Spine Research

Setting Scoliosis Straight Surgeon Performance Program

The Stanford Pediatric Spine group is participating in the Setting Scoliosis Straight Surgeon Performance Program, a quality improvement registry for surgical treatment of Adolescent Idiopathic Scoliosis (AIS). The program aims to empower surgeons to improve treatment processes and patient outcomes by compiling long term data on patients undergoing spinal fusion for AIS. As a community of surgeons, we will identify best practices in surgical care for AIS and help ensure that patients with AIS receive the most effective treatment.

Study led by site-Investigator, Dr. Imrie

Pediatric Spine Study Group

What is the Pediatric Spine Registry?

The Pediatric Spine Registry is a prospective cohort study conducted by the Children’s Spine Foundation. This registry specifically follows children with complex spine and chest wall disorders. As these conditions are quite rare, a single institution may only have a few of these  patients at a time, and thus cannot conduct large scale research. This registry, with data from multiple centers, will provide a dataset to meaningfully address research questions regarding spine and chest wall disorders in children. The research pursued through this registry may impact clinical care for patients globally.

How are individuals selected for this study?

Patients ages 40 years and younger who are currently receiving or have received treatment for a pediatric spine or chest wall disorder are eligible to participate. The Principal Investigator at each site determines whether a patient fits the goals of the registry.  

Why is this research being conducted?

The goal of this study is to better understand the effects of chest wall and spine deformities. Hopefully, this understanding will lead to more effective treatments in the future.  

Who is conducting this research and where is it being conducted?

The Principal Investigator at Stanford Children’s Health is Dr. John Vorhies. There are also physicians at multiple other institutions.   

Has recruitment started?

Yes.

I am interested in learning more, participating in, or have questions about this study. Who can I reach out to?

Please contact research coordinator, Joanna Langner, jlangner@stanford.edu with any and all study questions. If you would like to read more about the Pediatric Study Group, please visit https://childrensspinefoundation.org/.

Pediatric Scoliosis Surgery: Enhanced Recovery with Surgically Placed Catheters

The purpose of this study is to determine if using a new technique for pain management in children with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) can improve outcomes by decreasing opioid consumption and days spent in the intensive care unit (ICU) and hospital while simultaneously increasing patient mobility as measured by activity monitors. This study compares children who are given the standard of care with those who recieve an injection of morphine into the spinal canal during surgery.

How are individuals selected for this study?

Individuals being treated by our Stanford health care team who are diagnosed with AIS and undergoing PSF are eligible for this study.

Why is this research being conducted?

PSF is the most common surgical treatment for adolescent idiopathic scoliosis, and pain has been reported as the primary concern of patients planning to undergo PSF. Currently, most spine centers utilize multimodal pain management but rely heavily on opiods in the immediate postoperative setting. Opiods can be associated with significant side effects. In contrast,the erector spinae plane block (ESPB) is a new technique that provides non-narcotic, localized pain management by administering an anesthetic medication through a peripheral nerve block. Investigators aim to improve how well pain is controlled after spinal surgeries.

Who is conducting this research and where is it being conducted?

Dr. John Vorhies, Assistant Professor in the Department of Orthopaedic Surgery at Stanford University is the principal investigator. This study is being conducted at Stanford Children’s Hospital and clinics.

Has recruitment started?

This study opened for recruitment in August 2020, with the goal of recruiting around 60 participants.

Techniques in Elongation, Derotation, Flexion Casting

Early onset scoliosis (EOS) can affect  the developing heart and lungs. For patients with EOS, physicians recommend corrective measures, such as serial elongation, derotation, and flexion casting, that allow the thoracic cavity and lungs to continue to develop. Most described casting techniques call for the use of a specialized frame or casting table, the Risser frame, which is not readily available at many institutions. At Stanford, our physicians have developed novel techniques for EOS casting by modifying the more readily available Jackson table. We are currently evaluating the outcomes of patients that received casts on the traditional Risser frame as compared to the modified Jackson. If there are no significant differences in patient outcomes, many more institutions could offer Mehta casting for their patients using this modification of a table that is already available in their hospital.

Video coming soon!

The Role of Health Mindset in Adolescents’ Compliance with Brace Wear for Adolescent Idiopathic Scoliosis 

Psychology literature has demonstrated that variations in mindset can have notable effects on attitudes, goals, and behaviors within various domains of life from academic or work settings to social and interpersonal interactions. Mindset theory describes two different categories: "fixed", in which a particular personal characteristic is seen as unchangeable, and "growth", in which the characteristic is viewed as malleable and subject to improvement. Recently, the concept of mindset has been applied to the study of health beliefs and how they influence wellness behaviors. It has been demonstrated that children with chronic medical problems, such as type 1 diabetes, who have a fixed mindset towards health are less compliant with recommended treatments, resulting in worse health outcomes.

The purpose of "The Role in Health Mindset in Adolescents' Compliance With Brace Wear for AIS" Study is to utilize a previously validated psychological assessment tool to evaluate health mindset among patients with adolescent idiopathic scoliosis undergoing treatment with a brace. Secondarily, we plan to investigate if ‘health mindset’ relates to an adolescent’s brace wear compliance.  We hypothesize that children with a fixed mindset will have decreased compliance with bracing protocols as compared to those with a growth mindset. As prior studies have demonstrated that mindset is malleable, we believe that interventions to change mindset will also change compliance with recommended treatments.

Principal Investigator: Dr. Kali Tileston

Student Support: Gaby Joseph

Please contact Ann Richey at arichey@stanford.edu for any and all study questions.

Health Mindset in Postoperative Mobilization after Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

What is the focus of this study?

Our team is researching how health mindset influences early postoperative outcomes after posterior spinal instrumentation and fusion surgery for adolescent idiopathic scoliosis.

How are individuals selected for this study?

Children 10 years or older who are diagnosed with idiopathic scoliosis, are undergoing posterior spinal instrumentation and fusion surgery, and are willing to wear an activity monitor are eligible for this study.

Why is this research being conducted?

Limited tools exist to identify patients at risk for a challenging recovery after posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS).

Understanding the way a person’s mindset may affect mobilization after PSIF will allow health care workers identify those who are at higher risk for a challenging recovery. Targeted interventions to alter a person’s mindset and improve their post-operative recovery can then be implemented in the future.

Who is conducting this research and where is it being conducted?

Dr. John Vorhies, Assistant Professor in the Department of Orthopaedic Surgery at Stanford University is the principal investigator. Dr. Kali Tileston, Assistant Professor in the Department of Orthopaedic Surgery at Stanford University is the co-principal investigator. This study is being conducted at Stanford Children’s Hospital and clinics.

Has recruitment started?

This study will be open to recruitment from October 2020 to October 2022.

Please contact Ann Richey at arichey@stanford.edu for any and all study questions.

A Novel Blood Test for Acute Septic Arthritis in Children

What is the focus of this study?

This prospective observational study is aimed at testing a new blood test, Integrated Antibiotics Decision Model (IADM), that rapidly assesses the presence of bacterial infection in patients to enhance the diagnosis methods for acute septic arthritis.

How are individuals selected for this study?

Individuals who present with suspected septic arthritis at the Stanford Hospital Pediatric Emergency Department are eligible for this study.

Why is this research being conducted?

Patients often present to the emergency department with signs and symptoms of joint inflammation, such as septic arthritis. However, it is very difficult to distinguish joint inflammation among three diagnoses: (1) non-infected inflammation, (2) bacterial illness, and (3) viral illness. The current method for diagnosing bacterial septic arthritis is surgically obtaining joint fluid and attempting to grow bacteria from the fluid, which can take several days. The problem remains that if an individual has septic arthritis, treatment needs to occur much sooner than this in order to maintain the health of the joint. Blood will be collected from patients with suspected septic arthritis and the IADM test results will be compared to the physician’s diagnosis. If this test is accurate, it would replace standard diagnostic tests for this condition, allowing patients to avoid unnecessary invasive procedures, decreasing hospital stay, and minimizing misdiagnosis.

Who is conducting this research and where is it being conducted?

Dr. John Vorhies, Assistant Professor in the Department of Orthopaedic Surgery at Stanford University is the principal investigator. This study is being conducted at Stanford Hospital Pediatric Emergency Department.

Has recruitment started?

This study is currently open to recruitment until June 2022, with the goal of recruiting 30 participants.

Using Handheld Optical Particle Sizers (OPS) to Study Aerosol Generation in Orthopaedic Procedures 

What is the focus of this study?

There is some speculation that orthopaedic procedures, specifically ones that use high-speed drills, burrs, and oscillating saws might also be high risk for generation of aerosol particles but little data exists to support this claim. In this study we use a handheld optical particle sizer (OPS) to measure the generation of aerosols during surgical steps in spinal fusion. 

Why is this research being conducted?

The World Health Organization has warned that airborne transmission of SARS‐CoV‐2 can occur during medical procedures that generate aerosols especially those involving the airway. Some common orthopaedic procedures have the potential to aerosolize blood and other body fluids but little data exists to quantify the risk this may confer upon surgeons, leaving policy makers with a lack of evidence to guide decisions related to infection control. Our goal is to identify what surgical steps may be putting the surgical staff at risk of exposure to aerosols and airborne transmission of SARS‐CoV‐2, to better inform safety policies in the operating room.  

Who is conducting this research and where is it being conducted?

Dr. John Vorhies, Assistant Professor in the Department of Orthopaedic Surgery at Stanford University is the principal investigator. This study is being conducted at Stanford Hospital.