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Study design Case report and review of literature. Objective To illustrate the importance of "dynamic spinal cord mapping" (DSCM) in locating the site of neurophysiologic data loss during severe spinal deformity correction. During marked correction of severe spinal deformities, intra-operative neuromonitoring remains of paramount importance. This case illustrates the importance of a unique type of monitoring, particularly useful when obtaining correction at multiple sites. Methods A patient with symptomatic, progressive, severe kyphoscoliosis underwent multiple periapical posterior column osteotomies, partial T8 and complete T9 vertebral column resections and T2 to L3 posterior segmental instrumented fusion. During correction maneuvers, complete loss of spinous process descending neurogenic evoked potentials occurred. A flexible epidural catheter was placed at different spinal levels to dynamically stimulate the spinal cord and map out the site of data loss corresponding to the area of neural compromise. Results Using DSCM, the site of data loss was identified to the apex of the proximal thoracic region cephalad to the VCR site. This was rectified by releasing correction at the proximal end of the construct, and neurophysiologic data promptly returned to baseline. Postoperatively the patient was neurologically intact. Conclusion Dynamic spinal cord mapping helps map areas of neurophysiologic data loss permitting focused attention to the site of compromise to reverse the offending agent. This improves the chance for return of baseline data, avoiding the potential for permanent neurologic catastrophe for the patient. LOE IV.Study design Cross-sectional study. Objectives To provide a comprehensive, multi-stage investigation of vertebral body (VB) and intervertebral disc (IVD) coronal plane deformities for adolescent idiopathic scoliosis (AIS) patients with a main thoracic curve type, using a series of sequential magnetic resonance images (MRIs). Despite numerous investigations of AIS deformity at the spinal segmental level, there is little consensus as to the major contributor to the lateral curvature of a scoliotic spine. Moreover, scoliotic deformity is often described along a continuum of progression, with few studies having characterised the change in segmental deformity for AIS patients whose deformity progresses clinically over time. Methods 30 female AIS patients with primary thoracic curves were included between 2012 and 2016. Three sequential MRIs were captured for each patient. Datasets were reformatted to produce true coronal plane images of the thoracic spine (T4-L1). Overall curve morphology, coronal plane IVD and VB segmental deformity and rates of growth were analysed. Results Right-side asymmetry was greater in IVDs (18.5 ± 23.9%) when compared to VBs (8.3 ± 9.2%) (P 0.05). Conclusions VB wedging contributed more to the lateral deformity observed in primary thoracic subtypes of AIS patients than IVD wedging. While IVDs demonstrated the greatest asymmetric deformity, their relatively smaller height resulted in a smaller proportional change in lateral curve angle compared to the VBs. Level of evidence IV.Study design Retrospective. Objectives To assess final outcomes in patients with early-onset scoliosis (EOS) who underwent growth-preserving instrumentation (GPI). Various types of growth-preserving instrumentation (GPI) are frequently employed, but until recently had not been utilized long enough to assess final outcomes. Methods GPI "graduates" with multi-level congenital curves were identified. Graduation was defined as a final fusion or 5 years of follow-up without planned future surgeries. Outcomes included radiographic parameters and complications. Results 26 patients were included. 11 had associated diagnoses; eight had fused ribs. 17 were treated with traditional growing rods, seven with vertically expandable prosthetic ribs, and two with Shilla procedures. The mean GPI spanned 12.3 levels including 10.7 motion segments, age at index surgery was 5.5 years, treatment spanned 7.5 years, and follow-up was 9.2 years. 24 patients underwent final fusion. Mean major curve decreased from 73° to 49° with index surgery (p 22 cm in 6 patients (23%). On average, there were 2.6 complications per patient, including 1.7 implant failures. 12 patients (46%) experienced ≥ 3 complications; four patients (15%) experienced none. Conclusion We observed successful prevention of deformity progression but substantial residual deformity among GPI graduates with multi-level congenital EOS. Most coronal curve correction was attained during GPI implantation; thoracic height improved throughout treatment. While some favorable results were found, treatment strategies allowing improved deformity correction would be valuable for this challenging population. Level of evidence Therapeutic-III.Introduction Although the burden of adverse drug reactions (ADRs) has a significant impact on patients' quality of life, thorough knowledge about patients' perspectives on the burden of ADRs attributed to biologics is lacking. Objectives This study was conducted to gain insight into the patient burden of ADRs experienced with biologic use. Methods The Dutch Biologic Monitor is a prospective, multicentre, event monitoring cohort system including information collected by web-based questionnaires from patients using biologics, mainly for immune-mediated inflammatory diseases (IMIDs). Patients were asked to complete bimonthly questionnaires on biologics used, indication for the biologic, experienced ADRs, consequences of ADRs and burden on a five-point Likert-type scale, ranging from 1 (no burden) to 5 (very high burden). We assessed potential factors associated with patient-reported burden of ADRs. selleck chemicals Results A total of 1355 patients completed 6293 questionnaires between 1 January 2017 and 1 May 2019. Almost half of the patients (665 patients, 49%), 69% with rheumatic diseases and 31% with other diseases, collectively reported 1720 unique ADRs. Infections and musculoskeletal complaints were the most burdensome ADRs and injection-site reactions were the least burdensome. ADRs leading to healthcare professional contact were more burdensome than ADRs without healthcare professional contact. Smoking, respiratory and psychiatric comorbidities were associated with higher burden of ADRs. Crohn's disease, use of adalimumab and use of sulfasalazine as combination therapy were associated with lower burden of ADRs. Conclusions The patient perspective gives important insights into the burden of ADRs experienced with biologics. This information could be used by healthcare professionals to optimise treatment with biologics.