusion were associated with thoracoplasty.

Background: To evaluate the clinical impact of intraoperative tranexamic acid administration in minimizing intraoperative blood loss and transfusion requirements during minimally invasive scoliosis surgery (MISS). Methods: Consecutive data were collected from 97 patients with adolescent idiopathic scoliosis who underwent MISS between 2021 and 2023. Tranexamic acid was first introduced in June 2022. Surgical outcomes, complications, and blood parameters were compared between group A (no tranexamic acid) and group B (tranexamic acid). Results: Forty-three patients underwent surgery without intraoperative tranexamic acid (group A), and 54 underwent surgery with tranexamic acid (group B). Variables including age, height, weight, body mass index, hospital stay duration, Cobb angle, correction rate, curve type, fusion extent, and pre- and postoperative hemoglobin levels were not significantly different between the 2 groups (all p > 0.50). On average, 2.03 red blood cell (RBC) transfusions were administered. Group A required 2.6 units, whereas group B required 1.7 units, representing a significant reduction (p = 0.005). Postoperatively, an average of 0.5 RBC units were administered.Group A required 0.9 units, and group B required 0.3 units, with a significant difference (p = 0.001). No significant difference was found in the hemoglobin level between the day before surgery and postoperative days 1 and 4 (all p > 0.05). Significant differences were observed between the 2 groups in the estimated blood loss change (1,358 vs. 1,118 mL, p = 0.035) and Hemovac volume (1,063.26 vs. 910.65 mL, p = 0.002). Eleven patients in group A required thoracentesis or chest tube insertion after MISS, whereas those in Group B did not require invasive procedures. Conclusions In MISS, tranexamic acid reduced blood transfusion needs, Hemovac volume, incidence and severity of hemothorax, and pleural effusion were associated with thoracoplasty.

Background: The lumbosacral (LS) junction has a higher nonunion rate than other lumbar segments, especially in long-level fusion. Nonunion at L5–S1 would result in low back pain, spinal imbalance, and poor surgical outcomes. Although anterior column support at L5–S1 has been recommended to prevent nonunion in long-level LS fusion, fusion length requiring additional spinopelvic fixation (SPF) in LS fusion with anterior column support at L5–S1 has not been evaluated thoroughly. This study aimed to determine the number of fused levels requiring SPF in LS fusion with anterior column support at L5–S1 by assessing the interbody fusion status using computed tomography (CT) depending on the fusion length. Methods: Patients who underwent instrumented LS fusion with L5–S1 interbody fusion without additional augmentation and CT > 1 year postoperatively were included. The fusion rates were assessed based on the number of fused segments. Patients were divided into two groups depending on the L5–S1 interbody fusion status: those with union vs. those with nonunion. Binary logistic regression analyses were performed to identify risk factors for LS junctional nonunion. Results: Fusion rates of L5–S1 interbody fusion were 94.9%, 90.3%, 80.0%, 50.0%, 52.6%, and 43.5% for fusion of 1, 2, 3, 4, 5, and ≥ 6 levels, respectively. The number of spinal levels fused ≥ 4 (p < 0.001), low preoperative bone mineral density (BMD; adjusted odds ratio [aOR], 0.667; p = 0.035), and postoperative pelvic incidence (PI) – lumbar lordosis (LL) mismatch (aOR, 1.034; p = 0.040) were identified as significant risk factors for nonunion of L5–S1 interbody fusion according to the multivariate logistic regression analysis. Conclusions Exhibiting ≥ 4 fused spinal levels, low preoperative BMD, and large postoperative PI–LL mismatch were identified as independent risk factors for nonunion of anterior column support at L5–S1 in LS fusion without additional fixation. Therefore, SPF should be considered in LS fusion extending to or above L2 to prevent LS junctional nonunion.

Background: Menarche has a significant impact on the progression of adolescent idiopathic scoliosis (AIS); however, studies in this area are insufficient. This study used large-scale school screening data to investigate the relationship between menarcheal age and AIS, especially the severity of scoliosis. Methods: Of 2,326,577 students who participated in school screening for scoliosis (SSS) in South Korea from 2001 to 2021, 38,879 girls with AIS, who experienced menarche, were included. Data including the patient’s demographics, such as menarcheal age, Cobb angle, Risser stage, and the interval between menarche and the time of screening were retrieved from the SSS database.Pearson correlation coefficient was used to identify the changes in menarcheal age according to the birth year and to investigate the relationship between menarcheal age and each variable of interest. Results: Based on the birth year, the mean menarcheal ages in girls with AIS from 1988 to 2008 demonstrated a steadily decreasing trend over time (r = –0.857, p < 0.001). Girls with AIS and late menarche demonstrated a higher Cobb angle at the time of screening (r = 0.095, p < 0.001). Other variables did not significantly correlate with menarcheal age. Conclusions Based on the SSS, a large-scale school screening dataset, menarcheal age in girls with AIS demonstrated an ongoing downward trend in the recent 20 years in South Korea. Notably, girls with AIS and late menarche had a higher Cobb angle at screening. Our findings indicate the need for earlier screening of AIS in girls who have not undergone menarche.

Background: Spinopelvic fixation (SPF) has been a challenge for surgeons despite the advancements in instruments and surgical techniques. C-arm fluoroscopy-guided SPF is a widely used safe technique that utilizes the tear drop view. The tear drop view is an image of the corridor from the posterior superior iliac spine to the anterior inferior iliac spine (AIIS) of the pelvis. This study aimed to define the safe optimal tear drop view using three-dimensional reconstruction of computed tomography images. Methods: Three-dimensional reconstructions of the pelvises of 20 individuals were carried out. By rotating the reconstructed model, we simulated SPF with a cylinder representing imaginary screw. The safe optimal tear drop view was defined as the one embracing a corridor with the largest diameter with the inferior tear drop line not below the acetabular line and the lateral tear drop line medial to the AIIS. The distance between the lateral border of the tear drop and AIIS was defined as tear drop index (TDI) to estimate the degree of rotation on the plane image. Tear drop ratio (TDR), the ratio of the distance between the tear drop center and the AIIS to TDI, was also devised for more intuitive application of our simulation in a real operation. Results: All the maximum diameters and lengths were greater than 9 mm and 80 mm, respectively, which are the values of generally used screws for SPF at a TDI of 5 mm and 10 mm in both sexes. The TDRs were 3.40 ± 0.41 and 3.35 ± 0.26 in men and women, respectively, at a TDI of 5 mm. The TDRs were 2.26 ± 0.17 and 2.14 ± 0.12 in men and women, respectively, at a TDI of 10 mm. Conclusions The safe optimal tear drop view can be obtained with a TDR of 2.5 to 3 by rounding off the measured values for intuitive application in the actual surgical field.

Owing to rapidly changing global demographics, adult spinal deformity (ASD) now accounts for a significant proportion of the Global Burden of Disease. Sagittal imbalance caused by age-related degenerative changes leads to back pain, neurological deficits, and deformity, which negatively affect the health-related quality of life (HRQoL) of patients. Along with the recognized regional, global, and sagittal spinopelvic parameters, poor paraspinal muscle quality has recently been acknowledged as a key determinant of the clinical outcomes of ASD. Although the Scoliosis Research Society-Schwab ASD classification system incorporates the radiological factors related to HRQoL, it cannot accurately predict the mechanical complications. With the rapid advances in surgical techniques, many surgical options for ASD have been developed, ranging from minimally invasive surgery to osteotomies. Therefore, structured patient-specific management is important in surgical decision-making, selecting the proper surgical technique, and to prevent serious complications in patients with ASD. Moreover, utilizing the latest technologies such as robotic-assisted surgery and machine learning, should help in minimizing the surgical risks and complications in the future.

Objectives: This study was conducted to demonstrate the reliability of mini-open anterior lumbar interbody fusion (ALIF) combined with lateral lumbar interbody fusion (LLIF) followed by 2-stage posterior fixation in patients with adult spinal deformity (ASD).Summary of Literature Review: Although the correction of ASD using LLIF has become more widespread, the amount of sagittal plane correction has been reported to be suboptimal.Materials and Method: Thirty ASD patients who underwent ALIF with LLIF followed by 2-stage posterior fixation (AP group) were compared to 60 patients who underwent posterior-only surgery (PO group) and were matched according to age, sex, diagnosis, fusion level, pelvic incidence, and follow-up duration. Spinopelvic parameters, hospitalization data, clinical outcomes, and complications were compared between the 2 groups. Results: Postoperative lumbar lordosis was greater in the AP group than in the PO group (p<0.001). The reduction in the sagittal vertical axis was also greater in the AP group than in the PO group (p=0.005). Postoperatively, 90.0% of the AP group had a pelvic incidence– lumbar lordosis value within 9°, whereas only 50.0% of the PO group met that criterion (p<0.001). The operation time of the AP group was longer than that of the PO group, while estimated blood loss and red cell transfusion were lower in the AP group. Postoperative medical complications and delayed surgical complications developed more frequently in the PO group. Conclusions Mini-open ALIF with LLIF followed by 2-stage posterior fixation can restore sagittal balance more appropriately, with a lower rate of complications, than posterior-only surgery for the correction of ASD.

Magnetic resonance imaging (MRI) is recommended for patients with epileptic seizures to rule out an underlying focal lesion. However, abnormalities in idiopathic generalized epilepsy, including childhood absence epilepsy, cannot usually be identified using brain imaging modalities such as MRI. Peri-ictal MRI abnormalities have been most commonly reported secondary to status epilepticus and are rarely observed in patients with focal seizures and generalized tonic-clonic seizures. Transient peri-ictal MRI abnormalities in absence epilepsy are extremely rare. A five-year-old girl presented with a three-day history of absence seizures that persisted despite continued treatment with sodium valproate. Electroencephalography showed bursts of generalized 3-Hz spike-and-wave discharges, during and after hyperventilation. Abnormal cortex thickening in the left perisylvian region was detected on T2-weighted brain MRI, and cortical dysplasia or a tumor was suspected. The patient started treatment with lamotrigine and was seizure-free after one month. The abnormal MRI lesion was completely resolved at the two-month follow-up. We report on a patient with childhood absence epilepsy and reversible brain MRI abnormalities in the perisylvian region. To our knowledge, this is the first report of transient MRI abnormalities after absence seizures. Transient peri-ictal MRI abnormalities should be considered for differential diagnosis in patients with absence seizures and a focal abnormality on brain MRI.
Brain ; Diagnosis, Differential ; Electroencephalography ; Epilepsy ; Epilepsy, Absence* ; Epilepsy, Generalized ; Female ; Follow-Up Studies ; Humans ; Hyperventilation ; Magnetic Resonance Imaging* ; Malformations of Cortical Development ; Neuroimaging ; Seizures ; Status Epilepticus ; Valproic Acid