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ABSTRACT: STRUCTURED ABSTRACT: Study Design. Retrospective chart review.Objective. To accurately determine complication rates, particularly mortality rates, in surgically treated Early Onset Scoliosis.Summary of Background Data. The advent of modern segmental instrumentation for spinal fusion surgery in adolescent scoliosis has allowed for application of similar non-segmental un-fused techniques aimed at controlling scoliosis in the very young child. The dismal prognosis for these children without repeated spinal lengthening procedures is unquestioned though no controlled trials exist. Many if not most of these children need surgery, however the surgical complication rate is very high.Methods. During the study period all surgically treated children with EOS seen at our institution were identified. Inclusion criteria were: any patient who presented to our clinic with early onset scoliosis which was surgically managed.The total number of procedures, type of implants, number and type of complications, geographic origin of the cases and final outcomes were all assessed.Results. A total of 165 surgical procedures on 28 patients accrued over the study time period, including index implantation of instrumentation, lengthening and definitive fusion as well as operations performed for complications such as wound debridement and revision of failed implants. Clinical diagnoses included congenital scoliosis, syndromic and chromosomal abnormalities, cerebral palsy and spinal muscular atrophy. There was a complication rate of 84% overall with a mortality rate of almost 18%. The only patients with no complications were those whose entire surgical course had been at our institution only. The mortality rate was equal in patients whose treatment was performed elsewhere versus exclusively in our center.Conclusion. This study underlines the grave severity of these scolioses particularly in syndromic children. The high mortality rate is alarming, suggesting that further study is needed in this area.
Spine 08/2012; · 2.08 Impact Factor
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ABSTRACT: Abnormal thoracolumbar kyphosis in infants may be due to lumbar hypoplasia that resolves with development of upright posture. The cause of this deformity has not been previously identified. The goal of this study was to find whether excessive time in an upright posture while sleeping and sitting may play a role in the etiology of infantile thoracolumbar kyphosis. We retrospectively reviewed infants with the diagnosis of kyphosis from 2001 to 2005. Inclusion criteria were patients diagnosed prior to age 3 years without syndromic, neuromuscular, or congenital kyphosis and minimum 2-year follow-up. Serial radiographic evaluation was used to assess change in kyphotic deformity. Six infants with an average age of 7 months at the time of diagnosis were identified. All had marked thoracolumbar kyphosis with vertebral wedging and scalloping. Some had pseudosubluxation at the T12-L1 level. The initial average Cobb angle was 30° (normal, 0°-5°). Careful history revealed that all patients slept in an upright posture in addition to sitting while awake. All of the patients were observed following parental instruction in proper sleeping and sitting habits. At last follow-up, all patients had normal sagittal alignment with an average Cobb angle of 1.3°. Proper sleeping and sitting habits with good spine support is recommended for infantile thoracolumbar kyphosis with lumbar hypoplasia. Allowing "tummy time" during waking hours may help the paraspinal muscles gain strength to provide support to the spine. Radiographic evidence of vertebral body height restoration may be delayed for several years.
Orthopedics 01/2010; 33(10):731. · 2.66 Impact Factor
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ABSTRACT: A retrospective review of children with neuromuscular scoliosis treated at our institution with posterior spinal fusion and instrumentation including iliac screws.
To determine the safety and effectiveness of iliac screws in neuromuscular scoliosis constructs.
The Galveston technique has been a standard method of impacting rods in the iliac wings to provide anchorage for neuromuscular scoliosis constructs. Numerous studies have shown the increased strength of constructs using screws as part of segmental spinal instrumentation. The ideal method of caudal anchorage is still unclear, and the role of iliac screws has yet to be defined.
The medical records and radiographs of 50 patients with neuromuscular scoliosis treated with a modified Luque-Galveston posterior spinal fusion and instrumentation technique were reviewed. The instrumentation was anchored to the pelvis via iliac screws: Group A constructs included 2 screws; Group B constructs included 4 screws. The radiographs were analyzed for Cobb angle and pelvic obliquity before surgery and after surgery. Complications were recorded, including infections and implant-related problems.
The average curve correction was 48%. The average pelvic tilt correction was 59%. Complications included 4 deep infections requiring reoperation (8%), 10 screw-related complications (7 in Group A, 3 in the Group B), and 12 non-screw-related implant complications (11 in the Group A, 1 in the Group B).
The use of screw fixation in the ilium as a means of spinopelvic anchorage is safe and effective in the treatment of neuromuscular scoliosis. The use of 2 screws in each iliac wing provides more stable fixation with fewer implant-related complications than using a single screw.
Spine 07/2007; 32(14):1566-70. · 2.08 Impact Factor
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ABSTRACT: We retrospectively reviewed the results of partial wound closure after surgical release of severe equinovarus deformity in forty-eight (48) feet in thirty-two (32) patients. Epigard®, a commercially manufactured synthetic skin substitute was used as a temporary coverage medium. The decision to perform synthetic skin substituted partial closure was made intraoperatively, if primary closure with the foot in the corrected position threatened circulatory compromise, or loss of correction. We did not find it necessary to deviate from our usual protocol of 6weeks of postoperative casting, with one cast change at 3weeks for hardware removal. There were no infections. No feet required grafting or other secondary procedures, including dressing changes. We conclude that synthetic skin substituted partial wound closure is a viable alternative after surgical correction of the severe equinovarus deformity. This technique avoids the inconvenience of frequent cast changes or uncovered partial wound closure, and the expense and increased surgical risk of skin grafting and rotational flap techniques.Nous avons revu rétrospectivement les résultats de la fermeture cutanée partielle après capsulotomies libératrices pour pieds bots varus équins dans 48 pieds opérés chez 32 patients. Le produit commercial «Epigard», un substitut cutané synthétique a été utilisé comme revêtement temporaire. La décision d’utiliser Epigard avait été prise en per-opératoire lorsque la fermeture cutanée classique en position corrigée du pied après libération risquait de compromettre la vascularisation ou d’entraîner une perte de correction. Nous n’avions rien changé à notre protocole de six semaines d’immobilisation plâtrée avec changement du plâtre après trois semaines permettant d’enlever les broches métalliques. Il n’y eut aucune infection. Aucun pied ne nécessita de greffe secondaire ou d’autres gestes secondaires, si ce n’est le changement des chaussures. Nous concluons que l’utilisation de ce produit cutané synthétique constitue une alternative valable après correction chirurgicale de pieds bots varus équins sévères. Cette technique permet d’éviter les inconvénients des fréquents changements de plâtres ou ceux de la fermeture cutanée incomplète, ainsi que le coût et le risque accru d’une chirurgie secondaire de recouvrement cutané par lambeaux de rotation.
European Journal of Orthopaedic Surgery & Traumatology 11/2006; 16(4):393-395. · 0.10 Impact Factor
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ABSTRACT: Anaplastic large cell lymphoma (ALCL) is predominantly a systemic disease with nodal involvement, but extranodal involvement can occur either as the primary presentation or during the disease course. Primary epiphyseal involvement is extremely rare with lymphomas. This case report illustrates an 8-year old boy who first presented with pain over the right upper extremity, which was initially treated as epiphyseal osteomyelitis. A few weeks later, he presented with abdominal pain and an abdominal wall mass, which on biopsy proved to be an anaplastic large-cell lymphoma.
Skeletal Radiology 09/2006; 35(8):619-23. · 1.54 Impact Factor
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ABSTRACT: The purpose of this long-term study was to determine the efficacy of allograft bone for spinal fusion for adolescent idiopathic scoliosis. Prior studies comparing allograft and autograft have been short term.
This multicenter retrospective study was carried out on 111 patients with 132 total curves fused for adolescent idiopathic scoliosis. Minimum follow-up was 5 years (average 72 months). A variety of segmental instrumentation was used, with most being dual-rod, multiple-hook constructs.
Average preoperative curve was 59 degrees with immediate correction to 29 degrees (51%) and final follow-up of 32.24 degrees (45.4%). Average loss of correction was 3.5 degrees (5.9%). There were three pseudarthroses, one infection, and no rod breakage.
Pseudarthrosis rate of 2.7% and loss of correction of 5.9% are comparable with or better than those in previous reports using autogenous bone graft and either segmental or nonsegmental instrumentation.
Journal of Spinal Disorders & Techniques 03/2005; 18 Suppl:S73-6. · 1.50 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the problems associated with hip dislocation in adults with cerebral palsy. Twenty-nine subjects with dislocated hips and no prior hip surgery were identified. There were a total of 38 dislocated hips. Age range was 21 to 52 years (average 34). Seven dislocated hips (18%) were definitely painful and four hips (11%) produced only mild or intermittent pain. Twenty-seven hips (71%) were not painful. The seven painful hips underwent proximal femoral resection, resulting in excellent range of motion and no pain. In conclusion, for established nonpainful hip dislocation in the severely involved spastic quadriplegic patient, aggressive surgical treatment should be undertaken only after careful consideration of the natural history. If a dislocated hip becomes painful in adulthood or develops an adduction contracture interfering with perineal care, a proximal femoral resection can be performed with reliably good success.
Journal of Pediatric Orthopaedics 22(5):668-71. · 1.16 Impact Factor
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ABSTRACT: Osteotomy to correct malunion after forearm fracture in children is an uncommon procedure. The uncommon nature of this procedure and the complex nature of forearm anatomy contribute to the difficulty of restoring proper alignment. The purpose of this paper is to report nine cases and describe a simplified method for deformity correction. This is a retrospective review of the authors' experience with recommendations for surgical technique. Average maximum deformity prior to osteotomy was 31 degrees. All patients united with satisfactory postoperative alignment. There was one superficial wound infection. Average improvement in forearm rotation was 102 degrees. Based on these satisfactory results and a review of the literature, the authors recommend correction of forearm malunion when functional range of motion does not return by 6 months after the initial injury.
Journal of Pediatric Orthopaedics 26(2):193-6. · 1.16 Impact Factor
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ABSTRACT: We are reporting three children and adolescents who presented with incongruous reduction of the hip following injury. In each case, the diagnosis was initially missed. None of the patients presented with a hip dislocation, but two gave a history consistent with transient hip subluxation or dislocation. Low-energy trauma was the cause in two cases. Treatment consisted of arthrotomy to remove interposed capsule and labrum to obtain concentric reduction. When reduction of a hip dislocation occurs spontaneously, the condition may be misjudged. Any child or adolescent who complains of hip pain following injury should have radiographs scrutinized for asymmetric widening of the hip joints. Any asymmetry should be evaluated by appropriate imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). Removal of any interposed tissue is recommended, even when the diagnosis is delayed by several months.
Journal of Orthopaedic Trauma 16(10):730-5. · 2.13 Impact Factor
