The use of skin traction as an intraoperative adjunct for correction during pediatric neuromuscular scoliosis correction.

Purpose: Intraoperative traction can improve deformity correction during posterior spinal fusion (PSF). This is commonly done with invasive distal femoral or pelvic pins, or traction boots. The novel technique of intraoperative skin traction (ISkinT) avoids risks associated with intraoperative skeletal traction (ISkelT) or hyperlordosis with extended hip position.

Compensatory thoracic curve correction in lumbar anterior vertebral body tether (VBT) versus lumbar posterior spinal fusion (PSF).

Purpose: Anterior vertebral body tethering (VBT) is a non-fusion surgical option for skeletally immature patients with idiopathic scoliosis. Prior studies demonstrated compensatory correction of the thoracic curve after lumbar posterior spinal fusion (PSF); however, no studies have examined thoracic curve correction after lumbar VBT.

Methods: Patients with Lenke 5 + 6 lumbar scoliosis who underwent VBT and at least 2 years' follow-up were compared to matched lumbar PSF patients.

Pre-operative carbohydrate drink in pediatric spine fusion: randomized control trial.

Purpose: As rapid discharge protocols for pediatric spine fusion shorten stays, gastrointestinal (GI) complications are uncovered and cause delays in discharge. A pre-operative carbohydrate (CHO) drink has been shown to improve perioperative GI symptoms and functional return but has not been examined in pediatric spine patients. We aimed to determine if a preoperative CHO drink is safe in pediatric spine fusion patients, and if it improves their comfort scores and return of bowel function.

Intraoperative Neuromonitoring for Spines at Risk During Nonspine Surgery: A 9-Year Review.

Background: Patients with certain spinal anomalies are at risk for rare but devastating spinal cord injuries under anesthesia. We created a Spine at Risk (SAR) program to evaluate and recommend precautions for such patients, including intraoperative neuromonitoring (IONM) use for the highest-risk patients. We aimed to review all monitored nonspine procedures to determine rate of potential spinal cord injuries avoided in those who would otherwise have been unmonitored.

Can we automate spine fusion surgical site infection data capture?

Purpose: Spine fusion surgical site infection (SSI) rate is reported to national quality databases and used as a benchmark for orthopedic departments and hospital systems. However, accurate data require resource-heavy administrative review and even this has shown to vary. We aimed to create a passive electronic medical record (EMR) algorithm to automatically capture spine fusion SSI and compared its accuracy against the administrative chart review and self-reported morbidity and mortality (M&M) rates.

Interfacet distance at L4 is increased in spines with high-pelvic incidence.

Pelvic incidence (PI) is an angular measurement linked to spinal pathologies. There is an increasing distance between facet joints moving caudally down the sagittal plane of the spine. We defined pedicle divergence (PD) as the ratio of interfacet distance (IFD) between adjacent levels.

A delayed diagnosis of high-grade spondylolisthesis.

Spondylolysis, or pars defect, occurs in nearly half of children with back pain. Despite the marked prevalence, diagnosis of spondylolysis with spondylolisthesis often is delayed or missed secondary to referred pain and uncharacteristic presentation. This article describes an 8-year-old patient with 15 months of right heel pain who was initially treated by her primary care provider for presumed Sever disease before being referred to orthopedics.

The pediatric "Spine at Risk" program: 9-year review of a novel safety screening tool.

Purpose: We implemented an EMR-based "Spine at Risk" (SAR) alert program in 2011 to identify pediatric patients at risk for intraoperative spinal cord injury (SCI) and prompt an evaluation for peri-operative recommendations prior to anesthetic. SAR alerts were activated upon documentation of a qualifying ICD-9/10 diagnosis or manually entered by providers. We aimed to determine the frequency of recommended precautions for those auto-flagged by diagnosis versus by provider, the frequency of precautions, and whether the program prevented SCIs during non-spinal surgery.

Repeat Pediatric Trisomy 21 Radiographic Exam: Does Atlantoaxial Instability Develop Over Time?

Background: Atlantoaxial instability (AAI) is common in pediatric patients with Trisomy 21 and can lead to spinal cord injury during sports, trauma, or anesthetized neck manipulation. Children with Trisomy 21 therefore commonly undergo radiographic cervical spine screening, but recommendations on age and timing vary. The purpose of this study was to determine if instability develops over time.

The body image disturbance questionnaire-scoliosis better correlates to quality of life measurements than the spinal assessment questionnaire in pediatric idiopathic scoliosis.

Purpose: Idiopathic scoliosis (IS) patients can have body dissatisfaction which can affect their perception of health. Two body image measures, the Spinal Appearance Questionnaire (SAQ) and the Body Image Disturbance Questionnaire-Scoliosis (BIDQ-S), have been used in pediatric IS with variable correlation to the SRS-22r and radiographs, but have not been compared to each other. As patient reported outcomes (PROs) continue to be highlighted in large database studies and national hospital ranking system scoring, we should narrow use to the best and most efficient.

Classifying vertebral artery anatomy abnormality in children with skeletal dysplasia.

Purpose: Skeletal dysplasia (SKD) have predictably abnormal occipitocervical skeletal anatomy, but a similar understanding of their vertebral artery anatomy is not known. Knowledge and classification of vertebral artery anatomy in SKD patients is important for safe surgical planning. We aimed to determine if predictably abnormal vertebral artery anatomy exists in pediatric SKD.

Results of Conservative and Surgical Management in Children with Idiopathic and Nonidiopathic Os Odontoideum.

Objective: The outcomes of conservative and operative treatment of os odontoideum in children remain unclear. Our objective was to study the outcomes of conservative and surgical treatment of idiopathic os odontoideum in children and compare these outcomes in age- and treatment-matched nonidiopathic children with os odontoideum.

Methods: A retrospective multicenter review identified 102 children with os odontoideum, of whom 44 were idiopathic with minimum 2-year follow-up.

Delayed Postoperative Spinal Cord Ischemia After Posterior Spinal Fusion in a Pediatric Patient with Syrinx and Decompressed Chiari: A Case Report.

Case: We present a case of delayed postoperative neurologic deficits 1 day after posterior spinal fusion in a pediatric patient with syrinx and previous Chiari decompression, which reversed with urgent rod removal.

Conclusion: There is limited literature on delayed cord injury occurring after surgery in a patient with scoliosis of neuromuscular origin. Patients with syrinx and a history of Chiari decompression may have spinal cords more sensitive to injury including delayed ischemia after deformity treatment and should be paid extra perioperative attention including considering prolonged mean arterial pressure goals or more conservative deformity correction.

NSQIP versus institutional morbidity and mortality conference: complementary complication reporting in pediatric spine fusion.

Purpose: Other fields of medicine have demonstrated underreported surgical complication rates by institutional M&M compared to NSQIP. However, a study comparing surgical complication rates in the pediatric spine population, using an identical set of patients rather than nationally extrapolated, has not been performed.

Methods: A single institution's ASC-NSQIP Pediatric spine fusion cases and its departmental team-reported M&M database for the same were reviewed for January 1, 2012 to December 31, 2018.

What Should I Wear to Clinic? A National Survey of Pediatric Orthopaedic Patients and Parents.

Background: A number of factors have been shown to affect how surgeons are subjectively viewed, including their appearance in clinic. Patient preference for pediatric orthopaedic surgeon attire has not previously been studied, nor has its influence on initial perception of the surgeon.

Methods: At 5 pediatric regional sites across the United States, parents and patients presenting to the pediatric orthopaedic clinic were given anonymous surveys showing 8 photos of surgeons in different clinical dress including in business or scrub dress, each with or without white coat (WC).

Comparing short-term AIS post-operative complications between ACS-NSQIP and a surgeon study group.

Study Design: Prospective cohort review.

Objective: To compare two AIS databases to determine if a performance improvement-based surgeon group has different outcomes compared to a national database. The American College of Surgeon's National Quality Improvement Program (ACS-NSQIP) and a surgeon study group (SG) collect prospective data on AIS surgery outcomes.

Prospective spine at risk program for prevalence of intracanal spine lesions in pediatric hereditary multiple osteochondromas.

Study Design: Retrospective cohort study OBJECTIVES: To determine prevalence of hereditary multiple osteochondromas (HMO) and utility of MRI surveillance in a prospective Spine at Risk (SAR) program. Unidentified intraspinal exostoses in HMO can lead to neurologic injury in children during sedated procedures but no MRI guidelines exist. We sought to determine the prevalence and age of intraspinal exostoses from MRIs, and indications for MRI surveillance.

An Updated Algorithm for Radiographic Screening of Upper Cervical Instability in Patients With Down Syndrome.

Study Design: Retrospective evaluation of cervical spine images from 2006-2012 for the purposes of "screening" children with Down syndrome for instability.

Objective: To determine whether a full series of cervical spine images including flexion/extension lateral (FEL) radiographs was needed to avoid missing upper cervical instability.

Summary Of Background Data: The best algorithm, measurements, and criteria for screening children with Down syndrome for upper cervical instability are controversial.

Cerebral palsy - beyond hip deformities.

Cerebral palsy is a neurologic condition with myriad musculoskeletal and articular manifestations. While every patient is unique with innumerable variations in presentation, symptoms and treatments, there are broad themes and recognizable patterns of development. Many of these findings spill over to other neurodevelopmental disorders, and lessons learned from children with cerebral palsy translate well to multiple neurologic conditions.

Os Odontoideum in Children: Treatment Outcomes and Neurological Risk Factors.

Background: Treatment outcomes and risk factors for neurological deficits in pediatric patients with an os odontoideum are unclear.

Methods: We reviewed the data for 102 children with os odontoideum who were managed at 11 centers between 2000 and 2016 and had a minimum duration of follow-up of 2 years. Thirty-one children had nonoperative treatment, and 71 underwent instrumented posterior cervical spinal arthrodesis for the treatment of C1-C2 instability.

Pelvic Incidence in Spines With 4 and 6 Lumbar Vertebrae.

Study Design: Anatomical study.

Objectives: This study was conducted to determine the prevalence of abnormal lumbar vertebrae (4 and 6) and note any differences in pelvic incidence (PI) between spines with 4, 5, and 6 lumbar vertebrae.

Methods: We screened 2980 dry cadaveric specimens from an osteological collection.

Over-utilization of computed tomography angiography in extremity trauma.

Objectives: Widespread availability of computed tomography angiography (CTA) for diagnosing arterial injury in injured extremities has created the possibility of overuse. The objective of this study was to evaluate CTA utilization, indications, ordering personnel, and rate of significant findings for blunt or penetrating extremity trauma at a level I trauma center.

Methods: We performed a retrospective chart review of 1440 consecutive CTAs of upper and lower extremities from 2010 to 2012 at a large level I trauma center, and included only those done for acute trauma.