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Linden GS, Adhiyaman A, Zucker CP, Thakur A, Wisch JL, Hillstrom H, Groisser BN, Mintz DN, Cunningham ME, Haddas R, Hresko MT, Blanco JS, Widmann RF, Heyer JH. The Longitudinal Effects of Posterior Spinal Fusion with Derotation on Axial Deformity in Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2024:00007632-990000000-00655. [PMID: 38709012 DOI: 10.1097/brs.0000000000005021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE To characterize the change in angle of trunk rotation (ATR), axial vertebral rotation (AVR), and body surface rotation (BSR) in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) with en-bloc derotation across multiple postoperative visits. SUMMARY OF BACKGROUND DATA Previous research has documented ATR, AVR, and BSR correction for AIS patients after surgery. However, there is a lack of evidence on the sustainability of this correction over time. METHODS This was a retrospective study from a single-center prospective surface topographic registry of patients with AIS, age 11-20 at time of surgery, who underwent PSF with en-bloc derotation. Patients with previous spine surgery were excluded. ATR was measured with a scoliometer, AVR through EOS radiographic imaging, and BSR via surface topographic scanning, Data collection occurred at: preoperative, six-week, three-month, six-month, one-year, and two-year postoperative visits. BSR and AVR were tracked at the preoperative apical vertebral level, and the level with maximum deformity, at each respective timepoint. Generalized estimating equations models were used for statistical analysis. Covariates included age, sex, and body mass index. RESULTS 49 patients (73.4% female, mean age 14.6±2.2 years, mean preoperative coronal curve angle 57.9°±8.5, and 67% major thoracic) were evaluated. ATR correction was significantly improved at all postoperative timepoints and there was no significant loss of correction. AVR Max and AVR Apex were significantly improved at all timepoints but there was a significant loss of correction for AVR Apex between the six-week and one-year visit (P=0.032). BSR Max achieved significant improvement at the three-month visit. BSR Apex was significantly improved at the three-month and one-year visit. CONCLUSION ATR and AVR demonstrated significant axial plane correction at two-years postoperative in patients undergoing PSF for AIS. BSR did not maintain significant improvement by the two-year visit.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ram Haddas
- University of Rochester Medical Center, Rochester, NY
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Linden GS, Lee S, Cook D, Birch CM, Hedequist DJ, Hresko MT, Hogue GD. Is the Child Opportunity Index a Factor in Surgical Outcomes for Adolescent Idiopathic Scoliosis? J Pediatr Orthop 2024; 44:e394-e399. [PMID: 38523414 DOI: 10.1097/bpo.0000000000002658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Low socioeconomic status (SES) has been previously associated with delays in orthopaedic care. However, it is unclear how SES impacts patients with adolescent idiopathic scoliosis (AIS), particularly regarding preoperative major coronal curve angle or surgical outcomes. Utilizing the Child Opportunity Index (COI)-an address-driven measure of pediatric education, health/environment, and SES-we investigated whether COI is associated with differences in preoperative scoliosis magnitude, age at surgery, and AIS surgical outcomes. METHODS Consecutive patients with AIS surgically treated at a single center from 2011 to 2017 were reviewed. COI was calculated by inserting a patient's home address into the nationally available COI database to derive a COI value. COI is scored from 0.0 to 100.0 (0.0 is lowest, 100.0 is highest). Specifically, COI is categorized as very low (<20.0), low (20 to 39.9), moderate (40 to 59.9), high (60 to 79.9), and very high (≥80). Those without addresses were excluded. Patients without proper radiographs to assess curve correction were also excluded. A COI threshold of 60.0 was used to separate patients into a low (<60.0) or high COI ( ) group based on published COI guidelines. Outcomes, including preoperative curve magnitude, age at surgery, percentage curve correction, operative time (OT), intraoperative estimated blood loss per level fused, length of stay, and complications, were compared across groups. Pearson correlation analysis was used to assess correlations between COI and preoperative curve magnitude, as well as age. RESULTS Four hundred four patients were included in the study, and 263 had 2-year follow-up data. Patients were an average age of 14.9 years old (range: 11.2 to 19.8), had a median COI of 76 (range: 4 to 100), and had a mean preoperative major curve angle of 59 degrees (range: 36 to 93). COI was significantly higher for white patients compared with non-white (80.0 vs 40.0, P < 0.001), and higher for non-Hispanic individuals (79.0 vs 15.0, P < 0.001). Patients with Low COI were associated with a lower OT per level fused ( P = 0.003) and decreased postoperative complication risk ( P = 0.02). COI was not associated with preoperative major coronal curve angle, age at surgery, or any other surgical outcomes. CONCLUSION COI was significantly lower for non-white patients and those of Hispanic ethnicity. Patients from low COI backgrounds achieved similar surgical results as those from high COI addresses and had a decreased OT per level fused and complication incidence, though the clinical significance of these differences is unknown. Future prospective studies are needed to determine whether these findings are reproducible across other states and health systems. LEVEL OF EVIDENCE Level III-prognostic study.
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Affiliation(s)
- Gabriel S Linden
- Department of Orthopaedic Surgery, Boston Children's Hospital
- Tufts University School of Medicine
| | - Sydney Lee
- Department of Orthopaedic Surgery, Boston Children's Hospital
| | - Danielle Cook
- Department of Orthopaedic Surgery, Boston Children's Hospital
| | - Craig M Birch
- Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Daniel J Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - M Timothy Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Grant D Hogue
- Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
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Heyer JH, Wisch JL, Nagra KK, Thakur A, Hillstrom HJ, Groisser BN, Zucker CP, Cunningham ME, Hresko MT, Haddas R, Blanco JS, Di Maio MF, Widmann RF. Novel Surface Topographic Assessment of Lung Volume and Pulmonary Function Tests in Idiopathic Scoliosis: A Preliminary Study. J Pediatr Orthop 2024:01241398-990000000-00531. [PMID: 38595095 DOI: 10.1097/bpo.0000000000002677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Severe spinal deformity results in restrictive pulmonary disease from thoracic distortions and lung-volume limitations. Though spirometry and body plethysmography are widely accepted tests for pulmonary function tests (PFTs), they are time-consuming and require patient compliance. This study investigates whether surface topographic [surface topography (ST)] measurements of body volume difference (BVD) and torso volume difference between maximum inhale and exhale correlate to values determined on PFTs. METHODS This study included patients with idiopathic scoliosis and thoracic/thoracolumbar curves ≥40 degrees. Patients received ST scans, clinical examinations, and EOS biplanar radiographs on the same day. PFTs were performed within 3 months of ST/radiographic analysis. Univariate linear regression analysis was used to examine relationships between BVD, PFT values, and mean curves. RESULTS Sixteen patients (14.6 ± 2.2 y, 69% females) with idiopathic scoliosis and mean thoracic/thoracolumbar curves of 62 degrees ± 15˚ degrees (45 degrees to 93 degrees) were assessed. BVD displayed statistically high-positive positive correlations with forced vital capacity (R= 0.863, P< 0.0001), forced expiratory volume in 1 second (R= 0.870, P< 0.001), vital capacity (R= 0.802, P< 0.0001), and TLC (R= 0.831, P< 0.0001. Torso volume difference showed similarly high positive correlations to forced vital capacity, forced expiratory volume in 1 second, vital capacity, and TLC, but not residual volume. No correlations emerged between the mean thoracic/thoracolumbar curve and BVD or PFT values. CONCLUSION This study strongly endorses further investigation into ST scanning as an alternative to traditional PFTs for assessing pulmonary volumes. The noncontact and noninvasive nature of ST scanning presents a valuable alternative method for analyzing thoracic volume, particularly beneficial for patients unable to cooperate with standard PFTs. LEVEL OF EVIDENCE Level II-prognostic.
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Affiliation(s)
- Jessica H Heyer
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | - Jenna L Wisch
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | - Kiran K Nagra
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | - Ankush Thakur
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | - Howard J Hillstrom
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | | | - Colson P Zucker
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | | | | | - Ram Haddas
- Rochester, Department of Orthopaedics, Center for Musculoskeletal Research
| | - John S Blanco
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | - Mary F Di Maio
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
| | - Roger F Widmann
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery
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Zapata KA, Dieckmann RJ, Hresko MT, Sponseller PD, Vitale MG, Glassman SD, Smith BG, Jo CH, Sucato DJ. Publisher Correction: A United States multi-site randomized control trial of Schroth-based therapy in adolescents with mild idiopathic scoliosis. Spine Deform 2024; 12:519-520. [PMID: 38216827 DOI: 10.1007/s43390-023-00817-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Affiliation(s)
| | | | | | | | | | | | | | - Chan-Hee Jo
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Daniel J Sucato
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
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Liu DS, Farid AR, Linden GS, Cook D, Birch CM, Hresko MT, Hedequist DJ, Hogue GD. Utility of postoperative laboratory testing after posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 2024; 12:375-381. [PMID: 37884756 DOI: 10.1007/s43390-023-00771-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE With advancements to blood management strategies, risk of perioperative transfusion following surgical treatment of adolescent idiopathic scoliosis (AIS) has diminished. We hypothesize that routine laboratory testing on postoperative-day 1 (POD1) and beyond is unnecessary. The purpose of this study is to determine necessity of POD1 labs, particularly hematocrit and hemoglobin levels, following surgical management of AIS. METHODS We performed a retrospective cohort study of consecutive AIS patients aged 11-19 who underwent posterior spinal fusion (PSF) at a single institution. Univariable logistic regression was utilized to determine factors associated with hematocrit ≤ 22% on POD1 or a postoperative transfusion. Firth's penalized logistic regression was used for any separation in data. Youden's index was utilized to determine the optimal point on the ROC curve that maximizes both sensitivity and specificity. RESULTS 527 patients qualified for this study. Among the eight total patients with POD1 hematocrit ≤ 22, none underwent transfusion. These patients had lower last intraoperative hematocrit levels compared to patients with POD1 hematocrit > 22% (24.1% vs 31.5%, p < 0.001), and these groups showed no difference in preoperative hematocrit levels (38.2% vs 39.8%, p = 0.11). Four patients underwent postoperative transfusion. Both preoperative hematocrit levels (34.0% vs 39.9%, p = 0.001) and last intraoperative hematocrit levels (25.1% vs 31.4%, p = 0.002) were lower compared to patients without transfusion. Intraoperative hematocrit < 26.2%, operative time of more than 35.8 min per level fused, or cell salvage > 241 cc were significant risk factors for postoperative transfusion. CONCLUSION Transfusion after PSF for AIS is exceedingly rare. POD1 labs should be considered when last intraoperative hematocrit < 26%, operative time per level fused > 35 min, or cell salvage amount > 241 cc. Otherwise, unless symptomatic, patients do not benefit from postoperative laboratory screening.
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Affiliation(s)
- David S Liu
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Gabriel S Linden
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Danielle Cook
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Craig M Birch
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - M Timothy Hresko
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Daniel J Hedequist
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Grant D Hogue
- Harvard Medical School, Boston, MA, USA.
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
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Dolan LA, Weinstein SL, Dobbs MB, Flynn JMJ, Green DW, Halsey MF, Hresko MT, Krengel WF, Mehlman CT, Milbrandt TA, Newton PO, Price N, Sanders JO, Schmitz ML, Schwend RM, Shah SA, Song K, Talwalkar V. BrAIST-Calc: Prediction of Individualized Benefit From Bracing for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2024; 49:147-156. [PMID: 37994691 PMCID: PMC10841822 DOI: 10.1097/brs.0000000000004879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
STUDY DESIGN Prospective multicenter study data were used for model derivation and externally validated using retrospective cohort data. OBJECTIVE Derive and validate a prognostic model of benefit from bracing for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) demonstrated the superiority of bracing over observation to prevent curve progression to the surgical threshold; 42% of untreated subjects had a good outcome, and 28% progressed to the surgical threshold despite bracing, likely due to poor adherence. To avoid over-treatment and to promote patient goal setting and adherence, bracing decisions (who and how much) should be based on physician and patient discussions informed by individual-level data from high-quality predictive models. MATERIALS AND METHODS Logistic regression was used to predict curve progression to <45° at skeletal maturity (good prognosis) in 269 BrAIST subjects who were observed or braced. Predictors included age, sex, body mass index, Risser stage, Cobb angle, curve pattern, and treatment characteristics (hours of brace wear and in-brace correction). Internal and external validity were evaluated using jackknifed samples of the BrAIST data set and an independent cohort (n=299) through estimates of discrimination and calibration. RESULTS The final model included age, sex, body mass index, Risser stage, Cobb angle, and hours of brace wear per day. The model demonstrated strong discrimination ( c -statistics 0.83-0.87) and calibration in all data sets. Classifying patients as low risk (high probability of a good prognosis) at the probability cut point of 70% resulted in a specificity of 92% and a positive predictive value of 89%. CONCLUSION This externally validated model can be used by clinicians and families to make informed, individualized decisions about when and how much to brace to avoid progression to surgery. If widely adopted, this model could decrease overbracing of AIS, improve adherence, and, most importantly, decrease the likelihood of spinal fusion in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kit Song
- Carelon Health Services and the University of California, Los Angeles, CA
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Mac-Thiong JM, Hresko MT, Alzakri A, Parent S, Sucato DJ, Lenke LG, Marks M, Goulet J, Labelle H. A Surgical Treatment Algorithm for Restoring Pelvic Balance and Health-related Quality of Life in High-grade Lumbosacral Spondylolisthesis: Prospective Multicenter Cohort of 61 Young Patients. Clin Spine Surg 2023; 36:E442-E452. [PMID: 37482639 DOI: 10.1097/bsd.0000000000001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
STUDY DESIGN Retrospective multicenter cohort-study. OBJECTIVE We propose an evidence-based surgical algorithm for achieving normal pelvic balance while optimizing health-related quality of life (HRQoL) in high-grade spondylolisthesis. SUMMARY OF BACKGROUND DATA The principles of surgical treatment for young patients with high-grade L5-S1 spondylolisthesis remain unclear. There is a growing body of evidence supporting the central role of pelvic balance in the postural control and biomechanics of subjects with high-grade spondylolisthesis. METHODS This retrospective study assessed a multicenter cohort of 61 patients with high-grade L5-S1 spondylolisthesis. Classification and regression tree analysis was used to identify objective criteria associated with pelvic balance and HRQoL after surgery. RESULTS The most important predictor of a postoperative balanced pelvis was a postoperative L5 incidence ≤63.5 degrees. With postoperative L5 incidence ≤63.5 degrees,a residual slip percentage 9% and performing an L5-S1 posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) increased the likelihood of achieving a balanced pelvis postoperatively. When L5 incidence was 63.5 degrees,a balanced pelvis was most likely achieved with fusion limited to L5 proximally, residual slip percentage ≤40%, and residual lumbosacral angle 98 degrees. Predictors of postoperative HRQoL were the preoperative HRQoL score, L5 incidence and slip percentage. CONCLUSIONS A surgical algorithm is proposed to achieve normal pelvic balance, while optimizing HRQoL. The first step during surgery is to assess L5 incidence and if L5 incidence is <65 degrees, the next step depends on the pelvic balance. With a preoperative balanced pelvis, it is important not to reduce completely the slip percentage by leaving a slip percentage ≥10%. When the preoperative pelvis is unbalanced, a TLIF/PLIF at L5-S1 is recommended to facilitate correcting the angular deformity at L5-S1. If L5 incidence is ≥65 degrees,a TLIF/PLIF at L5-S1 should be performed to correct the angular deformity at L5-S1, and fusion should ideally end at L5 proximally, in addition to performing gradual reduction of the slip percentage. If fusion up to L4 is required, a lumbosacral angle ≥100 degrees is key.
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Affiliation(s)
- Jean-Marc Mac-Thiong
- University of Montreal
- CHU Sainte-Justine
- Hôpital du Sacré-Coeur, Montreal, QC, Canada
| | | | - Abdulmajeed Alzakri
- University of Montreal
- CHU Sainte-Justine
- Hôpital du Sacré-Coeur, Montreal, QC, Canada
- Department of Orthopaedic, College of Medecine
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Stefan Parent
- University of Montreal
- CHU Sainte-Justine
- Hôpital du Sacré-Coeur, Montreal, QC, Canada
| | | | | | | | - Julien Goulet
- University of Montreal
- Hôpital du Sacré-Coeur, Montreal, QC, Canada
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Cirrincione PM, Thakur A, Zucker CP, Wisch JL, Groisser BN, Nguyen J, Mintz DN, Cunningham ME, Hresko MT, Haddas R, Hillstrom HJ, Widmann RF, Heyer JH. Exploring Correlations Between Pain and Deformity in Idiopathic Scoliosis With Validated Self-reported Pain Scores, Radiographic Measurements, and Trunk Surface Topographic Measurements. J Pediatr Orthop 2023; 43:608-614. [PMID: 37599604 DOI: 10.1097/bpo.0000000000002493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Up to 75% of patients with idiopathic scoliosis (IS) report back pain, but the exact contributors are unclear. This study seeks to assess how pain correlates with demographics, radiographic and surface topographic (ST) measurements, and patient-reported outcome measures (PROMs) in patients with IS. METHODS Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference (PI) and Scoliosis Research Society revised (SRS-22r) pain domain from an IRB approved prospectively collected registry containing patients 11 to 21 years old with IS were correlated (Spearman coefficients) with measurements from whole-body EOS radiography and ST scanning, PROMIS 1.0 PROMs, Trunk Appearance Perception Scale (TAPS), and SRS-22r domains. SRS-22r and PROMIS-PI were also compared between different sex, scoliosis severities, and primary curve locations with Mann-Whitney U or Kruskal-Wallis tests, and if significant differences were found, included with the 5 highest univariate correlated variables into stepwise multivariate linear regression models ( P <0.05 to enter, P >0.1 to remove) predicting SRS-22r pain and PROMIS-PI. RESULTS One hundred and forty-nine patients (14.5 ± 2.0 y, body mass index 20.6 ± 4.1 kg/m 2 , 96 (64%) female, mean major coronal curve 40 ± 19 deg, range: 10 deg, 83 deg) reported mean PROMIS-PI of 42.2 ± 10.0 and SRS-22r pain of 4.4 ± 0.6. SRS-22r self-image was the most correlated variable with both SRS-22r pain (rho=0.519) and PROMIS-PI (rho=-0.594). Five variables, none of which were ST or radiographic measures, strongly predicted SRS pain domain (R=0.711, R2=0.505, N=138). Two variables (SRS-22r self-image and SRS-22r function) were utilized by a model correlated with PROMIS-PI (R=0.687, R2=0.463, N=124). CONCLUSIONS SRS-22r function and self-image domains were more strongly correlated with SRS-22r pain and PROMIS-PI than any radiographic or ST measurements. LEVEL OF EVIDENCE Level II-retrospective study.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ram Haddas
- University of Rochester Medical Center, Rochester, NY
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9
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Lins LAB, Birch CM, Berde C, Emans J, Hedequist D, Hresko MT, Karlin L, Glotzbecker MP. Late-presenting dural leak following spine fusion in the pediatric population. Spine Deform 2023; 11:1371-1380. [PMID: 37488330 DOI: 10.1007/s43390-023-00720-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/10/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE The purpose is to describe how patients with a late-presenting dural leak (LPDL) after posterior spinal fusion (PSF) was diagnosed and treated at a single institution. METHODS Of the 1991 patients who underwent a PSF between 2010 and 2018, 6 patients were identified with a clinical course consistent with a potential LPDL. RESULTS Six patients with median age 16.9 years had onset of headache ranging 1-12 weeks postoperatively (median 6.5 weeks). All six patients presented with positional headache, and half (3/6) presented with emesis. 5/6 patients underwent contrast brain MRI, which demonstrated pachymeningeal enhancement. 4/5 patients with dural enhancement went on to have CT myelogram. Five patients had a CT myelogram, which identified a dural leak in all patients and localized the leak in four of five patients. All patients underwent an epidural blood patch, which resolved the pain in five patients. One patient without relief underwent revision surgery with removal of a medially placed screw and fibrin glue placement resolving symptoms. CONCLUSIONS Postoperative dural leaks associated with PSF may present in a delayed fashion. The majority of leaks were not associated with screw malposition. In diagnosing patients with suspected LPDL, we suggest brain MRI with contrast as a first step. Most patients with pachymeningeal enhancement shown on contrast brain MRI had dural leaks that were identified through CT myelograms. For patients with a dural leak, if there is no disruption from screws, a blood patch appears to be an effective treatment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Laura A B Lins
- Department of Orthopedics and Rehabilitation, University of Wisconsin Hospitals and Clinics, Madison, WI, USA.
| | - Craig M Birch
- Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Charles Berde
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - John Emans
- Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Daniel Hedequist
- Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - M Timothy Hresko
- Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lawrence Karlin
- Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michael P Glotzbecker
- Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Orthopedics, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
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10
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Zucker CP, Cirrincione PM, Hillstrom HJ, Thakur A, Wisch JL, Groisser BN, Mintz DN, Cunningham ME, Hresko MT, Haddas R, Heyer JH, Widmann RF. The relationship between physical activity, structural deformity, and spinal mobility in adolescent idiopathic scoliosis patients. Spine Deform 2023; 11:1093-1100. [PMID: 37219815 DOI: 10.1007/s43390-023-00702-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/29/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) patients experience structural spinal deformity, but the impact of AIS on physical activity is not widely studied. Reports of physical activity levels between children with AIS and their peers are mixed. This study sought to characterize the relationship between spinal deformity, spinal range of motion, and self-reported physical activity in AIS patients. METHODS Patients aged 11-21 completed self-reported measures of physical activity using the HSS Pedi-FABS and PROMIS Physical Activity questionnaires. Radiographic measures were obtained from standing biplanar radiographic imaging. Surface topographic (ST) imaging data was obtained using a whole-body ST scanning system. Hierarchical linear regression models analyzed the relationship between physical activity, ST, and radiographic deformity while controlling for age and BMI. RESULTS 149 patients with AIS (mean age 14.5 ± 2.0 years, mean Cobb angle 39.7° ± 18.9°) were included. In the hierarchical regression predicting physical activity from Cobb angle, no factors were significant predictors of physical activity. When predicting physical activity from ST ROM measurements, age and BMI served as covariates. No covariates or ST ROM measurements were significant predictors of physical activity levels for either activity measure. CONCLUSIONS Physical activity levels of patients with AIS were not predicted by levels of radiographic deformity or surface topographic range of motion. Although patients may experience severe structural deformity and range of motion limitations, these factors do not appear to be associated with decreased physical activity level utilizing validated patient activity questionnaires. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- C P Zucker
- Hospital for Special Surgery (Pediatric Orthopedics), New York, NY, USA
| | - P M Cirrincione
- Hospital for Special Surgery (Pediatric Orthopedics), New York, NY, USA
| | - H J Hillstrom
- Leon Root Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - A Thakur
- Hospital for Special Surgery (Pediatric Orthopedics), New York, NY, USA
| | - J L Wisch
- Hospital for Special Surgery (Pediatric Orthopedics), New York, NY, USA
| | - B N Groisser
- Technion-Israel Institute of Technology (Mechanical Engineering), Haifa, Israel
| | - D N Mintz
- Hospital for Special Surgery (Radiology), New York, NY, USA
| | - M E Cunningham
- Hospital for Special Surgery (Spine Surgery), New York, NY, USA
| | - M T Hresko
- Boston Children's Hospital (Pediatric Orthopedics), Boston, MA, USA
| | - R Haddas
- University of Rochester (Orthopedics), Rochester, NY, USA
| | - J H Heyer
- Hospital for Special Surgery (Pediatric Orthopedics), New York, NY, USA.
| | - R F Widmann
- Hospital for Special Surgery (Pediatric Orthopedics), New York, NY, USA
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11
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Zapata KA, Dieckmann RJ, Hresko MT, Sponseller PD, Vitale MG, Glassman SD, Smith BG, Jo CH, Sucato DJ. Author Correction: A United States multi-site randomized control trial of Schroth-based therapy in adolescents with mild idiopathic scoliosis. Spine Deform 2023; 11:1293. [PMID: 37155135 DOI: 10.1007/s43390-023-00695-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Chan-Hee Jo
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Daniel J Sucato
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
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12
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Thakur A, Groisser B, Hillstrom HJ, Cunningham ME, Hresko MT, Otremski H, Morse KW, Page K, Gmelich C, Kimmel R, Wolf A, Widmann RF, Heyer JH. 3D surface topographic measurements for idiopathic scoliosis are highly correlative to patient self-image questionnaires. Spine Deform 2023; 11:871-880. [PMID: 36881217 DOI: 10.1007/s43390-023-00672-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/18/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) is a deformity of the spine that results in external asymmetry of the torso in the shoulder, waist, and rib hump. Several patient reported outcome measures (PROMS) including the Trunk Appearance Perception Scale (TAPS) and SRS-22r self-image domain are used to measure the patient's self-perception. The purpose of this study is to investigate the relationship between objective surface topographic measurements of the torso to subjective patient self-perception. METHODS 131 AIS subjects and 37 controls participated in this study. All subjects completed TAPS and SRS-22r PROMS followed by whole body 3d surface topographic scanning. An automated analysis pipeline was used to compute 57 measurements. Multivariate linear models were developed to predict TAPS and SRS-22r self-image using each unique combination of 3 parameters and leave one out validation where the best combinations were selected. RESULTS Back surface rotation, waist crease vertical asymmetry and rib prominence volume were most predictive of TAPS. The final predicted TAPS values from leave one out cross validation was correlated to ground truth TAPS scores with an R value of 0.65. Back surface rotation, silhouette centroid deviation, and shoulder normal asymmetry were most predictive of SRS-22r self-image with a correlation of R = 0.48. CONCLUSION Surface topographic measurements of the torso are correlated to TAPS and SRS-22r self-image scores in AIS patients and controls, with TAPS exhibiting a stronger relationship, better reflecting the patient's external asymmetries.
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Affiliation(s)
- Ankush Thakur
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - Howard J Hillstrom
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - M Timothy Hresko
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Hila Otremski
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Kyle W Morse
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Kira Page
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Caroline Gmelich
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | | | - Roger F Widmann
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jessica H Heyer
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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13
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Zapata KA, Dieckmann RJ, Hresko MT, Sponseller PD, Vitale MG, Glassman SD, Smith BG, Jo CH, Sucato DJ. A United States multi-site randomized control trial of Schroth-based therapy in adolescents with mild idiopathic scoliosis. Spine Deform 2023; 11:861-869. [PMID: 36807105 DOI: 10.1007/s43390-023-00665-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 02/04/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE The purpose of this study was to determine the feasibility and efficacy of a United States multi-site randomized control trial (RCT) of the Schroth-based therapy program in Risser 0 patients with mild adolescent idiopathic scoliosis (AIS) curves. METHODS Six sites enrolled 98 Risser 0 patients with single AIS curves between 12° and 24°. Patients were randomized to Exercise:Control group in a 2:1 ratio. Exercise group patients were instructed on the Schroth-based method and a home exercise program of 75 min/week for 1 year. RESULTS Enrollment across 6 institutions averaged 2.2 patients per month over 45 months. Patient attrition was 42% after 1 year (41/98) and 52% after 2 years (51/98). Exercise group patients were significantly younger (11.6 vs 12.5 years) without differences in the baseline Cobb angle (16.2° vs 17.1°). Self-reported exercise adherence averaged 82% at 6 months and 63% at 1 year (n = 35). A significantly lower frequency of patients was braced in the Exercise group after 1 year (26% vs 55%, p = 0.03) but not after 2 years (48% vs 63%, p = 0.31). Curve magnitude changes between groups were not significant after 1 and 2 years. CONCLUSION Performing a multi-site RCT for mild AIS in the United States is challenging with slow enrollment and high attrition. Young patients with small curves have difficulty adhering to the intensive demands of Schroth-based therapy. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | | | | | | | | | | | | | - Chan-Hee Jo
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Daniel J Sucato
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
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14
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O'Neill N, Ghessese S, Hedequist D, Lins L, Birch C, Hresko MT, Emans J, Karlin L, Cornelissen L, Glotzbecker M. Quantitative Sensory Changes Following Posterior Spinal Fusion to Treat Adolescent Idiopathic Scoliosis. J Pediatr Orthop 2023; 43:218-226. [PMID: 36737054 DOI: 10.1097/bpo.0000000000002362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sensory changes surrounding the incision frequently develop after posterior spinal fusion (PSF) to treat adolescent idiopathic scoliosis (AIS). Anecdotally, patients may experience sensory changes on the chest wall. Such postsurgical sensory changes are not well described quantitatively. This study aims to evaluate the presence, intensity, and duration of mechanical sensory changes in AIS patients postoperatively. METHODS A prospective cohort of AIS patients, 10 to 21 years old, was followed. Quantitative sensory testing (QST) included touch detection threshold [mechanical detection threshold (MDT)] and pain detection threshold (MPT), using VonFrey monofilaments and pinprick stimulators. QST was performed at 3 sites at T6: the right and left chest at the nipple line and adjacent to the incision below the inferior angle of the scapula. QST at the thenar eminence was the control. QST was collected at baseline, 3 days, 1, and 6 months postoperative. RESULTS Thirty-four patients (21% males; mean age: 14.9 years old; median preoperative curve: 58 degrees) completed all testing. Mean deformity correction was 64% (SD: 10.4). Adjacent to the incision site, MDT was significantly higher compared with baseline at 3 days and 1 month ( P < 0.001) but not at 6 months ( P = 0.19), whereas MPT was significantly higher at 3 days, ( P < 0.001), 1 month ( P < 0.001), and 6 months ( P = 0.001). For the chest wall in all patients, MPT was higher on the left chest at 3 days ( P = 0.04) and on the right chest at 3 days ( P = 0.022) and 1 month ( P = 0.05). For patients with right-sided curves, MDT ( P = 0.01) and MPT ( P = 0.015) overall were significantly higher on the concave side (left) chest postoperatively. CONCLUSIONS PSF is associated with sensory disturbances that are detectable within days, persist at 1 month, and improve at 6 months postoperatively adjacent to the incision and on the chest wall. We suspect that these sensory changes are transient. Describing postoperative sensory changes will help us better set postoperative expectations for patients undergoing PSF. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Nora O'Neill
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Semhal Ghessese
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Laura Lins
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Craig Birch
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - John Emans
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Lawrence Karlin
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Michael Glotzbecker
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
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15
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Sidhu K, Kim D, Lebel D, Alshammari A, Photopoulos G, Duarte MP, Provost M, Nielsen C, Oitment C, Cowley R, Dumas E, Dea N, Versteeg A, Eltit F, Rampersaud YR, Dandurand C, Grassner L, Alduwaisan A, Kennedy C, Christie S, Toobaie A, Algarni N, El-Mughayyar D, Pahuta M, Grassner L, Pelletier-Roy R, Bak AB, Singh S, Abbas A, Abbas A, Abbas A, Ajisebutu A, Aldahamsheh O, Martin S, Baron N, Basiratzadeh S, Beresford-Cleary N, Good C, Thomson A, Bhatt F, Bhatt F, Good C, Thomson A, Blake N, Briand MM, Shah V, Chen T, Cherry A, Rocos B, Cherry A, Chua R, Chua R, Cotter T, Coyle MJ, Dandurand C, Dandurand C, Dandurand C, Dauphinee E, Dionne A, El Bojairami I, Duarte MP, Duarte MP, Elahi MT, Ellingwood N, Ells B, Fallah N, Fernandes R, Fernandes R, Fleury C, Flórez-Jiménez S, Li P, Gennari A, Georgiopoulos M, Greene R, Yu C, Werthmann N, Hakimjavadi R, Hakimjavadi R, Heard B, Hutchison C, Kemna C, Kennedy C, Laflamme M, Laskin J, MacLean M, Mac-Thiong JM, Manson N, Manson N, Manson N, Urquhart J, Kuepper E, Pahuta M, Pahuta M, Parker E, Persad A, Phan K, Rachevitz M, Ridha B, Dhaliwal P, Sakoto S, Sarraj M, Sarraj M, Hache P, Singh S, Slosar P, Sun M, Sundararajan K, Sundararajan K, Thornley P, Thornley P, Thornley P, Thornley P, Thorogood N, Toobaie A, Belhouari S, Olotu O, Du JT, Saleh I, Varga A, Varshney V, Versteeg A, Visnjevac O, Wang Z, Wasim A, Wasim A, Wu J, Filezio M, Singh V, Ferri-de-Barros F, Dermott J, Lebel D, Machida M, Bath N, Levin D, Campbell F, Koyle M, Isaac L, Ruskin D, Brennenstuh S, Stinson J, Navarro-Ramirez R, Rabau O, Ouellet JA, Hurry J, Brooks J, Fitzgerald R, Louer C, Murphy J, Shaw KA, Smit K, El-Hawary R, Joncas J, Parent S, Duval M, Chèmaly O, Brassard F, Mac-Thiong JM, Barchi S, Labelle H, Beauséjour M, Ishimo MC, Joncas J, Labelle H, Le May S, Lewis L, Arnold K, Oitment C, Jentzsch T, Lewis S, Rienmuller A, Jentzsch T, Yashuv HS, Martin A, Nielsen C, Berven S, Ludwig T, Coyle M, Asmussen M, Edwards B, Nicholls F, Bigney E, Fleury C, El-Mughayyar D, Cherry A, Vanderwint A, Richardson E, Kerr J, McPhee R, Abraham E, Manson N, Attabib N, Small C, Couture J, Goulet J, Bédard S, Lebel K, LaRue B, Investigators CSORN, Gal R, Verlaan JJ, Charest-Morin R, Fisher CG, Wessels H, Verkooijen L, Ng T, Gokaslan Z, Fisher C, Dea N, Charest-Morin R, Urquhart J, Glennie A, Fisher C, Bailey C, Mcintosh G, Fisher C, Paquet J, Abraham E, Bailey C, Weber M, Johnson M, Nataraj A, Glennie A, Attabib N, Kelly A, Hall H, Rampersaud R, Manson N, Phan P, Thomas K, Dea N, Thomé C, Kögl N, Vo AK, Kramer JLK, Petr O, Visva S, Phan K, Nguyen-Luu T, Stratton A, Kingwell S, Wai E, Phan P, Puskas D, Pahuta M, Marion T, Greene R, Kehler S, Rockwood K, Urquhart J, Thornley P, Rasoulinejad P, Glennie A, Rampersaud R, Manson N, Abraham E, Fisher C, Charest-Morin R, Paquette S, Gélinas-Phaneuf N, Thomas K, Dea N, Dvorak M, Kwon B, Street J, Ailon T, Christie S, Bailey C, McIntosh G, Dea N, Charest-Morin R, Adams T, Bigney E, Cunningham E, Richardson E, Vandewint A, Attabib N, Abraham E, Manson N, Small C, LeRoux A, Kolyvas G, Investigators CSORN, Hebert J, Jiang E, Fisk F, Taliaferro K, Stukas S, Cooper J, Gill J, Fallah N, Skinnider MA, Belanger L, Ritchie L, Tsang A, Dong K, Streijger F, Street J, Paquette S, Ailon T, Dea N, Charest-Morin R, Fisher CG, Dvorak MF, Wellington C, Kwon BK, Dionne A, Richard-Denis A, Briand MM, Bourassa-Moreau É, Mac-Thiong JM, Moghaddamjou A, Fehlings MG, Nadeau M, Fisher C, Toor J, Larouche J, Finkelstein J, Whyne C, Yee A, Toor J, Du JT, Versteeg A, Yee N, Finkelstein J, Abouali J, Nousiainen MT, Kreder H, Whyne C, Larouche J, Toor J, Lewis S, Finkelstein J, Larouche J, Yee A, Whyne C, Dhaliwal P, Hasan M, Berrington N, Johnson M, Burger L, Nicholls F, Evaniew N, Cobetto N, Aubin CE, Larson AN, Cheng Y, Fourney D, Hakimjavadi R, Michalowski W, Viktor H, Baddour N, Wai E, Stratton A, Kingwell S, Phan P, Dandurand C, Mawhinney G, Reynolds J, Orosz L, Thomson A, Bhatt F, Guth M, Allen B, Boyd D, Grigorian J, Schuler T, Jazini E, Haines C, Orosz L, Bhatt F, Allen B, Sabet A, Schuler T, Haines C, Jazini E, Orosz L, Thomson A, Namian S, Bharara N, Jazini E, Good C, Schuler T, Haines C, Orosz L, Tewari A, Roy R, Good C, Schuler T, Haines C, Jazini E, Orosz L, Thomson A, Bhatt F, Grigorian J, Schuler T, Haines C, Merril J, Roy R, Jazini E, Wang M, Orosz L, Haines C, Jazini E, Bhatt F, Sabet A, Roy R, Schuler T, Good C, Greene R, Schmidt M, Christie S, Richard-Denis A, Le MT, Lim V, Mac-Thiong JM, Gallagher M, Cheung A, Brown J, Chaudhry H, Yee C, McIntosh G, Christie S, Fisher C, Jarzem P, Roy JF, Bouchard J, Yee A, Eseonu K, Ahn H, Cherry A, Rampersaud R, Davidson B, Rabinovitch L, Nielsen C, Jiang F, Vaisman A, Lewis S, Canizares M, Rampersaud R, Investigators CSORN, Avila M, Burket A, Aguilar-Salinas P, Mongrain R, Ouellet J, Driscoll M, Schmidt-Braekling T, Dobransky J, Kreviazuk C, Gofton W, Phan P, Beaule P, Grammatopoulos G, Street J, Fisher C, Jacobs B, Johnson M, Paquet J, Wilson J, Hall H, Bailey CS, Christie S, Nataraj A, Manson N, Phan P, Rampersaud R, Thomas K, Mcintosh G, Rasoulinejad P, Charest-Morin R, Hindi M, Farimani PL, Mashayekhi MS, Ailon T, Boyd M, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Urquhart J, Ailon T, Bailey C, Boyd M, Charest-Morin R, Dea N, Dvorak M, Glennie A, Kwon B, Paquette S, Rampersaud R, Street J, Fisher C, Vandewint A, Bigney E, El-Mughayyar D, Richardson E, Edward A, Manson N, Attabib N, Kolyvas G, Small C, Investigators CSORN, Mac-Thiong JM, Barthélémy D, Lim V, Richard-Denis A, Driscoll M, Aubin CE, Cobetto N, Roy-Beaudry M, Bellefleur C, Turgeon I, Labelle H, Barchi S, Parent S, Joncas J, Parent S, Labelle H, Barchi S, Mac-Thiong JM, Lee W, Phan P, Bigney E, Richardson E, El-Mughayyar D, Vandewint A, Abraham E, Manson N, Small C, Alugo T, Leroux A, Kolyvas G, Investigators CSORN, Attabib N, McIntosh G, Oxner W, Dunning PC, Glennie A, Wang D, Humphreys S, Noonan V, Urquhart J, Siddiqi F, Rasoulinejad P, Bailey C, Urquhart J, Thornley P, Rampersaud R, Glennie A, Rasoulinejad P, Fisher C, Bailey C, Investigators CSORN, Bigney E, Dumas E, El-Mughayyar D, Cherry A, Vanderwint A, Richardson E, Kerr J, McPhee R, Abraham E, Manson N, Attabib N, Small C, Couture J, Goulet J, Bédard S, LaRue B, Investigators CSORN, Macthiong JM, Bourassa-Moreau E, Ogden C, Gallagher M, Cheung A, Huong VT, Tarabay B, Al-Shakfa F, Yuh SJ, Shedid D, Boubez G, Wang Z, Gueziri HE, Santaguida C, Collins DL, Hall A, Alant J, Barry S, Weise L, Glennie A, Oxner B, Etchegary H, Christie S, Carreon L, Glassman S, Brown M, Daniels C, Polly D, Gum J, Gum J, Glassman S, Brown M, Daniels C, Carreon L, Hong HA, Fallah N, Humphreys S, Walden K, Noonan VK, Phan P, Basiratzadeh S, Wai EK, Phan P, Salo P, Krawetz R, Hart D, Bains I, Swamy G, Yang Q, Godoy A, Smith S, Lin C, Nataraj A, Puskas D, Pahuta M, Marion T, Dea N, Waheed Z, Thorogood N, Nightingale T, Noonan V, Touchette C, Duda T, Almojuela A, Bergeron D, Aljoghaiman M, Sader N, Kameda-Smith M, Alant J, Christie S, Hresko MT, Alzakri A, Parent S, Sucato DJ, Lenke LG, Marks M, Labelle H, Pereira P, Charles YP, Krutko A, Santos C, Park Y, Arzoglou V, Park SW, Franke J, Fuentes S, He S, Hosszu T, Varanda P, Mlyavykh S, Vanhauwaert D, Senker W, Franke J, Park Y, Charles YP, Santos C, Arzoglou V, Song Y, He S, Bhagat S, Hong JY, Vanhauwaert D, Senker W, Pereira P, Senker W, Charles YP, Pereira P, Santos C, Park Y, Arzoglou V, Park SW, Bordon G, Fuentes S, Song Y, Vialle E, Bhagat S, Krutko A, Franke J, Thornley P, Rampersaud R, Glennie A, Rasoulinejad P, Abraham E, Ailon T, Charest-Morin R, Dea N, Dvorak M, Gélinas-Phaneuf N, Kwon B, Manson N, Paquette S, Street J, Thomas K, Fisher C, Bailey C, Mishreky A, Hurry J, El-Hawary R, Jiang E, Fisk F, Taliaferro K, Dea N, Investigators CSORN, Al Anazi M, El-Hawary R, Kindrachuk M, Noyes E, Wu A, Fourney D, Pratt M, Wai E, Stratton A, Kingwell S, Wang Z, Phan P, Robarts S, Razmjou H, Yee A, Larouche J, Finkelstein J, Persad A, Huschi Z, Cheng Y, Fourney D, Rossong H, Zhang H, Johnson M, Goytan M, Zarrabian M, Berrington N, Zeiler F, Charles A, Roy-Beaudy, Parent S, Duong L, Marion T, Guha D, Pahuta M, Hache P, Oitment C, Guha D, Pahuta M, Sarraj M, Oitment C, Guha D, Pahuta M, Miyanji F, McAnany S, Cheung A, Dewitt D, Street J, Jurisica I, Perruccio AV, Rampersaud YR, Niu Y, Perruccio AV, Jurisica I, Rampersaud YR, Glennie A, Alahmari A, Al-Jahdali F, Fisher C, Rampersaud R, Urquhart J, Bailey C, Urquhart J, Bailey C, Urquhart J, Rampersaud R, Glennie A, Fisher C, Bailey C, Urquhart J, Rampersaud R, Glennie A, Fisher C, Bailey C, Harback K, Akpinar I, Adjetey C, Tindall D, Chernesky J, Noonan V, Fernandes RJR, Bailey C, Siddiqi F, Rasoulinejad P, Toor J, Abbas A, Brooks H, Larouche J, Abbas A, Bhatia A, Selimovic D, Larouche J, Yee A, Lewis S, Finkelstein J, Toor J, Abbas A, Toor J, Versteeg A, Finkelstein J, Toor J, Abbas A, Ahn H, Larouche J, Finkelstein J, Whyne C, Yee A, Slomp F, Thiessen E, Lastivnyak N, Maclean LS, Ritchie V, Hockley A, Osborn J, Paquette S, Sahjpaul R, Gal R, Charest-Morin R, Verlaan JJ, Wessels H, Fisher CG, Verkooijen L, Pastrak M, Truong VT, Liberman M, Al-Shakfa F, Yuh SJ, Soder SA, Wu J, Sunna T, Renaud-Charest É, Boubez G, Shedid D, Balasuberamaniam P, Shrikumar M, Chen T, Anthony T, Phillips A, Nathens A, Chapman M, Crawford E, Stark R, Schwartz C, Finkelstein J, Small C, Rampersaud R. Canadian Spine SocietyAbstract 57. Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy comparing radiologists’ reports and surgeons’ assessments?Abstract 74. How useful is prereferral spine imaging? A quality improvement projectAbstract 82. Early recovery after surgery, predictors of shorter length of stayAbstract 68. Gliding screws on early-onset scoliosis: a 5-year experienceAbstract 66. Reliability of radiographic assessment of growth modulation from anterior vertebral body tethering surgery in pediatric scoliosisAbstract 16. A dangerous curve: impact of the COVID-19 pandemic on brace treatment in adolescent idiopathic scoliosisAbstract 24. Development of a model of interprofessional support interventions to enhance brace adherence in adolescents with idiopathic scoliosisAbstract 94. Recognizing the importance of self-image in adult spinal deformity: results from the Prospective Evaluation of Elderly Deformity Surgery (PEEDS)Abstract 25. Assessing pain as a primary factor in the surgical treatment of adult spinal deformity surgery in patients over 60 years of ageAbstract 72. Application of the Ames-International Spine Study Group (AMES) radiographic modifiers to an asymptomatic population. Are the thresholds for “normal” appropriate?Abstract 109. Exploring the relationship between cannabis and narcotic use on preoperative health considerations in Canadian thoracolumbar patients: a CSORN studyAbstract 36. Metastatic spine disease: Should patients with short life expectancy be denied surgical care? An international retrospective cohort studyAbstract 91. What do patients expect of palliative treatment for symptomatic spinal metastases? A qualitative studyAbstract 44. Denosumab for giant cell tumours of the spine: molecular predictors of clinical response — a pilot studyAbstract 89. Surgical management and outcomes from “stable” degenerative spondylolisthesis (DS) from the CSORN prospective DS study: What the @#$ % are we doing?Abstract 33. Economic consequences of waiting for lumbar disc herniation surgeryAbstract 108. Motor recovery depends on timing of surgery in patients with lumbar disc herniationAbstract 106. Outcomes following revision decompression for lumbar spinal stenosis when compared to primary decompression: a matched cohort analysis using the Canadian Spine Outcomes and Research Network registryAbstract 64. Patient engagement, remote monitoring and virtual care — a pilot project in rural and remote patients undergoing elective lumbar surgeryAbstract 84. Development of a frailty index from the Canadian Spine Outcomes and Research Network (CSORN) to predict long-term success of surgery for patients with degenerative pathologies of the spineAbstract 102. Posterolateral versus posterior interbody fusion for the management of lumbar degenerative spondylolisthesis: analysis from the CSORN prospective LDS propensity score matched studyAbstract 31. Impact on patient-reported outcomes of ending the posterior construct proximally at C2 versus C3 in degenerative cervical myelopathy patientsAbstract 42. Perioperative factors predict 2-year trajectories of pain and disability following anterior cervical discectomy and fusionAbstract 61. Calculating utilities from the modified Japanese Orthopaedic Association score: a prerequisite for quantifying the value of care for cervical myelopathyAbstract 119. Serum neurofilament light (NF-L) and glial fibrillary acidic protein (GFAP) biomarkers and their association with MRI findings in human acute traumatic spinal cord injuryAbstract 95. The Montreal Acute Classification of Spinal Cord Injury (MAC-SCI): a new tool to detect and characterize spinal cord injury in the trauma patientAbstract 118. Mechanism of injury is associated with neurologic outcomes after cervical sensorimotor complete acute traumatic spinal cord injuryAbstract 13. Patient perspective: diagnosis and prognosis of acute spinal cord injuriesAbstract 136. Predictive analytics to improve dedicated spine trauma operating room resource allocationAbstract 138. Machine learning models to predict surgical resident workload at a level 1 trauma centreAbstract 139. Machine learning to predict duration of surgery and length of stay for single-level discectomy proceduresAbstract 9. Outpatient spinal surgery in ManitobaAbstract 131. Unexpected positive culture in presumed aseptic revision spine surgery: a systematic review and meta-analysisAbstract 50. Lumbar anterior vertebral body tethering: biomechanical assessment of the surgical decision factors influencing the immediate and 2 years postoperative correctionAbstract 145. Does prolonged symptom duration influence surgical outcomes for cervical radiculopathy?Abstract 147. A data-driven cluster analysis approach to create homogenous subgroups for traumatic spine injury: toward improving traditional classificationAbstract 41. The use of neo-adjuvant denosumab in treatment of giant cell tumours of the spineAbstract 5. Complications, revision rates and accuracy of robotic-guided S2 alar-iliac screw placementAbstract 6. Opioid use after spine surgery: How much are we over-prescribing?Abstract 7. Intradiscal injection of autologous bone marrow aspirate concentrate improves low back pain at 1 yearAbstract 8. Augmented reality–assisted spine surgery: an early experience demonstrating safety and accuracy with 218 screwsAbstract 22. Comparison of complications, revision rates and fluoroscopy time using the latest technology in robotic-guided surgery with historical fluoroscopic-guided controlsAbstract 23. Robotic-guided thoracolumbar fusion experience: a multi-surgeon, single-centre study of 628 patients and 3874 robotic-guided screws from 2012 to 2020Abstract 86. A province-wide assessment of the appropriateness of lumbar spine MRIAbstract 134. Concomitant traumatic spinal cord injury and brain injury diagnoses are more frequent and impactful than expectedAbstract 45. Spatial and depth mapping of nascent mineralization on Ti6Al4V surfaces demonstrating hierarchical macro-micro-nanoscale surface featuresAbstract 111. Propensity-matched outcomes comparing lumbar interbody fusion and total disk arthroplasty: a Canadian Spine Outcomes and Research Network (CSORN) studyAbstract 30. A Canadian-based pilot study of current surgical practice and implant preferences in lumbar fusion surgeryAbstract 32. Local contamination is a major cause of early deep wound infections following open posterior lumbosacral fusionsAbstract 99. Comparing patient preoperative expectations and postoperative expectation fulfillment between minimally invasive versus open fusion surgeryAbstract 146. Outpatient robotic-assisted lumbar spinal fusion using the Mazor X Stealth EditionAbstract 149. Lessons learned from my first 100 robotic-assisted lumbar fusions using the Mazor X Stealth Edition: surgical synergy with MIS, surgical navigation and roboticsAbstract 151. Freehand biomechanical testing for use in lumbar discectomy trainingAbstract 48. Spinal pathology and outcome post-THA: Does segment of arthrodesis matter?Abstract 27. Patient, surgical and institutional factors associated with length of stay in degenerative lumbar spine surgery: national multicentre cohort analysis from the Canadian Spine Outcomes and Research Network (CSORN)Abstract 28. The impact of the increasing proportion of degenerative spine emergency admissionsAbstract 51. Patient’s expectations of surgery for degenerative spondylolisthesis: analysis by site and type of surgery from the Canadian Spine Outcomes and Research Network (CSORN)Abstract 60. The impact of sex on thoracolumbar surgery outcomes in patients with diabetes — a CSORN studyAbstract 81. The impact of older age on rehabilitation outcomes following functional motor-incomplete traumatic spinal cord injuryAbstract 47. Devise and investigate a novel, intramuscular pressure based, muscle activation strategy in a spine stability modelAbstract 17. 3D radiologic outcomes for patients with moderate idiopathic scoliosis curves treated with internal (anterior vertebral growth modulation) versus external bracing: a 2-year observational studyAbstract 18. Is quality of life affected by concomitant isthmic spondylolisthesis when undergoing surgery for adolescent idiopathic scoliosis and nonsurgical management of the spondylolisthesis?Abstract 128. Toward macrostructural and microstructural investigation of the cervical spinal cord through quantitative analysis of T2-weighted and diffusion-weighted imagingAbstract 26. Minimally invasive versus open thoracolumbar spine surgery for patients who have lumbar spinal stenosis and an ASA score of 3 or above: a CSORN studyAbstract 101. Association between surgeon age and outcomes of spine surgery: a population-based retrospective cohort studyAbstract 77. Utilizing machine learning methodology to create a short form of the Multi-Morbidity Index in spinal cord injuryAbstract 70. Ten-year reoperation rate and clinical outcome in patients treated surgically for lumbar spinal stenosisAbstract 105. Assessing the importance of radiographic and clinical parameters when choosing decompression without fusion for LDS: results from the CSORN prospective DS studyAbstract 104. Preoperative cannabis use in Canadian thoracolumbar spine surgery patients: a CSORN studyAbstract 142. Post-traumatic ascending myelitis, about 2 cases, etiologic analysis and treatmentAbstract 55. NanoLOCK surfaces enhance osteoblast activities at the cellular levelAbstract 76. Which scoring system is the most accurate for predicting survival in patients undergoing surgery for spinal metastases from lung cancer?Abstract 11. Pedicle screw insertion using ultrasound-based navigation without intraoperative radiation: feasibility study on porcine cadaversAbstract 85. What barriers prevent patients being discharged from hospital following elective spine surgery?Abstract 15. Propensity-matched comparison of 90-day complications in robotic-assisted versus non-robotic-assisted lumbar fusionAbstract 56. No-tap (2-step) robotic-assisted cortical bone trajectory (RA-CBT) screw insertion is safe and efficient: comparative analysis of 179 patients and 924 RA-CBT screwsAbstract 124. Developing a Web-based application to promote the adoption of a clinical prediction model for independent walking in people with traumatic spinal cord injury — a protocolAbstract 125. Multivariable prediction models for prognostication after traumatic spinal cord injury — a systematic reviewAbstract 148. Expression of blood serum cytokines in the presentation of acute sciaticaAbstract 150. Do patient-reported outcome scores (PROs) correlate with bundled payment plan performance for elective spine surgeries?Abstract 46. Effects of delayed neurosurgery on anxiety, depression and economic burdenAbstract 69. Care close to home — a retrospective analysis of patients undergoing elective lumbar surgery in a rural satellite hospitalAbstract 110. Surgical adverse events for primary tumours of the spine and their impact on prognosis and outcomes: a PTRON studyAbstract 80. Spinal cord stimulation research in the restoration of function for individuals living with spinal cord injuries: a scoping reviewAbstract 132. Workup and management of asymptomatic extracranial traumatic vertebral artery injury: a Canadian Neurosurgery Resident Research Collaborative studyAbstract 12. A surgical treatment algorithm for restoring pelvic balance and health-related quality of life in high-grade lumbosacral spondylolisthesisAbstract 38. Effectiveness of 6 surgical approaches for minimally invasive lumbar interbody fusion: 1-year follow-up results from a global multicentre studyAbstract 39. Clinical outcomes and fusion success in patients with degenerative lumbar disease without spondylolisthesis: comparing anterolateral to posterior MIS approaches from a global multicentre studyAbstract 40. Anterolateral versus posterior approaches to minimally invasive interbody fusion for patients with spondylolisthesis: results at 1-year follow-up from a global multicentre studyAbstract 73. Benefit of minimally invasive lumbar interbody fusion versus traditional interbody fusion versus posterolateral spinal fusion in lumbar degenerative spondylolisthesis: a propensity-matched analysis from the CSORN prospective LDS studyAbstract 67. The effect of fusionless pediatric scoliosis surgery on 3D radiographic spinopelvic alignmentAbstract 62. Calculating utilities from the Neck Disability Index: a prerequisite for quantifying the value of cervical spine careAbstract 63. The psychometric properties of the mJOA for quality-of-life assessments in cervical myelopathyAbstract 59. Low radius of curvature growth friendly implants increases the risk of developing clinically significant proximal junctional kyphosisAbstract 144. Very long–term outcome of single-level minimally invasive lumbar microdiscectomy with a tubular retractorAbstract 112. Metal implant hypersensitivity in patients undergoing spinal surgery: a literature review and case reportAbstract 43. Diagnostic value of the lumbar spinal stenosis (SSHQ) survey in virtual care provided at a tertiary spine programAbstract 54. Is the Calgary Postoperative Pain After Spine Surgery (CAPPS) score correlated with long-term outcomes after lumbar fusion?Abstract 4. Development of a single-entry referral pathway for patients with spinal conditions in Manitoba: a cross-sectional review of impact and potential way forward for Canadian spine programsAbstract 113. Automatization of bone age calculationAbstract 123. An effectiveness and quality-of-life analysis of conservative care versus surgery for moderate and severe cervical myelopathyAbstract 133. Long-term survivorship of cervical spine procedures: a survivorship meta-analysis and meta-regressionAbstract 137. Natural history of degenerative cervical myelopathy: a meta-analysis and neurologic deterioration survival curve synthesisAbstract 14. Does intraoperative vancomycin powder affect postoperative infections in adolescent idiopathic scoliosis?Abstract 37. The clinical impact of nano-surface technology on postoperative opioid consumption in patients undergoing anterior lumbar interbody fusionAbstract 130. Design and implementation of a comprehensive perioperative complex spine communication toolAbstract 87. Stratifying low back pain patients in an inter-professional education and self-management model of care: results of a latent class analysisAbstract 88. Cohort accuracy versus confidence at the patient level: clinical challenges for AI-based prediction of low back pain outcomesAbstract 96. Preoperative disc angle is an important predictor of segmental lordosis after degenerative spondylolisthesis fusionAbstract 97. Preoperative depression, functional and radiographic outcomes after surgery for degenerative lumbar spondylolisthesisAbstract 116. A CSORN study of functional outcomes after surgery for lumbar degenerative spondylolisthesisAbstract 121. A CSORN study of the effect on radiographic alignment outcomes with different surgery type for degenerative lumbar spondylolisthesisAbstract 79. Spinal cord stimulation to restore neurological function: a costing analysisAbstract 107. Biomechanical properties of a novel morselized bone graft cageAbstract 93. Optimizing spine surgery instrument trays to immediately increase efficiency and reduce costs in the operating roomAbstract 103. Machine learning models can predict subsequent publication of North American Spine Society Annual General Meeting abstractsAbstract 117. The use of primary sacroiliac joint fusion for lower back pain due to sacroiliac joint pathology: a systematic review and meta-analysisAbstract 141. How to make the most of your operative time by optimizing surgical schedulingAbstract 126. Altering physician referral practices remains a challenge: a spine assessment clinic quality improvement studyAbstract 152. Outcomes of workers’ compensation patients undergoing neuromodulation for persistent neuropathic pain conditionsAbstract 90. Expectations of treatment outcomes in patients with spinal metastases: What do we tell our patients? A qualitative studyAbstract 52. Fluoroscopically guided radiofrequency ablation of the superior cluneal nerve: preliminary outcomes data for a minimally invasive approach for treating superior cluneal neuralgiaAbstract 21. Single-stage posterior approach for en bloc resection and spinal reconstruction of T4 Pancoast tumour invading spineAbstract 34. Predictors of sacral ulcers in patients with complete spinal cord injuryAbstract 135. Targeting geographic wait time disparities in Canada: a rapid review of domestic and international strategies to reduce orthopedic wait times in the MaritimesAbstract 143. The influence of coronal plane parameters on patient-reported outcome measures in patients undergoing decompression for lumbar spinal stenosis. Can J Surg 2022. [DOI: 10.1503/cjs.011622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Negrini S, Aulisa AG, Cerny P, de Mauroy JC, McAviney J, Mills A, Donzelli S, Grivas TB, Hresko MT, Kotwicki T, Labelle H, Marcotte L, Matthews M, O'Brien J, Parent EC, Price N, Manuel R, Stikeleather L, Vitale MG, Wong MS, Wood G, Wynne J, Zaina F, Bruno MB, Würsching SB, Yilgor C, Cahill P, Dema E, Knott P, Lebel A, Lein G, Newton PO, Smith BG. Correction to: The classification of scoliosis braces developed by SOSORT with SRS, ISPO, and POSNA and approved by ESPRM. Eur Spine J 2022; 31:2456-2457. [PMID: 35697860 DOI: 10.1007/s00586-022-07273-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy.
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | | | | | | | | | - Andrew Mills
- Sheffield Children's NHS Foundation Trust, Sheffield Children's Hospital, Sheffield, UK
| | | | - Theodoros B Grivas
- Department of Orthopedics and Traumatology, "Tzaneio" General Hospital of Piraeus, Piraeus, Greece
| | - M Timothy Hresko
- Boston Children Hospital, Harvard Medical School, Boston, MA, USA
| | - Tomasz Kotwicki
- Spine Disorders and Pediatric Orthopedics Department, University of Medical Sciences, Poznan, Poland
| | - Hubert Labelle
- Division of Orthopedics, University of Montreal, CHU Sainte-Justine, Montréal, QC, Canada
| | | | - Martin Matthews
- DM Orthotics Ltd, Redruth, UK
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Eric C Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Nigel Price
- Children's Mercy Hospital, Kansas City, MO, USA
| | - Rigo Manuel
- Rigo Quera Salvá, SLP Vía Augusta 185, 08021, Barcelona, Spain
| | | | - Michael G Vitale
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Man Sang Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Grant Wood
- Align Clinic, LLC and Align Technologies, LLC, San Mateo, CA, USA
| | - James Wynne
- Boston Orthotics and Prosthetics, Boston, MA, USA
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | | | | | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Patrick Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Eugenio Dema
- Scoliosis and Spinal Disease Center, Hesperia Hospital GHC SPA, Modena, Italy
| | - Patrick Knott
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Andrea Lebel
- Scoliosis Physiotherapy and Posture Centre Ottawa, Ottawa, ON, Canada
| | - Grigorii Lein
- H. Turner National Medical Research Center for Children's Orthopedics and Trauma Surgery, Saint-Petersburg, Russia
| | - Peter O Newton
- Rady Children's Hospital, University of California, San Diego, USA
| | - Brian G Smith
- Texas Children's Hospital, Professor of Orthopaedics, Baylor College of Medicine, Houston, TX, USA
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Linden GS, Birch CM, Hresko MT, Cook D, Hedequist DJ. Intraoperative Use of Robotics With Navigation for Pedicle Screw Placement in Treatment of Pediatric High-grade Spondylolisthesis: A Preliminary Report. J Pediatr Orthop 2021; 41:591-596. [PMID: 34516471 DOI: 10.1097/bpo.0000000000001947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Accurate pedicle screw placement is critical to surgically correct pediatric high-grade spondylolisthesis (HGS). The recent advent of robotics coupled with computer-assisted navigation (RAN) may represent a novel option to improve surgical outcomes of HGS, secondary to enhanced pedicle screw placement safety. This series presents the HGS-RAN technique adopted by our site, describing its surgical outcomes and feasibility. METHODS Consecutive patients with a diagnosis of HGS (Meyerding grade III to V), operated on using RAN from 2019 to 2020 at a single-center were reviewed. Demographics, screw accuracy, sagittal L5-S1 parameters, complications, and perioperative outcomes were described. All patients were treated with instrumentation, decompression, posterior lumbar interbody fusion, and reduction. Robotic time included anatomic registration to end of screw placement. Screw accuracy-defined as a screw placed safely within the planned intrapedicular trajectory-was characterized by the Gertzbein-Robbins system for patients with additional 3-dimensional imaging. RESULTS Ten HGS patients, with an average age of 13.7 years old, were included in the series. All 62 screws were placed without neurological deficit or complication. Seven patients had additional 3-dimensional imaging to assess screw accuracy (42 of 62 screws). One hundred percent of screws were placed safely with no pedicle breaches (Gertzbein-Robbins-grade A). Thirty screws (48%) were placed through separate incisions that were percutaneous/transmuscular and 32 screws (52%) were inserted through the main incision. There were statistically significant improvements in L5 slippage (P=0.002) and lumbosacral angle (P=0.002), reflecting successful HGS correction. The total median operative time was 324 minutes with the robotic usage time consuming a median of 72 minutes. Median estimated blood loss was 150 mL, and length-of-stay was a median 3 days. CONCLUSIONS This case-series demonstrates that RAN represents a viable option for HGS repair, indicated by high screw placement accuracy, safety, and L5-S1 slippage correction. Surgeons looking to adopt an emerging technique to enhance safety and correction of pediatric HGS should consider the RAN platform. LEVEL OF EVIDENCE Level IV-therapeutic study.
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Affiliation(s)
| | - Craig M Birch
- Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - M Timothy Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Danielle Cook
- Department of Orthopaedic Surgery, Boston Children's Hospital
| | - Daniel J Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
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Ogura Y, Glassman SD, Sucato D, Hresko MT, Carreon LY. Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. Global Spine J 2021; 11:1019-1024. [PMID: 32677526 PMCID: PMC8351071 DOI: 10.1177/2192568220935107] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Longitudinal cohort. OBJECTIVES Posterior spinal fusion (PSF) using all-pedicle screw constructs has become the standard procedure in the treatment of adolescent idiopathic scoliosis (AIS). However, there have been several reports that all-pedicle screw constructs or the use of pedicle screws at the upper instrumented vertebrae (UIV) increases the incidence of proximal junctional kyphosis (PJK). We aimed to evaluate the impact of instrumentation type on the incidence of PJK following PSF for AIS. METHODS We performed a stratified random sampling from 3654 patients enrolled in a multicenter database of surgically treated AIS to obtain a representative sample from all Lenke types. Patients were then allocated into 3 groups based on the instrumentation type: all-pedicle screw (PS), hook at UIV with pedicle screws distally (HT), and hybrid constructs (HB). We measured proximal junctional angle (PJA) and defined PJK as PJA ≥ 10° and PJA progression of >10° at the final follow-up. RESULTS Fifteen (4.3%) of 345 cases had PJK. PJK was significantly more common in PS (11%) compared with HB (1%) and HT (0%) (P < .001). PJK patients were similar to non-PJK patients regarding age, sex, curve type, UIV, and preoperative coronal Cobb angle. Thoracic kyphosis was significantly higher in the PJK group before surgery. Patients who developed PJK had a statistically significantly larger negative sagittal balance compared with the non-PJK group. CONCLUSION The incidence of PJK was 4.3% and was more common in all-pedicle screw constructs. Using hooks at UIV might be a treatment strategy to limit PJK.
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Affiliation(s)
- Yoji Ogura
- Norton Leatherman Spine Center, Louisville, KY, USA,University of Louisville School of Medicine, Louisville, KY, USA,Yoji Ogura, MD, Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
| | - Steven D. Glassman
- Norton Leatherman Spine Center, Louisville, KY, USA,University of Louisville School of Medicine, Louisville, KY, USA
| | - Daniel Sucato
- Texas Scottish Rite Hospital for Children, Dallas, TX, USA
| | - M. Timothy Hresko
- Harvard Medical School and Boston Children’s Hospital, Boston, MA, USA
| | - Leah Y. Carreon
- Norton Leatherman Spine Center, Louisville, KY, USA,University of Louisville School of Medicine, Louisville, KY, USA
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Hresko MT, Wynne J, Houle L, Miller J. Bracing for infantile scoliosis: no sedation needed. Stud Health Technol Inform 2021; 280:184-186. [PMID: 34190084 DOI: 10.3233/shti210463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mehta casting technique applied under anesthesia is standard treatment for infantile scoliosis (IIS). However, concern has been raised about frequent anesthesia in children less than three years. The development of a customized thoracolumbar sacral orthosis (TLSO) could avoid the risks of Mehta casting. To develop a bracing technique for IIS that achieves patient compliance and scoliosis correction. Nine patients with ISS were offered a custom TLSO as an alternative to Mehta casting. One patient declined due to an insurance issue. No anesthesia was required for measurement or fitting of the TLSO. A temperature sensitive monitor recorded wear time. Brace success was determined by radiographic correction and adherence to prescription of greater than 18 hours per day. Eight patients had brace treatment with mean(range): age 19(12-44) months, curve magnitude 34° (22-44°), rib vertebral angle of greater than 20° with follow-up 17(3-28) months. In brace correction was less than 15 degrees in 6 of 8 patients. Compliance monitor recorded wear: 4 patients ≥ 18 hours, 2 patients 16-18 hours, 1 had 14 hours, and 1 monitor malfunctioned and could not be read. Brace design evolved to maximize ipsilateral abdominal relief away from the lateral apical shift of the design. Foam lining was added to prevent skin irritation through the relief opening. Average number of braces per year =2.2. A customized TLSO can achieve in brace correction comparable to Mehta casting with acceptable compliance and without the need for general anesthesia, while allowing bathing and skin care.
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Affiliation(s)
- M T Hresko
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - J Wynne
- Boston Orthotics and Prosthetics, Boston, MA, USA
| | - L Houle
- Boston Orthotics and Prosthetics, Boston, MA, USA
| | - J Miller
- Boston Orthotics and Prosthetics, Boston, MA, USA
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Beling A, Hresko MT, DeWitt L, Miller PE, Pitts SA, Emans JB, Hedequist DJ, Glotzbecker MP. Vitamin D levels and pain outcomes in adolescent idiopathic scoliosis patients undergoing spine fusion. Spine Deform 2021; 9:997-1004. [PMID: 33683641 DOI: 10.1007/s43390-021-00313-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 02/14/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Prior research has indicated adolescent idiopathic scoliosis (AIS) patients have lower bone mineral density and lower vitamin D levels than healthy peers. Vitamin D deficiency has been associated with higher levels of pain. This study investigated whether vitamin D-deficient AIS patients had higher pain before or immediately after posterior spine fusion (PSF) surgery. METHODS 25-Hydroxy vitamin D levels were tested in all AIS patients at their pre-operative appointment. Patients were grouped by serum 25-hydroxy vitamin D level: deficient, < 20 ng/mL; insufficient, 20-29 ng/mL; sufficient, ≥ 30 ng/mL. Primary outcomes included pre-operative Scoliosis Research Society Health-Related Quality of Life (SRS-30) and numeric rating scale (NRS) scores (0-10) up to 72 h post-operatively, and analyzed using ANOVA and linear mixed modeling, respectively. 176 patients undergoing PSF were included. Intra-operative characteristics by vitamin D status were also assessed. The cohort was 82% female and an average of 15.2 years (range 10.6-25.3 years) at fusion. Average major curve was 60 (range 40-104) degrees pre-operatively. RESULTS Forty-five (26%) patients were deficient in vitamin D, 75 (43%) were insufficient, and 56 (32%) were sufficient. Patients with vitamin D deficiency had lower average household income by zip code (p < 0.01) and higher secondhand smoke exposure (p < 0.001). There were no differences in pre-operative SRS-30 score, pre- and post-operative major curve angles, or estimated blood loss across vitamin D groups. Trajectories of NRS indicated no differences in pain during the first 72 h after surgery. CONCLUSION Vitamin D deficiency in this population is associated with potential markers of lower socioeconomic status; however, it does not influence AIS PSF patients' experience of pain before or immediately after spine fusion surgery. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Alexandra Beling
- Department of Orthopedics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - M Timothy Hresko
- Department of Orthopedics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Leah DeWitt
- Department of Orthopedics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Patricia E Miller
- Department of Orthopedics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Sarah A Pitts
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - John B Emans
- Department of Orthopedics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Daniel J Hedequist
- Department of Orthopedics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Michael P Glotzbecker
- Department of Orthopedics, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
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Lewen MO, Berry J, Johnson C, Grace R, Glader L, Crofton C, Leahy I, Pallikonda N, Litvinova A, Staffa SJ, Glotzbecker M, Emans J, Hresko MT, Ellen M, Troy M, Singer SJ, Ferrari L. Preoperative hematocrit and platelet count are associated with blood loss during spinal fusion for children with neuromuscular scoliosis. J Perioper Pract 2021; 32:74-82. [PMID: 33826437 DOI: 10.1177/1750458920962634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess the relationship of preoperative hematology laboratory results with intraoperative estimated blood loss and transfusion volumes during posterior spinal fusion for pediatric neuromuscular scoliosis. METHODS Retrospective chart review of 179 children with neuromuscular scoliosis undergoing spinal fusion at a tertiary children's hospital between 2012 and 2017. The main outcome measure was estimated blood loss. Secondary outcomes were volumes of packed red blood cells, fresh frozen plasma, and platelets transfused intraoperatively. Independent variables were preoperative blood counts, coagulation studies, and demographic and surgical characteristics. Relationships between estimated blood loss, transfusion volumes, and independent variables were assessed using bivariable analyses. Classification and Regression Trees were used to identify variables most strongly correlated with outcomes. RESULTS In bivariable analyses, increased estimated blood loss was significantly associated with higher preoperative hematocrit and lower preoperative platelet count but not with abnormal coagulation studies. Preoperative laboratory results were not associated with intraoperative transfusion volumes. In Classification and Regression Trees analysis, binary splits associated with the largest increase in estimated blood loss were hematocrit ≥44% vs. <44% and platelets ≥308 vs. <308 × 109/L. CONCLUSIONS Preoperative blood counts may identify patients at risk of increased bleeding, though do not predict intraoperative transfusion requirements. Abnormal coagulation studies often prompted preoperative intervention but were not associated with increased intraoperative bleeding or transfusion needs.
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Affiliation(s)
- Margaret O Lewen
- Department of Pediatric Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Jay Berry
- Complex Care Service, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Connor Johnson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachael Grace
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Laurie Glader
- Complex Care Service, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Charis Crofton
- Complex Care Service, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Izabela Leahy
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikhil Pallikonda
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna Litvinova
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Glotzbecker
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - John Emans
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - M Timothy Hresko
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary Ellen
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Troy
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara J Singer
- Department of Organizational Behavior and Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Lynne Ferrari
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Vuillermin C, Wang KK, Williams KA, Hresko MT, Waters PM. Sprengel's deformity: an analysis of surgically and nonsurgically treated patients. J Shoulder Elbow Surg 2021; 30:e1-e9. [PMID: 33317707 DOI: 10.1016/j.jse.2020.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sprengel's deformity is a congenital anomaly of the scapula and can be associated with reduced shoulder mobility and esthetic concerns. Controversies remain regarding its natural history, radiographic findings, and optimal treatment strategy. METHODS A total of 74 Sprengel's shoulders in 71 patients presenting to a pediatric referral hospital were retrospectively reviewed including 24 surgically treated shoulders. Median age at initial presentation was 3.8 years. Median age at the final follow-up was 9.6 years. RESULTS Twenty shoulders were analyzed for range of motion across time. The median composite abduction range was initially 105° and at the last time-point 98°, with a median loss of 15° over 5 years (P = .007). A total of 26% of the nonsurgical shoulders reported pain at the latest follow-up, compared with 1 surgical patient (4%) (P = .028). Older age was independently associated with pain (P < .001); this effect was only seen in nonsurgical patients. Radiographically, the glenoid inclination angle (GIA) independently correlated with the abduction range (P = .001). Surgically treated shoulders underwent a modified Woodward procedure at a median 4.8 years of age. At a median follow-up of 41 months, the abduction range improved in the surgical group from 90° preoperatively to 110° postoperatively, with a median gain of 40° (P < .001). The median GIA changed from -2° to 4° with a median gain of 9° (P = .004). CONCLUSIONS The natural history of untreated Sprengel's deformity may be one of gradual decline in the abduction range, with a proportion of patients developing pain in adolescence. The GIA correlates with the shoulder abduction range. Surgery with a modified Woodward procedure may alter the natural history of the condition by improving motion and reducing risk of pain later in life.
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Affiliation(s)
- Carley Vuillermin
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
| | - Kemble K Wang
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Kathryn A Williams
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - M Timothy Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Peter M Waters
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
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23
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Cohen LL, Shore BJ, Williams KA, Hedequist DJ, Hresko MT, Emans JB, Karlin LI, Snyder BD, Glotzbecker MP. Diagnosing and treating native spinal and pelvic osteomyelitis in adolescents. Spine Deform 2020; 8:1001-1008. [PMID: 32306283 DOI: 10.1007/s43390-020-00110-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES To describe how pediatric patients with spinal and pelvic osteomyelitis are diagnosed and treated and assess the diagnostic value of magnetic resonance imaging (MRI), needle aspiration biopsy (NAB), and blood cultures in this population. Spinal and pelvic osteomyelitis de novo are uncommon in children and minimal literature exists on the subject. Research has shown that NAB and blood cultures have variable diagnostic yield in adult native osteomyelitis. At our institution, there is no standard protocol for diagnosing and treating pediatric spinal and pelvic osteomyelitis de novo. METHODS All diagnoses of spinal and pelvic osteomyelitis at a pediatric tertiary care center from 2003 to 2017 were reviewed. Patients aged 0-21 at diagnosis were included. Patients with osteomyelitis resulting from prior spinal operations, wounds, or infections and those with chronic recurrent multifocal osteomyelitis were eliminated. All eligible patients' diagnoses were confirmed by MRI. RESULTS 29 patients (18 men, 11 women) met the inclusion criteria. The median age at diagnosis was 11 years old (range 1-18). More than half of all cases (17/29, 59%) affected the lumbar spine. The most common symptoms were back pain (20/29, 69%), fever (18/29, 62%), hip pain (11/29, 38%), and leg pain (8/29, 28%). The majority of NABs and blood cultures performed were negative, but of the positive tests Staphylococcus aureus was the most prevalent bacteria. 86% (25/29) had an MRI before a diagnosis was made and 72% (13/18) had an NAB performed post-diagnosis. CONCLUSIONS MRI is a popular and helpful tool in diagnosing spinal osteomyelitis de novo. NAB cultures are often negative but can be useful in determining antibiotic treatment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lara L Cohen
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Benjamin J Shore
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Kathryn A Williams
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Daniel J Hedequist
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - M Timothy Hresko
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - John B Emans
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Lawrence I Karlin
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Brian D Snyder
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael P Glotzbecker
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
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Hogue G, DeWitt L, Grzywna A, Hresko MT, Hedequist D, Karlin L, Emans J, Le H, Miller P, Glotzbecker M. Does bracing for adolescent idiopathic scoliosis affect operative results? Spine Deform 2020; 8:427-432. [PMID: 32291582 DOI: 10.1007/s43390-020-00066-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 12/21/2019] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVES We hypothesize that preoperative bracing for idiopathic scoliosis results in increased stiffness, as measured by reduced correction on bending films, ultimately leading to decreased surgical correction. Bracing is the primary nonoperative treatment for immature AIS patients with mild to moderate curves. For patients who fail bracing and proceed to operative intervention, it is unknown whether their nonoperative treatment impacts their surgical results. METHODS We conducted a single-center, retrospective, comparative study on 181 consecutive adolescent idiopathic scoliosis patients, aged 11-17 years, who underwent posterior spine fusion between 2011 and 2013. Patient flexibility was measured as percent change in the curve angle of the spine from standing to supine bend. Overall curve correction was calculated as the preoperative to postoperative change in standing coronal measure divided by the preoperative measurement and reported as a percentage. RESULTS One hundred and twelve subjects (62%) underwent bracing prior to fusion. Braced patients had similar preoperative major Cobb angles than unbraced patients (56.5 vs 59.0, p = 0.07). Preoperatively, braced patients achieved less primary curve correction in bending films (33.6%) than unbraced patients (40.6%, p = 0.003). Postoperatively, Cobb angle correction was not different between the braced (75.7%) and unbraced group (77.2%) overall (p = 0.41). There was no difference in blood loss (p = 0.14) or surgical time (p = 0.96) between braced and unbraced groups when adjusted for surgeon and number of levels fused. CONCLUSIONS While braced patients may demonstrate less preoperative flexibility, there is no evidence that braced patients experience decreased curve correction compared to unbraced patients. Bracing treatment did not impact operative results, as indicated by similar Cobb angle correction, estimated blood loss, and surgical time in both groups. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Grant Hogue
- Department of Orthopaedics, Children's Health at University Hospital, San Antonio, TX, USA
| | - Leah DeWitt
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Alexandra Grzywna
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - M Timothy Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Daniel Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Lawrence Karlin
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - John Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Hai Le
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Patricia Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Michael Glotzbecker
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
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Dolan LA, Weinstein SL, Abel MF, Bosch PP, Dobbs MB, Farber TO, Halsey MF, Hresko MT, Krengel WF, Mehlman CT, Sanders JO, Schwend RM, Shah SA, Verma K. Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST): Development and Validation of a Prognostic Model in Untreated Adolescent Idiopathic Scoliosis Using the Simplified Skeletal Maturity System. Spine Deform 2019; 7:890-898.e4. [PMID: 31731999 PMCID: PMC6939758 DOI: 10.1016/j.jspd.2019.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/11/2019] [Accepted: 01/12/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prognostic study and validation using prospective clinical trial data. OBJECTIVE To derive and validate a model predicting curve progression to ≥45° before skeletal maturity in untreated patients with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Studies have linked the natural history of AIS with characteristics such as sex, skeletal maturity, curve magnitude, and pattern. The Simplified Skeletal Maturity Scoring System may be of particular prognostic utility for the study of curve progression. The reliability of the system has been addressed; however, its value as a prognostic marker for the outcomes of AIS has not. The BrAIST trial followed a sample of untreated AIS patients from enrollment to skeletal maturity, providing a rare source of prospective data for prognostic modeling. METHODS The development sample included 115 untreated BrAIST participants. Logistic regression was used to predict curve progression to ≥45° (or surgery) before skeletal maturity. Predictors included the Cobb angle, age, sex, curve type, triradiate cartilage, and skeletal maturity stage (SMS). Internal and external validity was evaluated using jackknifed samples of the BrAIST data set and an independent cohort (n = 152). Indices of discrimination and calibration were estimated. A risk classification was created and the accuracy evaluated via the positive (PPV) and negative predictive values (NPV). RESULTS The final model included the SMS, Cobb angle, and curve type. The model demonstrated strong discrimination (c-statistics 0.89-0.91) and calibration in all data sets. The classification system resulted in PPVs of 0.71-0.72 and NPVs of 0.85-0.93. CONCLUSIONS This study provides the first rigorously validated model predicting a short-term outcome of untreated AIS. The resultant estimates can serve two important functions: 1) setting benchmarks for comparative effectiveness studies and 2) most importantly, providing clinicians and families with individual risk estimates to guide treatment decisions. LEVEL OF EVIDENCE Level 1, prognostic.
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Affiliation(s)
- Lori A Dolan
- Department of Orthopaedics and Rehabilitation, University of Iowa, 01048 JPP, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | | | - Mark F Abel
- University of Virginia Children's Hospital, 2270 Ivy Road, Charlottesville, VA 22903, USA
| | - Patrick P Bosch
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA
| | - Matthew B Dobbs
- Washington University Orthopaedics in St. Louis, 1 Children's Place, St. Louis, MO 63110, USA
| | - Tyler O Farber
- University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Matthew F Halsey
- Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR 97239-3098, USA
| | - M Timothy Hresko
- Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Walter F Krengel
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Charles T Mehlman
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - James O Sanders
- University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC 27599, USA
| | - Richard M Schwend
- Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Suken A Shah
- Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | - Kushagra Verma
- 3851 Katella Avenue, Suite 255, Los Alamitos, CA 90720, USA
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Hresko MT, Deckey DG, Hinchcliff E, Kalish LA. Comparative Sacral Morphology in Spondylolisthesis Patients. Spine Deform 2019; 7:945-949. [PMID: 31732006 DOI: 10.1016/j.jspd.2019.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN Retrospective comparative case series. OBJECTIVES Evaluation of sacral morphology in spondylolisthesis patients compared with asymptomatic controls. SUMMARY OF BACKGROUND DATA Patients with spondylolisthesis are known to differ from asymptomatic controls in sagittal plane anatomy, but few studies examine the coronal and axial plane differences in these cohorts. METHODS This is a retrospective evaluation of magnetic resonance imaging of the lumbosacral spine in 29 spondylolisthesis patients and an asymptomatic cohort (n = 154). Measurements of the linear distance and angular position of L5 and sacrum were performed in the sagittal, coronal, and axial planes. Receiver operating characteristic (ROC) curve analysis quantified these associations. High- and low-grade spondylolisthesis patients were compared with two-sample t-tests. All p-values are two-sided and considered significant when p < .05. RESULTS Axial measurements showed the distance of the right to left anterior ala and the L5 body width did not differ between the cohorts. Sacroiliac (SI) joint angles in the spondylolisthesis cohort were closer to the true sagittal plane than in the controls 109° versus 121° (p < .001). In the sagittal plane, the linear measurement of the ratio of the midpoint anteroposterior width L5 to the sacral end plate was larger in the high-grade patients than the low-grade patients and controls. In addition, the kyphosis between S1-S2 and S2-S3 was larger in the spondylolisthesis cohort. CONCLUSIONS The SI joints in patients with spondylolisthesis were orientated closer to the sagittal plane than in the controls. An awareness of this positioning may be important in surgical implant insertion as well as rehabilitation of hip extensor weakness. The main anatomical differences found in this study were in the sagittal plane. Sacral end plate abnormalities were well visualized and consistent with radiographic findings in the literature. LEVEL OF EVIDENCE Level III, diagnostic.
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Affiliation(s)
- M Timothy Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - David G Deckey
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; Tufts Medical School, 145 Harrison Avenue, Boston, MA 02111, USA
| | - Emily Hinchcliff
- MD Anderson Hospital, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Leslie A Kalish
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Troy MJ, Miller PE, Price N, Talwalkar V, Zaina F, Donzelli S, Negrini S, Hresko MT. Correction to: The "Risser+" grade: a new grading system to classify skeletal maturity in idiopathic scoliosis. Eur Spine J 2019; 28:888. [PMID: 30725228 DOI: 10.1007/s00586-018-5854-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Unfortunately, the affiliation of the author Negrini S has been incorrectly published in the original version. The complete correct affiliation of this author should read as follows.
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Affiliation(s)
- M J Troy
- Boston Children Hospital, Harvard Medical School, Boston, USA
| | - P E Miller
- Boston Children Hospital, Harvard Medical School, Boston, USA
| | - N Price
- Children's Mercy Hospital, Kansas City, USA
| | | | - F Zaina
- ISICO - L'Istituto Scientifico Italiano Colonna Vertebrale, Milan, Italy
| | - S Donzelli
- ISICO - L'Istituto Scientifico Italiano Colonna Vertebrale, Milan, Italy
| | - S Negrini
- University of Brescia, Brescia, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - M T Hresko
- Boston Children Hospital, Harvard Medical School, Boston, USA.
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Glotzbecker M, Troy M, Miller P, Berry J, Cohen L, Gryzwna A, McCann ME, Hresko MT, Goobie S, Emans J, Brustowitz R, Snyder B, Hedequist D. Implementing a Multidisciplinary Clinical Pathway Can Reduce the Deep Surgical Site Infection Rate After Posterior Spinal Fusion in High-Risk Patients. Spine Deform 2019; 7:33-39. [PMID: 30587318 DOI: 10.1016/j.jspd.2018.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/20/2018] [Accepted: 06/23/2018] [Indexed: 01/19/2023]
Abstract
DESIGN Retrospective comparative study. OBJECTIVE The purpose of this study is to measure SSI outcomes before and after implementation of our center's multidisciplinary clinical pathway protocol for high-risk spinal surgery. BACKGROUND Surgical site infections (SSIs) after spinal fusion harm patients and are associated with significant health care costs. Given the high rate of SSI in neuromuscular populations, there is a rationale to develop infection prevention strategies. METHODS An institutional clinical pathway was created in 2012 and based on nationally published Best Practice Guidelines as well as hospital practices with a goal of reducing the rate of deep SSI in high-risk patients. Patient and procedure characteristics were compared prior to (2008-2011) and after (2012-2016) implementation of the pathway. Logistic regression using penalized maximum likelihood was used to assess differences in rate of infection before and after implementation. RESULTS Cohorts of 132 and 115 high-risk patients were analyzed before and after pathway implementation. Rate of deep infections decreased from 8% to 1% of patients (p = .005). Preoperative antibiotics were dosed within 1 hour in 90% of the postpathway cohort. Redosing was successful in 94% of patients for first redose and 79% for second redose. Betadine irrigation was used in 76% of cases and vancomycin administered in 86%. Multivariable analysis determined that instances of compliant antibiotics dosing had 63% lower odds of infection compared with instances of noncompliance (p = .04). CONCLUSIONS Implementation of a multidisciplinary pathway aimed to reduce infection in patients at high risk for SSI after spinal fusion led to a significant reduction in deep SSI rate. It is impossible to attribute the drop in the deep SSI rate to any one factor. Our results demonstrate that adherence to a protocol using multiple strategies to reduce infection results in a lower SSI rate, lower care costs, and improved patient-related outcomes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Michael Glotzbecker
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
| | - Michael Troy
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Patricia Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Jay Berry
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Lara Cohen
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Alexandra Gryzwna
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Mary Ellen McCann
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - M Timothy Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Susan Goobie
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - John Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Robert Brustowitz
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Brian Snyder
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Daniel Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
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Goobie SM, Zurakowski D, Glotzbecker MP, McCann ME, Hedequist D, Brustowicz RM, Sethna NF, Karlin LI, Emans JB, Hresko MT. Tranexamic Acid Is Efficacious at Decreasing the Rate of Blood Loss in Adolescent Scoliosis Surgery: A Randomized Placebo-Controlled Trial. J Bone Joint Surg Am 2018; 100:2024-2032. [PMID: 30516625 DOI: 10.2106/jbjs.18.00314] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is an antifibrinolytic drug that reduces surgical blood loss. Evidence supporting its efficacy in surgery for adolescent idiopathic scoliosis is not robust. This trial was designed to validate the clinical efficacy of TXA in surgery for adolescent idiopathic scoliosis. METHODS This institutional review board-approved prospective double-blinded trial involved 111 patients with adolescent idiopathic scoliosis who were randomized to receive either a placebo or TXA (50-mg/kg loading dose and 10-mg/kg/h infusion). Power analysis indicated that 50 patients per group would provide power to detect a >20% difference in blood loss. Two-way analysis of variance (ANOVA) was applied to compare blood loss rates (slopes) using the group-by-time interaction F test. RESULTS The risk of clinically relevant blood loss (>20 mL/kg) was more than twice as high in the placebo group than in the TXA group (44% versus 21%, relative risk = 2.1, 95% confidence interval = 1.2 to 3.7). Compared with the placebo group, the TXA group had a 27% reduction in intraoperative blood loss, a significantly lower rate of intraoperative bleeding per hour (mean and standard deviation, 190 ± 73 versus 230 ± 80 mL, p = 0.01; F = 9.77, p < 0.001) and per fused spinal level (82 ± 32 versus 110 ± 40 mL, p < 0.001), less intraoperative blood loss (836 ± 373 versus 1,031 ± 484 mL, p = 0.02), and less postoperative bleeding (in the drain) (498 ± 228 versus 645 ± 318 mL, p = 0.009). Six patients who received a placebo and no patient who received TXA required an allogenic blood transfusion. No perioperative adverse events, including thromboembolic events or seizures, were observed. Three independent factors were predictive of blood loss: TXA administration, duration of surgery, and number of levels fused. Greater intraoperative blood loss was the only independent variable predictive of a longer hospital stay. CONCLUSIONS Use of TXA in patients undergoing surgery for adolescent idiopathic scoliosis significantly reduced blood loss, by 27%, compared with that in the placebo group. The rate of intraoperative blood loss per hour and per level fused and the amount of postoperative blood loss were significantly lower in the TXA group. More placebo-treated patients received allogenic blood. Patients with greater intraoperative blood loss spent a longer time in the hospital. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Susan M Goobie
- Department of Anesthesiology, Critical Care, and Pain Medicine (S.M.G., D.Z., M.E.M., R.M.B., and N.F.S.) and Department of Orthopaedic Surgery (M.P.G., D.H., L.I.K., J.B.E., and M.T.H.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David Zurakowski
- Department of Anesthesiology, Critical Care, and Pain Medicine (S.M.G., D.Z., M.E.M., R.M.B., and N.F.S.) and Department of Orthopaedic Surgery (M.P.G., D.H., L.I.K., J.B.E., and M.T.H.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael P Glotzbecker
- Department of Anesthesiology, Critical Care, and Pain Medicine (S.M.G., D.Z., M.E.M., R.M.B., and N.F.S.) and Department of Orthopaedic Surgery (M.P.G., D.H., L.I.K., J.B.E., and M.T.H.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mary E McCann
- Department of Anesthesiology, Critical Care, and Pain Medicine (S.M.G., D.Z., M.E.M., R.M.B., and N.F.S.) and Department of Orthopaedic Surgery (M.P.G., D.H., L.I.K., J.B.E., and M.T.H.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel Hedequist
- Department of Anesthesiology, Critical Care, and Pain Medicine (S.M.G., D.Z., M.E.M., R.M.B., and N.F.S.) and Department of Orthopaedic Surgery (M.P.G., D.H., L.I.K., J.B.E., and M.T.H.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert M Brustowicz
- Department of Anesthesiology, Critical Care, and Pain Medicine (S.M.G., D.Z., M.E.M., R.M.B., and N.F.S.) and Department of Orthopaedic Surgery (M.P.G., D.H., L.I.K., J.B.E., and M.T.H.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Navil F Sethna
- Department of Anesthesiology, Critical Care, and Pain Medicine (S.M.G., D.Z., M.E.M., R.M.B., and N.F.S.) and Department of Orthopaedic Surgery (M.P.G., D.H., L.I.K., J.B.E., and M.T.H.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lawerence I Karlin
- Department of Anesthesiology, Critical Care, and Pain Medicine (S.M.G., D.Z., M.E.M., R.M.B., and N.F.S.) and Department of Orthopaedic Surgery (M.P.G., D.H., L.I.K., J.B.E., and M.T.H.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - John B Emans
- Department of Anesthesiology, Critical Care, and Pain Medicine (S.M.G., D.Z., M.E.M., R.M.B., and N.F.S.) and Department of Orthopaedic Surgery (M.P.G., D.H., L.I.K., J.B.E., and M.T.H.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - M Timothy Hresko
- Department of Anesthesiology, Critical Care, and Pain Medicine (S.M.G., D.Z., M.E.M., R.M.B., and N.F.S.) and Department of Orthopaedic Surgery (M.P.G., D.H., L.I.K., J.B.E., and M.T.H.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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30
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Affiliation(s)
- M Timothy Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard M Schwend
- Orthopaedic Surgery Division, Children's Mercy Hospital, University of Missouri, Kansas City
| | - Richard A Hostin
- Southwest Scoliosis Institute, Baylor Scott and White Medical Center, Plano, Texas
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Abstract
OF BACKGROUND DATA This is the first reported series looking specifically at factors associated with deep surgical site infections (SSI) following pediatric cervical spine surgery. OBJECTIVE To identify risk factors present in pediatric patients who are at risk for SSI following cervical spine surgery. DESIGN Level of evidence: level IV-retrospective case series. INTRODUCTION To date there are no studies regarding SSI in pediatric cervical spine surgery and thus no benchmark data or risk factors have been identified. METHODS Patients with acute deep SSIs occurring within 90 days of the index operation were identified. Patient and surgical characteristics were analyzed for possible predictors of SSI outcome using penalized likelihood logistic regression analysis. Characteristics analyzed included: age, diagnosis, comorbidity, levels fused, approach, implants used, allograft, halo, body mass index, revision, antibiotic dosing, and occipital plating. RESULTS A total of 112 patients were included in the study at a mean age of 12.5 years (2 to 18 y). Comorbidities were present in 51 (46%) patients, 15 patients had a documented connective tissue disorder (CTD). The mean number of levels fused was 3.7 (2 to 7) and mean number of screws was 4.4 (2 to 11). Allograft was used alone in 48 patients, occipital plating in 28 patients, and a halo in 39 patients. Deep SSI occurred in 3 patients: two of which had a CTD (1 Trisomy 21, 1 Ehlers-Danlos) and 1 patient with postradiation cervical kyphosis. All were gram-positive infections requiring return to operating room with prolonged IV antibiotics. All patients recovered and fused with spinal implant retention. The incidence of deep SSI was 2.7%. It was determined that a CTD was the only significant predictor of SSI. Subjects with a CTD had 12 times the odds of SSI [odds ratio=12 (1.5, 137.0); P=0.02]. CONCLUSIONS In our series of pediatric patients the incidence of a deep SSI was 2.7%. The only predictor of SSI was the presence of a CTD.
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Affiliation(s)
- David A Porter
- *Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY †Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
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Sousa T, Skaggs DL, Chan P, Yamaguchi KT, Borgella J, Lee C, Sawyer J, Moisan A, Flynn JM, Gunderson M, Hresko MT, D'Hemecourt P, Andras LM. Benign Natural History of Spondylolysis in Adolescence With Midterm Follow-Up. Spine Deform 2017; 5:134-138. [PMID: 28259265 DOI: 10.1016/j.jspd.2016.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/29/2016] [Accepted: 10/11/2016] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVES To use the Micheli Functional Scale to assess adolescent patients with spondylolysis treated conservatively at midterm follow-up. SUMMARY OF BACKGROUND Spondylolysis is a common source of back pain for adolescents and is generally managed with bracing and physical therapy. There is little data regarding the results of conservative management of spondylolysis over time. METHODS Four major academic pediatric institutions performed a retrospective chart review of patients from 5 to 21 years of age with the initial diagnosis of spondylolysis. Inclusion criteria were patients who initially underwent conservative management and had a minimum of 2 years' follow-up. The patients were contacted and asked to complete the Micheli Functional Scale Survey. RESULTS A total of 295 patients with the diagnosis of spondylolysis were identified and contacted. Sixty-one subjects with spondylolysis completed the follow-up survey. Sixty of 61 respondents (98%) answered questions regarding their current pain level. Thirty-five of 60 (58.3%) reported no pain (0/10) and 47/60 (78%) rated their pain at 3 or less, whereas 22% (13/60) rated their pain as 4 or higher. There was no correlation with pain ratings on the follow-up survey and radiographic healing at initial management. Of the 61 patients, 50 returned to sports (82%), 8 did not return (13%), and 5 returned to most but not all of their sports (8%). No correlation was observed between radiographic healing and return to sports (p = .4885). CONCLUSION Using a validated functional scale, this study demonstrated that with conservative management of spondylolysis a majority of patients at an average of 8 years out self-report a return to sports (90%), though many reported continued pain (42%) and interference with activities (67%). There was no correlation observed between radiographic evidence of healing and pain or return to sports with a mean follow-up of 8 years. LEVEL OF EVIDENCE Multicenter retrospective case series.
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Affiliation(s)
- Ted Sousa
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #69, Los Angeles, CA 90027, USA
| | - David L Skaggs
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #69, Los Angeles, CA 90027, USA.
| | - Priscella Chan
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #69, Los Angeles, CA 90027, USA
| | - Kent T Yamaguchi
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Jerald Borgella
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN 38104, USA
| | - Christopher Lee
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Jeffrey Sawyer
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN 38104, USA
| | - Alice Moisan
- LeBonheur Children's Hospital, 51 N Dunlap St #100, Memphis, TN 38105, USA
| | - John M Flynn
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Melissa Gunderson
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - M Timothy Hresko
- Division of Sports Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Pierre D'Hemecourt
- Division of Sports Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #69, Los Angeles, CA 90027, USA
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Affiliation(s)
- M Timothy Hresko
- Departments of Orthopaedic Surgery, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Vishwas Talwalkar
- Departments of Orthopaedic Surgery, University of Kentucky and Shriners Hospitals for Children, Lexington, Kentucky
| | - Richard Schwend
- University of Missouri-Kansas City School of Medicine and University of Kansas Medical Center, Children's Mercy Hospital, Kansas City, Missouri
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Upasani VV, Hedequist DJ, Hresko MT, Karlin LI, Emans JB, Glotzbecker MP. Spinal deformity progression after posterior segmental instrumentation and fusion for idiopathic scoliosis. J Child Orthop 2015; 9:29-37. [PMID: 25599928 PMCID: PMC4340851 DOI: 10.1007/s11832-015-0632-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/07/2015] [Indexed: 02/03/2023] Open
Abstract
STUDY DESIGN Retrospective chart and radiographic review. PURPOSE To assess the incidence of and variables associated with spinal deformity progression after posterior segmental instrumentation and fusion at a single institution. Progression of the scoliotic deformity after posterior instrumented spinal fusion has been described. Recent studies have concluded that segmental pedicle screw constructs are better able to control deformity progression. METHODS Retrospective review of a consecutive series of idiopathic scoliosis patients (n = 89) with major thoracic curves (Lenke types 1-4) treated with posterior segmental instrumentation and fusion. Deformity progression was defined as a 10° increase in Cobb angle between the first-erect and 2-year post-operative radiographs. Clinical and radiographic data between the two cohorts (deformity progression versus stable) were analyzed to determine the variables associated with deformity progression. RESULTS Patients in the deformity progression group (n = 13) tended to be younger (median 13.7 vs. 14.7 years) and experienced a significant change in height (p = 0.01) during the post-operative period compared to the stable group (n = 76). At 2-years post-op, the patients in the deformity progression group had experienced a significantly greater change in upper instrumented vertebra (UIV) angulation, lower instrumented vertebra (LIV) angulation, and apical vertebral translation (AVT). Two-year post-op Scoliosis Research Society questionnaire (SRS-22) scores in the appearance domain were also significantly worse in the deformity progression group. Patients in the deformity progression group had a significantly greater difference between the lowest instrumented vertebra and stable vertebra compared to patients in the stable group (p = 0.001). CONCLUSIONS Deformity progression after posterior spinal fusion does occur after modern segmental instrumentation. Segmental pedicle screw constructs do not prevent deformity progression. Skeletally immature patients with a significant growth potential are at the highest risk for deformity progression. In immature patients, extending the fusion distally to the stable vertebra may minimize deformity progression. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Vidyadhar V Upasani
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA,
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Abstract
PURPOSE Variation in rib numbering has been noted in adolescent idiopathic scoliosis (AIS), but its effect on the reporting of fusion levels has not been studied. We hypothesized that vertebral numbering variations can lead to differing documentation of fusion levels. METHODS We examined the radiographs of 161 surgical AIS patients and 179 control patients without scoliosis. For AIS patients, the operative report of fusion levels was compared to conventional vertebral labeling from the first thoracic level and proceeding caudal. We defined normal counts as 12 thoracic (rib-bearing) and five lumbar (non-rib-bearing) vertebrae. We compared our counts with data from 181 anatomic specimens. RESULTS Among AIS patients, 22 (14 %) had an abnormal number of ribs and 29 (18 %) had either abnormal rib or lumbar count. In 12/29 (41 %) patients, the operative report differed from conventional labeling by one level, versus 3/132 (2 %) patients with normal numbering (p < 0.001). However, there were no cases seen of wrong fusion levels based on curve pattern. Among controls, 11 % had abnormal rib count (p = 0.41) compared to the rate in AIS. Anatomic specimen data did not differ in abnormal rib count (p = 1.0) or thoracolumbar pattern (p = 0.59). CONCLUSIONS The rate of numerical variations in the thoracolumbar vertebrae of AIS patients is equivalent to that in the general population. When variations in rib count are present, differences in numbering levels can occur. In the treatment of scoliosis, no wrong fusion levels were noted. However, for both scoliosis patients and the general population, we suggest adherence to conventional labeling to enhance clarity.
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Affiliation(s)
- Hillard T Spencer
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Hunnewell 2, Boston, MA, 02115, USA,
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Zaina F, De Mauroy JC, Grivas T, Hresko MT, Kotwizki T, Maruyama T, Price N, Rigo M, Stikeleather L, Wynne J, Negrini S. Bracing for scoliosis in 2014: state of the art. Eur J Phys Rehabil Med 2014; 50:93-110. [PMID: 24622051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bracing is currently the primary method for treating moderate idiopathic scoliosis (IS) during the developmental phase of growth. Following a lengthy debate, during which researchers and authors questioned the role of bracing in the treatment of IS due to inconsistent evidence, the Bracing in Adolescent Idiopathic Scoliosis Trial study have provided a high level of evidence to the value of bracing and may have convinced most of those who were skeptic. However, although some guidelines have been published, there remains no standard for constructing scoliosis orthoses and no standard treatment protocol. The Scoliosis Research Society criteria were established to provide a framework by which to research bracing and adolescent idiopathic scoliosis, and the Society on Scoliosis Orthopedic and Rehabilitation Treatment criteria were published to guarantee a minimum level of expertise for MDs and CPOs involved in the brace treatment. However, very few contemporary papers follow both sets of criteria, and the extensive variety of braces makes it difficult to determine if one is superior to another. The aim of this paper is to provide an overview of state-of-the-art brace treatment, highlighting commonly used braces and their history, biomechanical concept, and results, as reported in published literature. Specific focus is placed on European (i.e., Chêneau and derivatives, Dynamic Derotating, Lyon, PASB, Sforzesco, TLI, TriaC) and North American (i.e. Boston, Charleston, Milwaukee, Providence, Rosenberger, SpineCor, Wilmington) designs. Details about different building techniques are also reported, along with recently developed tools that are designed to monitor compliance.
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Affiliation(s)
- F Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy -
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Abstract
BACKGROUND A relationship between spinal distraction and correction of the curvature of scoliosis has long been recognized. While attempts have been made to define the height that is lost with progression of scoliosis, much less information is available to define the height that is gained as a result of surgical correction of the curve and to quantify additional spinal growth after spine fusion. METHODS The present study included 116 patients (mean age, 14.8 years) who underwent spinal instrumentation and fusion for the treatment of idiopathic scoliosis. The study group included ninety-one female patients and twenty-five male patients; all Lenke curve types were represented. The Cobb angle and the T1-L5 spinal height were evaluated on preoperative, postoperative, and two-year follow-up radiographs. Kyphosis, lordosis, and T1-L5 spinal length were measured on lateral radiographs. The Scoliosis Research Society (SRS) questionnaire was completed prior to surgery and at each visit. Multivariate linear regression defined the relationship between spinal height gain, Cobb angle correction, and other variables as well as final spinal height. RESULTS The mean spinal height gain due to surgery was 27.1 mm (median, 25.1 mm; interquartile range, 14.5 to 37.9 mm; range, -3.8 to 66.1 mm). The magnitude of curve correction (mean, 38.2°; range, 6° to 67°), the number of vertebral levels fused (mean, 9.9; range, three to sixteen), and the preoperative stature (standing height) of the patient were all significant predictors (p < 0.01) of spinal height gain (R2 = 0.8508 for multivariate model). The mean changes in kyphosis and lordosis were small and were not significant predictors. An additional 4.6 mm of mean spinal height was gained at the time of the two-year follow-up; this increase was significantly related to young age, male sex, shorter fusions, and a Risser stage of ≤2 at the time of surgery (p < 0.01 for all in multivariate analysis). The SRS-30 scores improved significantly (p < 0.0001), independent of spinal height gain. CONCLUSIONS Patients undergoing surgical correction of idiopathic scoliosis gain substantial height related to the magnitude of surgical correction, the number of levels fused, and preoperative stature. Continued spine growth by two years after surgery is associated with shorter fusions, skeletal immaturity, young age, and male sex. Height gain is a quantifiable outcome of the surgical correction of scoliosis.
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Affiliation(s)
- Hillard T Spencer
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115. E-mail address for M.T. Hresko:
| | - Meryl E Gold
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115. E-mail address for M.T. Hresko:
| | - Lawrence I Karlin
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115. E-mail address for M.T. Hresko:
| | - Daniel J Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115. E-mail address for M.T. Hresko:
| | - M Timothy Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115. E-mail address for M.T. Hresko:
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Montgomery RA, Hresko MT, Kalish LA, Gold M, Li Y, Haus B, Glotzbecker M, Berthonnaud E. Spondylolisthesis: Intra-rater and Inter-rater Reliabilities of Radiographic Sagittal Spinopelvic Parameters Using Standard Picture Archiving and Communication System Measurement Tools. Spine Deform 2013; 1:412-418. [PMID: 27927366 DOI: 10.1016/j.jspd.2013.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 06/10/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN Reliability analysis. OBJECTIVE To determine the intra-rater and inter-rater reliability of common sagittal spinopelvic measurements from Digital Imaging and Communications in Medicine images on a commercial Picture Archiving and Communication system for patients with developmental spondylolisthesis. SUMMARY OF BACKGROUND DATA Computer-aided analysis of digital radiographs has been used in research protocols to define anatomic and positional characteristics of developmental spondylolisthesis. Previous studies have shown poor reliability and weak correlations of manual measurements used in clinical practice with research measurements, which limit the clinical value of prior research. METHODS Five raters of varying experience measured lateral spinopelvic images of 30 patients with developmental spondylolisthesis. Measurements were repeated after 1 week. Intra-rater and inter-rater reliabilities for each measurement were determined. Measurements were compared with those obtained from a computer-based image enhancement research system. Continuous variables were assessed by analysis of variance, whereas kappa statistics were determined for categorical variables. RESULTS Excellent intraclass correlations (ICC)s were obtained for all radiographic measurements based on linear values (slip ratio and C7 balance) as well as pelvic tilt angle. Angular measurements had good to excellent ICC but were weaker when the sacral plate was involved. There was poor agreement with classification of sacral doming. Some measurements had reduced reliability in the images with evidence of doming. CONCLUSIONS Excellent ICCs were found with measurements of from Digital Imaging and Communications in Medicine images using commercial Picture Archiving and Communication System tools. Sacral doming affected the reliability. A radiographic classification of spondylolisthesis will be most reliable when based on slip ratio, C7 balance, and pelvic tilt.
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Affiliation(s)
| | - M Timothy Hresko
- Department of Orthopaedics, Children's Hospital Boston, Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA.
| | - Leslie A Kalish
- Clinical Research Center, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Meryl Gold
- Department of Orthopaedics, Children's Hospital Boston, Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA
| | - Ying Li
- Department of Orthopaedics, Children's Hospital Boston, Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA
| | - Brian Haus
- Department of Orthopaedics, Children's Hospital Boston, Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA
| | - Michael Glotzbecker
- Department of Orthopaedics, Children's Hospital Boston, Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA
| | - Eric Berthonnaud
- L'Hôpital Nord Ouest, Site de Villefranche/Saône, BP 436, 69655 Villefranche/Saône Cedex, France
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Abstract
BACKGROUND Management of pediatric radial neck fractures is controversial regarding acceptable alignment, variable reduction techniques, and suboptimal outcomes. The purpose of this study was to assess the characteristics, management, and results in a surgical cohort, in efforts to identify prognostic factors and offer treatment suggestions. It was hypothesized that less invasive reduction maneuvers would precede open reduction and that worse results would correlate with fracture severity, open reduction, and the presence of associated injuries. METHODS Retrospective analysis of 151 children in whom a radial neck fracture had been surgically treated from 2001 to 2011 was performed. The mean age (and standard deviation) and duration of follow-up were 8.4 ± 2.9 years and 13.3 ± 20.0 months, respectively; 40% of the patients were male. A successful clinical result was defined as elbow flexion of ≥120°, flexion contracture of <20°, forearm rotation of ≥90° with ≥45° of supination and pronation, and no complications. RESULTS An isolated radial neck fracture occurred in 54% of the children. The mean angulation and displacement improved from 43° ± 19° and 37% ± 35%, respectively, before treatment to 13° ± 7° and 0.9% ± 4% after treatment (p < 0.001). Twenty-two procedural combinations were used to treat these patients, and 67% of the open reductions were not preceded by percutaneous or closed reduction attempts. Among 131 patients with adequate follow-up, 31% had an unsuccessful outcome. An age of ten years or more (odds ratio [OR] = 5.85, p = 0.001), a time to surgery of two days or less (OR = 4.73, p = 0.02), and greater fracture displacement (OR = 1.25 per 10%, p = 0.001) were independent predictors of unsuccessful outcomes. Increased fracture severity and open reduction were associated with poor results, although the presence of concomitant injuries was not. It is predicted that closed manipulation will fail for half of fractures angulated ≥36°, and that half of fractures displaced ≥65% will require open reduction. The predicted frequency of unsuccessful outcomes is 50% with 76% displacement. CONCLUSIONS There continues to be great variation in the approach to treatment of displaced radial neck fractures in children. Suboptimal results occurred in 31% of the patients in this series, with worse results in patients older than ten years, who had increased fracture severity, and who underwent open reduction. Less invasive reduction methods should precede open reduction whenever possible.
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Affiliation(s)
- Ryan M Zimmerman
- Massachusetts General Hospital, 55 Fruit Street, WHT 535, Boston, MA 02114
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Abstract
BACKGROUND DATA There has been an increased focus on the role of rib abnormalities in the development of scoliosis. Rib resection may influence the development of scoliosis. Although scoliosis has been identified in patients after thoracotomy, most of the currently available information is from case reports. METHODS We examined records of 37 patients who underwent a chest wall or rib resection for rib lesions at our institution during the period of 1992 to 2005. Adequate data was available in 21 patients. We gathered data on demographic information, location of resection, and changes in curvature after resection based on radiograph or scout CT films at the latest follow-up appointment. RESULTS Fourteen of 21 patients developed scoliosis with a mean Cobb angle of 25.8° (10°-70°). Eleven of these 14 patients had a progressive spinal deformity after chest wall resection with an average change in curvature of 29° (10°-70°). Eight of those 11 developed a convex toward the resection, while 3/11 developed a convex away from the resection. Seven of the eight patients with resections that included a rib superior to the sixth rib developed scoliosis, while four of 13 with resections below the sixth rib developed scoliosis. CONCLUSION Patients who have had a rib or chest wall resection are at risk for developing scoliosis, particularly if the resection is performed above the sixth rib.
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Affiliation(s)
- Michael P. Glotzbecker
- />Department of Orthopaedic Surgery, Instructor, Harvard Medical School, Children’s Hospital Boston, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115 USA
| | - Meryl Gold
- />Department of Orthopaedic Surgery, Instructor, Harvard Medical School, Children’s Hospital Boston, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115 USA
| | - Mark Puder
- />Department of Surgery, Children’s Hospital Boston, Boston, MA 02115 USA
| | - M. Timothy Hresko
- />Department of Orthopaedic Surgery, Instructor, Harvard Medical School, Children’s Hospital Boston, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115 USA
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Abstract
OBJECTIVE Adolescent idiopathic scoliosis (AIS) is a relatively common reason for referral to orthopedic surgery, but most referred patients do not require bracing or surgery. We developed a quality improvement (QI) program within the Pediatric Physicians' Organization at Children's, an independent practice association affiliated with Boston Children's Hospital, to reduce unnecessary specialty referrals for AIS. METHODS The QI program consisted of physician education, decision support tools available at the point of care, and longitudinal feedback of data on physician referrals for AIS. Referral patterns in the 2-year postintervention period were tracked and compared with those of the 2-year preintervention period. Clinical characteristics of referred patients were compared through claims analysis and chart review. RESULTS Initial visits to orthopedic surgery for AIS declined from 5.1 to 4.1 per 1000 adolescents per year, a reduction of 20.4% (P = .01). Process control chart analysis showed a rapid change in referral patterns after the initiation of the program which was sustained over the 2-year postintervention period and demonstrated that 66 initial and 131 total AIS specialty visits were avoided as a result of the program. CONCLUSIONS A QI program consisting of physician education, decision support available at the point of care, and longitudinal data feedback led to a sustained reduction in unnecessary referrals for AIS. This program can serve as a model for other programs that seek to shift the locus of care from specialists to primary care providers.
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Affiliation(s)
- Louis Vernacchio
- Pediatric Physicians' Organization at Children's, Brookline, MA 02445, USA.
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Affiliation(s)
- M Timothy Hresko
- Department of Orthopedic Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, USA
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Kocher MS, Kasser JR, Waters PM, Bae D, Snyder BD, Hresko MT, Hedequist D, Karlin L, Kim YJ, Murray MM, Millis MB, Emans JB, Dichtel L, Matheney T, Lee BM. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. A randomized clinical trial. J Bone Joint Surg Am 2007; 89:706-12. [PMID: 17403790 DOI: 10.2106/jbjs.f.00379] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Closed reduction and percutaneous pin fixation is the treatment of choice for completely displaced (type-III) extension supracondylar fractures of the humerus in children, although controversy persists regarding the optimal pin-fixation technique. The purpose of this study was to compare the efficacy of lateral entry pin fixation with that of medial and lateral entry pin fixation for the operative treatment of completely displaced extension supracondylar fractures of the humerus in children. METHODS This prospective, randomized clinical trial had sufficient power to detect a 10% difference in the rate of loss of reduction between the two groups. The techniques of lateral entry and medial and lateral entry pin fixation were standardized in terms of the pin location, the pin size, the incision and position of the elbow used for medial pin placement, and the postoperative course. The primary study end points were a major loss of reduction and iatrogenic ulnar nerve injury. Secondary study end points included radiographic measurements, clinical alignment, Flynn grade, elbow range of motion, function, and complications. RESULTS The lateral entry group (twenty-eight patients) and the medial and lateral entry group (twenty-four patients) were similar in terms of mean age, sex distribution, and preoperative displacement, comminution, and associated neurovascular status. No patient in either group had a major loss of reduction. There was no significant difference between the rates of mild loss of reduction, which occurred in six of the twenty-eight patients treated with lateral entry and one of the twenty-four treated with medial and lateral entry (p = 0.107). There were no cases of iatrogenic ulnar nerve injury in either group. There were also no significant differences (p > 0.05) between groups with respect to the Baumann angle, change in the Baumann angle, humerocapitellar angle, change in the humerocapitellar angle, Flynn grade, carrying angle, elbow flexion, elbow extension, total elbow range of motion, return to function, or complications. CONCLUSIONS With use of the specific techniques employed in this study, both lateral entry pin fixation and medial and lateral entry pin fixation are effective in the treatment of completely displaced (type-III) extension supracondylar fractures of the humerus in children. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mininder S Kocher
- Department of Orthopaedic Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Abstract
STUDY DESIGN Cross-sectional study of 37 patients to measure serum levels of nickel and chromium after posterior spinal arthrodesis using stainless steel implants. OBJECTIVES To investigate the relationship between factors such as age, gender, pain, time from surgery, length of arthrodesis, and level of arthrodesis to serum metal ion levels after instrumented spinal arthrodesis. SUMMARY OF BACKGROUND DATA Measurable levels of metal ions in the serum can be detected after the use of stainless steel implants. There is some evidence to suggest that long-term exposure can potentially be toxic. Posterior spinal arthrodesis with stainless steel implants is a common procedure to treat spinal deformity in the adolescent population; however, the extent of metal ion exposure after posterior spinal arthrodesis is unknown. METHODS Patients that underwent posterior instrumented spinal arthrodesis with more than 6 months follow-up were recruited for this study. Patients with altered neurologic function were excluded. Serum levels of nickel and chromium were measured using inductively coupled plasma mass spectrometry. Pain was assessed using the Oswestry questionnaire. Spine radiographs were used to look for evidence of pseudarthrosis. Forty-five patients were approached, and 37 agreed to the questionnaire and blood test. Ten patients were men and 27 were women. Mean age at surgery was 14 years with mean follow-up of 6 years. Statistical correlations between serum metal ion levels and age at surgery, time from surgery, gender, number of segments fused, spinal instrument interfaces, pain, and instrumentation type were assessed. RESULTS Abnormally high levels of nickel and chromium above normal levels (0.3 ng/mL for nickel, 0.15 ng/mL for chromium) could be detected in serum after posterior spinal arthrodesis using stainless steel implants. There was a significant inverse correlation between serum nickel (r = -0.61, P < 0.001) and chromium (r = -0.64, P < 0.001) levels and time from surgery. When patients were grouped based on lengths of time from surgery, 0 to 2 years (n = 7), 2 to 4 years (n = 11), and >4 years (n = 8), the mean +/- SD for nickel (ng/mL) was 3.8 +/- 2.6, 1.3 +/- 1.1, and 0.9 +/- 0.8, respectively. Analysis ofvariance revealed significant group differences (P =0.004). Similarly, the chromium levels were 2.7 +/- 2.7, 0.6 +/- 0.4, and 0.3 +/- 0.3, respectively (P = 0.018). Only time from surgery was a significant multivariate predictor of nickel and chromium serum levels. Pseudarthrosis was not seen in this cohort. CONCLUSIONS Elevated levels of nickel and chromium can be measured after posterior instrumented spinal arthrodesis. The levels diminish rapidly with time from surgery but still remained above normal levels 4 years after surgery. Long-term implication of this metal ion exposure is unknown and should be studied further.
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Affiliation(s)
- Young-Jo Kim
- Children's Hospital-Boston, Department of Orthopaedic Surgery, 300 Longwood Avenue, Hunnewell 225, Boston MA 02115, USA.
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Abstract
BACKGROUND The management of the contralateral hip after unilateral slipped capital femoral epiphysis is controversial. The purpose of this study was to determine, with use of expected-value decision analysis, the optimal management strategy-prophylactic in situ pinning versus observation-for the contralateral hip. METHODS Outcome probabilities were determined from a systematic review of the literature. Utility values were obtained from a questionnaire on patient preferences completed with use of a visual analog scale by twenty-five adolescent male patients without slipped capital femoral epiphysis. A decision tree was constructed, fold-back analysis was performed to determine the optimal treatment, and one and two-way sensitivity analyses were performed to determine the effect on decision-making of varying outcome probabilities and utilities. RESULTS Observation was the optimal management strategy for the contralateral hip given the outcome probabilities and utilities that we studied (the expected value was 9.5 for observation and 9.2 for prophylactic in situ pinning, with a marginal value of 0.3). Increased rates of a late second slip favored prophylactic in situ pinning (the threshold probability was 27%). Risk-taking patients with a high utility for uncomplicated prophylactic in situ pinning favored prophylaxis (the threshold utility was 9.8). CONCLUSIONS The iatrogenic risks of treating a healthy patient or an uninvolved body part rarely outweigh the potential benefits unless the probability of the adverse event is likely and the consequences of the adverse event are very severe. In this decision analysis, the optimal decision was observation. In cases where the probability of contralateral slipped capital femoral epiphysis exceeds 27% or in cases where reliable follow-up is not feasible, pinning of the contralateral hip is favored. For a given individual patient, the optimal strategy depends not only on probabilities of the various outcomes but also on personal preference. Thus, we advocate a model of doctor-patient shared decision-making in which both the outcome probabilities and the patient preferences are considered in order to optimize the decision-making process. LEVEL OF EVIDENCE Economic and decision analysis, Level III-1 (limited alternatives and costs; poor estimates). See Instructions to Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mininder S Kocher
- Department of Orthopaedic Surgery, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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48
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Abstract
We reviewed 15 flexion intertrochanteric osteotomies and 11 subcapital osteotomies done for chronic, severe, stable slipped capital femoral epiphysis at one institution with a minimum 2 years followup. The goal was to determine which procedure achieved better deformity correction and which procedure was safer. Radiographically, the two groups were equivalent in compensating for epiphyseal slip. Flexion intertrochanteric osteotomy was more effective in restoring proximal femoral anatomy, as determined by articulotrochanteric distance and trochanter-center of head distance. The incidence of complications, including osteonecrosis and chondrolysis, was low for both groups, but the reoperation rate was greater in the subcapital osteotomy group than in the flexion intertrochanteric group. Flexion intertrochanteric osteotomy seems to be an effective, safe, and reproducible realignment osteotomy for treatment of chronic, severe, stable slipped capital femoral epiphysis.
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Affiliation(s)
- Mohammad Diab
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143, USA.
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Zambrano E, Nosé V, Perez-Atayde AR, Gebhardt M, Hresko MT, Kleinman P, Richkind KE, Kozakewich HPW. Distinct Chromosomal Rearrangements in Subungual (Dupuytren) Exostosis and Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion). Am J Surg Pathol 2004; 28:1033-9. [PMID: 15252309 DOI: 10.1097/01.pas.0000126642.61690.d6] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Proliferative lesions of the bone surface, such as subungual (Dupuytren) exostosis and bizarre parosteal osteochondromatous proliferation (BPOP, Nora lesion) are currently classified as reactive, proliferative processes that mimic primary neoplasms of bone. METHODS Cytogenetic analysis was performed on 3 subungual exostoses of the great toe and 2 BPOP lesions of the radius and ulna. RESULTS A balanced translocation t(X;6) was identified in all cases of subungual exostoses. The chromosomal rearrangements observed in 1 case of BPOP differed from those seen in subungual exostosis. CONCLUSIONS The presence of chromosomal abnormalities in subungual exostosis and BPOP suggests that these lesions are neoplastic, with a different molecular pathogenesis, and that each is a distinct clinicopathologic entity.
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Affiliation(s)
- Eduardo Zambrano
- Department of Pathology, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Iobst CA, Hresko MT, Karlin LI, Hall JE. Postoperative shoulder-spine spica cast for young children. J Pediatr Orthop 2004; 24:227-30. [PMID: 15076612 DOI: 10.1097/00004694-200403000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Immobilization of the young child after spinal surgery is an important component of the surgical plan. This study reviews the authors' experience with postoperative immobilization in a shoulder-body spica cast and provides a detailed description of the technique. Twenty-two children with an average age of 31 months at the time of surgery were placed in the shoulder-spine spica cast after hemivertebra excision. There was no loss of correction in any of the 22 children during the period of postoperative immobilization. All patients were able to be ambulatory in the shoulder-spine spica cast while immobilized. Patients experienced the minor complications of prolonged cast wear, with one cast becoming loose and three casts causing skin rash. One patient required removal of the cast 6 weeks after surgery for unrelated nausea and vomiting. The shoulder-spine spica cast has been used at the authors' institution with great success and allows children to be ambulatory after hemivertebra resection.
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