Spinal Manifestations of Skeletal Dysplasia: A Practical Guide for Clinical Diagnosis.

Skeletal dysplasias are a group of genetic conditions defined by atypical bone or cartilage growth and development. Skeletal abnormalities include short stature, limb deformity, joint contracture, and spinal deformity. Over 90% of disorders have a known genetic mutation that can definitively determine the diagnosis.

Treatments and Sequelae of Pediatric Pathologic Proximal Femur Fractures Due to Benign Bone Cyst.

Background: The proximal femur is a common location for pathologic fractures in children, yet there is little published information regarding this injury. The purpose of this study was to investigate the outcomes of pediatric pathologic proximal femur fractures due to benign bone tumors.

Methods: A retrospective review of patients treated for pathologic proximal femur fractures from 2004 to 2018 was conducted.

How and When to Transition to the Next Phase: Reflections.

With Americans living longer, many physicians and surgeons have extended their medical and surgical practice life beyond the traditional 65-year-old retirement age. As retirement is inevitable, planning for that eventuality, which in early practice years appears unnecessary, is in fact an exercise which will pay dividends at the time of retirement. Two senior orthopaedic surgeons provide insight on the 2 main issues concerning retirement: how to prepare for retirement while in active practice, and factors to consider as to the timing of that major life event.

Coaching and Surgical Performance.

Surgical coaching is a form of mentoring that can improve surgical performance. While professional athletes have coaching their entire career, other professions, such as medicine, law, and education, are expected to manage their own improvement in performance over their careers. Methods of surgical coaching and the pros and cons of coaching to improve surgical performance and improve patient safety will be presented.

Using a dedicated spine radiology technologist is associated with reduced fluoroscopy time, radiation dose, and surgical time in pediatric spinal deformity surgery.

Study Design: Retrospective comparative study OBJECTIVES: The goal of this study was to investigate fluoroscopy time and radiation exposure during pediatric spine surgery using a dedicated radiology technologist with extensive experience in spine operating rooms. Repetitive use of intraoperative fluoroscopy during posterior spinal fusion (PSF) exposes the patient, surgeon, and staff to radiation.

Methods: Retrospective review was conducted on patients with posterior spinal fusion (PSF) of ≥ 7 levels for adolescent idiopathic scoliosis (AIS) at a pediatric hospital from 2015 to 2019.

High Parental Anxiety Increases Narcotic Use in Adolescent Patients Following Spinal Fusion.

Background: Parental mental status and behavior may influence postoperative recovery and the use of pain medication. The purpose of this study is to identify if parents with high anxiety are associated with prolonged narcotic use in adolescent patients following posterior spinal fusion surgery. Prolonged narcotic use in this study was defined as opioid use at their first postoperative visit.

Scoliosis-specific exercises: A state of the Art Review.

Scoliosis-specific exercises are prescribed and used by many centers either primarily or as an adjunct to other treatment methods for adolescent idiopathic scoliosis of mild to moderate severity. These methods are often used in Europe and are being used in the United States with increasing frequency. There are few publications about these methods in the spine or orthopedic literature.

Side Plank Pose Exercises for Adolescent Idiopathic Scoliosis Patients.

Background: Fishman et al. reported that side plank poses asymmetrically strengthened the convex side of the curve and decreased primary Cobb angle by 49% among compliant patients with adolescent idiopathic scoliosis (AIS).

Methods: AIS patients with curves of 10° to 45° were randomized into the front plank (control) or side plank group.

Comparison of Ponte Osteotomies and 3-Column Osteotomies in the Treatment of Congenital Spinal Deformity.

Background: Congenital spinal deformity (CSD) has traditionally been treated with 3-column osteotomies [hemivertebrectomy (HV) or vertebral column resection (VCR)] to address rigid deformities. Alternatively, multiple Ponte osteotomies (PO) may provide correction while minimizing risk. The purpose of this study was to compare safety and outcomes of patients undergoing surgical treatment for CSD with these 3 procedures.

High Satisfaction in Adolescent Idiopathic Scoliosis Patients on Enhanced Discharge Pathway.

Background: Recently, there have been several reports of using an enhanced discharge pathway following posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS). No previous studies have prospectively examined patient satisfaction of patients with AIS using an enhanced discharge pathway. The purpose of this study was to evaluate patient satisfaction with an enhanced discharge pathway for PSF and whether patients felt that their length of stay was appropriate.

Preventing Distal Junctional Kyphosis by Applying the Stable Sagittal Vertebra Concept to Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis.

Study Design: Multicenter retrospective review.

Objective: To assess the effectiveness of using the stable sagittal vertebra (SSV) for selecting the lowest instrumented vertebrae (LIV) to prevent distal junctional kyphosis (DJK) in selective thoracic fusions.

Summary Of Background Data: Cho et al.

Pain is the Greatest Preoperative Concern for Patients and Parents Before Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

Study Design: Prospective cross-sectional study.

Objective: To evaluate patients' and parents' concerns so they can be addressed with appropriate preoperative counseling.

Summary Of Background Data: Despite much research on outcomes for posterior spinal fusion (PSF) in adolescent idiopathic scoliosis (AIS), little is available about preoperative fears or concerns.

Lateral Femoral Cutaneous Nerve Palsy After Spinal Fusion for Adolescent Idiopathic Scoliosis (AIS).

Study Design: Prospective study of consecutive patients.

Objective: The purpose of the study was to evaluate the incidence, risk factors, and time to resolution of lateral femoral cutaneous nerve palsy (LFCNP) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Summary Of Background Data: No prior studies have prospectively evaluated the prevalence of LFCNP exclusively in the treatment of AIS.

Sacral Alar Iliac (SAI) Screws Fail 75% Less Frequently Than Iliac Screws in Neuromuscular Scoliosis.

Background: Despite recent popularity of sacral alar iliac (SAI) screws for fusion to the pelvis for neuromuscular scoliosis, there are little data regarding the failure rate of this technique compared with traditional modes of iliac fixation. Theoretical advantages of the SAI screws are obviating the need for a rod to iliac screw connector and a lower implant profile. The purpose of this study is to determine whether SAI screws have fewer failures than iliac screws in neuromuscular scoliosis.

How do you know it is true? Integrity in research and publications: AOA critical issues.

High-quality medical care is the result of clinical decisions based upon scientific principles garnered from basic, translational, and clinical research. Information regarding the natural history of diseases and their responses to various treatments is introduced into the medical literature through the approximately one million PubMed journal articles published each year. Pharmaceutical and device companies, universities, departments, and researchers all stand to gain from research publication.

Measurement Variability in the Evaluation of the Proximal Junction in Distraction-based Growing Rods Patients.

Background: Proximal junctional kyphosis (PJK) is a known complication of spinal fusion and has been shown to occur in the setting of growing rod instrumentation. Previous studies have shown good reliability in measuring PJK in adolescent idiopathic scoliosis.

Methods: Four pediatric orthopaedic spine surgeons measured the proximal junction in 10 patients with growing rod instrumentation using 2 methods.