Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Adolescent Idiopathic Scoliosis
Posted: Feb 9 2022 #(C101995)
A

Adolescent Idiopathic Scoliosis in 13F

HPI

The patient is a 13-year-old female that initially presented to clinic several years prior with scoliosis. She was given a brace but was unwilling to wear this for sufficient time during the day. The mother reports her curve has progressively worsened. The patient denies any back pain or lower extremity weakness, numbness, or tingling.

PMH

No contributory past medical and surgical history. Family history is positive for scoliosis in her sister.

PE

On examination, there is an obvious deformity of the spine with a large left-sided thoracolumbar prominence. The right shoulder sits about 2-3 cm higher than the left side. Forward bending does not elicit pain and there is significant vertebral rotation appreciated. There are symmetric 2/4 patellar and Achilles reflexes. Motor strength is 5/5 in the iliopsoas, quadriceps, tibialis anterior, extensor hallicus longus, and gastrocsoleous. There is a downgoing Babinski's.

Poll
1 of 15
1. Would you obtain additional imaging to guide management?
No - current radiographs are sufficient
40%
281/693
Yes - additional radiographs (aXR)
3%
21/693
Yes - CT scan (CT)
7%
51/693
Yes - MRI
24%
167/693
Yes - aXR + CT
1%
7/693
Yes - aXR + MRI
2%
19/693
Yes - CT + MRI
10%
70/693
Yes - aXR + CT + MRI
2%
18/693
Outside my area of expertise - best if I don't vote
8%
59/693
2. Would you use a Classification system to guide your management?
No - I would not use a classification
12%
85/662
Yes - King classification
4%
33/662
Yes - Lenke classification
66%
438/662
Yes - King-Moe classification
4%
29/662
Yes - other
1%
7/662
Outside my area of expertise - best if I dont vote
10%
70/662
3. How would you Manage this patient?
Nonoperative
4%
27/659
Operative
88%
580/659
Outside my area of expertise - best if I don't vote
7%
52/659
4. If you choose Operative management, what surgery would you perform?
I would not choose Operative management
0%
3/635
Anterior instrumented fusion (ASF) only
1%
8/635
Posterior instrumented fusion (PSF) only
75%
480/635
Combined Anterior + Posterior (A/P) instrumented fusion
11%
72/635
Outside my area of expertise - best if I don't vote
11%
72/635
5. If you choose Operative management, would you place the patient in traction prior to definitive surgical treatment?
I would not choose Operative management
1%
7/624
No
71%
449/624
Yes - Halo traction
8%
52/624
Yes - Halter traction
5%
33/624
Outside my area of expertise - best if I don't vote
13%
83/624
6. If you choose Posterior instrumented fusion (PSF) only, which level would be the planned Upper instrumented vertebrae?
I would not choose Posterior instrumented fusion (PSF) only
1%
6/598
C7
8%
49/598
T1
13%
79/598
T2
22%
133/598
T3
17%
107/598
T4
21%
127/598
T5
2%
13/598
T6
1%
8/598
T7
0%
2/598
Outside my area of expertise - best if I don't vote
12%
74/598
7. If you choose Posterior instrumented fusion (PSF) only, which level would be the planned Lower instrumented vertebrae?
I would not choose Posterior instrumented fusion (PSF) only
0%
2/576
T11
0%
3/576
T12
1%
7/576
L1
1%
6/576
L2
3%
23/576
L3
15%
90/576
L4
38%
220/576
L5
14%
86/576
Sacrum
8%
47/576
Pelvis
4%
28/576
Outside my area of expertise - best if I don't vote
11%
64/576
8. If you choose Posterior instrumented fusion (PSF) only, what type of instrumented fixation would you use for the vertebral bodies?
I would not choose Posterior instrumented fusion (PSF) only
0%
5/549
No hardware - decorticate Only
0%
0/549
Pedicle Screws (Screws) Only
52%
287/549
Sublaminar, pedicle, or TP Hooks (Hooks) Only
3%
18/549
Sublaminar Wires (Wires) Only
0%
1/549
Screws + Hooks
20%
110/549
Screws + Wires
3%
19/549
Hooks + Wires
0%
1/549
Screws + Hooks + Wires
7%
42/549
Outside my area of expertise - best if I don't vote
12%
66/549
9. If you choose Posterior instrumented fusion (PSF) only, would you perform any osteotomies?
I would not choose posterior instrumented fusion
0%
4/522
No - I would not perform any osteotomies
25%
132/522
Yes - Facetectomies (Fac) only
23%
123/522
Yes - Smith Peterson osteotomies (SPO) only
11%
62/522
Yes - Pedicle subtraction osteotomies (PSO) only
3%
16/522
Yes - Vertebral column resection (VCR) only
0%
2/522
Yes - Fac + SPO
13%
71/522
Yes - Fac + PSO
2%
12/522
Yes - Fac + VCR
0%
2/522
Yes - SPO + PSO
0%
4/522
Yes - SPO + VCR
0%
2/522
Yes - Other
0%
4/522
Outside my area of expertise - best if I don't vote
16%
88/522
10. If you choose Posterior instrumented fusion (PSF) only with pedicle screw (Screws) fixation, what technique would you use to you place your pedicle screws?
I would not choose Posterior instrumented fusion (PSF) only with pedicle screw (Screws) fixation
1%
6/508
Anatomic - X-rays or fluoro After All screws placed
28%
147/508
Fluoro-assisted - Fluoro During screw placement
35%
178/508
Navigation without robot - intra or preoperative CT/fluoro
16%
86/508
Robot + Navigation - intra or preoperative CT
8%
41/508
Other
0%
5/508
Outside my area of expertise - best if I don't vote
8%
45/508
11. If you choose Posterior instrumented fusion only (PSF) with pedicle screw and an Anatomic or Fluoro-assisted technique, do you use Power when you Cannulate, Tap, and Place the screw into the pedicle?
I would not choose Posterior instrumented fusion (PSF) only with pedicle screw and an Anatomic or Fluoro-assisted technique
2%
10/449
Cannulate Manually - Tap Manually - Place Screw Manually
56%
255/449
Cannulate Manually - Tap Manually - Place Screw with Power
6%
27/449
Cannulate Manually - Tap with Power - Place Screw Manually
1%
8/449
Cannulate Manually - Tap with Power - Place Screw with Power
4%
19/449
Cannulate Manually - Do Not Tap - Place Screw Manually
8%
37/449
Cannulate Manually - Do Not Tap - Place Screw with Power
2%
12/449
Cannulate with Power - Tap Manually - Place Screw Manually
6%
31/449
Cannulate with Power - Tap Manually - Place Screw with Power
0%
4/449
Cannulate with Power - Tap with Power - Place Screw Manually
2%
10/449
Cannulate with Power - Tap with Power - Place Screw with Power
3%
16/449
Cannulate with Power - Do Not Tap - Place Screw Manually
0%
3/449
Cannulate with Power - Do Not Tap - Place Screw with Power
3%
17/449
12. If you choose Posterior instrumented fusion only (PSF) with pedicle screw (Screws) fixation, in addition to decorticating bone, would you augment with bone graft and/or biologics?
I would not choose Posterior instrumented fusion only (PSF) with pedicle screw (Screws) fixation
0%
1/452
No – I would decorticate Only
12%
55/452
Yes - local bone Only (local)
26%
118/452
Yes - iliac crest autograft Only (ICBG)
5%
25/452
Yes - allograft Only (e.g., cortical or cancellous chips, DBM)
10%
46/452
Yes - BMP Only
1%
7/452
Yes - Local + ICBG
2%
13/452
Yes - Local + allograft
28%
127/452
Yes - Local + BMP
4%
20/452
Other
0%
0/452
Outside my area of expertise - best if I don't vote
8%
40/452
13. If you choose Posterior instrumented fusion (PSF) only, would you place Vancomycin powder (Vanco) in the wound?
I would not choose Posterior instrumented fusion (PSF) only
0%
4/450
No - I would not place Vancomycin powder
34%
157/450
Yes - I would place Vanco Deep to Fascia Only
28%
127/450
Yes - I would place Vanco Superficial to Fascia Only
5%
26/450
Yes - I would place Vanco Deep + Superficial to Fascia only
22%
99/450
Outside my area of expertise - best if I don't vote
8%
37/450
14. If you choose Posterior instrumented fusion (PSF) only and obtain the construct below, would you Brace the patient postoperatively and if so for how long?
I would not choose Posterior instrumented fusion (PSF) only
1%
5/446
I would not brace post operatively
58%
260/446
Yes - brace for 1-2 week
2%
13/446
Yes - brace for 3-4 weeks
4%
21/446
Yes - brace for 5-6 weeks
12%
54/446
Yes - brace for 7-8 weeks
6%
28/446
Yes - brace for 9-10 weeks
2%
11/446
Yes - brace for > 10 weeks
4%
18/446
Outside of my area of expertise - best if I don't vote
8%
36/446
15. If you choose Operative management, would you utilize software to develop a surgical plan, and if so would you use pre-contoured rods?
I would not choose Operative Management
1%
6/451
No - I would Not utilize software to develop a plan
52%
236/451
Yes - I would utilize software, but Not pre-contoured rods
21%
99/451
Yes - I would utilize software, and Obtain pre-contoured rods
12%
58/451
Outside my area of expertise - best if I don't vote
11%
52/451
PROCEDURE #1 DOP: 2/5/2022

T2-L3 posterior instrumented fusion, T2-L2 posterior column osteotomies

icon
OUTCOMES
Post-procedure P1
Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options