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1.
J Pediatr Orthop ; 43(8): e669-e673, 2023 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-37264495

RESUMEN

BACKGROUND: All-terrain vehicles (ATVs) are prevalent in Appalachia and cause significant morbidity and mortality in the pediatric population. This study investigated the injury types and severity in pediatric patients over a 15-year period. METHODS: A retrospective chart review was performed on pediatric ATV-related traumas presenting to our institution from 2005 to 2020. Patients were divided into 3 age groups (0-7, 8-12, and 13-17 y) to evaluate differences in accident demographics, hospitalization, Glasgow Coma Scale, Injury Severity Score, substance use, characterization of orthopaedic and nonorthopaedic injuries, and procedures performed. RESULTS: Inclusion criteria were met by 802 patients. Males represented 71.7% (n=575) and females 28.3% (n=227); the mean age was 12.4 years. The majority (88.5%, n=710) of patients admitted following their accident had a mean stay length of 3.3 days. Of admissions, intensive care unit admission was required by 23.8%, n=191 (mean stay 4.0 d). There were 7 fatalities. The vast majority of accidents occurred between May and September (79.2%, n=635). In patients with documented helmet status, 45% (n=271) were helmeted. Roughly half of all patients (n=393) sustained a fracture (excluding fractures to the head), 370 sustained an injury to the head/face, 129 sustained intra-abdominal/intra-thoracic injuries, and 29 sustained injuries to all 3 systems. The most common fractures involved the forearm (n=98), femur (n=65), and spine (n=59). The most common open fractures were the tibia (n=12), humerus (n=8), and forearm (n=8). The oldest group was more likely than the middle or younger groups to sustain spine ( P <0.0001), pelvis ( P =0.0001), hand ( P =0.0089), and foot ( P =0.0487) fractures. Ethanol testing was positive in 5.0% (n=25) of the oldest group and cannabinoids were present in 6.8% (n=34). The youngest group was significantly more likely to sustain a fracture of the humerus than the middle or older groups ( P <0.0001). Orthopaedic surgical management was required in 24.4% (n=196) of patients. CONCLUSIONS: Pediatric ATV accidents present a significant source of morbidity and mortality. Further intervention is necessary to minimize pediatric ATV injuries. LEVEL OF EVIDENCE: Level IV-Retrospective Case Series.


Asunto(s)
Fracturas Abiertas , Vehículos a Motor Todoterreno , Heridas y Lesiones , Masculino , Femenino , Niño , Humanos , Estudios Retrospectivos , Accidentes , Hospitalización , Accidentes de Tránsito , Centros Traumatológicos
2.
J Pediatr Orthop ; 39(9): e722-e728, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31503236

RESUMEN

INTRODUCTION: Electronic medical record (EMR) use among pediatric orthopaedic surgeons has evolved substantially within the past decade. In response to the Patient Protection and Affordable Care Act, large hospitals and tertiary pediatric medical centers rapidly acquired and implemented EMRs with uncertainty as to the potential impact on patient care and operational efficiency of subspecialists. This study reviews the background and regulatory framework for Meaningful Use of EMR and assesses the current landscape of EMR utilization by pediatric orthopaedic surgeons. METHODS: In 2015, the Practice Management Committee distributed a survey regarding EMR use and satisfaction to members of the Pediatric Orthopaedic Society of North America. Survey responses from 324 members were used to analyze levels of satisfaction by EMR platform and practice type and to consider drivers of satisfaction or dissatisfaction of end users. RESULTS: Although there were no differences in overall satisfaction based on vendor or practice type, significant differences were noted for 5 specific parameters of satisfaction, including: usefulness of templates, efficiency of practice workflow, information services support, number of logon events, and speed of the system. A user/vendor map is provided to facilitate networking among providers and groups utilizing common EMR platforms to help bring about rational improvements in EMR functionality for the future. CONCLUSIONS: Substantial effort needs to be made to improve subspecialty-specific EMR documentation, order entry, research tools, and clinical workflows to enhance the processes of care for children with orthopaedic conditions in the era of EMR. LEVEL OF EVIDENCE: Level IV.


Asunto(s)
Actitud del Personal de Salud , Comportamiento del Consumidor , Registros Electrónicos de Salud/estadística & datos numéricos , Ortopedia/estadística & datos numéricos , Pediatría/estadística & datos numéricos , Registros Electrónicos de Salud/legislación & jurisprudencia , Registros Electrónicos de Salud/normas , Humanos , Uso Significativo/legislación & jurisprudencia , Patient Protection and Affordable Care Act , Programas Informáticos/normas , Encuestas y Cuestionarios , Estados Unidos , Flujo de Trabajo
4.
Hosp Pediatr ; 11(5): 521-524, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33846141

RESUMEN

OBJECTIVES: To investigate prescription opiate usage, disposal rates, and methods of disposal after pediatric surgery. METHODS: This was a retrospective chart review of patients <18 years of age who underwent a surgical procedure at our institution and were given a postoperative opiate prescription between April 2017 and June 2018. A follow-up phone survey was conducted between 60 and 90 days postoperatively to ask about prescription opiate usage and disposal. RESULTS: A total of 290 patients with a mean age of 9.0 ± 4.7 years (62.8% male) met inclusion criteria. Sixty patients (20.7%) reported using all of their prescription opiate medication, whereas 230 patients (79.3%) did not use all of their pain medication. Of these 230 patients, 141 (61.3%) disposed of their leftover prescription opiates via flushing (56.4%), trash (28.6%), or take-back center (15.0%). At the time of phone survey between 60 and 90 days postoperatively, 88 patients (38.3%) still had leftover pain medication. By 7 days postoperatively, 234 of 290 patients (80.7%) had taken their last prescription opioid. CONCLUSIONS: In our study, 79.3% of patients were overprescribed opiate pain medication after pediatric surgery. Disposal rates at 60 to 90 days for leftover pain medication after pediatric surgery was just >60%. Pediatric patients are often overprescribed prescription opiates after surgery and typically only require a one-week supply of pain medication.


Asunto(s)
Analgésicos Opioides , Dolor Postoperatorio , Adolescente , Analgésicos Opioides/uso terapéutico , Niño , Preescolar , Femenino , Humanos , Masculino , Manejo del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Periodo Posoperatorio , Pautas de la Práctica en Medicina , Estudios Retrospectivos
5.
J Pediatr Orthop ; 29(5): 435-8, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19568012

RESUMEN

BACKGROUND: The majority of farm-related injuries in children are caused by farm machinery. The aim of this study is to report the incidence of children requiring hospitalization for orthopaedic trauma after injury secondary to farm equipment accidents. METHODS: Data for this study were culled from the Kids' Inpatient Database for the years 2000, 2003, and 2006 using the E-code for injuries caused by agricultural machinery to identify the study group. Only those children with fractures (nonskull) and/or amputations were included for analysis. RESULTS: The 3-year study data include 292 children, 88% male, with an average age of 11.9 years. Of the 439 orthopaedic injuries, there were 115 upper extremity, 173 lower extremity, and 96 vertebral, rib, or pelvic fractures, and 55 amputations (34 upper and 21 lower extremity). There were proportionally more closed fractures of the upper extremity in children under the age of 12 years compared with the older children with no difference in rates of other fractures or amputation by age group. CONCLUSIONS: This study provides data on incidence of significant orthopaedic trauma in children in the United States as a result of farm equipment accidents. Most earlier studies have focused on fatality rates or have been limited to a single institution or single state or have been from a non-US population. This study provides pediatric orthopaedists, particularly those practicing in agricultural areas, with injury statistics related to farm equipment injuries that may lead to more and better safety education programs.


Asunto(s)
Accidentes Domésticos/estadística & datos numéricos , Agricultura/estadística & datos numéricos , Amputación Traumática/epidemiología , Fracturas Óseas/epidemiología , Adolescente , Factores de Edad , Amputación Traumática/etiología , Niño , Preescolar , Bases de Datos Factuales , Seguridad de Equipos , Femenino , Fracturas Óseas/etiología , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Masculino , Estudios Retrospectivos , Factores Sexuales , Estados Unidos/epidemiología , Adulto Joven
6.
J Pediatr Orthop ; 29(8): 927-31, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19934711

RESUMEN

BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a virulent pathogen responsible for an increasing number of invasive musculoskeletal infections in healthy children. The purpose of this study is to characterize the presentation, clinical course, treatment, complications, and long-term morbidity of CA-MRSA musculoskeletal infection in children. METHODS: A retrospective study of children with CA-MRSA musculoskeletal infections from 2 institutions was conducted. RESULTS: The study group included 27 patients. Clinical presentation involved an extremity in 23 of 27 patients. Twelve patients required admission to the intensive care unit. Four of these patients developed acute multisystem failure. Magnetic resonance imaging was obtained in 21 patients and was diagnostic in all. Seven patients developed deep venous thrombosis and septic pulmonary emboli. All patients required surgical intervention, and 16 of 27 required multiple debridements. CONCLUSIONS: CA-MRSA is limb and life threatening. Prompt recognition and treatment are critical. Aggressive surgical drainage/debridement in addition to long-term antibiotics is required. There is significant potential for long-term morbidity despite aggressive management. LEVEL OF EVIDENCE: Level IV, retrospective case series.


Asunto(s)
Staphylococcus aureus Resistente a Meticilina , Enfermedades Musculoesqueléticas/microbiología , Adolescente , Antibacterianos/uso terapéutico , Artritis Infecciosa/microbiología , Niño , Preescolar , Infecciones Comunitarias Adquiridas , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/tratamiento farmacológico , Osteomielitis/microbiología , Piomiositis/microbiología , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Vancomicina/uso terapéutico
7.
Artículo en Inglés | MEDLINE | ID: mdl-27355085

RESUMEN

BACKGROUND: It has been propagated that patients with Klippel-Feil syndrome (KFS) exhibit "clinical triad" findings (CTFs), known as a short neck, low posterior hairline, and limited cervical range of motion (ROM). However, the literature has noted that up to 50 % of KFS cases may not present with such findings and the reasoning behind such assertions remains speculative. As such, the following study addressed the association between CTFs to that of congenitally-fused cervical segments and other risk factors in KFS patients. METHODS: We conducted a retrospective clinical study based on prospectively collected radiographic data. Thirty-one KFS patients at a single institution were assessed. Radiographs were used to evaluate the location and extent of congenitally-fused segments (spanning the occiput (O) to the first thoracic vertebra (T1)), as well as examining coronal and sagittal cervical alignments based on the Samartzis et al. KFS classification. Clinical records were evaluated to account for the initial clinical assessment of CTFs. Patients were further stratified into two groups: Group 1 included patients noted to have any CTFs, while Group 2 included patients who had no such findings. RESULTS: There were 12 males and 19 females (mean age at initial consultation: 9.7 years). No evidence of any of the CTFs was shown in 35.5 % of patients, whereas 38.7, 16.2 and 9.7 % were determined to have one, two or all three criteria, respectively. Limited cervical ROM was the most common finding (64.5 % of patients). In Group 1, 25 % had a short neck, 30 % a low posterior hairline, and 100 % exhibited limited cervical ROM. Group 1 had a mean of 3.9 fused cervical segments, whereas Group 2 had a mean of 2.5 fused cervical segments (p = 0.028). Age, sex-type, occipitalization and alignment parameters did not significantly differ to Group-type (p > 0.05). In Group 1, based on the Samartzis et al. Types I, II, and III, 16.7, 73.3, and 80.0 % of the patients, respectively, had at least one CTF. CONCLUSIONS: Complete CTFs were not highly associated during the clinical assessment of young KFS patients. However, KFS patients with extensive, congenitally-fused segments (i.e. Samartzis et al. Type III) were significantly more likely to exhibit one of the components of the CTF, which was predominantly a limited cervical ROM. Clinicians managing young pediatric patients should not rely on the full spectrum of CTFs and should maintain a high-index of suspicion for KFS, in particular in individuals that exhibit associated spinal findings, such as congenital scoliosis.

8.
Am J Orthop (Belle Mead NJ) ; 31(11): 647-51, 2002 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-12463587

RESUMEN

To evaluate standards of care in surgical treatment of thoracolumbar injuries (TLIs), we reviewed the cases of 79 surgically treated patients (39 males, 36 females) with TLIs and spinal cord injuries occurring from January 1985 to January 2000. We assessed radiographs of fracture-dislocation reductions; restorations of sagittal and coronal alignment of injured segments; instrumentation levels and strategies; operations, and reoperations. Mean age at time o f injury was 14.1 years. The majority of injuries were thoracic, and posterior spinal fusion with instrumentation was the most common index procedure performed. Mean follow-up was 23.4months. Reoperation rate was 20%. Problems in achieving fracture reduction, selecting correct instrumentation levels, restoring proper sagittal alignment, an d planning a nd performing surgeries were more prevalent in patients treated before 1990 but are still problematic, even with use of modern segmental instrumentation, and frequently require revision to improve function or relieve symptoms. These results indicate a wide range in standards of care in surgical treatment of TLIs.


Asunto(s)
Vértebras Lumbares/lesiones , Traumatismos de la Médula Espinal/cirugía , Traumatismos Vertebrales/cirugía , Vértebras Torácicas/lesiones , Adolescente , Distribución de Chi-Cuadrado , Niño , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Masculino , Radiografía , Reoperación , Estudios Retrospectivos , Traumatismos de la Médula Espinal/diagnóstico por imagen , Traumatismos de la Médula Espinal/etiología , Traumatismos Vertebrales/complicaciones , Traumatismos Vertebrales/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugía , Resultado del Tratamiento
9.
Orthopedics ; 26(4): 407-11; discussion 411, 2003 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-12722912

RESUMEN

Three hundred sixteen subluxed/dislocated hips (222 patients) underwent upper femoral osteotomy. Of these, 286 (90.5%) hips were casted (average patient age: 8.9 years) and 30 (9.5%) were not (average patient age: 13.6 years). Average follow-up was 4.7 years. Complications in the casted/noncasted groups (per hip) were: 43/0 (15%/0%) skin sores; 11/1 (3.8%/3.3%) wound infections; 6/0 (2.1%/0%) instrumentation failures; 22/1 (7.7%/3.3%) reoperations; and 13/1 (4.5%/3.3%) rehospitalizations. Differences between the groups were not statistically significant. Casted patients were younger and more neurologically involved. Casting is useful to ensure healing of osteotomies, prevent instrumentation failure and injury to the operated legs, and allow for ease of handling. Complications that occurred were managed and had no long-term sequelae.


Asunto(s)
Moldes Quirúrgicos/efectos adversos , Parálisis Cerebral/complicaciones , Luxación de la Cadera/cirugía , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Fracturas Óseas/etiología , Humanos , Masculino , Osteotomía , Cuidados Posoperatorios/efectos adversos , Estudios Retrospectivos , Infección de Heridas/etiología
10.
Orthopedics ; 42(3): 122-124, 2019 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-31099876
15.
16.
Spine (Phila Pa 1976) ; 36(20): 1692-700, 2011 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-21897188

RESUMEN

STUDY DESIGN: Data collected prospectively from the Prospective Pediatric Scoliosis Study (PPSS) were analyzed statistically to address the hypothesis that covered specific aspects of treatment and its outcome. OBJECTIVE: To assess and contrast Scoliosis Research Society (SRS) outcome scores for patients assigned to one of three types of spinal instrumentation constructs. The study hypothesis was that the instrumentation strategy that provides the best curve correction will be associated with the best SRS scores. SUMMARY OF BACKGROUND DATA: Surgical treatment of scoliosis has evolved over time using implants and surgical techniques; however, quality of life indicators have not typically been analyzed to assess whether surgery and instrumentation will improve quality of life in pediatric patients. METHODS: Patients were assigned to one of three instrumentation groups depending on the type of construct used. The Scoliosis Research Society's SRS-30 survey was used to measure patient outcomes comparing preoperative results to a 2-year follow-up. RESULTS: Changes in the SRS Pain, Activity, Appearance, Mental, Satisfaction, and SRS Total domains did not differ significantly among instrumentation groups for any time intervals. However, analysis of SRS Pain did show a significant change over time for all instrumentation patterns. The analysis of SRS Activity showed a significant change over time for all instrumentation patterns preoperatively to 2 years postoperatively. Analysis of SRS Appearance showed a significant change over time for all groups but no difference between instrumentation groups. The analysis of SRS Mental based on instrumentation types showed a significant change over time, but only the pedicle screw group's change was statistically significant. Finally, analysis of SRS Satisfaction by instrumentation type showed a statistically significant change over time for all instrumentation patterns. CONCLUSION: There were no statistically significant baseline differences among the three instrumentation construct groups based on mean scores for the six SRS domains. None of the SRS domains had differences among the instrumentation constructs in change scores or significant differences among the instrumentation constructs.


Asunto(s)
Fijadores Internos , Implantación de Prótesis/métodos , Escoliosis/cirugía , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Adolescente , Niño , Femenino , Estudios de Seguimiento , Humanos , Fijadores Internos/efectos adversos , Fijadores Internos/normas , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Implantación de Prótesis/mortalidad , Implantación de Prótesis/normas , Calidad de Vida/psicología , Radiografía , Escoliosis/diagnóstico por imagen , Escoliosis/patología , Fusión Vertebral/mortalidad , Resultado del Tratamiento
17.
Spine (Phila Pa 1976) ; 36(3): 248-54, 2011 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-21248593

RESUMEN

STUDY DESIGN: A multicenter prospective cohort study. OBJECTIVE: To compare the effect of all pedicle screw versus hybrid constructs on patient self-assessment of appearance after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis (AIS). This will contribute to future cost-effective analyses on surgical management of AIS. SUMMARY OF BACKGROUND DATA: For surgical management of AIS, the Spinal Appearance Questionnaire (SAQ) and the Scoliosis Research Society outcomes instrument (SRS-30) are reliable surveys of patient satisfaction, but neither tool has been used to assess outcome by implant type. METHODS: Patients received either all pedicle screws or hybrid instrumentation. Self-assessment of appearance pre- and after surgery was measured by SAQ and SRS-30. Statistical significance was evaluated through P values (P < 0.01 in the SAQ, P < 0.05 in the SRS-30) and effect sizes. RESULTS: There were 93 patients in the all pedicle screw cohort and 61 in the hybrid cohort. There were no significant preoperative differences between the cohorts in the SAQ or SRS-30. All pedicle screw patients tended to see more improvement in shoulder level than hybrid patients in 2 separate SAQ questions (P = 0.025, Cohen's D = 0.20; P = 0.013, D = 0.24). The screw patients also tended to have better scores than hybrid patients in the category, "looking better in clothes" (P = 0.017, V = 0.24) at 2 years postoperative. All pedicle screw patients self-reported significant greater improvement than hybrid patients in the SRS-30 Appearance and Mental domains (P = 0.016, ES = 0.038; P = 0.005, ES = 0.051). There were no significant differences between cohorts in age, gender, baseline curve, or major curve magnitude. CONCLUSION: All pedicle screw constructs lead to better self-assessment of appearance in operative treatment of AIS, as determined by SAQ and SRS-30.


Asunto(s)
Tornillos Óseos/normas , Satisfacción del Paciente , Escoliosis/psicología , Escoliosis/cirugía , Autoevaluación (Psicología) , Adolescente , Factores de Edad , Tornillos Óseos/economía , Niño , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Satisfacción del Paciente/economía , Estudios Prospectivos , Escoliosis/economía , Encuestas y Cuestionarios
18.
Spine (Phila Pa 1976) ; 36(23): E1501-8, 2011 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-21912326

RESUMEN

STUDY DESIGN: Retrospective study. OBJECTIVE: This study addressed in patients with Klippel-Feil syndrome (KFS), the role of congenitally fused cervical patterns, risk factors, and cervical symptoms associated with cervical scoliosis. SUMMARY OF BACKGROUND DATA: KFS is an uncommon condition, characterized as improper segmentation of one or more cervical spine segments with or without associated spinal or extraspinal manifestations. "Scoliosis" is potentially the most common manifestation associated with KFS. However, the role of congenitally fused cervical patterns along with additional potential risk factors and their association with cervical scoliosis, and its relationship with cervical spine-related symptoms remain largely unknown. METHODS: Plain radiographs were utilized to assess the location of congenitally fused cervical segments (O-T1), degree of coronal cervical alignment, and any additional cervical and thoracic spine abnormalities. The classification scheme, as proposed by Samartzis et al of congenitally fused cervical patterns (Types I-III) in KFS patients, was utilized and additional fusion and region-specific patterns were assessed. Patients with coronal cervical alignments of 10° or greater were regarded scoliotic. Patient demographics and the presence of cervical spine-related symptoms were also assessed. RESULTS: Thirty KFS patients were assessed (mean age, 13.5 yr). The mean coronal cervical alignment was 18.7° and scoliosis was noted in 16 patients. Patients that exhibited congenital fusion of the mid and lower cervical spine region, had multiple, contiguous congenitally fused segments (Type III), and associated vertebral malformations (e.g., hemivertebrae) were highly associated with the presence of cervical scoliosis (P < 0.05). Ten patients exhibited cervical spine-related symptoms; however, no statistically significant difference was noted between the presence of symptoms and coronal cervical alignment (P = 0.815) and cervical scoliosis (P = 0.450). CONCLUSION: The study noted a prevalence of cervical scoliosis to occur in 53.3% of young KFS patients. Such patients that exhibited congenital fusion of the mid and lower cervical spine region, had multiple, contiguous congenitally fused segments (Type III), and associated vertebral malformations (e.g., hemivertebrae) were highly associated with the presence of cervical scoliosis. However, in young KFS patients, the presence of cervical scoliosis may not be associated with the manifestation of cervical spine-related symptoms.


Asunto(s)
Vértebras Cervicales/diagnóstico por imagen , Síndrome de Klippel-Feil/diagnóstico por imagen , Escoliosis/diagnóstico por imagen , Adolescente , Adulto , Vértebras Cervicales/anomalías , Niño , Preescolar , Femenino , Humanos , Síndrome de Klippel-Feil/complicaciones , Modelos Lineales , Masculino , Análisis Multivariante , Radiografía , Estudios Retrospectivos , Escoliosis/complicaciones , Adulto Joven
19.
Spine (Phila Pa 1976) ; 36(19): 1579-83, 2011 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-21681138

RESUMEN

STUDY DESIGN: We performed a retrospective chart review of patients with nonadolescent idiopathic scoliosis who underwent open vertebral stapling for treatment of spinal deformity. OBJECTIVE: The objective of this study was to determine the efficacy of vertebral stapling in patients with scoliosis. Measurements included initial deformity correction and maintenance of correction. SUMMARY OF BACKGROUND DATA: Growth modulation has become a topic of interest recently in the spinal deformity literature. It refers to the tethering of growth on one side of the spine to allow for compensatory growth on the contralateral side, and, in theory, correction of scoliosis. Recent studies on endoscopic vertebral stapling have shown promising early results in adolescents with idiopathic scoliosis. Little is known about its applicability in patients with more "malignant" types of scoliosis. METHODS: The medical records and radiographs of 11 children who underwent open vertebral stapling between June 2003 and August 2004 were reviewed. Patients with adolescent idiopathic scoliosis (AIS) were excluded. RESULTS.: Diagnoses included myelodysplasia, congenital scoliosis, juvenile, and infantile idiopathic scoliosis, Marfan syndrome, paralytic scoliosis, and neuromuscular scoliosis. The average age at surgery was 6 + 11 year. All patients were skeletally immature. Preoperative curves averaged 68° (22°-105°). Of the 11, six thoracic curves and five thoracolumbar curves were stapled. Four patients had minor curves, which were not stapled. Initial postoperative radiographs averaged 45° (24°-88°). Average follow-up was 22 month for our series (16-28 month). At final follow-up, scoliosis averaged 69° (36°-107°). Five of the 11 patients have subsequently undergone secondary surgical procedures for progression of scoliosis, including growing rod insertion in three, combined anterior/posterior spinal fusion in another, and bilateral vertical expandable prosthetic titanium rib insertion in a patient with myelodysplasia. Three of the remaining six patients are scheduled for secondary surgery. CONCLUSION: More than half of the patients in our series have undergone or are scheduled to undergo further spinal surgery, at an average of 2 year after anterior vertebral stapling. It is unclear if progression may be related to the young age at surgery, the relatively severe average preoperative curve magnitude, the nature of the underlying scoliosis, or a combination of these.


Asunto(s)
Vértebras Lumbares/cirugía , Procedimientos Ortopédicos/métodos , Escoliosis/cirugía , Vértebras Torácicas/cirugía , Niño , Preescolar , Progresión de la Enfermedad , Estudios de Seguimiento , Humanos , Vértebras Lumbares/patología , Radiografía , Escoliosis/diagnóstico por imagen , Escoliosis/patología , Fusión Vertebral/métodos , Vértebras Torácicas/patología , Factores de Tiempo , Resultado del Tratamiento
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