{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:35:55Z","timestamp":1787754955853,"version":"build-2784847793"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,12,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Trisomy 21 or Down syndrome is associated with multiple orthopaedic manifestations. Although cervical instability is the most common spinal condition associated with Down syndrome, the prevalence of scoliosis has been estimated at 4.8% to 8.7%. Very few prior studies have documented the role of spinal fusion in this population, and all have included \u226410 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>An institutional review board-approved multicenter retrospective analysis of patients with Down syndrome treated with spinal fusion between January 2009 and December 2019 was performed by cross-referencing Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10) codes. Patients were followed for \u22652 years, with a mean follow-up of 3.77 years. Clinical and radiographic outcomes were collected, and complications were documented using the Clavien-Dindo-Sink (CDS) classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 23 patients were included: 96% had \u22651 medical comorbidities, including 16 (70%) with congenital heart disease, of whom 88% had previous cardiac surgery, and 10 (44%) with thyroid disorders. All 23 patients underwent posterior spinal fusion. The mean estimated blood loss was 617 \u00b1 459 mL, the mean length of the surgical procedure was 290 \u00b1 92.7 minutes, and the mean length of hospital stay was 6.03 \u00b1 2.91 days. The major Cobb angle measured 61.7\u00b0 \u00b1 17.6\u00b0, which corrected to 19.4\u00b0 \u00b1 14.8\u00b0 (68.6% correction; p &lt; 0.001), with well-maintained correction at 2 years of 22.0\u00b0 \u00b1 10.3\u00b0 (64.3% correction; p = 0.158). Thirteen (57%) of 23 patients had a change in curve of &gt;5\u00b0. There were no intraoperative complications; however, 12 patients (52%) sustained postoperative complications (e.g., need for reoperation, implant failure, and pulmonary complications), including 6 patients with CDS type 3 or 4 (e.g., wound dehiscence, late superficial abscess, pleural effusion, pseudarthrosis, and readmission for hypoxia). Four patients (17%) required a revision surgical procedure. One patient (4%) required an unplanned intensive care unit admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Although instrumented spinal fusion can effectively correct spinal deformity in these patients, complications are more frequent than in children with adolescent idiopathic scoliosis, with over half of patients sustaining a complication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.22.00588","type":"journal-article","created":{"date-parts":[[2022,9,27]],"date-time":"2022-09-27T14:04:53Z","timestamp":1664287493000},"page":"2068-2073","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Outcomes of Posterior Spinal Fusion in Pediatric Patients with Down Syndrome"],"prefix":"10.2106","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3292-7009","authenticated-orcid":false,"given":"Helyn G.","family":"Fraser","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arielle","family":"Krakow","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Lin","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Children\u2019s Healthcare of Atlanta, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay A.","family":"Andras","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6137-5576","authenticated-orcid":false,"given":"David L.","family":"Skaggs","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0643-0506","authenticated-orcid":false,"given":"John M.","family":"Flynn","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3479-9845","authenticated-orcid":false,"given":"Nicholas D.","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Children\u2019s Healthcare of Atlanta, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,9,27]]},"reference":[{"issue":"1","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S0030-5898(20)31410-3","article-title":"Orthopedic disorders in patients with Down\u2019s syndrome","volume":"12","author":"Diamond","year":"1981","journal-title":"Orthop Clin North Am."},{"issue":"207","key":"bib2-20250430","first-page":"74","article-title":"Orthopedic disorders in school children with Down\u2019s syndrome with special reference to the incidence of joint laxity","author":"Livingstone","year":"1986","journal-title":"Clin Orthop Relat Res."},{"issue":"11","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"610","DOI":"10.5435\/00124635-200610000-00003","article-title":"Down syndrome in children: the role of the orthopaedic surgeon","volume":"14","author":"Caird","year":"2006","journal-title":"J Am Acad Orthop Surg."},{"issue":"6","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1542\/peds.86.6.931","article-title":"Arthropathy of Down syndrome","volume":"86","author":"Olson","year":"1990","journal-title":"Pediatrics."},{"issue":"3","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/01202412-200006000-00008","article-title":"Musculoskeletal problems in Down syndrome European Paediatric Orthopaedic Society Survey: the Israeli sample","volume":"9","author":"Merrick","year":"2000","journal-title":"J Pediatr Orthop B."},{"issue":"278","key":"bib6-20250430","first-page":"101","article-title":"The hip joint in Down\u2019s syndrome. 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