New Advances in Spinal Deformity Surgery A total of 129 articles were honored at the SRS Annual Meeting held September 5-8, 2012, in Chicago, Illinois. Idiopathic Scoliosis Much discussion remains in the area of selective thoracic fusion for the treatment of pseudo double principal curves. This was discussed in several articles at the SRS Annual Meeting, primarily in the context of a thoracic bend that is greater than the lumbar bend, but the lumbar bend is a structural bend with rotation and paravertebral deviation. The only conclusion reached was that the choice of surgeons to perform elective thoracic fusion is highly controversial, which leads to different outcomes. Predicting prognosis based on the “rules” of elective fusion technique becomes very difficult. At least one article has shown that surgery for adolescent idiopathic scoliosis is cost-effective compared to coronary artery bypass grafting and total knee arthroplasty. The cost per quality-adjusted life year was approximately $8,182. Zheng Yanping, Department of Spine Surgery, Qilu Hospital, Shandong University A study compared the pedicle nail system with a hybrid nail-hook system and found that patients who underwent internal fixation with the pedicle screw system had a lower revision rate than those who underwent the hybrid nail-hook system (3.5% vs. 12.6%). Adult Spinal Deformities Considerable work is being done to evaluate the cost effectiveness of scoliosis orthopedics in adults. A recent group of studies has shown fairly significant outcomes in cases at two years of follow-up. However, the incidence of neurological deficits is quite high, as is the higher risk of proximal junctional retrognathism and poor fusion in the proximal junctional position. At least one study has shown that adult scoliosis deformity has similar effects on physical function as diabetes and cardiac system disease. For extension of the segmental fusion segment to the sacrum, the application of iliac fixation to protect the sacral screws is considered mandatory. However, it is still unclear whether iliac fixation or sacral wing screw fixation at S2 is preferable to first-generation iliac screws in terms of reduction of the posterior protrusion angle. The currently used third-generation iliac screw has a smaller screw and better implant insertion technique. Both techniques appear to have a relatively low complication rate at this time and both are effective in protecting the sacral screw. Three-column osteotomies are increasingly used in the treatment of severe adult scoliosis. The use of this procedure in adults is associated with a higher incidence of neurological complications than in children. The incidence of incisional infection in the surgical treatment of patients with neuromuscular scoliosis is high (6.5%), which is associated with the presence of a gastrostomy, preoperative large-angle kyphosis, long duration of surgery, and advanced age. In contrast, the ability to walk and implants with antibiotics may result in a lower rate of incisional infection. In contrast, one study compared non-surgical versus surgical treatment for delayed neuromuscular scoliosis (Duchenne-type muscular dystrophy, spinal muscular atrophy, etc.). Life expectancy was found to be higher in the surgical treatment group than in the non-surgical treatment group. Complications Various methods have been used to try to reduce the chances of deep incision infection after scoliosis reconstruction. Among them, intravenous administration of vancomycin and the application of cephalosporins were considered effective. In addition, preoperative skin preparation and topical application of antibiotics, especially vancomycin, appear to be beneficial. Early scoliosis The application of growth-valve techniques for the bracing of patients with progressive childhood scoliosis continues to be popular. The population supporting this philosophy considers it to be based on patients with congenital scoliosis or adolescent idiopathic scoliosis whose Y-shaped cartilage has not yet closed under the age of ten. There are many surgical options for this concept, but none is ideal. The technique is to surgically lengthen the internal implant approximately every 6 months so as not to restrict spinal growth. Other methods that have been investigated include segmental self-growth rods with a sliding link between the connecting rod and the fixation point and magnet-driven growth rods. Most of the spinal growth techniques have not been approved by the FDA and their use is considered “beyond the scope of application”.