Brice Ilharreborde

Study Design.: Retrospective multicenter registry study. Objective.: To compare sagittal spinopelvic alignment between normal subjects and Adolescent Idiopathic Scoliosis (AIS), to evaluate the relationship between T4 and L1 Pelvic Angles (T4PA–L1PA), including the influence of Thoracolumbar Inflection Point (TIP). Summary of Background Data.: Vertebropelvic angles were described as alignment targets for normal adults, but their role remains incompletely defined in younger AIS patients. Methods.: Full-spine radiographs of 1115 normal subjects and 1779 AIS patients (10–30 y) were analyzed. AIS was classified according to Lenke. Measurements included Pelvic Incidence (PI), Pelvic Tilt (PT), segmental Thoracic Kyphosis (TK) and Lumbar Lordosis (LL), T4PA, L1PA. A Pearson correlation analyzed the relationship between parameters. TIP was categorized as cranial (above T12), junctional (T12–L1), or caudal (below L1), and T4PA-L1PA analyzed according to TIP (ANOVA). Formulae LL=0.5×PI–21 and L1PA=1.4×PI–1.7×L1PA–2 were evaluated using linear regression. Results.: TK T1-12 was smaller P P 3° ( P 3° ( P 0.7), L1PA and PT (r>0.7), L1PA and T4PA (r>0.9) for normal and each Lenke type. T4PA-L1PA differences increased from negative to positive as the TIP moved from cranial to caudal in normal and AIS ( P 0.6). Conclusion.: Primary thoracic AIS had smaller TK T1-T12, TK T10-L1 and larger LL L1-L4, L1PA, while the T4-L1hip axis remained globally preserved in normal and AIS. The TIP influenced segmental alignment, with larger L1PA and smaller (negative) T4PA-L1PA differences. Vertebropelvic angles provide a reliable target for surgical planning in AIS.

Background: The goal of treatment in early onset scoliosis patients is to control the deformity while allowing chest and spinal growth. However, management, either conservative or surgical, remains controversial and require further clinical evidence. The aim of this study was to determine best practice guidelines for the management of early onset scoliosis patients in Europe. Methods: A Delphi approach was used among European experts to determine consensus in: (1) identification of progression risk factors, (2) clinical and radiographic evaluation, (3) conservative treatment, and (4) surgical management. Idiopathic and non-idiopathic groups were analyzed separately. Statements were only included in the final agreed consensus if at least 80% of respondents agreed with the statement. Results: A total of 22 pediatric orthopedic surgeons completed the first and second surveys, and 21 the third. Out of open-ended questions included in the initial Delphi, 75 statements for 59 multiple-choice questions in the idiopathic group and 47 statements for the 44 multiple-choice questions for the non-idiopathic group were formed for the second round. Of the total 122 statements, 50 (40.9%) reached consensus, and 72 did not. Among the 72 statements re-evaluated in Round 3, consensus was reached on 69 (96%). Conclusion: Early onset scoliosis represents a rare, heterogeneous, but life-threatening condition often associated with insufficient relevant evidence. Consensus is difficult to achieve (39.3% of the 122 statements), especially in the non-idiopathic group. However, 48 guidelines (33 for idiopathic and 15 for non-idiopathic) were provided by European experts to improve early onset scoliosis management. Level of Evidence: IV

Purpose Many surgeons have regained interest in conservative options for the treatment of idiopathic early onset scoliosis due to the significant complication rates and risks of unplanned returns to the operating room. Most treating physicians usually opt for serial casting or full-time bracing. However, there is very scarce data regarding night-time bracing in idiopathic early onset scoliosis patients (I-EOS). The aim was to evaluate the efficacy of the detorsion night-time bracing (DNB) in a cohort of juvenile I-EOS patients followed until skeletal maturity. Methods This is a retrospective study of all consecutive patients diagnosed with juvenile I-EOS treated until skeletal maturity by DNB between January 2008 and January 2023. All patients underwent low-dose, biplanar, standing full-spine radiographs and pulmonary function tests (PFTs), and filled the EOSQ-24 at final follow-up. Patients were divided into 3 groups according to the success of the treatment: group 1: success, group 2: progression, group 3: surgery. Results 80 patients were included, and surgery was avoided in 49% of the cases. Compliance was high, and patients were able to maintain their sagittal alignment during growth, as mean T4T12TK remained stable in group 3 (14.5° ±9) or increased in groups 1 and 2 (24° ±11 and 19° ±10, respectively) at mean follow-up. A correlation was found between the initial hypokyphosis and the Cobb at follow-up (r=-0.39, p < 0.001). Conclusion Exclusive night-time bracing is a reasonable well-accepted alternative for the conservative management of juvenile I-EOS This treatment does not flatten the spine and allows trunk growth and lung development. Keywords Early onset scoliosie, conservative treatment, detorsion night-time brace, bracing, pulmonary function test, EOSQ-24, sagittal alignment

In children under 4, septic arthritis of the hip (SAH) caused by Kingella kingae (SAH-KK) can be misdiagnosed, as it does not meet classic septic joint criteria (fever > 38.5°, pain, limited range of motion, and inability to bear weight). The objective of this study was to report clinical and paraclinical characteristics in a large cohort of children with confirmed SAH-KK and to evaluate the reliability of the Kocher (KC) and Caird criteria (CC) in predicting SAH-KK. Medical records of 140 children with confirmed SAH-KK were collected. Data on sex, age, temperature on admission, weight-bearing status, white blood cell (WBC) count, platelet count, C-reactive protein (CRP) value, and erythrocyte sedimentation rate (ESR) were extracted. The study focused on the sensitivity of KC (body temperature, refusal to bear weight, leukocytosis, and ESR) and CC (KC criteria plus CRP level). All patients had bacteriologically confirmed SAH-KK; most had mild symptoms and near-normal inflammatory markers. CRP (76.2%) had the highest sensitivity, followed by weight-bearing status (73.8%) and WBC count (69.6%). Body temperature and ESR exceeded cutoff values in less than 50% of cases. Among 77 patients fulfilling all KC, 49 (63.5%) had less than a 40% probability of SAH. Of 50 children with complete CC, 20 (40%) had a 62.4% or lower probability of SAH. KC and CC are not sufficiently accurate to confidently exclude SAH-KK in preschool-aged children due to heterogeneous clinical presentations. Further studies are needed to redefine diagnostic criteria based on patient age and causative pathogens.

Purpose: Multiple osteotomies are frequently associated with single-event multi-level surgery (SEMLS) in children with cerebral palsy (CP). However, appropriate management of perioperative blood loss is crucial for decreasing the length of hospital stay and early rehabilitation. Tranexamic acid (TxA) has been proven to significantly reduce perioperative bleeding in multiple major orthopedic surgeries. The aim of this study was to investigate the effectiveness of TxA in decreasing blood loss in children with CP undergoing SEMLS procedures. Materials and Methods: Between September 2016 and September 2022, 101 consecutive children with CP who underwent SEMLS were identified—50 patients did not receive TxA peri-operatively (Control Group, from September 2016 to September 2018), and 51 patients received TxA (TxA Group since September 2018). Bleeding, hemoglobin levels, transfusion rate, length of hospital stay and postoperative hematocrit were compared between the groups. The predictive factors of blood transfusion were determined. Results: The transfusion rate significantly decreased in the TxA Group (43.3% vs. 4%, p < 0.001). The use of TxA and epidural analgesia were the identified factors for a significant transfusion rate decrease. Bleeding (estimated red cell loss) was decreased in the TxA group in comparison to the control group 22.3 [17.3–27.3] versus 33.78 [27.4–40.2], p < 0.05). The hospital length of stay significantly decreased in the TxA group (7.3 vs. 6 days, p = 0.01). No TxA-related complications occurred in any of the patients. Conclusions: A blood loss prevention strategy based on a low dose of TxA in children scheduled for SEMLS significantly decreased bleeding and transfusion rates, allowing an earlier discharge from the hospital for patients.