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Pediatric spinal deformity

Michael Pickell, Stephen M Mann, Rajesh Chakravertty, Daniel P Borschneck
BACKGROUND: This is a prospective observational study examining the use of a surgeon-driven intraoperative neurophysiologic monitoring system. Intraoperative neurophysiologic monitoring is becoming the standard of care for spinal surgeries with potential post-operative neurologic deficits. This standard applies to both adult and pediatric spinal surgery, but a shortage of appropriately trained and certified technologists and physiologists can compromise monitoring capabilities in some centers...
September 2016: J Spine Surg
Ali Babashahi, Morteza Taheri
Spinal kyphotic deformity after spinal laminectomy or laminoplasty is more common in pediatric patients than adults. Laminectomy can lead to decreased cartilage growth, anterior wedging and posterior spinal muscle insufficiency which can result in kyphotic deformity. Herein we outline a case report of a child presenting with kyphotic deformity after receiving a spinal laminectomy to treat a penetrating spinal trauma. The 8-year-old male presented with penetrating spinal trauma following a gunshot wound and subsequently underwent L1 laminectomy and thecal sac decompression to remove the foreign body...
March 2016: J Spine Surg
Jennifer C Andrews, Richard B Stein, Kelvin E Jones, Douglas M Hedden, James K Mahood, Marc J Moreau, Eric M Huang, François D Roy
OBJECTIVE: To investigate whether low intensity transcranial electrical stimulation (TES) can be used to condition post-activation depression of the H-reflex and simultaneously monitor the integrity of spinal motor pathways during spinal deformity correction surgery. METHODS: In 20 pediatric patients undergoing corrective surgery for spinal deformity, post-activation depression of the medial gastrocnemius H-reflex was initiated by delivering two pulses 50-125ms apart, and the second H-reflex was conditioned by TES...
October 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Sean M Morell, Richard E McCarthy
Early-onset scoliosis is a complex condition with multiple facets. The goal of treating any spinal deformity is to improve the condition of the patient with the least intervention necessary. A system that allows for continuation of natural spinal growth while correcting the deformity should be the goal of treating this complex condition. The SHILLA growth guidance system allows for continued growth of the pediatric spine while correcting and guiding the apex and guiding the future growth of the curvature. The system involves selective fusion across the apex of the curvature, and minimally invasive instrumentation is then used above and below the apex to allow for continued growth of the spine...
2016: Medical Devices: Evidence and Research
Taralyn McMullan
PURPOSE: Spinal fusion (SF) surgery is a complex procedure that affects children with and without underlying disabilities. The purpose of this article was to describe the necessary steps when preparing a child, specifically with cerebral palsy (CP), and family for a SF, while also emphasizing the postoperative care during discharge planning. DESIGN: Literature review on pediatric patients undergoing spinal fusion and those who have cerebral palsy. METHOD: Literature was searched using the CINAHL database, from 2009 to 2016...
July 22, 2016: Rehabilitation Nursing: the Official Journal of the Association of Rehabilitation Nurses
Raheel Ahmed, Arnold H Menezes, James C Torner
OBJECTIVE Surgical excision is the mainstay treatment for resectable low-grade intramedullary spinal cord tumors (IMSCTs) in the pediatric age group. Chemotherapy and radiation treatments are generally reserved for progressive or recurrent disease. Given the indolent nature of low-grade tumors and the potential side effects of these approaches, their long-term treatment benefits are unclear. The aim of the study was to determine long-term disease outcomes and the therapeutic roles of surgery and adjuvant therapies in pediatric patients with low-grade IMSCTs over an extended follow-up period...
July 15, 2016: Journal of Neurosurgery. Pediatrics
Jaime A Gomez, M Timothy Hresko, Michael P Glotzbecker
Pediatric patient visits for spinal deformity are common. Most of these visits are for nonsurgical management of scoliosis, with approximately 600,000 visits for adolescent idiopathic scoliosis (AIS) annually. Appropriate management of scoliotic curves that do not meet surgical indication parameters is essential. Renewed enthusiasm for nonsurgical management of AIS (eg, bracing, physical therapy) exists in part because of the results of the Bracing in Adolescent Idiopathic Scoliosis Trial, which is the only randomized controlled trial available on the use of bracing for AIS...
August 2016: Journal of the American Academy of Orthopaedic Surgeons
Anthony P Trenga, Anuj Singla, Mark A Feger, Mark F Abel
PURPOSE: Congenital malformations of the bony vertebral column are often accompanied by spinal cord anomalies; these observations have been reinforced with the use of magnetic resonance imaging (MRI). We hypothesized that the incidence of cord anomalies will increase as the number and complexity of bony vertebral abnormalities increases. METHODS: All patients aged ≤13 years (n = 75) presenting to the pediatric spine clinic from 2003-2013 with congenital bony spinal deformity and both radiographs and MRI were analyzed retrospectively for bone and neural pathology...
August 2016: Journal of Children's Orthopaedics
Yingsong Wang, Noriaki Kawakami, Taichi Tsuji, Tetsuya Ohara, Yoshitaka Suzuki, Toshiki Saito, Ayato Nohara, Ryoji Tauchi, Kazuki Kawakami
STUDY DESIGN: A retrospective study. OBJECTIVE: To investigate whether PJK or obvious proximal junctional angle (PJA) changes in the sagittal plane develops following short fusion in children younger than 10 years of age with congenital scoliosis, and to investigate the possible risk factors. SUMMARY OF BACKGROUND DATA: Proximal junctional kyphosis (PJK) following long spinal fusion in adolescents and adults is a serious postoperative complication...
June 20, 2016: Clinical Spine Surgery
Gokhan Demirkiran, Ozgur Dede, Emre Karadeniz, Deniz Olgun, Mehmet Ayvaz, Muharrem Yazici
STUDY DESIGN: Retrospective cohort. OBJECTIVE: The purpose of this study is to compare the anterior-posterior surgery to posterior-only vertebra resection for congenital kyphoscoliosis in pediatric patients. SUMMARY OF BACKGROUND DATA: Vertebral column resection is a very powerful correction technique mainly used in the treatment of severe and rigid spinal deformities. The technique can be applied with combined anterior and posterior vertebral column resection (APVCR) or posterior-only vertebral column resection (PVCR) approaches...
June 20, 2016: Clinical Spine Surgery
Matthias Görges, Nicholas C West, Wesley Cheung, Guohai Zhou, Firoz Miyanji, Simon D Whyte
BACKGROUND: Underbody forced air warming is a method commonly used for intraoperative temperature maintenance in children. We previously reported that preoperative forced air warming of children undergoing spinal surgery substantially reduces the incidence and duration of intraoperative hypothermia (<36°C). OBJECTIVE: The aim of this study was to evaluate the effects of preoperative warming before spinal deformity surgery on surgical site infection rate, length of hospitalization, and bleeding (estimated blood loss and incidence of cell salvaged and/or allogeneic packed red blood cell transfusions)...
September 2016: Paediatric Anaesthesia
Stephen J Warner, Tyler J Uppstrom, Andy O Miller, Sean T O'Brien, Christine M Salvatore, Roger F Widmann, Stephanie L Perlman
STUDY DESIGN: Single-institution, retrospective case series. OBJECTIVE: To determine whether the microbiology of deep surgical site infections (SSI) after spinal fusion surgery for deformity has changed over the last decade at our institution. SUMMARY OF BACKGROUND DATA: Surgical site infection after pediatric spinal deformity surgery results in significantly increased patient morbidity and healthcare costs. While risk factors are multifactorial, prophylactic and treatment antibiotic coverage is based in part on historical epidemiologic data, which may evolve over time...
June 14, 2016: Spine
S S Ozerov, A E Samarin, E S Andreev, G V Tereshchenko, D Yu Kachanov, T V Shamanskaya, S R Varfolomeeva
Neuroblastoma (NB) is the most common extracranial solid tumor in children. The neoplasm grows from progenitor cells of the sympathetic nervous system and can be detected anywhere along the sympathetic neurological circuit: retroperitoneally, mediastinally, cervically, and pelvically. Examination of children with suspected neuroblastoma is comprehensive and performed in strict compliance with a therapeutic protocol. A decision on the treatment regimen is made based on the tumor staging and the risk group of the patient...
2016: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Ananth S Eleswarapu, Bakhtiar Yamini, Robert J Bielski
The cavus foot is a deformity characterized by abnormal elevation of the medial arch of the foot. Unique among foot deformities, cavus typically occurs secondary to a spinal cord or neuromuscular pathology, with two-thirds of patients having an underlying neurologic diagnosis. Thus, recognition of cavus foot and appropriate evaluation are essential in the primary care setting. Patients may present with unstable gait, frequent ankle sprains, or pain along the metatarsal heads or the lateral border of the foot...
June 1, 2016: Pediatric Annals
R Stücker
Growth of the pediatric spine occurs in phases. The first 5 years of life are characterized by rapid growth. The lower extremities and trunk contribute equally to the entire growth by 50 % each. In the following years, until the onset of puberty, a steady but reduced rate of growth is observed. During these years a T1-S1 growth of only 1 cm per year can be detected and the spine contributes only one third to the entire growth. Puberty consists of an acceleration phase lasting 2 years. In the first year of this phase the growth peak of the extremities and in the following year the growth peak of the spine can be noticed...
June 2016: Der Orthopäde
Sophia A Strike, Hamid Hassanzadeh, Amit Jain, Khaled M Kebaish, Dolores B Njoku, Daniel Becker, Michael C Ain, Paul D Sponseller
STUDY DESIGN: Review of techniques and description of institutional clinical experience. OBJECTIVE: To provide a historical review and description of key neuromonitoring concepts, focusing on neurogenic motor-evoked potentials and descending neurogenic evoked potentials, and to review the authors' experience with neuromonitoring techniques in children and adults undergoing spinal deformity surgery. SUMMARY OF BACKGROUND DATA: The original form of neuromonitoring, the Stagnara wake-up test, remains the "gold standard" for detecting true neurological deficits...
May 27, 2016: Clinical Spine Surgery
Chunda Yan, Yong Li, Zhange Yu
The aim of this study was to estimate the prevalence and patient outcomes of proximal junctional kyphosis (PJK) in pediatric patients and adolescents who received surgical interventions for the treatment of a spinal deformity.Literature was searched in electronic databases, and studies were selected by following précised eligibility criteria. Percent prevalence values of the PJK in individual studies were pooled to achieve a weighted effect size under the random effects model. Subgroup and meta-regression analyses were performed to appraise the factors affecting PJK prevalence...
May 2016: Medicine (Baltimore)
David W Polly, Kent Rice, Arvydas Tamkus
INTRODUCTION: There is variability in intraoperative neuromonitoring (IONM), anesthetic and surgical techniques for the treatment of pediatric spinal deformity. This study evaluates a series of patients treated at multiple centers utilizing transcranial motor and somatosensory evoked potentials (TcMEP and SSEP) and electromyography (EMG). The frequency of alerts and the intraoperative follow-up is reported. METHODS: Standard patient demographics and IONM data were collected from a two-month cohort of pediatric spine deformity cases...
March 2016: Neurodiagnostic Journal
Nicola Principi, Susanna Esposito
In children, infectious discitis (D) and infectious spondylodiscitis (SD) are rare diseases that can cause significant clinical problems, including spinal deformities and segmental instabilities. Moreover, when the infection spreads into the spinal channel, D and SD can cause devastating neurologic complications. Early diagnosis and treatment may reduce these risks. The main aim of this paper is to discuss recent concepts regarding the epidemiology, microbiology, clinical presentation, diagnosis, and treatment of pediatric D and SD...
2016: International Journal of Molecular Sciences
Tamir Ailon, Durga R Sure, Justin S Smith, Christopher I Shaffrey
Spinal deformity is defined as abnormality in alignment, formation, or curvature of one or more segments of the spine. Its characteristic clinical presentation and radiographic appearance differ according to patient age and the underlying cause. The most common deformity in the pediatric population is adolescent idiopathic scoliosis, whereas in adults many patients present with de novo deformity secondary to degenerative disease. Although the specific goals differ between patients, the broad aims include restoration of regional and global alignment, decompression of neural elements as necessary, and establishment of a solid fusion...
March 2016: Best Practice & Research. Clinical Anaesthesiology
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