Posterior convex release and interbody fusion for thoracic scoliosis: technical note
Bibliographic record
Abstract
Anterior release and fusion is sometimes required in pediatric patients with thoracic scoliosis. Typically, a formal anterior approach is performed through open thoracotomy or video-assisted thoracoscopic surgery. The authors recently developed a technique for anterior release and fusion in thoracic scoliosis referred to as "posterior convex release and interbody fusion" (PCRIF). This technique is performed via the posterior-only approach typically used for posterior instrumentation and fusion and thus avoids a formal anterior approach. In this article the authors describe the technique and its use in 9 patients-to prevent a crankshaft phenomenon in 3 patients and to optimize the correction in 6 patients with a severe thoracic curve showing poor reducibility. After Ponte osteotomies at the levels requiring anterior release and fusion, intervertebral discs are approached from the convex side of the scoliosis. The annulus on the convex side of the scoliosis is incised from the lateral border of the pedicle to the lateral annulus while visualizing and protecting the pleura and spinal cord. The annulus in contact with the pleura and the anterior longitudinal ligament are removed before completing the discectomies and preparing the endplates. The PCRIF was performed at 3 levels in 4 patients and at 4 levels in 5 patients. Mean correction of the main thoracic curve, blood loss, and length of stay were 74.9%, 1290 ml, and 7.6 days, respectively. No neurological deficit, implant failure, or pseudarthrosis was observed at the last follow-up. Two patients had pleural effusion postoperatively, with 1 of them requiring placement of a chest tube. One patient had pulmonary edema secondary to fluid overload, while another patient underwent reoperation for a deep wound infection 3 weeks after the initial surgery. The technique is primarily indicated in skeletally immature patients with open triradiate cartilage and/or severe scoliosis. It can be particularly useful if there is significant vertebral rotation because access to the disc and anterior longitudinal ligament from the convex side will become safer. The PCRIF is an alternative to the formal anterior approach and does not require repositioning between the anterior and posterior stages, which prolongs the surgery and can be associated with an increased complication rate. The procedure can be done in the presence of preexisting pulmonary morbidity such as pleural adhesions and decreased pulmonary function because it does not require mobilization of the lung or single-lung ventilation. However, PCRIF can still be associated with pulmonary complications such as a pleural effusion, and care should be taken to avoid iatrogenic injury to the pleura. Placement of a deep wound drain at the level of the PCRIF is strongly recommended if postoperative bleeding is anticipated, to decrease the risk of pleural effusion.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".