Thanks, Jian. The next speaker is Dr. Praveen Mumadini, Treatment of the Fractional Curve Only in Adult Scoliosis, Comparison to Lower Thoracic and Upper Thoracic Fusions. Great, thanks, Zoe, and thanks, Lou. This work was really primarily executed by Dean Chow, my partner, who asked me to give the talk, but really should take the credit for putting this together with the UCSF team. My disclosures are here. I do work with Dipute, Stryker, and Globus. So the question really becomes, what do we do with patients who look like this? This is the fractional curve down here, L4 to S1. Do we have to treat all this business if the symptoms really are coming from down here? If we only treat this area down here, are we going to get away with it? That's really the question we were after. So what we did is we figured out how many patients we had who had these fractional curves, so we only treated that part of the curve and left the rest of the lumbar spine alone, and usually the patients who had this problem had radiculopathy as their primary issue. So if we look at these fractional curve patients, what they end up getting is up-down foraminal stenosis on the concavity of the curve. They may get a lateral asthesis and they get radicular pain from that. And as the fractional curve basically collapses the up-down foramen, then they start getting foraminal stenosis and radiculopathy. And so some of these patients may or may not have some low back pain. Others don't really complain of back pain, they really complain of radiculopathy. And the question is, can we go after this kind of nerve root impingement here by expanding the disc space and expanding the foramen? So we started looking at if we could just treat that fractional curve. So this would be the construct for the fractional curve only. This is a construct of the lumbar spine. This is the long segment construct, upper and lower thoracic. So we looked at about 99 patients, almost 100 patients. About a quarter of them had the fractional curve only treated and the rest of them had much more extensive surgery. And then we started looking at blood loss and outcome. So what we figured out was, of course, if you just do the fractional curve, you lose a lot less blood. Your length of stay is significantly lower. Because you're doing less surgery, that all makes sense. If you look at the complication rates, the complication rate if you did the fractional curve only is much lower than if you did long segment fusion. A lot of these patients are in their 70s. And what about extension surgery? Well, a lot of these patients did have to have their surgery extended. And so a quarter of the fractional curve patients came back later. A lot fewer came back if we did longer surgery. So there is a price to be paid for doing this fractional curve only. That didn't quite reach statistical significance. It's probably a power issue. Discharge destination, if you do the fractional curve only, they went home. And the patients who had longer segment fusions, they ended up going to rehab almost one out of three times. And the other important thing is, you know, looking at their curves, obviously, we didn't fix the major curve with the fractional only surgery. So they're still scoliotic. So the limitations of this study is probably selection bias. We did shorter surgeries. You know, on patients who didn't have that much symptoms from the mid-lumbar spine. The PILL mismatch was higher in the fractional curve patients post-op. And those patients, of course, if you didn't instrument the entire curve, you have a limited ability to really correct the PILL mismatch. So even all that being said, what I think I can come away with this is, if you do the fractional curve only, there is a lower complication rate. There is a revision surgery rate that happens in one out of four of these patients over time. However, you get short-term benefits like shorter hospital stay, lower complications, lower blood loss. You don't have to discharge them to rehab. You can send them home. And they, or some of them do get extension surgery. So if you carefully select these patients to have radiculopathy as a primary complaint, you can just try to go after that fractional curve. And many times, it'll be enough for the patient. And you can warn them that they might have to come back for something later. Thank you very much. Thanks, Praveen.

Dr. Praveen Mumadini

fractional curve

adult scoliosis

lower thoracic

upper thoracic