Musculoskeletal injuries are commonly incurred by firefighters. Most injuries are attributable to overexertion, fall, slip, and trip mechanisms. These injuries may be caused by many factors, including the independent and collective effects of wearing personal protective equipment (PPE) and fatigue induced by performing occupational-tasks. The purpose of this study was to investigate the effect of PPE and fire-suppression tasks on static and functional balance among firefighters. 32 healthy male career structural firefighters (Age: 31.8 ± 9.5 yr) participated in this study. Statistical analyses revealed significant differences in static balance measures pre versus post-work in PPE p ≤ 0.009, and functional balance outcomes pre-work in station uniform versus pre-work in PPE p < 0.001. PPE negatively affected firefighters' functional balance, whereas occupational tasks negatively affected static balance outcomes. These findings highlight the importance of utilising countermeasures to combat occupational fatigue-induced decrements in neuromuscular function to reduce injury risk among structural firefighters.

Cerebral Palsy (CP) often presents with a sweeping thoracolumbar scoliosis and pelvic obliquity. With severe pelvic obliquity, the ribs come into contact with the high side of the oblique pelvis, termed rib-on-pelvis deformity (ROP). ROP can result in costo-iliac impingement, or pain associated with ROP, and can also adversely affect breathing and sitting balance. The goal of this study was to evaluate whether CP patients with ROP have worse health-related quality of life (HRQOL) before surgery and a greater improvement in HRQOL after surgery. A retrospective analysis of a prospectively collected, multicenter, international registry was performed for all nonambulatory patients with CP treated with spinal fusion with at least two-year follow-up. HRQOL was measured via the Caregiver Priorities Child Health Index of Life with Disabilities (CPCHILD) questionnaire domains (0 = most disability, 100 = least disability). ROP was defined as having a rib distal to the superior portion of the iliac crest on preop upright radiographs. The ROP group and control group without ROP were compared regarding six domain scores and total score of CPCHILD. Multiple linear regression was used to control for curve apex location, major coronal Cobb angle, type of tone, and pelvic obliquity. 340 patients met inclusion criteria (52

BACKGROUND:Firefighting is a physiologically demanding occupation and there is a need to evaluate physical and fitness characteristics that are related to attenuated physiological stress during fireground tasks. Previous studies have not measured associations between heart rate responses during simulated fireground tasks with a standardized work rate.OBJECTIVE:The purpose of this study was to examine associations between heart rate during a standardized pace simulated fireground test (SFGT) and heart rate recovery and variability following the SFGT. In addition, this study sought to evaluate associations between heart rate measures versus physical and fitness characteristics in structural firefighter recruits.METHODS:Twenty-one fire academy recruits performed a standardized pace SFGT while mean heart rate reserve (HRRes) during the SFGT, change in heart rate variability from rest to post-SFGT (LnRMSSDRest-Post), and 60-second post-SFGT heart rate recovery (HRR60) were measured. Regression analyses were conducted between HRRes, LnRMSSDRest-Post and HRR60 and between heart rate measures versus physical and fitness characteristics while accounting for differences in SFGT completion time.RESULTS:HRRes was associated with LnRMSSDRest-Post, but not HRR60. Height and pull-ups explained most of the variance in HRRes, height explained most of the variance in LnRMSSDRest-Post and push-ups and 1.5-mile run explained most of the variance in HRR60.CONCLUSION:Greater cardiovascular stress during fireground tasks is associated with greater depression of post-SFGT heart rate variability, but not heart rate recovery. Physical and fitness characteristics are important to consider in relation to firefighters' ability to cope with physical stress on the fireground.

BACKGROUND: Sleep restriction afflicts more than 33% of Americans and is known to induce muscle weakness through an unknown mechanism. The purpose of this study was to investigate how sleep restriction affects voluntary muscle strength, recruitment, and twitch properties of the knee extensors. METHODS: 11 (4 M, 7F; age 24.4 ± 2.3y) presumably healthy, physically active subjects completed an interpolated twitch (ITT) knee extension protocol at three time points: sleep adequate (SA, 8.0 ± 0.5 h), sleep restricted (SR, 5.0 ± 0.1 h, 3d), and after a washout period (WO, 8.3 ± 0.5 h, 7d). Maximal strength and ITT testing of the dominant leg (600 knee flexion) were conducted the morning after the last night of each sleep intervention. Following maximal voluntary isometric contractions (MVICs), subjects performed 10s submaximal contractions, at 15, 30, 45, 60, 75, and 90% MVIC. During the ITT, a constant voltage (400 V) electrical stimulus (120% of current need to elicit a maximal twitch response) was delivered to the femoral nerve, before, during, and after MVIC. Finally, subjects completed 5 repetitions of isokinetic contractions, in descending order, at speeds of 300, 240, 180, 120, and 60°·s-1. EMG activity of the VL was measured and time synchronized with torque output. We compared MVIC, voluntary activation (VA), submaximal EMG amplitude, twitch properties, and isokinetic torque by repeated measures ANOVA. RESULTS: MVIC tended to be lesser in SR (187.5 ± 55.6 Nm) than SA (203.2 ± 52.4 Nm, p = 0.073). MVIC was greater in WO (211.3 ± 48.9 Nm) compared to SR (p = 0.002), but not SA (p = 0.421). VA was not significantly different among SA (86.2 ± 11.1), SR (87.8 ± 12.1), and WO (88.6 ± 11.2%, p > 0.05). Peak twitch torque, rate of torque development, and post-activation potentiation were not significantly different among conditions. There was no significant effect of sleep or sleep x load interaction on submaximal EMG amplitude. There was no significant effect of sleep or sleep x velocity interaction on isokinetic torque. CONCLUSIONS: Three nights of sleep restriction did not significantly alter knee extension MVIC, VA, submaximal EMG amplitude, twitch properties, or isokinetic torque. However, seven nights of sleep extension significantly increased MVIC following a short bout of SR which was not explained by changes in voluntary activation.

Traditionally, less rigid fixation techniques have been applied to the pediatric cervical spine. There is a lack of long-term outcome data for rigid fixation techniques. The purpose of this study was to define the clinical outcome and safety of posterior instrumented fusion in the pediatric population using adult posterior instrumentation. A multicenter, retrospective review of pediatric patients who underwent posterior cervical fusion using a 3.5 mm posterior cervical system for any indication was performed. Outcome parameters included complications, revision and fusion rates, operative time (OR), blood loss, and postoperative neurologic status. Outcomes were compared between patient groups (posterior only versus anterior/posterior approach, short versus intermediate versus long fusion, and between different etiologies) using Mann–Whitney and chi-square test. Seventy-nine patients with a mean age of 9.9 years and mean follow-up of 2.8 years were included. At baseline 44 (56

To assess the complication risks associated with intrathecal baclofen (ITB) pumps in cerebral palsy (CP) patients undergoing posterior spinal fusion (PSF) and to determine if timing of pump implantation before or during PSF impacts the risk of complications. A prospectively collected multicenter database was retrospectively reviewed to identify CP patients undergoing PSF from 2008 to 2023. Patients were divided into 2 cohorts: those with an ITB pump (ITB cohort) and those without (non-ITB cohort). The ITB cohort was further categorized by placement of the pump prior to or during PSF. Cohorts were then compared in terms of postoperative complications, perioperative complications, and need for revision surgery. Four hundred six patients (ITB n = 79 [53 prior to, 26 during PSF], non-ITB n = 326) were included in this analysis. At an average follow-up of 4.0 years (range 2–10 years), there were no significant differences between the ITB and non-ITB cohorts in the rate of perioperative complications (5.0

Limited evidence exists comparing running biomechanics between individuals with chronic ankle instability (CAI) and those who fully recover (copers). The purpose of this study was to simultaneously analyse running gait kinematics, kinetics, and surface electromyography (sEMG) between ankle sprain copers and individuals with CAI. Twenty-six (13 CAI, 13 Coper) recreationally active females participated and ran shod on an instrumented treadmill at 2.68 m/s. We assessed lower extremity kinematics and kinetics and sEMG amplitude for the fibularis longus, tibialis anterior, medial gastrocnemius, and gluteus medius muscles. Ten consecutive strides from the beginning of the trial were analysed using statistical parametric mapping (SPM) independent t-test. The CAI group had significantly more ankle inversion during 0-6%, 42-53%, and 96-100% of the running stride cycle compared to the coper group. At initial contact (0%), the CAI group was in an inverted ankle position (5.9 degrees +/- 6.8 degrees) and the coper group was in an everted ankle position (-3.2 degrees +/- 5.5 degrees; p = 0.01, d = 1.5). There were no significant differences identified for any other outcome measures. Increased ankle inversion during the swing phase leading into the loading phase is concerning because the ankle is in an open packed position and inversion is a primary mechanism of injury for sustaining a lateral ankle sprain.

The primary purpose of this study was to compare biomechanical gait variables and perceived gait velocity between overground and treadmill walking conditions among typically developing children and adolescents. Twenty children and adolescents (Mage = 11.4, SD = 2.9 years) walked overground and on a treadmill at a matched comfortable walking speed while a 3-D motion analysis system captured spatiotemporal and kinematic gait parameters. In order to compare perceived gait velocities, we acquired data at self-selected comfortable and fastest walking speeds. Paired t-tests comparing the children's speed and gait in these two different walking conditions revealed significantly higher cadence (p < .001) and shorter stride length (p < .002), during treadmill versus overground walking. In addition, treadmill walking showed statistically significant differences in joint kinematics of ankle excursion and pelvic rotation excursions (p < .001). Participants chose slower speeds on the treadmill than for overground walking when they were asked to select their comfortable and fastest walking speeds (p < .001). Our findings suggest that these differences between treadmill and overground walking in cadence, stride length, and perceived gait velocity should be considered whenever a treadmill is used for gait research within the pediatric population. However, the differences we found in gait kinematics between these two walking conditions appear to be relatively trivial and fell within the common error range of kinematic analysis.

OBJECTIVES:To compare outcomes between two models of acute ischemic stroke care. Namely 1) "drip-and-stay", i.e. IV tissue plasminogen activator (tPA) administered at a spoke hospital in a telestroke network, with the patient remaining at the spoke, versus 2) "drip-and-ship", i.e. tPA administered at a spoke hospital with subsequent patient transfer to a hub hospital, and 3) "hub", i.e. tPA and subsequent treatment at a hub hospital. MATERIALS AND METHODS:We performed a systematic review and meta-analysis according to PRISMA guidelines. Literature searches of MEDLINE, Embase, and Cochrane from inception-October 2019 included randomized control trials and observational cohort studies comparing the drip-and-stay model to hub and drip-and-ship models. Outcomes of interest were functional independence (modified Rankin Scale ≤ 1), symptomatic intracranial hemorrhage (sICH), mortality, and length of stay. Pooled effect estimates were calculated using a fixed-effects meta-analysis and random-effects Bayesian meta-analysis. Non-inferiority was calculated using a fixed-margin method. RESULTS:Of 2806 unique records identified, 10 studies, totaling 4,164 patients, fulfilled the eligibility criteria. Meta-analysis found no significant difference in functional outcomes (mRS0-1) (6 studies, RR=1.09, 95%CI 0.98-1.22, p=0.123), sICH (8 studies, RR=0.98, 95%CI 0.64-1.51, p=0.942), or 90-day mortality (5 studies, RR=0.98, 95%CI 0.73-1.32, p=0.911, respectively) between patients treated in a drip-and-stay model compared to patients treated in drip-and-ship or hub models. There was no significant heterogeneity in these outcomes. Drip-and-stay outcomes (mRS 0-1, sICH) were non-inferior when compared to the combined group. CONCLUSIONS:Our findings indicate that drip-and-stay is non-inferior to current models of drip-and-ship or hub stroke care, and may be as safe and as effective as either.

Objective: To determine effects of 4-weeks of impairment-based rehabilitation on lower extremity neuromechanics during jump-landing. Design: Descriptive laboratory study. Participants: Twenty-six CAI subjects (age = 21.4 +/- 3.1 sex=(M = 7,F = 19), height = 169.0 +/- 8.8 cm, weight = 71.0 +/- 13.8 kg) completed 15 jump-landing trials prior to and following 12 supervised rehabilitation sessions. Main outcome measures: Frontal and sagittal lower extremity kinematics and kinetics and sEMG amplitudes (anterior tibialis, peroneus brevis, peroneus longus, and medial gastrocnemius). Means and 90% confidence intervals (CIs) were calculated for 100 ms prior to and 200 ms following ground contact. Areas where preand post-rehabilitation CIs did not overlap were considered significantly different. Kinematic and kinetic peaks and kinematic excursion were compared with paired t-test (P <= 0.05). Results: Following rehabilitation, CAI subjects exhibited less ankle (2.1 degrees (0.8, 3.4), P < 0.01) and hip (2.0 degrees (0.5, 3.7), P = 0.01) frontal plane excursion and lower peak hip abduction (2.5 degrees (0.0, 5.0), P = 0.05). There was less ankle (5.0 degrees (1.7, 8.3), P < 0.01) and knee (3.4 degrees (0.8, 6.0), P = 0.01) sagittal plane excursion following rehabilitation. There was decreased peroneus longus activity from 9 ms to 135 ms post ground contact and decreased peak plantar flexion moment (0.08 N*m/kg (0.01, 0.13), P = 0.02) following rehabilitation. Conclusion: Progressive impairment-based rehabilitation resulted in reductions in kinematic excursion and peroneus longus muscle activity, suggesting a more efficient landing strategy. (C) 2020 Elsevier Ltd. All rights reserved.

Observational. To report on the rate of major complications following spinal fusion and instrumentation to treat spinal deformity in patients with cerebral palsy (CP). Understanding the risk of major complications following the surgical treatment of spine deformities in patients with CP is critical. A prospectively collected, multicenter database of patients with CP who had surgical correction of their spinal deformity (scoliosis or kyphosis) was reviewed for all major complications. Patients with ≥ 2 year follow-up or who died ≤ 2 years of surgery were included. A complication was defined as major if it resulted in reoperation, re-admission to the hospital, prolongation of the hospital stay, was considered life-threatening, or resulted in residual disability. Overall complication and revision rates were calculated for the perioperative (Peri-op; occurring ≤ 90 days postoperative) and delayed postoperative (Delayed; > 90 days) time periods. Two hundred and fifty-seven patients met inclusion. Seventy-eight (30%) patients had a major complication, 18 (7%) had > 1. There were 92 (36%) major complications; 64 (24.9%) occurred Peri-op. The most common Peri-op complications were wound (n = 16, 6.2%) and pulmonary issues (n = 28, 10.9%), specifically deep infections (n = 12, 4.7%) and prolonged ventilator support (n = 21, 8.2%). Delayed complications (n = 28, 10.9%) were primarily deep infections (n = 8, 3.1%) and instrumentation-related (n = 6, 2.3%). There were 42 additional surgeries for an overall unplanned return to the operating room rate of 16% (Peri-op: 8.6%, Delayed: 7.8%). Thirty-six (14.0%) reoperations were spine related surgeries (wound or instrumentation-related). Eleven (4.3%) patients died between 3 months to 5.6 years postoperatively; 4 occurred ≤ 1 year of surgery. Two deaths were directly related to the spinal deformity surgery. Spinal deformity surgery in CP patients with greater than 2 years of follow-up have a postoperative major complication rate of 36% with a spine-related reoperation rate of 14.0%. Therapeutic-IV.

Background: Instrumented spinal fusion is performed to correct severe spinal deformity that commonly complicates cerebral palsy (CP). Prolonged intubation (PI) is a common perioperative complication, though little is known about the risk factors and consequences of this phenomenon. Questions/Purposes: The purpose of this study was to determine (1) the preoperative and intraoperative risk factors associated with PI after spine surgery for CP; (2) the perioperative and postoperative complications associated with PI; and (3) any long-term impacts of PI with respect to health-related quality of life. Patients and Methods: A retrospective case-control analysis of prospectively collected, multicenter data was performed on patients with Gross Motor Function Classification System (GMFCS) 4 or 5 CP who underwent instrumented spinal fusion. Patients extubated on postoperative day (POD) 0 were in the early extubation (EE) cohort and those extubated on POD 3 or later were in the PI cohort. Comparisons were made between PI and EE groups with respect to several preoperative and intraoperative variables to identify risk factors for PI. Multivariate logistic regression was performed to identify independent predictors of this outcome. The postoperative hospital course, rate of complications, and health-related quality of life at 2 years were also compared. Results: This study included 217 patients (52% male individuals; mean age, 14.0±2.8 y) who underwent spinal fusion for CP. In this cohort, 52 patients (24%) had EE and 58 patients (27%) had PI. There were several independent predictors of PI including history of pneumonia [odds ratio (OR), 6.2; 95% confidence interval (CI), 1.6-24.3; P=0.01], estimated blood loss of >3000 mL (OR, 16.5; 95% CI, 2.0-134; P=0.01), weight of <37 kg (OR, 6.4; 95% CI, 1.5-27.1), and Child Health Index of Life with Disabilities (CPCHILD) Communication and Social Interaction score of <15 (OR, 10.8; 95% CI, 1.1-107.3; P=0.04). In addition, PI was associated with a higher rate of perioperative and postoperative respiratory (P<0.001), cardiovascular (P=0.014), gastrointestinal (P<0.001), and surgical site (0.027) complications, in addition to prolonged hospitalization (P<0.001) and intensive care unit stay (P<0.001). Conclusions: Surgeons should seek to optimize nutritional status and pulmonary function, and minimize blood loss in patients with CP to decrease the risk of PI after spinal fusion. Efforts should be made to extubate patients on POD 0 to decrease the risk of complications associated with PI.

Study Design: This was a systematic review and meta-analysis. Objective: This study aims to perform a systematic review and quantitative meta-analysis of patient-reported outcome measures after spinal fusion for adolescent idiopathic scoliosis (AIS). Summary of Background Data: Radiographic correction of scoliosis is extensively reported in the literature but there is a need to study the impact of spinal fusion on patient-reported outcome measures. Prior reviews lacked homogeneity in outcome measures, did not perform quantitative meta-analysis of pooled effect size, or interpret the results in light of minimally clinically important difference thresholds. Materials and Methods: A systematic review of medical databases identified all studies that prospectively reported Scoliosis Research Society (SRS)-22 questionnaire data after spinal fusion for AIS. We screened 2314 studies for eligibility. Studies were included that reported preoperative and postoperative data at 24- or >60-month follow-up. Studies were excluded that failed to report means and SDs which were needed to calculate Cohen d effect sizes and 95% confidence intervals in estimating the magnitude and precision of the effect. Results: A total of 7 studies met eligibility criteria for inclusion in quantitative meta-analysis of effect sizes and 95% confidence intervals. Patients report large improvements in total score, self-image, and satisfaction; and moderate improvements in pain, function and mental health at 2 and 5 years after spinal fusion for AIS. All domains showed statistically significant improvement at all times except function at >60 months. All domains surpassed the minimally clinically important difference at all times except mental health. Conclusions: Moderate evidence suggests that spinal fusion improves quality of life for adolescents with idiopathic scoliosis in medium and long-term follow-up. Our results may help inform patient expectations regarding surgery.

Prospective cerebral palsy (CP) registry review. (1) Evaluate the incidence/risk factors of gastrointestinal (GI) complications in CP patients after spinal fusion (SF); and (2) investigate the validity of the modified Clavien–Dindo–Sink classification. Perioperative GI complications result in increased length of stay (LOS) and patient morbidity/mortality. However, none have analyzed the outcomes of GI complications using an objective classification system. A prospective/multicenter CP database identified 425 children (mean, 14.4 ± 2.9 years; range, 7.9–21 years) who underwent SF. GI complications were categorized using the modified Clavien–Dindo–Sink classification. Grades I–II were minor complications and grades III–V major. Patients with and without GI complications were compared. 87 GI complications developed in 69 patients (16.2%): 39 minor (57%) and 30 major (43%). Most common were pancreatitis (n = 45) and ileus (n = 22). Patients with preoperative G-tubes had 2.2 × odds of developing a GI complication compared to oral-only feeders (OR 2.2; 95% CI 0.98–4.78; p = 0.006). Similarly, combined G-tube/oral feeders had 6.7 × odds compared to oral-only (OR 6.7; 95% CI 3.10–14.66; p < 0.001). The likelihood of developing a GI complication was 3.4 × with normalized estimated blood loss (nEBL) ≥ 3 ml/kg/level fused (OR 3.41; 95% CI 1.95–5.95; p < 0.001). Patients with GI complications had more fundoplications (29% vs. 17%; p = 0.03) and longer G-tube fasting periods (3 days vs. 2 days; p < 0.001), oral fasting periods (5 days vs. 2 days; p < 0.001), ICU admissions (6 days vs. 3 days; p = 0.002), and LOS (15 days vs. 8 days; p < 0.001). LOS correlated with the Clavien–Dino–Sink classification. Gastrointestinal complications such as pancreatitis and ileus are not uncommon after SF in children with CP. This is the first study to investigate the validity of the modified Clavien–Dindo–Sink classification in GI complications after SF. Our results suggest a correlation between complication severity grade and LOS. The complexity of perioperative enteral nutritional supplementation requires prospective studies dedicated to enteral feeding protocols. Therapeutic—level III.

Retrospective descriptive, multi-center study. We hypothesize that a post-operative weight gain will result in patients who are underweight prior to surgery. Cachexia and low body mass index is common among children with cerebral palsy (CP). Many interventions are undertaken to assist the child in nourishment and to obtain a more normal body mass. Additionally, scoliosis is common among children with CP. In our practice we have noted weight gain post operatively in severely underweight children after spinal fusion. We underwent a retrospective review of a CP cohort from a multicenter prospective registry. Percentiles on the CP specific growth chart for which each child belonged were plotted based on the patients’ age, weight, gender, GMFCS level, and tube feeding status. We then assessed percentile change in patients between pre-op visit, 1 year, 2 years and for those with available data, 5 years follow up visits. Patients with under two years of follow up, patients with GMFCS III and below, and patients without weight data were excluded. We identified a total of 211 potentially eligible patients from a multicenter prospective registry. 109 had complete 2 years data to analyze and 37 patients had full 5 years data to analyze. We found that patients under the 50th percentile pre-operatively increased their percentile on the CP growth chart for weight 12.1 percentiles (95% CI 6.7, 17.5 p value < 0.001) whereas patients that began at the 50th percentile or above on average lost 2.2 percentiles (95% CI −6.8, 2.3) though the change was not statistically significant (p value 0.330). These changes appeared stable at 5 years. Although regression analysis showed that Cobb correction and pelvic obliquity correction, and hyperlordosis were not independent predictors of the change, we noted that patients with residual curves after surgery of 40° or more experienced 13.3 percentile less weight gain than those with better corrections. Patients with CP are at risk for cachexia, malnutrition, reflux and other GI disorders. Data presented here suggests that corrective spinal surgery may improve weight percentile in patients who start out at 50th percentile and lower. Patients with 40° or greater of residual scoliosis may benefit less from spinal fusion than those with a better correction. II; Prognostic retrospective cohort study.

Our purpose was to analyze the effects of 4 weeks of visual gait biofeedback (GBF) and impairment‐based rehabilitation on gait biomechanics and patient‐reported outcomes (PROs) in individuals with chronic ankle instability (CAI). Twenty‐seven individuals with CAI participated in this randomized controlled trial (14 received no biofeedback (NBF), 13 received GBF). Both groups received 8 sessions of impairment‐based rehabilitation. The GBF group received visual biofeedback to reduce ankle frontal plane angle at initial contact (IC) during treadmill walking. The NBF group walked for equal time during rehabilitation but without biofeedback. Dependent variables included three‐dimensional kinematics and kinetics at the ankle, knee, and hip, electromyography amplitudes of 4 lower extremity muscles (tibialis anterior, fibularis longus, medial gastrocnemius, and gluteus medius), and PROs (Foot and Ankle Ability Measure Activities of Daily Living (FAAM‐ADL), FAAM‐Sport, Tampa Scale of Kinesiophobia (TSK), and Global Rating of Change (GROC)). The GBF group significantly decreased ankle inversion at IC (MD:‐7.3º, g = 1.6) and throughout the entire stride cycle (peak inversion: MD:‐5.9º, g = 1.2). The NBF group did not have significantly altered gait biomechanics. The groups were significantly different after rehabilitation for the FAAM‐ADL (GBF: 97.1 ± 2.3%, NBF: 92.0 ± 5.7%), TSK (GBF: 29.7 ± 3.7, NBF: 34.9 ± 5.8), and GROC (GBF: 5.5 ± 1.0, NBF:3.9 ± 2.0) with the GBF group showing greater improvements than the NBF group. There were no significant differences between groups for kinetics or electromyography measures. The GBF group successfully decreased ankle inversion angle and had greater improvements in PROs after intervention compared to the NBF group. Impairment‐based rehabilitation combined with visual biofeedback during gait training is recommended for individuals with CAI.

BACKGROUND:Selective fusion of double curves in patients with scoliosis is considered to spare fusion levels. In 2011, we studied the lumbosacral takeoff angle, defined as the angle between the center-sacral vertical line and a line through the centra of S1, L5, and L4. The lumbosacral takeoff angle was shown to moderately correlate with the lumbar Cobb angle, and a predictive equation was developed to predict the lumbar Cobb angle after selective fusions. The purposes of the present study were to validate that equation in a separate cohort and to assess differences in outcomes following selective and nonselective fusion. METHODS:Patients with Lenke 1B, 1C, 3B, or 3C curve patterns undergoing fusion (both selective and nonselective) with pedicle screw constructs and a minimum of 2 years of follow-up were included. Selective fusion was defined as a lowest level of fixation cephalad to or at the apex of the lumbar curve. To validate the previously derived equation, we used this data set and analysis of variance to check for differences between the actual and calculated postoperative lumbar Cobb angles. Pearson correlation, multiple linear regression, and t tests were used to explore relationships and differences between the selective and nonselective fusion groups. RESULTS:The mean calculated postoperative lumbar Cobb angle (and standard deviation) (22.35° ± 3.82°) was not significantly different from the actual postoperative lumbar Cobb angle (21.08° ± 7.75°), with an average model error of -1.268° (95% confidence interval, -2.649° to 0.112°). The preoperative lumbar Cobb angle was larger in patients with deformities that were chosen for nonselective fusion (50.2° versus 38.9°; p < 0.001). Performing selective fusion resulted in a 3.5° correction of the lumbosacral takeoff angle (p < 0.001), whereas nonselective fusion resulted in a 9.3° correction (p < 0.001). CONCLUSIONS:The lumbosacral takeoff angle can be used to predict the residual lumbar Cobb angle and may be used by surgeons to aid in the decision between selective and nonselective fusion. The change in the lumbosacral takeoff angle following selective fusion is small. Improvement in the lumbosacral takeoff angle and coronal balance is greater in association with nonselective fusion. LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.