Pediatric spinal deformity: what every orthopaedic surgeon needs to know

Professor, Department of Orthopaedic Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Instructional course lectures 01/2012; 61:481-97.
Source: PubMed


Pediatric spinal deformity is an integral part of orthopaedic surgical practice. In a general or specialized practice, the well-versed orthopaedic surgeon should be aware of the diagnostic methods and the natural history from which practice standards are derived. It is important to be aware of the spectrum of spinal deformity in children (from early-onset scoliosis to adolescent idiopathic scoliosis, kyphosis, and spondylolisthesis) and current principles of growth and maturation as applied to the spine and the thorax. This information should be helpful in attaining the appropriate diagnosis, treatment, and/or referral for a pediatric patient with a spinal deformity.

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    • "At the same time, spinal deformity is to be corrected and partial functions are to be retained [14]. With more investigations of spinal deformity and further developments in minimally invasive surgery of spine, it may be available to control or correct spinal deformity through spinal growth control [15] [16]. Hemiepiphyseal compression staples were intrasegmental fixation instrument designed by hemiepiphyseal block technique [17] [18]. "
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    ABSTRACT: Shape memory alloy (SMA) staples in nickel titanium with shape memory effect are effective for spinal growth control. This study was designed to evaluate the biomechanical properties of the staples and observe the stability of the fixed segments spine after the staples were implanted. According to the vertical distance of the vertebrae, SMA staples of 5, 6.5, and 8 mm were designed. The recovery stress of 24 SMA staples in three groups was measured. The pullout strength of SMA staples and stainless steel staples in each functional spinal unit was measured. Each of the six fresh specimens was divided into three conditions: normal, single staple, and double staples. Under each condition, the angle and torque of spinal movements in six directions were tested. Results show that the differences in recovery stress and maximum pullout strength between groups were statistically significant. In left and right bending, flextion, and extention, the stability of spine was decreased in conditions of single staple and double staples. Biomechanical function of SMA staples was superior to stainless steel staple. SMA staples have the function of hemiepiphyseal compression and kyphosis and scoliosis model of thoracic vertebrae in goat could be successfully created by the fusionless technique.
    11/2013; 2013(2):384894. DOI:10.1155/2013/384894
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    ABSTRACT: Study Design: Retrospective cohort study using the Pediatric Health Information Systems (PHIS) database.Objective: To describe longitudinal patterns of prophylactic antibiotic use and determinants of antibiotic choice for spinal fusion surgeries performed at US children's hospitals.Summary of Background Data: Surgical Site Infections (SSIs) account for a significant proportion of post-spinal surgery complications, particularly among children with complex conditions such as neuromuscular disease. Antimicrobial prophylaxis with intravenous (IV) cefazolin or cefuroxime has been a standard practice, but postoperative infections caused by organisms resistant to these antibiotics are increasing in prevalence. Studies describing the choice of antibiotic prophylaxis for pediatric spinal surgery are lacking.Methods: We included children 6 months to 18 years of age discharged from 37 US children's hospitals between January 1, 2006 - June 30, 2009 with 1) an ICD9-CM procedure code indicating a spinal fusion and 2) combinations of diagnosis codes indicating adolescent idiopathic scoliosis (AIS, n = 5,617) or neuromuscular scoliosis (NMS, n = 3,633). After identifying antibiotics ordered on the operative day, we described variation in broad-spectrum antibiotic use over time, and measured associations between patient/surgery characteristics and antibiotic choice.Results: Prophylactic antibiotic choice varied across hospitals and over time. Broad-spectrum antibiotics were used in 37% of AIS and 52% of NMS operations. Seven (19%) hospitals used broad spectrum coverage for greater than 80% of all cases. For NMS procedures, broad-spectrum antibiotic use was associated with patient characteristics known to be associated with high SSI risk. Use of vancomycin and broad gram-negative agents increased over time.Conclusion: Broad-spectrum antimicrobial prophylaxis varied across hospitals, and was often associated with known risk factors for SSI. These results highlight the need for future studies comparing the effectiveness of various prophylaxis strategies, particularly in high risk subgroups. This research can inform the development of best practice for SSI prevention in spinal fusion procedures.
    Spine 01/2013; 38(7). DOI:10.1097/BRS.0b013e318289b690 · 2.30 Impact Factor