A "simple'' option in the surgical treatment of congenital scoliosis
2011; 11 (2): 119-121
Adolescent Idiopathic Scoliosis: Should 100% Correction Be the Goal?
JOURNAL OF PEDIATRIC ORTHOPAEDICS
2011; 31: S9-S13
Management of spinal deformity in cerebral palsy.
Orthopedic clinics of North America
2010; 41 (4): 531-547
What constitutes optimal thoracic curve scoliosis correction is controversial. The development and application of powerful pedicle screw-aided instrumentation constructs has, in some cases, led to hypercorrection of the thoracic scoliosis with resulting coronal imbalance, trunk shift, and shoulder imbalance. The purpose of this study was to compare the clinical and radiographic outcomes between Lenke 1 patients with the highest and lowest degree of correction to assess this risk. Our hypothesis was that greater scoliosis curve correction can be done without producing secondary decompensation.Using a prospective AIS database, Lenke 1 curves, with 2-year follow-up (n=385) were ranked by percent coronal correction. The top 15% or high correction group (>80% coronal correction) were compared with the bottom 15% or low correction group (< 40% coronal correction). Clinical and radiographic outcomes, including parameters of coronal and sagittal balance, were compared using ANOVA and ? tests (P ? 0.007).The high correction group (n=39) and the low correction group (n=40) did not differ preoperatively except in lumbar flexibility. In the coronal plane, the high correction group did not show postoperative clinical imbalance (trunk shift and shoulder height) and had better radiographic balance (C7-CSVL shift). The deformity-flexibility quotient (DFQ), which is the ratio of residual lumbar curve to remaining unfused lumbar segments, was lower (optimal) in the high correction group. The residual rib hump was also better. In the sagittal plane, the high correction group had less kyphosis secondary to a loss of kyphosis compared with a gain (improvement) in the low correction group. Despite these differences, SRS scores were not different.Maximizing Lenke 1 curve correction to achieve greater lumbar correction and improved clinical appearance can be done without compromising coronal balance but may occur at the expense of sagittal alignment. However, surgeons who are learning to apply powerful new corrective methods should be cautious in trying to obtain full correction. Proper preoperative evaluation, fusion level selection, and surgical technique are needed to attain this outcome.
View details for DOI 10.1097/BPO.0b013e3181fd8a24
View details for Web of Science ID 000288462100002
View details for PubMedID 21173626
Is ultrasound screening for DDH in babies born breech sufficient?
Journal of children's orthopaedics
2010; 4 (1): 3-8
An understanding of the three-dimensional components of spinal deformity in children with cerebral palsy is necessary to recommend treatments that will positively affect these patients' quality of life. Management of these deformities can be challenging and orthopedic surgeons should be familiar with the different treatments available for this patient population. This article discusses the incidence, causes, natural history, and treatment of patients with scoliosis.
View details for DOI 10.1016/j.ocl.2010.06.008
View details for PubMedID 20868883
To review our incidence of developmental dysplasia of the hip (DDH) in breech infants referred for ultrasound screening and to determine if subsequent follow-up radiographs are necessary in these patients with normal clinical and ultrasound examinations.A review of the clinical data and imaging studies of all children with the risk factor of breech presentation that were referred for orthopedic evaluation over a 5-year period was conducted. All patients were examined by a fellowship-trained pediatric orthopedic surgeon and all ultrasounds were done at approximately 6 weeks of age by an experienced ultrasonographer. Ultrasounds were evaluated using the dynamic method as described by Harcke. As per our protocol, all patients with normal screening ultrasounds were brought back for a final clinical examination and radiographic check at 4-6 months. Acetabular dysplasia was indicated by radiographic parameters-if there was severe blunting of the sourcil, abnormal acetabular index for age, or if there was significant asymmetry of acetabular indices side-to-side-in the setting of clinical parameters-if there was greater than 10° difference in side-to-side abduction or symmetric abduction of less than 60°.Three hundred patients with the risk factor of breech presentation were included. Thirty-four patients had clinically unstable hips; 266 had clinically stable hips and were screened by ultrasound. Sixty-four percent were female and 36% were male. Twenty-seven percent of these breech patients had abnormal screening ultrasounds and were subsequently treated. Of the remaining 73% with normal ultrasounds, who were returned per protocol at a mean of 5 months, 29% had evidence of dysplasia and underwent treatment. The diagnosis of dysplasia following a normal ultrasound was based on both radiographic and clinical parameters. Of the hips treated with a Pavlik harness, 62% had acetabular indices at least two standard deviations from the age-corrected average versus 26% of patients not treated. The average length of follow-up was 10 months.Retrospectively, we found that, at approximately 6 weeks of age, ultrasound screening of breech patients with clinically stable hips produces an incidence of DDH of 27%. In those patients with a normal ultrasound, 29%, at 4-6 months radiographic follow-up, were found to have dysplasia requiring treatment. This data supports breech as the most important risk factor for hip dysplasia and we, therefore, recommend careful and longitudinal evaluation of these patients with: a careful newborn physical examination, an ultrasound at age 6 weeks, and an anteroposterior (AP) pelvis and frog lateral radiograph at 6 months, as the risk of subsequent dysplasia is too high to discharge patients after a normal ultrasound.
View details for DOI 10.1007/s11832-009-0217-2
View details for PubMedID 19915881