Spine Research

In the clinics and operating rooms, our Stanford pediatric spine team provides exceptional care to children with spine conditions. Furthermore,  as researchers the pediatric spine physicians continually evaluate treatment options, develop new models for care, and collaborate with both U.S. based and international institutions to improve the ways in which we, as a community of health care providers, care for spine conditions. We recognize the importance of ethically conducting and critically understanding research to ensure that our patients receive the best possible care.

Registries and Chart Reviews

Surgical Techniques Research

Health Mindset Research

Additional Research

John Schoeneman Vorhies
Stanford Medicine Children's Healthcare Director of Scoliosis & Spine Deformity Surgery & Research, Stanford (2022 - Present)

Publications

  • Distal Radius Interventions for Fracture Treatment (DRIFT) trial: study protocol for a multicentre randomised clinical trial of completely translated distal radius fractures at paediatric hospitals in North America. BMJ open Balmert Bonner, L., Janicki, J., Georgiadis, A., Truong, W., Harris Beauvais, D., Belthur, M., Daley, E. L., Franzone, J., Howard, A., May, C., Rockhold, F., Schulz, J., Bailey, M., Chiswell, K., DeLaRosa, J., Brooks, J. T., Cantanzano, A. A., Chan, A., Chu, A., Dodwell, E. R., El-Hawary, R., Ellis, H., Fitzgerald, R., Frick, S., Ganley, T. J., Gargiulo, D., Gauthier, L., Gill, C. S., Goldstein, R., Halsey, M. F., Hardesty, C., Ho, C., Kaushal, N., Lawrence, J. T., Lee, R. J., Leitch, K. K., Masrouha, K., Mitchell, S., OMalley, N., Payares-Lizano, M., Perry, D., Ramalingam, W., Rhodes, J., Sanders, J., Shah, A. S., Sharkey, M., Silva, M., Silva, S., Thompson, R., Vorhies, J., Wright, J. G., Young, C., Burgess, J., IMPACCT Consortium, Castaneda, P. G., Cruz, A. I., Shea, K., Thompson, R. 2025; 15 (10): e088273

    Abstract

    INTRODUCTION: Distal radius fractures are the most common fractures seen in the emergency department in children in the USA. However, no established or standardised guidelines exist for the optimal management of completely displaced fractures in younger children. The proposed multicentre randomised trial will compare functional outcomes between children treated with fracture reduction under sedation versus children treated with simple immobilisation.METHODS AND ANALYSIS: Participants aged 4-10 years presenting to the emergency department with 100% dorsally translated metaphyseal fractures of the radius less than 5cm from the distal radial physis will be recruited for the study. Those patients with open fractures, other ipsilateral arm fractures (excluding ulna), pathologic fractures, bone diseases, or neuromuscular or metabolic conditions will be excluded. Participants who agree to enrol in the trial will be randomly assigned via a minimal sufficient balance algorithm to either sedated reduction or in situ immobilisation. A sample size of 167 participants per arm will provide at least 90% power to detect a difference in the primary outcome of Patient-Reported Outcomes Measurement Information System Upper Extremity computer adaptive test scores of 4 points at 1 year from treatment. Primary analyses will employ a linear mixed model to estimate the treatment effect at 1 year. Secondary outcomes include additional measures of perceived pain, complications, radiographic angulation, satisfaction and additional procedures (revisions, refractures, reductions and reoperations).ETHICS AND DISSEMINATION: Ethical approval was obtained from the following local Institutional Review Boards: Advarra, serving as the single Institutional Review Board, approved the study (Pro00062090) in April 2022. The Hospital for Sick Children (Toronto, ON, Canada) did not rely on Advarra and received separate approval from their local Research Ethics Board (REB; REB number: 1000079992) on 19 July 2023. Results will be disseminated through publication in peer-reviewed journals and presentations at international conference meetings.TRIAL REGISTRATION NUMBER: NCT05131685.

    View details for DOI 10.1136/bmjopen-2024-088273

    View details for PubMedID 41161832

  • Spinal Fusion in Patients with GMFCS IV or V Cerebral Palsy: Durable Correction and Lasting Quality of Life Improvements: Five-Year Multicenter Outcomes. The Journal of bone and joint surgery. American volume Hariharan, A. R., Brown, M. W., Bryan, T., Louer, C. R., Vorhies, J. S., Cho, R. H., Sponseller, P., Parent, S., Shah, S. A., Cahill, P., Pahys, J. M., Upasani, V. V., Lonner, B. S., Newton, P. O., Samdani, A. F., Miyanji, F., Harms Study Group, Hariharan, A. R., Brown, M. W., Bryan, T., Louer, C. R., Vorhies, J. S., Cho, R. H., Sponseller, P., Parent, S., Shah, S. A., Cahill, P., Pahys, J. M., Upasani, V. V., Lonner, B. S., Newton, P. O., Samdani, A. F., Miyanji, F. 2025

    Abstract

    BACKGROUND: Understanding outcomes of spinal fusion (SF) in children with cerebral palsy (CP) beyond the short term is important to determine efficacy and durability. This study examined complications, unplanned returns to the operating room (UPROR), and radiographic and clinical outcomes after SF in children with CP.METHODS: Patients with GMFCS IV or V CP who had been followed for a minimum of 5 years after SF were identified in a prospective multicenter database and analyzed. The major Cobb angle and pelvic obliquity (PO) were recorded. Data regarding complications and any UPROR were collected prospectively. The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire was completed preoperatively and at 2 and 5 years postoperatively. Data were analyzed using a generalized estimating equation (GEE), repeated-measures analysis of variance (RM-ANOVA), and the Kaplan-Meier method.RESULTS: One hundred and eighty-nine patients (mean age, 13.4 ± 2.7 years; 94 male and 95 female; 45% White, 24% Hispanic, 16% Black, and 4% Asian as self-reported) were included in the study. The preoperative Cobb angle (82.8° ± 23.0°) was improved at 2 years (29.9° ± 16.2°; p < 0.001), and the improvement was maintained at 5 years (30.2° ± 17.0°; p = 0.284). The preoperative PO (27.4° ± 15.6°) was improved at 2 years (9.7° ± 9.1°; p < 0.001), and the improvement was maintained at 5 years (9.9° ± 9.8°; p = 0.997). There were 46 patients (24.3%) with major complications and 25 patients (13.2%) who required UPROR, mostly within the first year. The probability of remaining free of major complications and of having no UPROR at 5 years was >75% and >87%, respectively. Improvements in CPCHILD scores were observed at 2 years and remained improved at 5 years compared with baseline. RM-ANOVA demonstrated no significant differences in the change in scores over time in patients with complications or UPROR compared with those who did not. Those with complications or UPROR showed no evidence of a major decline in CPCHILD scores.CONCLUSIONS: SF resulted in durable radiographic correction and sustained improvements in caregiver-reported quality of life over a minimum of 5 years. Patients with major complications or UPROR showed no deterioration in CPCHILD scores. These findings support SF as an effective treatment option for appropriately selected patients with GMFCSIV or V CP.LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

    View details for DOI 10.2106/JBJS.25.00186

    View details for PubMedID 40956877

  • Artificial Intelligence-Based Large Language Models Can Facilitate Patient Education. Journal of the Pediatric Orthopaedic Society of North America Bryson, X., Albarran, M., Pham, N., Salunga, A., Johnson, T., Hogue, G. D., Brooks, J. T., Tileston, K. R., Louer, C. R., El-Hawary, R., Imrie, M. N., Policy, J. F., Bouton, D., Hariharan, A. R., Van Nortwick, S., Upasani, V. V., Bauer, J. M., Tice, A., Vorhies, J. S. 2025; 12: 100196

    Abstract

    Background: Artificial intelligence (AI) large language models (LLMs) are becoming increasingly popular, with patients and families more likely to utilize LLM when conducting internet-based research about scoliosis. For this reason, it is vital to understand the abilities and limitations of this technology in disseminating accurate medical information. We used an expert panel to compare LLM-generated and professional society-authored answers to frequently asked questions about pediatric scoliosis.Methods: We used three publicly available LLMs to generate answers to 15 frequently asked questions (FAQs) regarding pediatric scoliosis. The FAQs were derived from the Scoliosis Research Society, the American Academy of Orthopaedic Surgeons, and the Pediatric Spine Foundation. We gave minimal training to the LLM other than specifying the response length and requesting answers at a 5th-grade reading level. A 15-question survey was distributed to an expert panel composed of pediatric spine surgeons. To determine readability, responses were inputted into an open-source calculator. The panel members were presented with an AI and a physician-generated response to a FAQ and asked to select which they preferred. They were then asked to individually grade the accuracy of responses on a Likert scale.Results: The panel members had a mean of 8.9 years of experience post-fellowship (range: 3-23 years). The panel reported nearly equivalent agreement between AI-generated and physician-generated answers. The expert panel favored professional society-written responses for 40% of questions, AI for 40%, ranked responses equally good for 13%, and saw a tie between AI and "equally good" for 7%. For two professional society-generated and three AI-generated responses, the error bars of the expert panel mean score for accuracy and appropriateness fell below neutral, indicating a lack of consensus and mixed opinions with the response.Conclusions: Based on the expert panel review, AI delivered accurate and appropriate answers as frequently as professional society-authored FAQ answers from professional society websites. AI and professional society websites were equally likely to generate answers with which the expert panel disagreed.Key Concepts: (1)Large language models (LLMs) are increasingly used for generating medical information online, necessitating an evaluation of their accuracy and effectiveness compared with traditional sources.(2)An expert panel of physicians compared artificial intelligence (AI)-generated answers with professional society-authored answers to pediatric scoliosis frequently asked questions, finding that both types of answers were equally favored in terms of accuracy and appropriateness.(3)The panel reported a similar rate of disagreement with AI-generated and professional society-generated answers, indicating that both had areas of controversy.(4)Over half of the expert panel members felt they could distinguish between AI-generated and professional society-generated answers but this did not relate to their preferences.(5)While AI can support medical information dissemination, further research and improvements are needed to address its limitations and ensure high-quality, accessible patient education.Levels of Evidence: IV.

    View details for DOI 10.1016/j.jposna.2025.100196

    View details for PubMedID 40791971

  • Systemic lidocaine absorption from continuous erector spinae plane catheters after paediatric posterior spine fusion surgery. Regional anesthesia and pain medicine Pan, S., Lee, C. K., Caruso, T. J., Vorhies, J. S., Tsui, B. C. 2022

    View details for DOI 10.1136/rapm-2021-103234

    View details for PubMedID 35012993

  • Does Navigation Make Spinal Fusion for Adolescent Idiopathic Scoliosis Safer? Insights From a National Database. Spine Kaur, J., Koltsov, J. C., Kwong, J. W., Cheng, I., Vorhies, J. S. 2021; 46 (19): E1049-E1057

    Abstract

    STUDY DESIGN: Retrospective Cohort.OBJECTIVE: To evaluate the effect of computer-assisted navigation (NAV) on rates of complications and reoperations after spinal fusion (SF) for adolescent idiopathic scoliosis (AIS) using a nationally representative claims database.SUMMARY OF BACKGROUND DATA: Significant controversy surrounds the reported benefits of NAV in SF for AIS. Previous studies have demonstrated decreased rates of pedicle screw breaches with NAV compared to free-hand methods but no impact on complication rates. Thus, the clinical utility of NAV remains uncertain.METHODS: Analyses were performed using the IBM MarketScan databases. Patients aged 10 to 18 undergoing SF for AIS were grouped by use of NAV. Patients with nonidiopathic scoliosis were excluded. Univariate and risk-adjusted multivariate analyses were performed. Primary outcomes were neurological complications, any medical complications, and reoperations. Secondary outcomes included adjusted total reimbursements and length of stay.RESULTS: A total of 12,046 patients undergoing SF for AIS were identified, and 8640 had 90-day follow-up. NAV was used in 467 patients (5.4%), increasing from 2007 to 2015. After risk adjustment, the odds for any complication within 90 days were lower with NAV (OR = 0.61, P = 0.025), but neurological complications were unrelated to NAV (P = 0.742). NAV was not associated with reoperation within 90 days (P = 0.757) or 2 years (P = 0.095). We observed a

  • Remodeling of Sagittal Plane Malunion After Pediatric Supracondylar Humerus Fractures. Journal of pediatric orthopedics Gamble, J. G., Vorhies, J. S. 2021; 41 (8): e700-e701

    View details for DOI 10.1097/BPO.0000000000001912

    View details for PubMedID 34397787

  • The Utility of Intraoperative Arthrogram in the Management of Pediatric Lateral Condyle Fractures of the Humerus ORTHOPEDICS Vorhies, J., Funk, S., Elliott, M., Riccio, A., Ramo, B. 2020; 43 (1): 30–35

    Abstract

    Intraoperative arthrograms are commonly used in conjunction with closed reduction and percutaneous pinning (CRPP) of pediatric lateral condyle fractures of the humerus. The authors sought to determine how arthrograms affect management of these fractures. They reviewed all lateral condyle fractures treated surgically at a pediatric level I trauma center from 2008 to 2014. They stratified patients managed with and without an arthrogram as well as by timing of arthrogram. The authors compared injury parameters, initial and postoperative fracture displacement, and complications between groups. They identified 107 patients who were taken to the operating room for attempted closed reduction, which they classified as either CRPP without arthrogram or arthrogram first and then a decision to treat open or with CRPP. Fifty-eight (54.21%) underwent CRPP without arthrogram and 49 (45.79%) underwent arthrogram. Of those who had arthrograms, 27 (25.23%) were prior to fixation and 22 (20.56%) were after fixation. There was no difference in age, weight, or preoperative displacement among the groups. Mean postoperative displacement was significantly lower in the no arthrogram group vs the arthrogram group (0.91 mm vs 1.68 mm; P<.0001), but it did not differ based on timing of arthrogram (P=.836). Arthrograms changed management in 4 (8%) of 49 patients who had them. There was no statistical difference in the rate of changed management by timing of arthrogram (before vs after fixation, 14.8% vs 0%; P=.060). The authors demonstrated that arthrograms may be useful for assessing final fracture alignment after CRPP, but are unlikely to result in a treatment change and are not associated with improved postoperative alignment. [Orthopedics. 2020; 43(1):30-35.].

    View details for DOI 10.3928/01477447-20191031-01

    View details for Web of Science ID 000508434100015

    View details for PubMedID 31693741

For Complete list of Dr. Vorhies's Publications visit any of the links below 

Faculty Contact

Dr. John Vorhies

Research Contact

Arianne Salunga

asalunga@stanford.edu
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