Study Design. Retrospective longitudinal study Objective. The main goal of this study was to measure the disability after AIS correction, according to the LIV. Summary of Background Data. Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that may require surgical correction. If the upper and lower instrumented levels (UIV and LIV) of these fusions are defined by the characteristics of the curve, the long-term consequences of the LIV choices are still partially unknown. Methods. This retrospective longitudinal study collected demographic, radiologic (Lenke classification, Cobb angle), and surgical data (approach, LIV, UIV) on 116 patients operated for AIS fusion on a specialized pediatric spine center were collected. All participants answered SRS30, SF12, lumbar and leg pain Visual Analogue Scales (VAS) at last follow-up. Statistical analysis between LIV (T12L1, L2, L3 or L4L5) and clinical data at last follow-up was realized. Results. The mean follow-up was 87months. The mean increase of back pain VAS per UIV level was 9 mm. No statistically significant difference between the different LIV was found, for SRS30 or SF12 MCS (mental component scale). There was a statistically significant difference between L3 UIV and L4L5 UIV for SF-12 PCS (physical component scale); (P = 0.03). Conclusion. The long-term consequences of LIV choice mostly affect levels distal to L3. If the LIV is mostly defined by the characteristics of the curve, one level caudally corresponds to +9 mm of back pain VAS at 7 years of follow-up. Surgeons may be aware of the long-term consequence of LIV choice and patients be informed.

Objectives: Global warming is certainly one of the greatest challenges of the century. The objective of this work is to estimate the carbon footprint of arthroscopic rotator cuff repair, and to evaluate the positive impact of the following actions: ambulatory surgery, performed under loco-regional anesthesia, and filtration of surgical fluids. Methods: The assessment protocol was compliant with the Greenhouse Gas Protocol, which has three components: 1/ use of volatile anesthetic agents; 2/ electric consumption related to the procedure (heating and air conditioning, ventilation, computer); 3/ related to patient and staff travel, implant delivery and waste management. The study covered the period from November 2020 to April 2021, and included any patient undergoing arthroscopic shoulder replacement surgery. Three actions aimed at improving the carbon footprint were taken: ambulatory surgery, performed under local anesthesia, and filtration of surgical fluids by Neptune® (Stryker). To examine the effectiveness, each patient included during the review period was matched to a patient who underwent surgery during 2018 before the implementation of this protocol. Results: Finally, 26 patients were included. The carbon footprint of arthroscopic rotator cuff repair was estimated at 260.5 +/- 35.03 kgCO2 eq. The main impacts could be attributed to single-use equipment (53.5%), restocking anchors (27.2%), contaminated waste incineration (5.9%), the sterilization process (5.4%), and traveling by the patient (4.1%). Setting up ambulatory surgery without the use of anesthetic gases and a water purifier reduced emissions by 25.9 +/- 2.5 kgCO2 eq (9.3%) per procedure. Conclusion: The carbon footprint of arthroscopic rotary cuff repair corresponds to a bit more than 60 km traveled in a car. The main factor that should be addressed is the impact related to single-use materials and inventory management.

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