Symptomatic spinal arachnoid cyst with spastic diplegia secondary to cerebral palsy: illustrative case.

Background: Selective dorsal rhizotomy (SDR) can improve the spastic gait of carefully selected patients with cerebral palsy. Spinal arachnoid cysts are a rare pathology that can also cause spastic gait secondary to spinal cord compression.

Observations: The authors present an interesting case of a child with cerebral palsy and spastic diplegia.

Treatment of femur fractures in young children: a multicenter comparison of flexible intramedullary nails to spica casting in young children aged 2 to 6 years.

Background: Spica casting is the standard of care for femur fractures in children up to 6 years of age. The indications for surgery are controversial. We sought to compare immediate spica casting (Spica) and flexible intramedullary nailing [titanium elastic nailing (TEN)] in a group of children ages 2 to 6 years.

Surgical Treatment of Scoliosis in Non-Ambulatory Spastic Quadriplegic Cerebral Palsy Patients: A Matched Cohort Comparison of Unit Rod Technique and All-Pedicle Screw Constructs.

Study Design: Matched cohort.

Objective: To compare the unit rod instrumentation (UR) technique with all-pedicle screw (PS) constructs in the surgical care of scoliosis in Gross Motor Function Classification System IV/V non-ambulatory spastic quadriplegic cerebral palsy patients.

Summary Of Background Data: Over the past 20 years, there has been a transition from the UR technique to the use of pedicle screws and iliac screws in neuromuscular scoliosis.

Femoral lengthening over a pediatric femoral nail: results and complications.

Background: Limb lengthening by callotasis as described by Ilizarov has become the standard method of lower extremity lengthening. Lengthening over an intramedullary nail to allow early removal of the external fixator has also become common in adults but few studies have addressed the efficacy in children.

Methods: A retrospective review of 37 consecutive children who had undergone femoral lengthening with external fixator over an intramedullary nail was performed.

Acute compartment syndrome after intramedullary nailing of isolated radius and ulna fractures in children.

Background: There exist varying reports in the literature regarding the incidence of compartment syndrome (CS) after intramedullary (IM) fixation of pediatric forearm fractures. A retrospective review of the experience with this treatment modality at our institution was performed to elucidate the rate of postoperative CS and identify risk factors for developing this complication.

Methods: In this retrospective case series, we reviewed the charts of all patients treated operatively for isolated radius and ulnar shaft fractures from 2000 to 2009 at our institution and identified 113 patients who underwent IM fixation of both-bone forearm fractures.

A treatment algorithm for stable slipped capital femoral epiphysis deformity.

The authors' current experience in the surgical treatment strategy of stable slipped capital femoral epiphysis deformities was reviewed. From this, a treatment algorithm was developed that could be utilized as a guide in the evaluation and treatment of future patients with slipped capital femoral epiphysis. The clinical parameters of patients' histories of symptoms, physical examinations, and radiographic assessments of slip severity were used in formulating the algorithm.

An analysis of suboptimal outcomes of medial malleolus fractures in skeletally immature children.

We retrospectively analyzed cases of intra-articular medial malleolar fractures in skeletally-immature patients (Salter-Harris III and IV) with suboptimal outcomes at St. Louis Children's Hospital and Shriner's Hospital for Children. Common causes of poor outcome were frac­ture malunion or malreduction and physeal damage.

Titanium elastic nailing radius and ulna fractures in adolescents.

Over the last 40 years, anatomic reduction with plate stabilization has become the standard in adult patients with diaphyseal fractures of the radius and ulna. When operative fixation has been indicated in skeletally immature patients with these fractures, a variety of techniques have been reported, with intramedullary fixation becoming increasingly accepted. There is currently significant variability in the treatment of adolescents with forearm fractures.

Spinal fusion for spastic neuromuscular scoliosis: is anterior releasing necessary when intraoperative halo-femoral traction is used?

Study Design: Retrospective radiographic and clinical study.

Objective: To compare the complications and radiographic outcomes of 2 types of surgical treatments, posterior-only fusion and circumferential fusion, in patients with nonambulatory quadriplegic cerebral palsy treated with adjunctive intraoperative halo-femoral traction.

Summary Of Background Data: Circumferential anterior-posterior spinal fusion (A/PSF) has been used to improve deformity correction and rate of fusion in patients with neuromuscular scoliosis (NMS) but is associated with increased morbidity.

Can posterior-only surgery provide similar radiographic and clinical results as combined anterior (thoracotomy/thoracoabdominal)/posterior approaches for adult scoliosis?

Study Design: Retrospective matched cohort analysis.

Objective: To determine if posterior-only (post-only) surgical techniques consisting of pedicle screws, osteotomies, transforaminal lumbar interbody fusion, and bone morphogenetic protein-2 may provide similar results as compared anterior (thoracotomy/thoracoabdominal)/posterior surgical approaches for the treatment of adult spinal deformity with respect to correction, fusion rates, or outcomes.

Summary Of Background Data: Combined anterior/posterior (A/P) fusion has traditionally been used to treat many adult scoliosis deformities.

Antegrade intramedullary nailing of pediatric femoral fractures using an interlocking pediatric femoral nail and a lateral trochanteric entry point.

Background: The treatment of femoral shaft fractures in older children and adolescents using rigid intramedullary (IM) nail fixation offers the advantages of decreased soft tissue stripping, low incidence of malalignment, leg length discrepancy, early ambulation, and decreased hospital stay. Recent reports have described the development of osteonecrosis of the femoral head in children after IM nailing through the piriformis fossa and the tip of the greater trochanter. Others have noted secondary proximal femoral valgus and femoral neck narrowing after antegrade IM nailing.

Do intraoperative radiographs in scoliosis surgery reflect radiographic result?

Unlabelled: It is often difficult to predict postoperative radiographic curve magnitude and balance parameters while performing intraoperative correction during scoliosis surgery. We asked whether there was a radiographic correlation between intraoperative long-cassette scoliosis film and postoperative standing radiographs of adolescent idiopathic scoliosis with pedicle screw instrumentation. We retrospectively reviewed 44 patients with adolescent idiopathic scoliosis who underwent posterior instrumentation with pedicle screws.

Comparison of magnetic resonance imaging and computed tomography in predicting facet arthrosis in the cervical spine.

Study Design: Retrospective review.

Objective: To determine the ability of magnetic resonance imaging (MRI) and computed tomography (CT) to predict the presence of cervical facet arthrosis.

Summary Of Background Data: In the Food and Drug Administration Investigational Device Exemption trials of cervical disc arthroplasty (CDA), the presence of facet arthrosis on CT was a contraindication to the insertion of a CDA.

Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs: minimum three-year follow-up of one hundred fourteen cases.

Study Design: Preoperative review of a prospective study, single institution, consecutive series. OBJECTIVE.: To analyze the intermediate-term follow-up of consecutive adolescent idiopathic scoliosis (AIS) patients treated with pedicle screw constructs.

Computed tomography evaluation of pedicle screws placed in the pediatric deformed spine over an 8-year period.

Study Design: A retrospective review.

Objective: To evaluate the incremental accuracy of pedicle screws used in spinal deformity via a free-hand technique at a single institution over an 8-year period.

Summary Of Background Data: The in vivo accuracy of free-hand pedicle screws placed throughout the deformed spine as evaluated by computed tomography (CT) scanning is unknown over a long time period.