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  • 1
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    Online Resource
    To tether or fuse? Significant equipoise remains in treatment recommendations for idiopathic scoliosis
    Springer Science and Business Media LLC ; 2022
    In:  Spine Deformity Vol. 10, No. 4 ( 2022-07), p. 763-773
    Details
    In: Spine Deformity, Springer Science and Business Media LLC, Vol. 10, No. 4 ( 2022-07), p. 763-773
    Type of Medium: Online Resource
    ISSN: 2212-134X , 2212-1358
    URL: Article
    DOI: 10.1007/s43390-022-00497-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 2
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    Image Distortion in Biplanar Slot Scanning: Patient-specific Factors
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Pediatric Orthopaedics Vol. 40, No. 9 ( 2020-10), p. 468-473
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 9 ( 2020-10), p. 468-473
    Abstract: Error within imaging measurements can be due to processing, magnification, measurement performance, or patient-specific factors. Previous length measurement studies based on radiographs have shown good intraclass correlation coefficients (ICCs) on single images; but have not assessed interimage distortion. In our study, “image distortion in biplanar slot scanning: technology-specific factors” we determined that there is minimal image distortion due to the image acquisition when using biplanar slot scanning. In this study, we aim to determine the role of patient-specific factors in image distortion, specifically evaluating interimage distortion. Methods: Digital radiographs and biplanar slot scanner images were reviewed in 43 magnetically controlled growing rod (MCGR) patients. Fifty-five postoperative anteroposterior digital radiographs, 184 follow-up biplanar slot-scanner scanner posteroanterior and 76 biplanar slot-scanner scanner laterals were measured by 2 residents and 1 attending. The manufacturer reported average actuator diameter of 9.02 mm was used as our reference width. Results: Overall, within image interobserver ICC were moderate to excellent (0.635 to 0.983), but the interimage ICCs were poor (0.332). Digital radiographs consistently overestimated the MCGR actuator width (mean=9.655) and biplanar slot-scanner scanner images underestimated it (mean=8.935). The measurement range was large with biplanar slot-scanner scanner posteroanterior (up to 15%) and lateral (22%) measurements and with digital radiographs (39%). Patients with abnormal muscle tone had higher degrees of measurement variability. Conclusions: We found that neither biplanar slot scanning nor digital radiography was precise or accurate. Digital radiographs consistently overestimated MCGR actuator width and biplanar slot scanning underestimated it. The poor ICC’s within and between image subtypes and large standard error of measurement reflected a magnitude of distortion that needs to be accounted for when using length measurements clinically. Unlike the clinically insignificant error that we noted in our previous study “image distortion in biplanar slot scanning: technology-specific factors” (0.5% to 1.5% of the measurement), the error noted in this study (0.2% to 38.5% of the measurement) has the potential to be clinically significant. Patients who have abnormal muscle tone had larger measurement errors, likely stemming from motion during the slot scanning process. Level of Evidence: Level III.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000001547
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 3
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    How to Optimize Pedicle Screw Parameters for the Thoracic Spine? A Biomechanical and Finite Element Method Study
    SAGE Publications ; 2022
    In:  Global Spine Journal
    Details
    In: Global Spine Journal, SAGE Publications
    Abstract: Pedicle screw study. Objective The selection of pedicle screw parameters usually involves the surgeon’s analysis of preoperative CT imaging along with anatomical landmarks and tactile examination. However, there is minimal consensus on a standardized guideline for selection methods on pedicle screws. We aimed to determine the effects of thoracic screw diameter to pedicle width on pullout strength determined by cortical bone purchase. Methods Biomechanical study performed with human cadaveric thoracic vertebrae and experimentally validated three-dimensional finite element model instrumented with pedicle screws of various diameters. We used a variable (SD/PW) ratio to express the screw selection. We hypothesized a positive correlation between the pullout load determined by the bone purchase and the SD/PW. This relationship was first investigated in a validated finite element model considering bone purchase related to the strength of an upper thoracic vertebra. Then, the correlation to the entire spine is evaluated. Results The failure load ranged from 371.3 to 1601.0 N, respectively, for 3 and 6 mm screws. The determinant coefficient was increased to R2=.421 when a linear relationship between pullout load and the SD/PW ratio was used. The peak loads of 1216 and 1288N were found for an SD/PW ratio of .83. Conclusion We have found that the screw pullout load is more correlated to SD/PW than other pedicle measures for a maximized SD/PW ratio of .83. This particular value should be considered the upper limit of the indicated SD/PW ratio and a means to determine the optimal screw diameter to enhance pullout strength.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/21925682221099470
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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  • 4
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    The Association Between the Utilization of Traction and Postoperative Complications Following Growing Rod Instrumentation for Early-onset Scoliosis
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Pediatric Orthopaedics Vol. 40, No. 9 ( 2020-10), p. e798-e804
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 9 ( 2020-10), p. e798-e804
    Abstract: Preoperative and/or intraoperative traction have been proposed as adjunctive methods to limit complications associated with growth-friendly instrumentation for early-onset scoliosis (EOS). By gradually correcting the deformity before instrumentation, traction can, theoretically, allow for better overall correction without the complications associated with the immediate intraoperative correction. The purpose of this multicenter study was to investigate the association between preoperative/intraoperative traction and complications following growth-friendly instrumentation for EOS. Methods: Patients with EOS who underwent growth rod instrumentation before 2017 were identified from 2 registries. Patients were divided into 2 groups: preoperative traction group versus no preoperative traction group. A subgroup analysis was done to compare intraoperative traction only versus no traction. Data was collected on any postoperative complication from implantation to up to 2 years postimplantation. Results: Of 381 patients identified, 57 (15%) and 69 (18%) patients received preoperative and intraoperative traction, respectively. After adjusting for etiology and degree of kyphosis, there was no evidence to suggest that preoperative halo traction reduced the risk of any complication following surgical intervention. Although not statistically significant, a subgroup analysis of patients with severe curves demonstrated a trend toward a markedly reduced hardware failure rate in patients undergoing preoperative halo traction [preoperative traction: 1 (3.1%) vs. no preoperative traction: 11 (14.7%), P =0.083]. Nonidiopathic, hyperkyphotic patients treated with intraoperative traction were 61% less likely to experience any postoperative complication ( P =0.067) and were 74% ( P =0.091) less likely to experience an unplanned return to the operating room when compared with patients treated without traction. Conclusions: This multicenter study with a large sample size provides the best evidence to date of the association between the use of traction and postoperative complications. Our results justify the need for future Level I studies aimed at characterizing the complete benefit and risk profile for the use of traction in surgical intervention for EOS. Level of Evidence: Level III.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000001628
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 5
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    Definition of Tweener: Consensus Among Experts in Treating Early-onset Scoliosis
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of Pediatric Orthopaedics Vol. 43, No. 3 ( 2023-03), p. e215-e222
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 3 ( 2023-03), p. e215-e222
    Abstract: The term “Tweener” is colloquially used to refer to early-onset scoliosis (EOS) patients whose age and development make them candidates for multiple surgical options. The purpose of this study was to establish expert consensus on a definition to formally characterize the Tweener population. Methods: A 3-round survey of surgeons in an international EOS study group was conducted. Surgeons were provided with various patient characteristics and asked if each was part of their definition for Tweener patients. Responses were analyzed for consensus (≥70%), near-consensus (60% to 69%), and no consensus ( 〈 60%). Results: Consensus was reached (89% of respondents) for including chronological age in the Tweener definition; 8 to 10 years for females and 9 to 11 years for males. Surgeons agreed for inclusion of Sanders score, particularly Sanders 2 (86.0%). Patients who have reached Sanders 4, postmenarche, or have closed triradiate cartilage should not be considered Tweeners. Bone age range of 8 years and 10 months to 10 years and 10 months for females (12 y for males) could be part of the Tweener definition. Conclusions: This study suggests that the Tweener definition could be the following: patients with open triradiate cartilage who are not postmenarche and have not reached Sanders 4, and if they have one of the following: Sanders 2 or chronological age 8 to 10 years for females (9 to 11 y for males) or bone age 8 years and 10 months to 10 years and 10 months for females (12 y for males). This definition will allow for more focused and comparative research on this population. Level of Evidence: Level V—expert opinion.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000002321
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 6
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    Juvenile Dermatomyositis : A Case of Calcinosis Cutis of the Elbow and Review of the Literature
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Journal of Pediatric Orthopaedics Vol. 35, No. 5 ( 2015-07), p. e43-e46
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 5 ( 2015-07), p. e43-e46
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000000358
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 7
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    Correction of Angular Deformities Due to Focal Fibrocartilaginous Dysplasia Using Guided Growth: A Preliminary Report
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Journal of Pediatric Orthopaedics Vol. 37, No. 3 ( 2017-04), p. e183-e187
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 37, No. 3 ( 2017-04), p. e183-e187
    Abstract: Focal fibrocartilaginous dysplasia (FFCD) is a rare benign disorder that may result in tethering of the physis. These most commonly occur around the knee and may result in angular deformities of the involved extremity. To date treatment has ranged from observation, to curettage, to osteotomy. Our goal with this study is to evaluate the efficacy of guided growth in treating patients with angular deformity due to FFCD. Methods: This is a retrospective review, we included 3 patients with angular deformities due to FFCD who had undergone 8 plate placement. We reviewed their preoperative and postoperative radiographs, assessed their sagittal and coronal balance and number of procedures. Results: Three patients with FFCD of the femur with an average of 14 months underwent guided growth to correct their angular deformity. Once appropriate correction was achieved the hardware was removed. At final follow-up none of the patients required further surgical intervention for their angular deformity nor had they shown any evidence of recurrence. Conclusions: FFCD is a rare benign disorder, they most commonly affects the proximal tibia and distal femur and can result in significant angular deformities. Our review of the literature found all of the cases involving the femur progressed to the point where they needed surgical intervention. This ranged from curettage to osteotomy. In this case series we present 3 cases of FFCD of the distal femur that were treated minimally invasively with guided growth. Level of Evidence: Level 4.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000000785
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 8
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    Use of Magnetic Spinal Growth Rods (MCGR) With and Without Preoperative Halo-gravity Traction (HGT) for the Treatment of Severe Early-onset Scoliosis (EOS)
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of Pediatric Orthopaedics Vol. 39, No. 4 ( 2019-04), p. e293-e297
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 4 ( 2019-04), p. e293-e297
    Abstract: Correction of severe scoliosis through distraction-based techniques poses a challenge. Magnetically controlled growing rod (MCGR) hardware complications are common with a 27.8% to 46.7% revision rate in under 2 years. Loss of correction and diminishing returns are the norm. Treatment of severe scoliosis with halo-gravity traction (HGT) before MCGR has not been previously reported. The purpose of this study was to assess initial correction, maintenance of correction, and complication rate in patients with severe scoliosis treated with and without HGT before MCGR. Methods: IRB-approved retrospective single site cohort study of a prospectively collected database. Forty-two patients underwent MCGR between 2014 and 2017 at a single site, 12 with prior growing constructs were excluded, 30 patients were included, 12 patients underwent preoperative HGT. Charts were reviewed for demographic, clinical, and radiographic information. Results: The HGT group had larger major curves averaging 90 (69 to 114) degrees versus 77 (56 to 113) degrees in the non-HGT group P =0.018. Percent correction on preoperative flexibility films were 17% versus 40% for those in the HGT versus non-HGT group, P =0.000. An additional 22% correction of the curve magnitude occurred between the flexibility and in-traction films representing 43% of the total correction achieved, P =0.000, was achieved. EBL, and postoperative major curve and major curve correction were not significant. Thirteen percent of patients experienced complications. Average follow-up was 712 versus 561 days in the HGT versus non-HGT groups. Conclusions: Large, rigid curves can achieve equivalent correction to flexible curves with HGT. Forty-three percent of the total correction achieved occurred during traction. Thirty percent of the total correction occurred at implantation of the MCGR in the HGT group versus 28% in the non-HGT group. At most recent follow-up HGT patients had statistically maintained their major curve correction better than non-HGT patients. Level of Evidence: Level III—therapeutic study.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000001282
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 9
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    Image Distortion in Biplanar Slot Scanning: Part 2 Technology-specific Factors
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Pediatric Orthopaedics Vol. 40, No. 10 ( 2020-11), p. 587-591
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 10 ( 2020-11), p. 587-591
    Abstract: Biplanar digital slot scanning technology has become the standard of care in the treatment of scoliosis. Yet, the amount of distortion and reproducibility of this type of imaging modality has yet to be fully investigated. In our paper “Image distortion in biplanar slot scanning: part 1 patient-specific factors” we found that there was potentially clinically impactful interimage distortion. The purpose of this study was to evaluate the degree to which this image distortion was secondary to the image acquisition process. Methods: Four 25 mm radio-opaque markers were placed at C3, T1, T12, and L5 on a full-length skeleton model. The skeleton was imaged in 10 different positions within the scanner. Five posteroanterior and 5 lateral images were obtained in each position. Two orthopaedic attending physicians and 3 orthopaedic resident physicians measured the markers for a total of 3200 measurements. Intraclass correlation coefficients (ICCs) and 95% confidence intervals were used to examine image distortion. Results: Average marker size was 24.77, with a standard error of measurement of 0.00493. Image distortion and standard error of measurement accounted for ∼0.5% to 1.5% of total the measurement. Overall, there was good reliability and consistency when looking at markers in different views (ICC 0.790), planes, and locations within the image. Horizontal measurements were found to be more consistent and have better reliability (ICC 0.881) than vertical measurements (ICC 0.386). Position within the scanner had minimal impact on the accuracy of the measurements. Conclusions: This study demonstrates that there is minimal error due to image acquisition and measurement when using a biplanar slot scanner. Biplanar slot scanning technology tended to underestimate the size of the marker; however, the least accurate measurements only erred by 1.5% from the true length. This indicates that unlike traditional radiographs the sources of error in biplanar slot scanning images are not due to parallax and are likely due to patient-specific factors and rather than the technology itself.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000001570
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 10
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    New Single-stage Double Osteotomy for Late-presenting Infantile Tibia Vara: A Comprehensive Approach
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of Pediatric Orthopaedics Vol. 39, No. 5 ( 2019-05), p. 247-256
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 5 ( 2019-05), p. 247-256
    Abstract: Successful surgical treatment of late-presenting infantile tibia vara (ITV) patient requires the correction of oblique deformities. The purpose of this study was to report on a new comprehensive approach to correct and prevent recurrence of these deformities with a single procedure. Methods: Medical records of 23 consecutive children (7 to 18 y) with advanced ITV (29 knees) were retrospectively reviewed after a mean of 7.3 years postoperatively (range, 2 to 22 y). Indications for the corrective surgery were any child 7 year or older with a varus mechanical axis angle ≥10 degrees or a varus anatomic axis angle ≥11 degrees and a medial tibial angle (MTA) slope 〈 60 degrees. The deformities were corrected with a dome-shaped osteotomy proximal to the tibial tubercle with a midline vertical extension to the subchondral region of the joint and a lateral hemi-epiphysiodesis. Results: At latest follow-up, means and medians of each tibial radiographic axis measurement improved significantly from preoperative values ( P 〈 0.001): mechanical axis angle from 23 degrees to 4 degrees varus, anatomic axis angle from 25 degrees varus to 1 degree valgus, MTA downward slope from 30 to 78 degrees, posterior MTA from 59 to 80 degrees. In total, 79% and 74% had good to excellent results based on radiographic criteria and clinical questionnaire for satisfaction, pain and function, respectively. Two abnormal medial tibial plateau types were described. Conclusions: This is the first study to use a single-stage double osteotomy performed proximal to the tibial tubercle for the late-presenting ITV for children 7 years of age or older. In addition to the effective correction of the 4 major tibial deformities, a lateral proximal tibial hemi-epiphysiodesis minimizes recurrence of tibia vara. A contralateral proximal tibial epiphysiodesis is recommended for treated skeletally immature patients with unilateral disease. Level of Evidence: Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000000926
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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