Daniel J Sucato

Texas Scottish Rite Hospital for Children, Texas City, Texas, United States

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Publications (104)229.27 Total impact

  • Daniel J Sucato, Kirsten Tulchin-Francis, Adriana de La Rocha, Vedant Kulkarni, David A Podeszwa
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    ABSTRACT: To analyze outcomes of adolescents treated with a periacetabular osteotomies (PAO) with a minimum of 2 years of follow-up. Patients undergoing a PAO for adolescent hip dysplasia were analyzed preoperatively, 1 and 2 years postoperatively. In 32 dysplastic hips significant improvement was seen in all radiographic parameters. Gait speed, hip flexion pull-off power, and hip abductor moment impulse were unchanged postoperatively, whereas strength was maintained in 85% (abduction) and 95% (flexion). The Harris Hip Score increased from 67.1 to 77.9 to 81.3 at 1 and 2 years, respectively. Ganz PAO is effective in correcting dysplasia in adolescents radiographically and functionally.
    Journal of pediatric orthopedics. Part B. 03/2015; 24(2):99-105.
  • Daniel J Sucato, Adriana De La Rocha
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    ABSTRACT: The patient with an unstable slipped capital femoral epiphsyis poses a challenging problem to the treating physician to improve the position of the displaced epiphysis to avoid femoroacetabular impingement without developing avascular necrosis (AVN)-a potentially devastating complication. Although the standard operative procedure of in situ pinning following an incidental reduction while positioning the patient on the table, has been the mainstay of treatment in North America, other viable options are available including a surgical dislocation approach to the hip followed by a modified Dunn osteotomy with control of the retinacular vessels, reduction of the epiphysis, and internal fixation with pins or screws. Although technically demanding, this approach offers an opportunity to reduce the epiphysis to avoid femoroacetabular impingement, and limit the possibility for the development of AVN. The early results for this procedure are promising with all studies demonstrating excellent reduction of the epiphysis and an overall lower incidence of AVN when compared with in situ pinning.
    Journal of pediatric orthopedics 10/2014; 34 Suppl 1 Supplement:S18-S24. · 1.23 Impact Factor
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    ABSTRACT: A traumatic hip dislocation in the pediatric patient is a rare but potentially catastrophic injury. The purpose of this study was to review our early clinical results and radiographic morphology of hips treated with a surgical hip dislocation (SHD) approach for intra-articular hip pathology resulting from traumatic instability in pediatric and adolescent patients.
    Journal of pediatric orthopedics 09/2014; · 1.23 Impact Factor
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    ABSTRACT: Questions remain as to the effect of pedicle screws on spinal canal development in young children. The purpose of this study was to determine the effects of unilateral placement of dual screws across the neurocentral synchondrosis on spinal canal development as assessed with histological analysis and measurement of the canal dimensions in an immature pig model.
    The Journal of Bone and Joint Surgery 09/2014; 96(17):e146. · 4.31 Impact Factor
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    ABSTRACT: Study Design Retrospective review of multicenter data set with adolescent idiopathic scoliosis (AIS) patients with at least 2 years of follow-up after posterior spinal instrumentation and fusion (PSIF). Objectives The purpose of this study is to investigate risk factors for coronal decompensation 2 years after PSIF for AIS. Summary of Background Data Coronal decompensation is a potential complication of spinal instrumentation for AIS. This can result in problems requiring revision surgery. Methods Demographic, clinical, and radiographic measures were reviewed on 890 identified patients. Coronal decompensation was defined as a change farther away from midline from 6 weeks postoperatively to 2 years in any one of the following radiographic parameters: change in coronal balance >2 cm; change in coronal position of the lowest instrumented vertebra (LIV) >2 cm; change in thoracic trunk shift >2 cm; or change in LIV tilt angle >10°. Patients with decompensation were compared to those without. The relationship between the LIV and lowest end vertebra (LEV) was examined as an independent variable. Results Two years postoperation, 6.4% (57/890) of patients exhibited coronal decompensation. Multivariate regression revealed that decompensated patients were twice as likely to be male, have lower preoperative Risser score, and lower percentage major curve correction. The relationship between the LIV and LEV as well as quality of life surveys were not significantly different between decompensated and nondecompensated patients at 2 years. Conclusions Two years after PSIF, 6.4% of patients with AIS exhibit radiographic coronal decompensation. Although this study did not demonstrate a significant association between the relationship of LIV and LEV and decompensation 2 years postoperation, results of this study indicate that skeletal immaturity, male gender, and less correction of the major curve may be related to higher rates of coronal decompensation.
    Spine Deformity. 09/2014; 2(5):380–385.
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    ABSTRACT: Study Design Consensus-based creation of a checklist and guideline. Objective To develop a consensus-based checklist to guide surgeon responses to intraoperative neuromonitoring (IONM) changes in patients with a stable spine and to develop a consensus-based best practice guideline for IONM practice in the United States. Summary of Background Data Studies show that checklists enhance surgical team responses to crisis situations and improve patient outcomes. Currently, no widely accepted guidelines exist for the response to IONM changes in spine deformity surgery. Methods After a literature review of risk factors and recommendations for responding to IONM changes, 4 surveys were administered to 21 experienced spine surgeons and 1 neurologist experienced in IONM. Areas of equipoise were identified and the nominal group process was used to determine items to be included in the checklist. The authors reevaluated and modified the checklist at 3 face-to-face meetings over 12 months, including a period of clinical validation using a modified Delphi process. The group was also surveyed on current IONM practices at their institutions. This information and existing IONM position statements were used to create the IONM best practice guideline. Results Consensus was reached for the creation of 5 checklist headings containing 26 items to consider in the response to IONM changes. Consensus was reached on 5 statements for inclusion in the best practice guideline; the final guideline promotes a team approach and makes recommendations aimed at decreasing variability in neuromonitoring practices. Conclusions The final products represent the consensus of a group of expert spine surgeons. The checklist includes the most important and high-yield items to consider when responding to IONM changes in patients with a stable spine, whereas the IONM guideline represents the group consensus on items that should be considered best practice among IONM teams with the appropriate resources.
    Spine Deformity. 09/2014; 2(5):333–339.
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    ABSTRACT: A comprehensive evaluation of hip radiographs in the young adult with hip pain has become increasingly complex and time consuming. The interobserver reliability of manually performed measurements of femoroacetabular impingement, including the alpha angle, has been questioned. Methods to improve the reliability of a radiographic evaluation may increase the clinical utility of these parameters.
    The American Journal of Sports Medicine 08/2014; · 4.70 Impact Factor
  • Adriana De La Rocha, Anna McClung, Daniel J. Sucato
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    ABSTRACT: Study Design Retrospective. Summary of Background Data Previous studies have reported the correlation of body mass index (BMI) with non-spine surgical outcomes; however, only a few reviewed the correlation of BMI to outcomes after spine surgery. Objectives To review the influence of preoperative BMI on the follow-up clinical and functional outcomes after posterior-only fusion (PSF) and instrumentation for adolescent idiopathic scoliosis in a larger patient cohort. Methods Retrospective review of a consecutive series of patients treated with PSF for adolescent idiopathic scoliosis from 2002 to 2009 at a single institution. There were 3 categories: underweight (UW), normal weight (NML), and overweight (OW). Percent correction of the major curve was collected at 2 years postoperatively and patient outcome scores were analyzed preoperatively and at 2 years postoperatively. Differences between groups were analyzed using analysis of variance, with p < .05. Results A total of 459 patients at an average age of 15.0 years (range, 10.0–21.3 years) treated with PSF instrumentation were included. At 2 years, all groups achieved and maintained equal percent correction with no differences between groups. Regarding preoperative Scoliosis Research Society (SRS) outcome scores, OW patients reported more pain than NML (p = .002) and UW patients (p < .001) despite less reported activity than for the NML (p = .033) and UW groups (p = .005). The total SRS score was also lower in the OW patients compared with NML (p = .009) and UW patients (p = .002). At 2 years, the OW group reported more pain than the UW (p = .031) and NML groups (p = .018), lower mental scores (p = .011) and lower SRS total scores (p = .005) than the NML group. Conclusions At follow-up, preoperative overweight adolescents reported more pain and lower mental, activity, and appearance domain scores after surgery than UW and NML patients despite equal percent curve correction. This information may help the surgeon with preoperative counseling of OW patients by stressing that their own assessment of outcome is influenced by BMI, which may help promote a healthy weight management program in this patient group.
    Spine Deformity. 05/2014; 2(3):208–213.
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    ABSTRACT: Adolescent idiopathic scoliosis (AIS) is a common rotational deformity of the spine that presents in children worldwide, yet its etiology is poorly understood. Recent genome-wide association studies (GWAS) have identified a few candidate risk loci. One locus near the chromosome 10q24.31 LBX1 gene (OMIM #604255) was originally identified by a GWAS of Japanese subjects and replicated in additional Asian populations. To extend this result, and to create larger AIS cohorts for the purpose of large-scale meta-analyses in multiple ethnicities, we formed a collaborative group called the International Consortium for Scoliosis Genetics (ICSG). Here, we report the first ICSG study, a meta-analysis of the LBX1 locus in six Asian and three non-Asian cohorts. We find significant evidence for association of this locus with AIS susceptibility in all nine cohorts. Results for seven cohorts containing both genders yielded P=1.22×10-43 for rs11190870, and P=2.94×10-48 for females in all nine cohorts. Comparing the regional haplotype structures for three populations, we refined the boundaries of association to a ∼25 kb block encompassing the LBX1 gene. The LBX1 protein, a homeobox transcription factor that is orthologous to the Drosophila ladybird late gene, is involved in proper migration of muscle precursor cells, specification of cardiac neural crest cells, and neuronal determination in developing neural tubes. Our results firmly establish the LBX1 region as the first major susceptibility locus for AIS in Asian and non-Hispanic white groups, and provide a platform for larger studies in additional ancestral groups.
    Journal of Medical Genetics 04/2014; · 5.64 Impact Factor
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    The Journal of Bone and Joint Surgery 03/2014; 96(5):e38. · 3.23 Impact Factor
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    ABSTRACT: Study Design. Retrospective review of prospectively collected data.Objective. To determine whether anchor density is associated with curve correction and patient-reported outcomes.Summary of Background Data. There is limited information as to whether anchor density affects the results of adolescent idiopathic scoliosis (AIS) surgery.Methods. 952 AIS patients met inclusion criteria (Lenke 1, 2, and 5 curves) with predominantly screw constructs (# screws/# total anchors > 75%). Anchor density was defined as # of screws, hooks, and wires per level fused, with less than 1.54 considered low density. ANCOVA analysis was undertaken to determine association of anchor density with% curve correction, SRS, and SAQ scores, controlling for flexibility, fusion length, demographics, and surgeon.Results. High compared to low anchor density was associated with increased% curve correction in Lenke 1 curves at 1-year (69% vs. 66% correction, p = 0.0022), controlling for% pre-operative curve flexibility, length of fusion, and gender (model, p<0.0001). Similar associations held at 2-year follow-up and for Lenke 2 curves. Decreased thoracic kyphosis was found with increased anchor density for Lenke 1 and 2 curve patterns. There were no associations found between anchor density and Lenke 5 curves.For Lenke 1 curve patterns at 2-years postoperatively, in the high vs. low anchor density cohorts, there were statistically higher SRS Activity (4.3 vs. 4.2, p = 0.019), Appearance (4.3 vs. 4.1, p = 0.0005), Satisfaction (4.5 vs. 4.3, p = 0.028), and Total Scores (4.3 vs. 4.2; p = 0.024). Similarly, the SAQ Appearance score at 1-year similarly was improved in the high anchor density group (high: 14.1 vs. low: 15.0, p = 0.03) for Lenke 1 curve patterns only.Conclusion. For Lenke 1 and 2 curve patterns, improved% correction of major coronal curve was noted in the high screw density cohort. Although statistical significance was reached, it is unclear if screw density resulted in clinically significant differences in patient-reported outcomes.
    Spine 01/2014; · 2.45 Impact Factor
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    The Journal of Bone and Joint Surgery 12/2013; 95(23):e1851-8. · 3.23 Impact Factor
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    ABSTRACT: There are no guidelines for when surgeons should allow patients to return to sports and athletic activities after spinal fusion for adolescent idiopathic scoliosis (AIS). Current recommendations are based on anecdotal reports and a survey performed more than a decade ago in the era of first/second-generation posterior implants. To identify current recommendations for return to sports and athletic activities after surgery for AIS. Questionnaire-based survey. Adolescent idiopathic scoliosis after corrective surgery. Type and time to return to sports. A survey was administered to members of the Spinal Deformity Study Group. The survey consisted of surgeon demographic information, six clinical case scenarios, three different construct types (hooks, pedicle screws, hybrid), and questions regarding the influence of lowest instrumented vertebra (LIV) and postoperative physical therapy. Twenty-three surgeons completed the survey, and respondents were all experienced expert deformity surgeons. Pedicle screw instrumentation allows earlier return to noncontact and contact sports, with most patients allowed to return to running by 3 months, both noncontact and contact sports by 6 months, and collision sports by 12 months postoperatively. For all construct types, approximately 20% never allow return to collision sports, whereas all surgeons allow eventual return to contact and noncontact sports regardless of construct type. In addition to construct type, we found progressively distal LIV resulted in more surgeons never allowing return to collision sports, with 12% for selective thoracic fusion to T12/L1 versus 33% for posterior spinal fusion to L4. Most respondents also did not recommend formal postoperative physical therapy (78%). Of all surgeons surveyed, there was only one reported instrumentation failure/pullout without neurologic deficit after a patient went snowboarding 2 weeks postoperatively. Modern posterior instrumentation allows surgeons to recommend earlier return to sports after fusion for AIS, with the majority allowing running by 3 months, noncontact and contact sports by 6 months, and collision sports by 12 months.
    The spine journal: official journal of the North American Spine Society 10/2013; · 2.90 Impact Factor
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    ABSTRACT: Study Design Longitudinal cohort. Objectives To determine the responsiveness of the Spinal Appearance Questionnaire (SAQ) in patients with adolescent idiopathic scoliosis (AIS) undergoing surgical correction of the deformity. Summary of Background Data The SAQ has been found to be a valid and reliable measure in patients with AIS. A recently published factor analysis and scoring system has been shown to be applicable to all Lenke types and had greater correlation to the curve magnitude than the Scoliosis Research Society (SRS) Appearance and Total score. Methods From a prospective multicenter database, 126 AIS patients who underwent correction of the spinal deformity with complete SAQ and SRS-22 Revised data at baseline and 2-year follow-up were identified. Discriminative properties of the SAQ domains (Expectations, Appearance, and Total) and SRS domains (Appearance, Activity, Pain, Mental, Satisfaction, and Total) were compared by computing the effect size (ES) and the standardized response mean (SRM). Results The SAQ Total had the largest ES (1.8) and SRM (1.5). This was followed by the SAQ Appearance, with an ES of 1.7 and SRM of 1.4; and the SAQ Expectations, with an ES of 1.5 and SRM of 1.2. Among the different SRS domains, only the Appearance (ES = 1.2, SRM = 1.1), Satisfaction (ES = 0.8, SRM = 0.6), and Total scores (ES = 0.8, SRM = 0.9) had effect sizes that were considered large. The SRS Mental domain had a moderate effect size (ES = 0.3, SRM = 0.3), whereas the Activity (ES = 0.0, SRM = 0.0) and Pain (ES = 0.2, SRM = 0.2) domains had small effect sizes. Conclusions The SAQ is sensitive and responsive to change, as evidenced by the large effect size for both domain and the Total score. The effect sizes are larger than those for any of the SRS domains, including Appearance and Total scores.
    Spine Deformity. 09/2013; 1(5):328–338.
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    ABSTRACT: Introduction: Charcot-Marie-Tooth disease (CMTD) is one of the most common inherited neurologic disorders and can be associated with hip dysplasia. Little is known regarding outcomes of the PAO for patients with CMTD. Our purpose is to document the early results and complications of the PAO for hip dysplasia associated with CMTD. Methods: A two centre, retrospective clinical and radiographic review was performed. Demographic and surgical data were recorded. Pre- and postoperative lateral centre edge angle (LCEA), acetabular index (AI), ventral centre edge angle (VCEA), and Tönnis osteoarthritis grade were compared. Hips were classified according to Severin. The Harris Hip Score (HHS) and the Western Ontario and McMasters University (WOMAC) index documented self-reported function. Results: Nineteen hips in 14 patients underwent PAO, mean age 16.2 (range 11.2-21 years). Thirteen concomitant procedures were performed, including seven proximal femoral osteotomies. Average follow-up was 3.4 years (range 0.9-8.5). Postoperative radiographic measurements significantly improved. Complications included femoral head AVN ( 1 ), transient complete bilateral peroneal nerve palsy ( 1 ), inferior rami fractures ( 4 ), and heterotopic ossification (Brooker stage 3) ( 1 ). The HHS significantly improved from a mean 49.6 preoperatively to 82.2 at final follow-up of four patients. Seven subjects reported a mean postoperative WOMAC score of 94 (range 58.3-100). Conclusions: Most patients presented with severe dysplasia in the second decade of life. The PAO successfully corrected the radiographic abnormalities. Complications were common. The majority of patients reported improved outcomes, although seven showed signs of radiographic progression of osteoarthritis.
    Hip international: the journal of clinical and experimental research on hip pathology and therapy 08/2013; 23(Suppl 9). · 0.34 Impact Factor
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    ABSTRACT: Study Design. Genetic engineering techniques were used to develop an animal model of juvenile scoliosis during a postnatal skeletal-growth stage.Objective. To investigate the effect of targeted SHP2 (Src homology-2)-deficiency in chondrocytes on the development of scoliosis during a juvenile growth stage in mice.Summary of Background Data. Juvenile idiopathic scoliosis can lead to progressive severe spinal deformity. The pathophysiology and molecular mechanisms responsible for this are largely unknown. Here, we investigated the role of SHP2-deficiency in chondrocytes as a potential cause of juvenile scoliosis development.Methods. Genetically engineered mice with inducible deletion of SHP2 in chondrocytes were generated. The SHP2 function in chondrocytes was inactivated during a juvenile growth stage from the mouse age of 4-weeks. Radiographic, micro-CT, and histological assessments were used to analyze spinal changes.Results. When SHP2-deficiency was induced during the juvenile stage, a progressive kyphoscoliotic deformity (thoracic lordosis and thoracolumbar kyphoscoliosis) developed within 2 weeks of the initiation of SHP2-deficiency. The 3-dimensional micro-CT analysis confirmed the kyphoscoliotic deformity with a rotational deformity of the spine and osteophyte formation. The histological analysis revealed disorganization of the vertebral growth plate cartilage. Interestingly, when SHP2 was disrupted during the adolescent to adult stages, no spinal deformity developed.Conclusion. SHP2 plays an important role in normal spine development during skeletal maturation. Chondrocyte-specific deletion of SHP2 at a juvenile stage produced a kyphoscoliotic deformity. This new mouse model will be useful for future investigations of the role of SHP2-deficiency in chondrocytes as a mechanism leading to the development of juvenile scoliosis.
    Spine 07/2013; · 2.45 Impact Factor
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    ABSTRACT: Chondrodysplasia punctata (CDP) is a common manifestation of an etiologically heterogenous group of disorders. There is very little data regarding the development and management of spinal deformity in patients with CDP. The purpose of this study was to present a multicenter series of CDP, to describe the surgical outcomes of spinal deformities in CDP patients and to emphasize important considerations that may influence choice of surgical treatment of spinal deformity in this patient population. The medical records and spinal radiographs of patients with the diagnosis of CDP followed in 2 centers between 1975 and 2011 were retrospectively reviewed. Epiphyseal stippling was present on radiographs in all patients who fulfilled the clinical criteria. Among the 17 patients who were diagnosed with CDP, 13 had spinal deformities. The mean age at diagnosis of spinal deformity was 14.6 months (range, 1 wk to 9 y). Males and females were close to equally represented (10 males and 7 females). Twelve patients (92%) required surgery to correct spinal deformity. Patients were followed for a median of 8.4 years (range, 2.8 to 19.5 y). The total number of surgical procedures performed was 17 averaging 1.5 per patient. Four patients required >1 procedure. Eighty percent of the patients who required >1 surgical procedure were females with probable diagnosis of X-linked dominant CDP. Revision surgery was indicated in 50% of the patients treated with combined anterior and posterior fusion and 20% of the patients treated with posterior fusion alone. Spinal deformity in CPD patients may range from significant kyphoscoliosis to minimal deformity that does not require any treatment. For those patients in whom spine surgery was indicated, a high incidence of revision surgery and curve progression after fusion was recorded. Female patients with probable diagnosis of X-linked dominant CDP were more likely to require a second surgical procedure. Isolated posterior fusion showed less favorable results compared with combined anteroposterior fusion in terms of revision surgery. Level IV-therapeutic study.
    Journal of pediatric orthopedics 07/2013; · 1.23 Impact Factor
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    ABSTRACT: Background: Symptomatic femoroacetabular impingement (FAI) is associated with hip pain, functional limitations, and secondary osteoarthritis. There is limited information from large patient cohorts defining the specific population affected by FAI. Establishing a large cohort will facilitate the identification of ‘‘at-risk’’ patients and will provide a population for ongoing clinical research initiatives. The authors have therefore established a multicenter, prospective, longitudinal cohort of patients undergoing surgery for symptomatic FAI. Purpose: To report the clinical epidemiology, disease characteristics, and contemporary surgical treatment trends in North America for patients with symptomatic FAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Upon approval of the institutional review boards at 8 institutions, 12 surgeons enrolled consecutive patients undergoing surgical intervention for symptomatic FAI. Patient demographics, physical examination data, radiographic data, diagnoses, operative data, and standardized patient-reported outcome measures were collected. The first 1130 cases are summarized in this study. Results: A total of 1076 consecutive patients (1130 hips) were enrolled; 55% (n = 622) were female, and 45% (n = 508) were male, with an average age of 28.4 years and average body mass index (BMI) of 25.1. Demographics revealed that 88% of patients who were predominantly treated for FAI were white, 19% reported a family history of hip surgery, 47.6% of hips had a diagnosis of cam FAI, 44.5% had combined cam/pincer FAI, and 7.9% had pincer FAI. Preoperative clinical scores (pain, function, activity level, and overall health) indicated a major dysfunction related to the hip. Surgical interventions were arthroscopic surgery (50.4%), surgical dislocation (34.4%), reverse periacetabular osteotomy (9.4%), limited open osteochondroplasty with arthroscopic surgery (5.8%), and limited open by itself (1.5%). More than 90% of the hips were noted to have labral and articular cartilage abnormalities at surgery; femoral head-neck osteochondroplasty was performed in 91.6% of the surgical procedures, acetabular rim osteoplasty in 36.7%, labral repair in 47.8%, labral debridement in 16.3%, and acetabular chondroplasty in 40.1%. Conclusion: This multicenter, prospective, longitudinal cohort is one of the largest FAI cohorts to date. In this cohort, FAI occurred predominantly in young, white patients with a normal BMI, and there were more female than male patients. The disease pattern of cam FAI was most common. Contemporary treatment was predominantly arthroscopic followed by surgical hip dislocation. Keywords: FAI; hip arthroscopic surgery; surgical hip dislocation; epidemiology
    The American journal of sports medicine 05/2013; · 3.61 Impact Factor
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    ABSTRACT: Study Design. Multicenter retrospective analysis of prospectively collected data.Objective. Evaluate radiographic and clinical characteristics of patients undergoing an STF for Lenke 1C curves.Summary of Background Data. Selective thoracic fusion (STF) of adolescent idiopathic scoliosis (AIS) has been advocated for the so-called "false double major" curve (Lenke 1C/King Type II). Despite these recommendations, many surgeons continue to perform non-selective fusions (NSF) for this curve type. It is unknown to what extent other factors influence the surgeon's fusion level selection.Methods. A prospective multicenter database included 264 patients with surgically treated Lenke 1C curves and were divided into two groups. The STF group included patients with the lowest instrumented vertebra (LIV) at or cephalad to L1, while the NSF group included patients with the LIV at or caudal to L3. Preoperative radiographic, clinical (scoliometer), Scoliosis Appearance Questionnaire (SAQ), and Scoliosis Research Society (SRS) questionnaires were analyzed and compared.Results. Only 138/264 patients (49%) underwent an STF. Gender ratio (90% vs. 86% female), average age (14.7 vs. 14.8 years), and preoperative main thoracic (MT) Cobb angles (56.0°±9.9 vs. 55.3°±11.4) were not significantly different (STF vs. NSF). However, the average thoracolumbar/lumbar (TL/L) preoperative Cobb angle was significantly smaller in the STF group (42.1°±8.6 vs. 47.0°±9.0; p<0.001) while the MT:TL/L Cobb ratio (1.35±0.20 vs. 1.18±0.15; p<0.001), apical vertebral translation and rotation (1.82±0.59 vs. 1.31±0.53; p<0.001), (1.16 vs. 0.98; p<0.001) were significantly greater in the STF group. Preoperative coronal balance, sagittal Cobb angles (including T10-L2 kyphosis) and Risser Grade were not significantly different. Preoperative TL/L scoliometer measures were significantly less in the STF group (8.1°±3.7 vs. 10.3°±5.4; p = 0.001). On the SAQ, the STF group had less desire for an appearance change.Conclusion. Despite the recommendation to fuse only the structural thoracic curve in a 1C curve, only 49% of patients were treated with an STF. An STF resulted in smaller TL/L Cobb angles, less TL/L clinical deformity, larger MT:TL/L ratios, and less desire for an appearance change.
    Spine 04/2013; · 2.45 Impact Factor
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    ABSTRACT: Study DesignRetrospective.Summary of Background DataThere is continued controversy regarding the morbidity associated with harvesting iliac crest bone graft (ICBG). More important, its effect on clinical outcomes is poorly understood.Objectives The purpose of this study was to determine whether harvesting ICBG affects clinical outcomes after posterior instrumented fusion in patients with adolescent idiopathic scoliosis (AIS).Methods We identified patients enrolled in a prospective, multicenter database of patients with AIS who had posterior instrumented fusion with complete preoperative and 2-year postoperative Scoliosis Research Society (SRS)-22R data. Patients who had a previous fusion, thoracoplasty, or anterior surgery were excluded. We classified patients into 2 groups: those who underwent ICBG harvest (ICBG group) and those who did not (non-ICBG group).ResultsWe included 342 patients in the ICBG group versus 563 in the non-ICBG group. There were no significant differences in preoperative age (14.9 vs. 14.8; p = .178), major Cobb angle (51.3 vs. 51.8; p = .782), minor Cobb angle (34.8 vs. 35.1; p = .846), or Pain (4.11 vs. 4.11; p = .912), Appearance (3.29 vs. 3.33; p = .384), Activity (4.15 vs. 4.14; p = .847); Mental (3.95 vs. 4.00; p = .313), or Total (3.86 vs. 3.87; p = .603) SRS-22R scores. The average operative time was slightly longer in the ICBG group (293.55 vs. 276.21 minutes; p = .002). Estimated blood loss was greater in the ICBG group (939.47 vs. 723.63 mL; p = .000; 12.2% vs. 9.2% estimated blood volume; p = .000). The average number of levels fused was similar between groups (10.6 vs. 10.3; p = .137). There were no significant differences in any of the postoperative SRS-22R domains: Pain (4.30 vs. 4.34; p = .373), Appearance (4.23 vs. 4.19; p = .310), Activity (4.31 vs. 4.33; p = .509), Mental (4.20 vs. 4.23; p = .532), Satisfaction (4.42 vs. 4.43; p = .870), or Total Score (4.27 vs. 4.29; p = .674). By 2-year follow-up, there was 1 nonunion reported in the ICBG group and none in the non-ICBG group.Conclusions After posterior instrumented fusion surgery for AIS, ICBG harvesting was associated with longer operative times and increased blood loss, but did not influence 2-year outcomes, which included pain and appearance scores.
    Spine Deformity. 03/2013; 1(2):144–147.

Publication Stats

776 Citations
229.27 Total Impact Points


  • 2002–2014
    • Texas Scottish Rite Hospital for Children
      Texas City, Texas, United States
  • 2013
    • Loyola University Medical Center
      Maywood, Illinois, United States
  • 2012
    • Miami Children's Hospital
      Miami, Florida, United States
  • 2011
    • Norton Healthcare
      Louisville, Kentucky, United States
    • Mayo Foundation for Medical Education and Research
      • Department of Orthopaedic Surgery
      Scottsdale, AZ, United States
  • 2003–2011
    • University of Texas Southwestern Medical Center
      • Department of Orthopaedic Surgery
      Dallas, TX, United States
  • 2010
    • University of California, San Francisco
      • Department of Orthopaedic Surgery
      San Francisco, CA, United States
  • 2003–2009
    • Shriners Hospitals for Children
      Tampa, Florida, United States
  • 2007
    • University of Kentucky
      Lexington, Kentucky, United States
  • 2006
    • Boston Children's Hospital
      • Department of Orthopaedic Surgery
      Boston, MA, United States