{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T09:14:38Z","timestamp":1789290878054,"version":"build-2803163510"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spine Deform"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>To investigate if serum inflammatory markers or nuclear imaging can accurately diagnose a chronic spinal instrumentation infection (SII) prior to surgery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>All patients who underwent revision of spinal instrumentation after a scoliosis correction between 2017 and 2019, were retrospectively evaluated. The diagnostic accuracy of serum C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR), <jats:sup>18<\/jats:sup>F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG\u2013PET\/CT) and Technetium-99m-methylene diphosphonate (99mTc-MDP) 3-phase bone scintigraphy (TPBS) to diagnose infection were studied. Patients with an acute infection or inadequate culture sampling were excluded. SII was diagnosed if\u2009\u2265\u20092 of the same microorganism(s) were isolated from intra-operative tissue cultures.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>30 patients were included. The indication for revision surgery was pseudoarthrosis in the majority of patients (<jats:italic>n\u2009=\u2009<\/jats:italic>15). 22 patients (73%) were diagnosed with SII. In all infected cases, <jats:italic>Cutibacterium acnes<\/jats:italic> was isolated, including 5 cases with a polymicrobial infection. The majority of patients had low inflammatory parameters preoperatively. For CRP\u2009&gt;\u200910.0\u00a0mg\/L, the sensitivity was 9.1% and specificity 100%; for ESR\u2009&gt;\u200930\u00a0mm\/h, the sensitivity was 9.1% and specificity 100%. The diagnostic accuracy for nuclear imaging was 64% for the FDG\u2013PET\/CT and 67% for the TPBS to diagnose infection.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The prevalence of SII in patients undergoing revision spinal surgery is high, with <jats:italic>Cutibacterium acnes<\/jats:italic> as the main pathogen. No diagnostic tests could be identified that could accurately diagnose or exclude SII prior to surgery. Future studies should aim to find more sensitive diagnostic modalities to detect low-grade inflammation.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s43390-022-00599-1","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T12:03:36Z","timestamp":1666699416000},"page":"319-327","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A high prevalence of Cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma"],"prefix":"10.1007","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3885-8179","authenticated-orcid":false,"given":"Stefan J.","family":"Gelderman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christhoper","family":"Faber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greetje A.","family":"Kampinga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul C.","family":"Jutte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris J. W.","family":"Ploegmakers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andor W. J. M.","family":"Glaudemans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjan","family":"Wouthuyzen-Bakker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,10,25]]},"reference":[{"issue":"9","key":"599_CR1","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1542\/pir.32-9-397","volume":"32","author":"JJ Rosenberg","year":"2011","unstructured":"Rosenberg JJ (2011) Scoliosis. Pediatr Rev 32(9):397\u2013398. https:\/\/doi.org\/10.1542\/pir.32-9-397","journal-title":"Pediatr Rev"},{"issue":"4","key":"599_CR2","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1302\/0301-620X.66B4.6746683","volume":"66","author":"P Deacon","year":"1984","unstructured":"Deacon P, Flood B, Dickson R (1984) Idiopathic scoliosis in three dimensions, A radiographic and morphometric analysis. J Bone Jt Surg Br 66(4):509\u2013512. https:\/\/doi.org\/10.1302\/0301-620X.66B4.6746683","journal-title":"J Bone Jt Surg Br"},{"key":"599_CR3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f2508","volume":"346","author":"F Altaf","year":"2013","unstructured":"Altaf F, Gibson A, Dannawi Z et al (2013) Adolescent idiopathic scoliosis. BMJ 346:f2508. https:\/\/doi.org\/10.1136\/bmj.f2508","journal-title":"BMJ"},{"issue":"3","key":"599_CR4","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1097\/BRS.0b013e318162016e","volume":"33","author":"JA Rihn","year":"2018","unstructured":"Rihn JA, Lee JY, Ward WT (2018) Infection after the surgical treatment of adolescent idiopathic scoliosis: evaluation of the diagnosis, treatment, and impact on clinical outcomes. Spine 33(3):289\u2013294. https:\/\/doi.org\/10.1097\/BRS.0b013e318162016e","journal-title":"Spine"},{"issue":"2","key":"599_CR5","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1007\/s00264-011-1426-0","volume":"36","author":"A Gerometta","year":"2012","unstructured":"Gerometta A, Olaverri JCR, Bitan F (2012) Infections in spinal instrumentation. Int Orthop 36(2):457\u2013464. https:\/\/doi.org\/10.1007\/s00264-011-1426-0","journal-title":"Int Orthop"},{"issue":"5","key":"599_CR6","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1093\/neuros\/nyaa133","volume":"87","author":"E Shiban","year":"2020","unstructured":"Shiban E, Joerger AK, Janssen I et al (2020) Low-grade infection and implant failure following spinal instrumentation: a prospective comparative study. Neurosurgery 87(5):964\u2013970. https:\/\/doi.org\/10.1093\/neuros\/nyaa133","journal-title":"Neurosurgery"},{"issue":"14","key":"599_CR7","doi-asserted-by":"publisher","first-page":"e633","DOI":"10.5435\/JAAOS-D-17-00698","volume":"27","author":"JG Khalil","year":"2019","unstructured":"Khalil JG, Gandhi SD, Park DK et al (2019) Cutibacterium acnes in spine pathology: Pathophysiology, diagnosis, and management. J Am Acad Orthop Surg 27(14):e633\u2013e640. https:\/\/doi.org\/10.5435\/JAAOS-D-17-00698","journal-title":"J Am Acad Orthop Surg"},{"issue":"7","key":"599_CR8","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1016\/j.jse.2014.12.021","volume":"24","author":"SJ Frangiamore","year":"2015","unstructured":"Frangiamore SJ, Saleh A, Grosso MJ et al (2015) \u03b1-Defensin as a predictor of periprosthetic shoulder infection. J Shoulder Elbow Surg 24(7):1021\u20131027. https:\/\/doi.org\/10.1016\/j.jse.2014.12.021","journal-title":"J Shoulder Elbow Surg"},{"issue":"5","key":"599_CR9","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1016\/j.arth.2018.02.078","volume":"33","author":"J Parvizi","year":"2018","unstructured":"Parvizi J, Tan TL, Goswami K et al (2018) The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 33(5):1309-1314.e2. https:\/\/doi.org\/10.1016\/j.arth.2018.02.078","journal-title":"J Arthroplasty"},{"issue":"1","key":"599_CR10","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1002\/jor.22553","volume":"32","author":"B Zmistowski","year":"2014","unstructured":"Zmistowski B, Della-Valle C, Bauer TW, Malizos KN, Alavi A, Bedair H, Witzo E (2014) Diagnosis of periprosthetic joint infection. J Orthop Res 32(1):98\u2013107. https:\/\/doi.org\/10.1002\/jor.22553","journal-title":"J Orthop Res"},{"issue":"suppl 1","key":"599_CR11","doi-asserted-by":"publisher","first-page":"i25","DOI":"10.1093\/jac\/dku250","volume":"69","author":"L Barrett","year":"2014","unstructured":"Barrett L, Atkins B (2014) The clinical presentation of prosthetic joint infection. J Antimicrob Chemother 69(suppl 1):i25\u2013i27. https:\/\/doi.org\/10.1093\/jac\/dku250","journal-title":"J Antimicrob Chemother"},{"issue":"3","key":"599_CR12","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1099\/jmm.0.035303-0","volume":"61","author":"LH Larsen","year":"2012","unstructured":"Larsen LH, Lange J, Xu Y et al (2012) Optimizing culture methods for diagnosis of prosthetic joint infections: a summary of modifications and improvements reported since 1995. J Med Microbiol 61(3):309\u2013316. https:\/\/doi.org\/10.1099\/jmm.0.035303-0","journal-title":"J Med Microbiol"},{"issue":"2","key":"599_CR13","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1007\/s00259-014-2961-x","volume":"42","author":"R Boellaard","year":"2015","unstructured":"Boellaard R, Delgado-Bolton R, Oyen WJ et al (2015) FDG PET\/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 42(2):328\u2013354. https:\/\/doi.org\/10.1007\/s00259-014-2961-x","journal-title":"Eur J Nucl Med Mol Imaging"},{"issue":"11","key":"599_CR14","doi-asserted-by":"publisher","first-page":"1450","DOI":"10.1302\/0301-620X.95B11.33135","volume":"95-B","author":"J Parvizi","year":"2013","unstructured":"Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Jt J 95-B(11):1450\u20131452. https:\/\/doi.org\/10.1302\/0301-620X.95B11.33135","journal-title":"Bone Jt J"},{"issue":"12","key":"599_CR15","doi-asserted-by":"publisher","first-page":"2990","DOI":"10.1007\/s00586-019-05889-3","volume":"28","author":"D Akg\u00fcn","year":"2019","unstructured":"Akg\u00fcn D, B\u00fcrger J, Pumberger M et al (2019) C-reactive protein misdiagnoses delayed postoperative spinal implant infections in patients with low-virulent microorganisms. Eur Spine J 28(12):2990\u20132995. https:\/\/doi.org\/10.1007\/s00586-019-05889-3","journal-title":"Eur Spine J"},{"issue":"22","key":"599_CR16","doi-asserted-by":"publisher","first-page":"2075","DOI":"10.2106\/JBJS.K.00861","volume":"94","author":"P Pottinger","year":"2012","unstructured":"Pottinger P, Butler-Wu S, Neradilek MB et al (2012) Prognostic factors for bacterial cultures positive for Propionibacterium acnes and other organisms in a large series of revision shoulder arthroplasties performed for stiffness, pain, or loosening. J Bone Jt Surg Am 94(22):2075\u20132083. https:\/\/doi.org\/10.2106\/JBJS.K.00861","journal-title":"J Bone Jt Surg Am"},{"issue":"6","key":"599_CR17","doi-asserted-by":"publisher","first-page":"442","DOI":"10.2106\/JBJS.M.00258","volume":"96","author":"MJ Grosso","year":"2014","unstructured":"Grosso MJ, Frangiamore SJ, Ricchetti ET et al (2014) Sensitivity of frozen section histology for identifying Propionibacterium acnes infections in revision shoulder arthroplasty. J Bone Jt Surg Am 96(6):442\u2013447. https:\/\/doi.org\/10.2106\/JBJS.M.00258","journal-title":"J Bone Jt Surg Am"},{"issue":"1","key":"599_CR18","doi-asserted-by":"publisher","first-page":"41","DOI":"10.2106\/JBJS.L.01634","volume":"96","author":"D Villacis","year":"2014","unstructured":"Villacis D, Merriman JA, Yalamanchili R et al (2014) Serum interleukin-6 as a marker of periprosthetic shoulder infection. J Bone Jt Surg Am 96(1):41\u201345. https:\/\/doi.org\/10.2106\/JBJS.L.01634","journal-title":"J Bone Jt Surg Am"},{"key":"599_CR19","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-020-03506-3","author":"Q Zhang","year":"2020","unstructured":"Zhang Q, Dong J, Shen Y et al (2020) Comparative diagnostic accuracy of respective nuclear imaging for suspected fracture-related infection: a systematic review and Bayesian network meta-analysis. Arch Orthop Trauma Surg. https:\/\/doi.org\/10.1007\/s00402-020-03506-3","journal-title":"Arch Orthop Trauma Surg"},{"issue":"10","key":"599_CR20","doi-asserted-by":"publisher","first-page":"2013","DOI":"10.1007\/s00259-019-04381-w","volume":"46","author":"T Falstie-Jensen","year":"2019","unstructured":"Falstie-Jensen T, Lange J, Daugaard H et al (2019) 18F FDG-PET\/CT has poor diagnostic accuracy in diagnosing shoulder PJI. Eur J Nucl Med Mol Imaging 46(10):2013\u20132022. https:\/\/doi.org\/10.1007\/s00259-019-04381-w","journal-title":"Eur J Nucl Med Mol Imaging"},{"issue":"1","key":"599_CR21","doi-asserted-by":"publisher","first-page":"3","DOI":"10.2967\/jnumed.116.184028","volume":"59","author":"SR Cherry","year":"2018","unstructured":"Cherry SR, Jones T, Karp JS et al (2018) Total-body PET: maximizing sensitivity to create new opportunities for clinical research and patient care. J Nucl Med 59(1):3\u201312. https:\/\/doi.org\/10.2967\/jnumed.116.184028","journal-title":"J Nucl Med"},{"issue":"1096","key":"599_CR22","doi-asserted-by":"publisher","first-page":"20180756","DOI":"10.1259\/bjr.20180756","volume":"92","author":"CP Reinert","year":"2019","unstructured":"Reinert CP, La Fougere C, Nikolaou K et al (2019) Value of CT iterative metal artifact reduction in PET\/CT - clinical evaluation in 100 patients. Br J Radiol 92(1096):20180756. https:\/\/doi.org\/10.1259\/bjr.20180756","journal-title":"Br J Radiol"},{"issue":"24","key":"599_CR23","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.2106\/JBJS.16.00149","volume":"98","author":"JE Hsu","year":"2016","unstructured":"Hsu JE, Gorbaty JD, Whitney IJ et al (2016) Single-stage revision is effective for failed shoulder arthroplasty with positive cultures for Propionibacterium. J Bone Jt Surg Am 98(24):2047\u20132051. https:\/\/doi.org\/10.2106\/JBJS.16.00149","journal-title":"J Bone Jt Surg Am"},{"issue":"1","key":"599_CR24","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.jse.2014.05.008","volume":"24","author":"E McGoldrick","year":"2015","unstructured":"McGoldrick E, McElvany MD, Butler-Wu S et al (2015) Substantial cultures of Propionibacterium can be found in apparently aseptic shoulders revised three years or more after the index arthroplasty. J Shoulder Elbow Surg 24(1):31\u201335. https:\/\/doi.org\/10.1016\/j.jse.2014.05.008","journal-title":"J Shoulder Elbow Surg"},{"issue":"5","key":"599_CR25","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1016\/j.jse.2018.10.016","volume":"28","author":"C Torrens","year":"2019","unstructured":"Torrens C, Mar\u00ed R, Alier A et al (2019) Cutibacterium acnes in primary reverse shoulder arthroplasty: from skin to deep layers. J Shoulder Elbow Surg 28(5):839\u2013846. https:\/\/doi.org\/10.1016\/j.jse.2018.10.016","journal-title":"J Shoulder Elbow Surg"},{"issue":"9","key":"599_CR26","doi-asserted-by":"publisher","first-page":"1920","DOI":"10.1016\/j.jse.2020.02.020","volume":"29","author":"MS Patel","year":"2020","unstructured":"Patel MS, Singh AM, Gregori P et al (2020) Cutibacterium acnes: a threat to shoulder surgery or an orthopedic red herring? J Shoulder Elbow Surg 29(9):1920\u20131927. https:\/\/doi.org\/10.1016\/j.jse.2020.02.020","journal-title":"J Shoulder Elbow Surg"},{"issue":"12","key":"599_CR27","doi-asserted-by":"publisher","first-page":"3902","DOI":"10.1007\/s00586-016-4539-8","volume":"25","author":"GD Shifflett","year":"2016","unstructured":"Shifflett GD, Bjerke-Kroll BT, Nwachukwu BU et al (2016) Microbiologic profile of infections in presumed aseptic revision spine surgery. Eur Spine J 25(12):3902\u20133907. https:\/\/doi.org\/10.1007\/s00586-016-4539-8","journal-title":"Eur Spine J"},{"issue":"6","key":"599_CR28","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1016\/j.cmi.2019.10.018","volume":"26","author":"O Grossi","year":"2020","unstructured":"Grossi O, Lamberet R, Longis P-M et al (2020) Risk factors for Cutibacterium acnes spinal implant-associated infection: a case-case-control study. Clin Microbiol Infect 26(6):743\u2013747. https:\/\/doi.org\/10.1016\/j.cmi.2019.10.018","journal-title":"Clin Microbiol Infect"},{"key":"599_CR29","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-020-03415-5","author":"N Pruijn","year":"2020","unstructured":"Pruijn N, van Diek FM, Meis JF et al (2020) Cutibacterium acnes infections in revision surgery for persistent shoulder complaints: a retrospective cohort study. Arch Orthop Trauma Surg. https:\/\/doi.org\/10.1007\/s00402-020-03415-5","journal-title":"Arch Orthop Trauma Surg"},{"issue":"4","key":"599_CR30","doi-asserted-by":"publisher","first-page":"3085","DOI":"10.3892\/etm.2019.7910","volume":"18","author":"G Tang","year":"2019","unstructured":"Tang G, Chen Y, Chen J et al (2019) Higher proportion of low-virulence anaerobic bacterial infection in young patients with intervertebral disc herniation. Exp Ther Med 18(4):3085\u20133089. https:\/\/doi.org\/10.3892\/etm.2019.7910","journal-title":"Exp Ther Med"},{"issue":"1","key":"599_CR31","first-page":"21","volume":"68","author":"CL Kiraly","year":"1988","unstructured":"Kiraly CL, Al\u00e9n M, Korvola J et al (1988) The effect of testosterone and anabolic steroids on the skin surface lipids and the population of Propionibacteria acnes in young postpubertal men. Acta Derm Venereol 68(1):21\u201326","journal-title":"Acta Derm Venereol"},{"issue":"6","key":"599_CR32","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1016\/j.jse.2019.08.008","volume":"29","author":"FA Matsen III","year":"2020","unstructured":"Matsen FA III, Whitson A, Neradilek MB et al (2020) Factors predictive of Cutibacterium periprosthetic shoulder infections: a retrospective study of 342 prosthetic revisions. J Shoulder Elbow Surg 29(6):1177\u20131187. https:\/\/doi.org\/10.1016\/j.jse.2019.08.008","journal-title":"J Shoulder Elbow Surg"},{"issue":"5","key":"599_CR33","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1016\/j.jse.2015.09.033","volume":"25","author":"CK Koh","year":"2016","unstructured":"Koh CK, Marsh JP, Drinkovi\u0107 D et al (2016) Propionibacterium acnes in primary shoulder arthroplasty: rates of colonization, patient risk factors, and efficacy of perioperative prophylaxis. J Shoulder Elbow Surg 25(5):846\u2013852. https:\/\/doi.org\/10.1016\/j.jse.2015.09.033","journal-title":"J Shoulder Elbow Surg"},{"issue":"17","key":"599_CR34","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.2106\/JBJS.M.01474","volume":"96","author":"MJ Lee","year":"2014","unstructured":"Lee MJ, Pottinger PS, Butler-Wu S et al (2014) Propionibacterium persists in the skin despite standard surgical preparation. J Bone Joint Surg Am 96(17):1447\u20131450. https:\/\/doi.org\/10.2106\/JBJS.M.01474","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"599_CR35","doi-asserted-by":"publisher","first-page":"1786","DOI":"10.1016\/j.arthro.2018.01.019","volume":"34","author":"N Heckmann","year":"2018","unstructured":"Heckmann N, Sivasundaram L, Heidari KS et al (2018) Propionibacterium acnes persists despite various skin preparation techniques. Arthroscopy 34(6):1786\u20131789. https:\/\/doi.org\/10.1016\/j.arthro.2018.01.019","journal-title":"Arthroscopy"},{"issue":"1","key":"599_CR36","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/j.1365-2133.2006.07517.x","volume":"156","author":"K Mourelatos","year":"2007","unstructured":"Mourelatos K, Eady EA, Cunliffe WJ et al (2007) Temporal changes in sebum excretion and propionibacterial colonization in preadolescent children with and without acne. Br J Dermatol 156(1):22\u201331. https:\/\/doi.org\/10.1111\/j.1365-2133.2006.07517.x","journal-title":"Br J Dermatol"},{"issue":"8","key":"599_CR37","first-page":"475","volume":"100","author":"LK Og\u00e9","year":"2019","unstructured":"Og\u00e9 LK, Broussard A, Marshall MD (2019) Acne vulgaris: diagnosis and treatment. Am Fam Physician 100(8):475\u2013484","journal-title":"Am Fam Physician"},{"issue":"4","key":"599_CR38","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/j.jse.2005.10.001","volume":"15","author":"MS Topolski","year":"2006","unstructured":"Topolski MS, Chin PY, Sperling JW et al (2006) Revision shoulder arthroplasty with positive intraoperative cultures: the value of preoperative studies and intraoperative histology. J Shoulder Elbow Surg 15(4):402\u2013406. https:\/\/doi.org\/10.1016\/j.jse.2005.10.001","journal-title":"J Shoulder Elbow Surg"}],"container-title":["Spine Deformity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-022-00599-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s43390-022-00599-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-022-00599-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T10:42:37Z","timestamp":1677494557000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s43390-022-00599-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,25]]},"references-count":38,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,3]]}},"alternative-id":["599"],"URL":"https:\/\/doi.org\/10.1007\/s43390-022-00599-1","relation":{},"ISSN":["2212-134X","2212-1358"],"issn-type":[{"value":"2212-134X","type":"print"},{"value":"2212-1358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,25]]},"assertion":[{"value":"30 September 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 October 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 October 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None of the authors had funding that might pose a conflict of interest in connection with the submitted article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This research study was conducted retrospectively from data obtained for clinical purposes. A waiver was obtained for this study from the UMCG medical ethical committee on 3 December 2019 (number 201900774).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publication"}}]}}