Vertebral anomalies causing congenital scoliosis are classified on the basis of failures of formation, segmentation, or both. The natural history depends on the type of anomaly and the location of anomaly. Patient evaluation focuses on the history and physical examination, followed by appropriate imaging modalities. The hallmark of surgical treatment is early intervention before the development of large curvatures. The surgical treatment of a congenital deformity mandates the use of neurological monitoring to minimize the risk of perioperative neurological deficit. Modern surgical techniques have evolved to include the routine use of spinal instrumentation. Patients with associated chest wall deformities or large compensatory curves may be candidates for vertical expansion prosthetic titanium rib placement or growing rods insertion to maximize growth.

A retrospective case series. To determine if implant retention is possible in spinal deformity cases which present as a delayed (greater than 3 months) surgical site infection. The retention of spinal implants in deformity surgery is possible with an acute surgical site infection. Currently, the decision whether or not to retain implants in a delayed surgical site infection is unclear. A retrospective review of 26 cases of delayed surgical site infections after spinal deformity surgery. Data and information was recorded regarding the initial management of the surgical site infection, the number of operations performed related to the infection, and whether or not the infection could be cleared with implant retention. The number of operations, hospital days, and charges related to the treatment of the infection were recorded. In this series, no patient was able to clear their infection without spinal implant removal. The number of operations required to clear the infection, length of hospitalization, and financial charges were proportionate to the timing of implant removal. Delayed surgical site infections after spinal instrumentation for deformity need to be treated with implant removal to clear the surgical site infection. Patients may require to undergo repeat instrumentation and fusion at a later date if they develop progressive deformity or symptomatic pseudarthrosis after implant removal.

Background: Tranexamic acid (TXA) is an antifibrinolytic drug that reduces surgical blood loss. Evidence supporting its efficacy in surgery for adolescent idiopathic scoliosis is not robust. This trial was designed to validate the clinical efficacy of TXA in surgery for adolescent idiopathic scoliosis. Methods: This institutional review board-approved prospective double-blinded trial involved 111 patients with adolescent idiopathic scoliosis who were randomized to receive either a placebo or TXA (50-mg/kg loading dose and 10-mg/kg/h infusion). Power analysis indicated that 50 patients per group would provide power to detect a >20% difference in blood loss. Two-way analysis of variance (ANOVA) was applied to compare blood loss rates (slopes) using the group-by-time interaction F test. Results: The risk of clinically relevant blood loss (>20 mL/kg) was more than twice as high in the placebo group than in the TXA group (44% versus 21%, relative risk = 2.1, 95% confidence interval = 1.2 to 3.7). Compared with the placebo group, the TXA group had a 27% reduction in intraoperative blood loss, a significantly lower rate of intraoperative bleeding per hour (mean and standard deviation, 190 ± 73 versus 230 ± 80 mL, p = 0.01; F = 9.77, p < 0.001) and per fused spinal level (82 ± 32 versus 110 ± 40 mL, p < 0.001), less intraoperative blood loss (836 ± 373 versus 1,031 ± 484 mL, p = 0.02), and less postoperative bleeding (in the drain) (498 ± 228 versus 645 ± 318 mL, p = 0.009). Six patients who received a placebo and no patient who received TXA required an allogenic blood transfusion. No perioperative adverse events, including thromboembolic events or seizures, were observed. Three independent factors were predictive of blood loss: TXA administration, duration of surgery, and number of levels fused. Greater intraoperative blood loss was the only independent variable predictive of a longer hospital stay. Conclusions: Use of TXA in patients undergoing surgery for adolescent idiopathic scoliosis significantly reduced blood loss, by 27%, compared with that in the placebo group. The rate of intraoperative blood loss per hour and per level fused and the amount of postoperative blood loss were significantly lower in the TXA group. More placebo-treated patients received allogenic blood. Patients with greater intraoperative blood loss spent a longer time in the hospital. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

The use of locking plates for pediatric femur fractures has not been studied. Locking plate applications for fractures associated with comminution, osteopenia, or minimal bone available for purchase have been well studied in the adult trauma population. We conducted a retrospective review of children at our institution treated with a locking plate for a femur fracture. We identified 32 patients treated at an average age of 11 years (6-15 years of age). Locking plates were chosen for comminution in 13 patients, nonmalignant pathologic fracture in 9 patients, fracture location in 7 patients, and osteopenia in 3 patients. All patients were treated with a locking plate and followed up until definitive radiologic union. There were no intraoperative complications related to this technology. All patients were healed with near-anatomic alignment with the exception of 1 patient who had valgus malalignment of 12 degrees, which was of no clinical concern and required no intervention. Seven patients had the plates removed with no noted complications. Locking plates are a safe and effective treatment for children and adolescents with femur fractures that may not be amenable to other current means of stabilization.

A retrospective radiographic and chart review of patients who underwent operative treatment with the use of reduced size spinal instrumentation for congenital spine deformities To assess the safety and efficacy of spinal instrumentation in young patients who were operated on for a congenital spine deformity. The use of spinal instrumentation has been shown to improve curve correction and arthrodesis rates in spinal deformity surgery. The advent of reduced-size implants has allowed surgeons to expand the use of instrumentation in pediatric patients. The use of reduced-size spinal instrumentation in children with congenital spine deformities has not been well documented. We retrospectively investigated the use of spinal instrumentation in 40 patients younger than 8 years with a congenital spine deformity. The review of radiographs and medical records was performed to assess the complications associated with instrumentation, the curve correction, and the arthrodesis rate in this patient population. The complications associated with the use of instrumentation in this group of patients were infrequent. Curve correction was excellent, and the sagittal profile was maintained in all patients at an average follow-up of greater than 3 years. All patients obtained a solid arthrodesis. The use of reduced-size spinal instrumentation in young patients is safe and efficacious. Curve correction, length of immobilization, and fusion rate are improved compared to similar patients in the literature treated without instrumentation.